Selected notes from readers of The Practitioner in 1912 on rheumatic disorders: Treatment by bee stings, The country doctor and acute rheumatism, and Dr Percy Wilde’s Method

 

'There is no doubt that in severe cases, and especially in acute rheumatism, the constant inhalation of strong radium emanation with oxygen to saturation of the system is of the greatest value; and no apparatus has given such excellent results as that which is shown here – the joint invention of Pro. Paul Zazarus and Dr. Saubermann. This apparatus is most useful when it is desired to highly charge the blood with radium emanation in order that it may exert its bactericidal power.'

'IN ANY TOWN where there are works of any kind one is constantly seeing accidents of various degrees of severity. Minor accidents are common. These generally affect the fingers and toes and vary from simple contusions and scrapes to complete amputations. I write from Earlestown, Lancashire, and being surrounded by several large works a great number of minor accidents are met with in practice. During the last two years I have personally attended over 250, the number in one month reaching as high as 27. As it is of the first importance that a workman should have all his digits, it is of even greater importance that none of them should be stiff or useless, because then they are only in the way and had better be amputated...'

By J. Mitchell Bruce, M.A., LL.D. (Hon.), MD, F.R.C.P. Presidential address delivered in 1911 before the Medical Society of London: 'Is the object of the Medical Society entirely fulfilled in the routine work of our meetings? I find that, whilst those who are in general practice constitute one-third of our number, only one communication in 15 comes from them – that they have read but four papers before the Society during the past 10 years...Let me call to mind some of the great things that have been accomplished by the family practitioner. I have but to mention the name of Edward Jenner, Fellow of our Society. Was not Koch a general practitioner; and Duchenne of Boulogne? And was it not the work that Manson did on filarial disease, when a practitioner in China, that led him to the induction of the relation of malaria to blood-sucking insects? Something short of the results of the achievements of these men in general practice would satisfy me.' 

100 years ago: 'Tuberculin plays an important part in the treatment of pulmonary tuberculosis in certain cases, and that its efficacy is greatly increased when it is diluted with a 1 per cent. solution of carbolic acid. However, tuberculin cannot take the place of sanatoria. Too much value is placed on tuberculin by tuberculin enthusiasts. It has an important place in the treatment of pulmonary tuberculosis, but must on no account be allowed to usurp sanatorium treatment. Its use is restricted to certain cases.' 

   “It is only when the patient is seized with the intolerable agony of angina pectoris that the nitrites should be used with any freedom”. By J. Campbell McClure, M.D., Clinical Assistant, West End Hospital for Nervous Diseases, and Mount Vernon Hospital, writing 100 years ago.

The number of deaths from measles in the County of London for the three months February, March, and April, 1911, was no less than 1,640, a weekly average of 126, constituting about 8 per cent of the total mortality during that period. The greatest mortality occurred in the poorer districts of London amongst children under five years of age. During the same period the total number of deaths from scarlet fever totalled only 29, though the average number of cases under treatment each week at the hospitals of the Metropolitan Asylums Board and at the London Fever Hospitals exceeded 1,000.

"Sir James Paget used to urge elderly men to educate their bladders and not allow them to dictate to their masters"

The ordinary means of bathing is from a machine, a contrivance which has not progressed in luxury or convenience with the lapse of time. Of course for those who cannot swim the attractions of the open sea and the dive from the boat are inaccessible. Delicate people and children should make use of a machine or tent, if obtainable, in preference to undressing in the open air, because the mere exposure to the air in the act of stripping is a potent means of loss of animal heat. It is best to avoid loitering about after undressing, and to run rapidly into the water and immerse the whole body under the first available wave.

'Yet a Gilbertian school of physicians has arisen who place breast-feeding in the same category as original sin and other evils of human heritage; and who stridently proclaim the superhuman virtues of unsterilized cow's milk; in their ministrations they analyse an infant's stool at a glance; it is given to them then to know the percentage composition of cow's milk which the infant needs; they prescribe in accordance with the revealed proportions and assert that on such a diet an infant thrives better than on its mother's milk.'

