« PreviousContinue »
The expenditure of $50,000 or $100,000 by in that restricted sphere have made his name Iowa for a sanatorium will within a few known all over the land; and in his line he short years greatly reduce our annual loss of has few superiors. But we have searched in over $10,000,000.
vain through the records of medicine to find Under the present systematic enforcement any indication of his having practised mediof isolation and disinfection, tuberculosis cine in his days of maturity, or contributed will be extinct in Prussia in 1927, in Eng. anything of value to non-surgical medicine, land in 1917.
much less to therapeutics; or that indicates Are not our citizens of as much value as that he has paid any attention to the developare those of any foreign country? Does not ments in the latter during the last twenty the medical profession owe to humanity the years. In fact, we must give his startling truths which it knows, and knows abso. assertion about the credit that our own would lutely?
receive, were we to state that there was no
surgical treatment for appendicitis. "The new shall do The unknown things, the wondrous deeds
But the influence exerted by such stateEarth's future needs demands ; Its hand shall shape the course ;
ments does not stop with the medical profesIts brain devise the plan
sion. They form part of that enormous sysTo win the richest prize that man can winThe betterment of man.”
tem of detraction and pessiwism by which the profession has been undermined in the estimation of the public, and the way opened
for the operations of quackery. The intelli- . THE PRESENT STATUS OF THE ALKA- gent layman says: "According to the leaders LOIDAL MOVEMENT.
of your own profession you have nothing to offer me except the sharp point of the knife.
I don't want it.” The quack says: "ReguW. C. ABBOTT, M. D.
lar medicine acknowledges she has no reme
dies but surgery. I bave." And he has. WHEN Boswell first met Samuel Johnson Nowadays the quack is a graduate of regular the latter was giving his views as to some
medical colleges, and as well qualified as the other man with considerable vigor. Boswell Average practician--perbaps a little better, endeavored to moderate the storm by remark. while relieved of the trammels of ethics and ing that he hardly thought the man as bad possessed of an infinitely greater knowledge as Johnson said; when the latter turned on
of human nature and of business methods. him witb— Sir, I do not see what right you
He is devoid of prejudices and quick to pick have to an opinion on the matter !"
up and utilize any improvements in medicines Very often we have the opportunity to ask
and methods that arise--far quicker than the this question, when people advance their views plodding general practician. The latter may with an ex cathedra air, as if that settled the
have in his office a microscope he never uses, matter in dispute.
and an electric outfit that is out of order, When a distinguished surgeon, professor of but he continues to prescribes squills and surgery in Rush Medical College, says flatly, paregoric for every cough, opium for every “there is no medical treatment for pneu- pain, whisky for everything else. " monia” we feel warranted in respectfully ask
Let me state as my profound belief, after ing-what right bave you to an opinion on studying quackery in all its aspects for years, this subject? and, for whom do you speak that its existence has a tangible, easily comthus? For yourself, for your colleagues, or prehended reason. That reason is little credfor the medical profession in general? If for itable to ourselves. If the profession is poor, yourself, we submit that you should have said if the doctor finds it yearly more difficult to that you knew of no such treatment; and
make both ends meet, to provide himself with with that statement we should have no quar
the needs of an up-to-date practice, if quacks rel. If you spoke for your colleagues, we ask multiply and the public accepts and enriches if they authorize this assertion, and if this is every new one, however absurd møy be bis the present teaching of Rush? If so, the claims, whose fault is it? It is our belief that physician who has medical students may well the whole mutter may be summed up, by say. consider whether they will get from Rush the
ing that the therapeutics of the regular medteaching be deems best. If Dr. Bevan speaks ical profession is not good enough to meet in behalf of the medical profession, we ask the requirements of the present day. It is by what authority does he assume the right this miserable, outworn therapy, I and my to do so? And as a member of that profession colleagues are endeavoring to reform. we repudiate bis assumption to speak for us, Well, what's the matter with our therapeuand deny the truth of his assertion.
