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709



had an opposite effect to that it was sup-
posed it would have. Women have been said
to have married persistent suitors to get rid
of them, and it was confidently asserted that
male voters would take in the women to
get rid of them, or they hoped to win by
violence what they often do by tears. On
the contrary a wave of disgust has gone
over the nation and the "cause" has been
retarded a generation if not permanently.
It has turned many advocates into oppo-
nents, because they think that those who
persistently break laws are not fit to make
them. The militant women themselves do
not realize that if breaking of laws is to be
stopped by changing them, there is an end
of all law, and that an equal suffrage law
passed under such compulsion will itself be
nullified by those opposed to it. The mili-
tants were at first treated with good na-
tured British tolerance and fair play, with
the usual amount of ridicule invariably
directed towards reforms and reformers,
good or bad ; but when private property was
destroyed maliciously, the owners protested
— particularly when the owners happened to
be in favor of the movement for equal
suffrage. Public opinion veered around
and violence was met by violence, as it
always is when old laws show themselves
unable to deal with new conditions of dis-
order jeopardizing life and property. It
became personally dangerous to work openly
and the women now commit their crimes
secretly — 2l crusade of bomb and torch. In-
dignation is so strong and widespread that
the nation may be trusted to devise a way
of ending the nuisance without giving the
slightest ground for the criminals to assume
the role of martyr, which, by-the-way, is
another fond dream of their feminine
brains. The medical interest in the prob-
lems centers in the mental state which can
lead to such abnormal acts, and whether or
not the mind is normal. Of course every
reformer with a new idea which is opposed
to the ideas of the vast majority of people,
has been called insane — and in fact, some
reformers are crazy. In asylums one finds
a multitude of plans for reforming about
everything, but even outside we find that a
brain so abnormal as to think differently
than all others, is apt to think crooked at
times and harbor ideas which differ from
delusions by so slight a degree that it is
difficult to define them. This is true of



some of the world's ablest benefactors, and
their very mental strength makes is difficult
to convince them of their minor errors.
They refuse to be convinced even when the
evidence is conclusive, and yet insanity can-
not be charged. Militant suffragettes go a
step further, for they seem now possessed
of "fixed ideas" which they will probably
hold as long as they live, yet it would be
as rash to accuse them of insanity as it
would be to call every professional criminal
crazy because he thinks the world owes him
a living. There is no question that the
women are very abnormal or they would
stay home like womenly women — indeed
their pictures often show evidence of "mas-
culinity" which is as much an evidence of
serious degeneration as "femininit/' in
males who also not uncommonly figure in
police courts for other crimes due to their
defective and distorted development, phys-
ical and mental. But what is the character
of this abnormal militant psychology if it
is not insanity? No one seems to know at
present and therefore no one seems to know
how to cure them of their false idea that
law is improved by contempt for it — a
weapon which will destroy anyone who uses
it. No action is possible until psychologists
and alienists clear up the matter a bit. Un-
fortunately such pronouncements as they
may make are foredoomed to discredit, be-
cause in the minds of some of our ablest
people female suffrage is considered an ex-
tremely sane and important, even vital,
reformation. They should join hands in
suppressing the violent ones, but it begins
to look as though the militants are incurable
and will continue in their ways as long as
they are allowed their liberty. It is brutal
to say the sooner they die the better for the
cause, yet it may be a brutal fact. If one
deliberately starves to death in prison and
the newspapers decline to make a martyr
of her— the whole crusade of violence will
collapse as a matter of course. But per-
haps the plan to release them for recupera-
tion and then rearrest them to serve more
of the sentence and repeat this course until
the whole time is served, may accomplish
the same end and save their miserable lives.



The increasiiig responsibilitieB of the
fillip's doctor must soon compel the trans-



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AMERICAN MBDICIMB

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}



MEN AND THINGS



I



NOVBMBEE^ 1918.

New Series, Vol. VIII. No.



