PROGRESS OF MEDICINE. With a fountain syringe and the canula of an aspirator, from one to two liters of the fluid is allowed to flow gently beneath the skin of the flanks. The tumor formed by the fluid is slowly rubbed away. He advises the warm bath in conjunction with the infusion. The operation may be repeated in two or three hours. Enteroclysis Catani employs as follows: If a diarrhoea do not yield to rest in bed and a warm opiated infusion of chamomile, then an enteroclyster of tannic acid solution should be injected. The tannin solution employed is as follows: B Infusion of chamomile warm. 2 liters Tannin.... Laudanum... 5 to 10 grams 30 to 50 drops Powdered gum arabic..... 50 grams CONSTIPATION.-The "New England Medical Monthly" recommends the following in con stipation: Aloin... Ext. bellad.. Ext. nux vomica. M. ft. pill No. 1. (Use no water to form mass.) (Keep in air-tight vials.) Dose, one pill once or twice a day. CHORALAMID IN INSOMNIA.- Dr. J. H. McBride states ("Review of Insanity and Nervous Disease" Sept., 1892,) that, in a case where all other hypnotics failed, ten grain doses of chloralamid produced a refreshing sleep. Sulphonal in this case caused gastro-intestinal irritation, and was followed by depression and irritability. Chloralamid had no such effects. ALCOHOL IN VAGINAL ULCERS.-Dr. Barsong reports ("Texas Courier-Rec. of Med.") the case of a woman who was admitted to the hospital for operation upon a carcinoma of the vagina. Owing to the overcrowded condition of the hospital, operative treatment was deferred, and the author, chiefly for the sake of cleanliness, washed the cancerous sore daily, later twice daily, with alcohol. Eight days later the sore had diminished to such an extent that the operation was again postponed. The ulcer healed completely, but two small sores reappeared 145 which closed up after washing with alcohol The patient left the hospital cured. In the case of another woman, in which a carcinoma of the vaginal portion of the cervix had been diagnosed, but operation refused, the author resorted to the alcohol washings with success. VISUAL DISTURBANCES FROM MALE FERN. -Katayama and Okamoto (Sei-I-Kwai, June 25, 1892) have reported cases in which administration of extract male fern has been followed by either temporary or permanent amblyopia. In each case the dose given had been about ten grams. Lewin reports many similar cases. ANTIPYRIN IN EPISTAXIS.-Dr. E. G. West, of No. 630 Warren St., Boston, (“Weekly Med. Rev.") has found no agent so reliably prompt in its action in epistaxis as antipyrin. When a case of unusual violence occurs, he saturates a pledget of cotton in a solution of antipyrin or in the dry powder and introduces it into the nostril t rapidly stops the bleeding. The patient by this method is relieved from the dangers of the disagreeable tarry clots formed by the solution of iron commonly used for this purpose. OBSTETRICS AND PEDIATRICS. BLUSHING is not ("Medical Record") an art neither is it an absolute sign of ill-breeding, as some unkind folk maintain. The fact is, it is just as natural for some people to blush on one occasion as it is for others to turn pale on another. The same laws of nature that govern the one rule govern the other. The capillaries or small blood vessels, which connect the arteries and veins in the body form, particularly over the cheeks, a network so fine that it is necessary to employ a microscope to distinguish them. Ordinarily the blood passes through these vessels in normal volumes, leaving only the natural complexion. But when some sudden emotion effects the heart its action increases, and an electric thrill instantly leaps to the cheeks. This thrill is nothing more than the rush of blood through the invisible capallaries; the color is nothing more than the blood just beneath the delicate surface of the skin. The causes that bring about this condition in the circulating system are called mental stimuli. They consist of joy, anger, shame, and the many other emotions. Sudden horror, remorse, or fear, on the contrary, influences the nerves which control the blood vessels, and the face becomes white. Blushing and pallor result from the sudden action of the mind on the nervous system. So, if the mind be forewarned and prepared for emotions both habits can at least be partially overcome. But when the nervous system is highly strung, it would be a lifelong, if not a futile, task to endeavor a permanent cure. It is the sensitive, nervous girl who blushes easily, while the girl stolid by nature or who, by education, has her nerves under perfect control seldom blushes. PARTURIENT EXAMINATION AND PUERPERAL FEVER.