existence, and often suffering exposure and privations, will present at winter's close the general condition of depletion, anemia, nervous debility and exhaustion. When you are called upon to treat them in a state of acute disease, you will be quite as much concerned in preserving carefully their strength, and consequent resisting power, as you will be in actively combatting the disease. In much the same condition of nervous prostration will be found the society butterflies, who have spent the winter amid the whirl of gayety, late suppers, sleepless nights, and other unnatural and unhygienic conditions. In determining the course of treatment you will adopt in the case of each patient, consider how he has spent the winter just drawing to a close. It will have much to do with the successful treatment of his case. Education-Qualifications. We have received a great many letters on the general subject of medical education and legal qualifications for practice which we cannot publish, partly because they contain nothing new, and partly because we have already had those subjects sufficiently discussed for the present in our columns. There should be a medium course adopted, as we emerge from the transitional state in which we are now. Truly no one class should be given unquestioned authority to say who shall be allowed to practice medicine; that is against American ideas of liberty. Yet, on the other hand, it will not do to throw down all legal barriers; that at once lowers the intellectual standard of the profession. How would this plan do? We all know that the student who is thoroughly grounded in chemistry, anatomy, physiology, and pathology, is able easily to pursue the branches of practical application. Let all who propose to practice be examined in these branches by a competent board, who, upon his successfully passing such examination, shall give him a certificate to that effect. Then, upon presentation of a diploma from any recognized medical college, he is admitted to practice. Thus he studies these fundamental branches wherever there are the best facilities for learning them, in a medical college, or in a special school of anatomy, chemistry, etc. He has thus shown to the State that he is well informed in those branches about which there are no differences of opinion, and of which unqualified practitioners are always most ignorant, and hence he may be considered a tolerably safe man to be entrusted with human machines that are out of order. He may then very justly be left to the teachings of his own particular school, in the branches about which there are not only differences between the sects, but also wide individual difference of opinion within the same sect. This is manifestly fair to all. It keeps out ignorant men, as the State ought to have a right to do. At the same time, it attacks no 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, in behalf of the student who is not able financially to obtain a medical education. We have fully as much hope for him who educates himself by his own manly efforts, as for him who has his way paid for him. The necessity for self-support disciplines the mind and hand for graver professional responsibilities. What a fine training he would receive who would serve in the capacity of a male nurse in the intervals of his student days; and there are thousands of dollars spent every year for such services, that ought to be given to young men who are preparing themselves for the profession of medicine. There are many other avenues by which the indigent student may come into the medical profession, as many who read this article can testify. Others have written, and our exchanges bring us such articles also, attacking the lecture system of instruction. In part they are right. The lecture has its place, and is nearly indispensable. But each lecture should be supplemented by at least three thorough recitations on the same subject. When the teaching institution ceases to be, also, the sole licensing authority for its own graduates, as intimated in the beginning of this article, then, perhaps, such teaching will be done. Rheumatism. BY LOUIS LEWIS, M. D. (Continued From Last Month.) DETAILS OF TREATMENT. Some few details will now be added concerning the various drugs already mentioned as used in the treatment of rheumatism; and they will be taken in the order in which they have been placed in the previous paper. QUININE is of service in acute rheumatism as an antipyretic in those comparatively infrequent cases which are hampered by great tendency to hyperpyrexia. Large doses are then required, and the amorphous hydrochlorate or the salicylate are the salts to be preferred. The cold bath should supplement this treatment when the temperature continues to rise inordinately. Towards the termination of acute rheumatism, quinine may be administered with a view to modify or prevent the profound anemia which is associated with the disease. Quinine is beneficial in the ulcerative endocarditis often associated with rheumatism. The following formula, modified. according to circumstances, is generally useful in acute rheumatism when the heart is involved: B Quinine sulphat. Potass. iodidi.. Potass. bicarbonat.. Pulv. tragacanth. co.. Aq. chloroformi. Эј gr. xxxv 3j .3 iss .ad.....3 vj M. S.