NATURE’S CURE OF PHTHISIS.

Dr. Henry P. Loomis states (Med. Rec.) that he has found quite a number of cases of recovery from phthisis. His summary is as follows:

1. Out of 763 persons dying of a non-tubercular disease seventy-one, or over nine per cent., at some time in their life had phthisis, from which they had recovered.

2. The new fibrous tissue by which the advance of the disease was apparently checked and the cure effected, developed principally by round-cell infiltration of the interlobular connective tissue, which in some instances had increased to an enormous extent. Some of the new fibrous tissue was formed later by round-cell infiltration in the alveolar walls and around the blood-vessels and bronchi. Pleuritic fibrosis appears to be secondary to tubercular processes in the lung substance. The interlobular connective tissue is the primary and principal source of the fibrosis.

3. Tubercle bacilli were present in the healed areas in three out of twelve of the lungs examined. These healed areas did not differ in their gross or microscopical appearances from those in which they were not found.

4. Thirty-six per cent. of all cases where the lungs were free from disease showed localized or general adhesions of the two surfaces of the pleura.

VENTRO-FIXATION OF THE UTERUS.

Dr. Spaeth, of Hamburg, according to the Lancet, has now published reports of twenty-five cases in which he has performed the operation known as ‘ventro-fixation of the uterus.’ None of the cases proved fatal. In seventeen permanent anteflexion was obtained; in fourteen there was, besides the retroflexion, a diseased condition of the uterine appendages necessitating their removal. Of the cases that were not so complicated all except one were successful. Dr. Spaeth rarely fastens the stump of the broad ligament into the abdominal wound, usually stitching the fundus uteri directly to the parietal peritoneum. In the later cases he adopted Schede’s method—that is to say, silver sutures were drawn through the whole thickness of the abdominal walls at intervals of about an inch and a half, but they were not at first tied. In the intervals finer silver sutures were inserted through the sheaths of the recti, the peritoneum and the fundus uteri, and tightened, twisted, and cut short, the whole of course being beneath the skin; the thicker sutures were then tightened and twisted and the lips of the wound brought together with superficial catgut sutures. The subcutaneous silver sutures remained, but never gave any trouble. Dr. Schede and Dr. Spaeth are both of opinion that this method is the best for preventing any hernia, and that when it has been employed abdominal binders are unnecessary. Dr. Spaeth does not perform or recommend ventro-fixation in cases of retroflexion unless there is either disease of the appendages or chronic peritonitis.

PNEUMONIA.

Croupous pneumonia has during recent times been defined as “an infectious disease characterized by inflammation of the lungs and constitutional disturbance of varying intensity.”

The recognition of an infection as a cause of this disease necessarily implies the existence of a specific germ, and as corollary we may state that this germ, like all germs, has a limited existence.

During the cause of the inflammation three stages have been recognized—congestion, red hepatization, and gray hepatization. Now, on a physician being called to a case of this kind, the query is, what is the best thing to do in the way of medical treatment?

If one consults some of his associates he will find remedies recommended ad nauseam. One declares the fever does no harm, while another is not satisfied unless one of the chemical antipyretics keeps the temperature near the normal standard.

Varying results, of course, follow these different treatments.

Having for a long time accepted and practised the doctrine that many diseases can be modified and conducted to a safe issue by giving a remedy that will attack the diseased cell-function, I have treated my cases of pneumonia in this way. The three remedies that I employ are aconite, bryonia and iodine. If I am called to see a patient during the first stage I give aconite and iodide of potassium, and on the development of the second stage I continue the iodide and also give bryonia. The aconite is given with a view of relieving the vaso-motor tension, and thereby equalizing the circulation; this, if doing nothing more, produces a measure of comfort. The last two remedies are given for their local effect. Now, as to a dose: in a half goblet of water I put ten drops of tincture of aconite, and in another goblet containing same quantity of water I put five grains of iodide of potassium, and give a teaspoonful alternately every hour. As soon as the second stage comes on I substitute five drops of tincture of bryonia for the aconite and continue to give in alternation with the iodide. If the heart becomes weak give one-fourth of a grain of extract of nux vomica every three or four hours. If the patient has much pain, hot applications are used. This with suitable food constitutes a treatment that bears excellent results. The physician who believes in giving large doses of quinine, ammonia, etc., will sneer at these small doses and hotly declare that nature cures independently of the drugs. In view of this declaration there is a compliment paid to vis medicatrix naturÆ that the writer recognizes, and to have such an ally is certainly a desirable help. Those who have faith in heroic dosage are not always mindful of this fact, nor yet of the condition which obtains under their hands, and that is a state of drug disturbance plus the disease. Nature here is hindered, not assisted.

