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of sugar. It is not, of course, neces- gan are very useful, they are weak, so weak sary that we should know the amount of sugar that it is necessary to drink very large quanpresent, it is enough for clinical purposes that tities of them. I have seen very great good we know the fact of its existence.

result from the use of Bethesda water. The In some diabetic patients we will have a Vichy water of Saratoga is very like the French peculiar form of cataract, known as diabetic Vichy, not quite identical, yet very useful in cataract; I do not note any such condition this disease; so that we have just as good here. Acute phthisis not infrequently occurs springs in this country as they have in Europe, in the course of diabetes, and in this way many and we need not send our patients on long cases find their termination; there is the so- and expensive journeys for that which they called " diabetic consumption.”

can procure at home. Therefore, in addition Now, as in the first case, what I more par- to diet, we should advise our patients to drink ticularly desire is to call your attention to the freely of alkaline mineral waters. treatment, for the diagnosis is usually very Of drugs, proper, very many have been easily made. The first and greatest point in recommended. I have seen what was apthe treatment is to exclude from the dietary all parently a cure result from the persistent use articles that go to make sugar, all starchy and of carbonate of ammonium, which, however, saccharine articles, gums, and all other articles is only indicated in fat, obese patients, being capable of this conversion. Such vegetables seemingly useless in thin, nervous persons; for as raw cabbage, celery, spinach, and tomatoes the latter, the alkaline treatment even seems may be used, while pure glycerine will make too depressing, it depraves the blood too quickly. an excellent substitute for sugar in coffee and In cases of hepatic origin I have seen very other places where sugar is generally used. good results from the use of phosphate of Cranberries may be eaten, the glycerine being sodium, more indeed than from any other used to remove their acrid taste. The diet, as drug; I say it is especially useful where there a rule, should be as near an animal diet as is hepatic complication, and I will add, that possible. A celebrated London physician has there are very few cases of diabetes without derived much of his reputation from confining such complications. I have also found good his patients to an animal diet. The skim-milk results from the use of chloride of gold and cure has been highly lauded of late, but I am sodium, which, when persistently used, I have not very enthusiastic over it, as it does not seen work apparent cures. I can now recall contain the elements to maintain flesh and several such cases. In these cases I also gave strength for a long-continued time. There the phosphate of sodium, alternating from one are, however, some persons who will thrive drug to the other. But I also believe that the very well on skim milk, and in such persons, former alone will do good, and I give it a very when suffering from diabetes, very good results high place in the therapeutics of the disease. will be achieved by its use. You might suppose In a case like this, where the gangrene evithat the sugar of milk was an objection to its dences the run-down condition of nutrition, use, but it has been demonstrated that milk- remedies must be directed to the disturbed nusugar is not convertible into dextrine or grape trition, and when the patient is thịn and anæmic, sugar, so that in suitable cases the skim-milk we should give cod-liver oil, which is importtreatment can be satisfactorily used. All fruits ant both as a drug and as an aliment. containing sugar must be avoided.

Neuralgia.--Here is a case of neuralgia of Now as to drugs, there are certain mineral the face and head, extending around to the waters that are extremely good, for example, spine, in a young lady who is decidedly anæmic, the alkaline mineral waters of Wisconsin. In and has disorders of digestion. Such a comFrance and Germany the Vichy water has a plexus of symptoms is very common; you will great reputation, and every year at the Vichy meet such cases every day. This woman leads springs are to be seen many diabetics. The a sedentary life, working indoors with her Carlsbad cure is greatly in vogue in Germany. needle. She has a poor appetite, and lives Now, in this country, we have some springs chiefly on bread and butter and tea, and that are very similar to it, only that they are starchy food. As a result of the confinement, not quite so rich. The Bethesda water of improper food, poor digestion, and faulty Wisconsin and the alkaline springs of Michi- assimilation, her nervous system becomes anæ

