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, 1913

, Vol. VIII

Fig. 2. Case Mrs. T. H. (Osteo-Arthritis) (Rheumatoid Arthritis).

Showing the progressive enlargement of bony growth along the shaft of the phalanges

of the hand. A true periostitis. Also the ankylosis of the distal small joints.

how in our efforts to prevent by medication its further progress, we all too often incapacitate our strongest ally, viz.: the

nutrition.

The picture at this time was of an exhausted woman, reduced in weight to 85 pounds, with a secondary anemia and a hemic murmur, constipation alternating with diarrhea, all of her joints involved, and marked deformities in the hands. In brief, a helpless invalid.

Her temperature ranged at this time from 101-102 deg. at night, with severe sweats necessitating the change of the night gown twice during the night. She would be aroused from sound sleep by a sudden, involuntary twitching of the legs, and at other times was kept awake by a severe basilar headache. At this stage we were at times in grave doubt as to whether we were dealing with a stage of a rheumatism, pure and simple. The doubt was an honest one, but was soon cleared up by the progress of the disease.

The bowels were promptly cleaned out with calomel and daily saline enemas: sponging with tepid water and alcohol every four hours. The affected joints were protected by dressings against temperature changes, and pillowed in cotton. Care was exercised to avoid jarring the bed, and dry heat by electrical pads alternating with hot moist local packs were applied at frequent intervals.

Great benefit was derived in reducing the night sweats by local and general application of hot, wet salt. The salt was rubbed thoroughly over the entire body and allowed to remain there for half an hour and then either removed by tepid sponging or the patient was placed in the tub.

Realizing the uselessness of the salicylates and iodides they were promptly discontinued.

In consultation with Dr. Hayes, we bent every effort to improve the nutrition, choosing foods having the highest caloric value and carefully tabulating them under caloric units.

Under this plan we found she could take from 7'800 to 12'000 calories per week and this is a form most easily digested. Our main effort, was Food, but Food in terms of absorption.

We must bear in mind, that among other things she was suffering from an over zeal of specific drug treatment, that she had just returned from 32 baths at Hot Springs, Arkansas, with her digestive tract entirely incapacitated, and an acute gastritis so severe she could not retain food.

On June 25th, 1911, her weight was 901⁄2 pounds, a gain of 51⁄2 pounds in 6 weeks. We found that even now 12'000 calories per week gave signs of overfeeding, and we kept to the lower figures. By the middle of August her temperature had come to normal, but the pulse continued high, and was affected on the slightest exciting cause. Even with strangers excluded, it continued between 90 and 100. With the abeyance of the temperature, the nervous phenomena subsided. She had fewer periods of depression, less twitching in her sleep, and the occipital headache did not keep her awake at night.

As the acute inflammation in the joints. subsided, the therapeutic lamp and light massage were used. Later we gave her modified mud baths, on the ankles, wrists and hands. These mud baths required careful oversight, as the operators in institutions do not always distinguish between light and strenuous treatment. The menstrual function which was abolished in May did not return for six months, and then in proportion to her general physical gain.

, 1913

, Vol. VIII

Inasmuch as joint cases are most adversely affected by changes in the weather, we advised an absence from New York after October, and not to return until the Spring.

In

The patient reached Colorado Springs, in good condition, and has improved amazingly since her arrival. Her life is spent out of doors, and the same tactful nurse is giving her faithful and enthusiastic support to carrying out the treatment. the nurses report under date of Nov. 22nd, 1911, she writes: "It is gratifying to report continued improvement in Mrs. H's condition. She looks really fat in the face, and her strength has improved remarkably. She has lunched out several times from one until four but has not shown the nervous fatigue, she did after exertion like this, before we left town, or even when we first came. Her feet are much smaller and she wears her high shoes without fatigue. Her intestinal tract, however, needs watching."

A letter under date of Jan. 19th, from the patient's husband further states that her weight is now 1044 pounds, and that she is steadily improving. Fearing the moist conditions in California in December and January, they decided to remain in Colorado Springs until the 29th of January. He says that his wife now prefers the colder weather, and sleeps with her windows open even in zero weather. She can dress her hair, write, sew, and go up and down stairs without assistance,

In the foregoing you have doubtless observed how small a part, medication has played in the improvement of the condi

tion.

I might say that with an idea of helping metabolism and helping out the thyroid deficiency theory, we placed her on five

grains of the thyroid gland three times a day, after meals. As far as we could see after several months careful trial, it made absolutely no difference in her condition.

What did give systemic tone, improving both appetite and digestion was a capsule suggested by Dr. Hayes, consisting of 3 grains each of calcium lactophosphate, and sodium glycerophosphate after meals. She noticed promptly, when it was discontinued. Further benefit was also gained from the administration of mixed fats as soon as the cooler weather permitted it. Salicylates and iodides have done no good. She has omitted all use of alcohol, and her long experience in the foods having the highest caloric values are her present guide in her diet.

With the foregoing history and course of rheumatoid arthritis, I would venture a few remarks, drawn from a careful study of this case:

One cannot be too conservative in arriving at a positive diagnosis, in cases of the rheumatic group. In this instance the mode of onset passed through the suggestive periods of synovitis of the knee, tubercular knee, and possible sarcomatous growth, gout, acute and chronic rheumatism, and finally its ultimate diagnosis acute rheumatoid arthritis.

