T. R. (Thomas Robert) Malthus.

The American therapist online

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remedies, and this question the writer pur-
poses briefly to consider from the rational

In support of the above mentioned the-
ory there is but one physiological fact
which can be adduced, namely, that the
administration of bromides in medicinal
doses results in a more equable distribution
of the blood; but this in itself is not suffi-
cient to account for the beneficial action
of a remedy whose general effect upon the
vitality of the patient is so markedly de-
pressant. Patients taking bromides for
any considerable time, even in small or
moderate dosage, not only suffer from
derangements of digestion, but there is a
markedly debilitating effect produced upon
the general nervous system. It is, there-
fore, not a reasonable supposition that
disease may be caused to disappear through
the instrumentality of starvation. This
brings us to a consideration of the in-
fluence exercised by a hitherto overlooked
factor, namely, that of cellular activity,
which supplies us with a rational ex-
planation of the whole matter. In ad-
dition to the effect of the bromides upon
the vascular system, we know that these
remedies relieve pain, through their in-
fluence upon the nerve centres, the nerve
trunks and also the terminal filaments;
in other words, they allay the pain brought
about by the engorgement, which is Na-
ture's method of attempting to remedy
diseased conditions by sending an in-
creased blood supply to the parts affected.
Pain being relieved, the cells composing
the structures involved, automatically go
about their work, discharging effett pro-
ducts, taking from the now equalized cir-
culation the needed pabulum for the re-

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storation of function. Although the bro-
mides are equally efifective in other con-
ditions than that described, we have no
more conspicuous illustration of their
practical adaptation to the relief and cure of
disease. True, the bromides do not always
cure uterine affections, but they will most
surely allay pain, and thus contribute ma-
terially towards recovery from that con-
dition heretofore recognized as ''uterine

Nevertheless, after what has been said,
it must be regarded as exceedingly un-
fortunate that this class of cases is grad-
ually but surely slipping away from the
general practitioner, principally because
he has depended too much upon the teach-
ings of those who would make clinical
facts take precedence over scientific facts.
Dependence upon the bromides alone in
this class of cases has undoubtedly result-
ed in the necessity for the adoption of
surgical measures for relief, because, from
the foregomg, it will be more than patent
that the influence of bromides is com-
paratively limited. In the first place, the
bromides derange digestion, always an
important factor in recovery from any
disease. In the second place, they debili-
tate the patient, owing to the constant de- j
pressant action upon the nervous system. '
And in the third place, they increase rather
than diminish the natural despondency
which attends all manifestations of dis-
order affecting the genital functions.

To use the bromides successfully for the
relief of uterine disorders requires not only
a nicety in discrimination, but the physi-
cian must take a broad and comprehensive
view of the general pathological condi-
tions which are usually concomitants.
More especially must he take into account
the functional activity of the cells compos-
ing the diseased structures, and every pre-
caution should be adopted with a view to
augment rather than to diminish the nor-
mal functioning. Not only should a gen-
eral survey of the hygienic and dietetic
condition of the patient be taken
into account, but the physical condition

and general vitality must be observed, and
no effort should be spared to put the pa-
tient in the best condition possible to resist
disease and untoward influences. Another
and yet more important factor to be borne
in mind is, the truth that many of these
patients who seem to demand the admini-
stration of bromides really require a me-
thod of treatment having for its object the
elimination of effete products. They suffer
from defective assimilation and faulty
elimination, and the administration of
bromides but adds to the trouble, although
it may mask it for a time.

The time has now arrived, when the
value of alkaloids in the treatment of dis-
eased conditions must be recognized by
the general practitioner, hence a few
words on the physiological basis of alka-
loidal therapeutics will be appropriate and

Experimental physiologists teach us that
alkaloids produce, when administered to
animals, certain manifestations — physical
manifestations, because they are unable
to estimate the influences produced upon
the cerebral functions (mind or instinct) —
and their reports have been very generally
accepted as the ** physiological actions" of
the particular alkaloid under considera-
tion. It has not occurred either to the
physiologists or to their followers that
these so-called physiological actions are
more closely identified with pathology
than with physiology. Indeed, the path-
ological record, in many instances, forms
the basis of scientific medication. Thus
strychnine, caffeine, morphine, aconitine
and atropine are universally recognized as
deadly poisons, and yet the physician
would be seriously handicapped in his
daily work without them. Notwithstand-
ing their deadly properties, he employs
them in medicinal doses, not only without
danger, but with most happy effects even
to the point of administering them in true
physiological doses to counteract patho-
logical conditions identical with those

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produced by the remedy when adminis-
tered in lethal doses, or in short, the very
conditions termed physiological effects by
the experimental investigator.

