The Current Medical Thought. Rheumatism. BY LOUIS LEWIS, M.D. (Continued from page 435, last month.) Chronic rheumatism may succeed the acute form, or may be chronic "ab initio." It mostly affects advanced life, and is characterized by local pain and swelling, with diminished mobility of the affected joint from effusion and thickening. Sufferers from this form are "walking barometers," and can usually foretell rain and damp with great precision. Another form of rheumatism-gonorrheal succeeds or accompanies that disease, and is characterized by considerable joint effusion. Its favorite habitat is the knee; but other joints, as also bursa, fasciæ, large nerves, frequently suffer. It is persistent, and causes much structural injury, often ending in anchylosis, and is apt to recur. Rheumatoid arthritis (rheumatic gout) is nearly always chronic, and causes those unsightly deformities so often seen in the smaller joints of the hand and foot. It is common among the ill fed poor, and is probably hereditary in its origin. The urine contains uric acid in excess. The joints become painful, but feel easier when swelling sets in; but joint after joint is affected, muscles become atrophied, and the hand, after awhile, is distorted and deformed. Muscular rheumatism includes pleurodynia, lumbago, torticollis, and other unnamed painful affections of muscles in various parts. Sometimes it affects the muscles of the scalp, or it may be intra-cranial, the duramater, a fibroid structure, being the seat of trouble. Uterine rheumatism is not at all uncommon, although not always recognized. Paroxysmal pains attack portions of the organ, the neck, the os, or the fundus; migrating from one part to another, and attended with the usual sour-smelling perspiration and mischief in the larger joints. Rheumatism is exceptionally prevalent in neighborhoods where the soil is habitually wet and the air damp; also in marshy, swampy ground, and by the side of sluggish streams and water-courses. Here, right in these localities, we find the willow and the poplar flourishing, as though providentially placed to supply an antidote to the prevailing disease. The willow contains salicin, but it can also be obtained from the bark and leaves of the poplar, or European aspen, in the form of populin, which is main y salicin combined with benzoic acid. (The cinchona tree, in like manner, is found principally in those regions where malaria holds its sway.) Salicin, in one or other of its forms or combinations, seems certainly as specific in its usefulness in rheumatism as quinine in malaria. The anti-rheumatic power of salicylates, salicylic acid, and salicin is really indisputable. After these, quinine, arsenic, bicarbonate of soda and other alkalies, aconite, colchicum, salol, guaiacum, lithia salts, mezereon, antipyrin, gaultheria, iodide of potassium, tincture of jodine, tincture of iron, lemonjuice, actoa racemosa, digitalis, cynara (artichoke), bromide of ammonium, caulophyllum (blue cohosh), ergotine, spigelia, manaca, cimicifuga, citric, nitro-muriatic and hydriodic acids, sulphur, cyanide of zinc, antimony, veratrum viride, benzoates, each have had, and many of them still have, their advocates; but nearly all our latest experience is unanimous in pointing to the salicylates as our best and trustiest and speediest weapons with which to combat rheumatism in its acute and often in its chronic form. Theoretically, benzoates should be as efficacious as the salicylates, salicylic acid being almost identical with benzoic acid, plus a little oxygen. Calomel and bleeding are but reminiscences, or rather remi-" nuisances," of a bygone time in the treatment of this disease. The employment of the willow in the treatment of rheumatic fever is new only to "civilized" nations; for the Hottentots and Dutch Boers in South Africa have used a decoction of the young willow-shoots as a remedy for ages, both in the treatment of rheumatic fever and other fevers with high temperature. Salicylate of soda, ammonia, potash or lithia may be given in fifteen-grain or scruple doses every two or three hours at the commencement of an acute attack, and less frequently and in reduced doses as soon as the severity of the disease abates. Salicin and salicylic acid may be given in the same doses. Occasionally, the salicylates manifest a tendency to depress the heart; therefore their action should be watched, and their employment not persisted with in the event of no impression being made upon the fever in the first instance. Perhaps the salicylate of quinine would be the better form of administration in cases where there are threatened heart complications. Tincture of iron and iodide of potassium well supplement the treatment of these cases. Salicylates seem to be less efficacious in the treatment of rheumatism in children than in adults; but they are not in any way contraindicated. Bromides counteract the headache and tinnitus sometimes due to these salts. merits of these drugs in the treatment of rheumatism, when it has been established, much may undoubtedly be done to avert the disease by due precautions, as care of the skin and its pores, avoidance of draughts and damp, and attention to the functions of