Billeder på siden
PDF
ePub

those pseudo sciences, medicine and surgery, as whose maid the noble discipline was made to do service. for centuries.

The coccygeal gland, its discovery and the investigations which have been made about it, will furnish an example of the different methods which may be employed to solve an anatomical problem, and I will use it to illustrate the points which are the subjects of my consideration given in the heading of this essay.

Fig. 1.

Coccyx of a 15-year-old boy with middle sacral artery ending in coccygeal "gland."

Prof. Luschka of Tübingen, about the year 1856, discovered a little organ situated near the point of the coccygeal bone on its anterior surface, just in front of the body of the last rudimentary vertebra which makes up this bone. He made numerous dissections and found that the little organ was present in every cadaver. It is usually the size of a large grain of wheat, sometimes reaches the size of a pea. Its color is a pinkish gray, it is soft in texture, is movably attached by some loose connective tissue to the periosteum of the last coccygeal vertebra behind, and to the perirectal connective tissue in front. He found that it was supplied with blood from the middle sacral artery; he could not trace any nerves into the organ, and found no duct of any kind in connection with the problematic organ. Under these circumstances he called it the coccygeal gland! In some unaccountable way the learned

[ocr errors]

professor saw some resemblance between this organ and the hypophysis cerebri and published a very lengthy and pompous monograph on these two glands (?) in 1860. The gland was soon dissected out by numerous anatomists, its existence corroborated, and it was called by the authors of numerous text-books Luschka's Gland." Some placed it into the very paradoxical class of organs which figure in some text-books as bloodgland or glands of the vascular system, the spleen being considered the typical representative of this peculiar kind of ductless glands. I have never been able to exactly comprehend by what process of reasoning any intelligent person could arrive at the conclusion that the spleen was a gland. We know that epithelial cel lular elements are the basis from which all glands must be developed, and in the absence of this tissue how some authors still continue to teach their students that the spleen is a gland greatly shakes my confidence in their reasoning powers.

These men have perhaps been dwarfed in their minds, because they were content to consider themselves mere servants who are tolerated only because they are necessary to their masters, the physicians and surgeons. These poor creatures who know their anatomy like parrots know their syllables or children their catechism, and who teach students anatomy by means of mnemonic rules, silly rhymes or senseless verses, are deserving of our pity, because they are devoid of the power which raises man above other animals, the power to think. The late Dr. Thomas Kennard used to say of a certain class of individuals that if an original thought were to strike one of them it would knock them down, and in some perhaps prove fatal.

I think that there is little danger of a sudden and premature death among the majority of the professors and demonstrators of anatomy from this cause, judging by the methods they employ to learn and to teach their science, which can be made so ennobling and attractive as I will try to show by the example before us.

Luschka's gland after it had been discovered for several years, was examined by all known methods microscopically and makroscopically, but no theory or satisfactory explanation could be found for its existence.

The microscopists soon discovered that it consisted of connective tissue of the lymphatic variety in which was a network of blood-vessels, apparently small arterioles. About the year 1870, Prof. Julius Arnold made an investigation of the organ, and by injecting it with fine mass of colored gelatine found that its principal tissue was of the vascular variety and in fact that it was almost nothing but a convolution of the end branch of the sacralis media artery, which was surrounded by cellular tissue in which a net of narrow capillaries was distributed. The small arteries, branches of the sacralis media were peculiar in so far as they were not of even caliber, they varied much in size, sometimes even having sacculated diverticula of their coats.

This investigator clearly proved that the little organ was certainly not a gland, but he also failed to solve the problem as to its true inwardness, its origin.

The next investigator adopted the developmental method of research. and established the fact that the gland grows larger in proportion as the body examined grows younger. He found that the organ has its greatest development during the last months of pregnancy, in the human foetus of the

seventh or eighth month. This observation seemed to warrant the conclusion that the organ was a rudiment of one formerly more developed in our ancestors.

Still another investigator adopted the comparative method. He examined the tails of various young animals. He found that similar small nodules were regularly present in mammals, attached to branches of the middle sacral artery (the tail artery, continuation of the aorta) at those portions where the vertebra of the tail are no longer perforated by the spinal marrow. This fact proves that the little organ, Luschka's gland, must be considered in connection with the gradual reduction of the tail, which follows the reduction of the caudal portion of the spinal marrow in the higher mammals. Gegenbaur from these investigations has concluded, and it is apparent to any one, that the "gland" is only a remnant of the caudal artery which in our ancestors supplied an important part of the body.

