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Therapeutics of Typhoid Fever in the Paris Hospitals.-There exists in Paris much divergence of opinion as to the efficacy of cold baths in the treatment of enteric fever. This method is attributed in France to Brand, of Stettin, although it had been advocated nearly a century ago by Currie. Dr. Juhel-Rénoy has just communicated to the Société Médicale des Hôpitaux the result of an inquiry he has conducted into this question. For this purFor this purpose he applied to eighty colleagues, forty of whom replied. Of these hospital physicians fourteen disapprove of the cold bath. Twelve, on the contrary, are enthusiastic believers in the method, which they apply indiscriminately to all cases, whether they be light or severe in character. Two believe in tepid baths gradually cooled down; and eight, while approving generally of cold baths, impose certain restrictions. Of 175 cases treated by the adversaries of the method, 25 died, giving a mortality of 14.2 per cent. Thirtynine cases treated by the method, with restrictions, yielded one death, or 2.56 per cent. In Professor Bouchard's wards, where progressively cooled tepid baths are in fashion, 54 out of 554 cases died, or 9.74 per cent. The advocates of systematic cold baths lost 40 out of 492 cases, or 8.13 per cent. M. JuhelRénoy concluded his paper by expressing his opinion that the introduction of balneotherapy into typhoid fever wards had been the means of reducing the mortality from that disease at least five per cent.Lancet.
Internal Use of Germicides.-A due consideration of the results attained by recent experimentation, a study of the clinical aspects of infectious diseases, together with some experience in their treatment, seem to me to warrant the following
1. The internal use of germicides is valueless in most cases of systemic infection. While they may alleviate symptoms, they possess no curative properties.
2. Such agents have at times a beneficial effect upon acute gastro-intestinal diseases, and are of some value in those of a more chronic nature.
3. Their remedial effects are not always due to their germicidal properties.
4. Systemic as well as local disinfection, when required, is effected far better by eliminatives than by germicides. Dr. Berry, N. E. Med. Monthly.
Dyspnea After Tea-Drinking.-Mr. Jonathan Hutchinson, in the January issue of the Archives of Surgery, describes a case of alarming attacks of dyspencea that were probably due to teadrinking. The patient was a rather delicate man, of nervous temperament, and there was a suspicion of gouty heredity. The attacks occurred after breakfast,
at which he drank tea freely, the meal being brought to him while he was yet in bed. During the attacks he had a corpse-like pallor, and seemed quite unable to take a respiration, on account of a pain like that of angina pectoris caused by the effort. The pain was referred to the epigastrium and lower part of the chest, rather than to the shoulder. Inspiration was accompanied with the greatest pain. The pulse was feeble during the time of the attack, and the patient could speak only in a whisper. The duration of the attacks was about an hour. An injection of morphine terminated the seizure quite promptly on two or more occasions. A careful thoracic examination, made by Dr. Gowers, resulted for the most part, negatively. At any rate, no organic affection was discovered that could explain the difficulty. The man was not a user of tobacco, but would imbibe tea freely, and this was sometimes followed by flatulence and a feeling of distention of the stomach. An over-indulgence in tea, especially with little or no food taken at the same time, will in some persons produce a sense of constriction behind the sternum, with some feeling of dyspnœa. In the case of a medical man who partook of tea of unaccustomed strength, and without eating any food, a distressing attack of dyspnoea occurred which lasted over thirty minutes. The recurrence of somewhat similar attacks having followed other indiscretions of tea-drinking on subsequent occasions, the mind of that physician became strongly impressed with the agency of strong tea in causing such attacks; so much so that for a long time he never ventured to drink tea except in his own home, where he knew its strength and quality. Mr. Hutchinson states that the painful attacks of the patient first above referred to bring to mind very distinctly those
from which John Hunter suffered, and which he himself so graphically described.-New York Medical Journal.
Habitual Constipation.-Two patients had had absolute obstruction for some days, so that symptoms of incipient paralysis of the bowels were present. Severe meteorism, vomiting, oppression, anxiety, loss of strength, cold sweat, feeble pulse were caused by the enormous hard, dry masses found in the rectum. In view of the necessity of immediate relief, two pieces of wood were shaped like a glove-stretcher, the ends smoothed and oiled.
