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contraction of tendons, swelling and adhesions. These cases are not benefited by any form of treatment other than that relative to the joint. Then what is the proper method of treatment and indications for treatment? They are to relieve pain, promote absorption, hasten the removal of adhesions and set up molecular changes in the surrounding parts. Only by mechanical means including calisthenics with its healthful exercise of body and limbs can we then hope to break up existing adhesions, to smooth the roughened articular cartilages, strengthen the contracted tendons and nerve tissues and restore the joint to its former suppleness. First, by a process of stroking and kneading in a centripetal direction, stimulating the lymphatics and venous currents and surrounding tissues to greater activity, carrying the lymph with greater rapidity towards the center. By these means the lymphatics and circulating system are stimulated, setting up changes in the nutrition, causing healthy activity in the parts. In cases where there is perceptible defective nutrition constitutional remedies with dietetic medication must be employed. I will give you a few cases that came under my care. After exhausting all other methods of treatment, the patients becoming tired of treatment, and threatening to go to some springs for relief, I began mechanical treatment by manipulation of parts, stroking, kneading with active and passive moments.
CASE I.—Mr. H. J., a day laborer, age 46, came to me in April of last year.
Complained of severe pain. Complained of severe pain in back and right thigh down to the knee. He was scarcely able to walk by use of cane, could not raise foot to stair steps without the help of both hands grasping and lifting it up. He said his right leg had troubled him for two years and had constant pain on posterior part of thigh. While seated he could not raise himself without the aid of his cane. While he was seated he could not raise his foot from the floor with leg extended more than one foot, it causing him severe pain in the posterior part of thigh in knee and hip. There was great sensitiveness at the point of exit of sciatic nerve and at different points along its course and in popliteal space. Knee slightly flexed and steps on toes. Patient well nourished and otherwise in good health. After faithfully trying medicinal means without any benefit, I began mechanical treatment by kneading and stroking of parts, all kinds of movements being very painful to the patient. It being very difficult for patient to raise foot or thigh, I laid him on the table and began the simplest movements, as raising the affected member as high from table as possible, desist when the pain becomes severe, for in these cases flexion or extension are very painful in hip and knee joints. As the distance in raising the foot is increased so will the pain become lessened when the patient is up and about.
Rest patient and try again increasing the height each time. By the manœuvre the sciatic nerve and the muscles and tendons are put upon a stretch, for in most cases these tissues become shortened, their phy siological action impaired, and by our endeavor to put these tissues on a stretch can we hope to bring back their normal physiological action. Alternate by stroking posterior part of thigh in a centripetal direction and kneading the muscles, having for its object the alterative changes that will follow in muscles and nerves improving the circulation and stimulating lymphatic resorption. Change movements by letting patient step over some object, say one or two feet high. It is a good plan to direct patient, for by partial disuse the cerebral powers causing the requisite contractions seem to be lost, so by directing patient this lost power is gradually restored. Then direct patient to bend knee on floor raising himself up several times. All of these movements can be increased each day. I then instruct patient to walk properly stepping on heel instead. By this manner of walking all the parts are kept on the stretch. These various exercises should be gone through every day. The object is to keep the parts active and giving patient all the movements you can employ. been affected about two years.
This patient had When under treat
ment eight weeks was discharged cured. More than a year has elapsed and he has had no return of rheu matism. The daily exercises lasted about twenty minutes, long enough to keep parts thoroughly exercised and not exhaust patient. In these cases the physician will become tired, and he will find that if he does his full duty it will be work for him as well as the patient.
