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therapeutics and practice.

The writer will not reflect on the intelligence of this society by attempt-
ing to enumerate the various diseases and conditions in Avhich alcoholics
seem to be indicated, but they are many.

Of the many local uses of alcohol, I will only mention a few. Diluted
alcohol has more or less antiseptic action, and is a very useful drug in
making many lotions and local applications for such conditions as bed
sores, ulcers, fissured nipples, etc. Pure alcohol is most useful for mas-
sage purposes, and nothing is finer than diluted alcohol for sponging in
high fever from any cause.



110 NORTH CAROLINA MEDICAL SOCIETY.

In the condition known as shock, alcohol is prescribed and with ad-
vantage. It is a good remedy in the condition of chill and in all acute
internal congestions, as it does dilate the cutaneous blood vessels and
brings the blood to the surface.

In cholera infantum or entero-colitis no drug is more valuable. Every
IDhysiciaii knows that many children have been rescued from collapse and
sustained through a tedious convalescence by alcohol.

In chronic suppurations and infections such as puerperal infection and
diphtheria it is a life-saving drug. Also in pneumonia, both croupous
and catarrhal, and especially in broncho-pneumonia in children, no drug
is more valuable.

Of all the diseases in which alcohol is prescribed it seems to the writer
that it is in fevers of a low and protracted type, such as typhoid fever,
that it renders its greatest service. How many patients in the third,
fourth, and fifth week of this exhausting disease have been kept alive and
finally restored to health by this drug alone will never be known, but
every physician knows that the number must be very large.

I but utter a truism when I say that alcohol is absolutely indispensa-
ble in modern pharmacy. Few indeed must be the number of physicians,
even the most rabid temperance advocates, who would be willing to ex-
change our elegant and palatable elixirs and assayed tinctures and fluid
extracts for the infusions and decoctions (dose wine-glass to teacupful)
of our fathers and grandfathers.

The medical profession is a conservative body, as it should be, and will
be guided by the old maxim, "Be not the first by whom the new is tried
nor yet the last to lay the old aside." This subject may safely be left to
the extremist, and in the meantime common-sense physicians will go on
prescribing alcohol in cases where indicated with satisfaction to the
doctor and benefit to the patient.

In closing this subject, I would say that the last word has not been
said on the subject of alcohol, and while Ave all welcome progress with
open minds, yet we realize that there is such a thing as being too previous
even in medicine.



MATERIA MEDICA AND THERAPEUTICS. Ill



EEST— THE MOST IMPORTANT SINGLE FACTOR IN THE
TREATMENT OF TUBERCULOSIS.



Lucius B. Morse, Physician-in-charge, Dr. Morse's Sanatorium,
Hendersonville, N. C.



The writer realizes that in choosing the above subject it may indeed
appear to be a return to a discussion of fundamentals. This is exactly
what it is. Had it not been for almost a crying need for a more wide-
spread appreciation of this very elementary fact it would never have
been chosen as the subject of this paper.

First, permit me to say most emphatically that there is no one agent
in the treatment of tuberculosis that is hardly to be compared with rest.
As much a believer as I am in the value of a continuous life out of doors,
if one were to have to decide as between complete rest in the ordinary
living room as against a continuous life out of doors, but with no care-
fully graduated exercise, there would in truth be no choice. The results
which would follow would be overwhelmingly in favor of the former.

The writer is rather of the belief that the average practitioner of
medicine would probably reverse the above order, giving precedence to
the outdoor life. This is perhaps due to the somewhat more recent and
spectacular features and associations that surround living out of doors —
a reversion, in a sense, as it were, to the habits of our primitive ancestors.

But rest, if not spectacular, is at least time-honored, for it was none
other than Hyppocrates who was the author of the dictum of "physiolo-
gic rest to the part inflamed." As well established as is this theory in
general, is it not rather singular that indeed till only relatively very
recently deep-breathing exercises have been advocted for the tuberculous ?

In choosing this subject I did so in a desire to really be of some assist-
ance, not so much to specialists, but rather to the general practitioner.
It must always be remembered that somewhere between 85 and 95% of
all cases of tuberculosis have to be treated by men in the general field.
The average case simply cannot get away to a resort or to a sanatorium ;
therefore it behooves the great rank and file of medical men to more
fully appreciate the value of this most important single agent in the
treatment of tuberculosis. There is really nothing else in its class.

