Part 2

2d Method.—A piece of excised living intestine is placed in a suitable apparatus to keep it moist and warm, and artificial circulation is established by a canula in the artery, connected with two flasks, as seen in the drawing copied from Brunton (Fig. 8), in one of which is pure blood and in the other the poisoned blood, arranged so that either can be turned on at will. The peristalsis is recorded by the lever, shown in the drawing. In this way Ludwig and Salvioli studied the action of a number of drugs.

ACTIONS OF CATHARTICS IN DISEASE.

Cathartics are not only of use to remove feces, but owing to the physiological relation of the intestinal tract to the other organs, they are often of great service in a number of different pathological conditions. With a knowledge of their mode of action we can select on a rational basis the proper cathartic for the different indications.

Cathartics are indicated:

(1) _To remove dropsical effusions._ In disease of the liver, heart, kidneys, etc., there are sometimes accumulations of serum in the serous cavities and subcutaneous cellular tissue. For this purpose those which stimulate secretion and cause a profuse watery discharge are best suited. When the effusion is due to obstruction in the liver so that the serum leaks from the congested postal vessels, they are most prompt in action, because they drain the water from the postal vessels and lower the high portal pressure. Magnesium sulphate, elaterium, and gamboge are efficient here.

(2) _To remove urea, etc., from the blood._ Sometimes the kidneys are so diseased that they cannot excrete the waste matter from the body, and its action, when abnormally accumulated, causes serious symptoms. For this purpose use those which cause watery stools, so as to wash the waste out through this channel. If the case is urgent as in uremic convulsions or coma, croton oil is the best to use, because it can be dropped on the tongue and does not have to be swallowed, and, besides, acts in an hour or two. As it is a violent irritant, it should not be continued.

(3) _To lower high systemic pressure._ High arterial tension often increases the disease as sometimes occurs in cerebral hemorrhage, in meningitis, and at the beginning of many acute diseases. Those drugs are of use which cause great dilatation of the intestinal vessels, draining the blood from the other organs, or which cause a profuse watery discharge from the blood. In this way croton oil is of use in cerebral hemorrhage, calomel in meningitis, etc.

(4) _To depress the liver when it is excessively active._ In that condition known as “biliousness,” where there is congestion of the liver, and enormous quantities of bile are poured into the intestine, chologogue cathartics are needed, because they remove all this bile from the duodenum, and give the over-active liver rest.

(5) _To deplete the mucous membrane in gastro-duodenitis._ When persons of a certain predisposition over-eat there is congestion or even inflammation of the gastro-intestinal mucous membrane. This extends up the bile-duct, and the swelling occludes it, so that the outflow of bile is obstructed, and soon it diffuses into the blood, and the person becomes jaundiced. The salines, specially sodium salts, are here of use, because they drain away the water without stimulating the mucous membrane, and hence lessen the hyperemia.

(6) _To stimulate the torpid liver._ This is not in biliousness, but when the liver does not secrete bile enough; the patient is constipated, and the stools are too light from lack of bile.

(7) _To remove pathogenetic material from the bowels._ Diarrhea is usually caused by the irritation of toxines formed by the growth of bacteria in the intestinal liquids. In the adult when this is an acute attack, salines are best to wash them out. In the child, when this continues for days, it is better to select those cathartics which are bactericides, so as to kill them, such as calomel and gray powder.

(8) _To remove feces._ This is probably the most common use of cathartics. Those which slightly increase peristalsis and secretion are adapted for this. The drastic purgatives are too strong for this purpose. Among those commonly used are magnesia, sulphur, castor oil, rhubarb, senna, cascara sagrada, jalap, podophyllin, and salines.

