presence 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 present, it is enough for clinical purposes that we know the fact of its existence. In some diabetic patients we will have a peculiar form of cataract, known as diabetic cataract; I do not note any such condition here. Acute phthisis not infrequently occurs in the course of diabetes, and in this way many cases find their termination; there is the socalled "diabetic consumption." The that it is necessary to drink very large quan- Now, as in the first case, what I more particularly desire is to call your attention to the 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 grapesugar, so that in suitable cases the skim-milk treatment can be satisfactorily used. All fruits containing sugar must be avoided. Now as to drugs, there are certain mineral waters that are extremely good, for example, the alkaline mineral waters of Wisconsin. In France and Germany the Vichy water has a great reputation, and every year at the Vichy springs are to be seen many diabetics. The Carlsbad cure is greatly in vogue in Germany. Now, in this country, we have some springs that are very similar to it, only that they are not quite so rich. The Bethesda water of Wisconsin and the alkaline springs of Michi trition, and when the patient is thin and anæmic, we should give cod-liver oil, which is important both as a drug and as an aliment. Neuralgia.-Here is a case of neuralgia of the face and head, extending around to the spine, in a young lady who is decidedly anæmic, and has disorders of digestion. Such a complexus of symptoms is very common; you will meet such cases every day. This woman leads a sedentary life, working indoors with her needle. She has a poor appetite, and lives chiefly on bread and butter and tea, and starchy food. As a result of the confinement, improper food, poor digestion, and faulty assimilation, her nervous system becomes anæ are adding hygiene to the curriculum, how the popular wave is at last in matters of prevention, you all are conversant. Surely this grand determination to fight disease, meeting it more than half way, is the glory of the nineteenth century. Do not imagine, gentlemen, that hygiene is alone for the well man. It is also the sickroom science. mic, and she suffers from neuralgia; she has | Boards are forming, how college authorities what we have spoken of, "neurasthenia." The pain here is mostly located in the fifth nerve and its branches. Now, how can we benefit such a case? The most important indication is to procure a change of occupation, to substitute an active, out-door life, for this sedentary, in-door existence. Then we must exclude the starchy and saccharine articles from her diet, and forbid the use of tea and coffee. She must have nitrogenized food, such as milk, eggs, and meat. I do assure you, that the hygienic management of such a case is of prime importance. For drugs we will use iron, quinine, or the triple phosphates of iron, quinine and strychnia, or cod-liver oil. But the chief reliance must be placed upon the regulation of the diet. OXYGEN IN THERAPEUTICS. GE BY C. C. VANDERBECK, M.D., PH.D., Lecturer on Hygiene, Medico-Chirurgical College, Philadelphia. ENTLEMEN: You ask me what relation does hygiene bear to clinical medicine? Are they in conflict? Is a sanitarian outside the pale of the regular profession? Can he with conscience use drug treatment? There is no conflict between the two great departments of practical medicine. The one is an aid to the other. A true physician will not abjure the one and cling to the other; he gathers from all sources, from the earth, below the earth, above the earth, from all philosophies and pathies; he uses all that is proven of value to suffering humanity; he is not restricted to a narrow basis of action, claiming no peculiar appellation; he is simply, grandly an M.D.-a doctorem in arte medendi. It must be admitted the profession has looked with a jealous and suspicious eye on the advances of sanitary science. Hygiene has been a favorite cloak for many a rampant empiric, and numerous one-sided medical systems, but, by the rapid advances of the true science, with a goodly number of brilliant victories, under world-wide known leadership, it is coming about that each year it is better recognized and more warmly welcomed to the fellowship of the regular schools and systems. It may be making a departure from the usual orthodoxy, when I now call your attention to a hygienic therapeutic agent much neglected. My mind is convinced of the great truth embodied in Dr. Wallian's generalization: "From the same agencies and elements which nourish, encompass, and sustain us in health, must we at last seek remedies through which to recover lost physical status." Is it not true that every vital process, construction, maintenance, repair, disintegration is accomplished directly or indirectly through the vital agency of oxygen? Is it not, as Wallian says, the rush to Europe, the numerous watering-places, and the mountains, essentially an unconscious