Universidad de Buenos Aires. Facultad de Derecho y.

The American practitioner online

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rior to a bellows. The brain is not an electric power-house, and the
human being can not be disconnected and disintegrated by a mechan-
ical device or a ** trick of the loop " and distributed to the chief artisans
of various workshops. No; there is a beautiful interdependent and
harmonious action existing between all parts of the human system.



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164 The American Practitioner and News.

The specialist who devotes his attention to the eye can never be a good
physician unless he fully understands that the affection of eye which
he treats may be due to a constitutional disease, and be treated accord-
ingly. The appendicitist must not be an exclusivist, an incisor of the
bowel, or the worshiper of a detached idea. The family physician is
the safest to employ, and should be first consulted in all cases of disease
before seeking any specialist. Should he detect a diseased condition
that may require more dexterity of manipulation or the skill of a crafts-
man, he will gladly seek counsel, and the knowledge derived from his
experience in treating the family, the inherited weakness of individuals,
or the special knowledge of the case will be necessary to the successful
labor of the specialist.

We find in the thirty-eighth chapter of Ecclesiastes the profession
of medicine approved by God, and the fourteenth and fifteenth chap-
ters of Leviticus treat of hygiene ; so the scientific view of specialism
is given in St. Paul's letter to the Corinthians, Chapter twelve, verse
twenty :

** For as a body is one, and hath many members ; and all the mem-
bers of the body, whereas there are many yet there is one body ; for the
body also is not one member, but many. If the foot should say ' because
I am not the hand, I am not the body ' ; is it therefore not of the body ?
And if the ear should say, * because I am not the eye, I am not of the
body ; Ms it therefore not of the body? If the whole body were the
eye, where would be the hearing ? If the whole were hearing, where
would be the smelling? And if they were all one member, where
would be the body? And the eye can not say to the hand: *I need
not thy help.' Nor again the head to the feet, * I have no need of thee.'
And if one member suffer any thing, all the members suffer with it."

Man is the dupable animal. Quacks in medicine, quacks in reli-
gion, and quacks in politics know this, and act on this knowledge.
There is scarcely any one who, like a trout, can not be taken by lures.
There are quacks of all kinds, from the most ignorant to the highest
type of intellectuality. The habit doctor, who ** cures " the whisky
habit, the tobacco habit, the morphine habit, the cocaine habit, is pos-
sibly the latest addition to the ranks of quackery. How any person of
reason can comprehend why a physician should give medicine for the
** cure " of a habit surpasses all belief. Suppose that I am a victim of
the whisky habit or morphine habit, and present myself to one of those
quacks for ** cure." I tell him I am in good health, and he, thinking



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The American Practttzoner and News. 165

himself able to make an examination of my physical condition, finds that
my heart, liver, lungs, brain, kidneys, nervous system, etc.,^are healthy.
Why, then, should he give me any medicine ? He might as well give
medicine to prevent the habit of swearing, as to give a healthy person
medicine for the cure of any habit. Of course, when there is an abnor-
mal condition of any organ, or of the nervous system, it becomes nec-
essary to use remedies for relief. This quack boasts of having a secret
remedy for the purpose of strengthening the will-power. How can he
tell what is involved? Habit mearis custom, fixed custom, not an
entity, and as it may not show any perverted condition of nervous
tissue, or of any organ, its treatment under those circumstances is the
sheerest nonsense. Why not take the chloride of gold or the sulphate
of strychnine for the habit of telling falsehoods? The opium and
cocaine habits are alarmingly, on the increase. I have made inquiries
of druggists in diflFerent portions of the city, and from their statements
I am led to believe that at least two thousand, and probably four thou-
sand, people in Louisville are addicted to the use of opium and cocaine.
It may be presumed that the same ratio to the population exists in other
cities and towns, but probably not so great in rural districts. How often
is the pleasing physician to blame for encouraging this enthralling,
crushing, and blighting habit by the unnecessary use of morphine,
given by the mouth or hypodermatically, simply because some patients
demand a sleep-producing or pain-relieving medicine, irrespective of any
contra-indication to its use that may exist. The accommodating drug-
gist IS also deserving of censure in refilling, for an indefinite period, pre-
scriptions containing opium without the consent of the prescriber.
The hypodermic syringe is getting to be a dangerous popular household
commodity, especially in high-strung and fashionable families. The
physician who orders a hypodermic syringe and morphia tablets to be
used by the patient is guilty of the act of a dangerous criminal. The
unfortunate victim of the opium or cocaine habit seems to be in a more
depraved and irretrievable condition than his brother in misery who
is a slave to the habit of alcohol.