Dr. Ising introduced this through the sphincter and into the fæcal mass, and stretching the sphincter energetically, began to loosen the hard masses. In about twenty minutes very offensive gas was given off; he then withdrew the instrument, gave an enema of cold water, and kneaded the belly with a cold wet cloth wrapped around the hand. The bowel was quickly emptied and comfort restored.
Dr. Ising also calls attention to the not infrequent cases, in which, in spite of daily passages or even diarrhoea, there are accumulated fæcal masses, causing the patient much trouble.
The objective symptoms are usually facies hippociatica; no fever, empty note over abdomen, except a small region about the small intestine and the stomach, which has a tympanitic note; doughy consistency of the abdomen; resistance along the colon, often throughout its whole extent; colic-like pains. The patients complain of discomfort in general and disturbance of digestion.
Mild cases of this sort are quickly cured by the use of massage, faradization, and hydrotherapeutic procedures.
All these means were used in vain for one patient. This man refused all food and suffered so intensely that he required two injections of morphine daily. After twelve days the patient sent, by telegraph, for his favorite old cognac, of which he drank a small glass each hour, which caused him to pass great quantities of thin excrement in which were mixed tough, knotty masses. The pains ceased and the patient's appetite returned.—Blaetter fuer Kl. Hydrother.
Medicated Inhalations.-The observation of Dr. A. Irsai, of Buda-Pesth Laboratory, on the effects of the inhalation of various substances on the lungs and air-passages, show that almost immediately after a few inhalations of air impregnated with Turpentine Oil the lungs became pale, but regained their ordinary appearance on the re-admission of pure air; a second administration of turpentine vapor was followed by the same appearances as the first. The cause of the pallor, in the author's opinion, was doubtless a spasmodic contraction of the pulmonary vessels-probably due mainly to peripheral action.
When Juniper Oil or Oil of Pinus sylvestris was employed, results of a similar kind, but less in degree, were obtained. The latter, however, is considered a more powerful vaso-motor constrictor than Turpentine Oil.
With Oil of Eucalyptus, Anise Oil, Peppermint Oil, and Menthol, scarcely any change was produced in the color of the lungs.
With Thyme Oil and Thymol, three or four inspirations were followed by a distinct reddening, which increased as they were continued.
Creasote and, in a still greater degree, Guaiacol, produced redness, there being rapid relaxation of the vessels and great hyperæmia of the lungs.
From these observations, Dr. Irsai concludes that in acute catarrhal affections with swelling, hyperemia and profuse secretion, substances should be selected for inhalation which produce anæmia, and that in chronic torpid conditions, or in phthisis where the
supply of blood and the nutrition of portions of the lung are defective, substances which induce hypermia should be used. Of course it is needful to exercise due vigilance in employing creasote or guaiacol in cases where there is any tendency to hæmorrhage. The Lancet.
Feeding of Infants in France.-A recent legal enactment in France prohibits the giving of any form of solid food to infants under one year of age without the authority of a prescription from a qualified medical man. The employment of the rubbertube nursing bottle is also forbidden. Two hundred and fifty thousand infants die in France every year, and it is claimed that 100,000 of this number could be saved by intelligent care. The passage of this law is due in great measure to the efforts of the recently organized society for the protection of children, of which Dr. Rouchard is the founder.- Cincinnati Lancet and Clinic.
The Medical Calendar.
The Remedial Uses of Apples.-Chemically, the apple is composed of vegetable fibre, albumen, sugar, gum, chlorophyl, malic acid, gallic acid, lime, and much water. Furthermore, the German analysts say that the apple contains a larger percentage of phosphorus than any other fruit or vegetable. The phosphorus is admirably adapted for renewing the essential nervous matter, lecithin of the brain and spinal cord. It is, perhaps, for the same reason, rudely understood that old Scandinavian traditions represent the apple as the food of the gods, who, when they felt themselves to be growing feeble and infirm, resorted to this fruit for renewing their powers of mind and body. Also, the acids of the apple are of signal use for men of sedentary habits, whose livers are sluggish in action, those acids serving to eliminate from the body noxious matters, which, if retained, would make the brain heavy and dull, or bring about jaundice or skin eruptions and other allied troubles.
