It is for the most part, pertain to diet and its relation to health. Although the authors have devoted the greater part of their research activities to nutritional problems in relation to disease, they would not use this approach in treating all forms of disease. In their clinical practice other accepted forms of treatment are employed as the patients’ needs demand. Some consideration of these is introduced so that no one will carry away the notion that food adjustments will cure all forms of sickness. The usefulness and value of the varied agencies used in the modern scientific care of those who are ill should be understood more than they are. In turn then there would be less tendency to take up narrow hobbies in treatment, which often have little to recommend them except the enthusiasm of their advocates.
The physician is confronted constantly with the patient who is always in a hurry, the patient who has been sick for many years, but confidently expects the physician to tell him what is wrong after listening to his complaints for a few minutes. A diagnosis cannot be made in this way, although sometimes one may make a shrewd guess which will cover some phase of the complaint. A careful history must always be taken. The patient must be questioned, keeping in mind each group of organs in the body to elicit symptoms or signs which the patient has over-looked. A careful physical examination should always be made. Certain routine laboratory tests should be done, such as a blood count, a urinalysis, a sputum examination if the patient coughs, a stomach analysis if the patient complains of stomach or digestive trouble, a stool analysis, especially if the stool is abnormal, and a basal metabolism test when there are indications for it. X-ray or other special examinations may be necessary be-fore any definite conclusion can be reached. Such a study usually requires several days to make it complete.
Many patients fortunately have conditions of health which are curable. Others have conditions which are in-curable so far as we know now, but for which excellent treatments are known. Then there are still others who have illnesses which are thought to be incurable, and for which unsatisfactory or no treatment is known. Medical research men are especially interested in the development of and working out of better forms of treatment for this last unfortunate group. Encouraging results are being obtained all the time. The discovery of insulin in the treatment of diabetes, of liver extracts in the treatment of pernicious anemia, and the use of X-ray and radium in the treatment of cancer are outstanding examples of what has been accomplished in the past few years.
Each of the many forms of treatment must be used in a proper setting. Sometimes a sick person can be cured or helped with one form of treatment, while in other cases a combination of several forms may be required. In the present review we shall discuss briefly only types of treatment which have proved to be worth while, and have been accepted in medical practice.
Rest is perhaps the oldest and one of the most important forms of treatment. An adequate amount of rest is also one of the best ways to prevent sickness. Every one needs a good “night’s rest” in every twenty-four hours, at least one day of rest each week, and a vacation each year. Without such periods of rest the human body wears out too fast. When sickness is present, a safe rule is to stay in bed until the cause of the sickness is ascertained, and suitable advice can be given. The rest enforced on a patient following an accident or surgery, is as important as any other care he may be given. As long as there is fever present from any cause, the patient should stay in bed. There are many other states of health in which rest forms the most important part of the whole course of treatment. Mentioning only a few, rest is most important in treating such sicknesses as tuberculosis, heart disease, kidney disease, high blood pressure, and even the early stages of infectious arthritis.
To live one must use not only an adequate amount of food, but as has been discussed in detail in previous chapters of this book, there are many fundamental requirements which must be kept in mind in choosing one’s food. In illness as well as in health diet plays a necessary part, although it is not always of primary rating. The following impaired states of health are only a few of the outstanding examples where special dietary treatment is essential. Diabetes mellitus, often referred to as sugar diabetes, is treated chiefly by using a selected type of diet. Underweight is frequently corrected by using a well balanced high caloric diet. Overweight from any cause requires an intelligent limitation of the food intake to be properly treated. Constipation disappears in the majority of persons when a suitable choice of food is made. The treatment of ulcers of the stomach is largely dietary, except when surgery is indicated. In treating diseases of the kidneys, beneficial results follow the use of foods that enable the physician to regulate the types of wastes that shall be passed in the urine. There are many conditions of health which follow a lack of sufficient mineral foods, and which are cured by using a balanced diet. In other instances supplying vitamins with the food used seems to make all the difference between health and disease. Rather than allow the sick patient to waste away be-cause of a lack of appetite or disturbed body chemistry, we now endeavor to maintain a normal nutritional state in every way possible, believing that the body can resist disease better when it is adequately nourished.
Our physical body needs constant use to function properly. When most of the people lived in the country or small rural communities, their routine lives afforded a reasonable amount of physical activity. Today when so large a part of the population has been shifted to urban centers with our men doing no outdoor work, and many of our women doing very little of their own housework, and nearly everyone owning an automobile, there is less and less opportunity of keeping the physical body fit in natural ways.