CASE II.-Mrs. H. K., aged 36, sent for me to go and see her at her home in June of last year. She came to the door on cratches. She said that she had been troubled with her feet and right knee for 18. months and had been compelled to use the crutches for the past ten months. Oh examination I found both ankles swollen, would pit some on pressure, movements entirely lost by her own efforts, and any effort in making active or passive movements caused her so much pain that all such efforts were delayed for some days. Right knee joint affected with constant pain, synovial exudation quite abundant, could not put knee on extension the pain was so sickening. The general nutrition was impaired. The heart was in proper position, and I could distinguish no murmurs, but the first sound of the heart was weak. It seemed to beat no stronger than second sound. It was easily excited and she complained of being faint at times and thought her heart would stop beating. For her heart I put on a mixture of tr. iron, quinine, strychnine and magnesia sulphate with a vehicle. of glycerine and water, to be shaken and taken three
times a day in plenty of water. After taking this mixture for a few days she began to improve in strength, her heart increasing in force, but her ankles and knee remained unchanged. I began by using hot and cold water on parts, alternating until the sensitiveness of parts was diminished, then gradually beginning by stroking and manipulating parts, followed by active and passive movements. This plan of treatment was continued for two weeks, increasing the movements each day at which time I took her crutches from her and told her not to use them any more, but to walk without them and try to walk properly. Her strength in ankles gradually returned and the swelling in ankles subsided. The active and passive movements were continued for six weeks, and at that time she was well enough to stop active and passive movements. The constitutional treatment was continued
for two months.
CASE III.-Mr. J. Mc K., a plasterer, age 46, sent for me in April of last year. I found patient confined in bed, could not turn over in bed without help. On examination I found some tenderness in loins on either side of spine in lumbar region, but no change of structure was apparent. I prescribed for him quinine and sodium salicylate, two grains of the former, and four of the latter, to be taken every two hours until the physiological action of the drugs was produced. This followed after they had been continued for ten hours, but no relief of the symptoms followed their use. I followed by using phenacetine in ten grain doses every three hours until the effect of the drug was produced. This in a measure reduced the pain, but the weakened condition of the heart that followed and general prostration compelled me to discontinue the drug, and resort to stimulants. I immediately administered a hypodermic of morphine and atropine, which was followed by improvement of all symptoms, but after the effects of the hypodermic had passed the pain returned with as great a force as at first.
Three days had now passed and my patient was no better. I then resorted to mechanical treatment, first by kneading muscles of back and stroking them. After I had proceeded in this manner for a few minutes my patient could turn over in bed, and said that he was feeling better. The next day I got patient out of bed and began active and passive movements by having him stoop down and raise up several times, then bend backwards several times. From this time patient kept on improving and remained up. It astonished me to see how fast this patient improved after active and passive movements, suffering with such a severe lumbago.
CASE IV.-Mr. J. D. A., machinist, aged 47, came to my office last October, walking unsteadily by use of cane, complained of pain in back and right hip and
thigh. Said he could not lift foot so he could walk well. On examination I found tenderness over exit of sciatic nerve and in popliteal space, knee slightly flexed, stepped on toes. While seated, when I lifted his foot he cried out that he "came to be cured and not killed." I explained to him that he must make up his mind to bear a little pain and that he would get well. I laid him upon the table and began by lifting foot as high as possible, stroking and kneading hip and thigh, gradually increasing height. I then changed his movements by having him walk and step over some object increasing height. I instructed him to kick as high as he could several times a day with this leg and keep it active for it needed activity and not rest. I took his cane from him and instructed him not to use it any more. I increased all movements as I had in case one, and after three weeks' treatment patient was discharged cured.
CASE V.-Mr. C. A., merchant, aged 66, came for treatment in March. He complained of pain in right shoulder, arm and fore arm at night so bad that patient could sleep only by the use of a hypnotic. Examination revealed tenderness at points on shoulder, on inner surface of arm along course of median and musculo-cutaneous nerves. The grip of hand was so perceptibly lessened in right hand that patient could not hold a glass of water. This condition had lasted nearly two years and constantly growing worse. I began by stroking, kneading and manipulating muscles of shoulder, arm and forearm, then directed patient to extend arms over head, which was very difficult for him to do. He could not fully extend arm, it gave him so much pain. I directed him to strike up, using all the force he could, first with one arm, then with the other arm, then directed him to strike out from body, then strike down, then throw arms backward as far as possible. By degrees these movements were increased in force and became more easy for patient. I then gave him weights to hold out, increasing the weight until patient could hold out as much with one arm as with the other. All of these movements were kept up every day for four weeks when patient could sleep without pain. This patient had resorted to medicines for more than a year for the relief of this cervico-brachial neuralgia without any benefit. To give more cases will make this paper too long and tiresome. These cases being unusually
severe ones will illustrate the method of treatment and its results, contradicting the old teaching that these cases need rest.
muscles and nerves are surely elongated, heat must necessarily be evolved by the manipulations, changing the molecules of the muscles from an inactive to an active state, causing internal work, setting up molecular changes in all the surrounding tissues. The circulation and lymphatic system are stimulated. By stroking in a centripetal direction the lymph and venous currents are increased, altering the whole process of nutrition. The waste material is carried away by increased action of the lymph and circulation, and new nourishment is more readily carried to all parts, feeding them and enlivening the whole organism.
