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INSENSIBILITY.

Prepared by Louis Lewis, M.D., M.R.CS.

CAUSES.

Predisposing.-Heredity, corpulence, senile decay, valvular disease, Bright's disease. Exciting-Pressure on brain, abuse of eating, drinking or narcotics; cerebral coneating, mental overstrain, extreme muscugestion, cold bathing after intemperate lar efforts, suppression of menses.

structions

Sewer-air, choke-damp or other noxious gases; drowning, hanging, lightning, obin air-passages, chloroformpoisoning, mechanical pressure on chest or spine, pulmonary collapse, tetanus, embolism, pleuritic effusion, extreme cold. In children, spasm and edema of glottis, diphtheria.

SYMPTOMS.

Pupils dilated (in danger contracted), eyes staring, flushed, distorted face, teeth closed, slow, full pulse, incoherent speech, stertorous breathing (usually), epistaxis, partial paralysis of face, body, palate or sphincters; high temperature, may smell of liquor.

Pupils dilated, eyes projecting and injected, faintness, vertigo, lividity of face, cyanosis of lips, frothy mucus, clammy skin, gasping or imperceptible respiration, loss of motion and sensation, flickering pulse, clenched hands, cold extending upwards; low temperature.

Pupils dilated, features shrunken, pallor, clammy skin, impaired vision, sighing respiration, feeble pulse, hiccough, nausea, vomiting, rigors, conex-vulsions, partial or complete loss of consciousness, sphincters relaxed, low temperature.

Collapse. General injuries, gunshot wounds, burns, rupture of internal organs, hemornervous system.) tensive urinary extravasation. (Sudden shock to general rhage, mental emoion, excessive cold,

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TREATMENT.

Horizontal posture, with head raised; cold to head, hot bottles to feet, sinapisms to legs; turpentine enema; leeches to anus, temples or nostrils; dry cupping to nucha; croton oil (m ij in mucilage), calomel, tincture of aconite, or of veratrum (my v), or ergotine (gr. 4) subcutaneously; bleeding (when the pulse is bounding).

Horizontal position, with head raised (except in embo-
lism); cold affusion, frictions upwards, rythmical pressure
over abdomen, artificial respiration, sinapisms over heart
and ankles; ammonia and whiskey subcutaneously; gal-
vanism, removal of obstructions from air passages, inverted
suspension, especially in chloroform-poisoning, tracheotomy,
etc.; bleeding, transfusion.

In asphyxia of new-born, slapping with wet cloths; hot
and ice-cold water, alternately; artificial respiration, gal-
vanism, catheterization of trachea, laryngo-tracheotomy;
non-interference with cord until pulsation has ceased.

Horizontal posture, with head rather low; hot bottles to feet and legs, warmth to epigastrium; frictions, nitro-glycerine (gr. ), ammonia to nostrils; beef tea and brandy; galvanism; ether (3 j) or quinine (gr.vj) or morphia and atropia (q. s.) or tincture of digitalis (m xij) subcutaneously.

Horizontal posture, with head raised; cold affusion, sinapisms, stimulant enema, stomach-pump (if poison suspected), artificial respiration, galvanism, warmth to extremities,catheterization,flying blisters, bleeding; croton oil (Mij). In suspected subcranial hemorrhage, with paralysis of one side, exploratory operation on opposite side of cranium. In opium poisoning, strong coffee, flaggelation, artificial respiration.

Horizontal posture, with head raised; ice to shaved
head, turpentine enema, croton oil (m ij) in mucilage,
catheterization, trephining, aspiration or perforation if ab-

scess is diagnosed; removal of tumors or other pressure. In children, avoidance of operation if no brain symptoms present.

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Epilepsy.

spine by railway or other injuries, or Blows or falls on the head, jars of the falls on the buttocks or back.

Predisposing-Heredity, scrofula, syph-
ilitic tumors of brain, cranial malformation.
Exciting.-Injury to head, intra-cranial
pressure, brain disease, polypus or suppu-
ration in ear, tumors, tape or other worms,
(Nervous disturbance either suppressed excretions, over-eating, sun.
stroke, extreme excitement, cold, some
fevers, prolor.ged waltzing.

centric or eccentric.)

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Inebriation.

In children, dentition, phymosis, worms, falls, injuries at birth, rickets.

Cerebral irritation from extreme emo

tion, sexual degrangements, change of
life, concussion of spine, puberty, suppres-
sed emotions, malposition of the uterus,
digestive disturbance.

Predisposing-Heredity.
Exciting. Abuse of liquors, alcohol or
(Poisoning of nervous centres its substitutes (fusel oil, etc.) in adulter-
ated liquors.

by alcohol.)

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Uremia.

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Direct solar heat, diffused heat com-
from bined with fatigue, hunger or intemper-

ance.

