Plate No. 7. Gentlemen, this is a case which brings out a point in general medicine which it is well for us to constantly bear in mind. This represents the case of Mrs. S., age twenty-seven, who came to me from Macon. When seventeen years old, had a protracted spell of typhoid fever. During the two months following her recovery she grew ten inches in height, was pale and anemic, and entire system was in a run-down condition. Being a young lady of fashion, she was put into corsets at once. Three months after her recovery, she menstruated for the first time after her illness. For two days prior, and all during its course, she suffered intense pain, bearing down in character. This dysmenorrhea continued, gradually increasing. Appetite became capricious, bowels constipated, and the long line of symptoms mentioned in the first of this paper developed. At twenty-two she married, after which all symptoms became worse until she became what I term a sofa invalid. In this condition she was treated by several physicians in Macon, one in Baltimore, and one in New York. Then she came into my hands, and the results attained by us all so far are not at all flattering. Her condition now is as follows: The uterine syndrome is complete; abdomen, hyperesthetic; anteflexion of body of cervix with retro-position and dextro-rotation; bladder irritable; no cystitis; ovaries and tubes exquisitely tender and slightly enlarged. In the last year has developed amenorrheas but at each period, though flow consists only of about one drachm of bloody mucus, she suffers with a burning, boring pain in uterus, shooting pains and intense headaches. These headaches are more or less continuous during the entire menstrual period. I have both packed and dilated the uterus, and tried to use supports of every conceivable kind, but she can tolerate none of them. Cotton wool even gives pain. The second flexion is so high that cervical amputation or incision would be of no avail, and ovariotomy is my last resort, which I will perform on my return to Columbus. The great point of interest in this case is a warning to us all to admonish our patients, convalescing from weakening or wasting diseases, or any condition diminishing muscular tone, to avoid corsets and heavy clothing suspended from the waist. Instead of the corset use the corset-waist. In this case we see the dire results from a disregard of the existing conditions. (Concluded.) HEMORRHAGIC FEVER. By O. B. BUSH, M. D., Hemorrhagic fever is one of the most fatal fevers that we have to contend with, being next in fatality to yellow fever. There are but few physicians that know how to treat this dreadful malady. This being the case and thinking that a short article. on the subject will be of interest, I will endeavor to discuss briefly its etiology, diagnosis, prognosis and treatment. Etiology.-Hemorrhagic fever is not infrequently a sequel of a severe attack of bilious fever, and it is frequently caused from mercury, the patient having an idiosyncrasy for mercury (calomel), which is necessary in every case of bilious fever; but generally speaking, hemorrhagic fever is caused from a specific germ, the name of which is known as malaria or miasma, which is inhaled from the low, marshy places with which this country (Southwest Georgia) abounds. It (malaria) is also taken into the system through drinking water which some people (generally of the lower class) use, being compelled, on account of wells drying up, to get water from a creek or pond. This germ is carried into the stomach, and from there to the, kidneys and all over and through the general system, thereby causing hemorrhage of the kidneys. Diagnosis and Symptoms.-There is a loss of appetite, a furred tongue, the fur being of a whitish yellow, the bowels constipated, some pain may occur in the region of the stomach; there is considerable nausea and some vomiting, the color of the vomit being of a yellow color containing bile pigment. The liver is somewhat enlarged and tender. The skin takes on an icteroid appearance, the sclerotic becomes yellow, the temperature ranges from 103° to 105°, the head sometimes aches and vertigo may probably occur; the spirit is depressed (from the knowledge of the patient of the fatality of this fever). The urine is almost entirely blood, the pulse runs from 120 to 140 to the minute. If the hemorrhage from the kidneys is not arrested in two or three days there will be complete exhaustion and emaciation. Prognosis. The mortality rate does not differ radically in the different epidemics that occur as does the mortality of yellow fever. The death rate in this fever is about two out of every three, or about sixty-six per cent.; this occurs not because the disease is so fatal within itself, but because it is made so on account of the ignorance of the attending physician, as will be seen in the treatment. The average duration is from five days to two weeks. If you can hold your patient up from six to thirty-six hours, as the case may be, after the first hemorrhage, the prognosis is generally favorable; the most favorable signs are a decrease in temperature, a quiet stomach and a diminution in the amount and frequency of the hemorrhages. But when the temperature is high and uncontrollable, the stomach nauseated and black vomit sets up, and the amount and frequency of the hemorrhages (which is very often from one quart to one-half gallon every fifteen, twenty or thirty minutes) increase the prognosis is very unfavorable. You had better withhold a prognosis until you can give a positive one. Treatment. There is no need of prophylaxis being used here, as this fever is caused solely from malaria, thought it is recommended by some of the authors. The treatment depends a great deal upon the condition and stage you find your patient in upon arrival. If the hemorrhage has not already set up, and the fever is very high (which is very sure to be the case, as you are not likely to be called until the cold stage has passed), the remedies needed are nitre and paregoric and viratrum (fever drops); this being given to run the fever down and to stay the heart's action to some extent. The natural inclination would be to give mercury, but not so; give nothing to devitalize the patient, as the hemorrhage might set up and, of course, it would be worse than if you had not given the mercury, because both (the calomel and hemorrhage) are very devitalizing. But if the hemorrhage has already set up when you get there, the first thing to be done is to check the hemorrhage if possible. To do this the best remedies to use are laudanum, buchu, nitre and tannic acid combined and given every two hours until hemorrhage ceases. In the meantime use, or if in use continue its use, the febrifuge to control the fever. Give stimulants to keep your patient stimulated, and nourishments to sustain your patient. If vomiting or nausea occurs give oneeighth of a drop of carbolic acid every half or every hour (as indicated) until nausea ceases. Now, the question naturally arises, what are you going to do to get rid of the cause of this trouble (malaria)? Give a solution of nitro-muriatic acid every four hours; that will answer all purposes until the patient can sufficiently recover to allow a tonic, then put him on a tonic of iron (mur. tr.), quinine and rhubarb. Authors of ancient times recommended, and do yet, bloodletting, but it is not only wrong in theory but decidedly wrong in practice. If constipation occurs give a mild cathartic, oil or salts; or if, on the other hand, they become troublesome, diarrhea sets up, give pill of opium and bismuth. Give no calomel, as it will certainly do no good, besides will do the greatest of harm-kill the patient. THE LOCAL TREATMENT OF PSORIASIS.* BY R. C. LONGFELLOW, M. D., Psoriasis stands in the front rank of those skin diseases whose course and duration is often chronic, accompaniened by frequent relapses. This disease is one that often exhausts the medical man's storehouse of remedies, as well as his ability to keep the patient satisfied with his condition and treament prescribed. One of the obstacles to proper local treatment is the usual objection of the patient to the remedies employed, their odor, staining qualities or ointment consistence. The essayist has no lauded specifics to offer Abstract of paper read before the Dermatological Section of the American Medical Association, Milwaukee, Wis., June 7, 1893. . |