The writer has frequently called atten-
tion to the fact that physiological medica-
tion, as usually practiced, is nothing more
than mechanical medication, but with the
modem followers of Burggrjeve, a dash
of sclent fie precision has been injected
into alkaloidal therapeutics. The plan
now adopted consists in giving the indi-
cated remedy in small doses at short in-
tervals until the desired effects are ob-
tained, which is far better than to create
at once a pathological condition by the
administration of a single large dose.

But is this all there is to be said from a
modem standpoint on the subject of alka-
loidal therapeutics ? To this we must re.
ply, that the question has just been opened,
Alkaloidal medication is a subject too
vast to be disposed of in a single short
article, but there is one significant point
not hitherto considered in the exhibition
of these "arms of precision."

For example, it has been demonstrated
that normal blood contains more or less
of a ferment, a substance whose proper*
erties have not yet been fully demon"
strated, although it is assumed that its
presence aids in maintaining that fluid in
a healthy condition. When these alka-
loids and salts of alkaloids are dissolved
and taken into the blood, the various
chemicals of which they are composed, —
C. H. O. N., must exercise an important
effect upon this ferment substance. Al"
though the chemicals themselves are no*
foreign to the organism, they evidently
produce sufficient change in normal con-
ditions to warrant further investigation.
It is but reasonable to assume that Nature
rebels against their artificial introduction,
hence the increased oxidation, which is
but another name for cellular activity, and
we look forward to the time when alka-
loidal therapy shall be accepted as the
hand-mafden and exponent of cellular

A distinction must always be made be-
tween fatty heart and fatty degeneration
of the heart, although it must be evident
to those familiar with the physical changes
occurring in cardiac disorders that the
former gradually, but certainly, lapses into
the latter. Fatty heart is nothing more
than an abnormal accumulation of fat in
the cardiac structures, crowding the mus-
cular fibres until they become so enfeebled
that they cease to functionate properly.
The physical signs are apparent to the
practiced ear, and taking into consid-
eration the general appearance of the sub-
ject, fatty heart may be readily determined
by an examination of the pulse. Usually,
the pulse is small, compressible and oc-
casionally intermits; for the most part, it
is fairly regular as to rhythm, now and
then running fast or slow with the least
excitement Placing the ear over the
cardiac area, we observe a feeble first, and
accentuated second sound, and generally,
this tendency to alteration in rhythm. The
patient has fatty heart, but unlike cases of
fatty degeneration of the heart, the sub-
ject may be wholly unconscious of the
defect. As a general rule, he will admit
only that he is a trifle "short winded" on
exertion, but there is an absence of pain
and no perceptible derangement of the
circulation. On the other hand, fatty de-
generation is always indicated by pain,
which occurs in paroxysms, amounting at
times to syncope, and an examination of
the superficial arteries shows that they fol-
low a tortuous course, thus interfering
with the blood supply to the tissues; for
the conditions found superficially are
identical with those which obtain in the
more deeply situated arteries. Fatty de-
feneration is, therefore, marked by well
known constitutional symptoms, although,
frequently the most careful examination
will fail to discover any marked physical
signs of physical degeneration, except
that the heart-beat resembles the sound
produced by a mechanical instrument, as
for example, the tick of a watch. In ad-

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dition to this, however, the cardiac action
is sh'ghtly labored, with a feeble first, and
accentuated second sound, resembling in
this respect the conditions noted in fatty
heart On making a comparison of the
subjects afifected by these two maladies,
however, there is marked contrast. Those
suffering from fatty degeneration are thin
and "flabby," while those suffering from
an accumulation of fat in the organ are
generally robust and stout, although, as
previously intimated, this condition too
often lapses into fatty degeneration, the
patients becoming debilitated from digest-
ive disorders, when the flesh becomes soft
and flabby. On post mortem examination
the distinguishing feature of fatty degen-
eration is discovered in the cardiac muscle,
which contains small oil globules at the
intersections of the striated portions in-
stead of healthy tissue. Other symptoms
might be described, but the above will be
sufficient for present purposes.

