Medical Society of the State of North Carolina. An.

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tics, at Skillman, gives seven hundred and sixty case histories of epilep-
tics whose heredity has been traced. Eour hundred and fourteen of these
cases show alcoholism in their ancestry. In two hundred and forty-
seven of these cases the alcoholism was in one or both parents.

General practitioners should now note the fact that opium habitues
begin the habit by taking morphine to relieve periodic pains of neuralgia,
tabes, dysmenorrhoea, rheumatism, etc., or the mental depression incident
to worry, loss of position, grief, and the like. A great many cases are
unfortunately traced to the carelessness of physicians in prescribing the
drug, and as if in retribution the medical men furnish the largest quota
of the sufferers (15 per cent).

As the underlying cause of the majority of our hospital drug cases is
a neuropathic diathesis, isolation is more important than keeping the
whiskey drinkers in an institution for a long time, not only for elimi-



92 NORTH CAROLINA MEDICAL SOCIETY.

nating the effects of the drug, but doing as much as possible in correcting
the diathesis by building up the physical health and reeducating the
mental and moral faculties.

Cocaine users are increasing rapidly. The drug is frequently tried as
a substitute for morphine. It is also frequently used in dentistry,
surgery, throat trouble, and patent medicines. From these sources a
knowledge of its analgesic effects is obtained, and its use is becoming
more or less general. Isolation is necessary for these patients. The
prognosis, if withdrawn, is good, but relapses are pretty apt to occur.

In a paper of this kind I can only mention a list of drugs in everyday
use that may produce mental disturbance from the effects of habituation,
namely, chloral, cannabis indica, somnol, sulfonal, paraldehyde, ether,
chloroform, asjiirin, antipyrine, phenacetin, trional, chloralamid, iodo-
form, belladonna, hyoscyamus, salicylic acid, quinine, the preparations
of lead, arsenic, and mercury, and the bromides. Permit me to quote Dr.
William A. White, of the Government Hospital for the Insane in Wash-
ington, D. C, on the possibilities of these common drugs in producing a
psychosis : It should be realized that many of these drugs are drugs in
common use, and that unless the possibilities of their producing a
psychosis are borne in mind, such an accident may arise as the result
of large doses or even of moderate doses in especially susceptible per-
sons. It is just such cases as these, together with the cases that arise
as the result of taking several drugs, analgesics, and hypnotics, that
one meets and finds that no suspicion has arisen as to the true cause of
the trouble. Attention has recently been called to the frequency of
bromide delirium (O'Malley and Franz, Casamajor). Casamajor has
called particular attention to the frequency with which bromide delirium
is produced in the treatment of alcoholism.

The character of the delirium in these cases may be described as
dream-like. The content of the delirious experiences reminds one of
delirium tremens, while the tendency to confabulation reminds one of
Korsakoff's psychosis. The patients are not usually apprehensive and
restless as in delirium tremens, but more composed, and may be dull and
stupid, though there are not infrequently outbreaks of violence, depend-
ent upon paranoid experiences. The following extracts from cases will
illustrate these points :

The patient, a woman, 36, had been taking morphine hypodermically
and bromides, chloral, and hyoscin hydrobromate. On admission she
sees men in rubber garb who stay in the water and look at her constantly.
She also sees the king and queen, bugs and snakes, and bulldogs with
huge open mouths. Says the king and queen congratulated her when she



MEDICAL JUKISPRUDENCE AND STATE MEDICINE. 93

picked up the broken glass at F's on Ninth Street. She hears bulldogs
scream and answers imaginary voices. Electricity is played on her by
Dr. B — , and she feels snakes which crawl about her neck. Says there
are men who throw green powder about her room.