tics? It is uncertain, inefficient, wrongly Dr. Bevan is a surgeon, whose attainment directed, unpalatable and crude, antiquated, and in a word unscientific. Let us take up Wrongly Directed.-Here we come to the each count of this indictment:
crux of the matter. We bave been directing
our attacks against diseases as entities, when Uncertain.-It is scarcely necessary to ex
there are no such things. Leaving out the patiate on this point. The writer has seen a
influence of quinine over malaria, mercury man with dilated heart die within an hour of taking a dose of finid extract of digi. stance of a specific for any disease? We are
over syphilis, and where bave we a third in. talis, tbat bappened to be weak in the
in truth not called on to treat diseases, but cardiac tensors and rich in the cardiac
conditions. No matter what may be the disdepressant, digitonin. He has given jaborandi to increase a mother's milk and
ease, we recognize the presence of autotoxe
mia, and remedy it; of hyperpyrexia, and had the drug dry up the secretion entirely,
quell it; and if we are qualified, of disturbbecause it was weak in pilocarpine and rich
ances of the vasomotor equilibrium, and corin jaborine. Even with cincbona, whose al.
rect them. Well were it if we did away with kaloids are pbenomenally synergistic, we
these things — the prescription books, the have practically dropped the cruder preparations for quinine. How much more neo
ready-made remedies for single diseases, and
the belief that a name.diagnosis is an essen. essary this is with plants that contain an.
tial preliminary to drug treatment. tagonistio principles. I will only allude to
Here is how we get wrongly started in our hyoscine, which is completely smothered
work; we see a patient; wait some days till by the accompanying atropine except in some
able to make a name-diagnosis-eight days rare specimens of hyoscyamus; arbutin, which
for a Widal--and then turn to our formula is accompanied by thirty-five times its weight collection-select the one that has the biggest of tannin, so that effective dosage was un
name behind it, or contains the most ingredi. known until the arbutin was separated and
ents, and give it throughout the attack. If administered alone.
we construct our own prescription we select But I must speak of the alkaloids of hy.
the remedy we prefer-not knowing just what drastis: Berberine contracts relaxed connec.
it will do we throw in a few others, any one tive tissue, while hydrastine contracts the
of wbich may hit the case, and let her go at smaller blood vessels, especially of the uterus.
that. The former is a much needed remedy for di. latation of the stomach, for uterine, gastrio formulas leaves us at the mercy of the manu.
The difficulty is that the dependence on and intestinal ptosis, for all relaxed states of
facturers who promote specific remedies for ligamentous tissues. Hydrastine is a useful specific diseases; and abdicating our funoremedy for menorrhagia and especially me. trorrhagia. The man who administers prep
tions as prescribers we follow the lead of pat
ent medicine makers. arations containing both when but one is
Instead of this, our attack should be di. indicated, loses much of the satisfaction that
rected against just what we see to attack-the comes from an intelligent practice of med. ioine. In a word, there is in the crude prep
symptoms present. We have fever-moder
ate it; we treat what there is to treat, and arations uncertainty as to the nature and
study our cases instead of our books. We do the degree of effect we are going to get, whereas with the active principles we have condition-diagnosis on which we base our
not wait for a name-diagnosis, but make a certainty as to both.
therapeutics. We can not stop to ascertain Inefficient.-When we have to wait for what is the cause of hyperpyrexia, because be. our medicinal principles to be dissolved fore we can do this our patient will be dead from an encumbering mass of inert sub. we just apply ice and cool him off-then stances, when we are uncertain as to the we hold an ante-mortem instead of a post. kind and quantity of effect that will follow, mortem to complete the diagnosis. This we we are paralyzed as to the prompt and effec- term condition-therapy. tive intervention at the beginning of an attack that is indicated, and that alone would
Unpalatable and Crude. Because we ad. prove capable of breaking up the malady be. minister uselessly a lot of inert woody fiber, fore it had become firmly seated in the tis
gum, sugar, pectin, albumen and other ingre. sues.
dients of the plant, which add no useful eleConsequently our attitude toward the pa
ment to the dose but make it larger, more untient tends to become that of a benevolent pleasant, slower to act, less likely to be re
a spectator, insteud of powerfully and intelli
tained by the stomach, and materially intergently intervening, and becoming the con
fere with the absorption of the active printrolling element in the situation. Sureness
ciples presented. we must have, to act with power. Sureness Antiquated. - Here is our final point. The as to our drugs gives us the first firm footing. basis of scientific therapeutios is the known
action of remedies. This has been ascertained will admit of an accuraoy of application of mainly through the medium of physiologio which we now see only the possibilities. experiment; and this is of necessity contined The great need is for clinical workers, who to the definite, uniformly acting principles will apply these agents and make careful ob, ,
. because certainties can not be deduced from servations as to their effects.