(9) _To relieve chronic constipation._ In selecting a cathartic for this purpose we will be guided so far as possible by local conditions. The trouble may be in the small intestine, colon, or rectum. We must decide whether it is due to diminished peristalsis, or secretion, or too rapid absorption. If it is due to a relaxed condition of the muscles of descending colon and rectum, aloes is efficient. If it is due to general relaxation of the intestinal muscles, physostigmine or strychnine may be of use. If there is a diminished secretion or increased absorption the ingestion of more water and foods containing water, as fruits and vegetables, will sometimes be of service.

(10) _To purge the nursing child._

168 S. Halstead St., Chicago.

_UNREGARDED CAUSES OF ILL-HEALTH IN AMERICAN WOMEN._

By JOHN FORD BARBOUR, M. D.

That ill-health is more common amongst American women of the middle and higher classes than amongst the women of other nations is proven by a great many considerations. In the first place, we have the testimony of many eminent physicians on this point. Dr. Austin Flint, Sr., is said to have declared that if things went on as they are now going, in fifty years it would be well-nigh impossible to find a healthy woman of American descent. Numerous articles have appeared in the medical magazines by such writers as Dr. Mary Putnam-Jacobi, Dr. Engelmann, and many others, calling attention to the alarming and increasing prevalence of ill-health among American women. We have in addition the testimony of such close and careful observers as our novelists, Howells and James, which is of even greater value, as coming from laymen, who would naturally not be so quick to notice such things as physicians. Howells speaks of the “typical American girl, never very sick and never very well.” Do we not all know her? And again and again he speaks of her lack of physical development as compared with her European sisters. James, in one of his stories, describes a little girl who comes dashing into the hotel parlor on roller-skates, crying, “Get out of the way.” One can see all too plainly from his description, the typical American little girl, with her weak ankles, her thin, flat chest, her feeble little arms and legs, and her lack of proper parental control. Again, in “_A Bundle of Letters_,” he makes one of his male heroines say: “The types here, excepting myself, are exclusively feminine. We are thin, my dear Harvard; we are pale, we are sharp. There is something meagre about us; our line is wanting in roundness, our composition in richness. The American temperament is represented by two young girls. These young girls are rather curious types. They are cold, slim, sexless; the physique is not generous, not abundant; it is only the drapery that is abundant.”

The bearing of two or three feeble children ought not to make a physical wreck of a woman; but how often do we see this the case? Compare the American mother—with her sick headache, her general physical inefficiency, her everlasting doctors’ and druggists’ bills, and her two or three delicate, bottle-fed children, with the stout, active German or English matron, and her sturdy brood of eight or ten, every one of whom she has nursed at her own breast.

Let the reader take his stand at some fashionable street-corner on a sunny afternoon and notice carefully the women who pass by. Below are given two figures after Lauder Brunton. The first represents the posture of health; the second, the posture of physical degeneracy.

He will find that about seven out of ten of the women who pass him will present the second posture. In addition to this, they will show by their sallow complexions, thin, flat chests, angular figures, and miserable gait, all the evidences of present or impending ill-health. He will hardly find one woman out of ten with bright eyes, a clear complexion, an erect carriage and a firm step.

It is simply impossible for human beings to live as most American women live, and have good health. After a girl puts on long dresses, she is taught that almost any sort of active bodily movement is unladylike. Her frail little body is enveloped in corsets, which effectually prevents the full development of the important trunk-muscles. At school she gets, perhaps, a little make-belief of calisthenics. During her life in society she waltzes with great ardor, it is true, and it is said that to go through all the evolutions of a German is equivalent to a walk of fifteen miles; but no one has ever seriously claimed that this form of exercise is conducive to health. After marrying, the American woman reduces physical exertion to the minimum. Any form of physical labor is regarded by her as menial. If the weather is bad, she will not put her foot out of the house for whole days at a time. If she does go out, often she will take a car to ride two squares.

American women take more drugs than other women. The drug-store is ubiquitous with us. They show increased susceptibility to stimulants and narcotics, sensitiveness of the digestion, increase of near-sightedness and weakness of the eyes, early and rapid decay of the teeth, sensitiveness to heat and cold, tendency to nervous exhaustion etc.