Another patient, woman, at 38, had been taking antirheumatic treat-
ment with aspirin to relieve pain, and later morphine and hyoscin. She
related the following delirious experience that occurred just before ad-
mission :

"I believed that a party of us were going down in the country on a
picnic and that a cavalry regiment had been ordered out. When we got
started, we found that a whole regiment of Indians and negroes were
following us. We went to the place in the country where I was born and
brought up, and there w^e found a hospital which was to be used for caring
for us until the negroes and Indians were allowed to kill us. The patients
in the hospital were all in little beds just like at Providence, but were
all sitting up. The doors were locked so that w^e could not get out, but I
could hear the negroes and Indians talking about killing us. They de-
cided to divide the party up and take us to their different camps. They
also talked of blowing the hospital up with dynamite. They talked of
setting fire to a haystack that was situated near my mother's home. I
heard them preparing fuse which was to be used in exploding the dyna-
mite. I was dreadfully afraid all the time I was at Providence Hos-
pital, and felt that I was among enemies. I thought the nurses were
trying to do the best they could for me, but that they were in the employ
of the Indians and negroes."

Another patient, female, 37, took ''bromo-quinine" for two weeks, when
she developed a delirium. The following is the substance of a letter she
w^'ote while suffering from the delirioid experience : "Just go there ; I
cannot talk; I am under a terrible spell. I do not knoAV what it is, but
it is the most wonderful experience I ever had. I am hypo, I am hypno-
tized. I may be in a trance for three months. Do not, for God's sake,
bury me alive, Molly. Keep me out of the grave for four or five months.
It will be all right. You will hear some things that will surprise you.
Ben, go in that room, for God's sake ; there is a man in there ; he scares
everybody dumb. I cannot talk, but for God's sake, break down that
door. Take Jack; he has got a good strong arm; break that door down.
That poor man is suffering; I saw him do something terrible, and it
awed me so I am half paralyzed. For God's sake, break that door down ;
hurry up."

In a case of bromide delirium (reported by O'Malley and Franz) the
patient had taken on an average 300 grains of bromide daily for fifteen



94 NORTH CAROLINA MEDICAL SOCIETY,

days. Her case illustrates well the dream-like character of the halluci-
natory and delusional experiences. She was disoriented on admission.
Three days later said she had spent the night in the city, with a large
crowd of men and women ; that her husband was dead and that she had
seen his body buried. The next day, asked where she had been the night
before, said : "I was over to the gipsy camp ; I went over in northeast
Washington and saw them kill my husband — smash his head ; his brother,
who is a sculptor, made a form of his head ; I saw it ; he will be buried
tomorrow." A few minutes later her husband visited her. She told
him she thought he was dead, took him to task severely for putting her
in the hospital and being unkind to her, but throughout the visit in-
sisted that he had been killed. Six days after admission she still had
visual hallucinations ; saw cats and rabbits ; thought some of the women
patients were men ; thought she had to walk on cats' heads when she left
her bed and that the physicians were watching her from the register
plate in her room. Later she complained that she was "spirited away
every night by some influence."

In the treatment of these cases the principal thing is, of course, the
removal of the drug, though often the underlying condition, for which
the drug was taken — pain, insomnia — must then be treated. It must
be borne in mind that it may take several weeks for the patient to clear
up after all drugs are discontinued.

On motion of Dr. F. R. Harris, of Henderson, all the papers in the
Symposium on ITarcotics were referred to the Committee on Publication,
it being left to their discretion to have any or all of them published in the
press for the benefit of the public.



MATERIA MEDIGA AND THERAPEUTICS.



THEEAPEUTICS— OLD XNB NEW.



R. A. Campbell, M.D.. Junior SfRGEOx, Long's Sanatorium,
Statesville, N. C.



Following distinguished precedent, we first seek a definition of thera-
peutics. At once the best and shortest definition I have found is : "The
art of curing disease." Art is thus defined : "The employment of means
to the accomplishment of some end ; the skillful adaptation and applica-
tion to some purpose or use of knowledge or power acquired from
Nature; a system of rules and established methods to facilitate the per-
formance of certain actions; familiarity with such principles and skill
in applying them to an end or purpose, as of a practical, useful, or
technical character, as opposed to science, which is 'systematized knowl-
edge of any one department of mind or matter.' " There remains no
doubt that the curing of disease is an art, and not a science, as many
would have us believe. For, surely, if deprived of the knowledge and
power acquired from Nature, we would indeed be poorly equipped for
the battle against disease. Knowledge and power, acquired by countless
thousands of experiments made by skillful investigators in laboratories
and in the field; the skillful adaptation and application of such knowl-
edge to some purpose or use — that, is, the art of curing the disease. "The
value o' the observation depends upon the application o' it."

