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Detroit, January 15, 1887.
Third Series, Vol. III. No. I.
Page The Use of Boracic Acid with Vaginal Pathology and Therapy of Fevers........ 53 Tampons.....
A New Operation for Hypospadias 54 New Investigations on Cholera.....
Thallin in Diseases of Children..... Original Communications.
54 Peroxide of Hydrogen in Diseases of the Medication of Nerves...
55 PAGE Eye........
42 Phenylhydracin a Sugar-Test in UrinalGeneral Considerations on the Dietetic Urethan an Antidote to Strychnine, Re- ysis
55 Treatment of Diseases of the Stomach
sorcin, and Picrotoxine.....
55 and Intestine. By Professor Dujar.
Codeine in Diabetes.....
The Treatment of Chronic Diarrhoea by din-Beaumetz...... The Antagonism between Strychnine Sulphocarbonated Water
55 Critical Observations and Experimental
43 The Treatment of Intussusception by Studies on the Influence of Pharmaco.
The Hypodermic Use of Spirits of Tur- Inflation and Massage..... logical Agents on Peripheral Vessels.
pentine in Malignant Tumors and Physiological Treatment of Cholera. By Prof. R. Kobert...
other Structural Degenerations ......... 43 Boracic Acid as a Local Antiseptic....... 56
10 Pneumato-Therapy. By Solomon Solis
44 The Action of Solanine....
The Effects of an Overdose of Cocaine. Cohen, A.M., M. D...
Iodine Irritation 14
57 A Case of Basilar Meningitis. By W. The Pharmaceutical Uses of Saccharin. 45 The Alkaloid of the Tulip........
57 G. Winner, M.D......
Bichloride of Mercury in Diphtheria.... 45 Treatment of Typhoid Conditions by
24 Galvanism and Bromide of Quinine in The Movements of the Heart and Intes
Benzoic and Salicylic Acids.......... 57 the Treatment of Chronic Catarrh of
tines, Mustrated by Photography...... 45 Treatment of Anal Fissure. the Middle Ear. By J. A. Patterson,
Liquor Ferri Albuminati.
Submucous Injection of Lactic Acid in M.D..
Unalterable Alkaloid Solutions, 27
47 the Early Stage of Laryngeal Phthisis. Therapeutic Indications in Different
Cannabis Indica and Belladonna in Turpentine in Chronic Diseases of the Temperaments. By W. G. Kemper,
47 Respiratory Organs in Children......... M.D..
Chloral Hydrate as a Vesicant..... 47 dema of the Prepuce..... Apocynum Cannabinum in Dropsy. By
Treatment by, Intestinal Injections of The Influence of Cocaine upon the Skin. 59 J. A. Lewis, M.D...
Treatment of Substantive Emphysema. 59 29 Multiple Abscess of the Liver. By J. A.
The Causes of the Poisonous Effects of
61 30 Permanganate of Potassium in Amenor. An Improved Trocar for Paracentesis of
Correspondence. rhæa. By Dr. H. I. Boldts.............. 31
67 upon the Central Nervous System...... Toxic Effects of Tea..........
68 Leading Articles.
Rare Lesions produced by Bromide of Chemical and Physiological Action of Cerebral Pneumonia
68 The Treatment of Whitlow...
Notes and Queries. Treatment of Chorea...
Worms in Children...... 35
49 Pilocarpine in Rheumatic Tetanus........ 31 Substitution of Drugs..
Influence of Drugs given to Nurses or Fatal Result of Peroxide of Hydrogen Mentholeate, or Solution of Menthol in Mothers on their Suckling Infants...... 50 Injections.....
68 Oleic Acid...... Milk as a Prophylactic against Renal Pills and Syrup of Sparteine...
69 The Prevention of Fever in a Malarious Albuminuria in Patients with Scarla- Eulylyptol.......
69 The American Book............................ 37 Hydrastis Canadensis not an Oxytocic An Intestinal Antiseptic.........
71 in the Human Subject.......