hunt for this oxygen? When in my lectures we studied the many sources of contamination of our air, the evil influence of many occupations, of cramped positions of confining business, was it not all a variation on the theme oxygen? When physiology teaches us that "we must inspire this gas with every breath, drink it with every draught, move in it at every step, and live immersed in it as a perpetual bath, or perish, do we wonder that preventive medicine deals so largely with ventilation and air contamination? When the same science tells us that 12,500 gallons of air is required to supply the lungs of an average adult for twenty-four hours, that 2500 gallons of this is oxygen; therefore, about 100 gallons of pure oxygen is required each hour to supply the requirements of a healthy adult organism, is it any wonder that the pathologist and etiologist claim that vitiated atmospheres are among the most potent and widespread of all the predisposing causes of disease, though the effects may not be sudden, causing no pain or discomfort for a time, but slowly and imperceptibly cumulative and tending ever downward in stamina, and toward disease and premature At my graduation, March, 1872, there was The studies in the newer fields of germ disor lectureships of hygiene. How rapidly State eases seem to confirm our previous opinion, that bad air is the culture-fluid of all zymotic | chemical knowledge prevailing at the time, it and germ-engendering disease the world over. And this has led naturally to the conclusion that the original and only unobjectionable and universally efficient antiseptic is pure oxygen. Are we not, gentlemen, robbed of a due proportion of this wonderful gas all along the devious path from the cradle to the grave? While being firmly convinced of the great need of purer air for all men, women, and children in all their duties of life, by day and by night, let us pass to the consideration of using oxygen as a method of treatment, or, at least, as a useful adjuvant to our therapeutics. History of Oxygen in Therapeutics.-I do not propose to give an exhaustive résumé. My object is attained when you see that this subject is not strictly new, and that a considerable amount of clinical facts by prime observers are on record. History of its Therapeutic use." As early as 1772, Marching Poullé, of Montpellier, and in 1774, Girtanner and Stoll, of Germany, attempted the use of oxygen gas in the treatment of diseases, with what results does not appear. The first reported case, of which any definite record remains, in which this agent was used, was treated by Caillens, in 1783. In the following year, Jurine, of Geneva, published a short essay on the subject, and reported a case of phthisis in a young lady very much benefited by oxygen. "The next record is by Chaptal, of Montpellier, who, in 1789, reported two cases of phthisis treated by the same agent, in one of which marked relief was obtained, while in the other the results were negative. "To Beddoes, more than to any other, belongs the credit of having called the attention of the profession in England to the medical use of the gas. His experiments were conducted on an extensive scale, and with a perseverance and enthusiasm worthy of a more practical success and a better recognition than he secured. "Other names occurring in connection with early experiments with the gas as a remedy, are those of Priestley, its co-discoverer, Lavoisier, Barthollet, Spallanzani, Thornton, Hill, Cavallo, Erichsen, Demarquay, and others. Sir Humphry Davy also materially assisted Beddoes in his chemical manipulations. The latter was a practitioner of note, and also Professor of Chemistry at Oxford. is fairly remarkable that any encouraging results were attained. To illustrate, Beddoes and his confrères procured their gas from an oxide of mercury, through what would now be deemed a crude and bungling process. The purification of the gas was so imperfectly accomplished that in some instances pytalism ensued, and the treatment had to be suspended to prevent mercurial poisoning. "The methods of exhibiting the remedy were also very imperfect, the patients being caused to remain for some time in closed rooms, the atmosphere of which had been previously impregnated with the desired gas. Thus the sufferer was caused to sit in and inhale an atmosphere, which, already tainted by an impure gas, was being constantly further contaminated by his own, perhaps fetid, exhalations, and having no way by which it could be definitely regulated or renewed."