M. Le Gendre, of Paris, in an article on "Dangers of Athletic Sports in Childhood," showed that the period of growth created certain morbid predispositions, as a tendency to excessive arterial tension, manifested by palpitations, epistaxis, pains in the head; in arthritic individuals, susceptibility to chill when the body is in a state of perspiration; in neuroarthritic persons, a tendency towards atony of the stomach, increased by the abundant ingestion of fluids; in others, of nervous temperament, a predisposition to headaches, tics, chorea and a craving for violent distraction. Under such conditions it is easy to understand how excess in physical exercise may be followed by serious consequences. After violent games of foot-ball, tennis, or the too prolonged use of the bicycle, the fever of over-exertion may supervene, 'with the complications that accompany it, as prostration, curvatures, pain, osteomyelitis, dyspepsia, with great anorexia, dilatation of the heart, palpitations, syncope, true asystole, and possibly hypertrophy, articular inflammation or typhlitis. The author therefore believed it of great importance for parents to have their children examined before allowing them to give themselves up to any particular sport, and to forbid it if there be any trouble of the circulatory, loco motor, digestive or nervous system; to insist upon progressive and gradual increase of the exercise, whatever it be; and, while encouraging athletics and gymnastics, to forbid any competition in these sports.-Ex. A wise old doctor, for the benefit of his health, travelled around the country in a caravan, in which he lived, stopping for short periods at the larger towns. He had a young lad for an assistant, who was more or less quick and intelligent, but rather inclined to jump at conclusions. The doctor taught him a little medicine whenever he could spare the time, and he learned considerable, but diagnosis was to him still a mystery, especially in some cases, when the wise old doctor had used his eyes to detect the source of the illness. They were staying for a few days in the town of B, and the doctor had been in some demand, having at a previous visit secured a reputation by some apparently marvellous cures. His young assistant accompanied him on one occasion, when the doctor had pronounced the patient sick from eating too many oysters. This puz zled the lad, and when they left the house he asked his master how he knew the patient had been eating oysters. "Very simple," his master replied; "I saw a lot of oyster shells in the fire-place and the answers to a few questions were all I needed to make a diagnosis." "One day, his master being absent when a call came, he determined to answer it and see if he could diagnose the case. He returned shortly after and triumphatly told the doctor that the man was sick from eating too much horse. "A horse, you stupid fool!" cried the irate doctor. What do you mean?" 66 "Why, master, it could not be anything else, because I saw a saddle and stirrups under the bed!"-Ex. Reading Notices. For a number of years it was our privilege to be able to give almost exclusive attention to the study of physiology. Nothing can be more fascinating either to pupil or teacher. During all this time, and even up to the present day, we had to believe that "The principal object of the saliva is to moisten the food, and thus aid mastication and degluti tion." And yet, we had to face the fact that an enormous quantity of saliva was secreted every twenty-four hours. It appeared almost like a waste of the forces of nature. We Dr. had to believe that the moment this saliva reached the stomach it became inoperative. But now all this is about to be changed. Although Frierichs came to the conclusion a number of years ago that salivary digestion continued in the stomach, yet his work was practically lost sight of. Now Dr. J. H. Kellogg, of the Battle Creek Sanitarium, has just published the report of some extensive experiments in his Laboratory of Hygiene on starch digestion. Kellogg examined the contents of the stomach, after a test meal, in 4,875 cases. In 669 of these cases he found the starch had been completely converted into sugar. Only in 1.8 per ct. of the cases did he find there was little or no conversion of the starch. This certainly must be accepted as conclusive, and hereafter we must teach that the digestion of starch takes place in the stomach by the aid of the saliva ferments. Clinically this will be of great value and must result in a number of changes in our ideas of diet. It is only within a few weeks that a chemist of Brooklyn, New York, Prof. E. H. Bartley, published an article in the "New York Medical Journal" setting forth the dangers of having digested starch in the stomach. Our readers may recall the fact that e number of years ago a committee on American Chemists were asked to