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The Current Medical Thought.
good. His treatment is as follows. The day before giving the worm medicine he allows no
food of any kind, except plain beef-tea, or Tonsilitis-Croup.
other very thin soup, and very little even of Two nemarkable articles appear in the edi. these. The first morning he gives one drachm torial columns of The Medical Register, of Jan- of compound jalap powder, which generally uary 12, 1889, illustrating the advantages of
operates three or four times during the day, aiming specifically at the cause of disease. and effectually clears out the bowels, bringing Regarding indigestion and rheumatism as
away at the same time large portions of the the source of tonsilitis, the writer reports con- worm. The patient, of course, keeps quiet in stantly successful use of salicylate of sodium, the house. On the second morning, on an ten to fifteen grains every three to four hours empty stomach, he gives a draught consisting If seen after suppuration has occurred, sulphide of from two or three drachms of oil of turpenof calcium, one-tenth grain five to ten times a tine and one drachm of oil of male fern in day, is required. The recognized value of sweetened emulsion.
sweetened emulsion. After an hour or so he guaiac in this disease would seem to fall in gives a dose of castor-oil. It will not be long with this line of thought.
before the whole of the worm with its head The other article relates to croup.
" In the will have passed, which will be found on proper early stages of croup, say in a child from two examination of the stools. The patient can to five years of age, a single two-grain quinine then take his usual diet, and the following day pill, given when it is gasping for breath at will be well. He has never known this treatabout two o'clock in the morning, will be fol. ment to fail. The doses, of course, are intendlowed almost immediately by relief. In the ed for adults. The frequent failure of the oil course of fifteen minutes the voice will return, of male fern as an anthelminthic is, he believes, the parents will be relieved of anxiety, and the attributable to the smallness of the dose exdoctor can go home and rest contented that hibited, less than a drachm for an adult being there will be no more trouble in that family for useless. The writer believes every native of the next twenty-four hours."
South Africa to be infected with one or more In regard to the treatment during the day he tapeworms. says: “The treatment of the disease is based upon the fact that we have to deal with an ab.
The Time for the Administration of Certain normal secretion, and we have a remedy in the
Medicines. sulphide of calcium which will exert a powerful influence upon its development. Instead, there. Iodine and the iodides should be given on an fore, of ordering the nauseating ipecac, we
empty stomach. If given during digestion, the should give a small portion of this compara
acids and starch alter and weaken their action. tively harmless remedy. In the worst cases
Acids, as a rule, should be given between meals. one tenth of a grain will accomplish all that Acids given before meals check the excessive secould be wished for ; larger doses appear to
cretion of the acids vf the gastric juice. Irritaexert no better effect than the smaller ones. * * ting and poisonous drugs, such as salts of arsenic, As a rule the first signs of on-coming croup
copper, zinc and iron, should be given directly may be satisfactorily overcome by the measures
after merls. Oxide and nitrate of silver should suggested, and for the general class of such be given after the process of digestion is ended; cases it will be necessary only that the little if given during or close after meals, the chemipatient should continue the treatment for a few cals destroy or impair their action. Potassium days, or; at most, a week.” Shall we believe permanganate, also, should not be given until that we may yet feel safe with a case of croup? the process of digestion is ended, inasmuch as
organic matter decomposes it and renders it The Treatment of Tapeworm.
inert. The active principle of the gastric juice
is impaired and rendered inert by corrosive In reply to a correspondent of the Lancet, sublimate, tannin and pure alcohol; hence they several communications are published in that should be given at the close of digestion. journal, including one from Dr. F. A. A. Smith, Malt extracts, cod liver oil, the phosphates, of Cheltenham, who says that during his stay etc., should be given with or directly after in South Africa he treated many cases, his own
food. included, and all with success. point in the treatment of tapeworm, he says, is
Abortive Treatment of Syphilis. to expose its head, which is attached to the (L. Mannicco, Giornale ital. delle mai intestine by its hooklets. So long as the head venerre, fasc. 2, 1887.) “Authorities," says is covered with feces no medicine will do much Mannicco, are becoming more numerous who
think it possible by early surgical intervention drachm of the ointment was rubbed into the to abort syphilis." He himself has had six scalp twice daily. It was well rubbed in until cases which he was able to observe from the no traces of the ointment remained. The first development of the initial lesion. After tincture of ver. vir. was administered in drop the local use of cocaine he destroyed the doses hourly, and the bromide of sodium used chancres, and in four cases no syphilitic symp- at night only in six grain doses." toms developed. That the lesions were really There was gradual improvement, and final syphilitic, he proves by the long duration of recovery. Meanwhile an eruption of boils apincubation, the unicity and induration of the peared on the thorax and abdomen, over fifty chancre, and, above all, by examination of the being counted at one time. persons who were the sources of infection.