11.



portation companies to make it worth while
for young men to take up the calling as a
life work. So many invalids travel to Europe
that our liners could almost be considered
sanitariums needing a high grade of pro-
fessional supervision, and the special con-
ditions of the service require more or less
specialization which unfits one for prac-
tice on shore. The position has generally
been urged upon recent graduates in need
of money, leisure to study and such ex-
perience as they could obtain. There is
now a positive demand for a high grade
of doctor, and we may soon hear
of physicians recommending certain
lines or boats for their patients be-
cause professional care on them will
be of the best. A large number of
ship's doctors are already of a high grade,
but the compensation is so low that the best
are under constant temptation to leave as
soon as a better chance comes their way.
The companies which pay their physicians
well enough to retain these excellent men,
will surely attract travelers and such lines
will be unwilling to pool their earnings with
those who make the least profits. Altogether
the outlook for this special kind of practice
is very bright, and the position is one of
increasing dignity too as the occupants are
making it dignified. We should soon be
assured that every invalid we send abroad
will receive the best possible care en route,
no matter what boat he goes on. We may
also soon expect important contributions to
medicine in the way of studies of the effects
of sea travel on certain ailments. As far
as we know, these physicians have con-
tributed comparatively nothing toward the
advancement of their science, though their
opportunities are numerous and leisure
ample. Let us hear from them at once.



Medical endowmentB and whole time
professors are becoming actualities, for
which we should thank Heaven and the
milHonaires. Recent donations to Johns Hop-
kins, we understand, have been made and
accepted with a view of compensating the
professors of surgery, medicine and pedi-
atrics so that they will not be compelled to
resort to private practice to make a living.
They are paid to devote their main energies



to the students and hospital patients. They
are to have a right to see outside cases, but
as they are paid for whole time, any outside
fees are the property of the hospital. In
all other businesses the employer takes the
money earned by the employees and why
not in the hospital business? Surely this
is the beginning of the long predicted
change which is eventually to place most if
not all practitioners on a salaried basis as
in the national medical services. The state
already employs some, the county here and
there some more, and the city quite a num-
ber, but they are largely psychiatrists,
sanitarians, executive oflfcers of hospitals
and physicians to prisons or other institu-
tions for the custody of incompetents. It
will be only a short step to extend the
salaried list to those who now give free
medical and surgical service. The money
cost to the public will be less than at present,
for the workers now make up for it by
unduly large fees to those who can afford it.
The increased taxation to cover salaries
would be less. The advantage to the prac-
titioner is to be freed of the nerve-wearing
struggle for existence, with its inevitable
professional jealousies, near-quackery, and
the other skeletons in our closet which we
do not like to expose to lay inspection. Of
course there will be no chance to make a big
fortune, but few of us do that anyhow. The
loss is more than compensated by the pen-
sion which comes with old age or disable-
ment. The world has no inkling of poverty
and distress of many an old physician who
has spent most of his energies in charity
and who is too proud to ask for help now
that his work power is gone. Let us repeat
what we have so often said before, medi-
cine is a way of making a living and like
every lawful business it must be mutually
beneficial to both sides. If we take the
view that it is solely for public benefit, we
must acept the suffering inevitable in the
old age or disablement of those who do not
receive a proper wage in their prime. It is
now time to pension old doctors and we
would suggest to the trustees of hospitals
and dispensaries that this is the right of
those who have so nobly worked for them
without pay. The time is not so far off
when we will be compelled to refuse to do
such unpaid service — self-preservation de-
mands a change.



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ORIGINAL ARTICLED



AMEBICAIC MiDICUfB

Complete Series. Vol. XIX.



711



ORIGINAL ARTICLES.



INTESTINAJ. PUTREFACTION, ITS

TBEATM£NT AND REPORT OF

NINET7.0NE OASES.



J. WALLACE BEVERIDGE. M. D.,
New York.

In recent years a great deal more atten-
tion has been directed by the internists
towards intestinal digestion and the con-
comitant results from putrefaction and re-
absorption of toxic substances which re-
quire our most skilful efforts to correct
than ever before.

In the infant at birth the intestinal tract
is filled with meconium, and if baby is
nursed by the mother during the required
period the many evil phenomena observed
in bottle-fed babies are practically lacking;
they are not affected by green stools, or
with colitis, and many of the grave condi-
tions that ofttimes cause premature death
of the little one do not appear.

Nature seems to provide a special com-
bination in mother's milk, which is readily
digested, while the best efforts of our
pediatricians in striving towards the modi-
fication or upbuilding of cow's milk, to
take the place of mother's, has, at best, been
unsatisfactory.

