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existence, and often suffering exposure and pri- studies these fundamental branches wherever vations, will present at winter's close the gen- there are the best facilities for learning them, eral condition of depletion, anemia, nervous
in a medical college, or in a special school of debility and exhaustion. When you are called
When you are called anatomy, chemistry, etc. He has thus shown upon to treat them in a state of acute disease,
to the State that he is well informed in those you will be quite as much concerned in pre- branches about which there are no differences of serving carefully their strength, and consequent opinion, and of which unqualified practitioners resisting power, as you will be in actively com- are always most ignorant, and hence he may be batting the disease.
considered a tolerably safe man to be entrusted In much the same condition of nervous pros
with human machines that are out of order. tration will be found the society butterflies, He may then very justly be left to the who have spent the winter amid the whirl of teachings of his own particular school, in the gayety, late suppers, sleepless nights, and other branches about which there are not only differunnatural and unhygienic conditions.
ences between the sects, but also wide indiIn determining the course of treatment you
vidual difference of opinion within the same will adopt in the case of each patient, consider sect. This is manifestly fair to all. It keeps how he has spent the winter just drawing to a out ignorant men, as the State ought to have a close. It will have much to do with the suc- right to do. At the same time, it attacks no cessful treatment of his case.
man's peculiar principles. The man who objects to this, doesn't want to qualify himself.
Some have written to us in a pathetic way, Education-Qualifications.
in behalf of the student who is not able finanWe have received a great many letters on the cially to obtain a medical education. We have general subject of medical education and legal fully as much hope for him who educates himqualifications for practice which we cannot self by his own manly efforts, as for him who publish, partly because they contain nothing has his way paid for him. The necessity for new, and partly because we have already had self-support disciplines the mind and hand for those subjects sufficiently discussed for the pres- graver professional responsibilities. What a ent in our columns.
fine training he would receive who would serve There should be a medium course adopted, in the capacity of a male nurse in the intervals as we emerge from the transitional state in of his student days; and there are thousands which we are now. Truly no one class should of dollars spent every year for such services, be given unquestioned authority to say who that ought to be given to young men who are shall be allowed to practice medicine; that is preparing themselves for the profession of mediagainst American ideas of liberty. Yet, on the cine. There are many other avenues by which other hand, it will not do to throw down all the indigent student may come into the medical legal barriers; that at once lowers the intel- profession, as many who read this article can lectual standard of the profession.
testify How would this plan do? We all know that Others have written, and our exchanges bring the student who is thoroughly grounded in us such articles also, attacking the lecture syschemistry, anatomy, physiology, and pathol- tem of instruction. In part they are right. ogy, is able easily to pursue the branches of The lecture has its place, and is nearly indispractical application. Let all who propose to pensable. But each lecture should be supplepractice be examined in these branches by a mented by at least three thorough recitations competent board, who, upon his successfully on the same subject. When the teaching instipassing such examination, shall give him a cer- tution ceases to be, also, the sole licensing tificate to that effect. Then, upon presenta- authority for its own graduates, as intimated in tion of a diploma from any recognized medical the beginning of this article, then, perhaps, college, he is admitted to practice. Thus he such teaching will be done.
- 3 iss
decided influence over the enlarged joints, and to BY LOUIS LEWIS, M. D.
mitigate the liability to cardiac complications, (Continued From Last Month.)
especially when combined with quinine. Bi
carbonate of potash is the favorite form of DETAILS OF TREATMENT.
administration, from half a drachm to two Some few details will now be added con- scruples being employed every three or four cerning the various drugs already mentioned as
hours, before meals, in acute rheumatism. It used in the treatment of rheumatism; and they
is well given in a state of effervescence, as, for will be taken in the order in which they have example: been placed in the previous paper.
R Potass. bicarbonat. QUININE is of service in acute rheumatism
3 ss as an antipyretic in those comparatively in
Liq. ammon. acetatis
. 3 iij
Aq. dest..... frequent cases which are hampered by great For one dose, taken with half a drachm of citric acid tendency to hyperpyrexia. Large doses are in two ounces of water. then required, and the amorphous hydrochlo.
