THE AMERICAN THERAPIST,
P. O. Box 1170. New York City.
Vol. II. JANUARY 15th, 1894. No. 7.
Editorial.
_INFLUENZA AND ITS TREATMENT._
The manifestations of Influenza in this section of the country during
the past two months have been numerous and varied, although the malady
has been far less directly fatal than on its first appearance in the
winter of 1889–90. The different types of the disease, the pulmonary,
the nervous and the abdominal, have been less distinctly marked, but it
has been especially severe in the case of elderly people when appearing
as an intercurrent affection. Another noticeable feature is, that the
disease has shown a greater disposition to attack children than in
former years, although when children have been enjoying usually good
health, fatal results have been rare. This, however, has not been the
case with sickly or puny children, as the disease has manifested itself
in various ways, such as throat, ear and other complications. In many
cases nothing more than the peculiar pains characteristic of the disease
have been noticed; in others, it has passed off with nothing more
serious than would result from a bad cold, so that large numbers have
fought it out on this line. The prevalence of the malady in the vicinity
of Philadelphia, and we presume this observation holds good elsewhere,
has been wide spread, showing conclusively that it is largely dependent
upon atmospheric influences. Indeed, up to the present writing, the
condition of the weather has been extremely favorable to the development
of influenza, and we all hope that better weather during the remainder
of the winter will tend to check its spread.
Judging from published reports, the treatment of influenza during the
present epidemic has been mainly symptomatic, simple remedies being
employed in place of the powerful antipyretics and analgesics that were
so extensively used three years ago, and this may account in part for
the reduced mortality. In this connection the writer ventures to suggest
the use of a limited number of remedies that have proven of signal
service within the past two months. In the pulmonary type, to relieve
the distressing and frequent cough, nothing has given better results
than morphine hydrochlorate and pilocarpine hydrochlorate, given hourly
in doses of one-fiftieth of a grain each, together. This combination
seems to allay sufficiently extraneous irritation, while it favors the
re-establishment of the normal secretions, and has shown remarkably
favorable effects when broncho-pneumonia threatened to supervene. Given
in these small doses, it produces neither narcotism nor depression, and
the patient is ready to take his regular meals, to which is added liquid
nourishment during the intervals. Hot milk—not boiled—and the free use
of beef-tea made from a good extract of beef, are helpful in assisting
to maintain the strength. In the abdominal type, with much pain along
with mucous discharges from the bowels, showing involvement of the
liver, a combination of mercury biniodide with codeine sulphate appears
to control and modify the progress of the disease. One one-hundredth
grain of the former with one-tenth to one-fifth grain of the latter may
be administered every two hours, and along with this, where we have to
contend with the pains peculiar to influenza—rheumatic and neuralgic—it
is well to administer conjointly small doses of bryonia. From two to
five drops of the tincture can be given at intervals of two to four
hours. Cases which do not respond readily to bryonia, will often quickly
show amenability to the administration of rhus toxicodendron, given in
one-drop doses of the green root tincture at intervals of two hours. It
is remarkable what power these two simple remedies exercise over the
fugitive neuralgic pains peculiar to influenza, doubtless because they
modify the nutrition of the cells composing the fibrous structures,
enabling them to throw off waste products and thus maintain a condition
approaching that of health. The after-treatment will embrace the
administration of the arseniates of iron and strychnine, and in
debilitated subjects this should be supplemented by the exhibition of
cod-liver oil or petroleum in the form of emulsion.
It will be noted that nothing has been said in regard to the
advisability of antiseptics, and for this reason, _viz._: That although
the disease may apparently be associated with a micro-organism, this
microbe plays no important part in the various manifestations of the
disease. Whatever influence it may possess is, as we have seen from
clinical experience, counteracted, discounted, by what the older
physicians were pleased to term the _vis medicatrix naturæ_; and
besides, we have absolutely nothing to warrant us in assuming that our
present antiseptic measures and remedies exercise any perceptible
influence when taken into the system, at least so far as regards this
particular malady. Further investigations in this line may develop some
new ideas in this respect, but for the present, we must rest content
with the stern facts as we see them at the bedside. Special attention
should be directed here to the theory of “_Digestive Leucocytosis_,” as
elaborated by Professor Chittenden, published in another department of
this number.
_AUTO-INFECTION IN ABDOMINAL DISORDERS._
In view of the complications arising in the course of abdominal diseases
from auto-infection, and with our recent knowledge in regard to this
important but insidious factor, it behooves the physician to be on the
look-out for such manifestations. Toxic anemia, as portrayed by Dr. JOHN
E. BACON, in our last number, brings to light some valuable truths which
should ever be uppermost in the minds of those having to deal with
occult affections.
