MALT EXTRACT.-A THERAPEU

TIC STUDY.

BY JOHN AULDE, M. D., PHILADELPHIA. Member of the American Medical Association, of

the Medical Society of the State of Pennsylvania, of the Philadelphia County Medical Society, etc.

WITHIN the past few years the general practitioner must have been forcibly impressed by the wide-spread prevalence of ailments, having their origin in the derangements of the digestive apparatus. Close observers have also witnessed numerous attempts on the part of manufacturing chemists to supply the medical profession with remedial agents to meet the demands of patients who sought relief. The last decade may, with propriety, be called the pepsin campaign. Physiological remedies have received such enthusiastic praise that we have been seriously threatened with a re-installment of the ancient, but now exploded doctrine of isopathy. At the present time, even, pepsin obtained from the stomachs of animals is seriously advocated in all forms of disorders affecting the human stomach; the use of ox-gall, obtained from the livers of cattle, is advocated as a sovereign remedy in many diseases peculiar to men with lame or crippled livers; the animal pancreas is likewise utilized to facilitate intestinal digestion, when this disorder is supposed to be dependent upon a lack of functional activity of that organ. Quite recently I listened to a paper read before a medical society, in which the ground was taken that dysentery was a disease due to the inactivity of both liver and pancreas, and cases were cited in which the exhibition of these remedies combined had sufficed to effect a cure. Of course the advantages to be gained from this line of treatment are obvious, but the principal good arises from metamorphoses taking place in the fats and starchy food products, rather than from any antiseptic properties which these agents are claimed to possess.

Failure of the digestive apparatus, however, is not always an indication for the employment of artificial ferments, as without a restricted dietary, these remedies prove of but temporary benefit. So unsatisfactory have been the results of this method in the hands of some physicians, that it has been abandoned. A physician made the remark to me lately, that he ordered digestive ferments only when all other remedies failed, and he did not know what else to give. My own experience with these preparations has been eminently satisfactory, but I have endeavored to exercise discretion in the selection of the dietary, when they were employed. Thus, in giving pepsin to assist a disabled stomach, the food should be selected with a view to lessen the work of the organ, while the exhibition of pancreatin requires that the demands upon intestinal digestion should be reduced to a minimum by excluding fats and starchy substances. Remarkable good results will often follow the adoption of a dietary regulated according to the foregoing indications, even without the exhibition of any form of medicine.

The truth is that too many people of this country are precipitating upon themselves a debilitated condition, with a class of diseases following in its train, that may be looked upon as certainly preventable, although but few practitioners have so far taken advantage of this practical fact. In nearly all diseases which have assumed a chronic character, the physician will seldom make a mistake in cutting off starchy food-products, while at the same time he supplies something which will assist in converting such articles that are permitted. To provide such a remedy, one which will be taken readily by persons whose stomachs have been made the dumping ground for the most diabolical combinations under the garb of medicine, is a requirement of no small magnitude. How many thousands of honest, thoughtful and conscientious physi

cians have been baffled in their attempts to solve this question, it would be difficult to say.

Just here I may refer to diastase, a valuable principle found in malt extract, a remedial agent which has recently attracted considerable attention. Diastase is a soluble substance, and possesses the power of dissolving starch, convert it into gum (dextrin), and finally into grape sugar, of a substance, which upon analysis, closely resembles grape sugar as it exists naturally in the grape. The amylolytic properties of diastase are, in some respects similar to that of the pancreatic juice, and when we desire to act upon starch alone, it will frequently prove serviceable when pancreatin cannot be used, owing to the destructive action of the gastric juice upon this delicate product. The activity of diastase is much like that of pepsin, except that the latter acts only upon albuminoids; the proteolytic power of a good pepsin is about the same as the amylolytic power of a good diastase, one part of the former being sufficient to convert two thousand parts of albumin into peptone, while one part of diastase will convert two thousand parts of starch into grape sugar. When we take into consideration the distinct therapeutical properties of diastase, together with the persistent demands of patients suffering from intestinal indigestion due to the consumption of starchy food-products, the rapidly increasing facilities on the part of manufacturers supplying physicians with malt extracts may be appreciated.