This quantity of fluid is prescribed advisedly. rate or the salicylate are the salts to be preferred. The cold bath should supplement this twenty-four hours, afterwards reducing it suffi
This dose may be repeated three times in the treatment when the temperature continues to ciently to maintain alkalinity of the urine. rise inordinately. Towards the termination of But, when large doses are intended, the soda acute rheumatism, quinine may be administered with a view to modify or prevent the
salts are to be preferred, as full repeated doses
of potash tend to devolop anemia. Bicarbonprofound anemia which is associated with the
ate of potash is highly diuretic when given in disease. Quinine is beneficial in the ulcera
hot water, with a little milk; this entirely contive endocarditis often associated with rheu
ceals its taste. matism. The following formula, modified
Acetate of potash is also prescribed-aloneaccording to circumstances, is generally useful in half-drachm doses, or more, every four in acute rheumatism when the heart is involved:
hours.' Some authorities speak highly of the B Quinine sulphat..
nitrate in sub-acute muscular rheumatism. Potass. iodidi..
Liq. potassæ, an old so-called remedy, is not Potass, bicarbonat..
.3j Pulv. tragacanth. co..
to be recommended. Citrate of potash may be Aq. chloroformi . .
:3 vj taken for a longer period than the bicarbonate, M. S.-One-sixth part thrice daily. Shake the bottle. and is less injurious to the stomach. Baths
Quinine is also indicated in those forms of containing bicarbonate of potash or scda rerheumatism associated with malaria ; and it lieve rheumatic pain; and the swollen joints of frequently renders good service in the various rheumatic fever are benefitted by the applicaforms of muscular rheumatism. But, on the tion of cloths steeped in hot alkaline solutions whole, its most prominent value lies in its with poppy-heads. Citrates of potash and antipyretic qualities, and as an adjuvant to lithia are recommended in muscular and articother more specific remedies.
ular rheumatism in the following proportions : R Lithia citrat. ....
:33 Arsenic is often useful in chronic rheuma
Potass, citrat.. tism, rheumatoid arthritis, and nodosities of
M. S.-One teaspoonful every
two hours in hot
lemonade. the joints, especially when the integuments are dry and inactive. Painful swellings of the
Lithia salts are also popular in the the treatsmaller joints of the extremities frequently
ment of gout, but it is doubtful if they are yield to arsenic, the joints rapidly returning superior to salts of potash or soda. to their normal size. Fowler's solution affords one of the best forms of administration, some
ACONITE as certainly reduces fever in acute times in large incisive doses, sometimes in
rheumatism as in other febrile diseases, and small quantities frequently repeated. A bath
relieves gout and pain in the joints, though it containing a scruple of arseniate of soda and is not credited with any specific action. It is four ounces of common washing soda is ser
best given in small hourly doses to commence viceable in some forms of rheumatoid arthritis.
with, say one drop of the tincture. It has been Fowler's solution is well taken in sherry wine
lauded in acute rheumatism, combined with or cinnamon water.
sulphide of ammonium, as follows:
me xvj Tinct. aconiti.
