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Since Listerine was first introduced to the dusting on Aristol powder to apply two or profession, it has been variously used, in all three thin layers of absorbent cotton and forms of fever, as an adjuvant, and as an im fasten each in place with collodion. These portant part of treatment. Diluted half and gauze strips, if properly applied, unite the lips half, or one part Listerine to four of water, it of the wound as firmly as sutures, and primary is administered in teaspoonful doses every union is as likely to take place. After their two to six lours, as a febrifuge tonic and al application Aristol powder is dusted thickly terative antiseptic; it iniproves the condition over the gauze and the dressing completed of the stomach for the reception of nourish with a layer of cotton and a bandage. These ment, and tends to the relief of intestinal dis- simple methods of wound treatment, which tention. It is admirable to introduce in the may be modified according to the locality and sponging and bathing so often advocated in character of the traumatism, have been suffici. typhoid conditions, and as a mouth-wash and ently tested to merit frequent employment, gargle during the whole period of confine. in the large class of cases of minor surgery of ment.

occurence in general medical

practice. The well known therapeutical properties of Antikamnia, Quinine and Salol make this

PROFESSOR LABADIE-LAGRAVE has used combination desirable in such intestinal affec- antipyrin successfully in the treatment of tions as fermentative dyspepsia, diarrhea,

certain uterine hemorrages. It is difficult to dysentery, duodenal catarrh, cholera infan introduce powdered antipyrin into the uterine tuni, and typhoid fever. The Antikamnia

cavity, so it occurred to him to use antipyrin controls the pain as effectually as morphine,

liquified with salol, thus producing a medicaand yet is never followed with any of those ment at once heinostatic and antiseptic. The undesirable effects so characteristic of opium

following is the mode of procedure : Equal and its derivatives. Freedom from pain saves parts of antipyrin and salol are placed in a an immense amount of wear and tear to the test tube so as to occupy abont one-third the system and places it in a much better position space; they are then heated over an alcohol for recovery. The Salol acts as an antiseptic lamp, when the mixture is soon transformed and removes from the intestinal canal the into a clear liquid with a slightly brownish first or continuing cause of the affections just tinge. This is not the time to use the solumentioned. The Quinine acts as a tonic, in

tion, for it will solidify too rapidly. The creasing the appetitite, and thus contributing heating is continued until a well-defined - much to a speedy recovery. Hare says qui- brown color is noticed, when there is no nine is not only a simple bitter, " but also longer any danger of its rapid solidification. seems to have a direct effect in increasing the

The liquid is introduced by means of cotton number of the red blood corpuscles.” A

soaked in it and rolled on a wooden applicatablet composed of Antikamnia two grains,

tor; after seeing that the liquid is not too Quinine Sulph. two grains, and Salol one hot, the application is made through the grain, allows of the easy administration of speculum. If the hemorrhage is excessive, these drugs in proper proportionate doses. two applications are made at the same sitting,

after which a tampon soaked in glycerated

creosote is placed in the vagina and the paAn excellent method of treating small tient sent to bed. The applications are free wounds of the face and extremities is as fol. froin danger and occasion no pain. Their lows: After careful disinfection with a car hemostatic action is rapid, sure and complete; bolized solution (4 per cent.) or a solution of the hemorrhage is quickly stopped and by corrosive sublimate, i to 2000, and drying the second day there is no trace of hemor. with a pledget of absorbent cotton, sutures are rhage ; it is rare that the application needs to applied if necessary, then Aristol is dusted be repeated. The method is efficacious against on, which forms an antiseptic aud protective hemorrhages due to fungous metritis, to film. A layer of plain gauze and a bandage misplacements, fibromyomata and also to macomplete the dressing. A still simpler and lignant tumors in the beginning, when the equally efficient dressing is to paint the wound hemorrhage is due more to congestion than with 10 per cent. Aristol collodion, or after to ulceration.

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SOME REMARKS ON EXOPHTHALMIC GOITER. READ BEFORE THE MEDICAL SOCIETY OF THE WOMAN'S MEDICAL COLLEGE OF BALTIMORE,

APRIL 2, 1895.

