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that he will do some bodily harm to someone or that someone will be compelled to defend himself against him." "Well," said Galen to his father, "I have just come from McS.'s. I found him suffering from acute delirium, for when I arrived in the house he informed me that I was not wanted, but that you, yourself, must come at once. He positively and forcibly refused my attention, but when I saw the dangerous condition he was in I proceeded to fill my hypodermic syringe, determined to quiet him at any and all hazards by giving him an injection of atropia and morphia, but to my utter surprise, when I endeavored to give him the injection, he knocked me down and, as I was held by his two neighbors, I was forcibly told that I was crazy; then I told him that I must be permitted to modify my diagnosis; that I certainly thought that he had symptoms of immortality, that even I might be an instrument to fix it so that he would never die
again, but eternally live in a world of infinity. This man is certainly delirious, hence I insist upon your going to see him, for I feel it imperative upon myself to control my anger, delirium or no delirium, for I am sad to confess to you that I have an unusually aching desire
to immortalize him."
McS. to Galen's father: "Why, my dear doctor, your son is, I am sorry to say, crazy, for no sane man would have acted as he did. Why, no matter what I said, he still continued to gaze at me with the fixed gaze of a lunatic; I told him that I was not sick, but that I had sent for you to see my wife, and that I only wanted you, but he insisted, with that fixed stare, which almost influenced me that I was in a dangerous condition, and he proceeded, in spite of all of our protestations, to treat me. He filled his hypodermic syringe and, with the glare of an angered tiger, came silently and insidiously toward me. I had to act and found no other way of preventing him from injuring me than by knocking him down and calling the assistance of my two neighbors who are here to help me. It was with the utmost difficulty that we got him outside, and as he stood outside he very gravely said that I had the symptoms of immortality and must surely die, even if he had to bring eternal life to me."
Galen's father to Professor L., to whom he had written for advice: "There has been, as
I can plainly see, a constant and rapid change in Galen. I have been compelled to keep him in the house and will not permit him to attend to anyone. I can see the change gradually come; he has become markedly unfeeling; he now inflicts absolute punishment and torture upon living animals. He not only treats these animals cruelly, but even seems to try to torture inanimate things. I found him out in the orchard cutting and bending down a series of small trees, so that they would bend and not stand erect, for he said that they were "rigidly and cruelly upright." Everything frets him; the movement of the leaves, the wind, the bellowing of a cow, or the neigh of a horse. He seems to be constantly fighting imaginary ills and only yesterday I saw him start up wildly, talk aloud and gesticulate toward Heaven. He is now busily engaged in trying to define various pathological conditions in insects. Again, he seems to be determinedly destructive, becoming more pessimistic than ever. Everything is coming to destruction; his always pale face seems to be more elongated and misanthrophic than ever. His fantasies and peculiarities are markedly profound. He is absolutely afraid of any pointed thing; the point of a needle seems to keep him in abeyance, but he appears to be thoroughly indifferent to the muzzle of a gun, or the mouth of a cannon. He has shown his utter indifference to danger recently on more than one occasion. has ceased to notice his mother and apparently has become cruel and vindictive against those he should love. What on earth am I to do with him?"
Galen's father, in a letter, two days later, to Professor L.: "My son left night before last without our knowing it, but told friends that he was going to a neighboring town. He wandered upon the railway tracks and was killed by being run over. I learned, in a letter from Dr. S., surgeon of the road, that according to the engineer's report, my son was walking down the track with his back toward the engine but turned when he heard the blowing of the whistle. Before the engine struck him he never seemed to quail, but defiantly shook his fist and started for the engine as though he would demolish it. After being picked up, when cruelly crushed, his only words were, "killed, killed, my God, by corporation's juggernaut."
The Columbus Medical Journal calls attention to the following editorial paragraph which recently appeared in the European edition of the New York Herald:
In addition to the sudden stoppage of a train, causing a violent shock against the partitions. of the carriage, as a cause for railway spine, recent research has unveiled the fact that long and frequent railway journeys may have the same action as railway accidents; that is to say may bring on nervous disorders very similar in character to traumatic neurosis, nervous disorders that seem worthy of being called a railway neurosis.
