By cocaine isolation I made larger incisions over the long axis of the dorsum of the foot. It was found necessary to gouge away completely the diaphyses of the second and third metacarpal bones with the middle and internal cuneiform. All the sinuses and anfractuosities running to the surfaces and under the fascia and the intertendinous spaces, were well curetted; the whole well drenched with a I to 40 carbolic solution, drained and embalmed with absorbent dressings: The sequelæ were simple. Gangrene Gangrene was arrested, restitutio ad integuum ultimately, quite complete, with a stiff but a solid, useful foot, as a reward for his stubborn refusal to permit of an amputation. Toe-fracture usually results from a crushing force; they are ground through, most frequently, by the wheel of a vehicle. I have seen an elevator crush of the big toe with resulting fracture, and nearly cost the patient the loss of his foot. The ungual phalanx of the big toe was ripped, the nail torn off, and the second phalanx fractared. Infection followed with swift gangrene destroying this toe, and the second and third; timely and drastic surgery saved the body of the foot, but appropriate treatment in the beginning would have obviated the necessity of the later large sacrifice of tissues that had to be made. This was an injury primarily caused by a defect in the elevator machinery, and an action at law was contemplated, but I warned the young man that if the defence made proper resistance, he would certainly lose, as mal-treatment, and not the broken toe alone, was responsible for the mutilation. FRACTURE OF THE BONES OF THE HAND. We rarely see any other than sprain. fracture, chipping or splitting, in the carpal bones, which can only be detected with certainty by the X ray. Metacarpal fracture of the open variety results only from direct violence. These bones are so bound together by a dense fascia, muscles and ligaments, that there is little or no displacement. We rarely see this fracture except on the infliction of great violence. Finger fracture.-As there is no muscular tissue in the finger shafts, the bones lie near the surface. The first or second phalanx may be broken by indirect force, but the third or ungual never, except by the direct. A fracture of an ungual phalanx is always a serious affair, because it often involves the loss of a joint, and like a deep puncture or laceration of the digital pulp, it may be the starting point of gangrene, or an infection which will spread through the lymph channels and menace the hand. I know of no class of traumatisms which tests the practitioner's skill and judgment more than open-fracture of the finger. In many of the most mangled cases, it is surprising to note what may be accomplished here by thorough cleansing, the careful adjustment of the fragments, with proper dressings. The accomplished practitioner will not despise small things, and in no class of apparently trivial injuries will his reward be more deserved than where he can spare a mangled finger, or any part of it. In these cases, dissossement or elimination is a most precious resort. New York City. Dear Doctor:-If it should so happen that you are not now a subscriber to the SUMMARY, will you please look this number over carefully, and then ask yourself the question: "Do I want the SUMMARY at a dollar a year?" This number represents a fair sample. We will not call your attention to any article in particular, but believe that you will admit, as hundreds have written us, that the SUMMARY is one of the most practical of all the medical journals published. Let us have the pleasure of entering your name on our subscription list at once. Do it now--to-day. Medical Progress. Under this head we endeavor to present a condensed summary of practical medicine, drawn from the best and most reliable sources, thus saving our readers much labor in winnowing out from the chaff medical grains of real value. Treatment of the Pains in Locomotor Ataxia. should be removed at once, and doné thoroughly. This is not always a simple operation. 5. In trying to remove foreign bodies from the ear, do not use any violence. Never push therein, and if you cannot remove them, simply send the case to an aurist, who is perfectly competent to do such work, as he is prepared for this, and it is generally very easy for him to succeed. 6. Remember that little boils in the outer part of the aural canal are no insignificant things, and that they may give rise to a great deal of trouble. 7. Remember that the artificial drums that you see advertised in the lay press are no good, and you had better warn your patient against the purchase of them. 8. Discard all such such practice as dropping sweet oll and other oily substances into the ear. Better use a little warm soda water. Dr. Campbell finds that the chloride of aluminum, first recommended by Gowers, gives absolute relief from the fulgurant pains in locomotor ataxia. The pains are usually controlled before the dose reaches half a grain. This dose, administered three times a day, largely diluted, after meals, has been given by the author to a number of patients for periods varying from a year to less, with absolutely no disturbance of the digestion, or of the general health. On the contrary, the immunity from the pain has enabled them greatly to improve in general health, and this improvement has reacted favorably on the other symptoms of the disease. A result such as this, attained without the use of narcotics or heart depressing or heart depressing Treatment of Hemorrhage in Typhoid Fever. analgesics, and with a certainty that amounts almost to specificity, is well worthy of a trial, especially in a class of patients who, in addition to these pains, have much to make life miserable. 