Billeder på siden
PDF
ePub

creasingly employed, while the degenerate muscles are still electrized with persistence. The cessation of treatment is indicated when, for many months, the amelioration has shown no progress, either from the point of view of the voluntary movableness or from that of the electrical reactions. Summarizing the whole subject, the authors state that if the treatment is started sufficiently early and continued with method and persistence, it produces, as a rule, in the course of time a reduction of the impotence and a return, more or less remarkable, to functional power.

ELECTRICITY IN GASTRIC NEURASTHENIA.

A. Herschell recommends three forms of electrical treatment, the condensation couch, the sinusoidal current, and the constant galvanic current. The condensation couch should be given daily for several weeks, with a dosage not exceeding 350 m. a. No advantage is to be gained from the use of the enormous currents produced by some of the apparatuses, and the element of danger is not absent. Of the sinusoidal current either the triphase or the monophase will give good results, the triphase being preferably administered by electrodes. The monophase, if used, is given by means of a water bath. This latter mode, by-the-way, is an easy and convenient way of treating neurasthenia, as it can be rigged up in the patient's house and applied by himself, or with the aid of a nurse. The triphase alternating current is especially useful in that form of neurasthenia which depends upon involvement of the splanchnics and the large nerve plexuses of the abdomen. Hence it is our best remedy in cases of nervous indigestion accompanied by varying degrees of muscular atony.

Good results are obtained by the use of the constant galvanic current prop

erly applied. It is best applied by means of a large electrode to the solar plexus, the anode being placed upon the epigastrium and the kathode upon the lumbar region. The dose should be from 20 to 50 m. a. In the treatment of muco-membraneous colitis and other intestinal complications of neurasthenia, excellent results have been obtained by the use of the hydro-electric rectal douche, employing the constant galvanic current.

THERAPEUTICS OF LIGHT.

McIntosh, in the Boston Medical and Surgical Journal, concludes that light penetrates the tissues; that in so doing the chemical rays produce fluorescence of the blood and serum which is reduced or absent in pathological states, as, for example, in malaria; that the action of light upon the blood stream reduces oxyhemoglobin and thus stimulates the chemistry of the tissue, that is to say, mproves metabolism. The most useful portion of the spectrum is not the heat or luminous portion, but the chemical portion. The physiological effects of light flow easily from the marked penetration of the light rays, particularly the chemical portion of the spectrum. The blue light has a peculiar field in the control which it has over pain and hyperemia. Red light by its exclusion of the chemical rays plays an important. role in the treatment of smallpox.

CO2 SNOW TECHNIQUE AND
INDICATIONS.

Edward Pisko, in the New York Medical Journal, declares that the practical use of the snow, how to apply, how much, at what pressure, how long to freeze, etc., cannot be learned from books; it must come to one naturally, one must study each case individually and find out the nature of the lesion. In a superficial juvenile wart or in a pin-head sized ordinary nævus in an infant, from twenty-five to thirty seconds, without any

pressure whatsoever, will do. On the other hand, a destructive process, which has disfigured quite an area of the face, will sometimes need a very hard pressure for over one minute. If bleeding is produced, there is no fear, nothing can happen, and a whitish scar develops if left alone, just leave the area exposed and uncovered. If the burning sensation is very severe, lasting for a number of hours after the application of the snow, a mild solution of boric acid is to be applied ice cold, but no ointments nor powders. Besides, a bulla of various size around the orbital region and around the lips an oedema follows the day after. The patient must be told so beforehand in order not to be frightened. The author does not use any ether. He does not believe it is necessary if the snow was made hard enough by packing.