Gynecology and abdominal surgery are American contributions to medical science.

This state of affairs is not limited to any particular section of the United States, but extends from Maine to California, and from Dan even unto Beersheba. It is national in its scope. The fact is that ill-health is so common in our women that we have grown accustomed to it, and have, quite unconsciously, set up a low standard of feminine health. If a woman is habitually constipated, dyspeptic, so weak that she can hardly walk a mile, has one or two headaches every month, irregular and painful menstruation, backache, napeache, cold hands and feet, leucorrhea, capricious appetite, and a moderate degree of nervousness and insomnia, she is considered to possess average good health. If she is free from all these, it is a rare exception, a fortunate accident, not a condition of health to be attained by the exercise of reason and common sense.

What, then, are the causes for ill-health which are peculiar to American women? These may be divided into two classes, _viz._: The unavoidable and the avoidable. Let us briefly survey the unavoidable causes.

By far the most potent of these is our climate, which differs from that of Europe in three respects; it is more variable; the extremes of heat and cold are greater; and the atmosphere is drier.

The reason for the extreme variability of our climate is found in the fact that our mountain chains run north and south, while those of Europe run east and west. In consequence of this, when up in Manitoba Territory King Aeolus reverses his spear and smites upon the side of the mountain, rude Boreas comes whistling down upon us with hardly a moment’s notice, except a hasty telegram from Washington with the familiar announcement that the thermometer will fall forty degrees in the next twenty-four hours. This is followed by nearly as rapid a rise in the temperature.

The extremes of our climate keep us house-bound for a large part of the year, and this is a very potent factor of ill-health. There are few portions of the country where it is agreeable to be out of doors for as many as a hundred days of the year.

The effect of a dry, variable, extreme climate is to stimulate powerfully the nervous system and keep it on the _qui vive_.

The liberty and enlarged scope of thought and action, which American women enjoy, must also be considered as causes of ill-health. How much more nervous energy an active, ambitious, American woman must expend than a German matron, with her placid, narrow life.

There are many other unavoidable causes of ill-health in American women which need not be discussed here; let us rather turn our attention to the more practical consideration of the avoidable causes of ill-health in our women. While there are very many of these, it has seemed to the writer that the following are the principal ones:

1. Lack of general exercise.

2. Lack of specific exercise.

3. Lack of abdominal breathing.

4. Improper modes of dress.

5. Superstition.

As every one is aware, there are three causes for the circulation of the blood.

(_a_) The contraction of the heart;

(_b_) Contraction of the voluntary muscles;

(_c_) The contraction of the diaphragm.

American women attempt to dispense with the last two; they neither take exercise nor do they breathe with the diaphragm. The muscles act precisely like the bulb of a Davidson syringe; when they contract the blood is forced into the veins; when they relax a new supply flows in.

Dubois-Reymond determined by experiment that the minimum amount of exercise, necessary to maintain the circulation, is equivalent to a walk of five miles a day. American women do not average one-fifth of this amount.

The diaphragm acts like the piston of a great pump, rising and falling sixteen times a minute, and pumping the blood out of the abdominal and pelvic cavities. Where its stroke is only one-half or one-third the normal, the amount of blood raised must be correspondingly less. The investigations of Dr. Thos. J. Mays, of Philadelphia, and of Dr. J. H. Kellogg, of Battle Creek, Mich., have shown that women ought to breathe precisely as men do. The thoracic type of respiration in women is entirely artificial, and is not, as physiologists have claimed, a wise provision of nature, having in view the restriction of the movements of the diaphragm during pregnancy.

The second cause assigned for the ill-health of American women is lack of specific exercise. All exercise is not of equal value; exercise of the arms and legs, while of great value, is relatively far less important than exercise of the trunk muscles, for the reason that the circulation through the thoracic, abdominal, and pelvic cavities is dependent upon exercise of the muscles surrounding these cavities. When the trunk muscles are not freely and systematically exercised, the circulation through the lungs and through the abdominal and pelvic organs becomes feeble, and the functions of these organs are imperfectly fulfilled.