-One-sixth part thrice daily. Shake the bottle. Quinine is also indicated in those forms of rheumatism associated with malaria; and it frequently renders good service in the various forms of muscular rheumatism. But, on the whole, its most prominent value lies in its antipyretic qualities, and as an adjuvant to other more specific remedies. ARSENIC is often useful in chronic rheumatism, rheumatoid arthritis, and nodosities of the joints, especially when the integuments are dry and inactive. Painful swellings of the smaller joints of the extremities frequently yield to arsenic, the joints rapidly returning to their normal size. Fowler's solution affords one of the best forms of administration, sometimes in large incisive doses, sometimes in small quantities frequently repeated. A bath containing a scruple of arseniate of sod and four ounces of common washing soda is serviceable in some forms of rheumatoid arthritis. Fowler's solution is well taken in sherry wine or cinnamon water. Liq, ammon. acetatis Aq. dest... 3 iss 3 ss .3 iij .3 iss For one dose, taken with half a drachm of citric acid in two ounces of water. This quantity of fluid is prescribed advisedly. This dose may be repeated three times in the twenty-four hours, afterwards reducing it sufficiently to maintain alkalinity of the urine. But, when large doses are intended, the soda salts are to be preferred, as full repeated doses of potash tend to devolop anemia. Bicarbonate of potash is highly diuretic when given in hot water, with a little milk; this entirely conceals its taste. be Acetate of potash is also prescribed-alonein half-drachm doses, or more, every four hours. Some authorities speak highly of the nitrate in sub acute muscular rheumatism. Liq. potassæ, an old so-called remedy, is not to be recommended. Citrate of potash may taken for a longer period than the bicarbonate, and is less injurious to the stomach. Baths containing bicarbonate of potash or scda relieve rheumatic pain; and the swollen joints of rheumatic fever are benefitted by the application of cloths steeped in hot alkaline solutions with poppy-heads. Citrates of potash and lithia are recommended in muscular and articular rheumatism in the following proportions: 3j 3j R Lithia citrat..... Potass, citrat... M. S.-One-fourth part every four hours, until subsidence of fever. .3 vj COLCHICUM has, long ago, been recommended in rheumatism, in acute and sub-acute cases. It fell somewhat into desuetude or disrepute on account of its supposed danger to the heart; but there is not enough proof of this to warrant us in discarding an agent which has, time and again, proved a useful, if temporary, remedy (for it certainly does not prevent recurrent attacks). It is undoubtedly apt to depress the heart, but this action can be advisedly antagonized by appropriate measures, coupled with caution. Twenty minims of the wine or tincture may be tried three times in the day, vichy water making an excellent vehicle of administration. The acetic extract of colchicum is notably useful in rheumatic gout. The following is a famous old formula: .gr. I M. et ft. pil. No. j. S.-To be repeated every six hours until free purgation. Colchicum wine is sometimes given in drachm doses, and even in large quantities; but it is apt to disturb the stomach, and sometimes causes some salivation. Nevertheless, it frequently "spirits away" all pain. In most cases of gout, colchicum is a veritable "pain-killer," but that is all; it is in no way curative. A good formula for purgation in rheumatic and gouty subjects is a pill of half a grain of extract of colchicum and two grains of watery extract of aloes, followed by a saline in the morning. SALOL is a combination of carbolic and salicylic acids. This agent and its analogue, betol, have both been successful in many cases of acute muscular rheumatism, lumbago, sciatica, etc. One or two drachms of salol may be given in the twenty-four hours. It is antipyretic, causes moderate diaphosesis, and does not produce any marked unpleasant effects, unless pushed to extreme doses, when its carbolic acid may cause inconvenient symptoms; these results are, however, heralded by deep discoloration of the urine. Salol is not fairly dissolved until it reaches the duodenum, being insoluble in the gastric juice; thus, irritation of the stomach is avoded. Betol may be given four times a day in from five to eight grain doses. The real value of salol is as yet "sub judice," but it has been highly endorsed as a remedy for sciatica. often causes some salivation, and sometimes a cutaneous eruption resembling measles. It has been highly extolled in chronic gout. What efficacy it possesses is due to its resin, which is insoluble in water; hence, decoctions and infusions have little or no value. The ammoniated tincture and the guaiacum mixture