Sir Adolphe Abrahams died in 1967.  He is seen as the founder of British sports medicine. His two brothers were both Olympic Athletes. (Harold Abrahams won Gold for 100 metres in the 1924 Paris Olympics.) In 1911 Adolphe wrote an article for The Practitioner  on the art of training athletes. '....  Those who look after long-distance men are well acquainted with their man's bad time, are on the watch for it and are quite well aware that it is only a question of coaxing him over his temporary distress by threats, abuse, flattery, or such material encouragement as champagne.'

'THE RESULTS of the recent Royal Commission on the Care and Control of the Feeble-minded have disclosed a state of affairs so appalling that there can now be no doubt whatever but that we have reached a period in our race history when it is the duty of every physician to cry aloud and rest not until the people are made aware of the true state of affairs, and are taught to recognise the canker-worm which is not slowly, but rapidly and surely, undermining our very national existence. Let us consider the position today. The lunatic, on the one hand, is detained in asylums, both private and public; for the imbecile, on the other, who is much the more potent agent of the two in racial deterioration, there is no State provision whatever; voluntary charitable effort has, through the instrumentality of some half dozen specially equipped training institutions, accomplished but a fraction of what is really necessary for efficient care and control by providing him with a home and training for a term of years, after which period he is discharged only, in the vast majority of instances, to continue to be a burden on the community, and a menace to his fellows.'

Practitioner 1911:Mrs. H. Aged 35, a lady of good social position, came to me in 1905. She had been ill for five years and had undergone many forms of treatment, including two rest cures, a course of high-frequency electricity, and osteopathy. She was a clever vivacious woman of highly artistic temperament, and felt her disability to take her place in society most acutely. The least exertion, mental or physical, left her exhausted; she had almost constant headache, and her sleep was disturbed by harassing dreams. She proved a most susceptible subject, falling at once into a state of somnambulism with amnesia on waking. She responded at once to suggestions, recovered the habit of dreamless sleep, and in three weeks was able to return home cured. I meet her occasionally, and she continues perfectly well and full of all kinds of activities. In this case the nervous breakdown followed a time of prolonged nursing and great anxiety aggravated by morbid remorse. She reproached herself for the illness of one of her children whom she had sent to a new school against the advice of her friends. This state of things was revealed after a little questioning, and the suggestions aimed at removing the feeling of remorse, which had become almost an obsession, by assuring her that she was not to blame in the matter and that everything would turn out for the best and end happily. Of course she had been told this hundreds of times by all sorts of people in her waking state, but it was only when mental receptivity had been insured by hypnotism that suggestions were accepted as true and acted as curative impulses.

Practitioner 1911: These facts are in a large proportion of cases known only to general practitioners, and very often to practitioners other than those who referred the patients to the operating surgeon. If all practitioners would make a practice of sending to the operating surgeon a brief record of every case of cancer that has been treated by operation, whether it show recurrence of the disease or not, and particularly would notify to the surgeon the fact of the patient's death, and whether due to cancer or not, our knowledge of the real value of operations for cancer would soon become more nearly exact than it is at present.

"If people sick, they come to me,
I purges, bleeds and sweats 'em;
If after that they likes to die,
What's that to me? I lets 'em"

"I generally put it away when an English doctor is coming, because I know he would disapprove of it. You English are so conservative, and, forgive me, you are such hypocrites; but what is even worse, in this matter, you are so backward. You frown at my diagram, but, believe me, it is not quackery, it is science; it is not charlatanism, it is psycho-therapy. That diagram has cured - yes, cured - more patients than all the waters in the spas in Europe."