When first began the art of curing disease is unknown — lost in the
dim ages of the past. Historians of the early ages, as of the present
day, give little space to the art of arts, yet are verbose in politics,
philosophy, physics, war, religion, science, and art. Take up any his-
tory — so labeled — of the United States, and you will find chapters de-
voted to all the various kinds of human endeavor save that of medicine
alone ! Thus it was in the old days ; consequently we have but frag-
ments of the medical knowledge and teachings of the ancients, and no
word at all of the beginning of an art that must have been nearly coinci-
dent with the beginning of the human race. Perhaps prehistoric man
followed an instinct, as did his little more savage neighbors, the wild
beasts. Perhaps he observed and followed the custom of the animals, and
when ailing turned to certain herbs and grasses for relief. At any rate,
when first we have knowledge of practitioners of medicine we find them



96 NORTH CAROLINA MEDICAL SOCIETY.

to be priests, witches, or conjurers. The most famous of the ancients,
Hippocrates, the Greek, was born of a family of priests of ^sculapius,
the god of health, in the first part of the fifth century B. C. The Greeks
had previously laid disease to the anger of the gods — acts of Provi-
dence — as is done by many at the present day, more's the pity. Hippoc-
rates broke away from the idea that disease was a divine punishment.
He maintained that diseases sprang out of natural causes, that they
could be studied, and that the body could be assisted in throwing them
off. His descriptions of many of the diseases common to him and to
us have never been bettered ; but the remedies he used were crude, out-
landish, and even horrible, from our standpoint. He it was that laid
down the rule of days, which we hold to at the present day without
knowledge of the reason therefor, thus : "The fourth day is the index
of the seventh, the eighth of the beginning of the week following. But
the eleventh day is to be considered, for it is the fourth day of another
seventh. And again the seventeenth day is to be considered, being the
fourth from the fourteenth and the seventh from the eleventh." He
also said that "When medicine will not cure, incision must be made ; if
incision fail, we must resort to cauterizing; but if that will not do, we
may judge the malady incurable."

Until recent years the treatment of disease or the application of
remedies to disease rested upon that crude and unstable basis, the em-
pirical system, Avhich is founded upon or derived from experience, and
even Hippocrates said : ''Experiment is dangerous, experience fallacious,
and judgment difficult." Yet upon this narrow and shaking foundation
had the art rested for ages ! Only within the last decade have we
broadened and made firm the base upon which now rests the art of the
treatment of disease. The old text-books attributed the origin of dis-
ease to many extraneous causes — bad air, exposure, improper diet, weak
constitution, weather conditions, climate, inheritance, etc. ; none to a
special sj)ecific cause, the same the world over, irrespective of color,
weather, social position, or what not. Yet it must be said of the ancients
that on occasion they approached close to the cause, as when, in the
days when Rome was the capital city of the world, a physician freed
his community of malarial fever by draining all the marsh land. He
thought the disease was caused by the night air being poisoned by the
emanations from the swamp. His experience taught him that the cause
lay in the swamp, but failed to tell him that the real carrier of the dis-
ease was the small and pesky mosquito, and not the harmless night air.
Thus with many of the diseases flesh is heir to, experience led almost to
the goal of success, but always the last and most important bit of knowl-



MATERIA MEDICA AND THERAPEUTICS. 97

edge was hidden from even the most earnest seeker. ISTot until the
power of the microscope to unveil the hidden mysteries was realized
was the last barrier overridden. Even this was by accident. But from
being a toy and curiosity the microscope became at once an instrument
of precision and the greatest adjunct to the acquisition of knowledge
of all the tools ever built by the hand of man.

The discovery that disease was due to certain specific causes — minute
vegetable or animal growths and parasites, or the products of such, led
to that first great advance in the treatment of disease, the prevention
of disease, as illustrated by Jenner's discoveries concerning smallpox and
Lister's aseptic and antiseptic measures to prevent wound infection.
Perhaps each dreAV a lesson from that famous French army surgeon
Pare, who saved so many lives by cauterizing amputation wounds.
Again in this we see results from experience but half realized, and the
true value almost lost, because the why was not discovered. The dis-
covery of the cause of disease led first to the discovery of the cure of
many of our most fatal maladies — smallpox, diphtheria, rabies, hospital
gangrene. Further study of the causative factors of disease brought us
to the present (or new) methods of treatment — the prevention of all
diseases — not merely intelligent treatment by means of vaccines, serums,
or antitoxins.

