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vates acute conditions. Senega is a drug that has
Cannabis largely gone out because it was wrongly used.
This is another drug of great activity, but its Aconite and Veratrum
preparations are notoriously unreliable and uncertain.
When one is sure of his preparation, the drug is very These drugs were formerly well used, and some
useful within a narrow range. Consult the textbooks. practitioners employ them properly today, never
Comment giving for over forty-eight hours and always in small
Perhaps some of the ultra-modern physicians will dosage in sthenic conditions, never in asthenic ones. The use of the alkaloids derived from these drugs this day of advanced pathology and diagnostics,
consider this subject as unimportant. Not so! In is never, in the opinion of the present writer, justi- remedies for ordinary ailments are unduly negfied in internal medicine, and the misuse of these
lected. Remedies must not be neglected, and we must alkaloids brought two exceedingly useful drugs into
do all we can to bring into modern usefulness the disrepute. These drugs were wrecked by the alka
comparatively few defined drugs we have, even those Loidal craze but should come back into favor again. which meet minor indications and meet them well. Lobelia
Symptomatic medication is important, despite our There is no doubt whatever of the activity of advances, and we cannot afford to allow really useful lobelia. Consult any text-book. There are plenty drugs to be discarded. of rational uses for lobelia; yet it has largely gone But there is always a reason, and this editorial out of use because its advocates were erratic and which uses a few drugs as illustrations is to emphaextreme in their claims for it.
Of recent years it size the fact that our present neglect of drugs, or was even urged as a sure thing for diphtheria, given certain ones, may be founded on the following facts: hypodermatically or intravenously, while antitoxin
first, a drug may be neglected for the just and suffwas held up to ridicule by the lobelia cranks. This cient reason that it is unnecessary, a comment apwas pure folly and has caused discriminating physi- plicable to many remedies long in use; second, the cians to abandon lobelia, which was and is a very wrong proximate principle may be used and the useful drug. From the time of the Thompsonian mistake be readily corrected, either by employing the craze lobelia has been the innocent cause of acrid right proximate or the whole drug; third, the whole discussion and all sorts of therapeutic nonsense. drug may be too nasty to use, whereas its active Gelsemiam
principle should be used and may be very useful;
fourth, the drug may be used under entirely wrong Here is a drug largely used in the South but
indications, whereas when used properly the agent which has never attained to any extensive vogue in
is most valuable; fifth, the drug may pass into the the North, and its advocates have steadily maintained
discard by reason of some modern craze or style that its toxicity is almost negligible. It is probably
that runs its course, leaving therapeutic wreckage less toxic in the southern fevers than in the north
and nihilism behind; sixth, erratic and extreme ern uses thereof in diseases of the nervous system;
claims for a drug turn the profession against it, but gelsemium is very toxic and has fallen into dis
whereas conservative claims may establish a proper use because employed in excessive dosage. The drug
place for the drug; seventh, a toxic drug may be is one of marked activity and great usefulness, es
used in excessive dosage, thus bringing it into dispecially in the treatment of certain nervous conditions. Doctor, read up gelsemium, both in Regular repute, whereas proper dosage may show the great
value to clinical medicine of a toxic agent; eighth, and Eclectic literature; then try it carefully, and
a drug may be so depressing that physicians are you will be surprised at your former neglect of a
justly afraid of it, and lastly, the pharmaceutical fine remedy. Pilocarpas
preparations of a drug may be unreliable and thus
an intrinsically useful remedy be neglected. Theoretically, this drug and its chief alkaloid fills many indications; it is assuredly very active and its very discreet use is often productive of much Modifying Milk for Sick Adults good; but, in general, it is too depressing. Here is a drug of known activity largely going out of use: OP-MILK feeding for infants has been so sucdoctors are afraid of it, and they use other and cessful in our hands that it was no surprise less depressing drugs to fill its indications. In a to find it equally useful in the case of many adults. hospital ward, where the patient can be watched, There is great lack of tolerance for milk in many pilocarpine is often of the greatest usefulness. The cases of achlorhydria, hyperchlorhydria, achylia gaswhole tendency is against the use of very depressing trica and various gastro-intestinal diseases marked drugs, specially when they are, like pilocarpine, of by hypersecretion, and unmodified milk seems to be little service except in dosage verging on the danger- really poisonous to some persons. We are inclined ously toxic.
to attribute this intolerance to the casein content.