In order to obtain some definite idea upon this subject it will be advisable to consider the character of the more important food-products containing starch, as by eliminating these substances from the dietary, or restricting their use, patients will receive more benefit from the exhibition of malt extract and its contained diastase. According to Professor Coleman, of Glasgow, Scotland, the following figures represent the pro

Starch, like sugar, fat, etc., is a heat producer, while albuminoids, such as fibrin, casein, albumin, etc., are fleshformers. When too much starchy food is taken into the system, the amylolytic function is arrested, fermentations occur accompanied by more or less physical and mental depression, due to the local irritation set up and the absorption of noxious materials. The most casual observer cannot fail to understand the deleterious effects which must attend upon a disordered condition of the digestion such as that described, and the intelligent physician will readily appreciate the benefits to be derived from the exhibition of remedies calculated to meet these difficulties. At one time bleeding was resorted to, and proving of temporary benefit, the plan was followed by a large number of practitioners; later, however, purgatives became the rule, but the more intelligent class of patients rebelled, and so they in turn have given place to antiseptics. Still without regulation of the diet, our practice under the new regime is exceedingly unsatisfactory. An ideal combination in this class of cases would include digestive ferments with the antiseptics, but owing to the incompatibility between the two, this plan cannot be adopted. Indeed, the physician too often finds that his resources have been exhausted, and is disposed to regret the uncertainty of all medicaments. This statement doubtless voices the sentiments of many physicians, and it is under such unfavorable auspices, I think, that attention should be given to malt

extracts.

Physicians in special practice do not hesitate to order malt extract for patients by the dozen bottles, often with

out other medication, in cases which have been passed over to them by the general practitioner. My own experience with a reliable preparation has been so uniformly successful that I am prompted to publish my conclusions, believing that by this means others may be guided into the same channel. To determine what is meant by a reliable preparation, several questions are to be considered, the most important of which viewed from a medical standpoint, may be mentioned as follows:

our first attention. When this important quality is lacking, we are to enquire whether or not the cause is due to an excess of alcohol, or to the addition of salicylic acid or other objectionable substances as preventatives. Both alcohol in excess and salicylic acid retard and practically destroy the diastasic power of malt extract, which may account for the favorable results obtained by Prof. Coleman with the genuine Joh. Hoff's malt extract, containing as it does, but three and one-half per cent. of alcohol and no

2. Purity, or its freedom from substance calculated to impair the therapeutic value of the product.

3. Palatableness because we wish to avoid nauseating mixtures where malt extract is indicated.

rence.

These questions will be discussed in a general way, in the order of their occurAttention first should be called to an erroneous impression which obtains, viz. that malt extract, ale, beer and porter are substantially the same, and consequently some physicians are opposed to the use of either, believing it contrary to public policy to encourage the establishment of breweries. The facts are, that malt extract is a product which differs materially from all the others, in its manufacture, diastasic power and contained alcohol. Dr. Coleman's investigations form a specific contradiction of this assumption. Duly measured quantities of bread were placed in a watery alkaline solution, which was maintained at body-heat for the period of six hours, with specified amounts of malt extract and the ordinary wellknown English beverages, with the following results:

of a malt extract, also called Hoff's, manufactured by Leopold Hoff, as repeated examinations by Professor Leffman, the well-known analylitical chemist and expert, discovered the presence of a much larger proportion of alcohol and invariably salicylic acid. Prof. Leffman says: "The effects of salicylic acid have been extensively studied, and the unanimous opinion of sanitary chemists is, that it is very objectionable as an addition to any form of food or drink, and especially objectionable in malt extract. From some observations made in my own laboratory, it appears that not only does salicylic acid wholly suspend the action of diastase, to which malt owes its starch converting power, but that the starch digesting power of the pancreatic secretion is wholly suspended by it. It thus appears that the addition of this body is to render the extract not only inactive so far as its own function is concerned, but it introduces into the system an injurious substance, which interferes with another important function."

The preparation referred to by Prof. Leffman enjoys an enviable reputation on both sides of the Atlantic, having been the first product of the kind offered to the medical profession as early as 1847, and notwithstanding the attempts which have been made to supplant it, the fact remains that it is incomparably the best of all the numerous preparations now on the market as regards diastasic

power, purity and palatableness. The improvements suggested by scientific study, together with long experience, have given the genuine Johann Hoff's article a reputation that has stimulated a host of imitators, but to-day it occupies a position far in advance of all competitors as an elegant, nutritious and efficient tonic, adapted alike to young and old, and especially to those in a debilitated condition dependent upon indiscretions in diet. It is an admirable remedy for the period of convalescence following long continued diseases, notably typhoid fever, when the functional activity of the intestinal glands is below par, and will be found of signal service in arresting the progress of all forms of disease in which failure of the digestive functions is a prominent factor.

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TOO MUCH SURGERY.

A PROTEST AGAINST THE RECKLESS USE OF THE KNIFE.

BY M. YARNALL, M. D., ST. LOUIS, MO.