Some such an experience must have led to our custom of taking apple sauce with roast pork, rich goose, and like dishes. The malic acid of ripe apples, either raw or cooked, will neutralize any excess of chalky matter engendered by eating too much meat. It is also the fact that such rich fruits as the apple, the pear, and the plum, when taken ripe and without sugar, diminish acidity in the stomach, rather than provoke it. Their vegetable sauces and juices are converted into alkaline carbonates, which tend to counteract acidity.-N. Amer. Pract.
Roast and Baked Meats.-A writer in the Lancet says that the adoption of the closed range has to a great extent caused the abandonment of the method of roasting our meats before an open fire, and substituted therefor the process of baking in a close chamber or oven. The latter no doubt is the more convenient and economical method, but it may be questioned whether it is as wholesome. In baking the meat is, as it were, cooked in its own juices; the vapors exhaled from the warm meat are confined in the close oven and do not escape into the atmosphere, adding no doubt to both the flavor and richness of the food. At the same time the joint surrounded by this dense vapor does not yield its juices so freely as when roasted. Moreover the gravy from baked meat when cut, always yields more grease than does that from roast meat.
It is this retention of the volatile aroma and unctuous juices that render baked meat so popular, and no doubt with persons of strong stomachs it is not harmful; but when digestion is weak it is undoubtedly injurious, and, when continued, its use aggravates or causes indigestion, and in many instances very considerable benefit has resulted from the physician's advice to the patient to have his meat roasted instead of baked.
Our knowledge at present regarding the respective
digestibility of different fats is very imperfect; still the general and popular opinion is that the more oily fats are less digestible and more "bilious" than the solid, and it is these fluid fats which form the grease of cooked meats.
The author states that he does not wish to raise a
panic with regard to the useful oven, but merely suggests that baking may in some instances be the unsuspected cause of indigestion, in which case a return to the roasting jack and the open fire would prove to be a step in the direction of a rightful cure. -Med. & Surg. Rep.
Paper Money as a Carrier of Infection.
-The possibility of infection being conveyed to a large number of persons by means of paper money has often been suggested, and an examination of the notes of the Bank of Spain current in Cuba which has recently been published by Drs. Acosta and Rossi in the Cronica Médico-Quirurgico de la Habana shows that this form of currency is indeed liable to contain septic germs. The notes chosen for their experiments were some that had been in use for a good while and were such as represented values of a few pence only. It was estimated that two notes, weighing altogether about fifteen grains, contained more. than 19,000 germs of various kinds. Cultures were made in broth, gelatine and agar, and these were injected into the peritoneal cavity of rats and guinea
pigs, most of which died within twenty-four hours, the post-mortem examination showing signs of peritonitis and congestion of the liver and kidneys. The blood of the heart and peritoneum was made use of to inoculate solid media, in which colonies developed. so rapidly that it was impossible to determine their precise nature, many different forms being intermingled.-London Lancet.
Tannin in Tea.-"Some examples which have Journal," of the results of analyses for tannin and been forwarded to us," says the British Medical
theine in tea indicate considerable variations in the amount of tannin, according to the quality of the tea and the state of growth at which it is picked. In some blends of China teas the percentage of tannin extracted by infusion for thirty minutes was 7.44; theine, 3.11; and a similar result was given in the examination of the finest Moying; while, on the other hand, with fine Assam tea a percentage of 17.73 of fifteen minutes, and two blends of Assam and Ceylon tannin by weight was extracted after infusion for tea gave, respectively, 8.91 and 10.26 of tannin. On the whole, it is probable that the Indian teas are much more heavily loaded with tannin than the China and Japan teas. Moreover, the common method of
prolonged infusion in boiling water is well calculated
to extract the tannin, while it dissipates the flavor of the tea.