Renvall made a good suggestion that has worked they knew almost nothing of these subjects and viout well in practice: he feeds diluted cream. We tally needed to know them. These students are have employed it by procuring a good double cream angry at their professors for failing to teach them and whipping it up stiff, or procuring it already the things they need in order to make a living from whipped from the nearest şoda fountain. With an practice. It is time for about five thousand profesordinary rotating egg-beater very gradually add sorial resignations. water, continuing the whipping actively during the process, until the mixture is one-fourth cream and three-fourths water, add a little salt, and feed cold or
Gastric Neuroses iced. Carbonated water may be used as a diluent. Remember that ordinary cream will not whip.
Nervous dyspepsia is a very frequent complaint.
It is characterized by both gastric and nervous sympAnother good plan is to prepare malted milk by
toms. adding the powder to fairly warm water and incor
On the gastric side we have as prominent porating well; then add pure cream to the mixture,
symptoms anorexia, nausea and vomiting, and gaseous
and acid eructations. Among the nervous symptoms put on ice for an hour, and serve with a little grated nutmeg and a spurt or two from a siphon of car
are general depression, dizziness and headache. There bonated water. Powdered milk may be used if malted
is a total absence of demonstrable anatomical lesions milk does not agree. In both of these products the
in the stomach, and a predominance of gastric and casein has been flaked or modified.
nervous symptoms as above. These cases are freIf a hot drink is desirable, we find a reversal of
quently classified under neurasthenia. Occasionally the usual coffee and cream mixture, viz., cream flav
they may and do occur in connection with definite orored with coffee, to work nicely. Use ordinary cream
ganic lesions. Reflexly, disturbances of the nervous and heat it in a double boiler; add a little strong
system may result from gastric troubles. coffee, and serve.
Classifying the drugs for the nervous symptoms we have: (1) sedatives and anti-spasmodics, as valerian,
the bromides, cannabis indicae and sumbul; (2) genOur Medical Schools Over-Manned
eral tonics and stimulants, as strychnine and nux
vomica; (3) narcotics and antineuralgics, as codein, N ARMY with too many officers and few pri- opium, veronal and aspirin. vates is often played up in comic opera, but it
Certain disturbances of the stomach are secondary actually exists in real life, much to the disadvantage
to nervous affections, notably the gastric crises in of the army. Yet such a condition exists in our
syphilis, the vomiting of meningitis and brain tumor, medical schools. Eliminating the nondescript schools
and the various psychoses. Then, too, irritants such and those giving only the first two years of a medical
as tobacco acting on the secretary nerves, also pylocourse, there are 14,132 medical students enrolled in
rospasm, chronic appendicitis and diseases of the the schools of the United States, and 7589 professors, gall-bladder and genitourinary tract not infrequently assistant professors, assistants, demonstrators, etc., give rise to various gastric symptoms. to instruct these students, or 1.87 students to each The neuroses are classified as (1) motor; (2) sen teacher—one teacher to less than two students. What
sory; (3) secretory. For the sensory group sedatives, a situation! It is pedagogically ridiculous and eco- narcotics and antineuralgics are used. For the denomically wasteful.
pressive group the stimulants are indicated. For the There is almost no parallel to this situation in
secretory and motor, the alkalies, HCl and the bitter schools giving instruction along other lines, but it stomachics. is actually growing worse in the medical schools. No Gastric lavage is also of use in prolonged pylorowonder that medical education is costing too much spasm with distension, and in the depressive and irand that our courses are unbalanced, as all of these ritative conditions. specialist professors insist on giving lectures, demon- Hydrotherapy is of value in the form of hot water strations, etc., filling the hours with predigested smat- bag to the epigastrium, hot and cold water coil, ice torings of a lot of inconsequentials and leaving in- bags, general baths as cold sponges in the morning, sufficient time for things of greater weight and im- and sometimes a hot bath at night with a hot drink portance to the student.
to induce sleep. Many needless abdominal sections This condition is largely due to a host of practi- are performed in these cases, hence a correct diagtioners, few of whom are real teachers, crowding on nosis is of paramount importance. to facilities to boost their own practices, and it is Pylorospasm may be due to a number of organic vastly unfair to the students. We have met three conditions as ulcer, erosion, carcinoma, etc. The chiet recent graduates lately who have just entered prac- symptoms are sudden shock, cramp-like pain in epitice, and every one was studying therapeutics and gastrium with eructations and vomiting. The treatmateria medica, for they had suddenly discovered ment consists in regulation of diet, change of scene,
if possible, gastric lavage, belladonna internally and
COMING IN NEXT ISSUE hot applications.