By Eugene F. Cordell, M, D., Professor of Principles and Practice of Medicine, Woman's Medical College, Baltimore. EXOPHTHALMIC goiter is an affection anemia, etc. “No immediate cause is characterized, when fully developed, by so frequent," says Gowers, “as emotion, protrusion of the eyeballs, enlargement sudden terror or prolonged distress." of the thyroid gland and inordinate ac In a case of mine it developed suddenly tion of the heart in varying relative in consequence of the shock produced degree and combination. Though rec by the unexpected arrival of the dead ognized previously it was first fully body of the patient's husband, whom described by Graves in 1835 ; hence it she had supposed well till that moment. has been called “Graves' Disease.” In another case homesickness seemed Somewhat later an account was given of to be the exciting factor. Usually, it in Germany by Basedow ; hence in however, the onset is slow and gradual that country it is commonly known as but not uniform in its rate of progress. “Basedow's Disease."

The heart symptoms usually are the Cases are far more frequent in women first to appear and in the form of palpithan men, Reynolds meeting with 48 tations. Following this at an indefinite females affected with it and but i male. period are enlargement of the thyroid and I have seen i male in 9 or 10 cases. It prominence of the eyeballs. The heart commences usually in early adult life. is easily excited by emotion or exertion, Occasional instances of inheritance have and after a time the excited action be. been reported, and several children in a comes habitual, usually 120 to 140 or family have been known to present evi. more, though often much exceeding this dences of the disease. A young Russian under the influence of exciting causes. woman told me that two of her sisters The impulse may be diffused and cardiac and a brother had heart disease, nervous dulness increased, indicating hypertroness and excitability. Much more com- phy. Heart action is usually regular. monly we find in the family of a patient A systolic murmur is often found, with evidences of neurotic tendencies in other greatest intensity at the base ; it may directions, as epilepsy, insanity, etc. be heard to the left of the nipple, indihas no relation to ordinary goiter. cating the relative insufficiency of the Whilst the affection may appear in per- mitral valve due to dilatation of the left sons in apparent health, it often suc. ventricle. There is increased pulsation ceeds some conditions of debility as preg seen and felt in the di carotids and nancy, abortion, childbirth, hemorrhage, thyroid vessels, often accompanied by a

thrill ; a loud systolic murmur is heard in the latter the attacks appear to be in the same situation. The thyroid en entirely distinct. Improvement somelargement is usually slow but may oc times takes place during pregnancy, as cur within a few days. It varies from in a case of mine, who insisted that the time to time and is moderate in degree. thyroid swelling had entirely disapIt is rarely entirely symmetrical, the peared during her three pregnancies. right lobe preponderating in the increase. Permanent recovery may also occur, In one of my cases it alone was enlarged. being most frequent in rapidly develop

The prominence ofthe eyes is bilateral. ing cases with cardiac symptoms preIt may be slight, amounting to a mere ponderating over those of the neck and stare, or considerable, so that the white eyes. Gowers thinks that about onesclerotic is visible above and below the quarter of the cases recover, chiefly cornea. In a still greater degree the those of mild degree, but recovery is movement of the balls is limited and the exceedingly rare in the severe cases. lids cannot meet over them. It is even Improvement, however, often occurs in said that the eyeball may become dis the latter. Death is due to disease of located from the socket and have to be the heart or asthenia and may be hastreplaced with the finger. Inflammation ened by exhausting diarrhea, tubercuof the conjunctiva and cornea and even losis or apoplexy. sloughing may arise from exposure of Post-mortem, valvular lesions and dithe ball. A characteristic eye symptom, latation are often found ; the arteries known as von Graefe's, is a failure of the are also dilated. The thyroid gland is upper lid to descend or a retarded des- hypertrophied. In the orbit the fat is cent when the eyeball is rotated down often increased. The cervical sympaward. The pupils are almost always thetic is rarely the seat of disease (not normal. Of the three chief symptoms once in 13 cases examined by Lewin). no one is invariably present, and two of the lower cervical ganglion is most the three may be wanting. The cardiac often affected. The central nervous disturbance is rarely absent; Gowers system and medulla are generally free estimates that goiter is absent in one from any obvious lesions. In some twelfth and exophthalmos in one-tenth cases congestion and even hemorrhages of cases. Patients are often anemic and have been found in the medulla but they exhibit loss of appetite and flesh. are not believed to possess any signifiAmenorrhea is frequent. A moderate cance. pyrexia is of common occurrence in ad The symptoms of this affection point vanced stages and occasionally profuse so strongly to the sympathetic system of perspirations are met with. The patient nerves that it is natural to look to that is often unable to sleep and is depressed source for their origin and explanation. and very irritable. Fine muscular trem Trousseau thought that he had found the or, most marked upon movement, is seat of the disease in lesions in the lowcommon. Occasional symptoms, but est cervical ganglion. But his concluless frequent than the above, are gly. ' sion was hasty and has not received supcosuria, diabetes insipidus, albuminuria, port from subsequent observers. The enlargement of glands, loss or increase frequency of the heart's beat, we know, of the pigment of the skin, edema, in may be increased by irritation of the sanity, especially mania, hysteria, paral- cervical sympathetic. But to explain yses, chronic spasms, diarrhea, epiphora the dilatation of vessels we must have and other vaso-motor disturbances. recourse either to a paralysis of the vaso

