GAILLARD'S MEDICAL JOURNAL. A MONTHLY JOURNAL OF MEDICINE AND SURGERY Scientia et Veritas Sine Timore. M. E. GAILLARD, (PUBLISHER.) P. O. BOX 1124. 106 Fulton St., NEW YORK. All business communications should be addressed to Gaillard's Medical Journal, P. O. Box 1124, New York. All editorial communications to Carter S. Cole, M.D., IOI W. 74th St., New York. Articles for publication will be received with the understanding that they are contributed exclusively to this journal. Reprints will be furnished at actual cost, orders for which should accompany the manuscript. Authors of accepted articles may receive twelve copies of the issue in which they are published. Necessary illustrations will be furnished without expense to authors when suitable drawings or photographs are furnished. EDITORIALS. THE DEATH OF DR. ERNEST BRAND. Although the chief object of the doctor's mission is to cure disease, therapeutics is a branch of medicine which seems to lag far behind all other branches in the march of progress. It is, therefore, a sad office to record the departure from this life of a man who has made the most substantial additions to life-saving therapeutics in modern times. The treatment of typhoid fever has passed through many phases, and、 is still the subject of earnest consideration, whenever practical physicians meet to discuss the chief problem of their daily lives. The expectant plan which resulted from the swinging of the pendulum in the opposite direction, after bloodletting and other depletive measures, held sway until the antipyretic theory pointed to high temperature as the chief lithol element. Then came Liebermeister's frequent cold baths and heroic doses of quinine, which improved the mortality statistics and elicited psalms of praise for the originator of this method. Then came those real antithermic agents, derived from coal tar, which bid fair to revolutionize typhoid fever management. If high temperature was the lithol element, we had a key to its suppression in these powerful antipyretics. How sadly we were disappointed is recorded in the history-book of every hospital and graven in letters of sorrow in many a household. Then came the antiparasitic theory of treatment, in which we are now floundering, and from which we are likely to emerge wiser men. In the meantime one method survives and meets all the demands of the most advanced science-the methodical bath treatment. This was inaugurated by Ernest Brand in the sixties, and stands to-day-thanks to his bold, unswerving, ceaseless advocacy-unshaken, because it is clad in the panoply of clinical results of undisputable character, which defy the skeptic and scoffer alike. That the Brand method has greatly diminished the mortality of typhoid fever was attested many years ago by Gottstadt, the director of the Imperial Statistical Bureau in Berlin, whose statement led the surgeon-general to recommend its adoption in the German Army. It was again attested last fall by Prof. Gerhardt, when, in opening his course of lectures in the Berlin University, on "Prognosis," he dwelt upon the change wrought by Brand's method in the prognosis of typhoid fever, which was thereby reduced to one-fourth of its former mortality. Although the value of this systematic method is not yet fully recognized, chiefly because of the difficulty attending its execution and its seeming heroic character, the student of clinical medicine discerns clearly the great boon which Ernest Brand has conferred upon suffering mankind by laboring with heroic self-abnegation for the recognition of his simple and effective method. We are called upon to mourn the death of this noble man, who, though not clothed in the paraphernalia belonging to a professorship, sent out from his humble private practice, the glad tidings of a treatment which, if adopted early, as he has insisted, renders the physician the master instead of the watchful guardian and slave of a disease, which has hitherto tantalized him by its sudden turns and appalled him by its fatal complications, against which he has felt himself powerless to contend. Brand has enabled us to prevent these complications; he has smoothed the path of patient and physician alike. May his memory be blessed, and serve to incite us to humble emulation ! ERRORS IN THE MANAGEMENT OF INFANTS. A recent paper before the Hufeland Society of Berlin, for an abstract of which we are indebted to our excellent contemporary, the Deutsche Medicinal Zeitung (March 15, 1897), emphasizes the excesses committed in the management of infants. Dr. Neumann presented some views to the society which, though somewhat iconoclastic, bear so much impress of truth and practical value, that our readers may profit by a brief reference to them. The bathing of the newly-born is regarded as unnecessary, because the child is issued into the world in a practically aseptic condition. Indeed, it is much cleaner than would seem, the veanix caseosa being an excellent protective which is not liable to decomposition, and which we should not be so anxious to remove as is usually done. The water in which the infant is bathed is regarded, and, we believe, justly so, as a frequent source of infections of the navel, which is usually handled too carelessly by the nurse. It would be better to use more caution in preventing infection of the navel by less manipulation than to be over-solicitous in dressing it with disinfectants. Neumann regards it as advisable to defer all bathing of the infant until after the cord has dropped off. The first bath may be retained, provided the infant is cleansed with soap and a clean sponge, before being put into it. Neumann quotes with approval the practice adopted in the Woman's Hospital of Philadelphia, where immediately after delivery of the head the infant's eyes are washed with an antiseptic solution, and the cord is not severed until the placenta is spontaneously delivered; when the mother is cared for and all the flow is stopped, the cord is cut afterward, and neither tied nor dressed; the child is wrapped up warm, and receives its first