The habit of self-medication causes far more deaths every year in
our country than the carnage inflicted on both sides during our recent
war with Spain. Our gambling propensities as a nation are shown
in the worst light when we gamble on our lives. The digestive tract
appears to be a slot-machine, into which its possessor takes pleasure in
thrusting any preparation with a euphonious name suggested for the

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1 66 The American Practitioner and News.

"cure'' of disease in newspapers, in circulars on our door-steps, on
posters on the dead walls of cities, in the street cars, on the fences
along the line of travel, yea! on the mountain-tops, to delude the
healthy or seeker of health from enjoying the advantages of such a
salutary region. A morbid hysterical condition often results in many
people by reading and studying flaming and picturesque notices
regarding their nerves, livers, hearts, kidneys, etc. Laboring under the
delusion of being ill, thousands will unnecessarily take drugs with-
out consulting a physician — try their luck in " cures '' as they would
in cards at the faro-table — and become dyspeptics, neurasthenics, and
inebriates in consequence. Instead of obtaining the best remedies and
advice from those qualified by education and experience to bestow them,
people will pour drugs of which they know nothing, into a body of
which they know less, and will try, and keep on trying their luck as long
as the pleasing advertisements appear, to be changed only when a more
alluring picture and catchy testimonial of a " sure cure *' presents itself
— 4, II, 44, you pay your money and you take your choice. A
veritable lottery on life! The great lotterj' drawings of the world will
give a list of the few big prizes that are won, but the names of the
thousands and thousands who did not succeed in getting any thing are
not intended to be known by the emotional and foolish creatures who
invest their money in such gambling schemes. And so it is with patent
medicines. The multitude whose constitutions are really injured, or
who received no benefit whatever from those nostrums, are never heard
of. "Foolery, sir, does walk about the orb like the sun; it shines
everywhere." How fortunate it would be for humanity if the tons of
headache powders, the barrels of blood-purifiers, and the hogsheads
of liver pills were thrown into the sea rather than into the stomachs
of people by men who scarcely know the name of a bone or muscle or
the function of a single organ of the body !

We have many myopic theorists within the profession who, like
limpits attached to the rocks, know nothing of what is going on beyond
their own shells or habitations. There are experimental doctors who
try every new fad and mechanical appliance and remedy that appear
in the journals, in order to be recognized asy?« de Steele. This so-called
up-to-date doctor is usually the greatest humbug that exists. Some-
thing new, but not necessarily true, the people want, and why should
he not be the man to give it to them ? He may be a " curer " by mas-
sage, electricity, or oxygen, the stomach-tube or the X-rays, or what-



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The American Practitioner and News. 167

ever may be the fashion of the moment. He exaggerates the impor-
tance of every new nostrum or mechanical device.

The advantages of hospitals for operative work, surgical rest, and
rational medical treatment can not be questioned, but there is some
danger " of goodness growing into a pleurisy and dying of its own too
much," resulting in a condition of hospitalism and institutionalism,
especially among the neurotic. The enervating influences due to lack
of employment, vicious luxury, and indoor life among those not confined
to bed in such institutions tend to lower vitality, and may increase
degenerative traits and hysterical tendencies. The abuse of massage
and electricity, by lessening will-power, may produce a condition of
prudishness and morbidity by magnifying the importance of peccadillos
into grave physical conditions. Our own lamented Dr. Cowling charac-
terized massage as a great remedy for those that are well but will not
take exercise, and are not too lazy to lie down and be rubbed.