To be drunk reasonably, tea should not be infused for more than a minute, and with water of which the temperature does not exceed 170° F. It should be taken without sugar or milk, which would drown the flavor of the delicate and aromatic infusion thus ob
tained. This at least is how the tea is drunk both in China and Japan, whence we have borrowed the use of it. With our European method of prolonged infusion in boiling water we destroy all the best flavor of the tea, and we extract such heavy proportions of tannin as to cultivate indigestion as the result of tea
drinking. Indigestion is unknown among tea drinkers in the East, and it is in all probability only the result of defective use of the leaf."-Scientific American.
A Research on the Poisonous Nature of Mouldy Rice.-Dr. J. Sakaki, in the Sei i-kwai Medical Journal, reports the results of his study upon the action of mouldy rice. The research is particularly interesting because it has been thought by students of the disease known as kakke that mouldy rice was the cause. From the experiments which Sakaki has made upon frogs and rabbits, it would appear that the poison is capable of producing, in the case of the rabbit, dyspnea, rapid pulse, pupillary dilatation, and paralysis, the animal dying in convulsions in from three hours to forty-five minutes. In
Indications for Colon or Rectal Irrigation in Dysentery.-In all cases of so-called catarrhal dysentery, where the stools are small, contain blood and mucus and in all cases, mild or severe, where the general or local symptoms are relieved by washing the rectum, no attempt need be made to do more than this. For even when the disease extends into the sigmoid flexure and colon, the curative influence is transmitted along the bowel-wall upward, as gargling the throat benefits laryngeal inflammation. If the patient continues to have fever, delirium, great restlessness or other symptoms of general infection, or if stools are large, thin, with a gangrenous odor, containing blood, mucus, and tissue-like shreds, then the attempt should be made to make the tube pass in the sigmoid for higher injection. If the patient is on his left side, with hips raised, a gentle current may pass from a raised fountain syringe into the colon, even if the point of the tube has not passed beyond the first curve of the "flexure." I need not add that there is a danger of perforating an ulcer, even with out much force being used, so that the operation should be done with the greatest gentleness. In the great majority of cases of dysentery as we see it, rectal irrigation may, I hope, by continuing experience be proved to be all that we need to gain the desired end. The quantity of water used depends upon the circumstances of each case; as a rule it should pass in and out of the bowel until it runs clear, and both in the case of the colon and rectum the amount thrown in should be equalled or almost equalled by the amount which escapes; if the egress is not free the operation must be stopped until the trouble is remedied. There need be no limit to the quantity of
The frequency of irrigation is to be regulated by the number of stools, state of decomposition in the bowel, and other conditions; a good rule is to try to prevent the patient from having any stools at all; let his bowel be emptied only at your command through the inserted tube; at first once in three hours, later three times daily, as the outflowing fluid contains less blood and has less odor. Keep the rectum empty and clean, is the one rule.
At first wash the bowel once in three hours; later three times daily, and so on with diminishing frequency as there are less odor, less blood and finally less mucus. When mucus is no longer seen in the form of thin flakes the patient may be said to be well;
but for a few days one daily irrigation serves a good purpose. Relapses should at once be met by a return to local treatment.
As an irrigating fluid water may be used plain, hot or cold, or may contain in solution any of the numerous antiseptics. Extreme cold or very hot water may be injected, but both must have a more or less irritating effect, and their action, in the nature of things, is intermittent.-DR. JOHNSTON, Am. Jour. Med. Sc., Aug., 1892.
Salt-Water Enemata in Hæmorrhage. -Dr. R. F. Gill, of London, regards these as a very good substitute for intravenous injection of saltwater in cases of grave hæmorrhage. In 1888 he published an account of a patient who was apparently dying from post-partum hæmorrhage, but who, he firmly believed, owed her life to the enemata, the immediate effects of which were striking. Since then the author has repeatedly seen the method used in cases of large losses of blood at the University College Hospital; he considers it particularly valuable to the medical man attending midwifery cases, because so few practitioners carry the necessary apparatus for venous transfusion, and because it is extremely difficult when the patient is throwing herself about (and perhaps losing blood all the time) and one is singlehanded, to perform the latter delicate operation; whereas the enema can be prepared by the nurse, while we control the uterus, the injection being made without relaxing our attention to the fons et origo of the mischief. Small injections (4-6 fl. oz.) are preferred by the writer, inasmuch as no risk is run. of exciting the bowel to expel its contents; the injections are repeated every fifteen minutes until the patient can retain liquids given per os, when both means may be continued as long as necessary.-The Lancet.