Solid carbon dioxide takes now the place of liquid air, which is quite difficult to obtain and to preserve, but we must admit that liquid air is the stronger and better agent, its freezing point being at 190° C., while carbon dioxide freezes at 90° C. Here is where the advantage of carbon dioxide comes in. It is not an ordinary cautery, it produces an inflammation, due to the freezing of the tissue,1 its action and effect can be fully controlled from a superficial erythema to a total destruction of the diseased tissue. The snow is, as a rule, used in more or less smaller areas and only where a scar as final result is wanted; nævus, hypertrophied scars, angioma, leucoplacia, Keratosis, verruca, rodent. ulcer, epithelioma, Keloid, Chloasma, tatoo marks, powder stains, dermatitis, and last but not least, lupus erythematosus. In all these we get the best cosmetic scar with a comparatively small amount of pain and skin destruction; it is "the" treatment for lupus erythematosus. Anything used heretofore was more or less undesirable for one reason or another, the destruction pertained to the entire skin and not only to the diseased tissue

and the scar could never be controlled; here we get the best cosmetic results, and what more with a few applications we can prevent the process from spreading, quite a factor for the face of a female. In cases of deep seated lupus erythematosus, as well as rodent ulcers and epitheliomata filling almost the whole of the orbital cavity much pressure must be used up to one or one and one-half minutes' duration, still the pain is very little owing to the intense cold of the carbon dioxide snow acting as a local anæsthetic.

H. F. VACUUM ELECTRIZATION.

Ermentrant, in the Physicians' Drug News, points out that the advantage of this mode over the faradic, is that there is much greater electro-motive force, and it is necessary for the patients to remove but very little clothing. This is a decided advantage where you have many patients to treat, and especially some timid ones who would not disrobe for a treatment by the general faradization or galvanization. These will not hesitate to take the high frequency vacuum electrization, which will penetrate medium weight clothing, without discomfort. This mode has very high potential, small capacity, and enormous frequency of oscillation. Nerves and muscles are acted upon in the same manner as by an application of faradization, but in a much more effectual and less painful manner. The muscles will react to this mode, when not the slightest reaction can be obtained with the strongest faradization. This mode may be used by means of special vacuum electrodes, viz. :-surface vaginal, rectal, ear, throat, and nasal tubes, but when the application is made to such sensitive parts, the negative pole should always be grounded, by means of a conducting cord, the end of which rests on the floor three freet from the patient. In giving these treatments with the high frequency electrodes, the hands should be kept as far as possible from the contacts of the vacuum tubes.

[blocks in formation]

SOME DOCTORS OF
OF FICTION.

BY GEORGE THOMAS PALMER, M. D.

[blocks in formation]

THE

HE other doctors whom we have met in these little journeys of ours together, we have come upon quite incidentally. They were minor characters, quite outshadowed by others greater and more distinguished with whom they were associated. Fielding would not have called a surgeon, had he not needed him to patch the head of that unfortunate hero, Tom Jones, although Fielding has been known to introduce a doctor into his narratives for no other purpose than to show his unreasoning antipathy to the medical profession*. LeSage gave us Sangrado merely as the praeceptor of the greater Gil Blas, and when Gil Blas abandoned the art of healing, Sangrado was lost in oblivion. Bob Sawyer and his fellows and the fiery Dr. Slammer are shown to us merely as members of the hosts of persons worshipping at the shrine of the immortal Pickwick and even the distinguished Dr. Parker Peps would be quite unknown to us had he not been employed in delivering into the world the son of the haughty house of Dombey.

But the good Monsieur Benassis comes before us in his own right, standing in the dignity of a book and a province of his own, immortalized and placed in his exalted position by the "greatest writer of the post-Revolutionary literature of France, in "Le Medecin de Campagne"-"The Country Doctor." In fact, as we close the scarlet covers of this unusual book, we feel that we have not read a novel, but rather a masterly sketch written for no other purpose than to tell us of the country doctor and his remarkable life and work. It hardly seems like fiction at all. It is more a work of biography, as Honore de Balzac would write biography.

It was Balzac's ambition, "by infinite patience," to picture exactly the people of his own day, and he has pictured Benassis with minuteness of detail which would be wearying were it not strangely interesting. The scenes, with all their beauty, were created merely as backgrounds for Benassis; the characters merely as his associates or as subjects for his conversation.