-The "Medical and Surgical Reporter" states that during the period of dilatation of the cervix, an internal examination should only be undertaken under the following circumstances: First, in cases where the condition of the patient is greatly impaired-as in eclampsia, nephritis, fever, bad circulation, etc.; second, in cases where there are local disturbances-hæmorrhage, abnormally painful labor, or an abnormally long period of cervical dilatation; third, in cases where an external examination reveals an abnormal condition-such as the head of the foetus over the pelvis in primiparæ, or after the rupture of the amniotic sac in multiparæ, an abnormal enlargement of the lower uterine, segment, rupture, lessening of the foetal heart sounds, or abnormal position of the fœtus. During the period of expulsion an internal examination is admissible only under the following circumstances: First, in cases of general derangement-such as fever, bad pulse, great excitement, eclampsia, and nephritis; second in cases of local derangement-such as delayed rupture of the amniotic sac, hæmorrhage, insufficient labor, or retarded delivery; third, in cases of an unlooked-for change in the position of the foetus, abnormal distension of the lower segment of the womb threatening rupture, lessening of the fœtal heart sounds, and displacement of the fœtal head above the pelvis. In order to be able to restrict the internal examination of parturients to the above named conditions, it will, of course, be necessary to submit the patient to a careful external examination, and indeed lay greater stress on the latter than is now generally done. It will also be necessary for obstetrical clinics and schools to give their students more exact data regarding external examinations than is generally done. This being accomplished, the results of a limitation of the internal examination of parturients will be speedily evident. EASY LABORS IN CASES OF CONTRACTED PELVIS. Tarnier ("St. Louis Med. and Surg. Jour.") warns his pupils against the fallacy that because a woman has had three or four easy labors the next future labor will certainly be easy. The contrary is often the case. Every day instances occur of women with a conjugate of nine centimeters (three and one-half inches) delivered spontaneously. After four or five such labors the next proves difficult. The explanation is not always easy; probably the size of the fœtal head had not been estimated or measured, proving larger in the last than in earlier labors. When a student, Tarnier was once summoned to a case, and found a big baby in a cradle. It was big when born, the mother said. On examining the mother, who was in labor, he found that the pelvis was contracted. The previous child had been delivered spontaneously. The labor in hand proved very difficult, and could not be concluded without the cephalotribe. UTERUS ATROPHY IN YOUNG WOMEN.— Gottschalk ("St. Louis Med. and Surg. Jour.") cites a large number of cases which he has observed in girls and young women. Atrophy of the uterus is often the direct or indirect result of scarlet fever, typhoid fever, and acute articular rheumatism. The uterus may be directly involved indeed, ovarian disease, particularly scarlatinal oophoritis, often proceeds slowly, and undergoes spontaneous cure, though when severe or very chronic it usually involves uterine atrophy. In four of his cases the patients were attacked by typhoid fever at the time of their first menstruation. These researches are held to show that it is necessary to maintain tonic treatment in all cases of the above-named acute diseases, when they attack young women, long after the disappearance of fever. The return of strength is then usually followed by the appearance of the period. Santonin and permanganate of potassium seem to hasten the disappearance of amenorrhoea. The pelvis must be explored, and if the ovaries feel enlarged, warm baths, iodine, and ichthyol will be needed. Should this complication be neglected, the atrophic condition of the uterus will soon become incurable. HEPATIC CIRRHOSIS IN CHILDREN.Jollye, after an analysis of 118 cases of hepatic cirrhosis occurring under the age of 18 (“Brit. Med. Jour."), concludes that alcohol, lues, and malaria account for 50 per cent of the cases, the others being mostly referable to the exanthemata and dietetic errors. Severe pyrexia, quick, rapid respiration are frequent symptoms of this state. When symptoms of failing health in children occur without adequate cause, especially if associated with epestaxis, or other hæmorrhage, the PROGRESS OF MEDICINE. development of nævoid growths or occasional jaundice, the liver should be examined for cirrhosis. Half the cases occur between 7 and 13, and among males are twice as frequent as females. If all symptoms disappear under treatment they are apt to return and end fatally within about three years. Tonic treatment constitutionally, with treatment of symptomatic indications, give the best results. THE DECIDUA AND EXTRA-UTERINE PREGNANCY.