The Medicinal Value of a Tried American Remedy.-Among the few modern synthetic chemicals, which may justly be termed true derivatives of the cold-tar series, antikamnia is intensifying its hold upon the confidence of the profession, so that now, as the statistics will show, it is prescribed in excess of any of the preparations of this class.
That this faith is justified in practice, is evidenced by its unfailing remedial properties in rheumatism, sciatica, neuralgia, the pyrexia superinduced by sunstroke, hemicrania and la grippe (influenza and dengue); also all neuroses due to irregularities of menstruation. In antikamnia these properties are more speedily, more safely and more efficiently manifested than in any of the others.
Antikamnia is a true derivative from organic substances, and its widespread adoption by the profession has made it the basis of a market for the imitators. After all "imitation is the sincerest flattery."
Dietetic and Hygienic Gazette
A MONTHLY JOURNAL OF PHYSIOLOGICAL MEDICINE.
NEW YORK, DECEMBER, 1892.
Contributions and Selections.
DIET OF CHILDREN FROM TIME OF WEANING TILL END OF SECOND OR THIRD YEAR.
BY H. T. MACHELL, M.D., Lecturer on Obstetrics in Woman's Medical College; Surgeon to St. John's Hospital for Women.
Mr. President and Members: The proper food for babies just after weaning, and young children up to two or three years of age, is not a subject about which the general practitioner ever gives much thought. Indeed, he is not often consulted in regard to the subject. More frequently the grandmother or some elderly nurse suggests that the child should be fed on this and that or the other thing, and it is given. Probably more frequently still the child gets a little of everything at the table, neither father nor mother thinking that little children should not have the same diet as themselves. Frequently the parents food is coarse and badly cooked, and when that is the case the baby must necessarily suffer accordingly. When one considers that the greater proportion of ailments among young children is due to digestive disturbances, and by far the largest number of these cases to improper feeding, I feel that I need no apology for bringing before this society a subject which may, at first thought, appear to be insignificant.
The time of weaning cannot be the same for all infants. The majority of authorities agree that it should take place between twelve and eighteen months. It should never occur before one year except for some grave reason, and not then if that time happens to come during the latter part of the spring or at any time during the summer. We know that digestion is carried on with much more difficulty during the hot weather--that the system is then less able to resist the entrance of certain micro-organisms into the alimentary canal and their multiplication there.
An effort should always be made to have the weaning take place a sufficiently long time before the hot weather, to enable the baby to get accustomed to the new food, whatever it may be. To allow a baby to be weaned deliberately during the summer months is almost criminal; it means that the baby has to run the gamut of all the intestinal diseases, and that, if it does survive, it will have received such a shock that it will take months, or possibly years to recover properly. The second summer is always a serious one for children. The laity have come to recognize this. The mother, if she be a wise one, will have accustomed her baby to take food out of a spoon or cup or bottle before weaning entirely; or she may have fed the baby during the day, reserving the breastmilk for the night time. By doing this the baby will have got accustomed to taking its food out of a spoon or cup, and thus one of the earliest lessons in feeding will have been learned.
Having weaned her baby at about a year old, what is the mother to feed him on? If, for any serious reason, the weaning has occurred during the summer months, the baby should be confined to a milk diet (by milk I mean cow's milk as ordinarily obtained in cities). If he thrive, it is advisable to continue with it alone till the eighteenth month at least. Many children will take nothing else than milk up to two or three years, and, provided enough be taken, no fear of their nutrition need be entertained. If a child thrive on milk, he is never to be forced to take additional food merely because a certain age has been reached; let the healthy appetite be the guide.
You have all seen "one cow's milk" advertised, and must have noticed it painted in large letters on the sides of the milk wagons going about the city. Do not allow your patients to be deluded with the idea that they are getting "one cow's milk "—even if they are paying an additional price for it. They are not likely to do so if the dealer has more than one cow. Some years ago I recollect a patient on Augusta avenue telling me, at one of my visits, that they had