DRUG ACTION.

Chemistry makes such rapid strides of late that it is impossible for the medical man in ordinary practice to keep pace with it. We have ptomaines and leucomaines, and in the literature of the journals these two terms are used indiscriminately, which is unfortunate, as tending to create confusion. While ptomaines are those alkaloidal products of metabolism belonging to the cadaver, or to any dead organism, whether animal or vegetable, the term is now applied to the same products in living tissues and which really are not ptomaines, but leucomaines. Chemically speaking, both ptomaines and leucomaines exist in the forms of monamines, diamines, and triamines, and have hitherto been regarded as resulting from the oxidation of ammonium salts by abstraction of water or from acids by substitution of amidogen. Yet the bacteriologists assure us that they are the secretions, or rather excretions, of bacteria, just in the same way that the strata of non-igneous rocks of the earth are formed primarily by the secretion, and secondarily by the excretion, of calcareous shells of diatoms, or of the cretaceous shells of those protozoans entitled rhizapods. Elsewhere in the Summary I have expressed myself to this effect in nearly the same language, and while it may seem pedantic, it should be borne in mind that this is the age of terminology.

We, each of us, have our special ties—shall I say hobbies? One of us making the eye a specially will make use of ophthalmological terms. Another turns his attention to the technology of animal tissues, and still another, with an eye towards the bacteriological existences, leads us into a labyrinth of Greek and Latin technics.

We are talking of ptomaines and leucomaines, and that their existence is probably due to bacteria. These are regarded as toxines, and certain diseases are said to be caused by these toxines, and not from the bacteria themselves directly, but indirectly. I appreciate the idea that the curative results of these diseases are due to the antagonism of the remedies to these toxines, and not to the destruction of the bacteria. Before we inquire into the curative action of remedies we must first find out how these toxines produce disease. The tendency is to trace the origin of all disease to a change in the protoplasmic cells. This change is evidently due to a toxine. A healthy physiological change in the cells may be termed metabolism, while an unhealthy or pathological change may be termed katabolism. The question arises, in what way does katabolism arise from these toxines? It occurs to me that it must be due to chemical affinity, or as it is sometimes very properly called, chemism.

In a brief but very excellent article on therapeutic action by Dr. Thomas J. Mays, of Philadelphia, in the American Therapist, he commences thus: “Every phenomenon in nature becomes intelligible only when considered in the light of force. Any scientific system of therapeutics must therefore be built on a broader basis than that of the mere drug action on the animal economy.” In this he is unquestionably correct; but when he, along with others, asserts that drug action is due to what is termed “interference,” to me, at least, he becomes unintelligible. I am utterly unable to take in the idea. When he refers it to molecular motion, which, after all, is chemical change, he is right. Heat, light, electricity, motion—each interchangeable, correlating with each other, constituting force—must be the source of all chemical action. These are, strictly speaking, proteodynamics. They act, as I have indicated, upon the cell. This action may be either metabolic or katabolic, and when the remedial agent is presented the change results. So true is this that the vis vitÆ itself results from chemism, so that every action, every change, has simply two factors—matter and dynamism.

In this connection permit me to make the following quotation from the Medical News: “Of course, it had been recognized that certain diseases are self-limited, and the phenomena of natural and acquired immunity were duly appreciated; but it required the knowledge gained by the advances in bacteriology to afford a rational explanation of these phenomena. There is yet much to learn. The beginning has but been made. Enough, however, has been seen to teach that disease has its chemistry, and that the treatment of the future will depend upon a knowledge of this fact and the application of chemic laws.”

The progressive physician does not believe that medicines cure. It is true he uses the word just as we say the sun rises and sets when we know that it does neither the one or the other, but that the phenomena are due to the revolution of the earth on its axis. The cell function is the building function, you may call it metabolism or anabolism. It is either a building or a repairing process. Now derange the process by means of toxines, and you have what may be called katabolism. The molecules are disorganized, the tissues become disorganized, and the result is impaired function. A remedy reaches the part; among the molecules of the remedy and the molecules of the protoplasmic cells chemism takes place; the toxine is antagonized, antidoted, neutralized, changed, and the metabolic process is established. This is the natural physiological process, and a healthy action results; and herein I have thought may be the secret of the action of minute doses. I will illustrate. In the chemical laboratory you have a combination of mercuric sulphate with about four-fifths its weight of chloride of sodium; and heating in a test-tube the result is mercuric chloride (HgCl{_2}), or corrosive sublimate. Repeat the experiment by using mercurous sulphate, with about a third of its weight of chloride of sodium, applying heat, and you have mercurous chloride (HgCl), calomel. Here by diminishing the amount of chlorine in one of the experiments you have quite a different result, due to quantivalence. Why, then, if the process of katabolism be chemical, may not a result be altogether different among the atoms of the molecules of the cells and of the medicine, in accordance with the law of definite proportions? If quantivalence exists among chemical radicals, why may it not exist among organic radicals?