The most effective remedy for fatty
heart is prophylaxis, and this may be se-
cured by proper attention to diet and hy-
gienic measures; but as the physician
seldom sees a patient in the early stages,
or overlooks the predisposition to degen-
erative changes in patients who only con-
sult him at irregular intervals, it is of im-
portance to determine an efficient remedy
when the symptoms are first brought to
his attention for correction. A number of
remedies have been brought to the notice
of the profession for the purpose of cor-
recting this malady, but even now the
deaths from cardiac failure are far too fre-
quent and numerous to warrant us in de-
ciding that treatment has attained perfec-
tion. Unfortunately, digitalis has not
been displaced from the armamentarium
of the general practitioner, a remedy
which is generally contra- indicated, owing
to its action upon the arterial system. By
the administration of digitalis, extra work
is thrown upon the cardiac muscle, already
in an enfeebled condition, and while the
patient may show evident signs of im-
provement during the early treatment,

there comes a time when, through par-
alyzation of the cardiac ganglia, digi-
talis and its derivatives do irreparable
harm. Cactus grandiflora and its gluco-
side, cactin, have been highly recom-
mended; arsenic is extolled by some; but
so far, no remedy has proven so useful as
strychnine or some of its numerous salts.
Still, the salts of strychnine do not fully
meet the difficulty, for the reason that
even in medicinal doses many patients
are unable to bear them for any consider-
able length of time, when they must be
temporarily discontinued. A combination
of strychnine and arsenic is an ideal
remedy, and is found in strychnine arsen ite,
the dose of which may be proportioned to
suit the demands of the patients. This
combination has the added advantage of
being indicated from a physiological
standpoint,, although originally strongly
advocated by Dr. Burggrjevk, the origin-
ator of Dosimetry, on purely empirical
grounds. The dose ranges from one one-
hundredth to one-thirtieth of a grain
every four hours. Clinical reports are
solicited on this comparatively new


Masturbation a Cause of Goitrk. — The
editor has received a communication from
Dr. R. E. Buchanan, of Independence,
Iowa, requesting an opinion as to what
influence, if any, masturbation has upon
the development of exophthalmic goitre,
or ordinary goitre. He says :

*'My case which was reported in The
American Therapist for June, 1895, which
I think was the first treated, still remains
well so far as the goitre is concerned, but
during the early autumn she began to
show signs of mental derangement. She
then confessed having been a masturbator
since childhood, but said she had not
practiced while under treatment with
nuclein solution, although she had com-
menced again a short time before 1 was
consulted for the mental trouble. I then
put the patient on anemonin, which bene-
fited her to that extent that she was
almost herself again.

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**It was with much gratification that I
read Dr. John E. Bacon's report of a case
of exophtalmic goitre treated (cured'i with
nuclein solution (Amerian Therapist, De-
cember, 1895). With these two cases in
mind, and what I have learned from other
sources, I am of opinion that if mastur-
bation or some other irritation or derange-
ment of the genital organs is not the
cause, it is at least an etiological factor in
both exophthalmic and common goitre."

The above suggestion is thrown out to
the profession with the hope that others
having experience in this direction may-
be sufficiently interested in the matter to
report their beliefs, estimated from clinical
observation and experience.

The Journal of Experimental Medi-
cine, — Messrs. D. Appleton & Co., an-
nounce the early appearance of a periodi-
cal with the above name, to be devoted to
original investigations in physiology, bac-
teriology, pharmacology, physiological
chemistry, hygiene and practical medi-
cine. Dr. William H. Welch, of Johns
Hopkins University, will act as editor and
will have the assistance of a number of
prominent investigators in the different
departments. For the present, the journal
will appear quarterly, or often er, should
the material furnished be sufficent to war-
rant more frequent publication.

