1898 Journal of the American Medical Association  
irritant to the diseased mucosa. In cases that are absolutely or practically functional, we naturally pay attention only to the digestive deficiencies; in severe organic diseases, such as acute catarrh, ulcer and some manifestations of cancer and chronic catarrh, gastric digestion must be discontinued entirely for at least a few days, the body being nourished by the bowel and skin while the stomach is being medicated. A large number of cases fall between these two extremes and, as a number of
more » ... d, as a number of favorite ready-made tablets and liquid mixtures show, many physicians simply stir together the various drugs indicated and administer them all at once, letting their diverse activities battle for the supremacy. In such cases, the rational treatment consists in doing one thing at a time. Give such foods as may be digested in, say, three hours; in other words, rather plain but still appetizing and ordinary articles of food. Administer such digestive aids as shall insure digestion and emptying of the stomach in about this time. Then, every morning and afternoon, a period of two or three hours is at our disposal for medicating the gastric wall, while a drug administered at bed-time has a much longer period of possible action. The writer would confess that his conception of a drug acting on the stomach and bowel itself is pretty nearly limited to bismuth, The various vegetable astringents lack the property of a powder dressing; silver, copper and zinc are too active for more than temporary use, and each, moreover, possesses special objectionable features. Cerium oxalate has no obvious advantage over bismuth, while, in most of the cases in which one or the other must be used, there is altogether too much oxalic acid formation in the system. The main point in administering bismuth is to give enough of it. With the possible exception of some of the newer antiseptic compounds, the minimum dose should be half a gram, and twice or three times this amount should usually be given. Yet, within a few days, a cautious druggist has telephoned the writer in regard to overdose in the case of a prescription calling for a gram of the subgallate, three times a day. h'or the long reach of bowel between the accessible portions of the alimentary canal, the same general principles of medication apply as to the stomach. It is of the greatest importance to be sure that the intestinal disturbance is not the final breaking down of the power to perform vicariously the duties of the stomach. Many stomachs habitually shirk digestion, and the owner is unaware of the suspension of function so long as the gastric motor power is sufficient to pass the chyme on to the duodenum. Next, by high enemata, we must keep the lower bowel clean and healthy. Finally, we must administer the slowly soluble antiseptics, occasionally ferments inclosed in stomachproof coatings, and usually the astringent bismuth, preferably now in pure petrolatum. Juggling with cathartics and constipating drugs is not therapeutics, although it may be an inevitable makeshift. Although in scolecitis, surgery affords the safest and most thorough treatment, there are certainly many mild cases which recover under either constipating medication with opium, or laxative treatment with salines or belladonna, with or without intestinal antisepsis and hydrotherapy. If we could be sure that free drainage existed from the mouth of the appendix and that gangrene and virulent ulcération could be excluded, medical treatment of even acute cases might be justifiable. But, at present, the only cases in which operation should not be insisted upon, are mild and more or less chronic ones, the patient being so situated that surgical aid may be called almost at a moment's notice. If we carefully consider the history of scolecitis cases, we must conclude that not grape seeds, nor other foreign bodies, not constipation, not necessarily catarrh of the bowel, not taking cold, not even anatomic peculiarities as to meso-, blood-vessels, and lymphoid tissue, are the essential causes, The real cause, in the writer's belief, is unusual virulence of intestinal bacteria, marked by prolonged intestinal indigestion and fermentation. Thus, there is a rational field for the use of antiseptics, drugs to regulate the proper discharge from the bowels, including water" and, in addition, some of the slowly soluble compounds of iodin as resorptives. In our appreciation of the seriousness of scolecitis ana tne danger of too long delay of operation, we have gone rather too far in abandoning the old-fashioned conception of typhlitis. There most certainly do exist cases of catarrh and atony, especially of the head of the colon, though not absolutely limited by an arbitrary anatomic division. Here we find the sausage-shaped fecal tumor just as truly as did our predecessors, and, in the absence of leucocystosis, of * a septic temperature and pulse, we have as plainly as ever an indication for medical treatment, including salines, antiseptics and, later, such means as will check the tendency to catarrh and prevent an atonic yielding of the bowel. The value of a therapeutic agent or method can not be measured by the volume of its literature nor yet by the enthusiasm of its advocates, and no doubt too great a measure of faith in the testimony of false witnesses has bred in us that skepticism which, however admirable as a mental attitude in scientific work, may nevertheless, if too greatly expanded, become a serious stumbling-block in the path of medical progress. We are right in insisting upon something more than dogmatic assertion or the voice of authority in the determination of therapeutic values; we may justly demand the right to withhold judgment, ask for substantial proofs and thoroughly sift our evidence, but behind all this there must be a sincere and earnest desire, not alone to detect error, but also to know the truth, and the ultimate test must after all be derived from personal experience and the repetition of such experiences. If a new procedure is rational, if the evidence in its favor seems fairly good, and if it promises more than the old, we are in duty bound to give our patients the benefit of the trial. The world has not moved very greatly in this direction in the last 200 years. We may now read with astonishment the vituperative paragraphs which proved with a most imposing show of logic and a vast amount of physiologic and anatomic Downloaded From: by a Penn State Milton S Hershey Med Ctr User on 05/23/2015
doi:10.1001/jama.1898.92450160020002d fatcat:g6krujkx3zdvdljoa6yi3bgrey