Now, let me speak more especially of "lung rest," for, in the last analy-
sis it largely revolves about two points, viz., reducing the cough to a
minimum and lessening the depth and frequency of the respiratory
curve.



112 NORTH CAROLIiVA MEDICAL SOCIETY.

Unfortunately, we cannot splint the tuberculous lung as we would a
hip or knee joint. The patient has to breathe ; he likewise has to cough.
In the latter connection, however, I wish it were possible for every physi-
cian to realize the axiomatic truth expressed in — "the Avorst thing for a
cough is to cough." There are exceptions to this rule, but for my present
purposes they are negligible. In large measure the cough of the tubercu-
lous patient is subject to control. It is little less than, amazing how a
conscientious "cure" taker, by a mere act of the will, can reduce the
quantity of cough. A rather close experience has convinced me that the
average case can, in this manner alone, lessen these spasmodic efforts by
at least two-thirds, and, many times, even more.

Practically all patients will be found to be laboring under the impres-
sion that it is imperatively necessary that sputa must be raised whenever
their minds are conscious of its presence in the bronchial tubes. This
delusion, I believe, costs the lives of many tuberculous patients. They
should be taught that, commonly, when sputa is first secreted into the
bronchial tubes or elsewhere it is likely to be tenacious in character, and
equally difficult to dislodge. Fortunately, if the impulse to cough is
repressed it will only be a short time until this same sputa will come uji
with a minimum effort — all due to the rapid action of certain bacteria of
liquefaction. This one injunction has reduced the temperature curve
visibly almost immediately in numberless patients. The more persistent
the repression, too, the more rapidly does it lessen the desire to cough
and the quantity of sputum. This repression, however, must be brought
about by persistent discipline. Aids to liquefaction are hot alkaline
drinks, hot aromatic spirits of ammonia, and small doses of tartar emetic,
pilocarpin, and apomorphine.

The lessening of the respiratory curve is chiefly, and unfortunately,
brought about by bodily rest. I say unfortunately because how com-
monly do we see patients Avhose bodies need exercise, but whose lungs
need- — must have— rest. The more rapid the disease, the more rapid the
respiration and pulse-beats, and the higher the temperature curve, the
more imperatively is rest demanded.

The non- or poorly immune incipient needs bodily rest much more
than does the partially arrested or immunized. All incipients whose
temperature reaches 99 degrees as a maximum should be in bed for from
thirty to sixty days. Chronic cases even, with lingering temperatures,
many times are benefited by prolonged stay in bed ; though in these
patients graduated exercise sometimes brings happy results. Exacerba-
tions in any and all cases demand rest.



MATERIA MEDICA AND THERAPEUTICS. 113

Excessive talking and laugliing are well recognized causative factors
of temperature and pulse elevations, and I believe these phenomena are
attributable directly to the greater and irregular respiratory movements,
with the resultant increase of the local blood supply in the diseased focus,
which in turn increases the absorption of toxins. It is thus seen how
vitally important it is to bring about lung rest.

Coupled closely with lung rest is throat rest. It is now recognized that
a very much larger percentage of pulmonary tuberculosis is accompanied
by throat complications than was formerly supposed, so that partial or
complete throat rest becomes a therapeutic weapon of great value. The
most important means of giving rest to a tubercular throat is in the
reduction of the cough to a minimum. The dictum that "the worst thing
for a cough is to cough" might with equal emphasis be paraphrased by
saying that "the worst thing for a tubercular throat is to cough." The
reason for this is self-evident. Constant throat irritation converts the
organ into a locus mlnoris reslstentce.

Next to interdiction of the cough comes the use of the writing pad.
Where there is a serious involvement in the vocal cords and arytenoids
its use is imperative. In still milder infections the amount of talking
should be sharply limited or the patient instructed to use only the whis-
pered voice. No other one factor is so important in lessening or curtail-
ing the inroads of a laryngeal tuberculosis.