For instance, uncertainties and the experimenters were there are two new remedies for epilepsy-verdriven perforce to these agents. It results benin and solanine. Each has won inore that we have concerning them a wealth of in- than popular repute. Verbenin has proved formation, reaching down to the minutest de- curative in a series of cases studied by Prof. tails, that enables us to prescribe them with Frenoh, of Carbondale, who believes it acts full knowledge of the effects to be expected. upon intestinal parasites. Solanine is the
active principle of the bull or horse nettle, of The active principles are not substitutes
bittersweet, and of several other plants that for the tinctures and extracts, but each has
have proved useful in this malady. How, why, a therapeutics of its own. We offer them on
what its action and the limits of its effectheir own merits. They may resemble the
tiveness, are yet to be determined. We have orude drugs, but this is incidental. Study
gathered these facts; and we ask the profesthe alkaloid for itself, without refereuce to
sion to ascertain further facts by clinical the parent plant. Of what possible conse.
trials; but they ask us for information inquence is it to us whether hyoscine comes
stead. We proffer brotherhood, they insist from ben bane or from scopolia ? Or what
on forcing us into an undesired leadership. these plants were used for in the earlier day?
I have recently traveled from the Atlantic We give hyoscine for its own powers, us
to the Pacific, addressing many medical socieshown by scientific experiment.
ties, in the endeavor to arouse an interest in In the Text-book of Alkaloidal Therapeu- purely scientific, purely ethical, non-secret, tics there are 155 remedies described; but non-monopolistic, therapeutics. The alka. these are far too few. Many alkaloids are loids form a very important part of this, but known to the chemist but not yet tested for by no means all. Many synthetics and sera the physician. There is a whole group of are as strictly scientifio as they. The results tetanizants of which strychnine is the type, hare proved bigbly satisfaotory. The profesembracing brucine, thebaine, laudanine, sion shows signs of waking up to the importgelsemine, calabarine, curarine, all having ance of this movement-the need of reform in similar effects—but not identical necessarily. therapeutics is universally admitted. The They have not been studied yet, except that scope of our work is being better comprewe know brucine is a local anesthetic, and hended. The cry of "commercialism” is si. that thebaine has shown powers in certain lenced. It is an absolute necessity that there cases of paralysis superior to those exerted by should be a source of standard supply for strychnine. We are convinced that a thorough these delicate instruments, or the propaganda study of this group would show valuable di- would be emasculated. Of what possible use versities in the powers of the different mem- would it be for us to recommend stropbanbers that could be fitted to like diversities thin, and send the physician out for it into in the
symptoms of diseases. For a market where the supplies vary in strength instance, at present the writer is struggling from one to ninety? But when a non-secret, with a case of so-called asthma.
non-monopolized remedy is advocated, which cular tract of the lungs becomes dilated, al- every druggist, every physician, may prepare lowing congestion, with strenuous cough and and dispense if he chooses, the cry of interfollowed by dyspnea. The indicated remedy ested motives becomes triling. The only opis one that will increase the tonicity of the position now manifested against the alkaloids vessels walls in the pulmonary tract with- comes from men who supply ready-niade preout affecting those of the general circulation, scriptions to physicians and who find their which are in a spastic state already. What sales decreasing under our advice for physi. is this remedy? Hydrastine does this ex- cians to study their cases, and do their own actly for the uterine tract. Adrenalin does prescribing with drugs they know all aboutit for the general circulation, for exactly the and of such opposition we are rather proud part we do not need it in. That there is such tban fearful. a remedy as we need we cannot doubt; but as We are not contending for the alkaloids long as the profession is satisfied with crude but for drug therapeutics, based on agents drugs there is no incentive to add to our list worthy of trust, because their effects are sure, by the careful and painstaking investigations uniform, perfectly well known; drugs neither necessary to establish the place of new alka- secret nor monopolized, with no commercial loids. When this has been done we will have backing as such, but depending for popular. a collection of finely selected remedies that ity on their effectiveness and nothing more.
