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eral allowed to remain in the bladder but a few minutes and then washed out with tepid water. I have recently had under treatment a very obstinate case of hæmorrhage from the womb, which was materially benefited by the injection of several ounces of a solution containing the muriated tincture of iron in the proportion of one to ten of water. It would be well after the astringent solution has passed away to inject an ounce or more of water containing one grain of sulphate of morphia to the ounce into the bladder, to tranquillize the organ, which in my opinion will compensate the surgeon well for all his trouble, and relieve the patient of her suffering, though it may not cure her.
PERISCOPE. Treatment of Croup.
At a meeting of the New York Medical Society, Dr. Jacobi remarked, that the remedies recommended for croup are as numerous as those against any known disease. From this alone we might infer how little reliance is to be placed upon any of them. The less curable any malady, the greater the number of remedies. The reason why so many different remedies have been extolled for his affection is to be found in the number of different morbid conditions which have been included under the term croup. Of this disease there are many different forms, ranging from simple catarrhal in. flammation to the very fatal membranous form occurring in diptheria. Each of these different forms will require a somewliat different mode of treatment. They all, however, have one symptom in common-some obstruction to the
passage of air through the larynx. The use of emetics he has seen attended with beneficial results in a certain number of cases, more particularly of the catarrhal form. Also in some cases of the same kind in which fibrinons deposits have taken place, they seem to be serviceable by equalizing the circulation and diminishing the swelling of the mucous membrane and vocal cords. But in cases of croup occurring in diphtheria, with the constitutional disturbance which exists in that affection, emetics are only productive of mischief. Possibly, even in these cases, they may be resorted to remove a
membrane already detatched or loose, but only when the evidences of such detatchment are unmistakable, for the results of post-mortem examination show how closely adherent these membranes commonly are, and how little we can hope to detach them by emesis. As to the choice of emetics, he would prefer sulphate of zinc or of copper. Tartar emetic is too prone to produce troublesome or even dangerous diarrhoea. The continued use of sulphate of copper in small doses after its first emetic action, though recently again recommended by high authority, has never in his experience been attended with any beneficial results. Muriate of ammonia is not deserving the ecomiums that have been lavished upon it. Although it may be, and probably is, serviceable in liqnefying the secretions, and thus favoring their expectoration in cases of catarrhal inflammations of the air-passages generally, yet in true croup it is probably of no service whatever. In Germany it is a remedy so common in use, that when a physician is at a loss what to prescribe, it generally presents itself as the most innocent medicament that he can resort to, and this circumstance perhaps best indicates its real value. The chlorate of potassa, or its equivalent, the chorate of soda, he frequently gives, partly because he must give something, and partly because of its general antistomatic properties. It is generally serviceable in most inflammatory affections of the mouth and throat, and helps to sustain the strength of the patient. Mercurials are probably worse than useless. He never resorts to them. Respecting inhalations, and topical applications of heat and cold, we must remember that we are dealing with a local inflammation in which there is a dilatation of the vessels, and a constant formation of new cells taking place, and we must therefore guard against the use of any measures that may tend in any way to increase or favor this morbid condition. Warmth, therefore, should be avoided as tending to promote dilatations and cell-formation, and cold should be preferred. The constant application of ice to the larynx may be productive of much benefit in a certain number of cases. The inhalation of warm vapor does not appear reasonable or likely to be of any service. There is already too little air entering the lungs, and saturating the atmosphere with moisture must lessen even this little.
The application of nitrate of silver to the false membrane, although at one time much used by him, he does not consid er to be of any service. Under any plan of treatment the mortality in croup is very great, rising as high as ninety or
even ninety-five per centin severe epidemics, and seldom if ever falling below seventy per cent. Since then so large a proportion of cases are inevitably fatal under any of the plans of treatment that have been proposed, we should look with great favor on any procedure which promised to save even a small per centage of the cases that would otherwise certainly die. Such a procedure we find in tracheotomy, which, although commonly resorted to only in articulo mortis, has yet saved more lives thau all other methods of treatment combined. From a number of statistics cited by Dr. Jacobi it appears that even in very bad cases tracheotomy is successful in about twenty per cent., and when resorted to in the earlier stages the percentage of successful cases rises as high as from twenty-seven to forty-five per cent. in his own practice he had sared thirteen out of sixty.
Di. Krackowizer had operated probably sonie sixty times, with about the same percentage.
Dr. K'rackowizer's Statistics.-Operations of tracheotomy for crour, 56; deaths, 40; recoveries, 16; total, 56.
Causes of Death.- Asphyxia during operation, 1; granulations from cicatrix, 1; exhaustion and pulmonary edema, 4; infeetious diphtheria, 3 ; scarlatina, 1; descending croup and bronchitis, 30; total, 40.