The College and Clinical Record. — ^The
announcement is made that the above
journal will hereafter be known as
"Dungiison*s College and Clinical Record:
A monthly journal of practical medicine. "
This journal has long been a favorite with
the graduates of the Jefferson Medical
College, and its talented editor has en-
deavored to make its contents of practical
interest and beneticial to its readers. The
editor of The American Therapist feels
under obligations for the republication in
its columns of a number of his literary
productions during the past few years,
and trusts that, under the new name,
its progress will continue, adding to the
editor not only reputation but shekels.

Cleveland Journal of Medicine. — This
is' the name of the successor to the
Western Reserve Medical Journal, the first
copy of which has been duly received.
It is offered as the official organ of the
Cleveland Medical Society, is edited by Dr.
Henry S. Upson and Dr. P. Maxwell
Foshay, and no doubt it will prove an ac-
ceptable addition to current medical liter-

Pediatrics. — Pediatrics is a new journal
devoted exclusively, as its name implies,
to the consideration of diseases of children.
It is owned by Dr. Dillon Brown, of New
York, and edited by Dr. George Carpenter,
of London, published by the Van Publish-
ing Co., 1432 Broadway, New York. The
first number of this journal contains sev-
eral exceedingly interesting and instruc-
tive papers, together with a condensed
abstract of society reports, practical notes,
an editorial by Dr. Manges on gastro-
intestinal diseases in children, and miscel-
laneous items of general interest.

The Medical News. — This well-known
publication has been removed to New
York City and the editorial management
will be in charge of Dr. J. Riddle Goffe.
This change has been determined upon
by the publishers solely for business rea-
sons, and while the writer regrets the loss
of the journal to the medical fraternity of
Philadelphia, he extends to it and to the
new editor his warmest congratulations
and best wishes. For the past fourteen
years the writer has been a regular sub-
scriber to the Medical News and has been
interested in the peculiar changes that have
occurred in its editorial management dur-
ing that time; notwithstanding the pe-
culiar tenets held by the different ed-
itors, the News has undoubtedly made
many firm friends among the profession.
Still, we regret to see the journal carted
off to New York, because it is less likely to
maintain its firm hold upon the local pro-
fession m Philadelphia and vicinity. The
first issue under the management of the
new editor has just reached our table and
presents a creditable appearance.

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£urreni Cttcrature^

A New Nasal Tablet. — Dr. Murray Mc-
Farlane of Toronto having become dis-
satisfied with the Seller's and Dobell's
solutions as being too irritating in the
majority of cases, has used with success
a tablet containing the soluble salts of the
blood plasma, which when added to two
ounces of lukewarm water, forms a solu-
tion like blood plasma. Each tablet con-
tains Vie o^ ^ grain of menthol — MaryL
Med. Journal

Thiol Succeeds Where Others Fail. —
Heller (Dtrmatologische Zeitschrifi, Band
II, Heft 5) reports his experience with
thiol in the treatment of various diseases
of the skin. Employed in seventy cases of
eczema of various forms and degrees of
severity, good results were, in general,
obtained. The best results were noticed in
those cases in which other treatment had
already been used. In seborrheic eczema
a lo-per-cent. ointment proved service-
able. The drug was employed only in the
liquid form, either in watery solution, one
to three or five of water; or, where fats
seemed to be indicated, in a 5- to 20-per-
cent, ointment In a case of herpes zoster
in a boy, applications of thiol gave great
relief to the pain, but employed in a second
case it was without result. In burns it
proved to be in no respect superior to the
usual remedies. In two cases of acne ne-
crotica its use was followed by satisfactory
results. The keratoplastic properties of
thiol make it a useful remedy in the treat-
ment of chronic ulcers of the leg, and in
two cases in which it was used it seemed
to be better borne than any other remedy.
As a remedy against itching it proved to be
of great service, being especially useful in
pruritus ani and in pruritus vulvae. In
parasitic diseases it was also effective.
In the author's opinion there are many
other remedies which, in most cases, are
quite as effective as thiol, but in a few
cases this remedy will be found to succeed
where others fail. — Unvv, Med, Magazine,