Some years ago I injected the middle sacral artery of a new born child with Hyrtl's mass, and finding the coccygeal gland well filled I placed it into corroding fluid. This was carefully watched and the fluid changed when necessary. After three weeks all the tissues had been eaten away from the red mass, leaving nothing but the conglomerated network representing the vessels which had been injected. I placed this globule into glycerine and examined it carefully with a magnifying power of 40 diameters on the stage of a dissecting microscope. The engraving below will give an picture of what I found. It seems to me, beyond the possibility of a doubt, that the four branches first given off from the main artery must be considered as homolagous to intercostal,

X

X

Fig. 2. Coccygeal gland vessels unravelled after injection and corrosion. Magnified 60 diameters. X signifies broken off ends.

lumbar or caudal arteries which are given off from the aorta at regular intervals each corresponding to a vertebra. In my attempts to unravel and follow out the branches of the conglomerated vessels, I could not distinctly follow any other symmetrical branches, but the two pairs are sufficient to establish the conclusion of Gegenbaur, so far as the human body is concerned. Thus we see that after the newly discovered organ was studied by rational methods of investigation its nature became clear to us, and it is no longer a gland of the vascular system.

The method of teaching anatomy which is en vogue in most of the colleges in this country, is merely the ordinary descriptive system which teaches the student a set of facts in an unconnected manner and he has merely his memory to depend on for remembering them. They are totally vanished and lost in a few months or years unless constant repetitions are kept up.

It is an undeniable fact that in order to understand thoroughly the structure of a building or of a machine it is necessary to see it in the process of being constructed. The same principle holds good of a living organism. Teaching is developing. The genetic method of teaching anatomical facts. makes it possible to explain them and its application makes the process of

teaching lucid and attractive. The genetic method exercises the powers of judgment, and facts arrived at by this means are not easily forgotten. St. Louis.

Temporary Paralysis of the Bladder with Retention of Urine Following Protracted Labor, et Sequelæ.

BY W. B. KERN, M. D.

Mrs. A., aged eighteen, was delivered of her first child April 24th, attended by a midwife, vertex presentation, large child. Labor was long and hard, child not being delivered for twenty-four hours after rupture of the bag of waters. On the day following delivery I was called to see her and learned of the manner in which labor had been conducted and completed, and also that she had been unable to empty the bladder since birth of child. On examination I found that organ very much distended. and tense over pubes. I relieved her by means of the catheter, and diagnosed temporary paralysis of neck of the bladder from contusion or long continued pressure of the child's head. I instructed the nurse in the use of the catheter, and had her relieve the patient two or three times per day, always using the proper antiseptic precautions. I advised hot fomentations over hypogastric region, and prescribed the usual remedies directed to stimulate the nervous supply to the bladder. Will say, however, I did not use galvanic current which is doubtless of much benefit in such cases. The case was rather protracted, lasting four weeks, at which time patient was able to pass the urine normally. On July 8th she came to my office complaining of dull, heavy dragging pains over and behind the pubes, almost constant and irresistible desire to urinate, the act of micturating itself being very painful,

slight pains in the back on exertion. She also said she had had a slight dull pain over region of bladder ever since abandoning the use of the catheter, but never thought it necessary to mention the matter, thinking it would probably be relieved without treatment, but recently had grown much more severe. On examination I found the vagina and uterus normal, excepting a slight laceration of the cervix. I found the urine cloudy, containing some mucus and pus, and a few blood corpuscles, with a very slight trace of albumen. Patient's general health not very good, capricious appetite. I diagnosed chronic catarrhal cystitis, probably resulting from too frequent use of the catheter. I prescribed tonics, light but nutritious diet, and a wash of borax and carbolic acid, to be injected into the bladder through a catheter each morning, allowed to remain a short time, then to pass out by catheter or urethra after withdraw. ing the instrument. After few days only irrigated bladder every second or third day. Used hop poultices over hypogastrium occasionally and hot hip baths. Later prescribed infusion digitalis with acetate potass., advised rest in recumbent posture, each day a little exercise in open air. After three or four weeks instead of infusion digitalis and potass. acetate as a diuretic, gave infusion buchu leaves and at same time omitted the bladder irrigation, as the cystitis was decidedly improved. Under the treatment patient's general health became good, all the symptoms of the disease subsiding. Cairo, Neb.

Jaundice.

Will some of the many readers of the BRIEF give me their treatment for jaundice in an infant? Give treatment through BRIEF, or by letter.