DIGESTIVE LEUCOCYTOSIS.

Many investigators, seeking after an explanation of the methods by which nutritive material is carried from the alimentary tract to the different tissues and organs of the body, have called attention to the possible importance of the white corpuscles in the assimilation of food-stuffs, citing the fact that in a well nourished carnivorous animal there is a marked production of new cells in the lymph spaces of the intestinal mucous membrane after the ingestion of food, the extent of said production being apparently dependent upon the amount of assimilable elements contained in the food. It has been further supposed that this increased production of lymph cells is followed by a corresponding increase in the passage of leucocytes into the blood, mainly on the ground that only a comparatively few of the cells could have any local action in aiding the nutrition of the intestinal walls. There has been, however, a lack of positive proof of these assumptions until Pohl,^[2] in his studies on the absorption and assimilation of food-stuffs, took up the matter experimentally, and sought to obtain some positive data bearing on the question. This investigator made a careful study of the physiological variations in the content of leucocytes in dog’s blood, using young animals and feeding them only one meal a day. The leucocytes were counted after Thoma’s method, preliminary experiments showing that there was very little difference in the number of white cells contained in a given volume of arterial or venous blood. Thus, in the case of a fasting animal, blood taken from the jugular vein contained 16,378 white corpuscles per cubic millimeter, while blood from the carotid artery of the same side contained 15,449 white cells per cubic millimeter. Further, from a well-fed animal, whose blood was examined during digestion, similar results were obtained, i. e., 27,036 from the jugular vein, and 26,866 from the carotid, thus showing that blood from the capillaries of either veins or arteries would give essentially the same results.

A single experiment, illustrative of the many reported by Pohl, may be given here, as showing the marked effect of food upon the number of white corpuscles in the circulating blood:

About thirty distinct experiments were tried on ten different animals, with only two or three negative results to fifty positive ones. The results, taken collectively, plainly indicate that the increase in the number of leucocytes in the circulating blood, after the ingestion of food, is very marked, the maximal increase being 146 per cent., while the average increase amounted to 78 per cent. This, as Pohl states, would indicate for the total content of blood in an animal an increase in some cases of 1,000,000,000 of leucocytes. Control experiments showed that, normally, there were only comparatively small variations in the content of leucocytes in the blood, from hour to hour, in the absence of food. It is to be further observed that this marked increase in the number of white corpuscles in the circulating blood, after the ingestion of food, usually reaches its maximum in the third hour, viz.: at a time when digestion would most probably have reached its height, no noticeable change being usually observed before the end of the first hour after the taking of food. Evidently, some transformation-products of the ingested food must be formed before leucocytosis becomes marked. The return to the normal number of leucocytes shows no regularity; in some cases being very gradual, in others quite rapid.

This marked action of food in increasing the number of leucocytes in the circulating blood, naturally raises the question whether all varieties of food possess this power, or whether it is limited to some one or more individual food-stuffs. In attempting to answer this question, Pohl tried a large number of experiments, the results of which afforded proof that neither water, salts, fats, carbohydrates, or even meat extracts, are able to materially affect the number of leucocytes in the blood. Proteid-containing foods, on the other hand, such as meat, Witte’s peptone, and gelatin peptone quickly raise the content of white blood corpuscles to a marked degree. Somewhat noticeable was the result obtained on feeding wheat bread. This food-stuff, in spite of its fairly large content of proteid matter, failed to exert any influence on the number of leucocytes in the blood, and in conformity with this result it was found that in herbivorous animals there was an utter lack of anything approaching a digestive leucocytosis, even after protracted fasting.