NOTES ON 676 CASES OF TYPHOID FEVER.
Mason (Boston Medical and Surgical Journal, April 7, 1892), gives interesting statistics of the above number of cases of typhoid fever, treated in the Boston City Hospital, in 1890 and 1891. He calls attention to the fallacy of drawing conclusions from a small number of cases. The mortality of the whole. number was 10.4 per cent. while two series of 242 cases gave a mortality of only two per cent. It is found that the mortality of 600 cases treated by the same methods differs but little. Eighty per cent. of the cases were admitted between July first and November first. Sixty per cent. were admitted in August, September and October. The mortality of cases under fifteen years was three per cent.; between fifteen and thirty-five, 10.5 per cent. Over thirty-five years it was 18.4 per cent. Delayed admission to the Delayed admission to the hospital materially increases the mortality; the mortality being highest in those who entered in the fourth week. About twice as many males were admitted as females. The mortality was about two per cent. greater in females than in males. Intestinal accidents occurred in six per cent. of the cases. He compares this series with a series of 1,173 cases treated by Brand's method, and finds his intestinal accidents less than the series treated by cold baths. He believes their higher general death rate 10.4 per cent. compared with 7.84 per cent. to be due to the fact that Brand's method prevents pyrexial exhaustion, which is so fatal in females. The therapeutics of the 676 cases was cold sponging, use of phenacetine in high temperature, laxatives, preferably salines in the first week, the use of napthol, salol and other internal antiseptics. Stimulants, he believes, should not be used too early, nor to too great an extent. He believes that careful attention to the digestion and to the eliminating organs, a free supply of drinking water, correct estimation of danger signals, and prompt application of such measures as each case may demand, are of more importance in the management of this malady than any systematic method. But the mor
tality from typhoid has decreased the world over within the last twenty-five years, and Brand's system of bathing is thought by the best observers to be an important factor in this reduction.
Dr. R. Osgood Mason, of New York, contributes to the Medical Record a remarkable article on what is variously called mesmerism, animal magnetism, and hypnotism; different names, as he remarks, for the same thing, each having its own appropriateness, and its own defect. He says:
In the application of animal magnetism or hypnotism, for therapeutic purposes, I often make use of passes in the following manner: Using the tips of the extended or slightly bent fingers, I commence at the top of the head and pass the hands slowly downward over the face, chest, body, lower extremities, and feet, not touching the person, but keeping the fingers at a distance of from a few inches to two or three feet away. Now, I have observed that certainly much more than one-half of the persons so treated are able to feel these passes, more or less distinctly, and to describe the sensation produced. Most patients. describe it as a breeze or current; sometimes designated as warm, sometimes as cool, and sometimes as the "pins and needles" sensation. Sometimes the latter sensation is felt so powerfully as to cause sharp pain, convulsive action of the muscles, and loud outcry, the patient at the same time begging me to desist. In those cases where shock and pain are experienced, if the distance of the hands from the patient is increased the unpleasant effect is diminished and becomes bearable. I have met, at least, three wellmarked cases of this kind. Generally the effect of the passes is agreeable, and very often results in a true hypnotic sleep. Regarding the sensation described simply as a current or breeze, I would say that it is impossible that it should be caused by any actual current made by the movement of the hand, since the more slowly the passes are made the more distinctly are the sensations perceived; they are also perceived equally well through the ordinary clothing with gloves and boots, or through the ordinary bed-covering.
