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The first is the absolute necessity for rest during the period of activity and temperature. So many physicians tell tuberculous patients to get out of doors and take exercise; to go on a farm and work. A tuberculous patient with temperature is not able to exercise, and I think that is where we make a mistake often, and I know there are members of the profession who make the mistake of not giving their patients absolute and positive instructions on this point.
In the second place, there is a general idea among the laity, and unfortunately among some members of the profession, that a tuberculous patient is benefited by the use of alcohol; that he can not be hurt by drinking whiskey. I believe you help to kill a tuberculous patient and hasten the process when you give such instructions or directions as those. I can not too earnestly protest against instructions for these patients to take whiskey. If whiskey has any therapeutical value beyond the possibility, when taken shortly before meals, of increasing and producing an artificial appetite, where the patient is able to take nourishment which he is able to digest, but no inclination to swallow, I have been unable to discover it.
In the third place, I regard nourishment, after fresh air and right along with it, of first importance in the treatment, and to tell the patient he must take plenty of nourishment amounts to nothing. It is our duty to tell him what he must take, and how much he must take, and when he must take it, etc., so that he may understand it and will do it.
So far as my own experience goes, I give them raw eggs, or that class of food which the greatest majority of patients can digest with the greatest ease. I have seen some physicians who seemed to fear giving a patient too many eggs; but I have had a number of patients with
tuberculosis who took twelve raw eggs a day for a period of six months without producing any nausea, without producing any discomfort, indigestion, or any trouble whatever, and they would gain in flesh right straight along on it. I have repeatedly in my office sent the office boy across the street for an egg, and have swallowed it raw to show the patient how simply and easily it is done. (Laughter.) Most people want a little lemon juice or wine in it to disguise the taste. But that is a matter of secondary consideration. But these patients should be kept in bed; they should be nourished; they should be given proper directions what to do; they should never have alcohol poured down them. That can not be toc strongly condemned by the members of the Medical Association of Georgia.
Dr. Oertel (in closing): It is flattering to have such a thorough discussion as the gentlemen have given these papers; and it is also flattering to me to have such an eminent gentleman as Dr. Harris write so similar a paper to my own.
My object was, as I stated, simply to call attention to the very lamentable fact that in almost every instance the early diagnosis of tuberculosis is overlooked. The question of tuberculosis is so large that it is almost impossible to make up one's mind where to begin or where to stop.
The treatment may be summed up in a few words: Fresh and proper air; proper food; proper rest; and proper medication. As to medication, all authorities agree that medication is of importance. Medication must be directed toward the relief of symptoms, and not given with the idea that it is specific. But unquestionably the use of drugs is very important in the treatment of tuberculosis.
It is my habit, when people consult me relative to their
condition, and ask my advice, if I think their cases are suitable and hopeful, to advise them to go to a sanatorium. In the last two weeks I have sent three patients West. I have told them I was not sending them West because it was West; I told them that Georgia was as good as the West practically, but that I was sending them West because I was sending them to a man who had a sanatorium in whom I had confidence, where they would get the proper handling and treatment of their cases, and if one can go to a sanatorium for treatment and place himself under the most desirable conditions, it is better for him to do so. He will have better supervision day after day than if treated in his home, because he will do things. in a sanatorium he would not do in his own home, and he would leave things undone in his own home which he ought to do. Therefore, the ideal place is to put such patients, if possible, in sanatoria. We have no place in Georgia where these patients can get this treatment. We hope to have soon. If my paper will in any degree bring about this most desirable effect, that tuberculosis can be eliminated to a large extent where it may be present, it will be all that I had hoped for.
Dr. Harris (in closing): I have very little to say, Mr. President, in addition to what I have said in the paper.
I, however, wish merely to call attention to the fact as regards dosage of tuberculin, a point made by Dr. Block. that it is perhaps well to start with a small dose, not that five milligrams will do a great amount of harm. As we all know, when tuberculin is injected it sets up a violent process around the tuberculous areas; so it is well to use small doses so as to get as little reaction as possible.
As to the period of time necessary to keep the patient at rest, I think that has perhaps been somewhat exaggerated by Dr. Block. Two or three weeks in practically
all instances would be long enough; nor is it necessary to keep the patient absolutely in bed, or that he should remain in his room. Care should be taken that he does not resort to an undue amount of exercise.
I wish to emphasize the very valuable point made by Dr. Jones, that whiskey should not be used at all in this disease. I have found in my recent visit to various representative sanatoria that they have two rules, which under no circumstances are varied from. One is that if a patient spits on the floor he is hustled out of the place. Another one is, if they find a bottle of whiskey on a man he is sent away. I think alcohol is one of the worst things possible in persons who have tuberculosis.
"A NEW AND ORIGINAL SIMPLIFICATION OF THE PRESENT METHODS OF INFANT FEEDING."
BY CHAS. E. BOYNTON, M.D., ATLANTA.
It is already so well accepted that woman's milk, provided it is of good quality and sufficient quantity, is the very best food for an infant during the early months that it would be a waste of time for me to more than mention the fact.
In former years it was believed that woman's milk, whether good or bad, was better than any prepared food.
In recent years, however, the vast amount of careful study put upon this subject has proven that correct scientific artificial feeding gives by far better results than poor nursing.
The difficulty of the subject is well shown in the number of "proprietary foods" which flood the market, the manufacturers trying to do for the doctor what the doctor should be able to do for himself, and could do if he would give a little more time and study to the subject.
The only proper food for an infant, of course, is a "whole food," namely, one which contains all of the elements-fat, proteids, carbohydrates, mineral salts and water—which are necessary for perfect growth and development, and, besides, one which contains the element of freshness.
In looking over the list we find that the milk of animals is the only one which fits all the requirements, and that of the cow alone can be obtained in sufficient quantity to keep the price within reasonable bounds.