And on this basis we ask from the profession tuberculous or have a strong predisposition a renewal of confidence in such drugs, and to tubercular infection. a trial of the therapeutic methods based on The importance of tubercular disease of the them; promising in return a renewal of that neck is made apparent by recalling that in optismitic faith that moves away mountains · 14% of cases of tubercular disease in other of disease.
parts of the body show these glands infected. This may to many readers be a many times The conclusion cannot be escaped that to artold tale; but it is one that has traveled far rest the disease in the neck we would reduce and met no serious attempt at controversion. tuberoular disease by just so much. It is a Many of the foremost men of our day have very familiar sight, I dare say, to every one assured me that we are right; and that the present to see persons in his practice, child. only trouble has been that the world required ren, adolescents and aged ones with these time to catch up with us. But we who are tuberculous lymph nodes. advocating this reform are painfully conscious It is no reproach to the profession of that it is a thing far bigger than the men now course, but at this day of general awakening in it and that at the best we may hope in of both profession and laity against tubercutime to be known as “forerunners,” but no lar disease, and especially along the line of more.
prophylaxis it is our duty to detect and remove The way is opening, the medical mind is These nidi. in travail, the result is not hard to foretell. It would be begging the question to say
this condition is secondary to and dependent on primary fooi in the mouth of upper air
passages, and that to correct these should be TUBERCULAR ADENITIS OF THE NECK. the aim of treatment I am thoroughly assured
that no modern physician would hold this ROBERT J. CHRISTIE, JR.,
view; it would be a striking parallel to the M. D.
assertion that because the Chicago drainage
canal pollutes the stream, those living on its In presenting this topic for your discuss. banks at Peoria, Alton and St. Louis should ion it is well to consider the frequency with not filter the water that is carried to their which the condition is met, and the usually every home. unsatisfactory course of the disease. I say
The answer to the query, why is 90% of disease; it is not entitled to be set aside as a glandular tuberculosis shown to be in the special disease, but the peculiar features pre- neck? is found in the fact of the abundant sented by tuberoular adenitis when located in lymphatic supply of this region, and the the cervical region justifies its study great exposure of the mouth and upper air apart from general tuberculosis or tuberculo. passages to the lodgment of germs. sis of lymph glands in other localities of When you reflect that 95% of all tubercuthe body. It differs in no essential from
lar disease becomes infected by way of the tuberculous glands in any portion of the mouth or nose, and that these cavities are anatomy.
constantly invaded by living germs, is it any The frequenoy with which glandular dis- wonder that the lymphatic chains of the ease is met in the first decade of life is neok, these faithful sentinels, ever on watch striking. Owing to it being the time of for the enemy, should sometimes suffer de. second dentition and to the predilection for feat? Greater is the wonder that they should the exanthemata this is the period of the achieve such numberless victories against greatest susceptibility to glandular disease. the arob enemy of the human body, so insid. It has been shown that about 85% of child.
ious and so relentless. ren in this period are affected.
It is needless for our purpose to discuss largely simple infections of non-pyogenic or
the numerous infections that may disturb the ganisms, and remain without producing any
glands of the neck. It is sufficient to say symptoms indefinitely. The number of these that any considerable enlargement of them, that are already tuberculous, and the number occurring in the second and third decades of which may at a later time become so cannot life, that are not lympho-sarcoma or pseudo. be expressed in numbers. But coming to leukemia, or syphilitic, or that does not the second and third decades of life we find rapidly progress to suppuration or resolution, 76% of cases of the affection, and that a large is in all probability tubercular and at once a per cent of these give a history of glandular surgioal disease. disease in childhood. So we know that a
I think we
are forever divorced from the large per cent of those in the first decade are sorofulous disease of the older writers as
meaning other than tubercular disease. I do *Read before the Western District Medical Society of Ilinois, at Alton, October 21, 1905.