We have now arrived at the point where we can trace, step by step, the evolution of ill-health in the American woman. Her undeveloped body is encased in corsets when she is fifteen years old. At school she learns a great many things, but is not taught that in order to have good health she must exercise the muscles of her body, and especially those of the trunk, daily and systematically. After marriage she settles down to a life of physical inactivity; she takes hardly any exercise, and even this little is not taken systematically; she does not breathe with the diaphragm; her circulation becomes feeble, her hands and feet are always cold, the blood accumulates in her abdominal and pelvic cavities, the functions of the abdominal and pelvic viscera are imperfectly carried on; she becomes dyspeptic; her stomach is distended with gas; her liver and intestines are torpid; the waste products of the system are not carried off, but accumulate in the blood. The opinion is constantly gaining ground that most of the functional nervous disturbances in women are due to auto-intoxication.

By-and-by the pelvic organs begin to show signs of disease. When one hears of the daily exploits of the abdominal surgeon, and learns that there is hardly one woman out of five who has not some form of pelvic disturbance, the conviction forces itself upon the mind that surely our women must be grossly violating some fundamental law of health. We have traced out the chain of physical causes which lead inevitably to a stasis in the abdominal and pelvic circulation. As a further result of this stasis there occurs a sagging of the abdominal and pelvic viscera, and as the latter are underneath, they catch the worst of it. Malpositions of the uterus are produced; the power of resistance of the pelvic tissues to invasion by pathogenic microbes is lowered; the tendency to plastic exudations is increased; the resolution of inflammatory processes is very much retarded; and thus the foundation for every variety of pelvic disease is laid.

The last cause assigned for ill-health in American women is superstition—not religious, but pharmaceutical superstition. The sublime faith with which an American woman will continue to swallow nauseous drugs in the belief that they will restore her to health and keep her in health, is only equalled by her faith in cosmetics. Drugs are wonderful things in their place, but it is not possible by any combination of drugs to replace the natural processes of health.

How are we to forestall this most serious of all our national evils, the physical degeneracy of American women? This matter is far too widespread and serious to be rectified by a little Anglomania, a little calisthenics, a little athletic craze. There are far too many women who lead lives that can only be characterized as parasitic; who have no independent existence, but merely cling to life like a polyp to a rock. They generate barely enough nervous energy to eat, drink, sleep, dress, take a great deal of medicine, complain constantly, and finally drop out of life without leaving the slightest vacuum.

The only way to meet this great evil is to introduce physical culture into our schools and make it compulsory. Not until then will our women realize the standard of feminine health as laid down by Walt Whitman:

They are not one jot less than I am, They are tanned in the face by shining suns and blowing winds, Their flesh has the old divine suppleness and strength, They know how to swim, row, ride, wrestle, shoot, run, strike, retreat, advance, resist, defend themselves, They are ultimate in their own right—they are calm, clear, well-possessed of themselves.

Louisville, Ky.

_POSSIBILITIES IN THE THERAPY OF NUX VOMICA._

(_Second Paper._)

By E. MACFARLAN, M. D.

Further clinical observations in the therapy of nux vomica have afforded me an accumulation of evidence of its efficacy in certain and hitherto untried affections of neurotic origin.