—Dr. E. A. Ayers (“American Journal of Obstetrics") concludes: In extra-uterine pregnancy the endometrium generally changes to decidua. Decidual tissue is pathognomonic of pregnancy. Portions of the endometrium may be obtained with the curette, examined with the microscope, and decidual tissue recognized if present. Such tissue may be a remnant of an abortion, a part of decidua surrounding a live ovum, or due to an extra-uterine pregnancy. The microscope, in connection with the clinical history, can determine to which variety the species belongs, and, if to the third, may establish the presence of an extra-uterine gestation. The woman was PUERPERAL TETANUS.-Dr. C. P. Noble reported to the Philadelphia County Medical Society the case of an inverted uterus, in consultation. Puerperal tetanus developed and the patient died ten days after labor. Tetanus came on one week after labor. under the care of a homoeopath. After delivery he tried to expel the placenta by traction and expression, but not succeeding, as he thought, a regular physician was called. It was found that the homoeopath had been trying to deliver the uterus and had partly delivered it. SURGERY AND OPERATIVE GYNECOLOGY. AMPUTATION OF THE FOREARM. The success recently attained by Esmarch in forming a movable and organic appendage to the stump of an amputated leg has led Albert ("St. Louis Med. Jour.") to offer the following suggestions with regard to amputation in the lower third of the forearm by interior and posterior flaps of skin. It is proposed that before division of the muscles, the tendons of the two radial extensors of the carpus, of the ulnar exter.sor, and of the two flexors of the carpus, be separated from their sheaths and the surrounding soft parts their attachments to their corresponding muscles being left intact and then divided as near as possible to their insertions. After division of the muscles and bones, and arrest of all bleeding, canals are drilled obliquely through the 147 ends of the divided radius and ulna, into each of which canals is inserted the free end of each of the above-mentioned tendons. In this way each tendon is made to acquire a firm attachment to its corresponding bone. After the wound has healed, and the stump become quite sound, Albert would endeavor to establish a freely movable false joint about a finger's breadth above the end of the two bones of the forearm, by resecting a portion of each. The patient when supplied with an artificial hand would, it is stated, derive much advantage from the existence of this movable segment, which could be flexed and extended at will. INSANITY AFTER OPERATIONS.-Dr. J. M. Baldy concludes, in a paper read before the Philadelphia county medical society, that cases of serious mental derangement may occur after operations on patients without any previous personal or family histories of insanity. Mental disorders are no more likely to follow operations on the sexual organs than on any other part of the body. Such disorders occur just as frequently in men as in women. Operations are at times the determining cause of mental derangements where there was no previous tendency to the disease. Mental disturbances occurring a considerable time (months) after an operation, are most probably independent of the surgical procedure. The development of psychoses may follow in those cases in which the convalescence from the operation has been perfect. The existence of a predisposition to psychoses should stay the surgeon's hand, except in such cases as are urgent and necessary. Mental derangements follow operative procedures with more frequency than is generally supposed. GALLBLADDER OPERATIONS.