Experiments with the patient blindfolded have often succeeded perfectly. I have made these experiments hundreds of times, often upon most decided and strong-minded sceptics. One of the latter sort, while undergoing the experiment, bounded up from the sofa upon which he was lying, and exclaimed with great emphasis, "Zounds, man, you have a battery somewhere about you!" It is needless to say
that such was not the case, and after a few passes the effect became simply noticeable and quite agreeable. Some years ago I had under my care a young lady. She was cured by hypnotism. She was, however, under my observation for several weeks after her cure was apparently complete. During her illness the manifestation of abnormal sensitiveness had been marked and frequently observed, and I became convinced that the same condition continued. Accordingly I instituted some experiments to test this point. I will describe two of them.
(1) Taking an old-fashioned copper cent, which I happened to have in my possession, I wrapped it in six entire coverings of tissue paper. This I took with me, held closely in the palm of my right hand, as I entered the room where my patient was lying on a lounge. I took a chair as I passed in, and placing it beside the lounge, I sat leisurely down and took her right hand in mine in such a manner that the little package was between our hands, and in close contact with her palm as well as my own. I remarked upon the weather and commenced the routine duty of feeling her pulse with my left hand. A minute or two were past in banter and conversation intended to thoroughly engage her attention, when, all at once, she commenced to wipe her mouth with her handkerchief and spit and sputter with her lips and tongue as if to get rid of some offensive taste. She then looked suspiciously at me and said, "I wonder what you are doing with me now." Then suddenly pulling her hand away from mine she exclaimed, "I know what it is you have put a nasty piece of copper in my hand!"
(2) I took two new, clean glass bottles, exactly alike, fitted with new corks, and put a small dot of ink in the centre of one of the corks, for the purpose of identification. I then filled the bottle with the plain cork with plain croton water. Immediately after I drew a goblet of water from the same faucet, and placing it on my desk I brought all my fingers together in a clump, and then held them for a minute or more over the water in the goblet, as near as convenient to it but without the slightest contact. This water it was, "and nothing more," with which I filled the second bottle, having the marked cork. I then wrapped the bottles separately in thick white paper, put them in a satchel and took them with me on my visit to my patient. During my visit I produced the bottles, taking care that my patient did not see them, much less distinguish the corks. I proceeded to pour out a teaspoonful of the plain water and I desired her to taste it. She did so, and I then asked her what she supposed it to be. She replied that she could taste nothing but simple water. I then took a teaspoonful of water from the marked bottle and desired her to swallow it; and on asking her the same question she
replied this also was water but that it was peculiar. It was not exactly like aerated water, but that conveyed the best idea she was able to give of how it differed from the plain water; it had a sparkle which she felt in her mouth and felt all the way down as it passed into her stomach. No matter how or in what order the two waters were given her, she never failed to distinguish them, and she always described the difference in the same way.
The tendency of the modern school of hypnotism is to decry and discredit everything which points to an unrecognized force, as a cause for the phenomena of hypnotism; especially is this the case when for any such force a physical basis is claimed.
Good hypnotic subjects are found among perfectly healthy persons as well as among the neurotic and hysterical.
Regarding imagination and suggestion, persons are often hypnotized who have not the slightest idea that any such effect is expected or desired, and even when they are separated from the hypnotizer, and have no suspicion that any hypnotic influence is being exerted upon them.
They have been put into the condition by the simple will of the operator, when the subject and operator were separated by distances so great that suggestion by any ordinary process or means of communication was impossible. There is also sometimes a community of sensation between the hypnotizer and the subject which has been demonstrated to exist when they were separated by a distance of a hundred feet or more, and when the distance was obstructed by walls and closed doors.
For such a purpose it is necessary that there should exist a medium possessing a physical basis, of however rare and subtle a character, through, or by means of which, psychical influences and impressions may be transmitted.
It is in this relation that the whole subject of animal magnetism, vital force, and the od force of Reichenbach will of necessity have to be reviewed and restudied. The leek which the un-scientific have ridiculed for a century past, will, after all, have to be smelt and tasted.-Sanitary Era.
Milk as Food. Sir Henry Thompson says: "Milk is a peculiarly nutritive fluid adapted for the fast-growing and fattening young mammal-admirable for such, for our small children, also serviceable for those whose muscular exertion is great, and when it agrees with the stomach, for those who cannot take meat. For us who have long achieved our full growth, and can thrive on solid fare, it is altogether superflu. ous and mostly mischievous as a drink.”
Medical Society Notes.
