there was constant dribbling. This incontinence continued for about two months after which patient could retain the urine for about two hours. The bowels seemed affected in much the same way as the bladder, being as a rule very much constipated. With the above changes, improvement seemed to follow in the extremities. In about eight weeks the left arm regained its normal function, accompanied a little later by a marked change for the better in the right arm, the right hand not improving so much. Improvement of motion was noticed to a slight extent in hip and knee joints of the right leg but not in the ankle joint. In the left leg only very slight motion returned. As to sensation, up to this time in the right arm it was very good; in the right leg somewhat affected; in the left arm totally unaffected; in the left leg slight feeling only, previous to operation recorded in this article. About two months after the accident he had pain over the lumbar region, radiating in the direction of the left shoulder but not extending farther upwards than the margin of the ribs. This he seems to think due to his kidneys, but there are no clinical facts that would point to such a cause. Appetite and digestion remained good, and the power of the higher senses. sight, smell, etc., was not impaired. The treatment which the patient had received during the above changes was salt water baths and electricity. Patient entered Toronto General Hospital on November 2nd, 1899, under the care of Dr. Geo. A. Bingham, who, after a careful examination decided to operate. An incision four inches in length was made in the middle. line from near the base of the skull to a point below the seventh cervical vertebra. The lamina of the sixth and seventh vertebrae were removed when it was seen that the fifth was dislocated forward and to the left and was exercising distinct pressure on the cord. This lamina was therefore removed and the wound closed. Healing was by first intention. Operation Nov. 29th, 1900. Complete paralysis of all the extremities was the first result, no doubt from pressure of exudates. This passed away in a few days. The patient has slowly but surely improved both as regards motor and sensory functions, and to-day, two months after operation, he has fair control over the sphincters, the upper extremities are functionally about perfect, and he is beginning to use the legs to a limited extent. Altogether the prognosis appears quite favorable. SELECTED ARTICLES. "COLD IN THE HEAD:" HOW IT MAY BE AVOIDED AND HOW TO TREAT IT. By GEORGE C. STOUT, M.D., Laryngologist and Aurist to St. Mary's Hospital; Instructor in Diseases of the Ear, Cold in the head is an Philadelphia Polyclinic, etc. membrane lining of the nose, acute catarrhal inflammation of the mucous extending at times to the adjacent sinuses, and manifested by sneezing, hyperemia, hypersecretion, and difficult respiration through the nose. This brief sketch will deal rather with the simple form of acute coryza than the specific forms which occur in the exanthemata or associated with special dyscrasia. Although it is apparently evanescent and self-limited, it is not well to pass it by too lightly, for while it often seems trivial to the physician it is not so to the patient, and it is really one of the most common excuses for recourse to the nostrum vender. Physicians too often consider a head cold unworthy of notice unless the accessory sinuses, the pharynx, or the middle ear have become involved. Causes. The chief underlying causes of this trouble is a depressed state of the nervous system, which results in a sluggishness of the heat-producing centers. Such a state may be brought about by excessive mental or physical fatigue, or by a lack of circulatory stimulus from inactivity of mind or body. In other words, the many exciting causes are not prone to bring about a cold unless there is also a relaxed condition of the heat centers. One is more apt to "catch cold" when in the depressed state brought about by a funeral or a dull lecture or meeting than when exhilarated as at a dance, or place of amusement, even though the exposure may be greater under the latter conditions. Sitting idly in a trolley car or train for some time makes one liable to cold. Improper clothing, sitting in a draught, changing from a warm to a cold room, or vice versa, are common exciting causes. So, too, the action of irritating matter, such as dust or certain chemical vapors, is a causative factor. Improperly protected feet and failure to promptly change wet stockings are very common causes. Those who are susceptible to colds from slight causes are usually sufferers from some nasal deformity -more commonly hypertrophic rhinitis. The excessive use of alcohol or tobacco is a predisposing cause. Acute colds are rare in old age. In order that the nose may properly perform its function of heating and moistening the inspired air, the amount of the blood supply and glandular secretion of its lining mucous membrane must be constantly varied to suit atmospheric conditions of temperature, dryness, or moistness, and in order that these changes may take place rapidly the mechanism governing these conditions must be delicately poised: thus the sphenopalatine ganglion and the fifth part of cranial nerves must be in a healthy condition to regulate the blood and glandular supplies, and for them to be in good condition means that the general nervous system should be normal. - Pathology. In the early stage the membrane lining the nose is turgescent, with a dry surface; this dry stage being shortly followed by a moist one in which there is an exudation of serous fluid, which is saline and irritant. The serous fluid later becoming charged with disquaminating epithelial cells and leucocytes grows thick and cloudy, and still later yellowish. This latter hue is probably exaggerated by the staphylococcus aureus present. Various bacteria have been found in the secretion, but none have been positively identified as the cause. Symptoms.