bath only after the lapse of twenty-four hours. If the first bath is insisted upon, subsequent baths should be omitted; the navel cut quite short after being tied well, and dressed with a cotton pledget, which should be removed on the third day and then every second day, until it drops off. Then the infant may be bathed and swathed daily. This is the method pursued in the maternity at Buda-Pesth, in which out of 230 newly-born, only 3.5 per cent. presented a febrile cord infection, and 11.9 per cent. had fever at all, while formerly the percentages were 22 and 45 respectively. Bathing the newlyborn may be injurious, also, because it cools the body too rapidly. Infants that are not bathed are more prone to gain weight than those who are bathed. In bathing the eyes of infants, it is a too common practice of nurses to cleanse the conjunctiva, which is not necessary unless a purulent discharge exists and may cause abrasion. Another excess is committed in cleansing the mouths of newly-born infants, which usually are clean enough. The practice of covering a finger with a cloth and scrubbing the delicate lining membrane of the cheeks and tongue and gums of the little one, cannot be too severely condemned. Stanolitis is frequently the result of abrasions thus produced; aphthæ result, which are again scrubbed, and which would heal more readily if left alone. Cutting the frenum lingnæ and scarifying the gums are slowly going out of fashion. Careful observation teaches the judicious practitioner the adsurdity of cutting the gums, and enables him to withstand the entreaties of anxious parents and friends to relieve the child by this barbarous procedure. Who has not observed how quickly such incisions heal and leave a scar, which presents the same obstruction to the passage of the tooth. Modern methods of examinations of sick infants have become so thorough that other causes than "difficult teething" may be readily discovered, to which the infant's illness may be traced. It is somewhat surprising to find, therefore, that Neumann regarded it necessary to inveigh against "cutting gums" in this enlightened era of pædiatrics. The young practitioner cannot be too guarded in watching the infant's first bath, especially providing against the use of any but boiled water, which should be applied with clean, fresh absorbent cotton and never with a sponge, since the latter is prone to be used for other purposes. The warning against injuring the lining membrane of the mouth is quite apropos; we do not remember its previous publication. Unless some of the fluids issuing with the child have entered its mouth, the interior of the latter should be scrupulously avoided by the well-meaning but officious nurse. A TRIBUTE TO HEROISM. We cannot pass without comment the recent tribute to the memory of two valiant and able physicians who sacrificed their lives during the yellow fever epidemic of 1877 in Fernandina, Fla. A stained glass window has just been placed in memory of them in St. Peter's Church there, and never was such a tribute more well deserved at the hands of a grateful community. The physicians were Drs. Francis Preston Welford and James Carmichael Herndon, both of whom volunteered their services and moved to Fernandina to fight the epidemic. Dr. Herndon had already a few years previously demonstrated his courage and ability in a similar epidemic. The window was given by Dr. J. Baxter Upham, and if the people had added a monument they would not have lavished too much upon the memory of these fearless and able physicians. It is a rather remarkable fact that monuments are so often erected to men who have done so little in comparison to the great work of some of the great physicians, while the tributes to men in our own profession in this especial line are so few as to be capable of enumeration in a very few lines. This may be due to the fact that the community remark the physician as simply doing his ordinary work, and yet however much he might be blamed for shirking or trying to escape his regular line of duty, when, as has so often been the case, he volunteers to go into the very midst of a death-dealing epidemic and contribute to the relief and recovery of the sick and suffering, he cannot be regarded in any other light than a hero. GAILLARD'S MEDICAL JOURNAL. VOL. LXVI. NEW YORK, JUNE, 1897. No. 6. ORIGINAL ARTICLES. PATHOLOGY AND TREATMENT OF INTERNAL HAEMORRHOIDS BY LIGATURE, WITH CASE.* By WM. H. PARKER, M.D., Richmond, Va. Professor of Genito-Urinary and Rectal Surgery in Summer School of The disease commonly called piles is the most common of all human ailments, except the ordinary "cold." Yet there are unfortunately few diseases in which, as in piles, the surgeon is able to assure the patient in every case that he can positively be cured. Piles have their origin in the over-distended and varicose hæmorrhoid vessels, principally the veins modified by the mechanical violence to which their position exposes them. The vessels are very liable to become varicose-first from the fact that valves are absent in the veins; second, because of the erect position; and third, because of the peculiar office of the rectum. The veins immediately around the verge of the anus form a continuous network by anastomosis with the hæmorrhoidal plexus of the rectum within. These veins anastomose even in the substance of the sphincter muscle. Therefore from the character of the veins in which they take their origin, there is no distinction between internal and external piles. Now these veins have no valves, and, consequently, whenever the portal circulation is sluggish or an abdominal tumor, ovarian, etc., or pregnancy exists, we have a stagnation of the blood and a dilated and varicose condition of the hæmorrhoidal veins-a condition similar to varicose veins of the lower extremities or a varicocele. Owing to the constant erect position is it a matter of surprise that we should find this varicose enlargement with thickened walls and pouchlike dilatations? *Read before the Richmond Academy of Medicine and Surgery, April 13, 1897. |