[There have been several cases of tubercular That such cases are so seldom observed from
meningitis, without doubt as to the accuracy of the beginning he thinks is due in part to the
the diagnosis, reported cured by treatment subcarelessness of the patients, and to their ignor- stantially the same as the above.--Ed.] ance. If the public were educated to a proper appreciation of the importance of early treat ment, he is satisfied that in many cases early
We have lately seen an urethral discharge destruction of the chancre would prevent
(which had not an infectious origin) quickly systemic syphilitic infection. -Deut. Med. subside by means of an injection of sulphate of Zeit.
quinine, five grains, and a little glycerine in
two ounces of water. Influence of the Iodides on the Elimination of Mercury.
Calomel on the Kidneys. (Souchow, Journal de Médecine; Wien. Med. Calomel is supposed to increase the eliminaIoch, July 7, 1888.) It is generally believed tion of glycogen and urea in the liver, and to that iodine salts hasten the elimination of cause dilatation of the renal vessels. Therefore mercury. Souchow's investigations have led it would be contra indicated in renal disease, him to the following conclusions: (1) When and serviceable in heart disease.
Yet persons mercury and iodine are taken at the same time, with "kidney troubles" seem usually to derive the elimination of mercury begins later and is much benefit from an occasional dose of less in quantity. (2) When iodine salts are calomel. given after the exhibition of murcury, the amount of the latter eliminated is at once di
Heart Disease in Children. minished; from which the writer concludes, contrary to the conclusions of other authors,
When heart disease affects children, it is that iodine hinders rather than increases the commonly the mitral valve that is at fault, and elimination of mercury.
it occurs more frequently in females than in males. Rheumatism is not the sole factor;
rickets, diphtheria, purpura, and extensive Tubercular Meningitis Cured by Iodoform.
losses of blood are among the causes.
The In the N. Y. Medical Times, Dr. Miner, of symptoms of heart disease in the young are New York, reports a case of undoubted tubercu- obscure, and frequently overlooked, until lar meningitis cured by inunctions of iodoform. ! adhesions perhaps embolism result. The child's condition is thus described :
should be enjoined and "Temperature, 105.40; pulse, 144, and digitalis, strophanthus, and iron prescribed, weak. Child cannot articulate.
Swallows according to indications. Should the patient with difficulty. Is extremely prostrated. Head attain the age of puberty, there will yet be drawn back, boring in pillow, and rolling con- much to apprehend, and the case will have to stantly from side to side. Screaming and be carefully watched. grating her teeth at intervals. Totally blind and deaf. Unconscious. Automatic motions
Fresh mackerel sometimes induces aggravated of legs and arms. Has not taken any nourishment in the last two days. Complete anorexia. symptoms of urticaria and poisoning, similar Tongue heavily coated yellow. Breath very occasionally have a like effect.
to those caused by mussels and lobsters. Eggs offensive. The case seemed to be beyond all hope of recovery, and an unfavorable prognosis was given."
When the tip of the tongue is protruded to The treatmeut was as follows: "The child's one side, the muscles of the side to which the head was shaved, a pomade was made of iodo- organ turns are paralyzed, excepting of course form and vaseline, 3ij to 3 j, and one-half cases of structural disease.