report upon the dangers of taking a predigested starch into the stomach. Glucose was becoming such a generally distributed article, and was so largely used in the manufacture of confectionery that this committee was asked to report upon its effects on the system. The report was both exhaustive and conclusive that no deleterious effects would follow its use, even in large quantities. But Prof. Bartley has recently taken exception to this report. This is a very important question, for it is a fact that today the best candies in the world con tain a large amount of glucose; while the most popular beer on the market has recently been shown to contain a larger proportion of glucose than any other brewed in this country. It is very interesting to analyze some of the statements of Professor Bartley; for instance, he says that milk sugar and cane sugar are "intended" as foods in preference to grape sugar, because the former require digestion before they can be absorbed. It is safe, then, to reason that the more difficult a food is to prepare for absorption, so much the more was it "intended" as a food: therefore, boiled pork and cabbage were "intended" as foods in preference to the more easily digested eggs and milk! For a long time there has been a growing sentiment in Germany that diabetes has not been properly treated. Hirschfeld believes that diabetic coma is favored by the exclusion of carbohydrates in the diet. Schmitz allows his diabetic patients a small quantity of albumen, while he orders the free use of food containing starch, and fat in large amount. Many American physicians are following this line of treatment with better results than heretofore. We must therefore conclude that the treatment of diabetes is bound to undergo a marked change in the near future.-National Medical Review. NORTH CAROLINA MEDICAL JOURNAL. A SEMI-MONTHLY JOURNAL OF MEDICINE AND SURGERY. VOL. XXXVI. Original Communications. No. 3. DEMONSTRATION OF A NEW METHOD OF APPLYING PLAS- BY HERBERT A. ROYSTER, A.B., M.D., Resident Physician, Mercy Hospital, Pittsburgh. In response to an invitation from the Chairman of the Surgical Section, I desire to bring to your attention a recently devised method of applying the plaster of Paris splint in the treatment of fractures. This method was original in its conception and in its practical details with Dr. J. J. Buchanan, of Pittsburgh, Pennsylvania, from whom I first learned it and to whom I am indebted for the privilege of this demonstration. The value of this splint is well-recognized by those who have had occasion to test its efficiency in the large surgical service at Mercy Hospital, where it has been exclusively employed for the past year and a half. Its mode of application is thus described by Dr. Buchanan: "The material required is the ordinary crinoline bandage, into whose meshes plaster of Paris has been well rubbed. The method of application is extremely simple. The length of the splint desired should be marked on a table. The width, also, should be laid off, taking the full semi-circumference at the widest and narrowest points as a measure. The proper size having been marked off on the table, the plaster bandage, soaked and squeezed, but still dripping, is unrolled and made to traverse the figure laid off, from end to end, covering the entire surface with from four to eight layers of crinoline, according to the strength required. A piece of muslin or Canton flannel is then applied to the upper surface of the plaster and the splint turned over so that the flannel lies next to the table. The edges of the flannel are trimmed, leaving a margin of half or three-quarters of an inch beyond the border of the plaster on every side. This border is then turned down and used as a binding for the splint, which is ready for application to the bare limb, the *Read before the North Carolina Medical Society, May 15, 1895. flannel surface next the skin. The limb is elevated and held in the position which it is desired to retain, the plastic splint moulded accurately to it and fixed in place by circular turns of a plain muslin or gauze bandage. The limb is lowered and held in proper position on a pillow for a few minutes till the plaster 'sets.' With good plaster this occurs in fifteen to thirty minutes. This splint can be easily removed by cutting the circular turns of the plain gauze bandage, should the limb swell or shrink. The application of a fresh circular bandage renders the splint as firm as before." The advantages of this splint over the more common way, of applying plaster of Paris are readily perceived and may thus be enumerated: (1) Its removable character. (2) Its adjustability. (3) The cleanliness of application. (4) Its safeness as regards circular constriction. (5) The facility and thoroughness with which antiseptic treatment can be carried out with it. (6) The non-necessity