The article referred to further states that in one of the cases cited an engineer, fortyfive years of age, whose previous health had been good, after being on the railway for four years began to complain of hallucinations, imperfect sight, vertigo, and other symptoms of railway neurosis, which continued even after giving up his occupation.
This New York Herald medical expert writes upon a subject without having previously taken the pains to understand, and we agree with Zimmermann that certain persons "with bookish knowledge are like children
with edged-tools; they hurt themselves and put others in pain." This expert seems to have no room for reason; but newspapers frequently make both fools and folly their particular care. Here is an intangible, indefinite and inadequate cause assigned as being a disease-producing factor. Abnormal, erratic, nonsensical and utterly childish reasons given without an iota of truth. Surely no sensible person would for a moment believe, because an engineer upon a railway became insane, had epilepsy, or had progressive locomotar ataxia, that railway traveling caused it. We might as well say, that because a woman gives birth to a child upon a train, that travel caused the child. It is true, it might bring about labor, but previous undoubted factors were the causation; the birth upon the railway train was simply a coincidence. So with the manifestations of this form of railway neurosis supposed to be occasioned by overtraveling. Too many millions of people daily, weekly, monthly and yearly travel, not to have discovered before this a peculiar and marvelous form of neurosis. It is an assertion unsupported by facts. A species of erratic sorcery, having for its object the delusion of the unthinking; it rarely, if ever, convinces. Opinion may be the Czar in Russia, but in this country it may represent all stages of mental thought and only of necessity has force in proportion to its merit and common sense. The idea of a traveling neurosis is a product of idiocy, which does not take into consideration hereditary hereditary or acquired conditions and our multiplex surroundings.
in a sociological way. One speaker claimed that France was being "depopulated by egoism." Here is, indeed, a sufficient and potent cause, if extended enough; for egoism, if profoundly acting in each individual person of a nation, certainly tends in the direction of individual gratification, and hence, naturally leads to ease and comfort and never to self-denial; its domain is only selfish. Egoism is more likely to develop depravity than exalted patriotism by the referring of all claims to one's self. And this judgment of all interest upon the narrow plain of self, if preponderating in a sufficient number of individuals composing a nation, would be a cause powerful enough in itself not only to depopulate a nation, but to bring about disintegration and decay as well. There can be no denying the fact that egoism is not only an absolute blemish to character, but of education as well, and undoubted proof of an undeveloped, stunted and vitiated morality, whose every step is a complete abbrogation of a nation's prosperity, as too exalted egoism can only lead to loss of patriotism.
For, if self only is considered, it is perfectly natural to infer that the time will inevitably and surely come when the nation, as a nation, will be lost sight of and swallowed up in the all-powerful and paramount consideration of self. Still another speaker claimed that the cause of the depopulation of France resulted from over-taxation, that large families were taxted too heavily, hence the people naturally preferred small families or no children at all. Still another speaker claimed that the question was one in which personal habits cut a more potent and extended figure than laws did. Finally, one speaker claimed that women play an important role in the population question. Certainly no one can doubt that this latter proposition is forcibly and pre-eminently the fact, for women do, indeed, influence, in more ways than one, the question of population. Emerson said: "A sufficient measure of civilization is the influence of good women." And it can be as truly said that the measure holds equally good and true regarding good men. The self-abnegation and wonderous moral force of good women is an incalcuable power in the body politic, and is as irresistible in its actions and accomplishment as civilization itself, for its potent influences predominate in man's life from the cradle to
Is the Husband's Consent to an Operation Indispensable?
The St. Petersburg Med. Wochenschrift of April 4 is devoted to a discussion of the question whether a physician does right to yield to the husband's refusal to consent to an absolutely_necessary operation on his wife or child. Russian physicians are collecting data of cases thus sacrificed to the general custom of deferring to the will of the man of the house, on which to found an appeal to the government for an extension of the rights and duties of the attending physician. A case has just been decided in Brussels, bearing upon this point. A couple of prominent surgeons were sued by the husband of a woman who had died after an operation, unauthorized by him, or, as he claims, by his wife. The verdict was in favor of the surgeons.-Kama Medical Journal.
Life is a waste of wearisome hours,
Which seldom the rose of enjoyment adorns;
And the heart that is soonest awake to the flowers,
Is always the first to be touched by the thorns.
