Malarial Toxemia.

Editor MEDICAL WORLD:

In the August number of THE MEDICAL WORLD I asked for a good treatment of chronic malarial poisoning. I myself have suffered for three years, have faithfully tried all modes of treatment, and yet I am still suffering from the effects of malaria in my system. I stated that quinia, iron, arsenic and the iodides failed to cure. Of course, quinine or the alkaloids of cinchona have helped and have done the most good, but never prevented a relapse. I admit a susceptibility to larger doses of quinia and cannot take over ten grains daily without marked deafness and tinnitis which renders me unfit to attend to my practice.

During the winter I had two attacks of intermittent fever lasting a week. I broke these attacks with quinine, but I cannot prevent the relapses of muscular aching, headache, sleepiness, malaise, etc., with any drug or combination of drugs. Probably half of the day I may feel well, and the other half I suffer with the above symptoms. I have a reasonably good appetite, good digestion, regular bowels, slightly furred tongue, and no trouble with my liver or spleen. I have been bilious at times with some tenderness over the liver, but it has yielded quickly to treatment.

In response to my August appeal to my medical brethren, our kind Editor of THE MEDICAL WORLD suggested the sulphurous acid compounds. I took a drachm of sulphite of magnesium every two hours, which failed to do me any good. It produced nausea and diarrhea after the first day, and I had to discontinue its use even in much smaller doses and at longer intervals.

I have saturated myself with picrate of amonia three different times and found no benefit from it.

This is not considered a malarial country, though it is near Philadelphia and practitioners in this locality all know we have many cases like myself to treat.

What can be the trouble? Who will suggest a successful treatment without change of climate?

I have my practice to attend to and do not have time to spend the summer at sea or in the mountains; but if it becomes necessary, where should I go, and how long would it take a change of climate to cure me.

There is no subject that interests me more than this one, and since my health and business are at stake, I would feel very grateful to the readers of THE MEDICAL WORLD to discuss in its columns the cause of my failures, and an efficient treatment for chronic malarial toxemia, especially when an idiosyncrasy forbids the use of quinia. O. C. ROBINSON, M. D.

Huntingdon Valley, Pa.

[Doctor, we will further add that we have found daily Faradization, positive over the spleen and negative over the liver, to be very

beneficial in such cases.

Why would not your case be a crucial test for the biochemic treatment of chronic malaria? See review of the book in August, 1888, page 313.-ED.]

Electro-Therapeutical Department.

DR. W. H. WALLING, 1411 Arch Street, Philadelphia, Editor. Cases, questions or views upon electricity in medicine are invited.

[Letters should be addressed to Dr. Walling, separate from any letter to the business department.]

In order to render this department still more useful to the patrons of THE WORLD, the Editor, Dr. Walling, will personally answer any inquiry regarding batteries or instruments, giving advice as to mode of operating, etc.

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Every battery sent out will be thoroughly tested, and all instruments carefully inspected, so as to guarantee satisfaction. If you have a preference, state it. Always enclose stamp for reply.

Electric Prostration. Several cases of this new malady are reported from Crensot, France.

and

It affects workers under electric light. The light exceeds 100,000 candle power, it appears that it is this excess of light, and not the heat which produces the nervous symptoms. A painful sensation in the throat, face, and temples is first noticed, then the skin becomes coppery red and irritation is felt about the eyes; much lachrymation ensues and these symptoms rapidly disappear, whilst the skin peels off in five days. The effects are comparable to those produced by walking over fresh snow in the sunlight, and may be regarded as a sort of a "sun-burning."-Lancet.

Dr. W. R. D. Blackwood, commenting on the above in the Medical Register of Feb. 9, said: "The same symptoms have affected myself some time ago, from constant handling of high currents in experimental work, the throat difficulty being prominent.

"Whilst this may happen, it can only do so rarely, for many exposures to greater light produce no injury in numerous instances. For instance, at St. Catherine's Point, in the Isle of Wight, the British Admiralty maintain a light of 700,000, which flashes at half minute intervals for five seconds, and as the beam is seen

Lapthom Smith's able paper, read before the American Association of Obstetricians and Gynecologists, Washington, D. C., Sept. 1888.