9. Do not "monkey" with an ear. Dr. R. G. Curtin makes the following recommendations as to the treatment of hemorrhage in typhoid fever. If caused by leakage from the mucous membrane, ergot hypodermically or by the mouth. Turpentine, internally or externally, is useful when the hemorrhage is associated with tympanites. Externally applied, it should be sprinkled on a flannel cloth. Oplum should be used if the bowels are loose. Oll of erigeron is useful if the stomach will bear it. It should be given in capsule. Ice externally, applied in an ice bag, or pieces of pounded ice passed into the bowel may be efficacious. Suprarenal extract, and, in some cases, thyroid extract are useful. Ligatures about the limbs, applied tight enough to obstruct the venous return of blood, should be used in extreme cases. The foot of the bed should be elevated. Dr. Curtin's records show that since the Introduction of the cold water treatment the percentage of hemorrhagic cases and the mortality of these cases has increased. -Medicine. Diet in Typhoid Fever. Dr. Frederick C. Shattuck says that from 1886 to 1893 his hospital patients were given an exclusive milk diet until the temperature had remained at or below 99° for a week; since that time he has fed his typhoid patients according to their digestive power rather than according to the name of their disease, simply avoiding anything which contains, or can reasonably leave a residue irritating or harmful to the ulcerated surface. Under the exclusive milk diet he had a mortality of 10 per cent. in 233 cases; with the enlarged diet the mortality has been 8.45 per cent. in 246 cases. Relapse was less frequent, hemorrhage and perforation no frequent than among milk-fed patients. The patients are more comfortable and have a shorter convalescence. more draught up the chimney. The bed should be a single one, preferably of iron, with wire spring, a soft hair mattress covered with rubber cloth, and a double layer of blanket over this. Sheets should be changed and the blanket aired daily, and the mattress changed and aired often. If there is room there should be two beds, that the patient may have a daily change Cleanliness with the least disturbance. and the use of means to destroy the germ of the disease should be enjoined. When all these things have been done, the question of drugs is of secondary importance.-Med. Record. Orchitis. Dr. Lutaud combats the pain of orchitis by the administration of cachets containing seven and one-half grains of sulphate -Boston Med. and Surg. Journal. of quinine. In the majority of cases pain is arrested after the first dose, and it is unnecessary to give an injection of morphine. At the same time the following is applied locally: Horse-Nettle in Epilepsy. Dr. W. L. Heeve reports most excellent success with horse nettle in the treatment of epilepsy. In the first case, by its use, he reduced the frequency of attacks from one every eight days to one every six weeks. He gave it in dram doses every three hours until it produced a slight stupor. In the second case the patient was having four seizures a month. After seven months' treatment she was apparently cured. In two syphilitic cases there was slight improvement only after six months' treatment. The author also found solanum to be a very reliable remedy in treating convulsions occurring during scarlet fever. It is also excellent in neurasthenia.-Med. Gleaner. possibly elixir of cramp bark for a week at the time of menstruation, is all that is necessary. To this may be added a hot astringent injection, given at bed-time, the patient lying on her back with her hips elevated while taking it. Zinc sulphate, lead acetate, copper sulphate, alum or creolin may be used in the water, or in the same way fluid hydrastis, 2 to 4 drams to the pint. In other cases, vaginal suppositories, each containing 2 to 5 grains of tannin, may be tried. If the leucorrhea is dependent upon a torn and lacerated cervix, of course, the treatment is surgical, but Monsell's solution, tannin or nitrate of silver solution (30 grains to the ounce) may be applied as a palliative meastre. All mucus must be removed before making applications. Dr. N. G. Price, of Newark, N. J., in a contribution to the "Therapeutics in Children, in a recent issue of the Phila. Med. Journal, draws the following conclusions on heroin in the treatment of diseases of children: Heroin is a non-irritating remedy, the only untoward symptom I have ever met with being vertigo of a transitory character. Its dose should be limited to that ordinarily given by me, namely, 1-240 grain, to a child one year old. 2. It possesses antispasmodic properties more potent than the bromides and the belladonna group of remedies. 