Page images
PDF
EPUB

the facial nerve, and we yawn. This phe. nomenon is more easily excited in the irritable, feeble, and nervous than in the more robust; and it is frequent at the onset of coma, and of eruptive and other fevers. But why do we yawn when others yawn? In church, if somebody coughs, others invariably follow suit. In talking to stammerers, we find ourselves stammering. The sight of a person in a hysterical or epileptoid fit will often induce a similar attack in others, as is frequently seen in hospitals. And if, in like manner, some one in our presence gapes, as though fatigued, we seem at once to associate their actions with a certain idea, the idea of gaping; we suddenly realize that we are tired, too, and so we yawn in chorus. But what originates this association of movements with ideas? Is it sympathy, mockery, jeal ousy, or what? LOUIS LEWIS, M. D.

[blocks in formation]
[blocks in formation]
[blocks in formation]

Salol, gr. vi, three times a day, in chronic rheu. matism.

Powdered sulphur locally, applied under hot flannel and oiled silk, in chronic rheumatism, lumbago, sciat ica, etc.

[blocks in formation]

R Ext. colocynth co.

gr. xlv

Ext, colocynth rad..........

.dr. ss

Ext. hyoscyami.

.gr. x

..gr. x

Divide into 30 pills.

One three times daily, in

chronic rheumatism.

matism.

[blocks in formation]
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]
[blocks in formation]

B Potass. iodidi.. Potass. bicarb. Vin. colchici. Ammon. carb.. Syr. zingiberis. Aq. dest..

..dr. j

.dr. ij

[ocr errors]

.gr. xxiv

dr. ss

ad oz. viij

Two tablespoonfuls thrice daily, in rheumatic head

ache.

Cold bath, or cold wet pack, in acute rheumatism with hyperpyrexia,

B Vin, colchici..

Sod, et potass. tart.

Aq. chloroformi.

partes equales.

Dr. j ter die, in chronic rheumatism.

Osmic acid, mg iv (100 per cent. sol.) hypodermically, in muscular rheumatism.

R Chloral hydrat.

Misce.

tism.

Acid. salicylici.

Ung, stramon i

..dr. j dr. ss oz. j

As an ointment, in acute articular rheuma

Those articles of food which contain the largest percentage of nitrates are the best builders of the muscular system; phosphates are most needed for the nerves and brain; carbonates help to form the fat. Beans, peas, oats, salmon, eggs, beef, all contain plenty of nitrates; the same foods, and, in addition, codfish, contain an abundance of phosphates; butter, rice, cabbage, corn, beans, provide the carbonates. Eggs fried in butter, or codfish similarly treated, constitute a perfect fleshformer.

Hemorrhage from wounds of the scalp is generally arterial, although it does occur, as a rule, in jets. It is to be recognized by its color. Venous hemorrhage from the scalp is of course darker in color, and indicates injury of the cerebral sinuses.

If a little bile be added to human blood, small, right-angled crystals will soon develop; horse's blood will develop cubes; pig's blood, right-angled prisms; sheep's blood, rhomboidal plates; chicken's blood, cubes, more or less regular; but the blood of a dog will present precisely similar crystals to that of a man.

The Current Medical Thought.

.86 "Knee-Jerk."

"Knee-jerk" is the most familiar and most demonstrable of the tendon reflexes. It is easily tested by hanging the leg of the patient over the fore-arm of the physician, whose hand is meanwhile placed on the patient's other knee. The leg should then be struck smartly with the edge of the hand (or with a percussion hammer), upon the bare skin. Reflex contraction of the quadriceps extensor muscle will be excited, and the foot will be involuntarily jerked upward. The manoeuvre should be tested on both legs, as a perceptible difference between the two sides may indicate some pathological condition of the spinal cord. The absence of knee-jerk, however, is no posisive sign of disease. Reflex movements may be excited in any sensitive part of the body, as the sole, the thigh, the buttock, the scapula, or the abdomen. Foot-clonus, personal reflex, and tendoachilles reflex are examples of deep tendon reflexes. "Knee-jerk " has been a common source of amusement among young people for years.

Bones of the Insane.

In many cases of insanity, the osseous structures undergo certain pathological changes, which render them peculiarly liable to fracture on the application of very moderate force-a degree of force in no way commensurate with the effects produced. This condition especially affects the ribs; and attendants on lunatics are open to charges of unnecessary violence, when the patients may have received their injuries through the unnatural brittleness of their own bones-a condition known as osteomalacia.

Talipes and Spina Bifida.

Talipes calcaneus in infants is commonly found associated with spina bifida. When the foot is drawn up permanently towards the forepart of the leg, with great prominence of the heel, a tumor constituting spina bifida may be looked for in the lumbar spine. Club-foot is also frequently thus associated.

The hysterical paralysis of the bladder, which is not infrequently met with in young females, generally yields to the administration of ergot and strychnine; say half a drachm of liquid extract and five or six minims of liquor strychniæ (P. B.) in chloroform water, three times a day. Of course the catheter is sometimes, but not always, required.