-WALLIAN. Dr. Busch, writing in 1857, says he has employed oxygen gas in his practice for some time and with most encouraging results. In the Lancet, 1858, Dr. C. R. Francis writes in laudatory terms of the use of oxygen inhalations in a case of scarlatina with putrid sore throat. His case presented livid countenance, coma, and almost imperceptible wrist-pulse. Oxygen was given six times in the space of two days, keeping the patient alive, giving an opportunity for other medicine to act, and with a final cure. He remarks, in this case there was simply a tendency to extinction of life from the noxious poison, and in just such cases great benefit may be expected from the use of this gas. In 1866, the American Medical Times reports a case of dyspnoea from cardiac disease, at the New York Hospital, greatly relieved by oxygen inhalation. Perhaps the best plan to further study this subject, is to group under certain diseases what I have been able to find concerning their treatment by inhalation of this gas. Anæmia." Everybody knows how difficult it is sometimes to get some much enfeebled chlorotic patients to take reparatory aliment, so great is their disgust for all azotized aliment, vomiting often ensuing when they attempt to eat meat. Some women live upon a little bread and salad, and the quantity of urea they eliminate is then very small, sometimes as little as from four to six grammes in twenty-four "Considering the extremely crude state of hours. In such women treatment becomes very difficult, it being nearly impossible to reproduce appetite in them. In these cases, Dr. Hayem, of the St. Antoine Hospital, Paris, employs a means which has furnished the most excellent results, and which consists in the daily inhalation of oxygen. The appetite soon returns, the vomiting disappearing at the same time; and so well do the patients then support azotized aliments, that the four regular portions' of the hospital diet scale become insufficient."-Med. and Surg. Reporter. Ringer sanctions the use of oxygen in success was marvellous. The other cases were anæmia. | but about the middle of September the author considered him to be definitely cured, the number of red corpuscles having returned to the normal."-Med. and Surg. Reporter. Dr. Buttles, of New York, reports in the New York Medical Journal three cases of anæmia successfully, and in one case brilliantly treated by this means. Oxygen inhalations have also been found serviceable in relieving and curing or assisting in curing anæmia, as well as dyspnoea, diphtheria, asthma, and croup. Beddoes says in essential anæmia, chlorosis, anæmia of convalescents, of newly-delivered females, or from hemorrhage, fatigue, and prolonged suppuration, oxygen gives most grateful results. In obstinate anorexia, it is one of the best means of stimulating the appetite. Dr. Andrew Smith, New York Med. Record, 1871, says oxygen inhalation causes an average of nine beats less in the heart. It acts upon the blood in such a way as to facilitate its flow through the capillaries. Asthma.-M. Demarquay reports three asthmatics treated with oxygen. In one case the complicated with emphysema and suffocating catarrh; in these the inhalation effected an amelioration of the symptoms. Albuminuria.-Eckert has seen albuminuria cease under the influence of the inhalations. Dr. Paul, of France, reports a case in which the albumen disappeared, but afterwards reappeared and carried off the patient. Asphyxia.-Dr. Wallian formulates from a paper by Layssel, the following: "Ist. In certain cases of poisoning, viz., by chloroform, ether, chloral, opium, sulphide of hydrogen, carbonic oxide and hydrocyanic. acid, oxygen is the only means of preserving life after all other means have failed. It "2d. Its presence in the operating room would be an infallible safeguard against fatal accidents from the use of anaesthetics. promptly restores sensibility and eliminates narcosis in all such cases. "3d. It offers the best prospects for success asphyxia from strangulation, drowning, poisonous gases, etc., as also in cases of suspended vitality in the new born. “4th. It will almost surely sustain life in all cases in which respiration has not entirely ceased, even if the intervals between inspirations be very great, provided it be persistently exhibited. "As a means of stimulating retarded tissue metamorphosis, inhalations of oxygen promise much. The Deutsche Med. Wochensch., of October 10th, contains the substance of a lecture given by Dr. Kirnberger in the Medical Society at Mayence, on the treatment of leukæmia and pseudo-leukæmia, in which he sug-in gests the inhalation of oxygen as a means of obviating the retarded tissue-metamorphosis which is characteristic of this disease. He cites a case in which he employed this treatment with good results. The patient, a boy aged ten and a half years, who had been treated with iron, arsenic, and quinine without any benefit, improving greatly, and finally becoming cured after the inhalation of oxygen, combined with arsenic, internally. The boy had reached a condition of extreme weakness, being entirely confined to bed, with loss of appetite and tendency to vomiting; the spleen considerably enlarged, and white and red blood corpuscles in the proportion of one to ninety. The treatment began in December, 1882, and after a daily inhalation of about thirty litres, the boy could leave his bed in ten days, and could go to school about the end of February. Some variations in his condition occurred from time to time; "5th. If cardiac and respiratory action have been absent for but a short time, resuscitation is often possible through the use of oxygen; and this agent should be perseveringly used in all such cases, even when appearances indicate that all efforts will prove useless. Cases have been frequently reported of drowned persons and apparently stillborn children being fairly raised from the dead by persistent endeavors with oxygen. 