G

mic, and she suffers from neuralgia; she has | Boards are forming, how college authorities
what we have spoken of, “neurasthenia.” The are adding hygiene to the curriculum, how the
pain here is mostly located in the fifth nerve popular wave is at last in matters of prevention,
and its branches. Now, how can we benefit you all are conversant. Surely this grand de-
such a case? The most important indication is termination to fight disease, meeting it more
to procure a change of occupation, to substi- than half way, is the glory of the nineteenth
tute an active, out-door life, for this sedentary, century.
in-door existence. Then we must exclude the Do not imagine, gentlemen, that hygiene is
starchy and saccharine articles from her diet, alone for the well man. It is also the sick-
and forbid the use of tea and coffee. She must

room science.
have nitrogenized food, such as milk, eggs, and It may be making a departure from the usual
meat. I do assure you, that the hygienic man- orthodoxy, when I now call your attention to
agement of such a case is of prime importance. a hygienic therapeutic agent much neglected.
For drugs we will use iron, quinine, or the My mind is convinced of the great truth em-
triple phosphates of iron, quinine and strychnia, bodied in Dr. Wallian's generalization: “From
or cod-liver oil. But the chief reliance must the same agencies and elements which nourish,
be placed upon the regulation of the diet. encompass, and sustain us in health, must we

at last seek remedies through which to recover

lost physical status." OXYGEN IN THERAPEUTICS.

Is it not true that every vital process, conBY C. C. VANDERBECK, M.D., PH.D., struction, maintenance, repair, disintegration Lecturer on Hygiene, Medico-Chirurgical College, Philadelphia. is accomplished directly or indirectly through

ENTLEMEN: You ask me what relation the vital agency of oxygen? Is it not, as Wal

does hygiene bear to clinical medicine? | lian says, the rush to Europe, the numerous Are they in conflict? Is a sanitarian outside watering-places, and the mountains, essentially the pale of the regular profession? Can he an unconscious hunt for this oxygen? When with conscience use drug treatment? There is in my lectures we studied the many sources of no conflict between the two great departments contamination of our air, the evil influence of of practical medicine. The one is an aid to many occupations, of cramped positions of the other. A true physician will not abjure the confining business, was it not all a variation on one and cling to the other; he gathers from all the theme oxygen? When physiology teaches sources, from the earth, below the earth, above us that “we must inspire this gas with every the earth, from all philosophies and pathies; breath, drink it with every draught, move in he uses all that is proven of value to suffering it at every step, and live immersed in it as a humanity; he is not restricted to a narrow perpetual bath, or perish, do we wonder that basis of action, claiming no peculiar appella- preventive medicine deals so largely with vention; he is simply, grandly an M.D. -a docto- tilation and air contamination? When the rem in arte medendi.

same science tells us that 12,500 gallons of air It must be admitted the profession has looked is required to supply the lungs of an average with a jealous and suspicious eye on the ad- adult for twenty-four hours, that 2500 gallons vances of sanitary science. Hygiene has been of this is oxygen; therefore, about 100 gallons a favorite cloak for many a rampant empiric, of pure oxygen is required each hour to supply and numerous one-sided medical systems, but, the requirements of a healthy adult organism, is by the rapid advances of the true science, with it any wonder that the pathologist and etiologist a goodly number of brilliant victories, under claim that vitiated atmospheres are among the world-wide known leadership, it is coming most potent and widespread of all the predisabout that each year it is better recognized and posing causes of disease, though the effects more warmly welcomed to the fellowship of may not be sudden, causing no pain or disthe regular schools and systems.

comfort for a time, but slowly and impercepAt my graduation, March, 1872, there was tibly cumulative and tending ever downward not one State Board of Health in the United | in stamina, and toward disease and premature States; there was no American Public Health death? Association; there were but few professorships The studies in the newer fields of germ disor lectureships of hygiene. How rapidly State eases seem to confirm our previous opinion,