HECATOMB of women survive to tell the story of innumerable operations that have been performed on their wombs. They are heroines, benefactors to their sex! Scalpel's modification of Bisturie's operation has saved their lives; one week longer and they would have perished, but now they are useful members of society, all from the phenomenal skill of Dr. Volsella, the great gynæcologist! "God save the mark!" Not one in a hundred is necessary. These operations on the womb are devised and perpetrated on the willing victim causing not a few deaths, invalidating many, and seldom doing good. In three-fourths of the cases treated by the gynæcologist the local treatment is unnecessary. With bated breath the patient will describe her imaginary suffering, the doctor with "wise saws and modern instances" will review the case; how he acted, what he

said and a lot of exaggerations, while, in truth, there is little aside from the aches and pains coincident to disturbed functions. The practitioner is not altogether to blame, the patient will have the operation "nolens volens"; it is done to satisfy the morbid craving for uterine treatment; the fashionable craze is yet on, and it will require time to modify it, the yearning of many women perhaps never will be satisfied until they are operated on. Let it be fully understood that the writer does not condemn surgical methods when necessary, but he will without fear assert that nineteen out of twenty of the gynæcological operations are unnecessary; many are criminal, because the operator knows they are uncalled for.

Let us enumerate a few of those procedures that are to a greater or less degree passing into oblivion.

The "bilateral" section of the os, the "anterio-posterior" section, the almost countless cases of laceration of the neck (all to be sewed up), "the murderous. sponge tent", the elytroraphies, etc., all of which are dead or dying, except in rare cases. Many operations are performed by the desire of the patient, her condition is morbid, her nervous system disordered, some aches or pains in the pelvic region, some slight lesion-and the knife must be used; the gynæcologist yields, she tells her friends she must be operated on, the doctor has given her that chance to live and become once more a useful woman. She is a heroine, in ninety-nine out of one hundred no operation is necessary or justifiable.

I tried an experiment some time since. I selected a number of uterine cases consecutively, not one of whom an operation upon was really necessary, but I suggested to each that perhaps an operation would be necessary or that it possibly would benefit them, and almost without exception they were willing, in some cases determined, to have something radical done "at once" ("How soon will you operate?"), and I may add that sev

A year or two ago, an eminent surgeon stated that he had never, nor had his father, a large practitioner, met a case that the laceration of the os was severe enough to require operative procedure. Now, I regard this view as an error on the conservative side. There are many cases that it is absolutely required, one notable instance occurring in my own practice; the woman has become insane, was from time to time placed in an asylum; she was radically cured by closing the lacerated margins of the os, and is now a useful and happy woman.

It is to protest against these indiscriminate operations, that I am prompted to write. Only a few days since a splendid woman, healthy and with few aches or pains, consulted me whether she should have an abdominal section performed, the only lesion was some slight deposits that were being absorbed, the remains of an old pelvic cellulite. This woman was almost ready to submit and yet she asked, "why should I have this done? I am not suffering to any great extent, I am in better health than for years!" This is an example; the suggestion was infamous, while the woman was intelligent. She was almost ready to have this formidable procedure take place, perhaps she thought she would become a heroine, proud that she too had one of these great capital operations performed on herself.

The abdominal surgeon should devote himself exclusively to that work and should be patronized, assisted and sustained by professional men. Above all he should be honest and if it be possible to have relief afforded by other means, it should be done. At last, when the operation is required beyond all question, let it be performed, not before. Now then, what shall we do to relieve these patients, before the knife is resorted to? Treat the moral as well as phisical condition; resort to every known method before you mutilate, injure or perhaps

ous treatments including electricity, and placebos, change of the mode of living, if it be possible, and try the various tonics that direct their action principally to the Uterine system, and there are a number of excellent ones. I have no hesitation at this time in recommending "Dioviburnia." This useful combination stands first of all that we now have, and like all tonics, no matter for what object they are exhibited, it will take time, and time is often the best adjuvant. A little less surgery, a little more conservatism.

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MEDICO-LEGAL NOTES.

BY HENRY A. RILEY, ESQ., NEW YORK.

MENTAL ANGUISH AND MONEY DAMAGES.

THE

HE COURTS of North Carolina and Texas are agreed that mental anxiety is a good ground for pecuniary compensation against telegraph companies, which fail to deliver telegrams on time. In a recent case in North Carolina it was held that where a telegram is sent by a wife about to be confined, to summon her husband, and by reason of negligent delay in its delivery of twenty-four hours he did not arrive, whereby she suffered more physical pain, mental anxiety and alarm on account of her condition, and sustained permanent and incurable injury for want of his presence and services, there could be a recovery.

In the Texas case the Court used the following language: "If it is made to appear from the testimony that Mrs. Cooper suffered more physical pain, mental anxiety and alarm on account of her condition, than she would have done if Dr. Keating had been in attendance upon her, and the failure to secure his services is shown to be due to the want of proper care on the part of the defendant's servants, whose duty it was to deliver the message, a fair and reasonable compensation should be allowed for such increased pain and mental suffering."