--Dr. Rufus B. Hall, Cincinnati, reports ("Medical Fortnightly") seven cases of the gall-bladder operations. In three the common duct was obstructed from three to seven and nine weeks, respectively. He would hesitate to advise an operation in cases where there had been complete obstruction of the common duct for seven to nine weeks. The power of recuperation in such profound and continued cholæmia is so feeble that there is but little hope for other than a fatal termination. He was strongly inclined to the opinion that there is a causative relation between gall-stones and malignant disease in and about the gall-ducts and head of the pancreas. He thought that the long years of continued irritation from the presence of gall-stones, and the consequent repeated attacks of hepititis favored the development of malignant disease in and about the gall-ducts. He urged early exploration in obscure hepatic disease of a number of years standing, even if positive diagnosis of gall-stones could not be made, and cited a case in which he removed ninety-one gall-stones under similar circumstances. In that case the patient had pains in the region of the gall-bladder and liver, but no other signs of gall-stones. If early operations were made there would not be so many case of obstruction of the common duct, with the high mortalitity following that complication. If all of these cases operated upon, where the common duct was obstructed, could be tabulated, the mortalitity would prob ably be very great. On the other hand, in cases where the common duct is not obstructed the mortality from operation is very small. TETANUS IN HEPATIC CIRRHOSIS.-Dr. G. A. Hewitt ("Med. Bull.") reports a case in which tetanus resulted during the progress of a case of hepatic cirrhosis, and was seemingly related thereto. INTESTINE FOREIGN BODIES SIMULATING TYPHOID FEVER.-Dr. Dorsett, at a recent meeting of the St. Louis Medical Society, reported a case in which he had been called in consultation by Dr. Smith. The patient, a seventeen-year-old girl, had all the symptoms of typhoid fever. A piece of cotton cloth, eight inches long by one and one-half inches wide, was found, under conditions which indicated that it had been discharged from the system of the patient. The family stated that it was two years since similar cloth had been in the house. The two ends of the cloth were tied in a double knot. Dr. R. H. Day, of Baton Rouge, La., has reported (MEDICAL STANDARD, Vol. IV, P., 101) a case in which coal tar swallowed by an eight-year-old gil produced typhoid symptoms. Poulet also points out ("Foreign Bodies") that typhoid symptoms may be produced by the presence of foreign bodies in the intestine. LIGHTNING STROKE.-Dr. S. M. Tancy, Port Republic, Va. ("Med. Brief."), reports the case of a thirty-five-year-old man who was riding beside a grove. A tall oak close by was struck by ligntning, which ran down the tree to a small limb and off of the limb onto the patient's head, passed down his side to the lower part of the abdomen, there dividing and running down each lower limb, destroying all the scarf skin in its course, killing the horse upon which he was riding, and rendering him unconscious for several hours. Dr. Tancy, on his arrival, found all the hair upon the top of the head destroyed' and the man in a semi-conscious condition. A month later all symptoms had disappeared except pain in the course of the current and loss of memory of recent events. Most of these cases recover perfectly. GENERAL MEDICINE. ALEXINES.-According to the researches of H. Buchner ("Medical Fortnightly"), the germicidal, globulicidal and antitoxic powers of fresh blood-serum reside in complex, albuminous substances named by him alexines. The influence of these bodies is to be considered physiological, rather than purely chemical. Their activity gradually disappears when the serum is kept outside the organism, and is rapidly destroyed by a temperature of 98° to 100°. Fivefold to tenfold dilution with sterilized normal salt solution scarcely alters their properties, whereas similar treatment with plain water also annihilates their energies. These may, however, be restored by subsequently adding 0.7 per cent of salt. The alexines of different species are antagonistic to one another. In connection with the foregoing may be mentioned the experiments of Tizzoni and Pattani (Riforma med.) showing that the serum of animals rendered refractory to tatanus will confer this immunity to others. The serum owes this power to changes effected by the spleen, an office which none of the other bloodforming organs are capable of assuming, Aside from the bearing which these facts have upon pathology, it would seem that they also carry suggestions of practical utility. Tommasoli ("Gazetta degli ospitali") successfully employed sheep's serum in the treatment of five cases of secondary syphilides and one case of syphilitic periostitis. Deep injections of from 2 to 8 ccm. of sterilized serum were made daily into the nates. Besides local induration, ephemeral fever, and in two cases an erythematous eruption, there was noted in the six cases an abatement of specific symptoms with a rapidity not attained by any other therapeutic procedure. CHOREA AND NEPHRITIS.