In Hypochlorhydria there is a general diminution of all secretions. This also occurs in chronic gastritis
Surgery of the Thymus Gland, by Albert J. Ochsner, and carcinoma of stomach. The treatment is dietetic,
M.D., LL.D., and Frank H'Doubler, M.D.,
Ph.D. a carbohydrate diet, small feedings at frequent inter
The thymus belongs to the so-called group of vals, and dilute HCI, 10 to 20 minims in water.
glands of internal secretion, being particularly Nervous vomiting occurs in young women, and the closely related to the thyroid. In cases of hypernervous symptoms are predominant. The vomiting plastic thymus which cannot be relieved by deep may sometimes persist for months. The condition
X-ray therapy, in the young or adult, thymec
tomy is indicated if there have been grave signs may be controlled by regulation of diet, building up
or symptoms of tracheal stenosis or if there is patient, change of scene, mental and physical rest,
ground for fearing them. and rectal or duodenal alimentation if necessary. For The operation may be expected to accomplish the gastric symptoms, sod. bicarbonate, gentian and several results: mechanical relief, decreased segastric lavage, in addition to above. For the nervous
cretion and stimulation to subsequent normal
tissue regeneration. symptoms, give sod. bromide, veronal at bed-time, and after two week's gentian before meals. Where the Ovarian Hemorrhage, not Due to New-Growths or gastric symptoms predominate, we use Tr. cannab. Pregnancy-With Report of Two Cases, by J. L. ind. and valerian in place of bromides. Cerium
Bubis, M.D., F.A.C.S. oxalate and bismuth are useful for nausea.
Abdominal hemorrhage is a grave condition and
requires serious and prompt attention. To know It is the general treatment, physical and mental
clearly where the bleeding is from, and conserest, and a thorough search for and removal of the
quently to know how to proceed, is always a cause, if possible, which are most important in this pressing question—a question of life and death. distressing condition.
Dr. Bubis differentiates ovarian hemorrhage from the usual entities it is often confused with. It
goes without saying this short and practical paper Treatment of Tuberculosis in General
is well worthy of consideration and should not
be overlooked. Hospitals
Unscientific Practice—Are You a “Pill Doctor?" by N 1916 the National Tuberculosis Association ad
John U, Fauster, M.D. I vocated the plan of opening tuberculosis wards
Dr. Fauster says that while he has due respect in general hospitals, and at the 1921 meeting of the
for the responsible pharmaceutical producers, and
realizes that the refinements in therapy are in a American Medical Association this plan was endorsed.
large measure their handiwork and that the deThere are at least two million tuberculous persons velopment of the biologicals is an epoch which in the Union and it is possible to admit only a small could be realized only with their co-operation, proportion of them to special tuberculosis institu- yet, on the other hand, the nostrum vender, tions.
whether he solicits patronage from the medical The help of the general hospital is needed.
profession or from the laity, cannot be too Not that we approve of the plan of herding large
strongly condemned. numbers of the tuberculous indiscriminately together,
Some Common Forms of Nasal Obstruction in the for we do not; but there are many cases needing
Adult, by L. F. Long, M.D. hospitalization and that ought to have it near to their
Dr. Long says it should be remembered that a homes, not at some far distant point.
deviated septum does not call for operation unless The public generally, as well as the incipient case ventilation and drainage are interfered with. of tuberculosis, have a horror of the special tuber
Also it is important to carefully examine these culosis institution, and for this horror there is quite
cases and institute proper treatment, since nasal
obstruction causes great discomfort and proa little statistical basis, as well as some very human, duces many diseased conditions. even if mistaken, reasons. Furthermore, this plan would keep the family and the family physician in Acromegalia-With the Report of a Case Having
Lymphatic Leukemia, by Hyman I. Goldstein, touch with the patient, which is a very desirable
M.D. thing. The half-way house to this plan is the recently Few diseases are as puzzling as acromegalia is. advocated county tuberculosis institution, a plan not For some obscure reason, the pituitary body "goes yet proved out as regards efficiency.
wrong," becomes disturbed, appears to over
function, and the skeletal tissues, like wild weeds, We believe it is a mistake to shoo the general
begin to thicken, enlarge, grow and overgrow. practitioner off the field of tuberculosis work; for, Both body-anatomy and body physiology become rather, the sensible thing to do, and the practical one perverted, controlless, helpless and hopeless. Dr. as well, is to engage the interest and active aid of Goldstein's case of acromegalia, complicated by
lymphatic leukemia, studied thoroughly and preovery capable physician in the fight against tuberculosis; it is too big a proposition to entrust wholly
sented in detail, is illustrious, interesting and in
structive. It is one of the diseases rarely met to the specialist or to special institutions.
and the paper should attract unusual attention.