We all enthusiastically agree that the new method is worth a thou-
sand — ten thousand — times the old to our Nation, our State, or com-
munity. Yet it is so new — some say unproven — that only a few of us
have made any attempt to cure disease by using the preventive measures,
so freely at our disposal. How many have initiated and enthusiastically
followed up an active campaign against mosquitos, against flies, against
filth and dirt in public places ? How many have systematically pursued
the deadly hookworm; have given the admonition, advice, and hygienic
measures to be followed in a case of bronchitis, which may, if left alone,
prove to be incipient tuberculosis ! Incipient tuberculosis, which may
be likened to the small blaze in a pile of waste paper in the basement
of a building filled with inflammable material. Incipient now, but an
uncontrollable, consuming fire if not at once stamped out. What is
being done by the great army of general practitioners against that
monster of destruction, typhoid fever? What physician but would
rather prevent than try to treat to a successful conclusion a patient in-
fected with the typhoid bacillus? The typhoid vaccine cannot be abso-
lute, but it is so nearly so, its administration is not clouded by difficult
or confusing technique, and, last of all, is furnished free and freely
to him that asks. Then let us be up and doing, striving and contesting



98 NORTH CAROLINA MEDICAL SOCIETY,

with all our strength, one with the other — not, as heretofore, to over-
reach each other in the number of our patients, to outdo our rival in
lucrative practice, or oust him from the position he holds in the esti-
mation of the community as a practitioner, but to outdo him, if possible,
in the laudable ambition of being the foremost advocate, adherent, and
champion of the new therapeutics — that noblest art of all, the prevention
of disease.



OCCUPATIOIsr AS A THERAPEUTIC AGENT.



Paul V. Anderson, M.D., Richmond. Va.



Years ago Dr. S, Weir Mitchell revolutionized the treatment of neu-
rasthenia and allied conditions by advocating his "rest cure," which
"cure" was adopted not only in this country, but practically all over the
world. His mode of treatment involved, first, physical and psychic rest ;
second, hypernutrition ; third, stimulation of metabolic processes, i. e.,
by massage, passive movements, and electricity ; and, fourth, the encour-
agement and education of the patient.

Although this treatment has proved wonderfully efficacious, yet many
patients who have undergone it relapse on account of the fact that after
such a long period of absolute rest they are soft and flabby physically
and are unable to take up their work and keep well at home.

Radical departures from this line of treatment are now being advo-
cated by many. From my experience with nervous exhaustion and allied
conditions, and even with mental troubles themselves, I am more firmly
convinced every day that rest followed by work is the sane method of
treating such troubles. No rest is so perfect as that made possible by
work under proper conditions. Both mind and body need work if health
and happiness shall be obtained. The problem of obtaining the kind of
occupation which means development and progress in cases of nervous
exhaustion without overdoing is a difficult one, but it can be done if the
problem is judiciously handled.

My interest was first aroused in work as a therapeutic agent while I
was assistant physician at the State Hospital at Morganton, North Caro-
lina. I was working especially with cases of dementia precox at that
time, and I found that many of these cases improved markedly and some
got well when I was able to get them interested in work, I found then,
as I have found since, that it is necessary to begin with the simplest task
and gradually get into more difficult tasks as the patient develops. It is



lEATERIA MEDIOA AND THERAPEUTICS. 99

important to give such work as the patient can do, no matter how simple
this is, and it is exceedingly important that the patients shall work on
something which they can complete. It is essential for them to see the
completed product of their industry and to realize that the work is worth
while.