Accumulation of urea, ammonia or other
nitrogenized debris in the blood from re-
nal disease or derangement; scarlatinal
(Blood-poisoning by constit- albuminuria, obstruction of uterus, im-
pacted stone, impassable stricture, extra-
yasation of urine, suppression.

uents of urine.)

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Pupils contracted at first, afterwards dilated;
helplessness, partial or complete insensibility,
flushed face (usually), soft, quick pulse; cold
surface, temporary paralysis, often involuntary

micturition, odor of liquor, low temperature.

Pupils dilated, pallor, cold, clammy perspira-
tion; vertigo, shallow respiration, almost imper-
ceptible pulse, partial or total insensibility, sud-
den in outset, short of duration; cold extremi-
ties, flaccid limbs, vomiting.

In hysterical syncope, pulse natural.

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Horizontal posture, with head raised; hot blankets, and
hot bottles to feet legs and sides; frictions, blisters to
nucha, ice to head, bleeding, mercury, beef tea and brandy
enema, enema of sal volatile in solution.

In protracted cases, setons to nucha.

In concussion of spine, prone position; counter irritation;
ice, or dry cupping over spine; chloral bromide of
potassium.

Horizontal posture, with head raised; gag between
teeth, sinapisms to nucha and calves of legs, removal of
spicula or pressing bone by trephine, pressure over caro-
tids, nitrite of amyl inhalations, nitro-glycerin, antipyrin,
bromides, puncture of cerebral abscess.

In children's convulsion, hot baths, cold to head, spinal
ice-bag; bromide of ammonium (about gr. iij every ten
minutes).

Horizontal posture; cold affusion, abdominal pressure,
compression of ovaries; nitrite of amyl or chloroform in-
halations, tincture of musk or valerian.

Horizontal posture, with head raised; cold affusion, zinc
or mustard emetics, stomach-pump, turpentine or salt and
water enema, strong coffee, vinegar, solution of acetate of
ammonia, pilocarpine (gr.), or strychnia (gr.), or
caffeine (gr. iij), subcutaneously.

Horizontal posture, with head low; cold affusion, stimu-
lating enema, frictions, ammonia to nostrils, snuffs, sina-
pisms, turpentine stupes over heart, nitro-glycerin (gr. o),
galvanism, tinc ture of sumbul (mv), or hydrobromate of
quinine (gr. iv in hot water), subcutaneously; artificial
respiration. In extreme cases, transfusion.

Horizontal posture, with head raised; cold affusion (ex-
cept when skin is cold), ice to head, spine or in rectum;
cold drinks, cold baths, turpentine enema, dry cupping or
blisters to nucha, chloroform, bromide of ammonium enema,
(gr. xx), antipyrin (j), or quinine (gr. vj), subcutane-
ously; nitro-glycerin (gr. r) every ten minutes; digitalis.

Horizontal posture, with head raised; cold to head, sina-
pisms to loins, vapor baths, diaphoretics and purgatives, hot
blankets, bleeding, catheterization, chloroform, jaborandi,
nitro-glycerine, strophanthus, elaterium, oxygen inhalations,
poultices of digitalis leaves to abdomen, transfusion.

THE MEDICAL WORLD

5

5

An Important Subject. Physic need not necessarily be nasty to make it efficacious. The influence of the mind over the body is such that the whims and fastidiousness of patients in respect of nauseous medicines have to be taken into account. Moreover many persons surreptitiously hide or throw away medicines that offend their taste, even in serious emergencies; and if they derive no benefit, or die, the doctor or the druggist gets the blame. Hence, palatability and convenient dosage are to-day subjects of supreme importance.

Injuries to the brain are liable to be attended by plastic effusion, causing adhesions or anchor age of the brain to its membranes, and of the membranes to the skull, so that the free play of the organ is impeded in the same way that the movements of the lungs are hampered by adhesions to the pleura. This may also happen to the brain during the formation of cicatrix. Under these conditions, the least movement of the brain pulls on its membranes, and vertigo, epilepsy, convulsions or inflammation ensue.

Pruritus vulvæ is relieved by the application

of a menthelene.

All wines, spirits, alcohols, ethers, fat-acids, aldehydes, turpenes, benzites, paraffins, chloroform, iodoform, oils, fats, starches and sugars are carbo-hydrates.

In Japan, the art of massage is entirely relegated to the blind, who practice it as a means of obtaining a livelihood.

Bacteria are said to be brought to the surface of cemeteries by earthworms, who carry them up from the decomposing bodies of the dead; thus the poisons of scarlet fever, smallpox, diphtheria, malignant cholera, etc., are supposed to be returned among the living, for they are undoubtedly transmissible through the body by more than one mode. It must be remembered however that earthworms are not found in the earth more than a few inches below its surface.