The disease usually lasts several years. constrictor fibers or persistent irritation Acute cases have subsided in a few days of the vaso-dilator fibers ; on the first supand, on the other hand, have proven position we must assume a partial affecfatal in a few weeks. The career is tion of the sympathetic, on the second, subject to great variations. Prolonged an opposite disturbance of its different periods of improvement and even entire elements. Either seems incompatible disappearance of symptoms occur so that with the idea of irritation or inflam.

mation. Gowers suggests that the va fluence of the operation upon the nerve gus may have some share in the cardiac centers. Finally, Begbie has advanced disturbance. Hence pathologists have the theory of a primary pathological recently been disposed to look to the blood state, but no facts are as yet availcentral nervous system for the primary able for the support of such a theory. morbid change. Gowers finds support The explanation of the mode of origin for this view in the law discovered by of the special symptoms is involved in Marey, viz.: that frequency of the heart's difficulty. The dilated heart may be action and diminished blood pressure due to its rapid action and incomplete are physiologically associated. The systole by which residual blood gradusympathetic system is under central con ally produces over-distention. The entrol and especially of the centers in the larged thyroid may be ascribed to dimedulla oblongata. In the absence of lated vessels and to some extent to hydefinite lesions, therefore, pointing in pertrophy from increased blood supply. other directions, we must for the present The exophthalmos is favored by the diaccept the view that the affection is a lated vessels and increased fat in the neurosis of the medulla oblongata de bottom of the orbit, and possibly by hypendent upon changes that baffle our pertrophy of the unstriated muscular powers of investigation but for which fibers of Müller, which run from the eyewe have analogies in other neuroses, as lid to the membranous lining of the orhysteria. Some confirmation of this bit and are innervated by the sympaview has been obtained by Filehne, thetic. Von Graefe's symptom was Doudouffis and Bienfait, who divided ascribed by him to spasm of the fibers of the anterior fourth of the restiform bod Müller, but by Gowers to spasm of the ies and thus produced exophthalmos and levator from central disturbance. The sometimes enlarged thyroid and even rare symptoms, abnormal vascularity of cardiac excitement. It has been pointed the skin, pigmentation and diarrhea, are out that excited heart, dilated vessels referred by Gowers to the sympathetic ; and wide-open, staring eyes are often in the case of the latter, from extension caused by emotions, especially great of the disease to the abdominal plexuses. fear, and many cases of exophthalmic Well marked cases are easily recoggoiter are on record where this suddenly. nized. The disease is apt to be overdeveloped group of symptoms has been looked in the early stage and in undecontinued permanently. Möbius has veloped cases. Under these circumadvanced the view that exophthalmic stances it is likely to be supposed to be goiter is due to increased secretion of mere nervous excitement or organic the enlarged thyroid gland producing a heart disease. A persistently rapid toxic blood state, and points to the pulse-rate should always excite suspiidiocy of cretins for proof of the malign cion and lead to careful examination. influence of enlargement of the thyroid. Ordinary goiter is recognized by absence The occasional benefit from excision of of the symptoms relating to the eye and the gland seems to lend some support to heart and by the great degree of enlargethis view. The influence of the thyroid ment. In some cases an ordinary goiter is now well recognized, since the rela may compress the sympathetic in the tions of myxedema with atrophy and neck, producing one-sided exophthalexcision of the gland and the effect of mos, dilatation of the pupil on the same treatment of that disease by feeding side and excited action of the heart. with the gland of animals are so well ap Early diagnosis is of the greatest importpreciated. But, as Gowers states, the ance in view of the prospect of permagreat discrepancy between the condition nent relief being chiefly to be anticiof the thyroid and the other elements pated then. of the disease seems to exclude it from The prognosis varies greatly. Some any direct or indirect influence on the acute cases subside entirely in a few symptoms; and the occasional benefit of days or gradually subside into a chronic excision may be due to the profound in career. Death has been known to occur