JAS. A. TURNER, M. D.

Sedgewickville, Mo.

Swamp or Malarial Fever.

A few brief remarks drawn from practical observation upon the above. disease may not be uninteresting to my brother physicians, and may superinduce a train of reflection which will serve to elucidate and utilize some of the principle pathological points, as well as to guide the practitioner in his treatment of what I consider one of the most formidable of all diseases. The terms "malarial or swamp fever," is to my mind indefinite and unsatisfactory, but may be the best to localize and designate it from other fevers. How ever this may be, I am prepared to regard this disease as somewhat analogous to, and but little short in point of fatality and general characteristics to that of yellow fever, and properly considered might be classed as cases of endemic or sporadic yellow fever. This disease in its most violent form often runs its course in from twenty-four to forty-eight hours, and when fatal, is sometimes attended with black or brown vomit in the last stage.

Preceded by a general feeling of malaise without any marked premonitory symptoms, the patient is suddenly seized with a violent chill at tended with severe pains and aching in the limbs. Retching and vomiting soon becomes incessant with nothing thrown up but a thin watery or viscid mucus, sometimes tinged with blood, and this irritability of the stomach becomes a marked symptom which is very difficult to allay. The bowels are obstinately constipated and torpor of the liver or biliary duct is soon indicated by a yellow tinge of the eyes and skin which, as the disease progresses, assumes a deeper and more marked lemon color. After a few hours hæmaturia supervenes, the urine assuming either a semi-sanguineous or dark-coffee colored appear

ance with increased activity of the kidneys. Reaction is very slow and imperfect, the fever never reaching the maximum of ordinary intermittents, but appears to be smothered and suppressed. The temperature is but little above normal heat in the early stages, and the pulse small, labored and frequent, as if oppressed and struggling to throw off a burden. Such is a very brief summary of symptoms; now let us pass to a brief schedule of treatment.

The physician should first consider that he is now about to measure swords with no contemptible foe; no petty sneaking intermittent, but a Goliath of strength, and happy will he be if he comes off a David from the trying conflict. "When Greek meets Greek then comes the tug of war," and now, my brother, you have no time to lose by palliatives or untried remedies; the chill has sounded the tocsin of war, and you have only to buckle on your armor of skill and prepare for a hard fought battle.

The first indication is to relieve the bowels and system as speedily as you can by free purgation, and for this purpose I prefer calomel from its alterative and relaxing effect, and give it in five grain doses combined with chlor. potass. and repeat every four hours, but as to size of dose, the practitioner should be governed by his knowledge or conjecture of the susceptibility of his patient and the obstinate constipation he has to combat. In addition to medicines per orem, we have a valuable adjunct in enemas, often repeated, and which should never be omitted. This done, let ice be procured as soon as possible and have it pounded up fine and put in a plate near the patient to be eaten freely. This will allay the persistent irritability of the stomach and break up any incipient congestion.

While the ice is being prepared, have a blister-ung. canthar.-placed over the stomach and be sure that it draws well. Let hot-not warm-foot baths be used often, as they will act as powerful revulsives and tend to equalize the circulation. Give in solution every four hours the acetate or salycilate of soda, as this will regulate the liver and neutralize the bile. As soon as the bowels are well evacuated and the irritability of the stomach is allayed, give quinine freely and systematically.

Such is a general outline of treatment, but of course the intelligent physician will be governed by his diagnosis and regulate his treatment pro re nata.

I would, however, in conclusion, respectfully say to the members of our profession, to beware of any hesitation or timidity in the treatment of this disease and to let the young lady of refinement be subject to the same prompt attention that would be applied to the rough field laborer. A young lady whose sister I was attending, once said to me, "Doctor, treat my sister just as you would a negro patient."

A sad death has just occurred in my neighborhood from swamp fever, but was not my patient. The victim was a young married lady with several young children and belonged to one of our most respectable families. ADDERTON MADDOX, M. D.

Near Rodney, Miss.
For the Removal of Superfluous Hairs.

In answer to W. E. Fariss, M. D., I will say that X. Bazin's dipilatory powder, though a patent medicine and I do not like to encourage them, will remove superfluous hairs in a very satisfactory manner. Make a paste with water and apply thick over the hairs for five or eight minutes and scrape off with back of knife and dress with oil. If not all removed repeat the process. Trabue, Fla.

M. T. DAVIS, M. D.

« ForrigeFortsæt »