In my work for the past three years I have found that my workshop
and my occupation teacher have accomplished more for my patients than
anything else. Especially good results have been obtained in neuras-
thenic, hysterical, and borderland mental cases, and even in mental cases
themselves reeducative work has been invaluable. I can best illustrate
the value of work as a therapeutic measure by giving a few reports of
cases whose recovery, I believe, was largely due to the fact that they did
things with the hands and thus forgot themselves and the many troubles
which pestered their souls so grievously.

Case I : Mrs. F. A. had been eontined to her bed for two years. She was
exceedingly emaciated and anemic and was so excessively nervous that she
would not allow any one to stay in her room except for a few minutes at the
time. It was difiicult to examine her properly, for she contended that she
could not breathe if any one were near her. She also thought that her heart
would fail if she made any exertion, and for this reason, as well as on account
of her weakness, remained in bed. She was brought to us on a stretcher.
Under forced feeding of milk and eggs she gained strength and three months
after admission was able to sit up. After she was up for a few days she was
put to work on a rafha basket, and in a short time she became so interested
that she carried her work to bed with her and worked while in bed. Soon
she was able to walk. She continued working right along ; increasing her
task as she grew stronger, and, in addition to basket work and brass work,
raised a nice brood of chickens and was greatly interested in the flower gar-
den. After a stay of eight months she went home well. Last summer I saw
her mowing her lawn, and she told me that when the cook left she was able
to do her own housework.

Case II : H. B. was a schoolgirl of eighteen whose parents were exceed-
ingly neurotic. She broke down while preparing for her final examinations
before graduation. Her physician attempted to give her absolute rest at a
hospital at her home town, but he could not control her mother. As she grew
worse and developed hallucinations of sight, and also an hj^sterical cough
and hiccough, she was brought to us. On admission she was exceedingly thin
and anemic. She was put to bed for two weeks and massage was given. She
also took milk and eggs in abundance, finally taking twelve eggs a day. After
she was able to be up she joined the occupation class and was soon quite an
enthusiastic worker in reed, raffia, and brass, making many beautiful baskets
and several brass and copper trays. As she gained strength she bowled,
played tennis, and walked. Just before she went home she was walking five
miles a day ; had gained twenty-five pounds, and was absolutely well. She has
continued her basket work and her walking at home, and recently wi-ote that
she was feeling better than she had felt for years.



100 NORTH CAROLINA MEDICAL SOCIETY.

Case III : Miss A. C, a girl of eigliteen, was frightened wliile at boarding
school. She thought that she saw a negro man trying to enter her room. She
became so wildly hysterical that it was necessary to remove her from the
school, and she came to us. When she was met at the train she was marlvedly
confused ; could not walk, and there were marked convulsive movements of
the arms, legs, and the head. On admission she was put to bed and a nurse
was necessary day and night, as she was constantly seeing the negro man
trying to come through the window, and, consequently, was attempting to get
out of the room. For a week she was in a distressing condition, but gradually
she became more quiet and rational. The trouble was then explained to her,
and she rapidly grew better. (Apologies to the psychoanalyst!) As soon as
she was able to be out she was put to exercising and working. She often said
that the work was her salvation, for it kept her from thinking about herself ;
as long as she was busy she was all right, but when she was not occupied she
was gravely depressed. After four months she was able to go home. She
still continues her exercise and her work, having taken a supply of basket
material .with her. A report from her a week ago says that she continues to
do well at home.

Case IV : Mrs. S. was a case of exophthalmic goitre, with excessively
marked nervous symptoms. Complete rest in bed with massage and electric-
ity worked wonders for her. When she was able to be up she began work in
reed and raffia and took great delight in this work, saying that this did her a
vast deal of good, for it kept her from thinking of her troubles. She was
practically free from nervous symptoms when she left after a two months
stay ; had gained a great deal in weight and is now doing splendidly at home,
where she continues to work on baskets.

Case V : Miss D. G. was a brilliant girl of eighteen who broke down while
at school. Her father's family was markedly neurotic and there was a bad
mental history in her mother's family. She had been upset at times for three
years and had been at sanatoria in Switzerland. England, and America. She
came to us from Phipps' clinic at Johns Hopkins with a diagnosis of dementia
priiecox, with a grave prognosis. The girl was greatly depressed, negative,
deluded, and practically mute. For quite a while she was inaccessible, but



Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 12 of 58)