In the intestine of the infant living on
mother's milk the hosts of evil intestinal
flora do* not seem to thrive, while in the in-
fants living on an artificial media the in-
testinal tract is always crowded with many
noxious intestinal bacteria and excess of
gas.

The normal functioning of the liver is
ofttimes impeded by the artificial food, then



the secretion of bile is either lessened
or of an inferior quality, which is one of the
potent factors in maintaining an intestinal
asepsis ; while with the infant nursed by its
mother the normal functioning of the liver
is maintained, and the bile is capable of per-
forming its cleansing action.

As the infant grows, should any intes-
tinal abnormalities form, which would pre-
vent active peristalsis, or permit a condition
of chronic stasis, intestinal putrefaction will
necessarily follow. This has been pointed
out by Dr. A. Jacobi, Dr. Joseph Winters
and others.

The great advance made in diagnosis of
the alimentary tract by the radiograph will
show where any mechanical defect is pres-
ent, and it is just as valuable in the infant
or small child as it is in the adult. During
the early youth of the child, if improper
food is permitted, consisting of an un-
balanced diet such as an excess of carbohy-
drates, or too great a quantity of protein,
to the exclusion of other foods, the intes-
tinal digestion is immediately taxed, and
only part may be assimilated while the rest
remains as waste.

When children are f>ermitted to exercise
violently, and allowed to become physically
tired the quantity and quality of food does
not seem to make such a great difference,
as the demand for new cell nutrition is so
great that during the metabolism of diges-
tion very little, if any, delay takes place in
the intestinal tract, and the putrefying
processes do not manifest themselves; but
it is in the children that are most carefully
guarded and only permitted to do certain
well-regulated daily exercise that the food
consumed makes a decided difference.
These children are not constantly endeavor-
ing to supply the cell broken down with
new fuel, and if an unbalanced diet is given



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Ambsicam Mboici:(b
Complete Series, Vol. XIX.



}



ORIGINAL ARTICLES



( NOVEMBSB, 1913.

I New Series, Vol. VIII, No. 11.



intestinal putrefaction will always be the
result.

In the adult, a similar law of food con-
sumption naturally follows. All the auto-
intoxications, intestinal toxemias, and their
many systemic symptoms, might be stated
to come from intestinal putrefaction.

The stomach, perhaps, plays the most
important part in food digestion.

Hyperacidity is one of the common causes
of gastritis — too much smoking, too much
alcohol, too much coffee, will all give hyper-
acidity. Any food that is capable of
stimulating to increased activity the epithe-
lial cells of the gastric mucosa will produce
hyperacidity. Fruits if green when eaten
contain acid that will cause hyperacidity.
Other factors in hyperacidity might be
placed under headings of disposition,
wherein the individual may be of an ex-
citable and irritable nature — Overwork,
wherein the individual may be under a
strain during a long number of hours, and
eat at irregular moments; errors in diet,
such as habitual over- feeding, especially
excess in proteid food and drinking great
quantities of spirituous liquor; imperfect
mastication with the bolting of food, espe-
cially of raw, coarse, insufficiently cooked
food — ^the stomach is given the task of
dividing the food before it is passed into
the intestine for final digestion. Thus, in
every instance, the stomach must first
thoroughly complete its part of digestion
before the food enters into the intestine for
its final stage, otherwise, the intestine is
called upon to overcome the defective gas-
tric digestion, as indicated by hyperacidity,
or hypoacidity, or any other abnormal
condition, and, if unable to do so, we have
the beginning of intestinal putrefaction.

The liver is recognized as the principal
organ in removing or eliminating the



toxines from the body circulation.

Some authorities claim, and I am inclined
to believe with them, that the liver is
capable of producing hormones. In dis-
eases of the liver, such as cirrhosis or
atropic conditions, we have an interference
not only with the production of bile, but
with its normal functioning. If the normal
production and quality of bile is in any way
impeded the peristalsis of the intestine is
lessened, and the hosts of intestinal flora
become abundant, at once showing the way
to intestinal putrefaction. When the liver
is not functioning normally the quantity of
urea manufactured is much less, and the
ammonia is greatly increased — this is al-
ways a serious condition, as it is well
known that when the protein is broken
down ammonia is liberated, and must be
changed, otherwise toxic symptoms man-
ifest themselves.