in a few weeks in an unusually violent beneficial. Drugs are uncertain and are attack, but usually the career of the dis to be used tentatively; a remedy which ease is protracted through many years benefits one case may prove useless or and it is noteworthy how few cases termi- hurtful in another. Digitalis, strophannate fatally under observation. I have thus, aconite, antipyrine, sulphonal, met but one such case in which death the bromides, and especially belladonna, was due to gradually progressive organic have proven more or less useful as heart heart disease with anasarca. In fully de. sedatives. Iron, quinine, arsenic, the veloped cases cure is rarely effected, im- iodides and strychnine are recommended provement being all that is to be expected as tonics. Iron should not be used unand in some this even is not secured. til severe symptoms have moderated. Relapses are common. In milder cases Belladonna and digitalis diminish artecomplete or nearly complete recovery is rial dilatation. A combination of these occasionally seen. The existence of or with iron, using the belladonna in full ganic heart disease and emaciation are physiological doses, with occasional full unfavorable symptoms. It is better in

It is better in doses of bromide of potassium, probably women than in men ; also when there is constitutes the best drug treatment a remittent tendency. Gowers thinks

Gowers thinks available. For the palpitation and dyspthat a family tendency, in a case in the nea Hoffman's anodyne and morphia are early stage, improves the prospects of applicable. Galvanization of the cervi. the patient. A distinct and removable cal sympathetic is often highly useful, exciting cause has the same significance. producing marked slowing of the pulse Predictions as to progress in any case and sometimes diminution of the size of are hazardous, as unexpected and even the thyroid. The effect is transient and prolonged periods of improvement or therefore the application has to be rearrest or, on the other hand, of unex- peated several times a day, one pole be. pectedly rapid development, may occur. ing placed over the nape of the neck and

The prognosis is better among the well. the other moved up and down along the to-do than the poor. The natural ten- anterior margin of the sterno-mastoid dency of the disease should be duly con- muscle. To be effective the patient sidered and “it is never right to exclude should procure a small battery and be the hope of ultimate improvement and instructed in its use so that he can apply even of possible recovery.” (Gowers.) it himself. Excision of the thyroid, al.

Rest of mind and body should be se though occasionally successful, is too cured as far as possible. In acute and uncertain and involves too many risks, severe cases it may be justifiable to con both immediate and remote, to be confine the patient for a time to bed. Ex- sidered a reliable procedure ; moreover, ercise should be avoided ; if the patient it is only warrantable in the early stage suffer for the want of it, gentle mas when remedial treatment offers a fair sage may be substituted. Change of prospect of cure or great improvement. air, especially to the seasllore, is often

THE INFLUENCE OF SYPHILIS ON LO as belong to cerebral syphilis. AntiCOMOTOR ATAXY.— Cardarelli (British syphilitic treatment as a rule does more Medical Journal) says that possibly a harm than good in tabes, and in any third of the cases of locomotor ataxy case in which this form of treatment did may be of syphilitic origin. Ataxia no good in fifteen to twenty days, the coming on twenty or thirty years after author thinks it useless to persevere primary syphilis, and not preceded by with it. On the whole Cardarelli thinks any decided syphilitic manifestation that the importance of syphilis as a during this time, is probably not syphi. cause of tabes has been greatly exaggelitic. So-called syphilitic ataxia has no rated. definite characteristics of its own, such

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