The pendulum must swing back from the enervating artificialities of
modern living to the plain and healthful simplicities of nature, from
tentative instrumentation and drugging for the ** cure '' of disease to
rational individual treatment on broad lines, if the invalidism which
characterizes the people of our present civilization be prevented. The
operative part, the instrumental aid, or the dose of medicine is generally
attended to, while the habits and habitation of the patient, his food and
drink, do not usually receive the consideration which their importance
as factors in the treatment deserve. Three minutes without air, three
days without water, or three weeks without food usually result in
death. Air may, therefore, be considered as the chief thing that the
body wants, though it is true that we can not live on air alone, but
require food and drink. Yet the dangers of air-sewage, or rebreathed
air, as an insidious poison in public places, churches, schools, and stores
are not fully recognized by the laity. While municipal legislation in
the matter of cleanliness is principally confined to filthy gutters and
alleys, whose obnoxious odors wound the sensibilities of our olfactories,
we have not yet progressed so far as to include the close and corrupted
air of stores and factories as a menace to our health. Probably the most
important question in hygiene that confronts the people, especially of
the cities of this country, is that of air, sufficiently pure to give more
red blood, better digestion, and invigorated muscular and nervous sys-
tems. Many of the large department stores and offices, with their arti-
ficial modes of heating and ventilation, are nothing more than disease-



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1 68 The American Practitioner and News.

breeding colonies, owing to their lack of fresh air. Our sky-scraping
buildings may present thoughts and ideas of modern progress to the eye of
the business man, but to the physician many of them are insidious death-
traps. Sunlight and sunlit rooms are at a discount in the houses of
commerce and trade. Hotels are built so that the modem troglodytes
who live there must eat, drink, and sleep, and use the least possible
amount of exercise, and inhale as little air as possible. Electric lights,
that are really dark with excessive brightness, burn brightly at noon-
day in the basements and oflSces of hotels and business houses, and
Holy Light, offering of heaven, first born, solar light, is excluded. In
the summertime the atmosphere of those luxuriously-furnished apart-
ments have, owing to their peculiar construction, a close, debilitating,
and stuffy atmosphere. In winter a temperature of about eighty degrees
pervades those buildings internally, while the mercury is many degrees
below the freezing point out of doors. The unfortunate cave-dweller
who lives under such conditions can not continue in the possession of
good health for many years. Such an existence does not tend to lon-
gevity. The tendency in the present fashionable style of architecture
in our cities is, unfortunately, to minimize space, rooms being made
very small, and windows so arranged as to exclude the air to a great
extent. How few patients who consult a physician deem the question
of pure air of any importance as a remedial agent to strengthen their
debilitated constitutions! Many of the wage-earners of our cities, but
particularly women employed in stores and offices, are underfed, owing
to lack of proper respiration — the last act in the process of digestion.
The shop girl who hurriedly eats a piece of bread and butter and takes
a cup of coffee for breakfast enters the street car, crowded almost to
suffocation by persons going to their different places of employment,
and incarcerated afterwards for hours in a business dungeon or a close
workshop, without having the privilege, perhaps, of resting her weary
limbs, even for a moment, has little appetite for her scanty lunch, and
less for the evening meal when she returns home fatigued and
exhausted. Lack of fresh air, proper exercise, and sunlight render her
an easy prey, owing to the lessened power of vital resistance, for the
germs of consumption to feast upon.

The limited space of this paper will not allow a notice of the impor-
tance of water, food, sunlight, and exercise in the treatment of disease.

The physician deems it better to get his patients well with little or
no medicine, if possible. He will carefully avoid using the word " cure."

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The American Practitioner and News. 169

While the number of remedial agents given in the books are legion,
yet he selects only those that have been tested and found to be trust-
worthy and reliable. He partakes of the spirit of the artist. The quick
eye, the observant gentleness, the sympathizing heart, the seizing of
the actual circumstances, the impressionableness to all that is soft and
winning and lovely and weak and piteous — these belong to the true
physician as well as to the true painter. He is an official minister to
human sorrow, and recognizes in his professional work the highest type
of duty, of man's humanity to man.
L0UISV11.LE.