[We think that the timely changing of the cutaneous electrode referred to above by Prof. Smith is a very important matter, and we are

As yet,

Faradism in Hysterical Sneezing. DR. N. S. ROBERTS, in the Journal of the Respiratory Organs for Feb., 1888, mentions a case reported by N. J. Solis Cohen, of mysterious sneezing cured by application over the sensitive spot with a continuous current, placing the positive pole in the nostril and the negative on the cheek. At first only five Daniel's cells were used, then twenty; the length of the sitting being from ten to forty (?) minutes.

Position of Electrodes in Treating Uterine
Fibroids.

The cutaneous electrode is generally called the abdominal, but over a year's experience has forced me to change its name in many cases. I have observed in three cases of fibroid that, after about twenty applications of the current, the portion of the tumor lying between the intra-uterine electrode and the abdominal wall completely disappeared, so that I could feel the sound through the anterior wall of the uterus. In fact, although a large part of the tumor-indeed, all the posterior segment of it -still remained, I did not dare to thin the anterior wall of the uterus any more. I then began to place the cutaneous electrode under the patient's bare back, as she lay on the sofa, so that then all the current passed through the remaining half of the tumor.

It is easy to understand this, for in electrolysis the chemical decomposition only takes place in the tissues through which the current passes, and it always passes by the shortest road between two points. believe this simple little point may have a very important bearing on the result of the treatment, so that even the largest tumors will be completely absorbed, as well as the smaller ones.

After care of patients.-If possible, the application should be given at the patient's house or at the hospital, so that she can be carried direct to bed and remain there until the next morning. If, however, the treatment is to be given at the office, it is a very necessary precaution to make the patient lie down on a sofa for at least half an hour afterwards, and she should be cautioned against doing any hard work until the following day.-From Prof. A.

We take a further precaution in the treatment of some of these cases, and that is to cover the tip of the platinum electrode with shellac, the same substance with which the stem of the instrument is insulated.

Being thus tipped it is, as a rule, more easily introduced; there is no danger of injury to the uterus from a strong current concentrated at a small point, at times directly in contact with its walls, and puncture is rendered less possible. The instrument, however, having been introduced, and the current turned on, should not be pushed in nor its position changed without first materially lessening the

current.

We also insist upon office patients lying down after intra-uterine applications; but this accommodation cannot be offered to out-patients at the hospitals. Yet, after considerable experience with such cases, we have seen little, if any, bad effect following the application of quite strong currents when the patients were reasonably careful afterwards.-ED.]

Treatment for Tonsilitic Concretions. Editor MEDICAL WORLD:

In THE WORLD for April, 1889, Dr. G. O. Fraser requests treatment for tonsilitic concretions. If the doctor, after removing the concretions, will introduce a small galvano-cautery electrode to the bottom of each affected crypt in the tonsils, and heat the wire sufficiently to destroy it, the disease will be completely cured. But two or three of the affected crypts should be operated on at one time, and the tonsils should be attacked alternately. If these precautions are observed, there will be no reaction, and the patient will not complain of the throat being sore. The operation is entirely painless, and should be repeated as soon as all signs of inflammation have subsided. The post-nasal catarrh should, of course, receive proper local treatment, according as it is atrophic or hypertrophic in its character.

In the second case the doctor would do well to examine the region of the middle turbinated bodies of each nostril for signs of "necrosing ethmoidetis" and dead bone. Such conditions are not unfrequent causes of offensive breath. E. BALDWIN GLEASON. 1346 Spruce St., Philadelphia.

Galvanism in Dysmenorrhea and Other Pelvic Pain.