.P. B. BICARBONATE OF SODA, potash, lithia, and
mexi Aq. menth. distill
.3 vj other alkalies, find much favor as remedies for
M. S. -One-fourth part every four hours, untii subacute rheumatism. They seem to exercise ' sidence of fever.
.gr. I .gr. I gr. I •gr. I
COLCHICUM has, long ago, been recommended often causes some salivation, and sometimes a in rheumatism, in acute and sub-acute cases. cutaneous eruption resembling measles. It fell somewhat into desuetude or disrepute on been highly extolled in chronic gout. What account of its supposed danger to the heart; efficacy it possesses is due to its resin, which is but there is not enough proof of this to war- insoluble in water ; hence, decoctions and inrant us in discarding an agent which has, time fusions have little or no value. The amand again, proved a useful, if temporary, rem- moniated tincture and the guaiacum mixture edy (for it certainly does not prevent recurrent are the most available preparations. The attacks). It is undoubtedly apt to depress the former is useful in drachm doses, given in heart, but this action can be advisedly antag- sherry wine, especially when the hands, feet onized by appropriate measures, coupled with and joints are cold and clammy. Or the caution. Twenty minims of the wine or tinct- following is a convenient formula: ure may be tried three times in the day, vichy
☆ Tinct. guaiaci ammoniatæ. .f3 vj water making an excellent vehicle of adminis
.f3 ss tration. The acetic extract of colchicum is Muc, tragacanth..
.fziv notably useful in rheumatic gout. The follow- Aq. cinnamoni..
,ad....fi viij ing is a famous old formula :
M. S.-Two tablespoonfuls three times a day.
Guaiacum is useful in' rheumatism attended R Ext. colchici acetici.. Ext, aloes barb.
with scanty menstruation, being itself an emPulv, ipecac
menagogue of no mean efficacy.
MEZEREON is a stimulating diaphoretic, at S.--To be repeated every six hours until free purgation.
one time in vogue for chronic rheumatism. Its Colchicum wine is sometimes given in acrid qualities militate against its employment. drachm doses, and even in large quantities; A decoction used to be administered in large but it is apt to disturb the stomach, and some- doses, but it is not to be recommended now. times causes some salivation. Nevertheless, it frequently “spirits away” all pain. In ANTIPYRIN reduces fever and relieves pain most cases of gout, colchicum is a veritable in acute rheumatism, while it causes no head“pain-killer," but that is all ; it is in no way ache, vertigo, or tinnitus, though it may curative. A good formula for purgation in produce diarrhea and sometimes vomiting. rheumatic and gouty subjects is a pill of half a Fifteen or twenty grains may be given every grain of extract of colchicum and two grains of four hours during the height of the attack, but watery extract of aloes, followed by a saline in it should be cautiously watched. Half this the morning.
quantity may be used subcutaneously, and
repeated "pro re nata.” Thus employed, it SALOL is a combination of carbolic and speedily lowers the temperature. It is adminsalicylic acids. This agent and its analogue, istered internally in simple solution, or, better betol, have both been successful in many cases still, in vichy water. Antipyrin has no specific of acute muscular rheumatism, lumbago, sciat- action in rheumatism, but probably helps, ica, etc. One or two drachms of salol may be through its powerful action on the nervous given in the twenty-four hours. It is anti- system, in the role of a muscular analyesic. pyretic, causes moderate diaphosesis, and does It is highly extolled in chorea of rheumatic not produce any marked unpleasant effects, origin, especially in children, who take it quite unless pushed to extreme doses, when its car- easily. bolic acid may cause inconvenient symptoms; these results are, however, heralded by deep GAULTHERIA - "oil of wintergreen" discoloration of the urine. Salol is not fairly praised by some in acute rheumatism. From dissolved until it reaches the duodenum, being five to twenty drops are given every two or insoluble in the gastric juice ; thus, irritation three hours; but the patient usually becomes of the stomach is avoded. Betol
be given intolerant of this medicine in a short time, four times a day in from five to eight grain though it often promises to be efficacious at doses. The real value of salol is as yet “sub first. judice," but it has been highly endorsed as a remedy for sciatica.
IODIDE OF POTASSIUM often cures cases of
rheumatism that have proved rebellious to all GUAIACUM was once a favorite remedy for other treatment, when the pain and swelling in chronic rheumatism of the aged and debilitated. the joints have persisted for a long period. It is useful in some cases, but, when adminis- Ten-grain doses, or more, here frequently render tered freely enough to exert its good effects, it signal service. It is best given in combination
with alkalies. Iodide exerts beneficial action action is tumultuous and threatening ; nor is it in gonorrheal rheumatism, sometimes quite contra-indicated in any case where the heart is promptly, when administered in large doses; implicated. Large doses are admissible, with also, in muscular rheumatism and gout. It is due precautions; or, small doses frequently well combined with arsenic, as follows:
repeated. It has no specific control over rheuR Liq. arsenicelis.