TRAUMATIC TETANUS.*

BY JOHN A. LEWIS, M. D.

In the brief presentation which I shall make of the subject of
traumatic tetanus, I shall present you nothing new or startling — nothing
which has not been often said, and better said by others who have
preceded me in the consideration of this subject.

An interesting question in the investigation of any disease is its
origin, whether the result of edict or accident ; a question which has
puzzled, and is likely to puzzle, the theologian, the philosopher, and
the physician for all time. Perhaps equally as interesting, and certainly
more important, is the question of treatment, but paramount to both of
these is the subject of prevention.

In my investigation of traumatic tetanus I can not hope to throw
any light upon its mysterious origin, nor can I help you much upon the
subject of treatment; but upon the more important phase, that of
^* prevention,'' I trust that I shall at least be helpful. Indeed, in my
estimation, it matters little to us whence or how came the disease if
we can answer the more vital question, how to rid ourselves of it.
The old methods of treatment — and I speak from experience — having
run through th^ entire r61e time and time again, from calabar bean to
chloral, are absolutely valueless. The new treatment by antitoxine
injections is as yet on trial, and those of you who have oftenest met
this old adversary on the battlefield will be the slowest to accept the
new treatment as a sure cure until thoroughly tested by honest and
competent observers.

Tetanus is one of the oldest ills of the flesh, old as Hippocrates,
vividly pictured by the Father of Medicine, fatal then, fatal now. The

<'Read before the Kentucky State Medical Society, Louisville, Ky., May 18, 1890.



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170 The American Practitioner and News.

burden, then, of this paper shall be not how to cure the disease, as yet
a hopeless task, but how to prevent it.

During the earlier years of my practice, which began thirty years
ago, it was not an uncommon thing for me to meet with cases of trau-
matic tetanus. These cases generally had their origin in punctured
wounds from nails or splinters, or from contused wounds, or from
gunshot wounds, or from badly lacerated wounds, or from wounds from
which the foreign bodies had not been removed. The offending cause
was sometimes pieces of clothing carried with the ball, sometimes shot
left in the wound, sometimes splinters, sometimes broken pieces of
glass. I am sure that I am accurate in the statement that in the first
twenty years of my practice I saw not less than twenty cases of traumatic
tetanus in my own practice, or in consultation with other physicians
in my vicinity. During the last ten years I remember of but one
single case that has fallen under my observation. This occurred during
the past summer, and occurred in the person of a lying-in woman,
following an instrumental labor, three weeks from the date of her con-
finement. She had seemingly entirely recovered; every abrasion of
the surface had apparently healed. The patient had been discharged
as well, when the symptoms of tetanus developed. She died three
days from the time of seizure.

The occurrence of this unfortunate case had the effect of bringing
the subject vividly before my mind, resulting in an investigation of the
subject, and, incidentally, resulting in this paper.

In my investigation of the subject the first thing which arrested my
attention was the apparent dropping off of the number of cases in the
last ten years of my practice, as compared with the preceding years.

Now, am I right in my observation, that cases of tetanus are of less
frequent occurrence now than formerly ? I am sure such is the case
in my own practice ; whether it is a fact in the case of others or not I
do not know.

1 am aware that tetanus has always been a comparatively rare dis-
ease, and yet I am of the opinion that investigation will show that I am
correct in my statement. I only wish that I had had the subject
sufficiently long under consideration to have collected data from which
I might have adduced accurate statistics bearing upon the subject. In
my opinion there are several reasons why we might legitimately expect
a decadence in the number of these cases. The first and most prom-
inent reason is, that with the more general and extended use of



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The American Practztzoner and News. 171

anesthesia we are able to do better and more complete surgery than
formerly.

The second reason is, that under the influence of modern surgery,
as now almost universally practiced, wounds after being freed from all
foreign substances are rendered thoroughly aseptic before they are
dressed.

