« ForrigeFortsæt »
employed to treat paralyzed muscles is in- cases. The thirst and dryness of the fauces jurious; since it enfeebles the muscle and and skin are relieved very soon after the causes atrophic structural changes.
beginning of treatment, and in the course of (c) That to strengthen or properly exer- a few months the patient is restored, at cise a paralyzed muscle, a slow rhythm of least temporarily, to his usual health. (This the faradic current-about thirty waves to was followed by an illustrative case showing the second-should be adopted.
good results.-Ed.) (d) That in some spastic conditions of muscles (due to paralysis of an opposing Morphinomania Cured by Gradually Increasing group) the strong tetanizing current may
Doses of Phosphate of Soda. be used to advantage to over-stimulate, and M. J. Luys reports the case of Dr. X, thus to fatigue the muscle.
who had been accustomed to employ about (5) Of the franklinic current or static seven grains of morphia daily. Small doses electricity, it may be concluded that it is of sodium phosphate were given subcutanean adjunct of great efficiency in practice, ously (with glycerine and water), and as since
they were gradually increased the morphia (a) It evokes the usual nerve and muscle was progressively diminished. In two reactions.
months the morphia was discontinued en(b) It affords a most convenient means tirely, and then the doses of sodium phosof stimulating the peripheral distribution of phate were progressively diminished, and the nerves in the skin, producing counter- finally stopped altogether in two weeks irritating, reflex, and other afferent im
There remained no desire for the pression effects.
morphia at all.-American Practitioner and (c) It has a local pertubatory action News. (spark). (d) It produces profound alterations in
Treatment of Bone and Joint Tuberculosis. the metabolism of the individual, increasing
Neuber (Archiv fur klinische Chiurgie.) the natural waste products and diminishing The author reports fifteen cases, of which the toxic or by-products. For this reason
fourteen are cured and one remains under it is specifically indicated in cases of mal
treatment. In eight there was primary nutrition, whether local or general.—Morton, before N. Y. State Med. Society.
union, in four cases secondary union without suppuration, while in two cases there
was a slight amount of pus. These results The Treatment of Diabetes mellitus.
were obtained by the use of a ten per cent.
glycerin emulsion of iodoform, which the By William Thompson, M. D., Little author used for its well-known specific acRock, Ark., in Jour. Ark. State Med. So- tion in tuberculous cases. The author ciety.
opens the joints, removes all fungous, tuberI give below the treatment used by me culous masses and necrosed tissues, washfor the last fifteen or twenty years:
es out all the pus, removes necrotic bone R Pot. bromidi Spts. ammo. aro
and sequesters, and then pours over the Aquae q. s. ad. Mix. Dose--Take two teaspoonfuls in
entire tuberculous area a ten per cent. iodowater three times daily, before meals.
form glycerin emulsion. After the joint has Or,
been opened and the diseased tissues reR Pot. bromidi.... Spts. ammo. aro
moved, he unites the joint capsule by a Liq. pot. arsen..
buried suture, the superficial tissues by an Aquam q. s. ad. three times daily in water, after meals, ordinary interrupted suture; the wound is
Mix. Dose-Take two teaspoonfuls not drained but firmly closed. Over the These two prescriptions form the base of wound he lays a small amount of iodoform my medical treatment. The usual diabetic gauze held in place by adhesive plaster, diet is enjoined upon my patients, except and afterwards a dressing, to hold the joint that milk of all kinds is allowed to the firmly in a fixed position. The cases, so far, patient's desire. I have treated quite a include elbow, ankle, foot and hip joints. number of cases of diabetes with these for- When a joint is only partially involved, mulas with very satisfactory results, never after opening it, he puts into the sound porfailing to reduce the quantity of urine to tion a tampon of iodoform gauze; when all about the normal quantity and cause the diseased tissues have been removed, he sugar to disappear, except a trace in some washes out the wound, removes the gauze
..oz. ii fi. oz. li .ff oz viii
.oz. li .fi. Oz, 11
f. dr. ii .fi. oz. viii
and foods the whole cavity with iodoform geal or this laryngeal affection? It is my emulsion, closing the wound by means of conviction that a state of hyperplasia or buried and superficial sutures without dam- chronic congestion or hypertrophy (whatage. The use of the same method in the ever may be the latter's nature) of the nose, treatment of other wounds he has found or naso-pharynx, also sometimes the crowdof value in securing primary union.-Inter- ing of enlarged tonsils, with the almost nat. Med. Magazine.
constant and at times constant pressure of (We think that equally good results can membrane on membrane,the stenosis and the be obtained by the use of the more agree- hypersecretion incident, is the cause of the able, less poisonous and cheaper acetanilid. major portion of all the affections of these -Ed.)