CASE I.—Was called, about one year ago, to Mrs. McG., age, 36. Found she had just miscarried at about four months pregnancy. The fetus and placenta had been expelled, but owing to inefficiency of uterine contraction, there was profuse hemorrhage; consequently soon after my arrival I found I had to contend with not only hemorrhage, but a grave case of syncope. Her extremities became cold, and the heart-beat was scarcely perceptible; and surely the case was rapidly becoming one of heart-failure. Quick action was necessary, and I at once concluded to test nux vomica, and proceeded immediately to administer one drop doses of the tincture every five minutes. When the sixth dose had been given the radial pulse-wave could be felt, and the heart-beat distinctly heard. After five more doses the pulse was nearly normal; warmth of body was restored and she was able to converse. Hayden’s viburnum compound brought on good uterine contraction, and I succeeded in controlling the hemorrhage. In a few hours after the first dose of nux vomica I found my patient in such a comfortable condition of reaction that I left for home.

About six months afterward I was called in the early part of the evening to Mrs. McG., who believed she was again pregnant and threatened with miscarriage. She had pain in the back and profuse hemorrhage. I was getting good control of the hemorrhage when syncope set in, and on finding it was becoming protracted and her condition very similar to that for which I had used the nux vomica so successfully, I at once resorted to the same treatment and with the same satisfactory result.—But I must state, she was mistaken as to pregnancy. In the course of that night she passed a very large blood-clot which was the cause of her trouble; it evidently had been accumulating in the uterus through several menstrual periods.

CASE II.—In the fall of 1892, I was called to Rose L., (colored), age, 20. Her symptoms at first were of indigestion and sluggish liver, and congested portal circulation; but on further investigation of the case I discovered considerable tenderness over the left ovary. On the third day of my attendance, contrary to my advice to remain in bed and keep quiet, feeling quite comfortable in the afternoon, and getting permission of her mother, she left her bed to sit in an adjoining room. In the early evening of that day I was sent for in haste to see Rose. I found her in a prolonged state of syncope, and her mother was greatly alarmed, fearful she would die. The patient’s pulse was small, weak and frequent, and counted 112; extremities cold; she was in a semi-conscious state, and when aroused would reply in a whispering voice, but immediately relapse into indifference to her surroundings. It seemed to approach so nearly to a case of heart-failure that I administered nux vomica in my usual way as to dosage and intervals, resulting within an hour in complete restoration of pulse, warmth of body and consciousness, and my patient became quite cheerful and talkative.

CASE III.—C. M., age, 28, had an attack, of acute inflammatory metastatic rheumatism. In the third week of the attack and while the disease was yielding to treatment, he was attacked with an exceedingly troublesome cough, but as he had been confined to his room, and in fact to the bed, by the rheumatism during this time, I was puzzled to account for the cough. Then I began to observe more closely the character of the cough and expectoration. A careful auscultation did not reveal any bronchial inflammation. By closely questioning the patient I found the cough was paroxysmal, and commenced with an annoying tickling in the throat; the cough steadily increased in violence with the return of every paroxysm until it became exhausting, and the patient would feel quite prostrated after each attack. I found also, his most severe paroxysms came on within ten minutes after his evening meal. I accordingly timed my evening visit for observation. I was now satisfied—having watched a paroxysm from beginning to end, which lasted over 30 minutes—that the cough was laryngeal and neurotic.

On examining the sputa it was found glairy and tenacious, and not such as we find in inflammatory conditions of mucous membrane of the air passages. I had given him a mixture which included compound tinct. benzoin and codeine without effect, but now being convinced the affection was of neurotic origin, it occurred to me to make a trial of tincture nux vomica in my one-drop-five-minutes-dosage. I timed my call the next evening so as to be present when the paroxysm of cough commenced. My patient had just finished his evening meal, and we had been conversing hardly ten minutes when the cough set in and rapidly increased in violence, and then came my opportunity for the crucial trial of nux vomica in this case. When I had given the seventh one drop dose the paroxysm began to yield, and by the time we had given the tenth dose it was almost over, the patient having an occasional cough. My patient was very happy over the sudden and unexpected relief afforded by the medicine I had just given him in such small doses, and of course was curious to know what it was. He then told me, these hard paroxysms sometimes lasted up to midnight, and on one occasion it had lasted almost until morning. I left him drops to take in the night in case he should have another paroxysm.