IS CLIMATIC INFLUENCE OF ANY HELP IN THE TREATMENT OF TUBERCULOSIS? BY L. P. BARBOUR, M. D. Fifteen years ago nearly every member of the medical profession believed that climatic treatment was the only treatment of tuberculosis of any use whatever. The writer of this was one of the first of the country to urge active treatment of this disease at home for those who could not go away from home. To-day the pendulum has swung to the other extreme, and the profession is now neglecting its most valuable asset in the combat with this disease. While some cases can be successfully treated at home, and while active efforts should be made at home for those who cannot get away, yet the synchronous action of climate with the same efforts that are made at home, will save many lives that are lost by treatment in the home climate of the East. Let me ask the readers of the SUMMARY how many of your patients are cured by home treatment? I have put this question to many eastern physicians, and they all acknowledge that their percentage of recoveries is very small. If, to the open air, good food, proper regulation of rest and exercise, and such medication as each individual needs, you could add the positive action of dry air, bright sunshine, and altitude, you would find your efforts crowned with a large percentage of recoveries instead. For the combined effect of dryness, bright sunshine, and altitude is of positive benefit. That this is true is proved by actual results. The country around Rocky Ford and throughout the Arkansas Valley of Colorado, is filled with former invalids who came here with tuberculosis and are now living in health and prosperity. To name individual cases would unnecessarily fill my allotted space; but if any doctor would like to have such cases cited, I will give him as many names as he can possibly want, to whom he can write if he doubts my word. Nor is a residence in this region a banishment to a wilderness, as some people of the East seem to think. The Arkansas Valley of Colorado is a highly organized, intelligent, and prosper ous community. Our schools and churches are as good as can be found in the world. Our farmers are progressive and many of them highly educated. Farming under irrigation tends to small farms and intensive farming, which attracts the intelligent. Our climate, outside of and irrespective of its effect upon health, is one of the most pleasant in the world. Knowing this climate as I now do, I have real sorrow for those people who live in the Mississippi Valley or Atlantic States, even though they may be in the best of health. Life here is so much more comfortable. That the readers of the SUMMARY may appreciate more fully the comfort of the climate here, I give a short table of comparison of reports from the weather bureau of the United States:Rocky Ford, Colo. 99 I Philadelphia. Cincinnati. 106 5 277 14.6 inches 106 41.7 inches 95 10 95 45. inches Nor does this table tell all the story. The low humidity, both actual and relative, makes both a high and low temperature much more bearable. It is an experience familiar to all easterners that a day with a high temperature and a high humidity-a steamy day-is vastly more oppressive than one with the same high temperature and a low humidity. Such "steamy" days we never have in the Arkansas Valley. Again, a day with a low temperature and high humidity is raw and chilly. Such days are common enough in the central and eastern States. They are rare, indeed-almost unknown-with us. A low temperature with a low humidity is crisp and bracing. Such are our winter days. Therapeutic Effect. The comfort of being able to be out of doors and moving around, in summer without sweltering, in winter without chilling, has no small therapeutic effect. You doctors of the east know how difficult it is to keep your patients out of doors, Here they willingly and cheerfully adopt the out-door life. Yet this is of minor importance compared to other effects, though this alone would make a change of climate desirable for the tuberculous patient. Physiologica and Therapeutic Effect of Sunshine. The active physical effect of sunshine is so patent as to scarcely require mentioning. It has been the subject of careful experimentation, as well as of every-day observation. We have all seen plants attempt to grow without sunshine, and all know how "pale and spindling" such plants are. The effect upon animals and upon mankind is the same. Direct rays of the sun promote the formation of hemoglobin, and promote constructive metamorphosis. Life in dark rooms and houses is one of the most potent predisposing causes of phthisis, and, conversely, life in the sunshine is one of the most potent means for overcoming a phthisical attack. Now, not only do we have more sunshine here than in Philadelphia by over 250 per cent. (see table above), but, owing to the altitude and absence of moisture, the thermic and chemic effects of the sun's rays are much more intense. A resident of the Atlantic Coast can scarcely realize this increased intensity. All of the effects of sunshine at sea level are intensified. The quick and decided increase of hemoglobin and tissue oxidation, the stimulated peripheral circulation, and the general well-being of the patient, are manifest in almost every one that comes here, sick or well. These effects are as positively shown as is the contraction of the uterus shown to follow the administration of ergot, or the relief of pain to follow morphine. Physical and Therapeutic Effects of Dryness of the Atmosphere.