Considering that we now have ample evidence that a sick person may be
his own worst enemy, by reason of an unhealthy condition of the
alimentary canal, it is not too much to assume that in many cases of
prolonged illness, the complications arising may frequently be due to
auto-infection, and thus, in addition to the disease which is seen,
there is another disease engrafted upon the first which is insidious but
persistent. The plan of using purgatives to unload the intestinal tract
and relieve the portal circulation has its value, but the habit, once
established, cannot be relieved permanently by this method. The addition
of antiseptics is likewise a valuable feature in the treatment of this
class of cases, and the two combined will often serve a useful purpose;
but cases occur in which either method alone, or both combined fail, and
it is then that we are compelled to study the philosophy of
cell-function.
In this connection, the studies of POHL, as elaborated by CHITTENDEN,
promise to shed a flood of light upon the vexed and complicated problem
which involves the theory of nutrition. If digestive leucocytosis, as
delineated by these authors, be true, and we have no reason to doubt
their conclusions, then we have a satisfactory explanation of the value
of proper food for the sick, to say nothing of the nutrition of those
who ordinarily enjoy good health. The fact being admitted that white
blood-corpuscles or leucocytes are more rapidly developed after the
ingestion of food, it follows that this cellular activity was intended
to accomplish or aid in accomplishing certain metabolic changes. And
when to this fact we add the knowledge advanced by METSCHNIKOFF
concerning the function of phagocytes, which are said to be modified
white blood-corpuscles, together with the scientific demonstrations of
VAUGHAN, that these cells produce through the activity of their nucleus
an antiseptic substance, we have a complete scientific explanation of
the need for suitable food stuffs, not only in illness of every
description, but also as a precautionary measure against disease.
It is time that the study of the class of cases under consideration
should be placed on a scientific basis, in order that we may have some
definite idea of the objects to be attained—and the method of attaining
them—expressed in terms which may be comprehended by the merest tyro in
therapeutics, and to this end the contributions of METSCHNIKOFF, POHL,
CHITTENDEN and VAUGHAN must be accepted as valuable preliminary data.
The next thing in order will be to make these scientific facts clinical
facts by making them practical, and it is therefore necessary that
others should take up the task in order that the work may be carried to
a successful termination.
_THE PRINCIPLE INVOLVED IN THE SUBCUTANEOUS USE OF BLOOD-SERUM._
An important revelation has been made to the medical profession in the
form of a communication to the _Medical News_ (Jan. 13, 1894), by Dr. C.
F. DARNALL, of Llano, Texas. According to the report, twins suffered
from ptomain-poisoning, and one of them died. The surviving child was
treated by the subcutaneous employment of a normal salt solution, but
without apparent benefit. Later, this was followed by the use of two
ounces of blood-serum drawn from the arm of the father, a healthy young
man. To quote the words of the author, “The child was carefully watched,
and reaction occurred in about six hours. Improvement gradually took
place, and in six days, upon a diet of thin corn-meal gruel at first,
later by fresh milk prepared, the child was well. It was placed at the
mother’s breast at regular intervals, and at the time of writing, nearly
nine weeks after the onset of the illness of the children, the lacteal
secretion is fully established.”
Now, this is evidently a very interesting case, and all physicians who
wish to understand the “whys” and “wherefores” would like to have some
additional light thrown upon this occult subject. In this instance,
there is no intimation that the father had been previously rendered
“immune” to the peculiar ptomain which, in this case, is supposed to
have been derived from a can of condensed milk. How, then, could this
blood-serum have exerted a favorable change in the metabolism of the
infant which was but ten weeks old? Our bacteriological friends will
tell us that the benefits were due to the “_natural antiseptic
properties_” of normal blood-serum; but the clinician and intelligent
and conscientious physician will want to know from whence this peculiar
property is derived. The blood is an alkaline fluid, and we are taught
that antiseptic solutions, to be effective, must be acid. How does it
happen, therefore, that blood-serum obtained from normal blood, which is
alkaline, possesses antiseptic properties?