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that bad air is the culture-fluid of all zymotic chemical knowledge prevailing at the time, it and germ-engendering disease the world over. is fairly remarkable that any encouraging reAnd this has led naturally to the conclusion sults were attained. To illustrate, Beddoes that the original and only unobjectionable and and his confrères procured their gas from an universally efficient antiseptic is pure oxygen. oxide of mercury, through what would now be

Are we not, gentlemen, robbed of a due deemed a crude and bungling process. The proportion of this wonderful gas all along the purification of the gas was so imperfectly acdevious path from the cradle to the grave ? complished that in some instances pytalism enWhile being firmly convinced of the great need sued, and the treatment had to be suspended of purer air for all men, women, and children to prevent mercurial poisoning. in all their duties of life, by day and by night, " The methods of exhibiting the remedy let us pass to the consideration of using oxygen were also very imperfect, the patients being as a method of treatment, or, at least, as a use- caused to remain for some time in closed rooms, ful adjuvant to our therapeutics.

the atmosphere of which had been previously History of Oxygen in Therapeutics. I do impregnated with the desired gas. Thus the not propose to give an exhaustive résumé. My sufferer was caused to sit in and inhale an atobject is attained when you see that this subject mosphere, which, already tainted by an impure. is not strictly new, and that a considerable gas, was being constantly further contaminated amount of clinical facts by prime observers are by his own, perhaps fetid, exhalations, and on record.

having no way by which it could be definitely History of its Therapeutic use." As early regulated or renewed.”_WALLIAN. as 1772, Marching Poullé, of Montpellier, and Dr. Busch, writing in 1857, says he has emin 1774, Girtanner and Stoll, of Germany, at- ployed oxygen gas in his practice for some time tempted the use of oxygen gas in the treat- and with most encouraging results. In the ment of diseases, with what results does not Lancet, 1858, Dr. C. R. Francis writes in appear. The first reported case, of which any laudatory terms of the use of oxygen inhaladefinite record remains, in which this agent | tions in a case of scarlatina with putrid sore was used, was treated by Caillens, in 1783. In throat. His case presented livid countenance, the following year, Jurine, of Geneva, published coma, and almost imperceptible wrist-pulse. a short essay on the subject, and reported a Oxygen was given six times in the space of two case of phthisis in a young lady very much days, keeping the patient alive, giving an opbenefited by oxygen.

portunity for other medicine to act, and with a " The next record is by Chaptal, of Mont- final cure. He remarks, in this case there was pellier, who, in 1789, reported two cases of simply a tendency to extinction of life from the phthisis treated by the same agent, in one of noxious poison, and in just such cases great which marked relief was obtained, while in benefit may be expected from the use of this the other the results were negative.

gas. In 1866, the American Medical Times To Beddoes, more than to any other, be- reports a case of dyspnea from cardiac disease, longs the credit of having called the attention at the New York Hospital, greatly relieved by of the profession in England to the medical use oxygen inhalation.

His experiments were conducted Perhaps the best plan to further study this on an extensive scale, and with a perseverance subject, is to group under certain diseases what and enthusiasm worthy of a more practical suc- I have been able to find concerning their treatcess and a better recognition than he secured. ment by inhalation of this gas.

“Other names occurring in connection with Anemia.-" Everybody knows how difficult early experiments with the gas as a remedy, are it is sometimes to get some much enfeebled those of Priestley, its co-discoverer, Lavoisier, chlorotic patients to take reparatory aliment, Barthollet, Spallanzani, Thornton, Hill, Ca- so great is their disgust for all azotized aliment, vallo, Erichsen, Demarquay, and others. Sir vomiting often ensuing when they attempt to Humphry Davy also materially assisted Bed- eat meat. Some women live upon a little does in his chemical manipulations. The bread and salad, and the quantity of urea they latter was a practitioner of note, and also Pro- eliminate is then very small, sometimes as little fessor of Chemistry at Oxford.