different organs, and make up in general
the cases that constitute this line of medical Dr. John B. Deaver has removed from practice. his former office on 18th street, to 1634 To begin with ear affections: The comWalnut street, Philadelphia. The number monest ear trouble is middle-ear deafness. of Dr. Deaver's operations for appendicitis I do not think that any one knows of any has now swollen to about 160, with only cause (unless very uncommon) for this disone death, reported in the first 30, showing ease that does not have its origin someabout 130 consecutive operations without a where around the mouth of the Eustachian death.
tubes and due to the influence referred to
above that eventually involves the mechanThe Interdependence of Chronic Throat, Nose
ism of the middle ear. and Ear Affections,
Then chronic suppuration, or acute for (The following, by George Wilkinson,
that matter, to what is it due? Omaha, read before the Nebraska State I grow firmer in the belief each year that Med. Society, so intimately concerns the all these cases, with practically no excepgeneral practitioner that we publish it here. tion, are due to direct infection from nose -Ed.)
and naso-pharynx and not otherwise. Thus The subject I have chosen is a good one the specific middle-ear suppurations in the because there are some things that can be infectious diseases of children, of la grippe learned only by long experience and prac- and for ought I know where the tubercle tice; and because the trend of text-books bacilli breaks down the ear in suppuration and other literature would make the student in cases of tuberculosis, not from the blood believe that all these mucous membranes or lymph channels, but from the secretions are separate and distinct, while in reality of upper respiratory passages through the clinical history of their chronic affec- Eustachian tubes. tions, barring so-called specific diseases, is Also the suppuration of ears from those one and the same thing in nearly all these "acute colds" of the mucous membranes cases—with but few exceptions if any. of these tracts and lastly the tendency ("ear
For purposes of instruction it is feasible ache") to suppuration—as well as middle to make as many divisions and classifica- ear sclerosis—in so many cases of nasal tions as can anatomically be done consist- hypertrophy in any form including aủeently, but in practice these must often be noids, polypi, etc. I think all will bear me cast aside if one would gain a correct idea
out where the mischief is primarily wrought of a rational treatment; so much so that it —not in the ear, I am sure. must appear to the student that he must Concerning the pharynx: The common learn all anew and that his text-book lore is chronic affection here, barring affections of at fault; and this is too often true of some of the tonsils and specific disease, is granular the more diagrammatic treatises. Fortunate- or some such chronic form of sore throat. ly this kind of literature having served its I believe that the etiology of this affection purpose (?) is giving way for a new and can be attributed in the greatest number of better order of things.
cases to the conditions of the membranes The medical man who is continually ex- above, although I do think that the congesamining this particular class of patients is tion and hypersecretion the only exciting often wont to wonder if the nose or nasopharynx were not now involved or were not In my experience this condition is comoriginally affected, acutely or chronically, mon in hypertrophy and is uncommun in would there now be this ear or this pharyn- nasal atrophic conditions—and this whether the nature of the pharyngeal trouble is dry It may be said that is mal organ ilat and fissured or the less chronic, simply in- is able to carry on its function normally flamed glands standing out as red points through life and is tus a safeguaril to all along with the prominent blood vessels mucous membranes conting sous is a grand feeding them. This does not tally exactly thing. If one is so unfortunate as to start in with the cause generally ascribed, nam-ly life with the hyperplasias of so-called scropoor condition of system, vitiated surround- fula or other faulty dyscrasia, or if this orings, enervation, etc. I grant this condition gan is injured by trauma, by the severe is found in just these cases, but the point I inflammations of the exanthemata and wish to make is that these are in the minor- diphtheria, or by the frequent swellings ity and may even have had their beginning due to "colds in the head” and the conseas indicated above.
quent overgrowth of nasal tissue incident There is yet a variety of chronic pharyn- thereto, one need never be surprised to find geal congestion or inflammation if you my of the affections I have enumerated in will, sub-acute at times and a very com- later life as sequences. mon trouble in my experience, in cases de- Now just one word as to what is meant pendent in part on hypertrophic nasal trou- by the treatment of the general health. ble, in patients of full habit and pelthoric, If the diagnosis is correctly made there especiallyif addicted to the use of liquor, to is in nearly all cases no such treatment to further heighten and relax the blood pres- be made; but one must be on his guard sure in these parts. The same affection of always, for there is a percentage of some pharyngeal mucous membrane is probably of these cases that do not come strictly unallied in these cases to another cause, name- der the character only of the affections I ly, where the blood is charged with effete am speaking, and are due to extraneous matter from high living and faulty habits irritation, as smoking, faulty use of voice of life, especially if the kidneys can not or are markedly systemtic, affecting these properly attend to their functions; these are membranes in some form or playing a part. the cases of gouty or uric acid intoxication, One must be always watchful of anemia, so-called relaxed membranes.
gout, syphilis and tuberculosis, and possibly Finally there are three common affections rheumatism. of the larynx which were it not for diseased But the number of these is by comparison conditions of the contiguous or rather
few. The bearing then this paper has upon continuous membranes above would not ex- treatment of the great army of those affectist.
ed, all who are familiar with this kind of The first of these is a chronic congestion
work will readily see. dependent on a hypertrophic and hyper- but as there are exceptions to every rule,
I believe these premises are well taken, secretive condition of nares. These cases are often quite chronic, yet they at times arc
and especially in medicine, it is possible i apparently well and prove to be worse at speak too broadly, for the limit of these every change of temperature where "cold in generalizations is short, yet with the cardinal the head” is liable; the voice at such times points involved I think all may agree. if often quite muffled.