-L. Thomas Freiburg ("Deut. Med. Woch.") reports a case of chorea which appeared in a neuropathic boy coincident with a nephritic attack. It did not yield to the usual remedies, but disappeared on recovery from the nephritis. TOBACCO AND THE EYES.-Dr. F. Dowling, of Cincinnati, after a study of 3,000 persons employed in local tobacco factories, finds that 95 per cent suffer from visual troubles of nicotine origin. Correspondence. ALCOHOL IN DISEASE. [To the Editor:] The American Medical Temperance Association, through the kindness of J. H. Kellogg, M. D., of Battle Creek, Mich., offers the following prizes: Ist. One hundred dollars for the best essay "On the Physical Action of Alcohol, based on Original Research and Experiment." 2d. One hundred dollars for the best essay "On the Non-Alcoholic Treatment of Disease." These essays must be sent to the secretary of the committee, Dr. Crothers, Hartford, Conn., on or about May 1, 1893. They should be in type-writing, with the author's name in a sealed envelope, with motto to distinguish it. The report of the committee will be announced at the annual meeting at Milwaukee, Wis., in June, 1893, and the successful essays read. These essays will be the property of the association and will be published at the discretion of the committee. All essays are to be scientific, and without restrictions as to length, and limited to physicians of this country. Address all inquiries T. D. CROTHERS, M. D., Secretary of Committee. to HARTFORD, CONN. TREATMENT OF GONORRHEA.-Dr. R. F. Price of Braddock, Pa., advises ("Med. Brief") the use of the following prescription in gonorrhoea : R. Lithiated hydrangea (Lambert) 4 ounces. Sig. Take two teaspoonfuls in water, with six drops of oil of gaultheria, three times a day, two hours after meals. B. Morph. sulph.... Aquæ dest...q. s. ad... 4 ounces. M. Sig. Use syringeful, after urinating, three times a day. Always instructs patient to exercise great care, when using the syringe, to press the urethra with thumb and forefinger to prevent the fluid from being thrown too far back. A little caution right here will prevent the intense irritation that so commonly follows the bladder use of the syringe, in causing irritation at the neck. The hydrangea is, par excellence, the remedy for painful urination combined with the lithia, which is a pleasant diurutic. Ol. gaultheria serves the same purpose as balsam copaiba while the injection quickly exterminates the exciting cause. CINNAMON OIL IN ALOPECIA.-Busquet ("Condensed Extracts") treated 80 cases of alopecia with cinnamon oil. He basis its uses upon experiments made on the lower fungi with ætherial oils, which led him to employ antiseptic treatment in parasitic dermatoses and especially alopecia. He prescribes : .f 3 viiss .f 3 xvi Ol. cinnamom. chin. Eth. sulph... The solution is painted to the affected surface once a day. The hair is cut as short as possible, and all washing of the scalp is forbidden during treatment. Cases of alopecia, which had for years defied all treatment, were rapidly cured. The average duration of treatment was between three and four weeks. The first applications sometimes provokes slight redness and sensation of heat which disappear when the treatment is omitted for a day or two. He treated three cases of alopecia of the beard. Two of them had placques 5 and 3 centimetres (about 21⁄2 and 11⁄2 inches) in size. In ten days the bare spots were thickly covered with hair. The third was a case of a year's standing. It recovered in 25 days. The oil has also proven successful in favus and herpes circinnatus. ASCARIDES AND TYPHOID FEVER.-Peracchia (Gazetta degli Ospitali) in an autopsy on a case of typhoid fever, with symptoms of acute intestinal perforation and severe intestinal hæmorrhage, found the gut wound occupied by a large ascaris. Two more ascarides were discovered in the ileum. He attributes the perforation to the ascaris. He previously observed several cases of typhoid extending over five or six weeks, which began to recover when worms were spontaneously passed or were removed by drugs. He advises anthelmintics, like santonine, at the outset of typhoid. THE centenary has just been celebrated of the establishment of the York Retreat by William Tuke. Tuke did for the humane treatment of the insane in England what Chiarrugi had previously done for the Italian insane and Pinel for the French. County or district care with lay control underlay the abuses these philanthropists tried to remove. |