digestion. Those who are predisposed to rheumatism, or exposed to risk by their calling, should wear woolen or flannel clothing constantly next to the skin; and would do well to take Turkish or hot-air baths periodically, and an occasional course of alkaline mineral waters when able. Many morbid conditions owe their origin to accumulation of excrementitious substances in the tissues, and may be often relieved by the introduction of plenty of fluid to flush the system, in the form of medicinal waters. Their bulk assists assimilation of the solids, and, by dissolving waste, facilitates its removal; while their alkaline ingredients, taken before meals (as these waters usually are), also aid assimilation, by stimulating the gastric acid secretions. Hence, the anti-rheumatic value of many fashionable springs, That which makes us have no need How to Get Thin without danger. Each morning, on rising, a teaspoonful of sulphate of soda in a tumblerful of warm water. Every night, at bed-time, five grains of iodide of potassium in a little water. Every other day an alkaline bath (soda). Little or no bread, no cakes, confectionery, rice, potatoes, beans, peas, or lentils. No fats, fat meats, butter or milk. No sugar nor candies of any sort. No wines, spirits or beers, and no syrups. Eat principally roasted or grilled meats, fish, eggs, fruits, and green vegetables, other than those above mentioned. Drink light red wine half diluted. Walk after every meal.-DR. DUNTZ, Paris. (We would rather be fat.) Tincture of Iron for Carbuncles. Carbuncles are said to have been cured by painting with tincture of perchloride of iron. Pneumotomy. Mr. Wheelhouse, Consulting Surgeon to the Leeds (England) General Infirmary, speaks emphatically and decisively of the advisability of operative interference in such cases of lung abscess as depend on traumatic origin, or acute pneumonia; and in which, up to the time of seizure, the health and general condition of the patient have been. good. He does not hesitate, under such conditions, to recommed incision, cleansing, and clearing of such cavities, however questionable might be the propriety of so dealing with chronic abscesses, phthisical cavities, or other pus collections in the lungs of patients whose strength has been long undermined by chronic disease. Antiseptic applications are not to be recommended; but free vent should be left for morbid discharges. Diphtheria. A Scotch physician speaks highly of the effects of a local application-by brush or sprayof a combination of carbolic and sulphurous acids, tincture of perchloride of iron, and glycerine, three or four times a day, with the simultaneous administration, internally, of a similar mixture with chlorate of potash, in suitable doses. Nutritious diet and the cautious use of wine are also advocated. Rickets. Opium is recommended as an important adjuvant in the treatment of "rickets." It favors absorption of nutriment by lessening peristaltic action, and so preventing food from being hurried along the intestine. It also reduces the amount of mucous secretion, hinders putrefaction, and lessens irritability of nerve-centres. Ancient Advice. "Good housewife provides 'ere a sickness do come And others the like, or else lie like a fool. THOMAS TUSSER (London, 1557). No doubt you have studied diagnosis thoroughly and are able to recognize diseases readily. Now you want the treatment. But methods of treatment have undergone many improvements since you pursued your studies. As you do not want to encumber your library by a new edition of all the works on Practice, you can get all their improved treatment by sending for our MANUAL OF TREATMENT. Now get a binder for 1888. "Who Is That Man?" man's blood is possibly evolving some irritating The question is not so easy to answer; for agent which is substituting the good old tissues what with the shiftings and changes and substiof his kidneys, and which argues a future for him that will savor more of the "Bright" tutions of our natures, we are none so sure that he is always intrinsically the same individual. than the comforting. He had better keep his A few short years ago, Brown was my intimate eye on his liver, if he is sufficient of an acrobat, friend. His form and his attributes, his infor that burly organ seems to be the source of stincts and his feelings, his likes and his dismuch mysterious pathological evil. So long as likes, were all as familiar to me as his name. his hepatic factory turns out enough of its proNow, through wear and tear of tissues and in- prietary materials, especially its "glycogen, cessant change of matter, though his outward the poisonous elements present in his blood may be neutralized; but so soon as these agents form remains the same, his actual make-up is undoubtedly different. Moreover, his very are insufficiently provided, poison will probably ideas and thoughts, tastes and feelings have run riot in his system. (This “glycogen” is a signally altered with the composition of his product formed in the liver, and in yolk of egg. body. He used to like beans; now he detests It is organic and sweetish, and closely resembles them. He hated raw oysters; now he affects starch, but is soluble. Ferments