Temperature in Jaundice.

In case of jaundice, the bodily temperature is abnormally low, except in those instances where jaundice is occasioned or accompanied by a disease which of necessity begets fever. When the liver is performing its functions naturally, much heat must necessarily be generated by the rapid chemical changes involved in its work; but when these changes are lessened or held in abeyance, as occurs in jaundice, the temperature would fall, and no doubt affect the whole system in like manner.

For Bacchanalians.

Half a teaspoonful of chloride of ammonium in a goblet of water will almost immediately restore his faculties and powers of locomotion to a man who is helplessly intoxicated. A wineglassful of strong vinegar will have the same effect, and is frequently resorted to by drunken soldiers to enable them to return steadily to their barracks.

Pain at the tip of the shoulder, so frequently sympathic of peptic disease, is also present in cases of disease of the pancreas. The other symptoms include a deep aching pain below the centre of the epigastrium, radiating through to the back, chest-walls, and left lumbar region.

When the muscles of the orbit are paralyzed, without any apparent lccal trouble in the eye or brain, rheumatism will be the most likely cause, or else some lesion of the spinal cord.

An enema of a strong infusion of green tea has acted antidotally in a case of opium poisoning.

Frequent doses of antipyrine often change the color of the blood to a rich chocolatebrown.

The Danger in Medical Abbreviations. We doubt whether many practitioners of medicine who are accustomed to write prescriptions daily realize the danger their patients run through abbreviated formulas. Some physicians affect an extreme brevity, as if it intimated their superior familiarity with the materia medica One of the best we ever knew always wrote out fully the names of the drugs in a clear hand, and took time to do it. How many sick persons have been poisoned by excusable mistakes on the part of the druggists in deciphering prescriptions it would be difficult to say, and the many jokes said to have been practised on drug clerks whereby meaningless

scrawl was translated into a bottle of some compound, have a basis in fact.

From an exchange the following list is taken, which shows how some common modes of abbreviating may be interpreted to mean severally from two to five different things, some poison

ous:

Acid. Hydroc.

Aconit.

Ammon.

Aq. Chlor.

Aq. Fontis.

Calc. Chlor.

Chlor.

Emp. Lyt.

Ext. Col.

Hyd. Chlor.

Hydr.

Mist. Ammon.

Potass. Hyd.

May mean Acidum Hy-
drochloricum, or Acidum
Hydro cyanicam.

SAcontine.

Aconiti Radix.
Aconiti Folia.

SAmmonia (alkali.)
Ammoniac (gum-resin.)
f Aqua Chlori

Aqua Chloroformi.
(May often be read Aqua
Fortis.

Chloride of Calcium.
Chlorinated Lime.

Chlorine.

Chloroform.
Chloral.

Emp. Lytharg (lead plas
ter, old name.)

Emp. Lyttae (blistering
plaster.)

Extractum Colchici.
Extractum Colocynthidis.
Calomel.

Corrosive Sublimate.
Chloral Hydrate.
Hydrargyrum (mercury.)
Hydras (hydrate.)
Hydrochloras (hydro-
chlorate.)
Hydrocyanas (hydro-
cyanate.)
Hydriodas (hydriodate.)
Ammonia Mixture.
Mixture of Ammoniac
(gum resin.)
Hydrate of Potash.

(caustic potassa.)
Hydriodate of Potash
(iodide of potassium.)
-Phrenological Journal.

The habitual use of macaroni is said to be a cause of acne.

Dr. Mathews on the Treatment of Hemorrhoids.

He

At the last meeting of the American Medical Association, Dr. Joseph M. Mathews, Professor of Surgery and Diseases of the Rectum in the Kentucky School of Medicine, Louisville, read an interesting paper on the above subject. thinks that hemorrhoids is a disease of middle life, and that they seldom affect children and old people. He also thinks that there is no anatomical basis for the classification of hemorrhoids into venous, arterial, capillary, etc. As to treatment, he was opposed to carbolic injections from the start, and he gives the conclusions of Dr. Andrews against this method, although he does not seem to have tried them himself. It is true that there has been some bad effects from this method; but it is now claimed by some of the later writers that these all arise from the use of too strong a solution of the acid, and that with the use of a solution of from seven to fifteen per cent. the method is perfectly safe. Dr. Mathews also opposes dilation of the sphincter, claiming that it is impossible to remove or cure a well-developed hemorrhoid in this way. Above all other methods he favors ligation, and his remarks upon this method are well worthy of quotation in full.