71 Reports on Therapeutic Progress. The Physiological Action of Acetophe
Treatment of Goitre.....
71 The Cause of Circular Gastric Ulcer.....
71 The Manzanilla-Tree...
71 Oleum Santali Ostindicum as an Anti- Uses of Hyoscyamine....
71 blennorrhagic.......... The Influence of Fluids upon the Tem. A Cure for Warts..
72 The Unrecorded Injury from the Con
perature of Fever Patients..
53 Binoxide of Manganese in Amenorrhea. 72 tinued Use of Large Doses of Iron.... 39 The Treatment of Varicose Veins by In- How to Prescribe Hyoscine....
72 Urethan........ 40 jections of Carbolic Acid
53 Tapioca-Root as an Antiseptic.......... 72
GENERAL CONSIDERATIONS ON THE DI-
By PROFESSOR DUJARDIN-BEAUMETZ, Paris, France.
this subject of diet in diseases of the stomach. It may be affirmed that the majority of gastric affections are tributary to an exclusive treatment based on hygiene, and that in the therapy of these diseases pharmaceutical agents play only a secondary rôle.
To give method to what I have to say, I shall proceed after the following order : I shall begin by establishing the bases on which you may institute the dietetic regimen of diseases of the stomach, and this will be the theme of the present lecture. Then, in another lecture, I shall apply these general considerations to each of the stomach disorders in particular.
Two modes of procedure are at the disposal of the practitioner to guide him in the study of affections of the stomach,—the clin
ical methods, properly so called, and the more mucous membrane of the stomach and its constrictly scientific methods, which are addressed tents. All these processes are based on the at once to the stomach. The clinical methods employment of the stomach sound and exwere the only ones which we possessed till plorers, and comprehend two distinct acts,Kussmaul's discovery enabled us to study di- examination of the duration of digestion and rectly the gastric functions. They consist in examination of the gastric juice. the palpation and percussioh of the stomachal Let us commence with means used to ascerregion, in an attentive interrogation of the tain the duration of the digestion. According patient, and in an examination of the vomitus to Leube, a healthy stomach ought in seven and dejecta. We thus used to obtain the only hours to have digested a plate of soup, a large signs that could guide us in the diagnosis of slice of beefsteak, and a small wheaten loaf. gastric affections.
The liquid of a lavage of the stomach, made These signs, from the particular point of after that lapse of time, ought to be absoview of the functional working of the stomach, lutely clear, if the stomach is doing its work were, it must be admitted, of doubtful exact.
well. Kretschy makes a single reservation ness. The patient can give you but very un
to the rule laid down by Leube,-during certain information concerning the precise menstruation in the female the duration of duration of the stomachal digestion, and the digestion may exceed seven hours. the repugnance which he often experiences But the examination of the gastric juice for certain articles of food is especially a requires multiple and somewhat difficult promatter of habit and custom, or, it may be, of cesses, and we have here to study, on the a particular idiosyncrasy. I once knew a pa- one hand, the acidity of the gastric juice, tient who could not eat veal kidney without and, on the other, its digestive power. Before veritable symptoms of poisoning ; others ex- entering on the consideration of these two perience similar effects from eggs, and the questions, I must briefly point out the methods list of cases of the kind might be consider- in use for obtaining gastric juice, and here ably augmented.
again we shall have to study the two followRecall to your mind in this connection the ing points : how to extract gastric juice from modifications which pregnancy effects in the the stomach, and how to make the mucous digestibility of certain alimentary substances, membrane of the stomach secrete this juice. also the still stranger tolerance or intolerance To obtain gastric juice from the stomach which some nervous and hysterical persons we have two methods,—that of the sound and manifest for certain articles of food, and you the sponge method. If you wish to use the will agree with me that if the ordinary clini-sound, the ordinary siphon-tube will answer cal processes are of use in the study of the the purpose, or, better still, the stomach-pump. way the stomach performs its functions, they I here place before you the one which I orlack precision.
dinarily use. This instrument, constructed Hence it is that we gladly welcome the by Collin, is very simple and very ingenious, more scientific methods which come to us and it suffices to turn the swivel which fixes from Germany, and of which Leube has been the syringe to make it communicate either the most ardent and able expounder,-meth- with the stomach or with an outward recepods which consist in directly examining the tacle (Fig. 1).
