« ForrigeFortsæt »
diseased conditions in which the oil is serviceable is a long one, and includes consumption, scrofula, chronic dysentery, chlorosis, rickets, skin diseases, rheumatism, chronic bronchitis, epilepsy, and so forth. Persons with these diseases, and with wasting diseases generally, require a fatty diet. For growing children a diet comprising fat is essential. If they do not get it their muscles grow flabby and their skin loses its firmness.
It is interesting to know that cod-liver oil differs from other fats in that it contains various biliary principles which, of course, are derived from its source, the liver of the cod. But it also contains traces of iodine, bromine, phosphorus, sulphuric and phosphoric acids, lime, magnesia, soda, and iron.
The objection generally advanced against the use of cod-liver oil is its nauseous taste. This has been removed by the art of the pharmacist and chemist, who have succceeded in making the oil palatable and even pleasant. This is not all that has been done, however, by these experts. By artificially emulsionizing the oil-e. e., by imitating nature's operation in the digestive processes—they have produced a preparation that is very easily digested and assimilated, even by the most delicate stomachs. Nor is this all. By combining the oil with the hypophosphites of lime and soda they add greatly to its value as a constructive food.
Exactly how these hypophosphites act when taken in the system we do not know, but we do know that they prevent waste of tissues, and that they promote what we call constructive tissue metamorphosis. This effect makes a given amount of food do a maximum amount of work. The best emulsion of cod-liver oil is, in my opinion, that prepared by Scott & Bowne, and known as Scott's Emulsion. This preparation I have found to be a carefully prepared emulsion of the best oil, combined with the hypophosphites of lime and soda. The dose for an infant should at first be very small, say from a quarter to half a teaspoonful after feeding, for a babe of three to six months, and not given oftener than four times daily. Gradually this amount may be increased until the child takes a half teaspoonful six times in twenty-four hours.
The effect of the oil on the bowels should be carefully noted and the dose regulated by the number of movements, their character, and the amount of oil contained in them.-Cyrus Edson, M.D., in the Doctor of Hygiene.
NEURALGIA.—A most interesting study, even from a practical or therapeutical stand-point, is that of the true seat of neuralgic pain. The entire subject can be reduced to a single question. Is the pain of the different forms of neuralgia really originated at the very spots at which the patients complain of it, or is it simply felt at those spots as though it arose there, in the same way, for instance, as patients who have undergone amputation of a limb, still complain of pain in the stump although the limb, which was the seat and sole cause of their snffering, has been removed?
The former hypothesis seems probable a priori, and has given rise to the so-called peripheral theory of neuralgia ; but a number of neuropathologists, and among them some very eminent men, defend what is known as the central theory of such suffer. ing. Although there can be no doubt that the latter theory is not applicable to all cases, still it accounts for the greater number of them, and is based on arguments that are well fitted to carry conviction, and of which the principal ones are the following:
When a nerve has been completely severed, as is sometimes done in cases of neuralgia that defy all treatment, it is not un. common to find the pain going on unchanged after the operation; it could not, therefore, have had a peripheral origin.
Just as no one disputes nowadays the existence of nutritive disorders in hysteria, in the same way no one can deny that in certain forms of neuralgia, without neuritis, the same kind of disorders may arise. Now, is not the most rational
way of explaining these disorders that of granting the central theory of neuralgia? Under these circumstances it is easy to see that the morbid irritation extends from the original nucleus of the diseased nerve to the original nuclei of the neighboring nerves, which will manifest their implication by creating nutritive disorders loco dolenti.
Inthe third place, a number of diatheses, and certain altered conditions of the blood, give rise to neuralgic pains, unless we admit that the spine is affected primarily, how can we understand why these diatheses and modifications of the blood should affect one nerve more than another, and, in some cases, only a few centimetres, or even millimetres, of a given nerve ?
Fourthly, it is known that neuralgic pains are connected very closely in different ways with hereditary neuroses. Now, the latter are undoubtedly localized in the nervous centers; how, therefore, could their effects be other than central ?
The theory of the central seat of neuralgic pains explains (and is the only theory that does so) the way in which such pains jump from one spot to another, alternate from one side to the other, and pass rapidly from this nerve to the next. We know how near to each other in the spinal cord are the original threads of the different nerves, and can consequently understand with readiness how the painful irritation of one nerve can extend with the greatest ease to its neighbor in the spinal cord.
After all, the daily practice of medicine supplies the central theory of neuralgic pains with a decisive argument.