Walking is the simplest and least expensive type of physical therapy, and many people would enjoy better health if they would walk an aggregate of about 100 miles per month. For the aged and frail it is hard to find any more agreeable exercise.
The best types of physical activity are either productive or entertaining. The office worker who has a lawn and small garden and cares for them is better off than if he hired the work done. The housewife with a flower garden is much healthier when she tends it herself than when she hires someone to take care of her flowers. Golf, tennis, horseback riding, and swimming afford excellent use of the muscles, combined with pleasure and entertainment.
If a patient is confined to bed, massage which brings passive exercise to most of the muscles, is an excellent substitute for the more active forms of exercise. Massage and rubbing bring about an increased circulation of the blood, especially on the surface of the body, and are often resorted to as a tonic measure by those who are not ill.
Other forms of physical therapy make available a great variety of treatments, such as baths, sprays, and other forms of hydrotherapy, electrical treatments, light treatments where use is made of both the chemical and heating properties of light and postural training. Properly used these several forms fill very useful and valuable places in a full scheme of treatment.
Many people do not appreciate the value of sunshine. This body of ours was designed perhaps to live in the torrid zone with a minimum of clothes. There the sun-shine acting on the ergosterol in the skin would form the natural vitamin D so essential in the calcium-phosphorus balance of the body. The temperate zone requires the wearing of clothing which prevents the sunshine from coming in contact with the skin, so it has become necessary to supply vitamin D, particularly at those periods when the human body needs an extra amount, or when the natural supply is at a minimum.
There is no denying the fact that the mind has a great effect on the body either for better or for worse. It is possible to make a person seriously ill simply by repeatedly and convincingly telling him that he is sick. One of the most difficult problems in diagnosis oftentimes is a differentiation between some psychic influence and some-thing anatomically or functionally wrong. There are many instances on record where serious gastrointestinal upsets, for which no anatomical or functional cause could be found, have been traced to a misunderstanding of the motive prompting the words or actions of a friend or relative. Worry, needless or otherwise, can certainly up-set the whole system. In the diagnosis or treatment of such conditions it is often a difficult problem to gain the confidence of the patient so that he or she will frankly tell the basis of the worry. The clergy are often excellent psychotherapists. The old-fashioned physician who knows all the details of a person’s life from birth, is a better psychotherapist than a busy modern clinic physician. Some forms of religious healing are illustrations of psychotherapy, but many of us feel that treatment associated with prayer is better than prayer alone.
Many hundreds of years ago the Arabs attempted to find a drug specific for each disease. A large number of drugs have proved to be very valuable in the treatment of various ailments. There have been found, however, only a few specific drugs so far, the outstanding examples of which arequinine for malaria, arsenic and mercury for syphilis, and some other spirochetal infections, and certain preparations of arsenic for parasitic infections of the bowel. Most drugs are used simply as aids in treatment rather than as specific cures.
Anesthetics, which enable us to do both major and minor operations without pain and shock, should head the list of all drugs. Opium and its derivatives can control any type of pain. These, however, must be used with much precaution, because their continued use leads to a form of neuritis and addiction to the drug. If, for ex-ample, opiates are used to control the pain of sciatic rheumatism, the neuritis is actually increased and in-creasing doses of the drug must be used. All opium preparations should be used cautiously, and only under the direct supervision of a competent physician.
Acetyl salicylic acid, commonly known by its trade name “aspirin” is perhaps one of the safest household drugs used for the control of pain. Fortunately, it can be taken in fairly large doses with minor damage to the system. It is much safer in fairly large doses for the control of a headache, than the more potent drug, amidopyrine, commonly known under the trade name “pyramidon,” which is believed at times to depress the natural formation of the all-important white blood cells. Large doses of aspirin are safer in controlling the pain of “rheumatism” than some more potent drugs like cincophen, which are prone to fatally damage the liver.
As it is learned that the intestinal elimination can be properly managed with diet, less and less cathartic sub-stances are being used. Digitalis is a valuable drug in the treatment of various forms of heart disease. Iron and organic iron compounds and liver are used extensively in the treatment of anemia. It is to be regretted that so many patients who cannot sleep are taking sedatives as a poor substitute for proper physical therapy and exercise.