Dr. Franklin H. Martin, Professor of Gynecology in the Post Graduate Medical School of Chicago, etc., in a very able and interesting article upon the above subject in the North American Practitioner for April, 1889, cites three cases and gives the treatment, which con sisted in negative vaginal cauterization with a current of 100 milliamperes for five minutes at each visit. In one case intra-uterine applications were made. The current strength seems excessive to begin with, but he cured his patients. We are sorry we have not room for the entire article. He says:

"In citing the above, I am aware that three successful cases alone are not sufficient to establish a system of therapeutics. My object has been to give three typical cases of many successful ones in which I have depended on galvanism in strong doses as a sure remedy, to the exclusion of everything else. I have given these three particular cases, too, because they illustrate cases that have received the ordinary approved routine treatment of the gynecologist without obtaining the slightest benefit. I have emphasized these particular cases, also, because they represent a type upon which the gynecolo gist, without galvanism or the questionable use of the knife, have learned to look with almost hopeless dismay.

"Neither is there anything mysterious in the fact that galvanism will cure these pelvic difficulties. The conditions in each case reported were the same. Long-continued inflammatory action had left unyielding exudations, hyper trophied tissues, and contracting cicatrices. The unyielding exudate, in one case, interfered with the functions of the ovaries, and excruciating pain was the result, until the congestion was relieved. In the second case these new and abnormal formations, which were the result of inflammatory action, in turn produced irritation, which favored a continuation of the congestion, to be followed by new inflammation and the distressing symptom-pain. While in the third the progressive contraction of a mass of inflammatory product upon sensitive nerve tissues caused the symptom-painto manifest itself.

"Clearly the remedy here, in each case, was the removal of the product of inflammation. This was accomplished by a strong, continuous current of electricity passed through the parts from which it was desired to remove the superfluous tissue. Upon the large external surface represented by the positive pole very little action was perceptible, except what might be expected from a weak sinapism. As the current traversed the tissues from the large surface

electrode to the small internal one, it becomes more concentrated-the lines of force, in other words, that commence their radiation from a surface of 400 sq. c. m., gradually conveger to a surface of 4 sq. c. m. Within this inverted truncated cone of tissue traversed by one tenth of an ampere for five minutes, a given amount of chemical decomposition takes place. Whereever the current is the most concentrated, there takes place the most active electrolysis, provided everything else is equal. The internal electrode represents the apex of our electrolytic circuit, consequently at that point the greatest action takes place. If this point is observed through the speculum, an active bubbling of hydrogen gas through the secretion is noticeable, owing to the powerful electrolytic action. A profuse flow of serum also takes place from this, because of the cataphoric action of the current. If the current is sufficiently intense, an active solution of the tissues in contact with the poles will take place, as a result of concentrated alkalies liberated.

"What takes place at the poles can be reasonably expected to occur, throughout the course of the current, wherever it meets the slightest obstruction in the way of solid par

ticles.

"I hope I may be pardoned if, at the risk of repetition to some, I reproduce certain theories, formulated in a previous article, as to the manner in which electrolysis accomplishes absorption. We believe that a strong galvanic current, passed through a portion of tissue, causes its most susceptible molecules, by electrolysis, to become broken into their original elements:

"I. These elements immediately make a similar or different combination with neighboring elements of opposite electrical tendencies, making thereby new compounds which act as foreign particles; as foreign bodies they are. promptly removed by the nearest absorbent.

2.

4.

Other elements, as they become free from their original molecules, make combinations with elements which are already leaving the tissues through one of their innumerable minute vascular or absorbent canals. 3. Many, in the form of gas, pour into the atmosphere beneath and surrounding the electrodes. Others attack the electrodes and are disposed of in form of deposit on their surfaces. 5. The current, by its cataphoric action, that is, by its direct transference of fluid particles in the direction of the negative pole, produces an engorgement of the tissues at the negative side of the part acted upon. The absorbents in that portion of the tissue will promptly make an effort to establish an equilibrium, and by a direct action of endosmosis they are filled and

the excess is carried away in their current. This is what takes place in normal tissue when the galvanic current is passed through it.