3. It is a sedative to all mucous membranes, but particularly to the mucous membrane of the respiratory and genitourinary apparatus. It soothes irritation and allays congestion. 4. It diminishes peristaltic hyperactivity and hypersecretion of the intestine. 5. Heroin is rapidly absorbed by the rectal mucous membrane when previously washed free from fecal accumulations, exerting in this manner of administration its usual influence. The dose per rectum should be double the dose per mouth. 6. This drug is completely oxidized in the system and produces no cumulative symptoms. 7. Heroin hydrochloride is preferable to the alkaloid itself, because it is readily soluble in all vehicles, and more rapidly absorbed. Heroin is not adapted for mixtures, or for hypodermic use, because of its insolubility. 8. Heroin hydrochloride is compatible with the expectorants, and with the other antispasmodic, analgetic and sedative remedies. Menopausal Headaches. Dr. Leuf makes the statement that many cases of menopausal headaches yield to aconite, in drop doses of the tincture, given hourly or half hourly until effective. If elimination is defective, 5 drop doses of the wine of colchicum often give surprising relief. Severe throbbing headaches are often quickly relieved by veratrum viride, of which five or ten drops of the fluid extract may be given at hourly intervals until effective, and continued thereafter as needed. If the pain is due to excitement, there is nothing better than potassium bromide, one-haif dram in a goblet of water. Coal-Gas Asphyxia. In Merck's Archives we find the statement that a most efficient remedy in carbonic acid poisoning through inhalation of coal gas is found in the administration of hydrogen peroxide by the mouth and per rectum. The basis of this treatment lies in the absorption of oxygen from the hydrogen dioxide into the blood current. By the mouth it is given in doses of one ounce, diluted with an equal volume of water. Per rectum it may be given full strength in doses of two ounces. A piece of ice inserted into the rectum is also of great service in restoring consciousness. Heroin for Whooping Cough. Dr. N. G. Price states that in whoopingcough heroin has given most convincing proof of its antispasmodic properties. It diminishes both the frequency and the violence of the paroxysms and insures undisturbed slumber. It apparently shortens the duration of the disease, and seems to prevent the pulmonary complications which so frequently occur in the course of this malady. This result is brough about because heroin abates the violence of the spasmodic cough, thus minimizing the mechanical injuries to the delicate airvesicles-injuries which play the most important part in the formation of a nest for pathogenic bacteria.-Phil. Med. Jour. Common Errors in Examining Urine. It is necessary for all physicians to make urinary examinations in order to be in touch with the condition of his patients. The large majority of physicians make use of very crude and inexact methods in urinary diagnosis. Whenever albumen is found, nephritis is diagnosed without recourse being made to the microscope in a large number of cases. Although the presence of albumen is of great significance in every case, it does not signify that a kidney lesion must of necessity exist, since the presence of pus from a case of cystitis, urethritis, or vaginitis is sufficient to give the reaction of albumen. In some cases of advanced interstitial nephritis, the quantity of albumen is very slight, and on microscopical examination urinary casts are few, and can only be discovered on prolonged and repeated search after the sediment has been thoroughly centrifugaled. The method of testing for albumen with most physicians is the heat test, and is a good test if carefully and properly done. The following test will mucin included. Another most common Malarial Vertigo. -Periscope. Dr. T. J. Mays believes that vertigo is a very much overlooked symptom of malaria. It may be intermittent or permanert, merely a condition of dizziness or associated with other neuroses, and is attributed to the effect of the malarial poison on the solar plexus. Associated with the vertigo are headache and backache, depression of spirits and exhaustion. The most favorable combination of remedies known to the author is a combination of quinine, pushed to mild cinchonism, and strychnine, blue mass, and capsicum. In obstinate cases of vertigo the possibility of a malarial origin must never be lost sight of.-A. M. A. Jour. be found most satisfactory: The urine Ichthyol Ointment in Pneumonia of Children. The lower stratum of clear urine furnishes a convenient comparison. No other proteids except albumen will respond to this test, neucleo-albumen or Dr. Franke has had good results from the use of ten-per-cent. ichthyol ointment, spreading it in the breath of two hands over the back of the patient, and applying over the dressing two or three times dally a wet pack for one and a half hours. He reports that in forty-eight hours the restlessness disappears, the temperature sinks considerably, the cough is painless and loose, and the appetite improves.-Medical Age. Second to None. The SUMMARY is second to none. It is 1 |