In attempting to explain the cause of this increase in the number of leucocytes in the circulating blood, after the ingestion of proteid food, we are at once confronted with the possibility of this apparent increase being relative rather than absolute; as possibly due to a loss of water from the blood, incidental to the marked outpouring of digestive juices accompanying digestive proteolosis. For this view, however, there is very little support. In the first place, the blood would need to become very much thickened by loss of water to account for the increased number of leucocytes observed in the experiments. Furthermore, we know that the outpouring of watery secretions into the intestine during digestion is accompanied by an absorptive current in the opposite direction, which would tend to counteract any tendency towards concentration of the blood, and, indeed, might lead in many cases to a direct dilution of this fluid. Again, if the increase in the number of white corpuscles is to be explained in this manner, there should be a corresponding increase in the number of red blood corpuscles. As a matter of fact, Pohl’s results show that those conditions of diet tending to increase the number of white blood corpuscles are without any noticeable effect on the red corpuscles. Abstraction of water can not, therefore, be the cause of the large number of leucocytes contained in the blood after a proteid diet. Much more plausible is the view that the increase is due to a more rapid transference of the corpuscles from their point of origin, viz.: from the intestine and from the lymph glands of the mesentery, to the blood. In other words, it seems probable that digestive proteolysis in the stomach and intestine is followed or accompanied by a rapid production of new cells in the lymph spaces surrounding the intestine. If this view is correct, there should be a much larger number of leucocytes in the blood and lymph flowing from the intestine, in an animal in full digestion, than in the arterial blood coming to the intestinal tract. That such is the case is shown by the following experiment taken from the many reported by Pohl:

Dog weighing 3,330 Grams, in Good Digestion.

A.M.

8.50.

Blood from skin contained 8,330 white corpuscles in cubic mm.

9.10.

Blood from skin contained 9,618 white corpuscles in cubic mm.

120 grams meat and 20 c. c. water fed.

10.40.

Blood from the skin contained 15,092 white corpuscles in cubic mm.

10.55.

Body opened, several loops made with the small intestine, and blood withdrawn from vein and artery without any great loss of blood.

White Corpuscles in Cubic mm. Blood.

1.

Intestinal loop. 11.35 A. M., venous blood contained 17,077.

11.39 A. M., arterial blood contained 7,649.

2.

Intestinal loop. 11.40 A. M., venous blood contained 15,033.

11.40 A. M., arterial blood contained 7,061.

The facts would thus seem to warrant the assertion that, as a rule, the venous blood flowing from the intestinal tract of an animal, fed on a rich proteid diet, contains a much larger number of leucocytes than the arterial blood flowing to the intestine; although, if space permitted, we might instance certain occasional exceptions due to various causes, which, however, do not reflect against the view that there is a marked production of leucocytes in the lymph spaces surrounding the intestine, and in the lymph glands of the mesentery, as a normal accompaniment to digestive proteolysis.

Taking into account all of the circumstances attending the circulation of the blood through the abdominal organs, especially the rate of flow, and remembering the great increase in the number of leucocytes contained in the blood during the several hours attending digestive proteolysis, it is plain that a comparatively large amount of proteid matter must be transferred from the intestine to the blood in the bodies of the white corpuscles so abundantly produced in the lymph glands, etc., during proteid digestion. Indeed, Pohl calculates, on the basis of his own and the observations of others, that in the case of an animal weighing 5 kilograms, and fed with 100 grams of fresh beef, containing 20 grams of proteid matter, the entire amount of albumin required to supply the loss incidental to the normal physiological processes of the body could be absorbed into the circulation from the intestine in the form of leucocytes, assuming a digestive period of six hours. Moreover, the evidence acquired from Pohl’s experiments of the enormous production of new cells in the intestinal walls during the height of digestion renders such a theory of the transference of proteid matter from the alimentary tract to the tissues and fluids of the body quite plausible. At the end of twenty-four hours the leucocytes have fallen back to their normal number, having presumably been broken down in the blood-plasma or dissolved in the tissues and organs, thus giving up the proteid matter, of which they are composed, for the general nourishment of the body. Obviously, we can not admit that all the proteid matter of the food is absorbed in the form of leucocytes, for, as we know, some at least of the proteid food ingested is carried beyond the peptone stage, either through the action of trypsin, or through the action of the organized germs in the intestine, but we can certainly accept the views so admirably worked out by Pohl, in so far as they indicate one way in which proteid matter may pass from the intestine into the blood, after having undergone a preliminary transformation in the alimentary tract into primary albumoses and peptone. Again, if Pohl’s views are correct, we see that the proteid foods are quickly transformed into organized material in the body of the lymph cell prior to their absorption into the blood, a view which is in harmony with the long-known fact that peptone and other products of digestion can not be detected, in any quantity, at least, in the blood of the portal vein, even after the ingestion of a diet rich in proteids. As has been frequently stated in the past, the products of proteolytic action are transformed in the very act of absorption, presumably through the activity of the epithelial cells of the villi, and we may now assume, in the light of Pohl’s results, that this transformation may be due in part, at least, to the upbuilding of the ordinary products of digestion into the living protoplasm of the white corpuscles in the intestinal walls, and in this form as organized albumin circulated through the body.