In the proper treatment of stomach and intestinal complications the
element of "physiologic rest" must ever be borne in mind. Any adequate
dietary is beyond the limits of this paper ; suffice to say that in selecting
the proper diet for any and all alimentary complications we once again
emphasize the rest feature of the disease.

Particularly would I say that this is true of those cases of tuberculosis
of the ileum and caecum. An easily digestible, nonfermentable diet is
most important in lessening the peristaltic pain which so certainly saps
the vitality of these unfortunate people. In this connection I have found
the arsenite of copper most valuable when given in ^q grain doses before
all nourishment.

It would be inconsistent, in covering this subject, not to speak of the
great value of rest — or conservation, if you please — of the mental and
emotional sides of patients' lives. I realize that, likely, it is a more vital
consideration among the upper or overcivilized classes than it is in the
lower walks of life. However, the relation existing between a man's
mind and his body is so close and intimate that a person can hardly treat
the one and neglect the other.



114 NORTH CAROLINA MEDICAL SOCIETY.

The coexistence of neurasthenic and psychasthenic states with tubercu-
losis is well recognized. It matters not whether they are causative or
resultant phenomena, it is a fact that their presence is most common.
As a direct result there are numberless things that deserve the attention
of every one who treats tuberculosis. These patients react, as it were, to
mental and emotional stimuli as few other people do. Here again the
temperature records the damage done. In this disease it is rather a sin-
gular fact that whatever the deviation from the normal may be, whether
physically, mentally, or emotionally, it records itself almost unmistaka-
bly on the heat centers— usually, but not always, by a rise in the temx^era-
ture. This being so, mental and emotional rest is imperative.

Every patient must be individualized, but it will be found that certain
apparently harmless things are, if sifted down, the cause of temperature
fluctuations. In one, it may be reading, even the reading of an ordinary
newspaper. In another, writing letters, and still in another the playing
of games will be the exciting cause. Of all the causes of emotional
unrest, however, visiting I believe to be the most pernicious. The un-
emotional life is unquestionably indicated for these people. It is thus
seen that emotional and mental rest go hand in hand with rest of the
body and of the lungs.

It is thus understood that the attainment of these varied ends is by no
means easy. It demands first of all intelligent, sustained cooperation on
the part of the patient with the physician. A two-hour temperature
record taken by the patient is essential. This will almost always lead to
a certain amount of introspection. N^ow, introspection may be good or
it may be bad, wholesome or morbid. It will not become morbid if the
physician gives to his patients the sustained interest which he expects
from them. That wholesome, rather than morbid, introspection super-
venes is, also, I believe, due to the fact that in no other way can a person
check up on his life. He gets a graphic result of his every act. Patients
thus learn to measure their mistakes, their indiscretion, and the manifold
number of accidents entering into their lives. The damaging factor must
he recognized before it can he corrected.

Self-preservation is the first law" of nature; but to intelligently pre-
serve one's self demands in this instance a specialized knowledge of one's
self. In this very connection I have come to the conclusion, for several
years back, that downright selfish people, while they may make disagree-
able patients for the doctor, make good "cure" takers. They are unmis-
takably more apt than are the unselfish to "liew to the line" in the battle
for self-preservation. Selfishness essentially is in fact a sort of unlovely
outgrowth of the law of self-preservation.



MATERIA MEDICA AND THERAPEUTICS, 115

Again, per contra, in this connection I am certain that my experience
has led me to believe that unselfish people are more commonly the vic-
tims of tuberculosis. Into many, many of these people have I had to
inject the doctrine of self-preservation. They must be taught that they
have a duty to themselves as well as to others. To them should we give
our closest heed, to ascertain if they are getting a large quantity of that
all-important therapeutic entity, rest — rest of body and of mind. They
must cease to carry other people's burdens, and, for the time at least,
emulate the law of the brute, namely, the law of self-preservation.



THERAPEUTIC USES OF SOME OF THE PRODUCTS OF
THE DUCTLESS GLAN'DS.



Dr. H. B. Weaver, Asheville.



In 1911 your humble writer had the temerity to read before this society
a paper upon the physiological functions of the internal secretions of
the ductless glands. At that date literature was very meager on the sub-
ject, and no text-book of physiology had given any definite knowledge
concerning the manner in which these glands elaborate their secretions
or the nature of their functional relations with each other.