.f3 ij matism apart from its conservative action on Potass, iodidi..
the heart. Syr. simplicis.
* M. S.-One teaspoonful in water thrice daily. Iodide of potassium is useful, in large doses,
CYNARA—artichoke_is in vogue among the in the renal and vascular changes which some
peasantry of Norfolk, England, as a domestic times follow arthritic affections, with albumi- remedy for chronic and acute rheumatism. A nuria. When iodide of potassium retards diges- decoction is used freely both as an internal tion, iodide of sodium may be substituted with remedy and as a local application. The tinctbenefit.
ure has proved useful in acute rheumatism in
drachm doses, when the temperature has been TINCTURE OF IODINE is serviceable in rheu
moderate. Chronic rheumatism and rheumatic matic arthritis, internally, ten minims, or
gout are peculiarly prevalent in Norfolk and fifteen, being admissible three times a day, Suffolk, presumably owing to the fine chalk in largely diluted. The affected joints may be
the air and along the coast. Many of the insimultaneously coated with the same prepara
habitants habitually void uric acid, and numtion, or with equal parts of iodide tincture and
bers suffer from stone in the kidneys and rectified spirit.
bladder. TINCTURE OF IRON is recommended in acute BROMIDE OF AMMONIUM has been beneficially rheumatism occurring in anemic and feeble employed in acute rheumatism, in scruple or subjects. It is said to shorten the attack and half-drachm doses, every four hours; but it protect the heart; and also acts as a prophy- acts deleteriously on the heart. It is best lactic. Half a drachm may be tried every four given in milk or in an orange infusion. It has hours. Small blisters to the affected joints aid
no value in chronic cases. this treatment.
CAULOPHYLLUM- -" blue cohosh”- is said to LEMON-JUICE and citric acid are sometimes relieve articular rheumatism. About twenty useful in cases of rheumatism associated with drops of the tincture, or ten of the fluid exalkaline urine and depression of the system. tract, may be administered three or four times Lemon-juice has been recommended in acute a day. rheumatism, in tablespoonful doses, eight or twelve times a day. The following is an old- ERGOTINE has been advocated as useful in time formula :
acute rheumatism, in full doses. It is said to & Succi limonis. ...
obviate the tendency of salicylates to produce Syr. limonis..
.f3j me chiratæ.
tinnitus aurium. M. S.-Two tablespoonsuls three times a day, when acute symptoms seem imminent.
SPIGELIA-pink-root-has been used in rheu
matism, but without noticeable success. It is ACTEA RACEMOSA has been praised in acute better adapted for the treatment of intestinal rheumatism, and certainly seems to ease the pain. It comes well recommended in lumbgo and sciatica. The pulse is notably lowered by MANACA has been successfully used in gonactea, both in force and frequency. Chronic orrheal rheumatism, in five minim doses of rheumatism of the back is said to be much re- the fluid extract, every three hours. It has lieved by its use ; also, some forms of rheuma- also been tried, with uncertain success, in toid arthritis, especially when the pain is chronic muscular and articular rheumatism. It severest at night. Uterine rheumatism often is pleasant to take; and when it is going to yields to actea; also, rheumatic chorea. Half help the disease, it is prompt to manifest its a drachm of the tincture may be given three action. From m v. to 3 ss of the fluid extract times a day, or five minims every hour or two may be given two or three times daily. in chloroform water.
CIMICIFUGA RACEMOSA has proved useful in Digitalis is often useful in the acute rheu- muscular rheumatism of the back of the neck, matism of robust individuals when the heart's in torticollis and in lumbar rheumatism. Its
.ft. f3 ij
action is apparently improved by combination It has been, also, advised in acute rheumawith chloride of ammonium, as thus :
tism. B Ammon, chloridi,
3j Ext, cimicifuga.