General Principles Involved in Amputation. so important as the sanitary arrangements. Si
It is sometimes necessary to amputate as soon James Y. Simpson showed that five times as as consistent with safety. Now, what is to many deaths occurred after amputations in guide the surgeon in his decision of so import- large city hospitals as in private and country ant a question? In cases of compound com- practice. minuted fracture, with injury to the main artery We will now discuss the indications for an of the limb and with great loss and destruction amputation: of tissue in the soft parts, the hemorrhage is Aneurism. often alarming, and amputation is called for Malignant disease. imperatively as the only salvation for the pa
Perforating ulcer of foot. tient. What is the earliest moment a surgeon
Uncontrollable hemorrhage (primary or secondary),
The operation of expediency in deformity, in tumors should operate? Never during profound shock, and tetanus. and the rule which must govern a surgeon is A disease of the joint. to employ all means to control hemorrhage and
The moist variety of gangrene. to bring about reaction from shock, and wait.
In certain compound fractures and dislocation.
Old sloughing and varicose ulcers. If the patient has pallor and coldness of skin,
Necrosis of bone. weak and feeble pulse, sighing respiration,
These ten indications for amputations have non-reacting pupils, traumatic delirium, in
thus been arranged in an acrostic, which will ternal injuries, no amputation is indicated.
always enable the student or surgeon to have at The earliest possible time an amputation can be
his command the information. performed, under great necessity from hemor thage, is when reaction is beginning; but un
REQUISITES OF A GOOD STUMP. less the patient is likely to become exsanguined The bone must be amply covered. by delay, the beginning of reaction is an un- The flaps must not be adherent to the bone nor favorable period of operation, and it is wise to
exert pressure on traction upon the cicatrix.
3. The nerves must not be adherent to bone or defer it until reaction is fully established. Am
cicatrix. putation should not be performed with a sub
4. The nerves must be cut high enough so as not to normal temperature, a cold skin, a feeble rapid be affected by pressure or by atmospheric changes, pulse, or during traumatic delirium—especially
5. The bone must be smooth and capable of bearing in children. The condition, then, of the tem
firm pressure upon it. perature, the skin, the character of the pulse and the mental state, are all important factors
r Sequestrum from inin the solution of this problem. I have seen an
jury to bone in sawing, Esmarch elastic bandage applied above a lacer
by rough use of saw, by ated wound, over sound tissue, and when the
suppuration in bone,
Necrosis at end of bone. flaps were made a certain amount of sloughing
by injury to periosteum,
by sawing without irrifollowed from the compression. The wound
gation to prevent the itself is the proper place to apply firm compres
saw from acting as an sion, never above the seat of the wound. This
| actual cautery. point is one of practical importance, because
Conical shaped stump. spasmodic retraction of the elastic bandage, as a means of controlling
muscles, growth of bone. hemorrhage, has been misused; instead of ap
External pressure, loplying the compression over the bleeding part,
cal and constitutional has been carried above the bleeding part and
3. Neuralgia of stump. causes, bulbous enlargeover sound tissue. As a result of this, gan
ment, adhesion to cica. grene in the flaps may occur, with its accompanying septicemia.
We may now direct attention to a careful The hygienic conditions are most important study of the technique of the operation in its in affecting the mortality. Patients in the present perfected state. For the purposes of country do better than those in the city, and description of an amputation in general the the latter do better in private practice than in following points are to be considered in an hospitals. Always secure for a patient abund- amputation of the leg: ance of fresh air and plenty of sunlight. Too 1. Preparation of patient. much stress cannot be placed upon his hygienic 2. Provision against hemorrhage before opsurroundings. While the weather, age of pa- eration. tient, seat of amputation, the part of the bone 3. Formation of a suitable flap. sawn through, whether for injury or disease or 4. Section of the bone. deformity-above all and beyond all, the 5. Provision against hemorrhage during ophygienic conditions stand out foremost; and if eration. we exclude serious organic disease, nothing is 6. Treatment of wound.
CHARACTERISTICS OF A BAD STUMP.
