Universidad de Buenos Aires. Facultad de Derecho y.

The American practitioner online

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locomotor ataxia; and, as I mentioned before, osteopathy plays the
mischief with .the poor little suffering children with spinal and hip
diseases by their brutality in attempting to reduce the imaginary dis-
locations of the spine and other joints.

Why do the people allow such treatment ? Where is their common
sense ? What is the fundamental cause of this condition of things ?
It has been recently stated that more than half the people in the world
are worshiping fetiches. May it be because so recently the other half
were in the same box and are still influenced by the old atavistic super-
stitions and jump at things mysterious and miraculous ? What tends
to foster these ideas? Is it the fault of the scientist who fails to teach
understandingly, or is it the Church, which teaches them that mirac-
ulous things have happened in the world and may be expected to happen
again ?

Dr. Thos. H. Manly, of New York, in a recent paper on this subject,
says :

There is no subject, perhaps, to which one may turn that presents so
many intricate and singular features as that of the illegal or irregular
practice of the healing art. It has been said that " the practice of medicine
is as old as history itself, but the science of medicine is scarcely fifty years
old." It may be added that the charlatan is older than either, and that,
although the sciences have unfolded many of the mysteries of vital phe-
nomena, and widespread educational advance over the entire civilized world
has enlightened the masses, still it can not be denied that with all the
revolutionizing influences following in the wake of these changes the
demand for the empiric or the mountebank has not in the least diminished ;
nay, if we read aright the signs of the times, the eager avidity and ceaseless
craving of communities for novelties, for new systems and creeds, for
mysterious remedies and nostrums totally devoid of any warrant of scien-
tific value, we must be convinced that education has rather given quackery



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The American Practitioner and News. 47

deeper root and wider growth. Nor can it be said that the spread of the
religious spirit, and the greater adherence to dogmatic creeds, have in any
special manner lessened its growth or augmented the faith of the people
in scientific medicine.

During the last quarter of the nineteenth century, a period of Amer-
ica's greatest intellectual, scientific, and industrial activity, sectarian medi-
cine has made extraordinary progress ; its most notable conquests being
among the cultivated and aristocratic members of society.

The American Medico-Surgical Bulletin has something to say on
this point in an editorial :

Any unbiased analysis of the success of quackery in all its protean
forms will reveal the fact that ignorance, fear, and self-interest are the forces
that keep it alive. Only so far as the growth of civilization is a growth in
intelligence among the masses does it in any degree check the career of the
charlatan.

Why can not something be done toward getting rid of quacks ? The
one answer to this is, that too many people are financially interested in the
maintenance of quackery. When vested interests are opposed, honor,
honesty, truth, and progress must step aside. Quacks are liberal advertisers,
and always have been so. Newspapers and magazines lead the public mind.
As long as this condition lasts, the masses are not likely to learn the truth
very soon. But for the influence of the newspapers it would be an easy
matter to force education upon all who attempt to treat the sick. Once edu-
cated, and they would themselves lose faith in their present methods and
use better ones. Once get rid of the present baneful influence of the press,
and it will work a revolution of more importance to the life and health of
the race than any thing that has happened for centuries. There is but one
way to bring about such a change. Medical men must take into their
hands the education of editors. If the average newspaper-editors, and par-
ticularly those who edit religious papers, could be shown how positively
immoral their present course is, a start would at once be made toward bet-
ter things. Until they are taught, there can be no hope for the masses.