The Therapeutic Action of Iron. — ^E.
Reinert ( Wiener medicin, Bldiier, April 25th)
criticises the theories advanced at the
recent Kongress fUr innere Medicin, held
at Munich, by Bunge, who made experi-
ments by giving inorganic preparations of
iron to animals, and found that it reap-
peared in ioto in the feces. If organic pre-
parations were used they were absorbed,
but he doubted if they were assimilated.
He therefore came to the startling con-
clusion ihat the results of treatment by
iron must be referred to the domain of
suggestion, and would substitute a diet
rich in iron, particularly meat, eggs,
spinach, etc., for the usual method of
administration. Reinert advances the fol-
lowing facts against these conclusions:

(i) A priori we should expect a dif-
ference in relation to the absorption and
assimilation of iron between a healthy and
a chlorotic subject, where much of the
normal iron is lost with the hemoglobin,
and Reinert is not acquainted with an
idiopathic chlorosis in the animals ex-
perimented on analogous to that occuring
in man.

(2) Bunge's experiments were all made
on animals, and he neglects those made
by others on the human subject In the
Tubingen Clinic experiments were made
with chlorotic girls, who were placed for
weeks under the best hygienic surround-
ings, with excellent food and plenty of rest
in bed, but only had a quinine mixture for
medicine. The percentage of hemoglobin
in the blood rose very little in several
weeks. When, however, an organic iron
(Blaud's pills) was given, the percentage
rose rapidly. Similar experiments with
like results have been made by Von

(3) The part played by other therapeutic
factors in the treatment of chlorosis is
doubtful, but out-patients usually quickly
recover when iron is given (unless the
hemoglobin has fallen below 40 per cent
of the normal) while pursuing their usual
callings, and without special change of

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(4) The diagnosis of chlorosis must al-
ways rest on an examination of the blood.
Omission to do this accounts for some
apparent failures in cases treated by iron.

(5) Lastly, all so-called specifics, for
example, mercury or quinine, fail in iso-
lated cases. — University Medical Magazine.

To the foregoing may be appropriately
added the following instructive observa-
tion. On page 340 of Prof. Schmiedeberg's
(Strassburg) * ' Arzneimittellehre " (latest
edition, 1895) this eminent pharmacologist,
in proving absorption and assimilation of
organic iron products, states.

"The fact and effect of a craving for
iron (Eisenhunger) can be experimentally
proved on animals. — A strong, frisky dog,
after a moderate loss of blood, was fed for
five months on pure milk only, and grad-
ually became so weak that he refused
further nourishment, became reduced in
body weight, tottered when on his legs,
and finally was at the point of death. At
this stage i gramme of ferratin was added
to the milk per day; the dog ate this with
ravenous appetite, and within 14 days had
regained his weight and general condition
to nearly equal the normal strength and
activity possessed before commencement
of the experiment."

Reinert's experiments proved thatBlaud s
pills rapidly increased the hemoglobin; he
did not try, or at least does not report on,
ferratin. Banholzer, of Eichhorst's clinic
in Basel (see Sajous' Annual, vol. V, 1895)
says: "When compared with Blaud's pills,
which also gave good results, ferratin was
found to lead to a greater increase in hemo-
globin." Such is also the testimony of
Jaquet, Germain S6e, Marfori, De Filippi,
Vay, and other authorities.

Nitroglycerin. — Some eighteen or twen-
ty years ago, says Dr. S. Solis-Cohen edi-
torially in the Philadelphia Polyclinic (Jan.
18, 1896), when Professor Roberts Bartho-
low was preaching the use of nitroglycerin
in various conditions of disturbed circu-
lation, especially those in which it was
desired to relieve the heart of opposing

pressure in the terminals of the arterial
channel, or to overcome pathologic con-
traction of those terminals for the purpose
of securing better nutrition of the territory
supplied by them, there were few practis-
ing physicians that gave assent to those
teachings. To-day, m the United States
at least, the practice has become wide-
spread, owing largely to the persistency

Online LibraryT. R. (Thomas Robert) MalthusThe American therapist → online text (page 94 of 115)