"The Ligature.-Certainly, of all known methods, the ligature stands preeminent as an operation for internal hemorrhoids. It has stood the test of years in the hands of the most eminent surgeons. To-day it is the most popular method. Easy of execution, free of danger, and rapid in its results, it can but command the attention of all who are interested in this operation. To the principle involved in the use of the ligature all are agreed, but the method of application is to a certain degree disputed. The method, as practiced by Mr. Allingham, is to dissect the hemorrhoidal tumor away from its attachments, and then to surround the remainder, at its base, with a tight silk ligature. For the first few years in special practice I did the operation after this plan. I then modified it for these reasons: 1. It was misleading to teach students after this fashion, because there was much danger in their dividing the artery which supplied the tumor. 2. There was more cutting than was necessary.

"The modification consisted in running a delicate knife around the base of the pile, simply going through the integument. This saves any deep cut, and, at the same time, removes all superfluous skin, or external piles. Indeed, there are many cases of internal hemorrhoids which require no cutting at all. This point is not sufficiently brought out in the books. I Pepsin helps to destroy tape-worm by diges- allude to the large internal piles which have no

The uvula is only found in men and monkeys.

tion.

complication as mentioned here, viz.: super

fluous flesh, or external piles. These require only to be brought in sight, ligated and returned into the bowel. Much stress is laid upon the degree of tightness that should be accorded the ligature; some saying apply it loosely, others advising it to be drawn tightly. I am sure that the tighter a ligature is drawn, the quicker and more effectual will be the cure. A point is made in suggesting the kind of material to be used in the ligature. Many prefer silk. I am in the habit of using the stoutest linen thread, such as is used by saddlers or shoemakers. The twist of silk, or other material, I am sure, has nothing to do with it, as some seem to think it has. The kind of knot to be tied is spoken of, Mr. Allingham remarking that he ties the knot three times. Twice is quite sufficient, and the surgical knot has no advantages over the common hard knot. All internal piles existing should be ligated at the same sitting, and all returned into the rectum. The greatest care should be taken in cutting off the tumors after ligating. It is much best to leave the whole mass, rather than to have one ligature slip after returning the tumors into the bowel. The presence of the mass in the gut cannot result in any harm; the ligature is between it and the circulation. As a rule, then, it should not be cut off. A number who have written upon this subject say that the bowels should be confined for from five to seven days, and a light liquid diet enjoined. Certainly this is a mistake, for two reasons: 1. In this length of time the feces will become hardened and impacted. 2. These patients generally require all the nourishment they can get. When following this advice I have had as much, or more, trouble result from impaction, than from the original operation: My habit is to purge the patient the day of the operation, and to give an aperient on the second day after the operation, and each succeeding day thereafter, until the patient is discharged. Consequently a full diet is prescribed if required. When operating under an anesthetic, I always divulse the sphincters, more especially if any cutting is done. This prevents the contracting of the muscles, hence obviates much pain when inflamed.

"Anesthetics.It is often asked if the operation for internal hemorrhoids can be done without the use of anesthetics. If the sphincter must be divulsed because of the complication of fissure, ulceration, or what not; or if any cutting is to be done, then an anesthetic is absolutely necessary. If internal hemorrhoids exist without any such complication, and protrude well in response to the bearing down effort, then an anesthetic is not necessary. It is often suggested that cocaine could be used with

benefit in these operations. In the removal of external piles much benefit is derived from throwing the solution under the growth. the operation for internal piles I have found it of little value.

"Antiseptics.-Unfortunately,

In

strict antisepsis cannot be practiced in these operations. Fortunately, it is not as necessary as when operating elsewhere. I am in the habit, however, in all these operations, of having strict surgical cleanliness as regards both the person and instruments. If any cutting is done, the parts are dusted freely with iodoform, and the gauze of the same applied over the wound.

"Results.-As the caption of this paper intimates, I have operated about one thousand times for hemorrhoids by the ligature. I have never had to operate the second time upon the same patient for the affection. Have never had an unnatural contraction around the anus as the result of the operation, nor had ulceration or stricture to result. I have had in this time one case of tetanus, which I believe to have been superinduced by a debauch, the patient having been drunk for several days before the operation. The tumors protruded, strangulated and mortified, hence the operation. He recovered from the tetanus under the bromide treatment. had one case of secondary hemorrhage occuring on the third day. The rectum was plugged and the bleeding stopped. Also one dangerous case of hemorrhage which occurred one hour after operation was done, in consequence of the slipping of the ligature. the pile having been cut off. The patient was pulseless and cold when seen, but the artery was quickly secured and tied, and he made a good recovery. I have never had a single death result from the operation, and but few untoward symptoms."

Have

A poisoned finger is an example of erythema, and frequently occurs to cooks, poulterers, and the performers of post-mortem examinations. The member becomes swollen and inflamed in the neighborhood of the puncture, and red lines spreading up the arm represent inflamed lymphatic vessels, leading to the glands in the axilla, which will also be probably enlarged. Whitlow affects the distal phalanx of the finger, and is accompanied by the formation of pus and loosening of the nail. If there is no evidence of pus near the surface, the inflammation is in the periosteum, and the symptoms will be

more acute.

Stricture of the esophagus causes no real difficulty in swallowing; but the food persistently regurgitates into the mouth.

« PreviousContinue »