Bleeding from the ear after a blow does not of necessity mean fracture at the base of the skull; it may arise from laceration of the meatus or pinna, or from rupture of the membrana tympani. Bleeding due to cranial fracture is nearly always followed by the escape of clear watery fluid from the subarachnoid space.

Dr. R. D. Ramey, of Dayton, Cass Co., Mo., wishes our readers to send him "A good prescription for dissolving gall-stones."

Biniodide of Murcury as an Antiseptic.

Dr. Rogée Saint Jean-d' Angely states that biniodide of mercury is not irritant to wounds, and a more powerful antiseptic than carbolic acid. It has no odor, and an alcoholic solution 1-300 is soluble in all proportions in warm water. Lister's dressing is expensive and not adapted for use in armies. Since 1885 the author has employed exclusively the biniodide with dressings of cotton and gauze, and in 108 operations (32 major) had only one death.Translated from Lemaine Medical.

atine.

A Disinfectant of Air.

According to M. Keldyche, who has just published the results of a series of experiments on the air drawn from his hospital wards, air which has been saturated with eucalyptol will no longer give rise to colonies of bacilli in gel. The spores of fungi are able to pass unharmed, but as their action on the higher animals is probably limited, it is not a matter of much importance. If confirmed by independent observation, this valuable quality renders the drug worthy of wide-spread employment,

for no other disinfectant is known which can be relied upon to effect its purpose without rendering the air irrespirable, besides acting very injuriously on furniture, clothing, etc.-Medi

cal Press.

A Hair-Restorer.

Make a pommade with three ounces of lanolin and five drachms of lard, and a little essence of roses. Shake up seventy-five grains of subnitrate of bismuth, and forty-five grains of citric acid in three and a half drachms of glycerine, and add the mixture to the pommade. This is stated to restore white or gray hair to its pristine brown color.

CLASS-ROOM NOTES.

From The College and Clinical Record. · -Ordinarily, one woman in eight is sterile; but in women who have fibroids, one in three is sterile. (Parvin.)

-In facial erysipelas, where you cannot conveniently apply ordinary means, paint the part with a ten per cent. iodoform collodion. (Prof. Gross.)

-For a case of trifacial neuralgia, Prof. Da Costa ordered five drops of tinct. of gelseminum t. d., increased until double vision results; also a full diet.

-In posterior displacements of the uterus always replace the organ before introducing a

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-The following are the means of arresting hemorrhage, arranged in their order of usefulness: ligature, torsion; acupressure; compression, forced flexion of a limb; styptics; and the actual cautery. (Prof. Gross.)

-For specific vaginitis, Prof. Parvin ordered mucilaginous injections and warm hip baths in the acute stage, followed by injections of 1 to 1000 corrosive solution and tampons of boracic acid and glycerine.

-For fractures of the forearm in the middle third or lower down, Prof. Forbes uses two straight splints extending beyond the finger ends, thus keeping the fragments from being displaced by movements of the fingers, which is liable to occur if a short splint, like Bond's, is used.

-Prof. Da Costa prefers the use of the bismuth test for sugar in the urine. Take equal parts of urine and liquor potassæ, add a pinch of bismuth subnitrate, boil thoroughly. If sugar is present, the powder turns brown or black.

-For ptyalism, Prof. Gross advises thirty grains of potassii chloras every four hours, and & Liquor. plumbi subacet..... .fl. dr. j Aquæ destillat...... .fl. oz. viij

M. Sig. Use as a mouth wash.

-For diabetes mellitus in a man aged 44 years, in addition to the usual regulation of diet, Prof. Da Costa directed saccharine as a substitute for sugar to sweeten coffee, etc. Also half a grain of codeia morning and evening.

-As a substitute for iodoform, iodol or subiodide of bismuth, which are worthless as germicides, Prof. Gross directs the use of hydronaphthol to wounds which require it, as lacerated wounds, where there is danger of sloughing.

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-The proper thing to do for a case of sunstroke or heat exhaustion is to remove or loosen clothing about the neck; do not move unless hospital is near; throw buckets of water upon patient, or, what is better, rub down with ice. Get the bowels open; turpentine injections or croton oil if not too much exhausted, or inject cold water, or one-half drachm of glycerine, into rectum. For the stroke, draw blood if pulse is full and strong. Antipyrin is of great value, not only the immediate but subsequent allow a bland diet. result good. When he commences to recover, As one attack predisposes

to another, patient should be careful in hot weather; go to the mountains, if possible; keep the bowels open. To control convulsions, use morphine hypodermically, or inhalation of small amount of chloroform.