Leube employs a soft rubber sound, six | into the gastric cavity, and by means of the millimetres in diameter, the parietes of which stomach-pump, with which it is connected, are two millimetres thick, which is introduced the contents of the stomach are extracted. Ewald makes use of a very handy method. paratus is one of the most simple, and its inHe passes down into the stomach a soft rub- troduction and removal are exceedingly easy, ber catheter scarcely larger than a good-sized especially in individuals who are used to the urethral sound, and seventy centimetres long. stomach-tube. This is introduced nearly the whole length, In connection with the foregoing methods, when he causes the patient to make an effort consisting in stomach catheterization, the at vomiting, and at the moment that the liquid sponge method deserves mention, being a appears at the upper extremity of the sound, process which is very simple, and very much he seizes the latter with his fingers and quickly employed in Germany, and which we owe to withdraws it from the stomach. He then blows Edinger. Little bits of sponges enveloped in into a wineglass the liquid which the catheter gelatin are attached to the extremity of a long contains.
thread. The patient swallows the sponge I have myself constructed a stomach-ex- while fasting. It is allowed to remain half plorer, made for me by Galante, and which I an hour in the stomach, then is withdrawn by here place before you (Fig. 2). It compre- means of the thread, and the contents squeezed
into a watch-glass for testing. Fig. 2.
If you have not the prepared sponges, such as are made in Germany, you can very easily replace them by the following means. You take one of those gelatin-capsules, divided into two parts, encased the one in the other, and known under the name of Lehuby capsules. You place in the interior of the capsule a little sponge, to which is firmly attached a long silk thread, which is made to pass through the second part of the capsule, and the two hemispheres of the capsule are then firmly joined together, and are ready for use. The gelatin-capsule is soon dissolved in the stomach, and becomes impregnated with the gastric juice.
The sponge process is more painful than that of the sound. The object of resorting
to this method is to do away with the neceshends, as you see, a stomach-sound precisely sity of the introduction of a tube into the insimilar to the tube of Debove, having a length terior of the stomach, but the deglutition of a of half a metre. In the interior of this tube sponge held by a thread, and which has to reis a little glass bulb, perforated at both ends, main half an hour in the stomach, produces to whose lower extremity is attached a little more nausea and vomiting than the sojourn rubber tube to put the bulb in communication of a sound. I have tried these sponges on a with the mucous membrane of the stomach. good many patients and on myself, and I have The narrow upper extremity of the glass bulb reason to abandon the method. is adapted to another rubber tube, which is Now that you know the means employed much longer, and ends in a flask-shaped rub- to obtain gastric juice, I will tell you what ber ball similar to that which makes a part of you must do in order to provoke the secretion an ordinary spray-producer. Finally, a stout of this fluid. You know very well that the string enables us easily to withdraw the glass stomach, at the moment of your exploration, reservoir. The mechanism of this apparatus ought to be entirely empty, as the presence is easily understood. You introduce the tube of food in that cavity considerably modifies into the interior of the stomach, then, by the reactions of the gastric juice. You must, means of the rubber ball, you exhaust the air then, operate when your patient is fasting, in the glass bulb, which then admits gastric and to stimulate the flow of gastric juice, you juice ; then you withdraw the sound. When
may employ three processes,-mechanical, once the tube is out of the stomach, you re- chemical, and thermic. move the glass bulb by means of the string, The mechanical processes consist in irriand empty the gastric juice which you have tating the gastric mucosa by a foreign body, extracted into a watch-glass by means of as the point of a sound or a sponge. The pressure made on the rubber ball. The ap- chemical processes consist in the employment