of interposing any protective between skin and splint. (Buchanan.) My individual experience in the use of this splint includes 37 cases, and my personal observation extends over a still larger number. Simple and compound fractures of the leg constituted by far the largest class in the list; in the latter variety the splint proved to be particularly valuable. The skinopening, if a compound fracture of the leg, being generally, as is wellknown, on the anterior surface, since it is here that the tibia lies subcutane. ously, the wound, after having been thoroughly disinfected, may be dressed with perfect antiseptic precautions, the plastic splint applied to the posterior half of the limb, and subsequent change in the dressing be made without disturbing the relation of the fragments in the slightest degree. Its superiority over the fracture-box in this instance consists in its greater cleanliness and closer apposition of the fragments. Indeed, it has been frequently seen that this apposition is too perfect, not giving that limited freedom which sometimes materially aids union. This latter point is still under consideration. mem COCAINE IN CHLOROFORM NARCOSIS.-Rosenberg, at a recent meeting of the Berlin Medical Society, advised the anesthetizing of the mucous brane of the nose with a spray of cocaine solution before the administration of chloroform. By this means anæsthesia is more readily induced, and reflex action on the heart is prevented. Cocaine is an antidote to chloroform, and, therefore, its absorption would probably lessen the danger of the latter. -Canadian Practitioner. REPORT OF A CASE OF INTESTINAL PERFORATION. BY R. H. WHITEHEAD, M.D., Chapel Hill, N. C. The case which I am about to report to you is so different from anything that I have ever seen in my practice, that I have thought it not unworthy of being recorded. Moreover, I do not feel certain as to its nature, and shall welcome expressions of your opinior on that subject. The patient was a young man, about 18 yaars old, who entered the University last September. He gave a history of severe suffering from dyspepsia during the past summer, and had found it necessary to live almost solely on milk and crackers much of that time. He had recently improved, and' being a very ambitious fellow, had insisted upon entering the University. He stated that he had almost constant pain in the abdomen. This pain was often severe and was not limited to any particular part of the abdomen, which was flat and not tender to pressure. He had no diarrhoea, and was positive. that he had passed no blood, mucus or pus from the bowels. There was no objective symptom that I could detect except anæmia, which was striking. He was so anxious to pursue his studies that I consented to his entering college on the conditions of light study and withdrawal in case he did not improve. He did improve, to some extent, for about a month, when he was suddenly taken sick with what seemed to be an attack of cholera morbus. These symptoms rapidly passed away, and on the following day I permitted him to sit up. A few hours after leaving his bed he was seized with violent pain in the epigastric region, tympanitis rapidly developed to such an extent as to obscure the liver dulness, and the temperature rose to 103° F. He lived five days, and died with all the symptoms of severe septic peritonitis. I had suspected a perforation of the appendix, or, perhaps, of the duodenum; so that I was much astonished when I opened the abdomen post-mortem to find, not one, but a great many perforations of the small intestine extending from the duodenum to the colon. The appendix was apparently not diseased. The perforations varied in size from that of a pin-head to that of a garden pea. Some were situated on indurated bases, others had ragged, gangrenous margins. In several places the wall of the intestine was much thickened, hard and contracted, as if by cicatricial tissue. The mesenteric glands were somewhat enlarged. There were a few soft recent adhesions. The abdomen contained no pus, but its entire contents presented that livid hue which we see in the worst cases of septic peritonitis. I regret to say that no microscopical or bacteriological examination was made. This is certainly not the usual history of any of the forms of intestinal perforation with which I am acquainted. The supposition which best explains the case to my mind is this: that the patient had chronic intestinal tuberculosis, as evidenced by the indurated bases of some of the ulcers and the cicatricial remains of others, that from some cause or another an acute inflammation was lighted up, leading to perforation of one or more of the ulcers, thus causing a septic peritonitis, which, in its turn, may have produced the perforations which had thin gangrenous margins. *Read before the North Carolina Medical Society, May 15, 1895. |