^STotwithstanding the shortcomings of physiology as taught up to recent
date, any one who is at all familiar with the literature of today cannot
help observing the rapid accumulation of knowledge concerning the duct-
less glands and their physiological and pathological relations in their
coordinating functions and the therapeutic use of the various glandular
products in the treatment of diseases. It was then theory; it is now
facts. This wonderful and rapid transformation of thought is owing
chiefly to the indefatigable work of Charles de Sajous, who has, with his
colaborers, for twenty years, labored with a zeal and knowledge unsur-
l)assed by any other alert thinkers, and whose chief aim has been to give
a new interpretation of the scientific factors of all the branches of medi-
cine, and to establish the clinician upon bases of precision and confidence.
This suggests the idea that we should look to the autoprotective resources
of the body as a foundation for a scientific therapeutics. As Chittenden
well says :

"Not only have we learned that certain of the ductless glands, which hitherto
were considered of little importance to the welfare of the organism, manufac-
ture specific internal secretions all-powerful in the maintenance of health, but



116 NORTH CAROLINA MEDICAL SOCIETY.

it has also been shown that these secretions owe their power to definite chemi-
cal substances produced through the metabolic activity of the gland cells."

Since the early experience of Berkley and Glee, showing that the
removal of any group of these glands causes the most profound disturb-
ances in the general metabolism, the later works of Starling and Zuelzer
have demonstrated the correlation of these chemical substances in the
production, within the blood plasma, of certain definite products or
hormones. The word "hormone," first coined by Starling, comes from
the Greek root and means ''I incite; I stimulate." Starling says "The
significance of these hormones lies in their dynamic influence on the
living cells," and compares them to the alkaloids in their specific action.
These hormones being secreted during the normal performance of the
body functions, and carried in the blood stream to all the tissues, must
stimulate certain cells to specific action. In the language of Zuelzer,
they can therefore be considered as chemical "messages" or chemical
"reflexes" which by the way of the blood mediate specific functional
relations between "distant organs."

This new chemical theory controverts and supplants the old "nervous"
theory, and has been amply demonstrated by such men as Dorhn, Star-
ling, and Zuelzer in their late contributions to physiology.

In recounting, therefore, the role which the ductless glands play in
the protection of the body functions and in mentioning the therapeutic
uses of their products, I have time only to refer to those whose actions
are best understood, namely, the Adrenals, the Thyroids, and the Pi-
tuitary body. The laboratory extracts of these glands have now been
in use sufiiciently 'long, and their clinical effects so thoroughly tested,
that it may be said they have passed the experimental stage; but the
question recurs : How do they act ? Upon what organ or tissues do
these different extracts exert their influence, or what deficiency do they
supply? This is the crux of the whole proposition.

Chittenden, with emphasis, declares :

"The ductless glands become, then, miniature laboratories, charged with the
function of elaborating specific chemical products which are needed for main-
taining the normal rhythm of nutrition. Let these glands cease their func-
tional activities, and the lack of their specific products entails disease and
possible death."

On the other hand, excessive activity of this system produces equally
as disastrous results, as in the case of hyperthyroidism and acromegaly.

JSTumberless investigators the Avorld over are now laboring in research
upon the problem presented by the ductless glands in their correlation



MATERIA MEDICA AXD THERAPEUTICS. 117

and the pliysiological effect of their activity in functional disturbances
as well as in health, and possibly there are fewer efforts Avhich seem to
be of more supreme importance in the .physiology and pathology of
today.

Hence, I think we are safe in concluding that the adrenals, the thy-
roids, and pituitary body, functionally united, as they are, constitute
an atonymous system which furnishes the dynamic chemical" elements,
the hormones necessary for the complete oxygenation of the tissues of the
whole system, whereby the two living processes — ambolism, the build-
ing up of the tissues, and catabolism, the breaking down of the tissues
as waste products — are subserved and by which only life is sustained
and disease averted.

THE ADRENALS.