-These are well known even to the laymen if he resides in latitudes subject to marked temperature changes. At first there is often a sense of dryness and discomfort in the nostrils accompanied by sneezing. There may be fever, chilliness, or in severe cases a distinct rigor. Dull head pains, especially after mental effort, and painful sensations in the muscles or joints, together with a feeling of lassitude, are often present. Following the dry stage by a few hours the secretion becomes excessive, the engorged blood vessels exuding their liquor sanguins, which mingles with the disquamated cells The stuffness. or complete closure of the nares by the swollen erectile tissues adds materially to the discomfort, occasioning mouth-breathing and its concomitants, vocal impairment, sore throat and cough. Should the frontal sinus become involved there is distressing supraorbital headache. This is often the case when congestion only is present in this region, without suppuration. If the antrum of Highmore becomes involved, neuralgic pains in the face and teeth will be experienced. There is often a sense of fulness in the ears, or even deafness, with or without ringing noises. from closure of the Eustachian tube orifices. This closure is thought to be a provision of nature to prevent septic infection through the tubes, but if persisted in may lead to middle-ear inflammation. If the orifices of the tear duct under the interior turbinate are encroached upon by the swollen mucous membrane, there will be an overflow of tears on to the cheek. The senses of smell and taste are often lost, and there is at times difficulty in concentrating the attention (aprosexia). The exoriation so often found at the edge of the nostrils is probably in part due to the irritating secretion, but chiefly to undue use of handkerchiefs. Treatment. This should be divided into prophylactic, abortive, and curative. Prophylaxis embraces rational clothing, the avoidance of draughts, care of the digestive functions, and maintaining the nervous tone. Too much clothing is more apt to be worn than too little. Those whose life-work is indoors should wear light underwear the year round, and put on heavy outer garments when going out in cold weather. The feet and legs should be especially well protected, and stockings should be changed at once upon becoming wet. preventive measure a brisk dry massage of the body and limbs morning and evening is excellent. This may be reenforced by a laxative tablet of calomel and sodium bicarbonate, and a granule of strychnine sulphate to grain three times a day, or a hot drink at bedtime after a hot foot-bath; then covering up well in bed so as to cause general perspiration; dressing rapidly in the morning, and remaining in the house until the circulation is thoroughly established. After an attack is fairly started the bowels should be regulated by a saline cathartic, and the nerve tone should be maintained by grain of strychnine thrice daily after meals, or if the discharge from the nose is free the following tablet may be used: B. Morph. sulph., gr. 1-32; M. Sig. One to three daily according to symptoms. The local treatment should be carried out with great gentlenesss; the patient should be cautioned not to blow or wipe the nose except when absolutely necessary, and then only gently, blowing one nostril at a time while it is entirely free from pressure. As a preliminary measure the nares should be thoroughly though gently sprayed with an alkaline antiseptic solution, which should pass through the nasopharnyx into the mouth. The chief remedial agent is a one-per-cent. solution of cocaine, to which may be added two grains. of boric acid to the fluid ounce. When the secretion is excessive and the breathing space nearly closed, a small quantity of this solution should be sprayed into each nostril, barely sufficient to cover the membrane, but not enough to reach the nasopharynx or to run out in front. This should be allowed to rest undisturbed upon the membrane for about five minntes, when it may be followed by a spray of B. Antipyrin, gr. x; M. Aquæ destillat, f 5 j. This in turn should be allowed to soak for five minutes and then gently blown out, and a coat of the mild chloride of mercury insufflated over the turbinates so lightly that it barely turns the surface gray. This may be followed by an oily protective solution, e.g. : B. Menthol (crystals), gr. v; Liq. petrolei, f 3 j. The above procedures should be carried out once daily by the physician. This treatment, while seemingly elaborate, will shorten the attack and greatly alleviate the symptoms, and it is very simple if the remedies are at hand. Hemming or hawking should be restrained; the motion of swallowing will often relieve the desire to do these; if not, a lozenge of red gum or slippery elm may be allowed to slowly dissolve in the mouth to relieve the tickling sensation in the throat. Pharyngitis or laryngitis if present will be relieved by a spray : B. Ol. eucalyptol, m ij; M. Zinc. sulph., gr. x; This should be sprayed into the pharynx and inhaled into the larynx every two or three hours. Frontal sinus pain is relieved by the above local treatment, to which may be added a hot-water bag across the eyes when the pain is severe. Suprarenal extract has been used to prolong the action of the cocaine solution, but as it aggravates the symytoms in a number of cases I no longer use it. The danger of giving the cocaine habit must be borne in mind, as it is easily done, in spite of authorities to the contrary. The patient therefore should not know what he is getting, and a prescription should never be given containing this remedy. In rare cases which are very aggravated I sometimes give the patient a half-drachm vial of cocaine solution, instructing him to add the contents to an atomizer half filled with an antiseptic solution, as follows: R. Sodii bicarb, gr. v; Nodii borat, gr. x; He may spray a small quantity of this into each nostril when the stiffness is excessive; but under no circumstance should he be told what it is. A capsule composed of the following may be given every two or three hours in place of the anticold tablet mentioned above: B. Pulv. opii, gr. † to gr. § ; Camphora, gr. j ; Ammon, carbonat, gr. j to iij. M. -Therapeutic Gazette. AN OUTLINE OF A NEW PATHOLOGY. Diseases of the Clothes. It has long been vaguely understood that the condition of a man's clothes has a certain effect upon the health of both body and mind. The well known proverb, "Clothes makes the man," has its origin in a general recognition of the powerful influence of the habiliments in their reaction upon the wearer. The same truth may be observed in the facts of everyday life. On the one hand we remark the bold carriage and mental vigor of a man attired in a new suit of clothes; on the other hand we note the melancholy features of him who is conscious of a posterior patch, or the hunted face of one suffering from internal loss of buttons. But while common observation thus gives us a certain familiarity with a few leading facts regarding the ailments and influence of clothes, no attempt has as yet been made to reduce our knowledge to a systematic form. At the same time the writer feels that a valuable addition might be made to the science of medicine in this direction. The numerous diseases which are caused by this fatal influence should receive a scientific analysis, and their treatment be included among the principles of the healing art. The most distressing cases are those where the patch assumes a different color from that of the trousers (disimilitas coloris). In this instance the mind of the patient is found to be in a sadly aberrated condition. A speedy improvement may, however, be effected by cheerful society, books, flowers, and, above all, by a complete change. |