Has Sufficient Time Elapsed to Completely Establish Ultimate Value of New Treatment?
By D. ALEXIS MYERS, M.D., D.D.S.
all due to syphilis, although at times they are beProfessional Building, 1831 Chestnut Street, lieved to be by some of the profession. He also Philadelphia, Pa.
emphasizes the fact that, estimating the prevalence
of the disease as judged by morbidity statistics, two Assistant Oral Surgeon to Temple University Dental methods of diagnosis must be distinguished. The School, Philadelphia; late Syphilographer and first is what may be called the "clinical method,” Dermatologist to Walter Reed U. S. General i. e., by means of scars, history and symptomatology; Hospital, Washington, D. C.; late Derma- the second method, which is, of course, the more tologist, Camp Merritt, N. J.
scientific, deals with specimens of blood or spinal
fluid and brings into consideration the results of the Treatment Is Individaal; Never Routine
Wassermann blood test.
But, at best, as just remarked, the prevalence of ing aptly applies, that medicine is an art disease is very much greater than was ever presented as well as a science. Laboratory findings in any statistical table. How, then, can the investimust never, and cannot, usurp the results of gator approach nearer to the truth in forming a clinical findings. Injections of this or that correct estimate of the inroads of this grave malady medicament are not to be regarded as all upon the social fabric? that is required, and all cases are not to be
Statistics treated alike.—THE EDITORS.
This is best accomplished by studying the statisHE COMMANDING importance and the ap
tics of certain representative groups. These include the reports of examination by medical men of em
ployes, applicants for licenses, army recruits, etc. appreciated through a statistical consideration, as recorded through certain registration areas. In 1915, serving the proportion of syphilis found among pa
Also by examining the records of hospitals and obthe number of deaths from syphilis in the United States was 5819. And yet we must, from every
tients treated in dispensaries, as well as those ad
mitted to the wards. Thus, an estimate made by day experience, conclude that even these figures are
the United States Marine Hospital showed: all cases, far too low, for physicians hesitate to inscribe such
53,344; of these 11,414 were venereal, comprising a cause of mortality in filling out the death certificate. It would be interesting to know how many
6974 cases of gonorrhea and 4440 of syphilis.
With the introduction of the Wassermann reaction persons die annually in the United States from syphilis. Cases that are reported as due to general pa
the study of syphilis rested upon a firmer scientific
foundation; for it has been found that two and a resis of the insane, apoplexy, tabes dorsalis, and
half times as many cases of the disease are found other medical entities, are too often the sequelæ of
in comparison with diagnosis by the older clinical syphilitic infection.
method. Has, then, the older method any uses? To It is the opinion of the Hibbs (Journal of Sociological Medicine*) that practically all deaths re
this we emphatically answer "yes." The data of the
bedside must and will always appeal as the logical ported under "general paralysis” result from syph
and correct method, for when our data are computed ilis; but he is extremely doubtful whether such cases
by this method, we need but multiply the result by as congenital debility, icterus and scleroma are at
two and a half to find the approximate number of An excellent resumé of Albb's elaborate and painstaking syphilitic cases by the most modern method at man's study appears in The Urologic and Cutaneous Review, Jan
command. vary, 1919.