Tests for Albuminuria. There is another kind of laryngeal con
Dr. C. Fouchlos (Le Progres Medical) gestion combined with granular pharyn- recommends the following tests for albugitis and dependent upon it and better or min in urine. He states that they are exworse with the pharynx condition, and yet tremely delicate and absolutely trustworthy. not due primarily so much to the pharynx
(1). Add a few drops of a I per cent. soas to having its first cause in a naso pliaryn- lution of corrosive sublimate to the susgeal trouble.
pected sample. A turbidity which persists The third laryngeal affection is due to after the addition of a little acetic acid indidirect infection from the dropping, in in- cates albumin. stances where the epiglottis will allow of it, (2). Add a few drops of the following of the fetid secretion of hose bad cases mixture to the sample; 100 c.c of a 10 per of atrophy of nares known as ozena, di- cent. solution of sulphocyanide of potassirectly into the larynx. The voice in these um mixed, 20 c.c of acetic acid. If albucases is often lost and regained on thor: min be present a turbidity or white precipiough and constant cleansing of the nasal tate will appear, according to the amount secretions.
Detection of Sugar in the Urine.
s1.fficient to effect a cure in mild cases of ine Dr. A. R. Elliott (N. Y. Med. Jour., July disease. 27th) gives the following formula devised In posterior urethritis i:11s solution is to by himself for the testing of sugar in the
be injected into the bladde: wlich is then urine:
emptied in the normal way; 400 Cc. (14 f. Solution 1.
oz.) should be injected each time, repeatCupric sulphate...
ing this operation until the 1.5 liter lias Glycerine (pure).
been injected.-Amer. Med.-Surg. Bulletin. Liq. potassae
ad oz. Dissolve the cupric sulphate in the glycerine and water and gently heat. When
Treatment of Acute Phthisis by Continuous
and Persistent Reduction of cold add the liquor potassae.
Body-Temperature. Solution 2.-A saturated solution of
(Australian Medical Journal, February chemically pure tartaric acid. These solutions are quite stable and keep den, Victoria.
20, 1895.) By G. Marr Reid, M. B., of Cobindefinitely.
This author believes that "it is theoreticInto a test tube pour a drachm of the
ally and scientifically correct to try the cicupric oxide solution. Boil gently over a
fect of a continuous and persistent antispirit lamp. Then add two or three drops pyretic and bacillicide form of treatment of the tartaric acid solution and boil again.
based on the idea of both lowering the 22The urine is now added slowly drop by
tivity and consequent virulence of the bacill: drop until eight drops are added.
by reducing and keeping reduced the allreaction takes place by this time, there is
necessary surrounding temperature, and at no sugar. The reaction is a yellowish, or
the same time exposing them, when thus reddish, or greenish-grey deposit of sub
weakened and attenuated, to the destructive oxide, which is marked and unmistakable.
power of some trustworthy bacillicide." AnIn a few minutes the reaction deepens.-N.
tifebrin is recommended as the antipyretic. Y. Med. Jour. As a test for sugar in the urine, a writer
the temperature never being allowed to go
above 101 degrees F. The application of a in the New York Medical Times says: Add
spirit lotion to some absorbent material to a small quantity of urine the same
placed on the chest is also recommended amount of a saturated solution of picric
Inhalation of undiluted creosote, alternatacid. To this add half as much more liquor
ing with the administration of the drug by potass. If sugar is present the color be
the stomach in gradually-increasing doses. comes very dark and opaque. If no sugar
is the germicide. is present the color is a handsome bright
The history of one case in which this red.
mode of treatment was tried is given in de
tail, and shows a great amelioration in the Citric Acid in Gonorrhea.
condition of the patient, the tubercle bacilli Dr.Pellissier (Corresp.-bl. f. schw. Aerzte, having entirely dsappeared from the sputum. 1895, XXV, p. 288).