-For a case of quinsy seen in the first twenty-four hours the treatment is simple. Add one drachm of ammoniated tincture of guaiac to a teaspoonful of milk; gargle and swallow every three hours; after the third or fourth dose the swelling of tonsils subsides and patient is much relieved; most likely he will have a diarrhea; this is the time to reduce the tincture to one-half drachm. When the case goes thirty-six hours without interference the treatment is different and difficult. Allow small pieces of ice in the mouth, while internally, twenty grains of bromide of potassium combined with fifteen drops of wine of ergot, or six drops.of tincture of belladonna every three hours, although the latter frequently causes headache; if tonsil has a tendency to go to abscess do not let it rupture spontaneously; find tender spot with finger; take a curved bistory and open, not cutting deeply; bind with cloth. (Šajous.)

"Help! Help! Here's a man in a fit,”—

As I trudge my professional round,-
"His eye-balls are rolling, his tongue it seems bit,
And he's wriggling about on the ground."
I quickly attend him, and hasten to lend him
Whatever of skill I possess;

I glance at his face, and examine the case,
While loos'ning a part of his dress.

His pupils dilated, his breathing abated,

All consciousness gone from his brain;

His fingers clenched tightly, his aspect unsightly,
Though utterly heedless of pain.
The people all tell that he suddenly fell,

And a man must indeed be a skeptic,
Who would not agree in his verdict with me,
That this was a fit EPILEPTIC.

Wild animals, such as rabbits, pigeons, squirrels, are found to frequently "throw back" in their breed, or revert to their original form or

color. A white cross has been known to suddenly show itself in pigeon-breeding after years of the most careful breeding. The same has occurred in other wild animals, and is termed albinism. We also find white-haired, whiteskinned, pink-eyed people occasionally among ourselves, usually as the denizens of a Dime Museum; and these people assert that, as far back as they know, their parents and progenitors have been like other people. Can it be that we were all originally "albinos?"

Disinfection and Cleansing of Sponges. Make a 2 per cent. solution of permanganate of potash, and a 2 per cent. solution of oxalic acid (adding a few drops of sulphuric acid.) Immerse your soiled or discolored sponges in the former for about ten minutes, then dip them in the latter. They will come out a brilliant canary-like color, and uninjured.

Why Not?

Some journals speak of the proposition that physicians wear a badge or other distinctive mark as a matter of absurdity. We don't see it. There seems to be a growing fondness for badges of every description; and, if it be a matter of importance for Masons, Odd Fellows, Mollusks, G. A. R. members and numberless others to wear a distinctive badge, which can benefit themselves, why not let the doctors be as easily recognizable?-Phila. Med. Times.

The Medical World Visiting List and Ledger of Monthly Balances.

This visiting list, among other things, has the advantage of being printed and bound in many thin and easily-carried booklets, which can be inserted in and removed from the handsome Russia leather case. It is not, for this reason, so cumberous as most visting lists

ASTIGMATISM is caused by irregularity in the curvature of the cornea. It is not as it should be-symmetrical, but has different curvatures

in directions at right angles to each other. Consequently spherical glasses are quite unsuitable. They have to be cylindrical.

What Prohibition Does.

A gentleman who has spent several months in Kansas says: "Kansas boys ten years old and under never saw a saloon since they can remember. They never saw a man under the influence of liquor. On arriving at man's estate, they will have no more desire for drink than they will have for opium or hasheesh." This is very true, for we believe that, in very found its origin in the imitative propensities of many cases, the habit of drinking liquor has humanity; and where the example is not set, the habit will not be acquired.-Annals of Hygiene.

Sulphide of Calcium in Chronic Discharges.

Dr. Mortimer Wilson lately called attention to the beneficial action of sulphide of calcium in leucorrhea, ("Therap. Gazette") and quotes over a hundred cases which have been either cured or much ameliorated by this agent, given internally, without any local application what

ever.

We would recall attention to Dr. Louis Lewis' statement in these columns some years ago, that the same treatment was useful and frequently curative in urethritis ahd chronic gonorrhoea.

Notes of Some New Remedies.

CHLORALCYANHYDRATE.

Formed by the action of hydrocyanic acid on chloral, and proposed as a substitute for hydrocyanic acid, of which it contains 151⁄2 per cent.

CANTHARIDIN.

The active blister-producing principle of the Lytta vesicataria (cantharides) colorless, rhombic, light refracting tablets, nearly insoluble in water or alcohol, more soluble in chloroform, ether or the fatty oils.

ARBUTIN.

A glucoside in white acicular crystals, from the leaves of Uva Ursi, soluble in water, odorless and slightly bitter. Diuretic, useful in catarrh of the urinary organs, urethritis, etc. Dose, 15 to 20 grains three times a day.

EPHEDRINE HYDROCHLORATE.

A new mydriatic alkaloid obtained from Ephedra vulgaris by M. Kinnossuke Minra. It has to be employed in a solution, ten times more concentrated than homatropine, but it is much less costly. It does not paralyze the accommodation for near vision.

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