The preparation of the patient consists in a gradually increasing the force, and in half a careful study of the patient's history, and also minute or a minute the result is accomplished. the special preparation of the member to be In a varied and extensive ambulance service, removed. Before the operation the heart and extending over eight months' continuance, I lungs should be examined, the urine analyzed, have applied this test so frequently and, as my the general habits of the patient inquired into statistics will show, with such marked and with reference to intemperance, and opium remarkable success, that I feel constrained to habit, or previous disease, and other points of publish my results. interest which influence the treatment after To the physicien' in private practice it may operation, as well as the mortality. In other be of comparatively little use; but to such as words, the surgeon should study thoroughly are in the hospital service, especially in the the individual upon whom he is to operate, ambulance department, or to those employed in and make himself complete master of the situa- the army or navy, or elsewhere where large tion. The local attention to the part consists bodies of men are at work, and where malingerin thorough ablution, shaving, and free irriga- ing and alcoholism are common, it will be of tion with carbolic acid or bichloride of mercury solution.
For let it be remembered that if the applicaThere is no real inconsistency between tion of the test fail in obtaining the desired antiseptic surgery, as now understood, and result, the physician may rest assured there is treating a wound openly. A careful study of something more than simple alcoholism, or the principles of antiseptic surgery shows that those other forms mentioned in the case. And both methods are in accord with its precepts, so, on the other hand, what a comfort it is for only that in the open method the wound heals him to know that, after the heroic and protractby secondary union, and still the wound is
ed efforts of the police and other parties have aseptic. In the open method the stump is irri- failed, he can step in and in a moment have gated every few hours with carbolic acid solu- the patient on his feet. tion. Balsam of Peru is used to stimulate the During my ambulance service at the hospital, granulations, and in ten days the granulating the following particulars may be mentioned : surfaces upon the flaps are approximated, Out of 1620 ambulance calls, 213 were to and healing takes place between these two alcoholics ; 26 to malingerers; 18 to hysteria granulating, instead of between two fresh, sur- cases, and 28 to delirium tremens. faces. In epidemics of diphtheria I have found Of the 213 above mentioned, 137 were the open method preferable, because a healthy comatose, the police and friends being utterly granulation surface is a barrier to the entrance unable to arouse them, and this treatment of septic poison.
brought i 28 of the 137 to consciousness. Of In conclusion, endeavor to obtain primary the cases where no result was obtained, 5 were, union in all amputatians by using every detail besides alcoholism, suffering from cerebral requisite to success. When the conditions concussion, 2 fracture of the base of the skull
, are unfavorable, aim at secondary union by the I uremic coma and i syncope from valvular open method.-Dr. Dennis, in four. Am. Med. heart trouble. Assoc.
In cases of hysteria I had absolute success ;
no one case failed to respond, and the same A Small Point Worth Knowing.
with malingerers. Nine of the delirium tremens (L. L. Von Wedekind, M. D., Senior of quieted down and spoke rationally; in the Staff, Chambers Street Hospital, New York.) remainder I had varying degrees of success, By simply pressing on the supraorbital notches some becoming more quiet, while in others but with a steadily increasing force, you may, with little change was noticed. a certainty of success, detect a malingerer ; I have tried it in forty-seven cases where no bring an unconscious alcoholic to his senses, result was obtained, and where something more and thus differentiate on the spot between alcol serious than alcoholism or malingering was holic and other comas; cause cessation of hys- suspected. terical convulsions, and in many instance- Of these cases 26 were cerebral concussion; quiet violent alcoholic delirium.
9 fracture of the base of the skull (diagnosis The best way of applying this test is: When confirmed at autopsy) ; 4 cerebral hemorrhage; the patient is in the recumbent position, the 6 uremic coma, and 2 simple depressed fracture physician, standing at the head of the cot, or of the skull. These cases are mentioned as kneeling when the patient is on the ground, proof of what is above stated. Where no fixes the tips of the thumbs over the supraorbital result is obtained, there you may look for some notches, as above described, never minding the intracranial lesion, or other cause of coma. occasional yell or struggle, pressing steadily, Med. Record.