When so able a writer and thinker as the editor of the Washington,
D. C, Times can make no better a defense of the quack than he did in his
issue of October 26th, under the heading of " The Practice of Medicine," it
is evident that the task would not be so great as it at first might appear.
He seems to think that the credulity of the masses in medical matters is
itself a proof of the ineflSciency of the medical profession. He tells us :

** It is surely unbecoming in medical journals to ridicule the credulity
of the masses of mankind in the light of the many fallacies that have ruled
the profession and in the light of its present uncertainties in therapeutics.
What the profession has learned of value is that most of its dogmas were
fraudulent. Any man who should attempt to cure disease in this day by
the methods of the regular profession of only a century ago would be con-



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48 The American Practitioner and News.

demned as a quack more mischievous than all the army of * healers ' who
have found some use for a discovery of which they exaggerate the impor-
tance as much as the profession undervalues it. In spite of its greater
knowledge of physiology and psychology, the medical profession neglects
the virtues of moral treatment, and thus opens the way to persons who
magnify them. It makes large claims to exclusive authority in healing,
because of studies that have as little apparent influence in the treatment
of disease as the knowledge of microbes."

The Memphis Lancet for November^ 1898, while bewailing the pres-
ent depraved level of the American press and endorsing the recent
movement, the outgrowth of which has been the organization of ** The
American Society for Press-reform, and the Direction in which Press-
reform is Needed," says :

We are sure all will agree that the aim of such an organization is
highly commendable, although we are compelled to admit that the accom-
plishment of that aim will probably never be attained while the daily papers
pride themselves on publishing ** all the news," and will probably bring their
combined influence to bear against the passage of any law to curtail their
liberty in this jespect. But there are other practices to which they are
addicted, and which, to our mind, are a greater evil than the publication of
the details of crimes, criticism of officials, and the betrayal of State secrets.
The greatest of these is the unbridled freedom with which they print
advertisements of means for the prevention of conception, advertisements
of abortionists and remedies intended to induce abortions, and remedies for
the cure of venereal diseases, " lost manhood," etc., expressed in such unmis-
takable terms that " he who runs may read." Could any thing be more vil-
lainous ? We wonder if the owners and managers of these papers are con-
scious of their enormity. We wonder if our legislators ever take their
minds from a contemplation of their chances for re-election long enough
to realize that such practices are an offense against decency ; that the ful-
fillment of the promises made in these offers are crimes against the State,
and the papers which give publicity to these people and these agents are
** accessories before the act."

But such things are, and have been, and will be, till the moral sense
of the community rises to a plane which it now does not know. The finan-
cial return to the paper which publishes these advertisements is probably
not five dollars an edition, and yet for this " Judas coin " the owners and
managers prostitute their souls, insult their patrons, and fling defiance in
the face of the State.

We doubt if the publication of these facts will deter a single paper
from accepting such advertisements, or influence a single person to with-
draw his patronage from such as do. So long as the law does not forbid it,
so long as '* lovely woman stoops to folly," and is willing to pay to be



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The American Practitioner and News. 49

shielded from. its consequences, so long as these people are prosperous
enough to pay for space in the paper, just so long will these outrageous
advertisements continue to appear.

I might enter into the discussion of the religious institutions, the
shrines, Lourdes knocks, the sepulchre of the Saviour, etc., all giving
evidence of the wonderful power of the superstitions handed down
from the ages gone by, which are fostered by the same craving on the
part of the people for the miraculous. As Zola puts it in his book,
" Lourdes, the grotto, the cures, the miracles are, indeed, the creation
of that need of the lie, that necessity for credulity, which is a charac-
teristic of human nature.'*

What is the remedy to be applied for the correction of these evils?
Bacon says, "Truth is the daughter of Time,*' but it seems to me that
here we are at the end of the nineteenth century since Christ, and the
lie is still with us. I will close with a quotation from an address by
an Indiana physician. Dr. Jameson, on the science of medicine and its
relation to the people :

To legislate against the dangers to which the victims of the pathy and
cure delusions are subject, to protect such against themselves, to suppress
these so-called schools by law, would be right and wholesome. But we are
reminded that what is right and wholesome is not always expedient or
practicable. We are warned constantly that the remedy may be worse
than the disease. Legislation would not and could not remove the condi-
tions that make possible the various forms of medical charlatanism. Legis-
lation against insanity can not cure insanity. It can, if it be wise, control
its victims, relieve society from the menace which they are to it, and in a
large way, and sometimes in apparently remote directions, tend to alleviate
the conditions that produce the results deplored. Development is rarely
round and even. Many can see life steadily, but " to see life steadily and to
see it whole'* is the good fortune of but few.