Many of the activities of the body are controlled by secretions from the so-called glands of internal secretion, such as the pituitary, pineal, thyroid, parathyroid, thymus, pancreas, adrenals, ovaries, and testicles. The tiny pituitary gland at the base of the brain is perhaps the most interesting of all because it is apparently a master gland, producing many hormones, which regulate the activity of other glands of the body. The function of the thyroid gland is perhaps best understood. It regulates the consumption of oxygen in the body. Fortunately, its preparations are active when taken by mouth, whereas the hormones from other glands are either non-active when given by mouth, or have very little activity. Some extracts of other glands can be given by hypodermic injection with good results. The discovery of insulin in 1922, with its extraction from the pancreas, was an event of great importance. Now all the subsequent work necessary to make this extremely delicate hormone available, can be applied in the study of the hormones of other glands of internal secretion. We would hope that in the near future improved extracts can be prepared which can be given in forms that will be useful to those so unfortunate as to have glands that do not function normally. One of the theories regarding cancer is that it is a disease which occurs when certain glands fail to function properly. We know that there is a hormone which comes from the pituitary gland, found in the urine of pregnant women, which certainly checks the growth of one type of cancer in experimental animals.
VACCINES, SERUMS, ANTITOXINS, AND BLOOD TRANSFUSIONS
Vaccination against smallpox was the earliest successful type of vaccination. The disease, smallpox produces life-long immunity. The much less dangerous similar disease, cowpox also produces life-long immunity to small-pox. Vaccination against smallpox is done with the cow-pox virus. Where it has been done generally and repeated frequently enough, the disease smallpox rarely ever occurs.
Fifty years ago diphtheria was a very common and fatal disease in children, with a mortality of about 50 per cent. Children who had diphtheria and lived, did so be-cause their own bodies were able to make enough anti-toxin to neutralize the toxins produced by the diphtheria germs in the throat. Horses inoculated with the dead diphtheria bacilli develop enough antitoxin in their blood so that eventually large numbers of living diphtheria germs can be injected with no untoward effect. It is from this source that the antitoxin used so successfully in the treatment of diphtheria is made, reducing the death rate from this disease to almost nothing when the antitoxin is given early. We now know that if a child is inoculated with small doses of the toxin-antitoxin or toxoid mixtures, such a child is immune to diphtheria for a long period of time. Diphtheria could be completely wiped out by this method of immunization.
Shortly before the Boer War (1898) it was learned that if a person were inoculated with three increasing doses of dead typhoid bacilli, that he became immune to typhoid for two or three years, and possibly longer. Universal immunization of soldiers was tried during the Boer War with almost complete eradication of typhoid, whereas during the Spanish-American and Civil Wars, typhoid fever killed more soldiers than bullets. So universal was the practice of immunization against typhoid during the World War by every nation that typhoid was almost eradicated from the entire civilized world.
It is conceivable that any disease like chicken pox, whooping cough, measles, and mumps, which usually gives life-long immunity, might be prevented by some method of immunization. Very encouraging work has already been done in protecting children against whooping cough. It is believed that some protection is afforded patients who have infantile paralysis when they are given injections of serum from the blood of others who have had the disease.
If a person has an infection sufficient to produce a fever, such an infection usually leads to a decrease in immunity. Vaccines are used therapeutically to increase the person’s immunity. Large doses of vaccine originally given which produced a febrile reaction, probably de-creased immunity rather than increased it, hence the present method of giving extremely small doses of vaccine, seems more logical. After a vaccine the patient should either feel better or at least no worse.
Blood transfusions are used in severe anemias from any cause, and to help build a patient’s resistance and strength. It is necessary that the bloods of the donor and recipient be matched so that they may be mixed. Surgical technique must be observed in transferring blood from one to another.
There are a number of conditions which primarily need surgical care. Aside from the superficial cancers of the skin, so successfully treated with radium and X-ray, a cancer should always be removed surgically if possible. If the patient has a toxic goiter, or a tumor of the thyroid gland, removal of the abnormal tissue is probably the best form of treatment. All tumors of the breast should be removed, because so many of them eventually become malignant. If a person has an ulcer of the stomach causing such a high degree of obstruction that he cannot be nourished properly, or when an ulcer does not respond satisfactorily to medical management, then an operation should be advised. If the gall bladder is infected with or without stones and troublesome symptoms are present, it should be removed. If one has appendicitis, the sooner the diseased organ is taken out the better. Hernias should be cared for surgically if they are causing trouble and a patient’s health permits. Gangrene of the extremities usually requires the removal of the dying tissue, although the new physical treatment, where alternate positive and negative pressure is employed, such as that given with the “Pavaex” machine, will probably save many patients from this extreme procedure.