In the third place, the pathology of the disease has been entirely
rewritten, enabling us to act intelligently in preventing the disease.
If you will recall the fact that the wounds which -are more largely
followed by tetanus are the punctured wounds — wounds from splinters,
from rusty nails, wounds from pieces of glass, wounds that do not
drain, contused wounds, lacerated wounds, gunshot wounds, wounds
in which foreign bodies are retained — you will better be able to appre-
ciate how modern surgery, under anesthesia, would insure more favor-
able results than under the old regim^.

These wounds (many of them seemingly trivial) all require surgery
to rob them of their seriousness. Formerly the pain attending the
necessary incisions and explorations deterred both patient and family
from any interference, and, with the application of some simple oint-
ment or lotion, the wound was left to take care of itself. Thirty years
ago the administration of chloroform or ether was not nearly so general
as now. The practice of administering an anesthetic, except for the
most important operations, was looked upon as extra hazardous. The
majority of the profession were loth to administer anesthesia except
in extreme cases, and when it was done it was with the gravest appre-
hension. The laity were strenuously opposed to the use of anesthesia,
and would not consent to its administration except in the most danger-
ous cases and unavoidable conditions.

Surgeons were not nearly so abundant as now ; perhaps not more
than one physician in each county town made any pretensions to the
practice of surgery. The general practitioner rarely performed surgical
operations of any importance. Indeed, he seemed quite content to be
free from the responsibility which accompanied the practice of surgery,
and when he called a consulting physician he rather enjoyed the
spectacle of seeing him tread the wine-press alone.

As a natural result of this state of things, the majority of wounds
which I have enumerated as most liable to be followed by tetanus were
left to take care of themselves. Drainage was not established by free
incision; pus was allowed to accumulate and burrow; wounds were



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172 The American Practitioner and News,

so dressed as to favor infection ; foreign bodies were overlooked or left
to be drawn out by some favorite poultice of fabulous drawing power,
suggested by some neighborhood male or female wiseacre.

All these things favored the production of tetanus. Now the surgeon
(and as the result of advanced methods of teaching and increased
requirements for graduation and post-graduate schools every commu-
nity is well supplied with excellent surgeons) promptly and fearlessly
anesthetizes the patient, carefully explores the wound with his eye and
his finger — not with the probe, for th6 probe, having served well its
day and generation, has ** fallen on sleep" — removes all foreign bodies,
renders the wound thoroughly aseptic, establishes drainage, then puts
the wound up in thoroughly sterilized dressings. A few years have
wrought a wonderful change, especially in the management and
treatment of wounds. The laity have been educated to understand
that anesthesia is absolutely necessary for thorough surgery, and that
the dangers attending its administration are not as great as those which
we encounter every day in riding in a buggy or on a railroad train.

The general use now of anesthesia has robbed surgery of its terrors,
opening the way for better and more thorough work. Asepsis has
done the rest; and this statement speaks volumes, for no human power
can estimate what has been accomplished in saving life and limb by
the promulgation of the doctrine of asepsis as applied to modem
surgery. The doctrine of perfect purity in dealing with wounds now
seems so clear and simple that we wonder that a Lister had not arisen
hundreds of years ago to have blessed the human family ; and yet it
has been left to our day and generation to witness the promulgation
of a truth, the most simple and yet the most potent in the realms of
human knowledge.

What can be more simple than the doctrine of asepsis? When
summed up, it means nothing more nor less than the free and thorough
application of hot water and soap — things with which we are supposed
to have been slightly familiar all the days of our lives. How simple,
and yet how potent ! What a complete revolution has been wrought in
the science of surgery in the last decade by this simple means ! If
the giants of medicine and surgery of half a century ago could step into
one^of our modem operating-rooms of to-day and witness the advances
made in the domain of surgery — progress made possible alone by the
teaching of Lister — they would simply stand dumb with amazement.
They could not believe their own eyes. They would involuntarily



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1 he American Practitioner and News. 173



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 74 of 109)