6th. There is no contra-indication of the gas in any case of asphyxia. "7th. The gas can be respired in notable quantities without the slightest injury. Dr. Paul reports a case of laudanum poison- | the details of the work. The best and cheapest ing, and three cases of suffocation from charcoal fumes saved by oxygen inhalations. Demarquay, Duory, and Ozanam consider oxygen the antidote for all the asphyxias. Duory and Ozanam insist upon the use of oxygen for relief in cases of overaction of an anæsthetic. Professor Jackson, of the University of Pennsylvania, also advised such use of [To be continued in April number.] the gas. ORIGINAL COMMUNICATIONS. THE COLLECTION, REMOVAL, BY E. L. B. GODFREY, M.D., results would probably be obtained by making the collection and disposal of garbage a branch of the street-cleaning service, under the direct control of a superintendent. He should be responsible either to the executive, legislative, or health authorities, and should be furnished with all the force and all the appliances needful for the performance of his duty at the expense of the city. Under such circumstances, an intelligent supervision would soon establish the needs for thorough scavengering, and probably obtain a sufficient revenue from the sale of garbage, to sensibly diminish the expense of its collection and removal. Such a system is in vogue in Boston, and enough money is realized from the sale of properly collected garbage to pay about one-half the expense of its collection and removal. The scavenger department of Boston is provided with horses, carts, drivers, and helpers at the expense of the city. The men are required to enter yards and houses, and carry out ash and garbage receivers, and, after emptying their contents into the cart, to return the receivers to their proper places. When the cart is filled, the garbage is immediately taken to regular depots, of which there are four in the city, dumped upon raised platforms, and sold to farmers as food for swine. It is required that the collections of the day be disposed of before night. The carts are built by the city especially for the service, and when leakage occurs while passing through the streets, the fact. is immediately reported by the police to the proper authorities. When no offal is found at inhabited dwellings, the case is reported to the Board of Health for investigation. The Boston method is a decided improvement over the methods of those cities which require ash barrels and garbage vessels to be placed upon the sidewalk to await the arrival of the scavenger, and after being emptied to be left in a damaged state when found. Such a measure is equally inconvenient to housekeep THE are HE removal of filth by sewerage has been thoroughly studied and amply provided for in most cities. But the methods and appliances for the collection, removal, and disposal of garbage, ashes, street dirt, etc., have not received in some of the smaller cities the attention their importance demands. The subject, therefore, is one of serious concern to health authorities, because of its direct bearing on individual and public welfare. Public health and enterprise unite in requiring thorough scavengering, and, therefore, only the means to be employed remain to be considered. The supervision of the work either devolves directly upon the municipal authorities, or is by them given out into contracts. The former method is the better, because the work can be more thoroughly systematized, and infractions of sanitary laws more quickly remedied. Under the contract system, the contractor is apt to look more closely to the financial terms of his contract than to the public health, and, therefore, the work is rarely done (whether in the collection, removal, or disposal) in a satisfac-ers, and unsightly to foot-passengers. tory manner. On the other hand, there should not be a division of responsibility among city authorities; for under such circumstances, the best results are not easily obtained. Neither should a work of such importance be in charge of a committee, who do not control either the appropriation, expenditure, or the force to be employed, and who, moreover, are not in office for a sufficient length of time to master As to the collection of garbage, laws addressed both to the housekeeper and the scavenger would assist matters very materially. Each should have their special duties, the fulfilment of which would facilitate the efforts of both. The dry refuse of the kitchen should be kept apart from ordinary garbage. They should be placed in separate vessels, and collected separately. The throwing together of "slops," |