Civil pride and duty are so much developed as to make it almost im-
possible to accomplish much in the direction of saving people by law
against the fanaticism that trifles with the public health and destroys
individual life. The spirit of liberty so much needed to rescue mankind
from obvious forms of slavery and subjection, like all things in our ken, has
the defect of its qualities, and we must accept with equanimity the idea
that liberty of thought and action shall reach a condition that is really little
short of anarchy. If a spurious coin were uttered in Massachusetts, the
whole force of the commonwealth embodied in its laws would be invoked
to suppress it and to punish the offender, because the utterance vitiates
property and robs people of their material wealth. But a spurious sect
may utter doctrines ruinous to health and to life itself, demoralizing where



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50 The American Practitioner and News,

it is not destructive, sapping the sanity of people where it does not destroy
their lives, and no measure of restraint or edict of abolition must be
adopted !

In this condition it behooves us, and all who seek to know the truth
and to regulate their lives by it in order that they may attain the fullest
possibility of life, to inculcate a more rational method of living. The cau-
tion can never be too strenuously made nor too often repeated that in
times of expansion, enormous expansion, such as the present is, it is not
only wise but necessary that the mental and nervous organization should
be brought to terms with it. We should seek by every means better to-
educate the public concerning the powers and limitations of the human
organism, and the possibilities, not assumptions, of medicine; in other
words, apprize them of the attainments of rational medicine. They should
know that the only succor in disease must be the result of scientific attain-
ment based on a knowledge of and obedience to the stable laws of nature*
We are nearly out of the belief in or hope of relief by special providence.

It is our duty — the duty of all who seek the truth — to maintain stead-
fastly that, were the special providences so ardently sought and so fervently
importuned realized, the orderly processes of nature would be deranged, and
chaos would come. So now realization of dogma and pathy and school
would mean simply that science must come to an end ; that deduction must
fail in its result ; that truth must not be truth ; that a thing that is neces-
sarily one and the same, true under all circumstances, must no longer be
so, but must give way to the erratic attainments of a pathy or cure that
must be different in every part of the world, varying with every practi-
tioner, the special creation of agent or patient, differing constantly as these
differ.

It is the duty and privilege of the medical profession, and equally the
duty and privilege of all who hope for the advancement of mankind, with
unalterable firmness and with limitless patience to enforce again and always
the simple faith that there is no short cut or royal road to any thing, but
only a steady, sure step holding fast the ground won, toward the truth in all
things, as the patient endeavor of man may win truth by the reverent study
of nature.

LOUISVII^LE.

NORMAL SALT SOLUTIONS IN SURGERY.*

BY JAMES B. BULLITT, M. D.

The use of the normal salt solution in surgery was the direct and
natural result of the efforts at transfusion of the blood itself. This pro-
cedure is very ancient, was never any thing more than a curious exper-
iment, however beautiful theoretically, and has quite deservedly been
abandoned now entirely. The transfusion of blood from one animal to

<* Read before the Kentucky State Medical Society at Louisville, May, 1899.



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The American Practitioner and News. 5 \

another of the same species, or to an animal of a diflFerent species^
depended on the assumption that the receiving organism was able to
appropriate and utilize the blood received as such, i, e.j that the blood-
cells so transfused would continue to live and exercise their functions
just as they did in the circulation of the host from whom they were
obtained. It has been shown that such assumption was fallacious ; in.
animals of like species, even, the blood-cells are not so received, but
perish and break down, and so throw on the organism an additional
eliminative strain. For animals of a diflFerent species it has been
shown that the blood serum is often toxic, producing sometimes, if in
sufficient amounts, even fatal eflFects. Furthermore, transfusion was
always a difficult operation because of both the technical difficulties as
well as that of securing proper and willing individuals from whom to
obtain the blood. I

These facts, added to the danger of the procedure from sepsis and;
embolism, have, as has been stated, practically completely relegated
blood transfusion to the interesting medical history of the past, and have
substituted therefor the use of the normal salt solution. '

Infusion of milk and other albuminous fluids is an old procedure, biit
at this time the term infusion has come to signify the injection into the
circulation of a normal (0.6 per cent) saline solution of a sufficiently
high temperature.