As Commandant Genestas rode into the little mountain village in which Benassis had made his secluded home, after the tragedies of his early life, he held a brief interview with a poverty-stricken woman which gives us the key-note of the character of "the country doctor."

"Is M. Benassis a clever doctor?' he had asked, and this unfortunate had answered: 'I do not know, sir; but he cures poor people for nothing.""

It has occurred to me many times, that when we make charity methodical and systematic, we may increase its efficiency, but we rob it of most of its beauty. Bounty and generosity seem inconsistent with rules and figures, perhaps because rules and figures contemplate giving to each man his exact deserts; while charity of the beautiful kind, overflows with blessings for all, regardless of right or merit. But Balzac follows an established rule when he makes the country doctor-him who is * In "Amelia", Fielding interpolates a chapter, which has not the slightest bearing on the story-a chapter which some of the editors have omitted, contending that it serves no purpose other than reflecting the author's dislike for doctors.

beloved by all who know him for his goodness and generosity-utterly careless as to the details of his household, his clothing, his money or his personal affairs. His gate is in need of paint, sags on its hinges and is left wide open; his domestic affairs are ruled absolutely by a hired servant, and his home life is made tolerable merely because that servant chances to delight in cookery and housewifery.

It is true that there are many beautiful characters in the medical practice of real life, who spread their charities with prodigal generosity; who smooth the hair of the pauper with infinite nicety, while neglecting due application of the comb to their own tangled locks; who give wine to the sick when unable to afford small beer for themselves; who, even when poverty stings them most, know not who owes them money, and care less. But whether such men be common or rare in real life, they are fascinating in fiction and the wise writer is the one who gives the people exactly what they want.

Balzac, in permitting the beloved Benassis to over-indulge in tea, that he may labor through the night under its stimulation, panders to popular taste. The scientist and the physician are permitted by common consent to carry out their unusual mental accomplishments under the influence of subtle drugs. There is nothing more attractive and fascinating in Dr. Conan Doyle's conception of "Sherlock Holmes,” than that of the clever detective injecting cocaine into his arm, and that injection would not be half so effective—upon the reader-if the bright light was not "reflected upon the delicate barrel of the syringe."

There is a very common saying concerning the man of moderate ability who becomes dissipated--particularly if he be a surgeon-that "he is more skilful when intoxicated than the average man when he is sober." It is a popular fancy that the mending of the human body is a work so different from other vocations; so mysterious and developing such unusual forces in the physician, that there is no incongruity in conceiving these faculties greatly accentuated by subtle and mysterious drugs, which would prove only deadening and injurious to others. We must not conclude from the foregoing that Benassis was, in the least dissipated; but that reliance upon even the stimulation of tea, in a man who was in all things moderate, is a clever touch to the conventional medical man of fiction which one would expect from him who held the supreme place in French fiction.

In person Benassis "was a man of ordinary height, broad shouldered and deepchested." His face was "not unlike that of a satyr; there was the same slightly protruding forehead, full, in this case, of prominences, all more or less denoting character; the same turned-up nose, with a sprightly cleavage at the tip; the same high cheek bones. The lines of the mouth were crooked; the lips, thick and red. The chin turned sharply upward. There was a sharp, animated look in the brown eyes, to which their pearly whites gave great brightness, and which expressed passions now subdued. His iron-grey hair, the deep wrinkles in his face, the bushy eyebrows that had grown white already, the veins on his protuberant nose, the tanned face covered with red blotches, everything about him, in short, indicated a man of fifty and the hard work of his profession." And we find this man, pictured with the infinite detail of Balzac, standing, in solemn dignity, at the bedside of a dying cretin.

The Commandant, who thus found Benassis, felt a thrill of surprise and horror at the sight of the patient-"a human face which could never have been lighted up with thought-a livid face in which a look of dumb suffering showed so plainly

« ForrigeFortsæt »