The severe toxemia accompanying its early stage, with evening temperature, sweating, and cardiac instability, which was evidently of central origin, as evidenced by the spinal involvement, cephalalgia, and muscular twitchings, all pointed to an acute infection. Instead of combating the infection by striving through food and nutrition to increase the opsonic index, iodides were pushed, which in large quantities invariably produce gastric irritation; and likewise salicylates, which in large

doses precipitate the pepsins in the stomach and markedly reduce to Hb. content of the blood. In other words the only means of combating the disease through nutrition and digestion is denied us by the previous excessive use of drugs.

Let me not be misunderstood in giving the impression that iodides and salicylates have no place in rheumatic conditions. In this case we are dealing with a rheumatoid arthritis, which is a separate and distinct disease.

The art of giving salicylates and iodides in indicated cases, is not in giving thembut in knowing when to stop giving them.

I cannot emphasize too strongly the assistance to be derived from measures directed toward local treatment of affected joints. Drugs of the anodyne group should be avoided as far as possible, particularly morphine, as the patient in this more than any other disease of a chronic character, soon learns the relief obtained and becomes an habitue. Codeine may be required occasionally, but aspirin is to be preferred, and then only when the symptoms require temporary relief.

The hot oven, the therapeutic lamp, and moist heat will give good results in the acutely inflamed stage. Naturally an inflamed joint must be kept at rest and immobilized. Our aim locally must be reparative stimulus, without motion. As the condition improves and the inflammation. subsides we meet a condition of adhesive joint which will require careful passive motion and massage, and in this last procedure we are often surprised at the results obtained from regular systematic treatment. It will often take weeks and months to secure results but by continuous effort we can restore partial and in some

instances complete function to stiffened joints.

Before closing I would speak a word of caution in relation to baths:

Baths invariably diminish weight, and that too often to an alarming degree. A bath which throws the patient into a profuse perspiration claims its pound of flesh, and the body economy, in this very loss, is less able to protect itself against later temperature changes and toxemia.

Bear in mind that rheumatoid arthritis is a chronic disease requiring limitless patience and resource, but also bear in mind that a hearty cooperation between patient, doctor, and nurse can accomplish wonders.

113 West 78th St.

THE ONION (ALLIUM SEPA) AND GARLIC (ALLIUM SATIVA) AS A REMEDY FOR PNEUMONIA AND PULMONARY TUBERCULOSIS.

BY

H. O. HALL,

Library of the Surgeon General's Office, U. S. A.

The subject of this paper, the onion and its near relation, garlic, seems to have entirely escaped the attention of American medical writers, so far as its use as a remedy is concerned, for I have been unable to find in the Index Catalogue of the Library of the Surgeon General's Office a single American reference to it in that connection. European writers, however, seem to have considered it worthy of careful study.

It is for this reason, and because of my long belief that the onion is a valuable remedy in pneumonia and other diseases

which has been lost sight of by medical men in the multiplicity of other remedies for pneumonia (a partial list of which is given below), that I venture to bring to the attention of the profession a few observations regarding it. Its very simplicity may in part account for its absence from the materia medica of the family physician. But it is more probable that the lack of any American medical literature, and the consequent paucity of information regarding its valuable properties as a germicide, disinfectant for ulcers, and as a remedy for pneumonia and tuberculosis, and all bronchial affections, accounts for its not being more generally used. I therefore earnestly ask that the thoughtful attention of the members of the American Medical Fraternity be given to the facts herein set forth.

The U. S. Dispensatory, speaking of the onion, says: "It is used as a stimulant, diuretic, expectorant, and rubefacient, and the juice is occasionally given made into syrup in infantile catarrhs and croup. Roasted and split the onion is sometimes applied as an emollient cataplasm to suppurating tumors."

Its near relative, "garlic," says the same. authority, “as a medicine is of the highest antiquity. The oil may be given with great advantage in obstinate bronchitis, and in catarrhal pneumonia of young children.

powerful properties, and that Aristotle, Sotion, and Dioscorides state to the same effect. Hippocrates, he says, states that garlic fumigations have the effect of bringing away the after-birth. Diocles prescribed it for dropsy and for phrenitis. Praxagoras used to prescribe garlic for jaundice; he employed it also as a liniment for scrofulous swellings of the neck. Garlic, Pliny says, cures cough, and suppurations of the chest, however violent they may be. Bulbed leek, says Pliny, furnishes thirty-nine remedies. Is good for coughs, catarrhs, and all affections of the lungs and trachea. To cut leek he ascribes thirtytwo remedies, and says it has the same effect as bulbed leek, but the latter is the most powerful remedy. He states that the Emperor Nero used to eat leeks and oil every month on stated days to improve his voice. The allium sativa of Linnaeus was much eaten by the Roman soldiers and sailors and by field laborers. As to its value as a dietetic in preserving health, it is recorded that 1,600 talents of onions, garlic and horseradish were consumed by the workmen who were employed in building the pyramid of Cheops. We are also reminded that the Israelites, during their wanderings in the wilderness, murmured, saying: "We remember the cucumbers and the melons, the leeks and the onions."

The bruised garlic cloves are often applied Among the ancient Egyptians the onion as poultices to the lungs, and similar applications were formerly used to the feet for nervous restlessness, or even convulsions of young children."

With regard to the antiquity of the onion as a medicine, it may be interesting to state that Pliny* ascribes to the onion twenty-seven remedies; to garlic sixty-one remedies. He says that garlic has very *Pliny, Nat. Hist., II, 122.

formed an object of worship, and the modern Egyptians assign it a place in their paradise.

The correspondent of the London Lancet, "From time immemorial garlic, which is writing from India (1), Dec., 1908, says: grown all over India, sold in every bazaar, and used very commonly in preparation of curries, has a high estimation in domestic. medicine, and also in the ancient systems

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