The surgeons of today are especially interested in the removal of foci of infection. Tonsils should always be removed if infected. The nasal sinuses should be treated if infected, and normal drainage brought about. Infected teeth should be removed. With our present knowledge of the role of focal infections in serious types of disease, we are gratified that the removal of all possible sources of infection is preventing a considerable proportion of the major surgery of the past.
Nearly every young women anticipates the time when she will become a mother. Childbirth has been beset by accidents from earliest times, but a better understanding of the problems of this occasion, assisted by modern surgical skill, has changed the record of misfortune. Many complications have been traced to bacterial infection, so that now the same care is used in the birth room that is used in the operating room.
The orthopedist is not only interested in the setting of broken bones and replacing dislocated joints, he is also skilled in the care of various unnatural bony curvatures and slight displacements of the bones which may press on nerves and cause considerable discomfort. Not infrequently lameness and backache can be explained as the result of weak arches in the feet which need support and care. The many complications which follow such conditions as birth palsies and infantile paralysis are looked upon today as problems which can be worked out to a degree that the sufferer can once again have a useful part in life.
X-RAY AND RADIUM
X-rays are obviously valuable in the diagnosis of broken bones, and dislocations of joints. The exact location of a fracture may be ascertained, and check pictures taken to prove proper setting and progress in healing. They are used extensively to aid in the diagnosis of lesions of the teeth, lungs, gastrointestinal, and urinary tracts, and gall bladder.
X-ray and radium are also used extensively in the treatment of malignant diseases. They are alike in principle, radium giving off rays that are similar to X-rays. Some forms of skin cancer and many other cancers which cannot be removed surgically can be cured by their use.
Great improvement has been made in the technique of X-ray therapy, and more and more powerful machines have been inventedthe 100,000 and 200,000 volt ma-chines being much more effective than the earlier 10,000 volt machines. At the present time experiments are being carried on with 1,000,000 volt machines in the hope that more effective treatment of such conditions as cancer of the prostate gland, rectum, and colon, and other deeply placed organs, may be possible.
Patients with tuberculosis or bronchial asthma feel better in dry, high altitudes. Dry climates are usually a help to those who have chronic arthritis, and those who suffer with sinus diseases. Patients with heart or kidney disease are more comfortable in the sedative middle or sea level altitudes. Hay fever is often relieved or its symptoms may be checked where the air is free or freest from pollens.
Professional nursing originated during the Crimean War, and reached an excellent degree of perfection as early as the Civil War. The physician sees his patient for only a short period each day. Some person adequately trained often must be in charge of patients throughout the entire twenty-four hours. Such a person must under-stand medical treatments and know the nature of the medicines ordered by the physician. This is the field of the trained nurse. A very large percentage of the actual cost of the care of patients in the modern hospital is the result of this necessary nursing care. And because this is available for every one many persons choose to go to a hospital when they are taken by sickness. In the care of persons suffering from such illnesses as influenza and pneumonia, or of those who are recovering from a surgical operation or accidental injuries, no part of the treatment is more important than the service rendered by a careful, competent, and skillful nurse.
We believe it is clear to the mind of any thoughtful man or woman that such a variety of agents available for the treatment of disease requires special knowledge to use them correctly. It has always been true that men are prone to fix their attention on limited fields of thought and become satisfied therein. This may be due to one of two reasonsthe field may be all that one man can cover, or the single worker may lack the interest or ability to enquire further. In either case the worker must depend upon others for what he does not have at hand. The average person must depend upon the judgment of those trained in medicine to guide him in matters of physical well-being, and to bring the help he needs in the presence of disease.
It is easy to be satisfied. A sensible dissatisfaction with the present is necessary if we are to advance in any line. A physician who would presume to cure all illnesses by drugs without looking for new methods justly may be considered as narrow in his views as the one who claims that diet alone will cure all sickness. The more we learn of the physiology of the human body, the more we think of health as being that state where each organ functions freely without our being conscious of its existence.
The future holds more promise of progress by teaching and informing men so that they can care for themselves than by centering our attention on restoring health when it has been lost. This latter may appear the more spectacular, but the physician who guides his patient away from illness has done as much as the one who restores him after a disease has established itself in his tissues. We think he has done more. He has gone far on the road toward establishing a mutual confidence between the scientific physician and those who need his help. For out of such a confidence there appears a way to enjoy a better and fuller measure of health, without which the joy of living loses its thrill and the hope of future happiness.