NEW YORK ACADEMY OF MEDICINE. PAEDIATRIC SECTION MAY 12, 1892. DR. NORTHRUP IN THE CHAIR.
Dr. J. Lewis Smith presented a child of twenty months suffering from double ranula. The tumors were large and very vascular, and excessive hemorrhage was to be feared if treated by excision.
Dr. Baruch thought the danger of hemorrhage was not excessive and favored excision of two-thirds of the
Dr. Koplik presented a case of microcephalus, the patient being four months of age. There was facial paralysis and a marked spastic paralysis of the legs. The diagnosis was microcephalus with congenital retarded development of the cerebrum with involvement of the pyramidal tracts. Operation, the speak er believed, was not indicated.
Dr. Leszynsky believed that the Lannelongue operation was a dangerous one. In this case an operation on the skull would not aid the brain, which was evidently undeveloped.
The nervous symptoms of diarrhea are numerous and often serious. Uraemic wasting will account for a few, sluggish circulation of impoverished blood through the brain for others, but by far the greater number result from toxaemia, due to the absorption of ptomaines generated by fermentation in the bowel. Dr. Simon Baruch read a paper on "Conditions Indicating Baths and Change of Air." Change of air is not demanded by reason of any special difference in the proportion of oxygen or other chemical constituent, but rather to avoid two sources of danger: 1. A high temperature and marked humidity, one or both.
2. The presence of impurities. Of what avail are stimulants, tonics and food when the little sufferer is forced to toss in a stifling atmosphere laden with moisture and the impurities which actively contribute to the development and maintenance of his disease? The elements necessary for successful treatment are clean food, taken into a clean stomach and its detritus removed through a clean intestinal tract. It is to obtain these, not oxygen, that a change of air is demanded. The lessons derived from long experience at a summer resort are two:
The subject of discussion was: "Summer Diarrhoea change of air, treatment is also important. in Children."
Dr. Henry D. Chapin read a paper entitled, "Relation of the Stools to the Lesions and to the Prognosis; Nervous Symptoms and their Origin." It is not always possible to determine the exact seat of disease or extent of the lesions by the character of the stools. In the diarrhoea of acute indigestion the passages consist of undigested and fermenting food and the products of an irritated mucous membrane, viz.: thin watery secretions and more or less mucus.
In the diarrhoea of inflamation the passages will contain masses of fat and small lumps of curd. If milk is stopped and broths are given they become darker and often very offensive. Mucous in various forms is present. The more closely it is mingled with the fecal muss the closer is the lesion to the colon. When the lower bowel is involved the mucus appears in glairy or pulpy masses or shreddy particles resembling membrane. Blood, if mixed in streaks, comes from the ileum or upper colon; if free and red, from the lower colon or rectum. White, dryish, putty-like stools consist chiefly of fermenting fat; brownish stools of albuminous matter from animal broths. The causation of green stools has been the subject of much controversy. However caused, they are clinically seen in connection with much irritation of the bowels with active fermentation of their contents. When there is rapid loss of vitality, out of proportion to the number and character of the stools, ulceration is to be suspected.
2. Among the better situated, change of air need not be insisted upon until all approved methods of treatment have been tried. A change from a comfortable home to a crowded country hotel is only to be advised after most careful reflection.
Bathing for cleanliness is always demanded in summer diarrhoea. For therapeutic purposes baths are especially indicated in cholera infantum. temperature reaches 102° F. the child should be placed at full length in a tub of water at 90°, after the face and hands have been bathed with ice water. The temperature of the bath should then be gradually reduced to 80°. The bath should be continued fifteen minutes, active friction being constantly employed. The child should then be placed on a linen sheet laid smoothly over a blanket, in which it should be wrapped and allowed to dry if the temperature was over 103.5° before the bath. If under that point he should be dried and dressed at once. The object of the bath is not primarily to reduce temperature, but to counteract the vaso-motor paralysis evinced by the pallor of the surface when the rectal temperature is high. In subacute diarrhoea baths are indicated to improve the general nerve tone when there is general depreciation of the system, a condition in which tonics often fail. Here general ablutions are preferable to baths. The child is placed on a soft woolen blanket and bathed, not sponged, as follows: From the hollow of the hand water at 70° F. is poured upon the skin, which is then gently rubbed with the same hand. The body is