"A similar change is produced in pathological tissues alone, or in pathological tissues incorporated with normal tissues. The ultimate The ultimate effect, however, on the two tissues of repeated electrolysis is different, because of the constant effort upon the part of non-pathological or normal tissue to repair itself, and the inability, with a few exceptions, of pathological tissue to do so.

"Besides the purely electrolytic effect of the galvanic current, which of necessity is only local, we also get a general effect, which might be expected from stimulation of trophic centres, or nerves, and which is therefore termed in a previous article the trophic effect of the galvanic current.

"The successful employment of galvanism, thus, in the relief of pelvic pain must be based upon: 1st, the varying effects of the poles from a slight irritant to a violent acid or al kaline caustic; 2d, the effect of inter polar electrolysis, which promotes rapid absorption, and 3d, its general trophic effect, with general improvement of nutrition.

Electricity, unlike all other applications, upon which the gynecologist has learned to depend, with varying degrees of success, has something more than a surface effect. The amount of electricity that passes through a hyperplastic ovary is the same that traverses the electrodes between which it lies. If the remedy is of value at all, that ovary must get the benefit of its effect just as certainly as though the sponges of the electrodes were in actual contact with it. With electricity we have a remedy, then, with which we can make local applications to the most deeply situated organs.

"I have given, in detail, three cases of pelvic pain in which galvanism has proved an ef fectual remedy. I have also endeavored to give what are generally accepted as the physical and chemical effects of the remedy when employed upon tissues like those found in the pelvis. From this the general indication for treatment seem to me plain. I must, at all events, in conclusion, be content to enumerate a few conditions where pain is often the predominant symptom, in which galvanism, in strong doses, will prove an infallible and prompt remedy:

"First. Do not advise the removal of an ovary for persistent pain until galvanism has been systematically and thoroughly applied, if any of the following conditions are suspected as a cause: (a) chronic ovaritis, either with or without hypertrophy; (b) where inflammatory

deposits, either with or without adhesions, surround one or both organs; (c) ovarian neuralgia; (d) all pain coincident with menstruation; (e) in all cases of ovarian pain not known to be the result of active, acute inflammation; septic or specific inflammation; and cystic

tumors.

"Second. Galvanism is a sure remedy for all pain resulting from tubular diseases, except when septic or specific inflammation is the cause, or the presence of pus is demonstrated.

"Third. Galvanism is positively indicated in dysmenorrhea or other pelvic pain when a result of chronic metritis; when a result of hyperplastic enlargement of the uterus; when a result of fibrous or other non-malignant growths of the uterus.

"Fourth. Galvanism is emphatically indicated in pelvic pain when a result of old pelvic exudates of all kinds, provided acute inflammatory action is absent and the presence of pus is not suspected or demonstrated.

"Fifth. Galvanism is indicated in pelvic pains arising from reflex disturbances, or hystero-neuroses, the condition well defined by Engleman as "a phenomenon which simulates a morbid condition in an organ that is anatomically in a healthy state.

"Sixth. Galvanism is indicated in dysmenorrhea when the result of cervical lacerations, with unyielding cicatrized plugs; when the result of cervical endometritis or uterine vegetation."

Intra-Stomachal Faradization in the Treatment of Dilatation of the Stomach.

M. Baraduc, well known for his clever applications of electricity, presents this subject to a local medical society and shows a number of cases to prove its efficacy. It consists in using Faradization only, with a simple celluloid catheter and fine wires, in all nervous gastralgias with slight dilatation. When the dilatation is very marked a larger wire is used, with the stomach sound arranged to evacuate excess of liquid. A retraction of the stomach walls is produced, which causes slight cramps, but leads to decided amelioration, and accomplishes final cure in (9) cases given by Dr. Baraduc.

-From Paris letter in Philadelphia Med. Times, April 15, 1889.

Phosphorus for Goitre.

Phosphorus, in full doses, is sometimes singularly beneficial in the treatment of goitre or bronchocele. The twelfth of a grain may be given in pill or perle, three times a day, its effects of course being carefully watched.