Camphoric Acid as an Anti-Catarrhal, as a tenesmus and anal burning. Rest and sleep Dermatic, and as an Anti-Diaphoretic. follow, and, in some cases, a cure results with
out any repetition of the enema. In other A paper recently read by Dr. M. Reschert before the Berlin (Germany) Medical Society 'tervals of a few hours.
cases two or three enemata are required, at inattributes to this acid, which hitherto had no therapeutic use, an eminently beneficial effect in both acute and chronic inflammatory affec- Why don't prostitutes conceive? Answers tions of the mucous membranes of the entire requested. respiratory track. Likewise in various acute diseases of the dermis.
Chorea and Convulsions. A topical application of a 3 to 6 per cent.
In chorea there are irregular, uncontrollable solution of camphoric acid effects a contraction
contractions of the voluntary muscles, alternatof the surface-tissue (dermis or mucous membrane) within as little as two minutes, thus ing with their atony, and occurring without
In true convulsions, the muscles, after immediately causing a sensation of relief and
having been thrown into a spasmodic state, only palliation of pain, which phenomena are com
return to their normal condition; in chorea, on bined with an essential reduction of the inflammatory symptoms. Acute coryza has repeatedly influence occurs, so that the muscles become,
the contrary, a further diminution of nervous yielded to the nasal douche charged with a
in all marked cases, entirely passive or inert in solution of 1 in 500, or to a cottɔn-wool tampon
the intervals between their irregular and involwith a 2 per cent. solution. Withal, this acid exhibits no caustic accessory
untary actions. Chorea of childhood usually
occurs at about eight or nine years of age, and effects ; on the contrary it actively promotes granulation (in laryngeal ulceration, etc.), and mostly but not always affects girls. solutions of but 0.9 of one per cent. act aseptically.
Brown sugar passes through many hands, and It may be exhibited subcutaneously or topic- may fairly be credited with the suspicion of ally in 14. to 12 per cent. solution, or as an being an occasional cause of threadworms in inhalant in 1 to 2 per cent. solution.
children. The probabilities are, that this substance may prove beneficial also in other directions besides those named. (Tuberculous processes, how
The percentage of nicotine determines the
“strenght" of tobacco. Havana tobacco conever, are not influenced by it.) Dr. Furbringer, for instance, reports its
tains about two per cent. Anything exceeding
four per cent. is an intoxicating agent. prompt efficacy—in at least 50 per cent. of the cases treated—in stopping the night-sweats of consumptives. He uses, for this purpose, either
Tar-Water as a Hemostatic. 15 grains three or four times through the day, Distilled tar-water or "eau-de-goudron” is a or 30 grains in the evening. This is said by powerful hemostatic, arresting bleeding as effectDr. F. to be the only specific action possessed ually as hamamelis. That prepared from the by camphoric acid, which he terms: "an agree- pine wood is the best. About a wine-glassful able, very slightly toxic, and very little irritant, may be taken in the twenty-four hours, in antiseptic."
pulmonary, uterine, and renal hemorrhage. It Camphoric acid is in thin, colorless, scale- is extolled by the French in the hemorrhage of like crystals, or in large, limpid, monoclinic phthisis. crystals, of acid taste; melting-point 178° C. (352.4 F.); little soluble in water; easily so
Cranberries are utilized in Russia, where they in alcohol or ether Fats and oils dissolved up grow wild in enormous quantities, as a source to 2 per cent. of it.—Merck's Bulletin.
of citric acid. They yield about two and a half
per cent. of the gross weight; but the supply Dr. Barwell reports to the Lancet a case of is sufficiently great to make the process profitaregular menstruation after entire removal of ble. Is this not possible in our own country? both ovaries.- The Polyclinic.
Editor MEDICAL WORLD: Naphthalene Enemata in Dysentery.
I lost my visiting list out of my pocket in September,
and all my record of practice for eight months. With Guitergoff (New York Med. Abstract) has had most excellent results with gr. vij to gr.
your visiting list no such calamity could have occured.
It seems to be the very thing needed, and no physician viij of naphthalene to f3 j of water for a single should be without it. Yours respectfully, enema.
He finds this quickly relieves the Cantonsville, Md. WM. E. WYSHAM, M. D.