with a cessation of all the physical signs Citric acid has been added to the long
of phthisis.--Internat. Medical Mag. list of remedies recommended against gonorrhea. According to Dr. P. this acid is
Collodion in Plastic Operations. beneficial even in obstinate cases of this In the Boston Medical and Surgical Jourdisease. Citric acid, he maintains, acts not nal for May 23, 1895, Dr. David Coggin. only through its bactericidal properties, but of Salem, in the correspondence columns. it renders the mucous membranes an un- calls attention to the value of collodion in fruitful field for the propagation of the plastic surgery. By its use the inconvenigonococci.
ence and pain of sutures can frequently be In anterior urethritis the acid is to be
dispensed with. For example, when inverused by injection or urethral irrigation. sion of the lower eyelid is present, as is The injecting fluid consists of a I per cent. not uncommon in elderly people, and which aqueous solution of the acid to be used six
naturally causes much annoyance, it is often times daily in the usual way.
sufficient (Noyes) to apply two or three coats The daily irrigations consist of
of collodion on the skin below the inturned Citric acid.
.8 gm. (2 drs.) .1 to 1.5 L. (2 to 3 pts.)
lashes, and repeat its application every two It is claimed that 4 to 5 irrigations are or three days for some weeks, till either re
lief follows or the patient consents to have a disappointment in a slow recovery. Show a strip of skin excised. When the latter is kind, pleasant, sympathy, if you have it, and done, fibres of cotton saturated with the if not then assume this great virtue. collodion will keep the edges of the wound Don't fail to be neat in your appearance; in perfect apposition during the healing pro- clean hands always, and the Bible adds "a cess, sutures not being called for.
pure heart”—have that, too; it will do you Its contractile property is also of value no harm—but the clean hands must be emafter the outscooping of cysts on the eye- phasized and insisted upon. lids. They are ordinarily incised through Don't scowl at this. I know some of the the tarsal surface, and when evacuated the “big doctors” whose hands are so dirty they sac sometimes becomes much distended by are enough to repulse a strong well person, hemorrhage, and occasionally an abscess much less an ill one. is the sequel. Collodion applied on the skin Don't sit on the side of the sick-bed; that over the site of the chalazion expels the is not the right kind of interest to show. If blood and brings the walls together, and so there is not a chair convenient, then kneel promotes immediate union. This is favored beside the couch. Most doctors do very by inserting a drop of castor oil in the line little kneeling; it won't hurt you, though. of the incision, which it tends to keep open Don't cry out, “My! What a fever!" nor for a day or two. He also again calls atten- otherwise startle the patient. tion to the use of collodin on distended Don't flutter, nor finick, nor walk the tear-sacs, in several instances of which it
floor, nor put your hands over your cyes. has helped in abridging the treatment of Such signs are ominous to the eagle eyes of this not uncommon affection.
the sick, watching closely your every ex
pression and action—nothing escapes them. For Local Anesthesia
Sit still and quietly, and in a calm, soft, genA mixture of chloroform (ten parts), tle voice (Oh! there is so much good in a ether (fifteen parts), and menthol (one part), pleasant voice!) give your directions and used as a spray, recommended as an ex- advice. cellent and prompt means for obtaining lo- Don't hold the patient's hand too long, cal anesthesia, lasting for about five min- especially if it is a lady's hand. She don't utes.-Boston Med. and Surg. Journal. like to ask you to relinquish it, fearing to
magnify what seems to be a very little matDon'ts for Doctors.
ter; but it is well, disagreeable. Don't do BY A PATIENT.
it. Don't be a doctor at all if you are tyran
Don't ridicule the patient's whims, even nical, severe or brusque.
though they are vagaries; treat them will Don't start in the profession with the
respect, and, so far as you can, humor them idea that medical wisdom will die with you;
—a different course often harmfully irri
tates. recognize that there are other physicians, both male and female, at least your equal.
Don't fail to take the patient into your Don't stop short of all the learning you
confidence when it is possible; tell him can acquire, and then have full confidence what you are giving him, and the effect you in yourself and inspire your patients with desire your prescription to have, the pains the same belief.
it will overcome and those it will bring. He Don't give up a patient while there is may refuse to take your drugs; sometimes breath left in his body; make a hard fight his very refusal will be his salvation and with the grim monster, holding on and
yours, too. standing by until the end comes. A faithful Don't neglect to occasionally take a little doctor is what the sick want. If you
desire gift to your patient-a newspaper, a tiny practice, that will bring it sooner than any- book, just a little flower—any little thing thing else. I am one of the initiated; there- will prove that you have thought of him. fore, believe me.
And who is not pleased to be remembered? Don't enter the sick-room wearing creak- I once had a dear old doctor to bring me ing, noisy shoes; knock gently before en- some biscuits and a bottle of fresh milk, tering, then be quietly cheerful, never bois- and, although I could eat nothing with terous nor gloomy.
comfort, I heroically swallowed his offering Don't ask your patient what he is "going with a feeling of gratitude I never had beto have next,” nor manifest impatience nor fore. And still another one called late at
From Cincinnati Lancet-Clinic.