I have shown in another paper, and
Baylis and Starling have positively proven
that acid digestion as it passes through the
duodenum is the medium by which the ac-
tive pancreatic secretions are stimulated
during digestion, and the product so formed
which is capable of stimulating the pancreas
is known as secretin, manufactured in the
epithelial cells lining the duodenum. When
the pancreas is unable to function normally,
and the enzymes are not produced, diges-
tion is again interfered with, portions of
the unchanged protein pass into the large
intestine, ever-ready for putrefaction.

The serious attention which within recent
years has been given to the action of the
intestinal bacteria, and the necessity for
their presence, to complete digestion is
now positively recognized.

Some of the investigators claim that in
the normal, healthy intestine bacteria should
be absent, but this is not so, and has been



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Complete Series, Vol. ZIX.



713



proven otherwise. If chickens are hatched
from eggs with sterile shells, and brought
up on sterile corn, they will not thrive the
same as the control chickens that are per-
mitted to follow the natural course of feed-
ing. The guinea-pigs that are delivered by
Cesarean section, and fed upon sterile milk
do not thrive as guinea-pigs in the normal
way. Although it was shown several years
ago with the polar bear, the pelican, the
reindeer, and several other Arctic animals
that they had no bacteria in their intestinal
tract, but whether the investigators who re-
ported these findings could really be de-
pended on is a question.

So we come to believe that not only the
chemical action in digestion is vital, but the
bacterial action upon the protein and sugars
is most essential for normal digestion.

There have been many kinds of different
bacteria isolated in the intestinal tract of
man, but the general biological formation
is on the bacilli coli communis type.
There may be paratyphoid organisms, ty-
phoid organisms, streptococcic and staphy-
lococcic organisms present without doing
any apparent harm. The function of the
bacteria seems to be to attack the large al-
bumin molecule and break it down into
many different parts; the sugars are at-
tacked and changed, etc., glucose into
levulose, etc., the proteids into indol, skatol,
etc. When too much proteid food is con-
sumed an excess of indol is created, and we
have it appear in the urine as indican.
When too great a quantity of carbohydrates
is taken the sugars are not readily changed,
and the glycogenic function oi the liver is
overtaxed with traces of sugar appearing
in the urine — ^the acids and amino acids
which form as the result of proteid diges-
tion, such as xanthin, hypoxanthin, leucin,
tyrocin, etc., must all be taken care of.



When the intestinal flora become too
abundant they have an autolytic action of
their own which seems to kill them, other-
wise the large intestine would be so filled
with bacteria that it would interfere or pre-
vent the passage of the waste material.

Nature guards against toxicity of the
blood stream by the intricate lymphatic
glandular and adrenal system. The thy-
roid, the suprerenals and the liver are given
credit for being the main factors in pre-
venting a toxic blood condition.

Now, how does intestinal putrefaction
generally occur? The main pathological
cause is bad food, food improperly cooked,
food that is contaminated, food that is
eaten in too great quantities, and food that
is unbalanced with reference to the carbo-
hydrates and proteid radical. The other
causes would be imperfect metabolism dur-
ing digestion from any change in the
stomach, pancreas or liver, and mechanical
defects.

The mechanical defects in the gastro-
intestinal tract that occur in all cases of in-
testinal stasis should always be ascertained
by radiograph. The splendid work accom-
plished in this direction by Dr. A. J. Quim-
by of the Polyclinic, New York, has placed
radiograph findings in such cases upon a
very firm and scientific basis; and to ob-
tain a ccMnplete diagnosis we must have a
thorough understanding of the many com-
plications found, which arise from adhe-
sions, ulcers and other lesions plainly
shown by radiograph.

Intestinal putrefaction always results
when intestinal stasis is present. All the
chronic constipations, all autointoxications
come from intestinal stasis. Intestinal
stasis is due to bands of adhesion forming,
preventing the active motility of intestinal
peristalsis. Ptosis of the intestine, which
is a dropping down due to a pendulous ab-



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71/1 AHBBZCAIY MBDICINB ) CkinfiTK AT ARTfPTira I NOYBMBES, 1913.