The train of symptoms which may follow various accidents, in which the patients may or may not have received a serious injury (now known as traumatic neurasthenia) was formerly ascribed to concussion of the spine, inflammation of the meninges and spinal cord, haemorrhages into the meninges and surface of the brain and cord, etc., and since greater public attention has been devoted to those occurring after railway accidents, the condition has been called "railway spine" and "railway brain". There can be no general rule of treatment applicable to all cases; each case must be separately studied. Where the original nerve shock has been great, and the symptoms of palpitation, headache, nervousness, and loss of memory are prominent features, the best treatment undoubtedly is a "rest-cure" for six weeks. Complete rest in bed is essential for the first two weeks at least, and isolation from relatives and friends and correspondence, with massage and overfeeding. General electrification by means of the faradic or sinusoidal current bath is usually the most efficacious means of applying electricity in these cases, the patient being immersed up to the neck in a warm bath, with two large flat electrodes applied, one to the back, the other to the feet, connected to the secondary coil of a faradic battery or sinusoidal current transformer.

'In spite of the extravagant advocacy during recent years of the value of hydrotherapy and special exercises in the treatment of cardiac failure, there is no therapeutic influence that compares in efficacy with physical and mental rest. The carrying out of this principle does not necessarily entail complete rest in bed; each case must be considered in the light of surrounding conditions with the object of ensuring a maximum of relief to the heart with a minimum of disturbance to the patient. In other words, the mental, moral and physical requirements of the case must be carefully weighed and allowed for in drawing up a plan of treatment.'

To the general practitioner the operation for removal of tonsils and adenoids must always constitute a large proportion of his minor surgery. Few operations are more commonly performed, and few, perhaps, are done worse. This state of affairs is due to a non-observance of certain general rules... Haemorrhage is really the only complication of any importance; it usually corrects itself, ceasing when the patient loses sufficient blood to make him feel faint.

'I have no doubt that the risks to which I have alluded are being daily diminished by skilled operators; but now that practically every County Council school is ordering, or trying to order, X-rays for every case of ringworm, and seeing that skilled radiographers and dermatologists are limited in number and are not to be found everywhere, I shall not be surprised if we do hear of children whose scalps  have been permanently injured by X-rays.'

'Hitherto there has been no separate recognition of mental diseases as a subject worthy of diploma by the examining bodies, although the London University may be quoted as conferring the title, Doctor of Medicine, upon those of its medical graduates who specialise and pass an examination in this and other subjects. The Medical-Psychological Association of Great Britain and Ireland, consisting of both medical men and women in this country and abroad, who are especially interested in mental diseases, and numbering over 700 members, grants a certificate to qualified men for proficiency in the subject of psychiatry, and it has recently approached the Royal College of Physicians of London and several of the degree-granting authorities for the purpose of promoting further interest, and, if possible, to inaugurate a diploma similar in the scope to those granted for Public Health and Tropical Medicine, and those which the University of Oxford propose to grant in Business or Journalism. It is also considering the establishment of special post-graduate courses for those who make mental disease their life-work. '

'A healthy lad with a moderate outfit, good food, personal cleanliness, plenty of work, and a disposition that does not worry will do well in India. When a man begins to worry it is time for him to go home, and that applies if he suffers from the so-called Aden or Burma or Punjaub or Madras head. When a man forgets, calls things by wrong names, gets irritable, broods about his work at night, develops insomnia, and loses his confidence, those are symptoms of neurasthenia and the treatment is to send the case home. The Government gives one year's "leave" in every five and a month in every year, and the Goverment would not do that if it did not find that it was necessary.'

We want to attack tuberculosis before it attacks us. The key is that about the period of adolescence, when business life succeeds that of childhood every youth and maid ought to be taught in a sanatorium, how to live as part of the State education. An education also at this period involving an elementary knowledge of human physiology would reap great benefits, for did the man in the street but know, for instance, the actual amount of waste products that he casts off in twenty-four hours by means of perspiration, then, I submit, that he would become more careful than he is now of personal ablutions, changes of underclothing, and perhaps of linen; with untold advantages to our national matters and morals.... Women, too, might be taught the true principles of house-cleaning, which, they might be astonished to learn, they by no means know.

THERE is probably no disease affecting the female urinary genital organs which presents itself so often to the practitioner as the chronic variety of gonococcal infection. The successful treatment of the condition is invariably difficult, calling for considerable exercise of patience and discretion on the part of the medical attendant. Injudicious treatment, especially in the way of systematic curettings, etc., is not infrequently followed by extension of the disease.