not concede that there is such a condition or
entity, certainly not from a practical point of menacing condition? I would lay the blame view, as simple chronic hyperplastic adenitis. equally on the patient or his parents, on This classification is based on the character- the doctor and on the patent medicine man istic long period of involvement, the inactiv. and his congeners; the doctor in many in. ity and the sometimes spontaneous oure by stances for not insisting on an early operaabsorption.
tion; the patient for following the mislead. This I maintain is illogical. These glands ing claims of the uneducated or vicious, will in the great majority of cases prove and the patent medicine man for his crime themselves to be tuberculous, and will surely of hypocrisy against the credulity and fixed go on to caseation and suppuration. Not to superstitions of the average man. What so consider them would compare well with should be the rule in the treatment of these the argument that says, let the appendix conditions ? First, excise every tuberculous alone until it suppurates. It can only be gland found, and do it at the earliest stage if said for taking this chance course that it possible. may be justified by results. It is poor argu. It would follow as a rational principle that ment, as the evolution in the treatment of the source of infection should be sought out, appendicitis plainly shows, and the analogy and if possible corrected, whether it be the is so true that it must carry conviction. Why tonsil, post adenoids, caries of the teeth or not remove the doubt along with the disease? abrasions of the mouth, nose or pharynx. If
I would, therefore, make a plea for the early the case is not presented at this early and extirpation of these glands. What do we favorable period, but belungs to the second, gain by an early operation, and what may we excision should still be the rule. not suffer by delay? These are pertinent Do not temporize with iodoform injections questions, and their correot answers should or bichloride injections or iodine injections; determine the course of all toward an early you may get results, but the chances are operation.
against you, so do a clean excision, and do What do we gain ? In the first place we not be satisfied with the removal of one casesave from more extensive and widespread tu- ated gland; remember that there are always berculosis 14% of patients. Secondly, we
three or more involved at this stage. treat a simple uncomplicated surgical disease impelled to speak rather strongly on this of the neck and we get an ideal and perfect point. In my own cases, at least, those recovery. These things accomplished for the that have done badly were those that bad patient and humanity are not to be despised. been treated expectantly in the first stage If any plan of treatment could reduce the and by injections in the second, and have mortality of pulmonary tuberculosis 14% it reached the third by progressive gradation. would be bailed as a dispensation from What is the rule for this third stage of the heaven. This is what early and complete disease? Excision ! excision! broad, bold operation does if statistics are true, and my and deep if there is any possibility of entirely premises, and conclusions are correct. What removing the masses. The excision should do we suffer by a delayed operation? We include all tissues involved in the disease, cannot escape the suppurating abscesses of skin, fascia, muscle, and if need be vesicles the neck and the hazard they carry to life and and nerves, excluding of course, the carotids, happiness.
and the pneumogastrio, the cervical, symTubercular disease of the lymph glands of pathetic and recurrent laryngeal nerves. It the neck considered as a surgical disease may should be remembered that the structures be classified in tbree divisions. Tubercular mentioned can in most instances be avoided infiltration, which is the early stage of all and protected. The carotid sheath by some tuberculous glands; caseation and softening fortunate principle of immunity is seldom is the second division, and is the next step in involved. the progress of the disease, and third the It is not within the province of this paper periadenitis when the disease is no longer to discuss surgical technique, this is fully contined within the capsule of the gland, and treated by all modern works on surgery. has penetrated into the contiguous tissue, After a rather extensive experience I am and we have those large indurated masses convinced that the principles herein set involving all the tissues whose center is a forth, and sought to be made impressive suppurating chain of glands connected by are correct, and I may add that they are not sinuses and discharging purulent matter. my dictum, they are the doctrines enunciated This third division is, unfortunately for the by all surgical authorities, and if I have patient, and also for the complacence of the made them forceful and effective for some doctor, the one he is most often called hesitating and vacillating brother, then my upon to treat.
Now who is blameless or plea has not been in vain and his grateful most to be blamed for this distressing and soul will answer to his satisfied conscience