This question has already taken up so much space in the journal that,
aside from our prospective subscribers, it would not be advisable to
take further time for its elucidation. It will be sufficient, however,
to say that it involves a principle first developed from a scientific
standpoint by Professor VAUGHAN, who has shown conclusively that the
antiseptic property of blood-serum is due to the fact that the nucleus
of the white corpuscles secretes an actively antiseptic substance, a
substance having all the characteristic of a proteid, which he has
denominated “_nuclein_.” At the risk of becoming monotonous in
furthering this measure, we repeat that nuclein solutions may be
obtained from yeast-cells, from the yelk of the egg, from the thyroid
gland, from the spleen and from other organs of the body, and when
properly prepared, they are as powerful in modifying the multiplication
of microorganisms as is corrosive sublimate or any other recognized
bactericide. The principle underlying the subcutaneous use of
blood-serum is, therefore, demonstrable, and is strictly within the
confines of scientific medicine. How long it will require to educate the
medical profession in this knowledge remains to be seen; but if it was
merely an empirical claim or chimerical fancy, and backed by sufficient
capital or government patronage, the period would be short indeed.
_EDITORIAL NOTES._
The contents of this issue of the AMERICAN THERAPIST are as usual
varied, practical, interesting, original—carefully arranged to make
the reading harmonious as well as profitable. We say this for the
benefit of those casual readers of this issue who are not yet—but
ought to be—subscribers and regular readers.
* * * * *
The American delegates to the International Sanitary Congress, to
meet in Paris this month, were named by the chief officer of the
Marine Hospital Service; the delegates are Dr. Stephen Smith, New
York City, Dr. Shakespeare, Philadelphia, and Dr. Bailhache,
Washington, D. C.
* * * * *
The advance copies of the “Minutes, Reports, Papers and Discussions
of the 41st annual meeting of the American Pharmaceutical
Association, held at Chicago, August 14th to 20th, 1893,” have just
been issued to members of the association. The regular bound volumes
of the “1893 Proceedings,” containing the notable annual report on
“Progress in Pharmacy,” will be issued later.
* * * * *
THE NEWBERRY LIBRARY.—Prof. Senn has made a munificent gift to this
institution by giving to it his collection of medical books,
including especially valuable works on anatomy and surgery, full
sets of periodicals, and the collection of books of the late
Professor Baum of Göttingen. With this nucleus, added to by other
donors, and its own already extensive collection and ample
resources, the Newberry Library is apparently in the front rank, and
will afford the profession in Chicago unexcelled bibliographical
facilities.
* * * * *
The four years’ course is gradually being adopted by all the leading
medical colleges. The Jefferson Medical College (Philadelphia) has
just concluded to make the four years’ course obligatory after this
year, and the Medico-Chirurgical College (Philadelphia) is
considering the advisability of making the same rule. The latter
college, by the way, has just established new professorships of
Otology, Genito-Urinary Diseases and Orthopedic Surgery; the new
offices will be filled shortly.
* * * * *
The PENNSYLVANIA STATE MEDICAL SOCIETY will hold its next meeting at
Gettysburg, May 15, 16, 17, and 18, 1894. Those desirous of
presenting papers are requested to notify, at an early date, the
Chairman, or any other member of the Committee of Arrangements. Dr.
E. E. Montgomery, of Philadelphia, is the chairman, and the other
members of the committee are: Dr. Isaac C. Gable, of York; Dr. Geo.
S. Hull, of Chambersburg; Dr. John C. Davis, of Carlisle; Dr. Henry
Stewart, of Gettysburg; Dr. George Rice, of McSherrystown; Dr. E. W.
Cashman, of York Springs.
* * * * *
The American Medical Association meeting is to be held this year at
San Francisco, on Tuesday June 5th. To Californians this date is a
little late for showing off their City and State to best advantage;
it will be a trifle too hot for comfort by that time. A better date
would have been May 5th, and by arranging early excursions the
visitors could have taken in Lower California in April, then the
Mid-Winter Fair—which will undoubtedly extend to May—and wound up
their hours with attendance at the Convention. Perhaps a general
request to re-consider the date should result favorably with the
Committee who make the date and all arrangements.
* * * * *
After a spirited and quite acrimonious campaign, the New York County
Medical Society held its annual election Monday evening, January
15th, 1894. All the candidates on the regular ticket, excepting Dr.
McLeod for president, were elected on the first ballot. For the
presidency three candidates were in the field, and none of them
obtained a clear majority on the first ballot; a second ballot
resulted in the re-election of Dr. McLeod. The candidacy of Dr.
Alexander, urged by the younger and progressive members, was the
disturbing cause in this election; the feelings of the contesting
factions were wrought to a high pitch, and the proceedings were so
turbulent that the daily press of New York took up the matter and
regaled the public with entertaining accounts of the contest. All is
now harmony again, we hope.
Correspondence.
_THE DOSE OF SANTONIN._