The suprarenal gland is composed of two distinct portions, the cortex
and the medolary substance, which, like the anterior lobe of the pituitary
body and the thyroids, contains cromaffin cells and which is connected
with the nervous system through the sympathetic. It is established be-
yond question that the suprarenal gland manufactures an internal secre-
tion which is emptied into the blood through the suprarenal veins ; that
it passes through the inferior vena cava to the right side of the heart ;
thence to the lungs, where it absorbs the oxygen in the alveoli, for which
it has great affinity, whereby a new chemical compound is formed, con-
taining 94% of oxygenated adrenal secretion and 6% of hematin, which
constitutes the oxydizing hormone which carries on the vital process
of the body at large. This substance is isolated from the gland for
therapeutic uses in the form of powdered extract and in solution in
the form of adrenalin and epinephrin.

It is apparent, therefore, that the purpose or function of the adrenal
secretion in the organisms should be shown before we can define with
any degree of scientific accuracy the therapeutic use of the adrenal
preparation. Suffice it to say that the adrenals are the source of a
chemical substance, the constituent of the hemoglobin which takes up
the oxygen from the pulmonary air to carry it to the tissues and sustain
the general oxydation therein, and hence, metabolism and nutrition.
The familiar role of blood pressure is itself but an expression of en-
hanced metabolism in the vascular muscles, by direct and indirect
action of the adrenal principal, resulting in contraction of the vessel
walls, which is the cause of blood pressure. In the same way adrenalin
acts as a heart tonic by increasing the muscular tone of the heart through
the Thebasian foramina and through its action on the vaso-motor center
which controls the coronary arteries.



118 NORTH CAROLINA MEDICAL SOCIETY.

The diseases in which the suprarenal preparations are especially in-
dicated are those of asthenic type, where they compensate for functional
incompetence of the adrenals, foremost of which in my experience in this
connection stand the disorders of Addison's disease and typhoid con-
ditions of infectious diseases. Through its action on the vagus and also
sustaining the contractile force of the right ventricle, adrenalin has
the power of sustaining the heart's action in the crisis of pneumonia
and typhoid fever unequaled by few other remedies. Ten drops hypo-
dermically every two hours will tide the patient over the crisis. In
surgical heart failure or collapse from shock, or excessive hemorrhages,
epinephrin timely administered in saline solution will stay the hand of
death when all other remedies fail. It should be slowly administered
intravenously, five minims to the pint of warm saline solution.

In asthma adrenalin arrests the paroxysm by augmenting the pul-
monary intake of oxygen and cardio-vascular propulsion of arterial
blood. From five to ten drops of suprarenin given hypodermically will
arrest the paroxysm in ten minutes. In neuralgia and neuritis applied
to the cutaneous surface, adrenalin in ointment will produce eschtemia
of the hyperemic nerves and thus arrest the pain. In like manner the
adrenalin preparations act locally on the mucous membrane of the eye,
nose, and throat, contracting the peripheral blood vessels, thereby re-
ducing the congestion and inflammation. Of course it goes without
saying that the dosage must be regulated according to the indications of
each case.

THYROIDS.

Since Baumann first demonstrated iodine in the colloid secretions
of the thyroid gland, and that the para-thyroids secreted phosphorus,
the thyroid apparatus has assumed a most commanding importance, espe-
cially from a pathological standpoint, as in hyperthyroidism. Hutchin-
son closed a review on the effect of thyroid extracts on the organism
with this remark : "Briefly, then, it may be said that the effect of ad-
ministration of thyroid is to inci'ease the oxidation of the body. It
makes the tissues, as it were, more inflammable, so that they burn away
more rapidly."

Beebe lately remarks that he does not know positively upon what set
of tissues thyroid secretions act, but rather that "most of the tissues in
the body are in some way affected by this substance, perhaps through the
nervous system." "We know," says he, "that it is in some way connected
with the functions of oxidation in the body."

In summarizing our present knowledge of the use of thyroid extracts
in therapeutics, we are warranted in the following conclusions :



MATERIA MEDICA AND THERAPEUTICS.



119



First. That the thyroid glands, the pituitary body, and the adrenals
are functionally interdependent and constitute a system through which
cardiac action, respiration, and general cellular oxidation are main-
tained (Sajous).



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 14 of 58)