and weak them. He was a lover of base-ball; now he acids transform it into grape sugar.) And so on with the innumerable effects of tissue-change likes poetry. All is changed in him; and so, no doubt, in me. As our bodies have been on our individualities. The upshot of all which constantly repaired by new sustenance, begetable task in trying to answer the question in the speculation is, that we have really no inconsider ting new blood and consequently new flesh; the old, by continual deperdition and insensible perspirations passing out from us and giving way to fresh, so have our very brains and minds changed. There isn't a bit of us left! We are not numerically the same in our material person as when we first knew each other, nor were we the same in our youth as we were in our childhood, nor the same in our childhood as we were in our very first abiding place. In fact, we are not entirely sure of our own identity. Our various foods and changes of climate are partly responsible for this; but any how we are not the identical fellows we once were, but rather their worthy or unworthy representatives. Who are we then? What has caused the change? The conscious living matter in our brains and the living feeling matter in our bodies have both been ousted and replaced. We are almost as completely metamorphosed as though we had been changed at our birth. If we are not careful our changes of food or climate may perchance occasion a deposition of something undesirable; our blood may gradually develop some organic material in excess-say uric acid and make us rheumatic, or gouty; or our fathers may have good naturedly handed this down to us, in which case the grand old men will have had all the fun, while we will have secured the pain. I know a man named Jones (as who does not?), whose memory is even now failing him, at the early age of twenty-three. Is the new material that is replenishing the "recollecting" portion of his brain of an inferior quality to the old? or does he willfully try to forget the twenty dollars he owes me? Another fellow, called Smith, is "complaining of his back" at the age of thirty-two. This abstract-Who is that man?" LOUIS LEWIS, M. D. Disease Germs. "Every specific disease is due to the influence of a distinct morbid substance on some parts at which the characteristic signs of the disease can be and are manifested. Two conditions must coincide in each: the one general or diffused in a morbid material in the blood; the other local, in some part with which this material produces disease. By this morbid substance I directly by a distinct species of minute parasite, mean those changes produced directly or ina microbe, a bacillus, or some other vegetable of lowest organization, yet specific. I believe that micro-parasites, or substances produced by them will eventually be found in essential relation with cancers." SIR JAMES PAget. Diphtheria Treated by Chloral. Dr. Adolph Mercier, of Besancon, claims to cure diphtheria in forty-eight hours. He gives a light ipecac emetic, followed by one-half to one and one-fourth drams every half hour, according to age, of a mixture of chloral hydrate one part to syrup twenty parts. No drink after giving the medicine. Glandular enlargement is prevented by belladonna ointment. neck is wrapped in cotton. Diet at pleasure. Syrup of quinquinia may be added. The chloral is stopped when the membranes have disappeared, and, in the laryngeal phase, astringent gargles take its place. The Lime for Cancer. The administration of lime-salts internally, in the treatment of cancers, has been suggested and tried, on the supposition that they have the power of hastening the calcification of the tubercular deposit, and diminishing the blood supply to the cancerous growth, and accelerating its cretaceous degeneration. One or two reported cures have been hypothetically explained in this manner. Cancer, Carbonate of Lime. We suggest the use of the remedy below, as suggested by Dr. Peter Wood, in the Lancet. Bake oyster shells in an oven, and scrape off the calcined white lining of the inner side; powder and take as much as will lie on a silver quarter, twice daily for several months. The theory is building up the coats of the blood vessels. Lime in the Economy: In early youth the lime-salts of the blood are utilized for the progressive growth of the bones; after puberty, when the increase of body-growth is ceasing, these salts are more specially devoted to the formation of hair, resulting in the appearance and augmentation of the manly attributes of beard and moustache. Cancer Cure. The composition of a cancer cure (name not given), which has for years enjoyed great reputation in upper New Jersey and Eastern Pennsylvania as effecting some remarkable cures, has been found by F. Moerck (Am. Jour. Phar.) to consist of about two-thirds arsenic and onethird charcoal of a peculiar kind. It was used as an external application, and is reported by Dr. Pursell of Bristol, Pa., to have cured many cases of epithelioma and other cancerous growths.