ANTIMONY was, at one time, employed in Syr, simp'icis,
acute rheumatism, but later experience is Aq. lauro-cerasi...
almost universally against its adoption. M, S.-One teaspoonsul thrice daily.
VERATRUM Viride is sometimes useful in NITRO-MURIATIC ACID (dil.) is advised, com- acute rheumatism, sciatica and lumbago. Its bined with iron, in " latent" rheumatism, physiological action is somewhat similar to where the joint affections are trifling and tran- that of colchicum, being an antipyretic and sient. Twenty minims may be given thrice an analgesic. It slows and weakens the heart. daily, with half that quantity of liq. ferri per- Minim doses, administered every hour, somet chloridi.
times relieve the pain of acute rheumatism, bu
it is sometimes apt to cause nausea and even HYDRIODIC ACID is useful in chronic rheu- vomiting. matism, and sometimes acts better than iodide of potassium or tincture of iodine. The syrup BENZOATES have been favorite remedies in of hydriodic acid may be given in drachm
France and England in the treatment of doses thrice daily.
chronic rheumatism and gout. The salts usu
ally employed are the benzoates of sodium and SULPHUR has been employed in the treatment
lithium. They are, however, only of doubtof chronic rheumatism almost from time im
ful value. They are said to prevent the exmemorial. Pliny recommended sulphur to be cessive formation of uric acid by combiniug rubbed into rheumatic limbs. In sciatica and with glycogen in the liver, passing off through lumbago it has been long employed locally, the kidneys in the form of hippuric acid. and rheumatism of the soles of the feet is frequently relieved by its use. Internally, it has Mostly all the agents that have been used, its uses, in chronic cases from five to twenty in the past or present, for the relief of the grains being administered. Sulphurous baths, various forms of rheumatism, have now been as the waters of Virginia, Sulphur Springs of briefly alluded to in the above category; some Welaka, in Florida, Aix-la-Chapelle, Aix-les- have their uses, some are comparatively valueBaines, Baráges, Harrogate, etc., are frequently less; but, as already advanced, none have efficacious in chronic rheumatoid arthritis achieved such unqualified, “ all-round " success when employed at a high temperature.
as the various combinations of salicylic acid : old English remedy for chronic rheumatism, and, until a more reliable remedy crops up, on “ Chelsea Pensioner," is thus prepared : them we pin our faith, taking salicylate of soda R Potass, acid, tart.,
as our champion medicament for one of the Sulphuris sublim...
3i most baming diseases with which we have to Pulv, guacaci.
contend. Pulv, rhee
3 ij Pulv, zingib.
.3 ij Mel. M. S.-Two tablespoonfuls night and morning.
Claude Bernard, the physiologist, frequently Frictions of the limbs, with equal parts of chemist, respecting his habit of imbibing num
reproached his intimate friend, Balard, the vaseline and ichthyol, are frequently useful in
erous little glasses of brandy during a repast, chronic rheumatism, presumably on account of the contained sulphur. In England, among
to aid his digestion. “My friend," one day
said Bernard, “ I will demonstrate to you the the country people, sulphur is frequently car
Listen ried in the pockets as a supposed prophylactic
true action of alcohol on the stomach.
to my practical experience. I have fed dogs against rheumatic troubles.
with various alimentary substances, and have
then made them swallow some alcohol. Well, CYANIDE OF ZINC has been highly commended
on opening their stomachs some hours afterin articular rheumatism; it is said to lessen
wards, I have found that the digestion of these pain and lower the pulse. It may be tried as
substances has been notably retarded, and that follows:
some of them have not even been touched by B Zinci cyanidi..
.gr. Pulv, acciæ,
the gastric juice! What can you conclude Sacch. lactis...
from such testimony as this?” “I conclude,'' M. et ft. pil. No.j
said Balard, gravely, “that brandy was never S.-Ten to be taken in the twenty-four hours.
intended for dogs!”