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the progressive metamorphosis of albumen is checked, and the corpuscle is deprived of its power of producing heat; and thus algidity supervenes.
I have now given three examples to show how the development of animal heat may be suppressed, and if this were the place and occasion, might adduce others; but my only object is to impress on the physician the proximate cause of algidity of the body, so that when a case of illness, with extreme or unexpected absence of warmth supervening, is presented, the medical man should inquire of himself: What is this diminished heat production owing to? and, especially to unite with this inquiry, Is there in this case a clear intellect combined with the bodily cold; and is there absence of dyspnea or any labored respiration? If the function of respiration is not embarrassed, arterialization of the blood ought to go on pari passu with the respiration ; that it does not do so is not due to the lungs, but to some condition of the blood; it is clear that oxygen has entered the blood, but the corpuscle has not seized it; why? there must be some substance present in the blood which prevents the corpuscle obtaining it; what is the substance or the class? Is this something produced within the body, or has it come from without? Is it likely to be produced by grief, by impending calamity, or by other moral causes? or is it due to poison? and what poison ? Is it a true narcotic, as opium? not likely, for the intelligence is undisturbed. Is it an anæsthetic? not likely, for the odor of breath gives no indication, and the respiratory movements are not markedly lessened in number, and the intellect is clear; also, there is no sleepiness or oppression. These last symptoms are wanting-we push aside the class of anæsthetics. Then there should be asked, Did this condition of the patient come on slowly? are these typhoid conditions? or those of septicemia? If these be absent, then the class of septic poisons are excluded. Now we fall back upon the previous history of the case. Were there, at the outset, symptoms of gastric irritation or intestinal excitement ? What was the attributed origin of such ? If this last fact can be shown to have existed, and the origin not satisfactorily explained, we have every reason for having a suspicion of poison; to which must then be superadded the nature of the environment—the relations of the society, family history, the fact of sexual or other irregularities on either side, and the numberless minor concomitant surroundings which may help to confirm the
suspicion that this was a case of administration of an irritant poison.
I hope I may be pardoned for bringing to your notice these crude suggestions on diagnosis in obscure cases of sudden illness, and for pointing out the lines in which our thoughts should run, and our inquiries be shaped, to arrive at a rational diagnosis. I have felt the pursuit of such lines of thought useful for myself, and I submit the conclusions at wbich I have arrived for the benefit of others travelling the same road; and to travel with ease along this road, the inquirer must be a symptomatologist.
It is not of course my desire to conceal the fact that there are multitudes of cases where the synıptoms resemble those of poi. soning; where cases of gastro-enteritis run their course with great severity, and terminate fatally, the result being due to the ingestion of ordinary food or dessert, where the articles have been eaten hastily and abundantly. Such cases remove the imputation of poisoning after the autopsy is made. The physician expects to meet these cases. My object has been, not to ignore these, but to awaken the young physician to the fact that the number of concentrated poisons circulating throughout the community is very great, and that cases of accidental or intestinal poisoning must also be numerous.
REPORT OF COMMITTEE ON SANITARIA AND ON
REPORT ON SANITARIA. In submitting the following report, your committee would refer to the precise terms of their appointment. They were to report “on the establishment of proper sanitaria for consumptives and on the more accurate utilizing of the various mineral wells of our country.” As regards the establishment of special sanitaria at any such localities, your committee has felt unwilling to make any suggestions. It is manifest that it would be inexpedient for the American Medical Association to give the authority of its recommendation to any individual place or places as specially adapted for the climatic treatment of phthisis. There are a large number of localities which comply with the various conditions that are recognized as desirable and important in such climates. It is far from being admitted that advantage would follow the establishment of sanitaria for patients with phthisis at such localities. It is evident that the mode of life has equal influence in determining the result of any given case of that disease, with the particular climate and locality in which the patient is placed. Ample opportunities for out-door life and exercise; attractive and healthful occupations; cheerful and invigorating surroundings; abundance of good, wholesome food are among the most powerful influences for good that can be invoked in the treatment of phthisis. The congregation of numbers of such cases in one locality can scarcely conduce to the enjoyment of these essential advantages. Apart from the most injurious moral effects of such association of sick persons, it must be remembered that the sanitaria would be commercial ventures on the part of those who established them, that it would be difficult or impossible to decide and control by whom they should be started and managed, and that consequently the Association, in recommending the establishment of any such
sanitaria, would throw the weight of its authority in aid of business speculations conducted by independent and uncontrolled individuals. Your committee could not therefore recommend any action on the part of this Association looking towards such a result,
REPORT ON MINERAL SPRINGS.
In so far as their duty involved a study of the mode in which the mineral springs of this country might be better utilized, your committee have felt they could best comply with this requirement by presenting a classified list of all reliable analyses of such waters which they could obtain.
The benefits derived from the use of any of these waters directly from the spring, are partly due to the influence of the medicinal agents contained in the water, but partly also to the good effects of change of scene, of bracing climate, of simple habits of living, etc. The material does not exist for a complete study of the clinical effects and value of the mineral springs of North America. Unfortunately, there are few places at which any restrictions are imposed upon either the manner or quantity in which the waters are consumed, or upon the mode of life, diet, etc., of those who are drinking them. In consequence the most erroneous ideas prevail; and it will not be until a definite system is adopted at each such health resort, and carried out under the supervision of competent resident physicians, that we shall secure information concerning the effects of our mineral waters as accurate and reliable as exist in regard to those of European countries. The indications for the use of the chief varieties of mineral waters are, however, so definite and well established that the possession of a classified list of reliable analyses will be of considerable practical importance, and will prepare the way for a more extended and rational employment of these powerful adjuvants.
The following classification has, after careful reflection, been adopted as comprising all the leading varieties represented among American waters. It will often be found that a water will present the marked characteristics of more than one of the varieties. In these instances the water has been included under that heading which is believed to represent its leading and most important ingredient.
In order to render this report of as much practical value as