-Western Druggist. Paraffin in Surgery. The Albany Medical Annals calls attention to paraffin as a dressing material in surgery. It answers admirably, says the Annals, for splints and jackets for young children suffering from spinal disease. The advantages are that it is clean, light, capable of being molded while it is soft, and sets rapidly by pouring cold water For the use indicated, its melting point should be 130°. The paraffin is melted in a water bath. Muslin bandages, loosely rolled, are allowed to soak in the paraffine for a few minutes, and then applied, the part having been previously covered with an antiseptic an antiseptic dressing on a separate bandage. If much support is required, a piece of paraffined cottonwool is applied first. wool is applied first. This is placed where most stiffness is wanted, and the bandage ap-. plied as for plaster-of-paris dressing. It may, however, be drawn tight, as the paraffin shrinks in cooling. Cold water is then poured on it, and the part is held in position till the paraffin has set. When a bone tends to project it can be kept in position by the finger till the paraffin has set. The hole left by the finger can then be filled up with some melted paraffin. In case of compound fracture, the paraffin has the great advantage of not being affected by the discharge from the wound. Neuralgia Remedy. Dr. John T. Metcalf says (Boston Medical and Surgical Journal) that the following formula was learned by him from one of his patients whom he sent to Cuba with the hope that a change of climate would afford relief from sciatica. A French physician, who there attended him, used this remedy with the best results, and Dr. Metcalf has tried it so often with success, that he speaks of its value with great confidence: Equal parts of the tinctures of aconite root, colchicum seeds, belladonna, and cimicifuga. Six drops to be taken every, six hours until relief is felt. The Doctor says, that "as an internal remedy it is worth all others put together of which I have knowledge." Malaria. While a supply of good potable water is of undoubted importance in malarious localities, there is no real proof that malarious infection has been caused by water. The city of Rome, in Italy, is supplied by the finest water in the world, as universally admitted; yet this very water is brought from springs on open land, where, to pass a night or two, would involve certain danger to health and perhaps to life, on account of its malarious influences. It would seem that malaria is neither wind nor waterborne, but that it is purely local and dependent on local conditions; and the local conditions, which favor its development, are those which affect the local climate. Every formula in the Official Formulæ of American Hospitals has been thoroughly tried through years of experience. No experimenting when you use these combinations. We can point out many formulæ there, any one of which is worth much more than the price of the book, Carbolic Acid for Dog-Bites. Carbolic acid has been proposed as a more rational substitute for the altogether useless application of nitrate of silver to dog-bites. It is claimed by an English physician that this acid, immediately applied to a wound caused by a rabid dog, would entirely preclude the possibility of hydrophobia as a result. Responsibility of Lunatics. With respect to the moral responsibility of the insane, it is urged that a great number of persons mentally afflicted retain a certain amount of intelligence, and are to a certain extent guided in their actions by the same instincts and motives as persons in full possession of their reason; thus the same principles of common law might reasonably be applied to them. Apart from criminality, the moral responsibility of the insane may not be contested; and the converse is even more obviously true. Men of the greatest genius have shown indubitable signs of mental alienation; but this fact has never been used to diminish their merit. Newton and Comte are illustrious examples. They had both been confined in asylums previous to their great works. Criminal lunatics certainly exist, and individual predisposition should be taken into account. Great heroes and great criminals and great saints constitute an anomaly in human nature, and are beings outside the ordinary. The justification of punishment is its mania deterrent power. It is justified by the feeling of fear it inspires in illconstituted organizations; it is a barrier of defence raised for the protection of the honest, who also have their claims to legislative sympathy. We have no "phrenometer" to gauge the degree of responsibility that each individual of this category may lay claim to. And the same reasoning is applicable to ordinary criminals. Lunatics undoubtedly there are, who, without possessing a clearly defined notion of right and wrong, yet have a very distinct perception of the danger of being amenable to punishment. L. LEWIS, M. D New Test for Death. A few drops of the "liquor ammoniæ fortior," or stronger solution of ammonia of the pharmacopeia, applied to the skin under a watch-glass, will raise a blister in a few minutes. It would make a very decisive test of actual death, as of course no such results would follow its application to a cadaver. It would certainly be as good a criterion as belladonna applied to the eye, or a ligature round the finger. |