It is a matter of common occurrence that of neuralgia of the trigeminal, sciatic, or superficial nerves, that have stubbornly resisted the action of the various local anesthetics and different forms of counter-irritation, disappear as if by magic after only a few days' use of bromidia. This extraordinary result is readily explained by the well-known physiological effects of the active elements of bromidia. Purified brom. potass. and chloral, cannabis indica, and hyoscyamus; for it must be remembered that they act on the cerebro-spinal centers. Therefore, in the great majority of cases, neuralgic pains have a central origin; and in this is once more verified the truth of the old Hippocratic axiom, “Naturam morborum ostendunt curationes,” by the use of a preparation that is now so well known as to no longer require any praise—bromidia.—Dr. Dujardin-Beaumetz, in Bulletin General de Therapeutique, Paris, Feb. 28.
THE PRESENT POSITION OF GALL-BLADDER SURGERY.Czerny, after a general consideration of gall bladder surgery, presents the folļowing conclusions ;
1. Gall-stones require operation, if they cause frequentlyrepeated or lasting trouble.
2. Empyema of the gall-bladder imperatively demands operation, as does hydrops, if it gives serious trouble.
3. The typical operation for gall-stones consists in incision, removal of the stones, and suture of the gall-bladder; in this, however, the abdominal wound should be drained for a short time.
4. If the cystic duct is closed, if the gall-bladder is the seat of inflammation, or the contents are greatly altered, then a tem. porary gall bladder fistula must be made.
5. Extirpation of the gall-bladder is indicated only in cases of severe inflammatory carcinomatous involvement.
6. When the ductus choledochus is closed, the operation is absolutely indicated, if the strength of the patient will permit. If one does not succeed in removing the stone or obstruction, then it is recommended to produce a fistula between the gallbladder and the duodenum.
7. The best incision for gall-bladder operations is an 1-shaped cut; the vertical limb lies in the linea alba, and the horizontal part runs toward the right, just below the level of the umbilicus.
8. The danger to life of gall-stone operations will be probably less than in operations for vesical calculus.—Epitome of Medicine.
CIRCUMSCRIBING ERYSIPELAS.—A short while since I was called to see an aged lady with facial erysipelas. The pose, cheeks, and eyelids were red, turgid, and painful; the temperature was 103° and pulse 120. She was somewhat delirious; the initiatory symptom was a cold stage.
This lady had an attack of erysipelas in New York some years ago, which confined her for a number of weeks, and her life was at the time despaired of. Later she had a similar seizure at one of the Virginia springs.
In the recent attack I applied a strip of adhesive plaster onethird of an inch wide across the forehead, two other similar strips from the extremities of the forehead strip, extending across the temples downward to a point below the angle of the lower jaw. I covered the strip well with aristolized collodion. I did not apply the strip across the neck, as I have never seen erysipelas of the face and scalp cross the neck. Within this “pen” of plaster and collodion I applied frequently mentholated alcohol, thirty grains to two ounces. I gave nourishment, wine and citrate of iron and quinine. The fever gradually subsided, and on the fifth day the disease had terminated. The inflammation extended to the collodionized plaster, but did not cross it. Devices somewhat analogous to the preceding have been suggested and carried into practice by Fraske and others, but the agencies used were different from those described and carried into practical use by myself in the above presented case.
Since the above case occurred another has fallen under my observation and treatment. Mr. C—-, a former representative in the Legislature, suffered from an attack of facial erysipelas while in attendance on that body, and was treated by my friend, Dr. Wooten. I treated him in his last (recent) attack, which, so far as location of the disease was concerned, was analogous to that of the lady above mentioned, and I adopted practically the same line of treatment as in that case, using mentholated alcohol as the local treatment. Later in the disease, upon the appearance of blebs upon the eyebrows and cheeks, I substituted thirty per cent. ichthyol ointment for the mentholated alcohol. In the last case, as in the first, the disease extended to the plaster, but did not appear beyond it. In six days the patient recovered and resumed the duties of his profession.
Recent observations, which have determined that the microorganisms of erysipelas are conveyed through the lymphatics, perhaps furnish us with the rationale of the treatment suggested. -E. J. Beall, M. D., of Ft. Worth, Tex., in N. Y. Med. Record.
ACETANILIDE POISONING has been relieved, in a case in which three drachms were taken with suicidal intent, by hypodermics of ether and the practice of lavage. After several hours the cyanosis gradually disappeared.—N. Y. Medical Record.
THE KIDNEYS are of first importance in contemplated surgical operation. If the patient has got Bright's disease, he will have