According to Schachner, this particular procedure was first metlpd-
ically called attention to by E. Schwartz in 1881, but there were isolated
instances of such use before this time. However, it has only been since
about 1889 that very general familiarity with the normal salt solution
has been apparent ; and even to-day it is believed many lives might be
saved if surgeons and practitioners were universally cognizant of the
importance of the procedure as a life-saving measure and were more
familiar with the simplicity of its technical employment.

In surgical practice the normal salt solution is useful in several
ways : First, in case of extreme hemorrhage, to replenish the circu-
lating medium and by refilling the blood-vessels permitting the mechan-
ical acts of the circulation to proceed ; second, in case of extreme shocks
to stimulate the heart and arteries so that the blood which has accumu-
lated and stagnated, especially in the large abdominal vessels, may
again be put in active circulation ; third, in cases of faulty and insuffi-
cient excretion on the part of the kidneys, to stimulate excretion, both
by the kidneys and by the skin; fourth, in cases of sepsis, and perhaps



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52 The American Practitioner and News.

in cases of drug toxemia, to favor by dilution and increased elimination
the throwing oflF of the toxic materials.

It may be here remarked that this last usage is not so clearly defined
nor well established as the first three ; but many claims, supported by
some cases, have been made of its great use in such conditions as
diabetic coma, pneumonia, purpura hemorrhagica, ulcerative endocar-
ditis, pyelitis, carbon-monoxide poisoning, mushroom poisoning, exten-
sive bums, toxemia due to colon bacillus, painters' colic, carbolic acid
poisoning.* In such conditions it is usually recommended to withdraw
by venesection a certain portion of the blood, replacing it then by the
normal salt solution. Such possibilities of its use are of the greatest
interest, but beyond their mere mention they can not concern us further
here.

While the physiological action of normal salt solution has not been
elaborately studied, Bov^e states that it seems to be determined that
while it increases the volume of the blood and lessens its specific gravity,
it at the same time stimulates the cardiac ganglia and arteries, and
accelerates the circulation of the blood. The increased arterial tension
furnishes more nutrient blood to the heart through the coronary arteries,
and in like manner it stimulates the nerve centers. In the same way
all the organs are made to do more work, and especially is it true that
elimination through the kidneys and skin is markedly increased.
Locally its action on the blood-vessels themselves is to stimulate con-
traction of the unstriped muscle fibers, and in this way it exercises a
hemostatic action.

Reilly, quoting Delbert, states that it tends to produce hemostasis
by stimulating clotting ; but other writers hold the view already men-
tioned, that the hemostatic action depends entirely on the stimulation
to contraction of the smaller arteries.

Dawbarn has insisted that the maximum of stimulation to both
heart and blood-vessels is attained by injecting the salt solution at a
temperature as hot as the hand can bear (iio° to 120° F.), and cites the
undoubted eflFect of hot intra-uterine douches in post-partal hemorrhage
in support of his position. It has been shown that globulin only coag-
ulates at 158° F. and serum albumen at 162° F. Experimentally, it has
been shown that saline solutions of much higher temperatures, as high
as 165° F. even, are well borne by the dog.

The salt solution can be introduced in several ways, thus: By injec-
tion into a vein, intra-venously ; by injection into an artery, intra-

• Thomas F. Reilly, M. D., in New York Medical Record, November la, 1898.



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The American Practitioner and News. 53

arterially; by injection beneath the skin into the connective tissue
spaces, hypodermoclysis; by injection into the rectum and colon; by
leaving the fluid in the abdominal cavity after laparotomy. Each of
these methods has its advantages and special indications, which will
be considered presently.