are the most available preparations. The former is useful in drachm doses, given in sherry wine, especially when the hands, feet and joints are cold and clammy. Or the following is a convenient formula: B Tinct. guaiaci ammoniatæ.. Muc, tragacanth.. Aq. cinnamoni.. .f3 vj .f 3 ss .fziv ..ad....fž viij ANTIPYRIN reduces fever and relieves pain in acute rheumatism, while it causes no headache, vertigo, or tinnitus, though it may produce diarrhea and sometimes vomiting. Fifteen or twenty grains may be given every four hours during the height of the attack, but it should be cautiously watched. Half this quantity may be used subcutaneously, and repeated "pro re nata." Thus employed, it speedily lowers the temperature. It is administered internally in simple solution, or, better still, in vichy water. Antipyrin has no specific action in rheumatism, but probably helps, through its powerful action on the nervous system, in the rôle of a muscular analyesic. It is highly extolled in chorea of rheumatic origin, especially in children, who take it quite easily. IODIDE OF POTASSIUM often cures cases of rheumatism that have proved rebellious to all other treatment, when the pain and swelling in the joints have persisted for a long period. Ten-grain doses, or more, here frequently render signal service. It is best given in combination CYNARA artichoke is in vogue among the peasantry of Norfolk, England, as a domestic remedy for chronic and acute rheumatism. A decoction is used freely both as an internal remedy and as a local application. The tincture has proved useful in acute rheumatism in drachm doses, when the temperature has been moderate. Chronic rheumatism and rheumatic gout are peculiarly prevalent in Norfolk and Suffolk, presumably owing to the fine chalk in the air and along the coast. Many of the inhabitants habitually void uric acid, and numbers suffer from stone in the kidneys and bladder. * DIGITALIS is often useful in the acute rheumatism of robust individuals when the heart's * * * * * * CIMICIFUGA RACEMOSA has proved useful in muscular rheumatism of the back of the neck, in torticollis and in lumbar rheumatism. Its SULPHUR has been employed in the treatment of chronic rheumatism almost from time immemorial. Pliny recommended sulphur to be rubbed into rheumatic limbs. In sciatica and lumbago it has been long employed locally, and rheumatism of the soles of the feet is frequently relieved by its use. Internally, it has its uses, in chronic cases from five to twenty grains being administered. Sulphurous baths, as the waters of Virginia, Sulphur Springs of Welaka, in Florida, Aix-la-Chapelle, Aix-lesBaines, Baráges, Harrogate, etc., are frequently efficacious in chronic rheumatoid arthritis when employed at a high temperature. An old English remedy for chronic rheumatism, "Chelsea Pensioner," is thus prepared: * * ANTIMONY was, at one time, employed in acute rheumatism, but later experience is almost universally against its adoption. * VERATRUM VIRIDE is sometimes useful in acute rheumatism, sciatica and lumbago. Its physiological action is somewhat similar to that of colchicum, being an antipyretic and an analgesic. It slows and weakens the heart. Minim doses, administered every hour, somet times relieve the pain of acute rheumatism, buit is sometimes apt to cause nausea and even vomiting. * * * * BENZOATES have been favorite remedies in France and England in the treatment of chronic rheumatism and gout. The salts usually employed are the benzoates of sodium and lithium. They are, however, only of doubtful value. They are said to prevent the excessive formation of uric acid by combining with glycogen in the liver, passing off through the kidneys in the form of hippuric acid. Mostly all the agents that have been used, in the past or present, for the relief of the various forms of rheumatism, have now been briefly alluded to in the above category; some have their uses, some are comparatively valueless; but, as already advanced, none have achieved such unqualified, "all-round" success as the various combinations of salicylic acid; and, until a more reliable remedy crops up, on them we pin our faith, taking salicylate of soda as our champion medicament for one of the most baffling diseases with which we have to contend. Claude Bernard, the physiologist, frequently reproached his intimate friend, Balard, the chemist, respecting his habit of imbibing numerous little glasses of brandy during a repast, to aid his digestion. "My friend," one day said Bernard, "I will demonstrate to you the true action of alcohol on the stomach. Listen to my practical experience. I have fed dogs with various alimentary substances, and have then made them swallow some alcohol. Well, on opening their stomachs some hours afterwards, I have found that the digestion of these substances has been notably retarded, and that some of them have not even been touched by the gastric juice! What can you conclude "I conclude," from such testimony as this?" said Balard, gravely, "that brandy was never intended for dogs! |