Dr: Voss had operated about fifty times; the percentage of, his earlier cases being even much larger than this.
These results should leave no doubt as to the very great value of this operation, the only indication necessary for its use being obstruction of an inflammatory character in the larynx, threatening death. Scarcely any condition contraindicates it, not even the presence of pneumonia. As to the objection that it is useless when the membrane extends below the larynx'into the trachea and larger bronchi, he would only state that we have no means of determining the presence of false membrane below the larynx, and ought not to be deterred from the operation by a mere conjecture.American Journal of Obstetrics.
The Medical Record of this city says that the avidity of the educated classes in seizing upon scientific facts is such that they are willing to listen to the vilest pretenders who foist upon otherwise sound understandings all sorts of special practices and quack nostrums, but it confesses they are not to blame, for the medical faculty has refused to impart the
proper knowledge. It says, also, that medical men have been 80 atcustomed to treasure up their legends, and to hand down their watchwords, as to be oblivious of the changes wrought around them. In every other department of science, the public have been educated to discriminate between true and false doctrines; but in regard to medicine, the faculty stands in the same relation to the people that it did a hundred years ago. It is urged, therefore, that the people should be educated in the general principles sufficient to enable them to judge between true science and quackery, and this notwithstanding it has been said that “ a little learning is a dangerous thing," for it is conceded in these days that true knowledge, upon all subjects, must be good ; nor need it be feared that persons so enlightened will depend upon themselves, and not call upon physicians when ill. A case is mentioned of a
. French blacksmith, who showed such aptitude for surgery that means were supplied for his education, but when he discovered how many bloodvessels and other organs are contained in the human structure, he became frightened at his temerity, and returned to his anvil. The best way to begin the reform, according to our authority, is by having physiology, elementary anatomy, and hygiene, become a part of the regular study in our schools and academies; and, in addition, and by a more direct way, through the popular lecture system. If this should be properly done, “there need be no fear that the dignity of our calling will be compromised!” Already has this course been adopted in a few schools with great success, and it is noted that where college students in their undergraduate course have received medical instruction they have not only attained practical knowledge “ in regard to the preservation of the health of the body and mind, but they have become rationally convinced of the utter absurdity of all exclusive systems, and of infinitesimal dilutions.”
To all this we agree, and we hope the proposed plan will be put in execution throughout the length and breadth of our land. In addition to the advantages named, it is to be hoped that people will learn enough to decide when a doctor is needed, and whether he is fit to be sent for at all. Whether, again, an educated man may undertake to prescribe for him self, after having acquired some medical knowledge, the same as he may pettifog a case before a Justice of the Peace, or partake in the exercise of a week-day prayer meeting, will probably depend upon circumstances, but at present this subject had better not be discussed. Perhaps the fling at “infinitesimal dilutious" is a little ungenerons on the part of those who formerly carried ponderous saddle-bags, but who now instead carry a small case in the vest pocket, and who formerly iet out with the lancet rivers of blood, but who now think no practice so injurious. However, we all live to learn, and we are glad to be told that the common people should no longer remain in ignorance.-N. Y. Tribune.
The mixture known among the Koraks as Manyalla is eaten by all the Siberian tribes, as a substitute for bread, and as the nearest approximation which native ingenuity can make to the staff of life, in a country where no grain ean grow. It is also valued as much or more for its medicinal virtues as for its own intrinsic excellence and tastiness. Its original elements are clotted blood, grease, and the half digested inoss which is found in the stomach of the reindeer, where it is supposed to have undergone some essential change which fits it for human consumption, health, and happiness. These curious ingredients are boiled up together with a few handfuls of dried grapes, to give the mixture consistency, the dark mass is tlien moulded into small loaves, which are frozen for future use.- Putnam's Magazine.Medical Gazette.
New Diagnostic Sign of Phthisis.
Upwards of twenty years ago Schroeder van der Kolk discovered that the sputa of persons affected with phthisis, frequently contained particles of living tissue. Sometime afterwards, Dr. Andrew Clark noticed the same fact. They both adopted a very tedious and uncertain mode of examination. The expectoration was poured out on a flat surface, and particles that seemed to contain elastic lung fibre were picked out with needles and placed beneath the microscope. Considerable care and experience were required for such procedures, and the examiner could never be quite certain that some portions of the lung structures had not been overlooked. Quite lately, Dr. Samuel Fenwick hit upon the idea of liqnefying the mucus of the expectorated matter by boiling the sputa with soda, from which the particles of elastic fibre of the lung will always be precipitated.
The recognition of tiie various tissue elements is a sim