*^^ Complete Series, Vol. XIX. } OBIQINAL AHTICLES { j^^w Series, Vol. VIII, No. 11.

domen with inadequate muscular and liga- When cathartics are given to flush the

mentous support, also plays a part in stasis, intestine, we often note that headaches and

When we have a well-defined case of stasis malaise result — ^this is due to part of the

the food is delayed in its passage through waste material being evacuated, and the re-

the alimentary tract, and putrefaction al- mainder continuing in the colon, subject to

ways results before the food is eliminated, putrefaction.



Fig. 1.
KEY TO PLATES.

S. stomach. P. Point of tenderaess.

D. Dnodenom. — 1| Radlmted Pain.

P. Pylorus. Ad. Adhesions.

U. Umblllciuiu Dl. DUntntloa.

I. Ileom. L. K. Ii«ne Kink.

A. Appendix. L. Loop.

C. Ceenm. St. Stasis.
A. G. Ascending Colon. Pt. Ptosis.
H. F. Hepatic flexare. Ul. Ulcer.

S. F. Splenic flexure. N. Neoplasm.

D. C. Descending Colon. P. C. Peristaltic Contraction.
Sm» sigmoid. R. P. Reverse Peristalsis.

R. Reetnm. Dt. Deformity.



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NOYEHBES^ 1913. )

New Series, Vol. VIII. No. 11. J



ORIGINAL ARTICLES



{



AMBBICAM BiODICIira

Complete Series, VoL XIX.



715



The symptCMns of intestinal putrefaction
are many — one case may present scarcely
any, while others may give well-defined
symptoms of grave illness.

In this series of cases we generally found
the patient complaining of severe headache,
chronic constipation, pains in the legs (espe-
cially the calves), pains in the lumbar sacral



change materially, although the hemoglobin
is always below 8o. Blood pressure is not
diagnostic. Analysis of the stomach con-
tents will give either hyperacidity or an
almost total lack of free HCl, with very
low acidity. The stomach is generally
dilated, and this is always a factor in iir-
testinal stasis.



Fie. 2.



region, malaise, loss of ambition, more or
less inability to carry on the daily tasks and
occasional vomiting with nausea, some with
ravenous appetite, while others with loss of
appetite.

The general nutrition of these patients is
always interfered with. Some are obese,
and others have lost weight, but none have
normal metabolism. The blood does not



It is interesting to observe that in chil-
dren with intestinal putrefaction tonsilitis
and rheumatic pains are often noted ; while
in the Cornell Clinic for Children's Dis-
eases many such cases observed would clear
up entirely by giving proper food, without
medication.

The case histories herein reported are
typical :



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ORIOINAIi ARTICLES



( NOVBMBBB. 1913.

\ New Seriea, Vol. VIII. No. 11.



Case No. i. — Dr. M., age 31 years. Com-
plained for nine years of severe frontal
headaches, beginning on the supraorbital
fossa, with loss of vision, and would have
to discontinue* work for two or three days.
His urine showed marked excess of in-
dican. He was inclined to eat considerable
meat, and neglect the daily exercise. Was
somewhat constipated. Condition, well
nourished ; skin moist ; tongue coated ; heart



gained six and a half lbs. in weight, feels
in normal health. Prognosis good; urine
n^ative. Case discharged as completely
cured.

Case No, 2, — Miss I. D., age 30 years,
occupation, sedentary. Complained of
severe nervous headache and inability to
sleep. Markedly constipated; urine, specific
gravity 10.27, reaction markedly acid, al-



FiG. 3.



normal; liver easily palpable; stomach
slightly dilated. No radiograph was taken
in this case.

His meat was entirely stopped for two
months, otherwise on normal diet. He was
given four tubes of the culture of the bacil-
lus bulg^ricus, each tube representing 3 c. c,
for six weeks, and then one tube a day.
At the end of eight months he has only had
two headaches of serious moment, and has



bumin none, sugar none, phosphates in ex-
cess, indicanuria markedly in excess,
amount voided in twenty-four hours sixty-
three ounces; lungs, chronic bronchitis;
heart, systolic murmur; liver not palpable;
stomach, no dilatation observed ; weight 116
lbs., poorly nourished; skin dry. Used



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