I have no sympathy with the man (or woman) who holds the opinion that labour pains are “natural” and therefore not to be interfered with. Patients in labour will cry out bitterly that they are too weak to endure the increasing pains of the latter half of the first stage; chloroform here is contraindicated we know in the large majority of cases. Is there nothing more we can do then, certain in action, and absolutely safe for mother and child?

'The last place where a leper settlement existed in Britain was in the Shetland Islands. There the disease seemed to have been rife, possibly owing to the fact that the natives were of Scandinavian origin and were in more or less constant communication with Norway and Iceland where the disease was prevalent.'  Extracted from a 1910 issue of The Practitioner

'Doubtless many men dig their graves with their teeth, and the general span of life might be lengthened by the adoption of greater prudence and moderation in the selection of food. An attack of gout will turn a man into a savage, but man in the savage state was innocent of the indiscretions which bring on the gout. It may be gravely argued that many present-day diseases and other evils are the result of over-civilisation. These evils are due to many complex causes, but among them we may reckon over-feeding and ignorant feeding on the part of the well-to-do, and underfeeding and still more ignorant feeding on the part of the poor.'

'...in this kneeling position, he wrote all his works, the blood having thus to travel to his brain in a horizontal line, instead of upwards against the force of gravity as it would have had to do in the sitting position.'

'The death of his children, the loss of the many brave young heroes in the ambulance tents during the war, the epidemics he had witnessed, all this human suffering weighed upon him and determined him to do his utmost to solve the problems which medical men, working alone, seemed unable to fathom.'

'Many... have been launched upon their course of inebriety by putting too liberal an interpretation upon loose medical advice'

'There is a growing inclination to rely upon the evidence of laboratory investigations in diagnosis, and no doubt that tendency is increasing.'

Extracted from The Practitioner 1868

Extracted from The Practitioner 1868

The Editors, being desirous of making this department a useful medium of communication between practitioners, will be glad to receive short notes on theoretical or practical points in therapeutics.

Extracted from The Practitioner 1868

Dr. W. C. Maclean, than whom there is no higher authority on sunstroke, gives the following advice to those who have to deal with this affection.

A medical contemporary recently drew attention to the fact that doctors are a short-lived class of the community. The exigencies of his calling often make it impossible for him to practise the hygienic doctrines which he preaches.

By Guthrie Rankin, M.D., F.R.C.P. (Edin.), M.R.C.P. (lond.), Physician to the Seamen’s Hospital, Greenwich; Physician to the Royal Waterloo Hospital for Children and Women, London Extracted from the February 1908 issue of The Practitioner

By F. W. Mott, M.D., F.R.S., F.R.C.P., Physician to Charing Cross Hospital; and Pathologist to the London County Asylums. Extracted from the January 1908 issue of The Practitioner

By Bernard Myers<br />M.D., C.M, M.R.C.S.

By Gordon Lambert, M.D.

By George F. Still, M.A., M.D., F.R.C.P., Professor of Diseases of Children, King’s College, London; Physician for Diseases of Children, King’s College Hospital; Physician to Outpatients, Hospital for Sick Children, Great Ormond Street.<

By G.A.H. Barton, M.D., M.R.C.S., &C., Anaesthetist to the N.W London Hospital; Anaesthetist to the Throat Hospital, Golden Square, &c.

Extracted from the May 1907 issue of The Practitioner

By Alfred W. Sikes, M.D., D.Sc. (Lond), F.R.C.S., Late Medical Registrar and Demonstrator of Medicine to St. Thomas’s Hospital.

By Raymond Crawfurd, M.A Oxon., M.D., F.R.C.P Physician to King's College and the Royal Free Hospital

By I. Burney Yeo, M.D., F.R.C.P Emeritus Professor of Medicine in King's College, and Consulting Physician in King's College Hospital

By Woods Hutchinson, M.A., M.D. <strong>Arrowhead Springs, California, U.S.A.</strong>

By Theo B. Hyslop, M.D. Senior physician, Bethlem Royal Hospital; Lecturer on Psychological Medicine, St. Mary's Hospital