Extracts and Abstracts.
Compound Fracture of Thyroid Cartilage.
Dr. E. L. Bell, North Woodstock, N. H., reports the following case in a recent issue of the Medical Record: Although accidents somewhat similar to the one here recorded may not be uncommon, this case seemed to me interesting, not only on account of the complicated nature of the injury, but also on account of the uninterrupted recovery under manifestly unfavorable circumstances.
J. K., aged twenty-nine years, cattleman, while loading a vessel was gored in the throat by a steer. He was brought to the Boston Emergency hospital in an ambulance.
Examination disclosed an exceedingly large, dirty, lacerated wound, extending from the median line of the neck to the edge of the sheath of the large vessels of the neck on the right side. All the larger muscles covering the larynx and trachea were reduced to pulp, with the exception of a few remaining shreds. The two alæ of the thyroid cartilage were completely separated in the middle line. The right ala had a longitudinal fracture involving two-thirds of its surface. The crico-thyroid membrane was ruptured and the cricoid cartilage was badly bruised. The trachea was opened throughout its whole extent almost down to the sternum. The thyroid body was apparently entirely destroyed.
Hemorrhage had at first been severe, but it was easily controlled by a temporary dressing. There was a large lacerated wound under the right ear, which was immediately closed with silkworm gut.
The patient was placed in the tracheotomy position. The anesthetic used was cocaine in four per cent solution. Under strict asepsis, with the assistance of Dr. W. B. Segur, I cleansed the entire region with a weak Lichloride solution, removed the loose fragments of cartilage, trimmed the edges, fitted and fixed them in place with fine sterilized silk. The different shreds of muscles were next cleaned, patched and fastened in proper places, as were also the tracheal rings. The fascia and skin were next sutured with silk
worm gut and covered with simple antiseptic dressing.
Beyond passing reflex spasms of the glottis and some slight dyspnoea, the patient seemed to suffer no great inconvenience; but he was watched carefully for any signs of approaching adema or septic pneumonia. The temperature the day after the accident was 100° F. and remained at this point or below during the man's stay in the ward. The wound was dressed on the third day. It then exuded a little dark blood on pressure. On the fifth
day a slight discharge appeared which was found to come from a small sinus resulting from deep muscle-suture irritation. On the eighth day the external sutures were removed. Under daily dressings the discharge had seemed to lessen. On the twelfth day two silk muscle sutures sloughed out and were removed. On the sixteenth day the sinus was curetted under cocaine anesthesia. The next day there was but little discharge and in a week the wound had entirely cicatrized.
Step by step, beginning the day after the injury was received, the gradual change from almost complete aphonia to approximately perfect vocal action could be plainly marked. In fact, I am inclined to believe that if the patient's supply of stimulants during his convalescence could have been curtailed, the slight amount of huskiness present on his discharge would have been much less noticeable.
The plan of using a trachea tube and allowing the surface to close in with more or less rapidity has been suggested, but it has seemed to me that the method followed in the instance above outlined, provided the case can be watched, is much quicker and easier both for patient and surgeon.
Chipault (Rev. de Chir, February, 1896) reports three cases of successful operation on the spine. The first was one of partial compression of the cord by a fragment of bone detached from the left half of the eleventh dorsal vertebra. The chief symptoms were motor paralysis of the left lower extremity, anæsthesia of the right extremity, and loss of power of the sphincters of the bladder and rectum. On the eleventh day from the date of injury, after exposure by a long vertical incision of the lower portion of the dorsal spine, a projecting piece of bone was found, which consisted of the left lamina and a part of the left side of the body of the eleventh dorsal vertebra, which had encroached on the left half of the canal and com
pressed the corresponding portion of the cord and the nerve roots. This portion of bone was removed in fragments, the rent in the dura mater sutured, and the wound closed without drainage. The symptoms gradually disappeared after the operation, the patient was able to walk without any support at the end of the fifth month, and when last seen after an interval of two years and a half was quite free from any result of his injury save some weakness of the bladder and anus. The second case was one of extension of the fourth and fifth cervical nerve roots by a subluxation forward and to the right side of the fourth and the fifth cervical vertebra caused by a fall. The primary symptoms of weakness of all the limbs gradually subsided, but resulted in persistent motor
and sensory disturbances in the left upper limb, the muscles of the shoulder and arm being paralyzed, and the skin over the shoulder and along the outer surface of the arm and forearm very hyperæsthetic. Thirteen months after the accident the seat of injury was exposed, and the nature of the injury, which had previously been diagnosed, clearly made out. The displaced fourth cervical vertebra, which was movable and could be readily reduced, was fixed in its normal position by silver wire attaching its spine to the spines of the third and fifth vertebra. This patient also made a good recovery. At the end of the second year he was able to move his head freely from side to side, and the left upper limb had regained its normal strength, and was quite free from tenderness. The third operation was performed for the cure of very painful and persistent neuralgia of certain closely circumscribed regions of the right upper extremity. After the trial of many plans of treatment, both medical and operative, the patient was completely relieved after exposure of the cord in the cervico-dorsal region, and resection of the posterior nerve roots corresponding to the last two cervical and the first dorsal vertebra.British Medical Journal.