Arsenicals In the treatment of syphilis the old saying aptly
The arsenical treatment of syphilis was commended applies, that medicine is an art as well as a science.
to the notice of the profession by Paracelsus in 1529. Laboratory findings must never, and cannot, usurp
Fowler's solution came into vogue in 1756, and was the results of clinical findings. Injections of this supplanted by the administration of Donovan's soluor that medicament are not to be regarded as all that tion in 1788. In 1863 Béchamp, a French chemist, is required, and all cases are not to be treated alike. discovered atoxyl, from which was derived a whole Per contra, syphilis is not a medical entity with an series of organic preparations of arsenic. Atoxyl undeviating symptom-complex; but may exhibit was the first of these substances to be synthesized certain morbid tendencies, inherited or acquired, in and applied to the treatment of protozoön diseases. association with well-defined constitutional taints, be
When the microorganism of syphilis was isolated and this alcoholism, tuberculosis, plumbism, the gouty or
was regarded as a protozoon, atoxyl was energetirheumatic diathesis, etc., that may modify the dis- cally administered, but was soon abandoned because ease and demand modified or additional treatment.
of the resultant optic atrophy which was prone to Syphilitic treatment is individual and never routine.
assert itself. Because of the limitations of space and irrelevancy,
Then followed the memorable labors of Ehrlich I will not detail treatment of syphilis as concerns
and other German collaborators. Upon the assumpmedicaments employed, technic of application, or the tion that drugs act upon an organism when they physiological effects produced; but, rather, I would enter into chemical combination with its cells, Ehremphasize the fact that at the present time the prin- lich developed a theory as affecting parasites in in
. cipal drugs at our disposal, in the treatment of fective diseases, namely, the trypanosomes and the syphilis, are mercury, salvarsan and its allied prod- spirochaetes, and asserted that the protoplasm of the ucts, and the iodide of potassium.
parasite exhibits certain receptive cellular elements A serious obstacle to the employment of mercury
or "chemoceptors,” showing a marked affinity for is the great length of time necessary to effect a certain drugs and combining with them to produce cure. The patient rebels against this lengthy period death of the parasite, and he declared these effects to and often disappears before the curative effect has be parasitotropic, as distinguished from organotropic been established.
action, wherein the cells of the host were affected, In the early history of medicine mercury was
producing a toxic action. classed as a cure for syphilis, and down through
Salvarsan the ages this powerful drug has sustained its repu
As previously stated, the discovery of atoxyl (the
name tation as a cure, which in the darkened period of
a misnomer, since the term signifies "free the world's history was widely employed by means
from" or "against" poison) marked an epoch in mediof "inhalations” and “rubbings."
cal science, for it and its associated substances were
widely tried in the field of medicine; but the toxicity Mercurials
of the drug (which became to be more familiarly Beside the usual methods by mercurial treatment designated sodium arsanilate) forbade its adminisby ingestion, inunction, fumigation and introduction
tration, and the reputation that the new medicament through the rectum, Scarzenio, in 1864, introduced
had so suddenly acquired was soon lost in the disasto the notice of the profession the subcutaneous and trous results reported. Early in the present century, intramuscular soluble injections, given daily or on Ehrlich, acting upon the theory above noted, sucalternate days, or by insoluble injections given
ceeded in obtaining a chemical substance that exerted weekly. The injection of insoluble preparations is
a parasitotropic action, and after experimenting for made intramuscularly, although Lang, who introduced the six hundred and sixth time he announced the disgray oil injections, made them into the subcutaneous
covery of dioxy-diamido-arseno-benzol, and in 1911 tissue. Soluble preparations are adapted for subcu
this chemical was patented under the name of Saltaneous or intramuscular use. The advantages by
varsan. this method are, exactness of dosage, control by the
The first trials of the drug by Alt offered little specialist himself, and secrecy. The disadvantages
*With the announcement of this discovery, the following are, pain, the formation of nodosities at the point of chemically equivalent compounds of new arsenical preparainjection and very rarely the occurrence of pulmonary
tions were soon placed upon the market: The French intro
duced Arsenobenzol-Billon. England offered Kharstvan and embolism.
Arsenobillon. Diarsenol appeared in Canada. Arsphena
mine in the United States. Other closely allied products According to Schamberg and Kolmer, the toxic are Neosalvarsan (a modification of Salvarsan) and simi
larly, Neokharsivan, effect of mercury is due to the amount of metallic
Neodiarsenol and Neoarsphenamine. Among widely emmercury present in the mercurial salt and is variously
ployed French preparations are: Galyi, Hectine and Sul
pharsenol. Luargol contains, in addition to arsenic, antimanifested as a stomatitis, a gastro-enteritis, as mony and silver. Quite recently the Germans introduced
Silver Salvarsan. Among a large number of syphilographers, cutaneous eruptions, or in general disorders of nu- this last substance, it is asserted, is more active than neotrition.
salvarsan and, while perhaps less active than salvarsan, it is surely less toxic.