Hemorrhage has always given the surgeon the greatest concern.
Before the days of absorbable ligatures and the temporary elastic tour-
niquet it was the Mte nair of surgery ; and next to the advances which
have resulted from the application of the knowledge of bacteriology to
the uses of surgery, nothing has been more striking than the improve-
ment in the technical ability to prevent hemorrhage, in the first place,
and to deal with it successfully when it does occur, in the second place.

Death from hemorrhage may occur as a result of an absolute loss of
blood, in which event not enough blood remains to support the vital
functions, even if this amount could be kept in active circulation ; or
death may occur as a result of a relative loss of blood, the fatal issue in
such case depending on the disturbance of the mechanism of circula-
tion. Thus, if an insufficient amount of fluid is in the vessels, it becomes
impossible for the heart and elastic arteries to transmit the force of the
heart's contractions to the distant portions of the body, and as a conse-
quence the blood which is left in the vessels fails to complete the cir-
cuit; nutrition and stimulation of the heart and all the centers fail,
and death ensues.

Hunter states that in lower animals, even after the loss of one half
or two thirds of the total amount of blood, death does not ensue if the
circulation is maintained by supplying an indifierent fluid in place of
the lost blood. He calls attention to the fact that in some cases of
pernicious anemia the number of red blood-cells may be reduced to ten
per cent of their original number, or even less, and yet the disturbance
of respiration may be little marked. Such losses, however, are sustained
gradually, and are therefore better borne than if they occurred rapidly
as in sudden hemorrhage.

If more actual blood could be supplied rapidly in the first instance
of the absolute loss of blood, it can readily be conceived that life could
be saved and prolonged even after extremest losses. But as it has
been shown that the blood-cells as such are not accepted by the
receiving organism, we must conclude that whenever the absolute loss
of blood is so great as to render the remaining blood insufficient for
nutrition and stimulation, even if kept in circulation, then death must



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54 The American Practitioner and News.

^nsue. When the loss is not so great the mechanism of the circulation
can be restored by injecting into the circulation an indiflferent fluid
approaching or exceeding in quantity the blood lost. After such injec-
tion the rapidity with which the red blood-cells are resupplied by
the organism is very surprising. A normal salt solution has been
found most useful for the purpose, in that it supplies the fluid needed
without doing any damage to the remaining blood. Plain water when
injected directly into the vessels, on the other hand, extracts the hemo-
globin from the red cells, and so acts as a poison.

Dawbarn reports a case where a mistake was made in experimenting
on a dog, the animal dying in a minute after receiving a considerable
amount of plain water so injected.

When the volume of blood in the vessels has been diminished by
liemorrhage, a ready absorption of saline fluid takes place through all the
routes mentioned. Where only moderate blood-loss has been sustained,
it suffices for usual purposes to leave several quarts of the fluid in the
abdomen in the case of laparotomy, or to inject a similar amount into
the bowel with a long rectal tube. When the hemorrhage is more
severe it is more quickly efficient to inject as much as a pint or a pint
and a half into the connective tissue with the hypodermic needle and
permit it to get into the circulation more quickly by lymphatic absorp-
tion. When the hemorrhage is sudden and copious, and there is
impending danger of failure of the circulation, the injection should be
made into a vein, or, as Dawbarn first suggested in 1892, directly into an
artery, preferably the femoral. This last mentioned procedure seems *
at first glance a heroic one, but the operation has been performed a
number of times without accident and with marked success.

Circumstances might arise which would render its use important or
imperative, and therefore the simplicity of its technique should be
understood. For general use after hemorrhages which are not too
^severe the subcutaneous method (hypodermoclysis) is undoubtedly the
simplest and most useful. By its use there is little danger of overload-
ing the circulation and further handicapping an already embarrassed
heart. This danger exists in the incautious forcing into the circulation
large quantities of saline in a short space of time by the intravenous or
intra-arterial routes. The technique of these procedures will be taken



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 61 of 109)