as from four to six grammes in twenty-four Considering the extremely crude state of hours. In such women treatment becomes

of the gas.

very difficult, it being nearly impossible to re- but about the middle of September the author produce appetite in them. In these cases, Dr. considered him to be definitely cured, the Hayem, of the St. Antoine Hospital, Paris, number of red corpuscles having returned to employs a means which has furnished the most the normal.”—Med. and Surg. Reporter. excellent results, and which consists in the Dr. Andrew Smith, New York Med. Record, daily inhalation of oxygen. The appetite soon 1871, says oxygen inhalation causes an average returns, the vomiting disappearing at the same of nine beats less in the heart. It acts upon time; and so well do the patients then support the blood in such a way as to facilitate its flow azotized aliments, that the four regular por- through the capillaries. tions of the hospital diet scale become insuf- Asthma.-M. Demarquay reports three asthficient."-Med. and Surg. Reporter.

matics treated with oxygen. In one case the Ringer sanctions the use of oxygen in success was marvellous. The other cases were anæmia.

complicated with emphysema and suffocating Dr. Buttles, of New York, reports in the New catarrh; in these the inhalation effected an York Medical Journal three cases of anæmia amelioration of the symptoms. successfully, and in one case brilliantly treated Albuminuria.-Eckert has seen albuminuria by this means.

cease under the influence of the inhalations. Oxygen inhalations have also been found Dr. Paul, of France, reports a case in which the serviceable in relieving and curing or assist- albumen disappeared, but afterwards reappeared ing in curing anæmia, as well as dyspnoea, and carried off the patient. diphtheria, asthma, and croup. Beddoes says Asphyxia.--Dr. Wallian formulates from a in essential anæmia, chlorosis, anæmia of paper by Layssel, the following:con valescents, of newly-delivered females, or “ ist. In certain cases of poisoning, viz., by from hemorrhage, fatigue, and prolonged sup- chloroform, ether, chloral, opium, sulphide of puration, oxygen gives most grateful results. hydrogen, carbonic oxide and hydrocyanic In obstinate anorexia, it is one of the best acid, oxygen is the only means of preserving means of stimulating the appetite.

life after all other means have failed. “ As a means of stimulating retarded tissue “ 2d. Its presence in the operating room metamorphosis, inhalations of oxygen promise would be an infallible safeguard against fatal much. The Deutsche Med. Wochensch., of accidents from the use of anæsthetics. It October 10th, contains the substance of a lec- promptly restores sensibility and eliminates narture given by Dr. Kirnberger in the Medical cosis in all such cases. Society at Mayence, on the treatment of leu- “3d. It offers the best prospects for success kæmia and pseudo-leukæmia, in which he sug in asphyxia from strangulation, drowning, gests the inhalation of oxygen as a means of ob- poisonous gases, etc., as also in cases of susviating the retarded tissue-metamorphosis which pended vitality in the new born. is characteristic of this disease. He cites a case “4th. It will almost surely sustain life in all in which he employed this treatment with good cases in which respiration has not entirely ceased, results. The patient, a boy aged ten and a half even if the intervals between inspirations be very years, who had been treated with iron, arsenic, great, provided it be persistently exhibited. and quinine without any benefit, improving “ 5th. If cardiac and respiratory action have greatly, and finally becoming cured after the been absent for but a short time, resuscitation inhalation of oxygen, combined with arsenic, is often possible through the use of oxygen ; internally. The boy had reached a condition and this agent should be perseveringly used in of extreme weakness, being entirely confined all such cases, even when appearances

indicate to bed, with loss of appetite and tendency to that all efforts will prove useless. Cases have vomiting; the spleen considerably enlarged, been frequently reported of drowned persons and white and red blood corpuscles in the pro- and apparently stillborn children being fairly portion of one to ninety. The treatment began raised from the dead by persistent endeavors in December, 1882, and after a daily inhala- with oxygen. tion of about thirty litres, the boy could leave " 6th. There is no contra-indication of the his bed in ten days, and could go to school gas in any case of asphyxia. about the end of February. Some variations 7th. The gas can be respired in notable in his condition occurred from time to time; quantities without the slightest injury.

the gas.