-Increased action of the sweat glands and increased circulation of the skin and mucous surfaces and of the submucous and subcutaneous vessels, are the most marked results from a dry atmosphere. Whether this is true or not you can learn at home. Watch the weather bureau reports and then notice upon yourself the effect of days with a low relative humidity. If it is cold weather even a very low relative humidity will not cause visible perspiration. But the increased circulation is plainly evident in the reddened skin and general good feeling. Now change to a high humidity. You will see a "blue" surface and will feel chilled and uncomfortable. Hot weather with a high humidity does, indeed, leave a visible perspiration. The air is already so laden with moisture that it can take no more, and beads of sweat hang on to the surface to check further perspiration. The skin becomes pale, con gestion of internal organs occur, even to the brain, and we have "sunstroke." Given a low humidity, a dry air, with the same temperature, and the perspiration comes with great rapidity, but is just as rapidly absorbed by the thirsty air; the skin is reddened and the individual, though warm, is not depressed or overcome. Now, all this increased action of the peripheral circulation, the increase of blood in skin and mucous surfaces, is certainly to be desired in the case of phthisical patients. We have, during the last two or three years, heard much of the Bier's method of treating tuberculosis of the joints and other accessible parts. effect of sunshine and dry air upon the skin and mucous surfaces is similar to the Bier's treatment upon the joints, and the results are just as undoubted. The Physical and Therapeutic Effect of Altitude. This has been the subject of much discussion and experimentation, but has been finally settled forever. Altitude does increase the number of red blood-corpuscles of the blood, and the increase is actual, and not merely apparent. Altitude also increases the amount of hemoglobin by 20 to 30 per cent. It also increases the oxidation of the body, as shown both by the amount of oxygen absorbed and the CO produced. It increases both the rate and depth of breathing. And further it stimulates the assimilation of nitrogenous matter. Because of this stimulation of all the metabolic processes to too great action, a very high altitude-7000 feet upward-becomes detrimental to some people. This effect is most commonly shown upon the nervous system, but is not so common as physicians of the East seem to think. I have never seen serious effects from the moderate altitude of the Arkansas Valley: 4177 feet at Rocky Ford. Rarely are any detrimental effects shown short of an altitude of six or seven thousand feet. I want to repeat, every one of the physiological and therapeutic effects of sunshine, dry air, and altitude, given above, have been established by careful experimentation, as well as by observation, and are as well settled as are the therapeutic effect of any drug upon any diseased condition. Rocky Ford, Col. 103 F., then extend time to every six hours, discontinuing capsules when temperature falls as low as 102 F. If tenderness with tympany of the bowels exist to a considerable extent, use the following as an external application to the bowels: Oil turpentine Oil eucalyptol, .3ij. Tinct. opii (stupe for bow- Castor oil (cold pres.).q. s. 3vj. M. Sig. Shake well together, then put the mixture in a pan or some other vessel to heat. Saturate a piece of flannel, three to four double or folds, and apply over the tender part of the abdomen as warm as the patient can bear it. It should be re-saturated and warmed every three to four hours. This will remove the soreness and facilitate the action of the bowels. Will also act as a general alterative. If the above fails to remove soreness and tympanic condition, paint over the abdo with tincture iodine, evening and morning, until the skin becomes too sore from the effect of the iodine to permit its continuance, when the castor oil, stupe, or a poultice may be used instead of the tincture of iodine. After the skin has recovered from the effect of the iodine, it may be used again if necessary. We believe the tincture of iodine to be one of the best, if not the very best, local application that can be made to the tender abdomen in cases of typhoid fever. On the sixth or seventh day drop off capsule No. 2, and give the following: ing to his judgment, in relation to the special case on hand. And as we rarely, if ever, find two cases of any disease exactly alike, therefore the treatment of all cases of disease is, to a greater or less extent, experimental. In a vast majority of cases, however, of typhoid fever, if the treatment herein outlined is commenced within the first three to five days from the attack, and persistently followed, the disease will be aborted, or will not run more than twelve to fifteen days before convalescence will be thoroughly established. The idea of the treatment that we have herein formulated was suggested by Dr. Woodbridge, formerly of Youngstown, Ohio, now of Chicago, Ills., and while our formulæ differ to some extent, the principle and results are the same. Our prescriptions can be put up by any good druggist, hence are always fresh and free from deterioration. We have been using the treatment above outlined for fifteen years, during which time we have lost only a single patient from typhoid fever, and he died from failing to obey orders; while the longest period that the fever continued in any one case was seventeen days. Since we adopted the treatment herein suggested, we have had at least two epidemics of typhoid fever that we got through without the loss of a single case. Troy, Mo. DROPSY: AN INTERESTING CASE. BY J. R. BORLAND, M. D. Miss E. K., age 49 years, was taken with congestion of the right lung on January 17, 1908, and in forty-eight hours the left lung became congested, resulting in double pneumonia, Blisters were applied over the congested area of both lungs, which had a very decided influence in arresting the congestion. Veratrum and aconite were used to control temperature, and mild expectorants for the cough. She also had cardiac trouble from mitral insufficiency, for which strychnine and other heart tonics were employed. She passed through the pneumonia fairly well, and but little expectoration attended recovery. She had dropsy when 18 years old, from which she recovered, but it left a torpid liver, and she had occasional attacks of severe cramps (probably hepatic colic), which continued till about fifteen years ago, and her heart's action has never been quite normal since she had dropsy, as before stated. Some months previous to this attack her lower limbs were swollen, and continued to swell during and after her recovery from pneumonia. Then, along in March, her abdomen began to bloat in spite of the use of cholagogues and hydragogue cathartics, until she was as large as though in the last stage of pregnancy. About the first of June I called Dr. G, who had seen her several times during the pneumonia. He prescribed elaterium tablets, but they made her so sick that, after two days, they were discontinued. Nephroson (Merrell) was then given, with no result, which was followed by apocynum, sparteine, strophanthus, digitalis, etc., with no result that I could see, the bloating, dyspnea, and heart trouble increasing. The case looked desperate. The patient had heard of a case that Dr. W was credited with curing, and he was called in consultation. He prescribed nux and digitalis combined, and diuretic tablets; but these had no perceptible effect except to regulate the action of the heart. Both physicians and myself had about concluded that it was a case of ascites, and that tapping would have to be done as a dernier resort. I said to the doctors that I had derived benefit from a decoction of the green bark of boretree (sambucus niger) in hard cider, with an infusion of horseradish root, in dropsy. Dr. W— said he had often used a decoction of squills, and added to it potass. nit., with marked benefit. I had often given the jalap comp. with potass. bitart., with excellent results. This was about the middle of August. I put on my studying cap and decided upon the preparation, which follows: I got a boy to go along, and we gathered a lot of boretree stalks of that summer's growth, stripped off the bark, until I had three or four double handfuls. Could not get cider, so took cider-vinegar, one part to four of water, and made a strong decoction of the bark; then made a decoction of two ounces of squills, in a similar menstruum, put them together and simmered them down to a quart; then filtered it and added two ounces of potass. nit. and two ounces of fld. ext. jalap. I had the patient take two tablespoonfuls every two hours, until the bowels were freely moved and plenty of water in the evacuations; then smaller doses or enough to keep them going. It nauseated somewhat, but not enough to induce vomiting, a matter which had concerned me all through her sickness. The result of the action of this remedy was most remarkable. Thirty-six hours after the remedy was commenced, the bloating began to go down, and continued to go down at the rate of an inch a day, until the water was completely evacuated. This by actual and careful measurement. The medicine acted on the kidneys as well as the bowels; the heart's action and respiration were improved as the water was evacuated. The urine was frequently examined, which contained a considerable amount of urates, but no albumin. The liver and heart were, no doubt, the main factors in causing the dropsy. She is now quite well, but takes the dropsy mixture and heart tonics occasionally. Shortly after putting this lady on the dropsy mixture, I was called to see a man, age 44 years, who for several years had been troubled with asthma, and, in addition, had mitral insufficiency and anasarca. After relieving him of the asthma he was put on the dropsy mixture, which removed the water in less than a week. Neither of these patients will probably be entirely relieved of the heart trouble; but by taking this remedy occasionally with proper heart tonics, they may have their lives indefinitely prolonged. Now, dear reader, if you have a case of dropsy which baffles your best efforts, try this remedy. Give it in large enough doses to cause free watery evacuations and you will not be disappointed. The inner (green bark) of the mature shrub is the part used. Cut the stalks in proper lengths to go in the stove oven, heat them until the outer bark can be rubbed off by the hand, then cut off the inner bark. If in the latter part of the summer, this is not necessary. I am now having the remedy used on the third dropsical case, and look for favorable results. If one will read up on the therapeutics of these drugs, he need not be surprised at their action. I should have stated, in regard to the first case, that for several weeks before and during the administration of the dropsy remedy, until the water was completely evacuated, she could get no rest without a hypodermic of morphine and atropine; but fearing she would become addicted to it, I changed to the H. M. C. No. 2 (Abbott's) tablets, which contain the eighth of a grain of morphine. She said she could quit them, and she did. or By E. S. MCKEE, M. D. Environment-city, town, village, country practice makes a difference. The country practitioner, far removed from a reliable, up-to-date drug store, should have a liberal supply of drugs, all necessary proved pharmaceuticals pruning his supply, as all doctors should limit their use of drugs to those which will stand the test, eliminating the worthless unreliable fads of to-day. We obtain our best results in the practice of our art, not through the careless indiscriminating use of numerous drugs, but by the proper selection and appropriate application of a few with which we are well acquainted, and in the use and abuse of which we are well informed. Prestige, as well as valuable time and possibly a still more valuable life, is lost in urgent cases by not having some few picked remedies at hand. For the relief of pain, the prompt evacuation of the stomach and bowels, one should always be prepared; also for the checking of hemorrhage and the relief of syncope and cardiac affections. The doctor who enters the chamber of suffering, "when the iron tongue of midnight hath told twelve," armed only with a pencil and a piece of paper, is as unwise as the soldier who rushes to repel the at |