The Duty Line in Medical Journalism.
The following excellent paper was read by Joseph R. Clausen, A. M., M. D., managing editor of the Times and Register, before the American Medical Publishers' Association, Atlanta, Ga., May 4, 1896:
The most carefully edited journals are not, as a rule, either the most popular or the most successful.
This is a discouraging statement to make, and the sadder for being true, for true it is.
Were the reverse the rule, two powerful incentives would exist for the more careful editing of our columns-popularity and profit; but, since this is not the case, it is duty, not business enterprise, that calls for a closer editing of copy and galley proof; nor from title page the "ad" that disfigures the cover should anything escape this editorial scrutiny and revi
It is hard, at times, to do one's duty, even when the plaudits of the populace, to say naught of their shekels, will in the end reward our efforts, but for an editor to conscientiously do his duty, recognizing at the time that in the doing of it he is lessening the popularity of his paper and the size of his income, is harder still. Yet it is the unflinching performance of this duty that we urge, insisting on it not alone for duty's sake, but because concerted action in this direction would soon restore medical journalism to the high eminence from which we feel it has fallen, and the faithful performance of the duty referred to would soon receive other
and more substantial reward than virtue's own. In short, the entire situation would be changed and the best edited papers would at once be the most successful and popular.
It is high time that the duty line in medical journalism was drawn and universally recognized when, as a unit, the medical press shall say to the abuses that threaten its usefulness: "Thus far shalt thou go, and no farther." A line, too, that shall shut out the petty weaknesses that now impair its dignity and lessen its influence.
And what are these abuses, these weaknesses?
First, sensationalism-that bane of the newspaper press of to-day. Disguised, of course, in physician's garb, but none the less insidious in character, and all the more harmful in its influence.
Too great readiness to give space to the discussion of questionable theories, to the exclusion of sound, instructive argument in support of those that have been proven tenable.
A tendency to overshoot the intelligence of our readers, forgetting that we are writing to the many not the few, and that every general practitioner is not a specialist.
A disposition to, at least, passively, encourage professional "fads" simply because they are popular, instead of vigorously opposing them and mercilessly exposing them as fads.
A forgetfulness of the fact that we are, or are supposed to be, leaders of medical thought and not caterers to the perverted tastes of professional or literary epicures.
The ridiculous practice of expressing plain truths in such stilted, awe-inspiring language that the truths themselves are wholly obscured in the verbiage of words that clothe them.
A disposition to make our editorial columns subservient to the advertising pages, forgetting that even the negative endorsement of a medical journal has an influence that scarcely be calculated and may be given a publicity by the advertiser that we ourselves would be most reluctant to have it given.
And last, but by no means least, the too frequent surrender to that potent factor-a yearly contract and the acceptance of advertising that should have no place in the columns of a well-edited medical journal that respects the principles it professes to uphold.
We mean, in short, that the advertising columns should be as carefully edited as any in the paper, and that no preparation or article should be advertised that we cannot fully, intelligently and conscientiously endorse.
It is no new code of newspaper morals that we ask shall be adopted, but recognizing our high mission as the medical press of this country, that we return to first principles, those that combine honesty with common sense.— Times and Register.