Dr. Paul reports a case of laudanum poison- | the details of the work. The best and cheapest ing, and three cases of suffocation from char results would probably be obtained by making coal fumes saved by oxygen inhalations. the collection and disposal of garbage a branch

Demarquay, Duory, and Ozanam consider of the street-cleaning service, under the direct oxygen the antidote for all the asphyxias. control of a superintendent. He should be

Duory and Ozanam insist upon the use of responsible either to the executive, legislative, oxygen for relief in cases of overaction of an or health authorities, and should be furnished anæsthetic. Professor Jackson, of the Univer- with all the force and all the appliances needsity of Pennsylvania, also advised such use of ful for the performance of his duty at the ex

pense of the city. Under such circumstances, [To be continued in April number. ]

an intelligent supervision would soon establish the needs for thorough scavengering, and prob

ably obtain a sufficient revenue from the sale ORIGINAL COMMUNICATIONS.

of garbage, to sensibly diminish the expense of

its collection and removal. Such a system is THE COLLECTION, REMOVAL, in vogue in Boston, and enough money is re

AND DISPOSAL OF KITCHEN- alized from the sale of properly collected garGARBAGE.

bage to pay about one-half the expense of its BY E. L. B. GODFREY, M.D.,

collection and removal. The scavenger deMember of the New Jersey Sanitary Association, etc. etc., partment of Boston is provided with horses, Camden, N. J.

carts, drivers, and helpers at the expense of HE removal of filth by sewerage has been the city. The men are required to enter yards

for in most cities. But the methods and appli- ceivers, and, after emptying their contents into ances for the collection, removal, and disposal the cart, to return the receivers to their proper of garbage, ashes, street dirt, etc., have not re- places. When the cart is filled, the garbage is ceived in some of the smaller cities the atten- immediately taken to regular depots, of which tion their importance demands. The subject, there are four in the city, dumped upon raised therefore, is one of serious concern to health platforms, and sold to farmers as food for swine. authorities, because of its direct bearing on in. It is required that the collections of the day be dividual and public welfare. Public health disposed of before night. The carts are built and enterprise unite in requiring thorough by the city especially for the service, and when scavengering, and, therefore, only the means leakage occurs while passing through the streets, to be employed remain to be considered. The the fact. is immediately reported by the police supervision of the work either devolves directly to the proper authorities. When no offal is upon the municipal authorities, or is by them found at inhabited dwellings, the case is regiven out into contracts. The former method ported to the Board of Health for investigation. is the better, because the work can be more The Boston method is a decided improvement thoroughly systematized, and infractions of over the methods of those cities which require sanitary laws more quickly remedied. Under ash barrels and garbage vessels to be placed the contract system, the contractor is apt to upon the sidewalk to await the arrival of the look more closely to the financial terms of his scavenger, and after being emptied to be left contract than to the public health, and, there in a damaged state when found.

Such a fore, the work is rarely done (whether in the measure is equally inconvenient to housekeepcollection, removal, or disposal) in a satisfacers, and unsightly to foot-passengers. tory manner. On the other hand, there should As to the collection of garbage, laws adnot be a division of responsibility among city dressed both to the housekeeper and the scavenauthorities; for under such circumstances, the ger would assist matters very materially. Each best results are not easily obtained. Neither should have their special duties, the fulfilment should a work of such importance be in charge of which would facilitate the efforts of both. of a committee, who do not control either the The dry refuse of the kitchen should be kept appropriation, expenditure, or the force to be apart from ordinary garbage. They should be employed, and who, moreover, are not in placed in separate vessels, and collected sepaoffice for a sufficient length of time to master rately. The throwing together of " slops,”

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