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which are observed in patients suffering from dilatation of the large intestine, and in rheumatic and nervous patients affected by that curious disease which has been described under the name of "pseudomembranous colitis."
Typhoid fever forms an intermediary group in which we find, as causes of congestion of the liver, both ulcerations of the intestine and the presence of a special microbe in the economy.
In the description of the different forms of typhoid fever given by Chedevergne, he describes the hepatic form. There clearly exist, in fact, some cases of typhoid fever with notable congestion of the liver. There is a true form of bilious typhoid fever. But it may be said that the majority of infectious maladies may be accompanied by a congestion of the liver.
Since Laverane has shown that special organisms are developed in persons suffering from malaria, we must place in this group the congestions so frequently produced by malarial fever. It may be affirmed that there is no case of profound malarial poisoning which is not accompanied by a congestion of the liver. This is a most frequent cause of hepatic affections among Europeans living in hot countries.
Certain diatheses are a cause of congestions of the liver, in the same way as infectious maladies. Although we are ignorant of the intimate mechanism of this congestion, it is nevertheless certain that in rheumatics and in patients suffering from skin disorders, we frequently find congestion of the liver. As in dilatation, the biliary calculi are frequently found in these patients, we may properly inquire if these congestions are not more dependent upon one or the other of these conditions.
Finally, in the third group are to be found persons affected with heart disease as the result of mechanical congestion of the liver. All patients suffering from an organic affection of the heart, and in whom the muscular walls of the heart are no longer able to peform the tasks imposed upon them, sooner or later suffer from an increase in the volume of the liver, which results from a stasis of the blood in the right auricle, and consequently, in the inferior vena cava.
It should be well understood that in some affections of the right heart, me
chanical congestion of the liver occurs with great rapidity, and that in a case of tricuspid insufficiency, this congestion is the rule. But the same is also true of the left heart, for there is a mass in the lesser circulation, as the result of mitral lesions, which induces distensions of the right heart, and consequently the mechanical disturbances of which I have spoken.
In all cases in which an asystolic condition of the heart is found, we encounter the complexion characteristic of the hepatic congestion. Such persons suffer from weight and pain in the origin of the liver, a pressure in the hypochondriac region which produces more or less severe pain.
In his description of the cardiac cycle, Peter has well shown the influence of congestion of the liver upon the production of this general state which has been called "cardiac cachechsia," and has indicated how a disease at first absolutely local becomes a general malady.
(To be continued.)
THE HYGIENE OF CONSUMPTION.
[IN view of the fact that from one fourth to one seventh of all deaths in old and thickly settled districts are the result of one disease, viz., pulmonary phthisis, or consumption of the lungs, everything pertaining to the hygiene and treatment of persons suffering from this malady is possessed of very great practical importance. This will be still more clearly recognized as true, when the fact is recalled that examinations after death of persons dying in city hospitals show that more than one half of all such persons have suffered at some time in their lives from pulmonary ailments closely allied to consumption, and so serious in character as to have left behind distinct evidence of their existence, in structural changes in the lungs. We translate the following suggestions respecting the treatment of consumption from the pen of G. Daremberg in La Médecine Moderne.J. H. K.]
The consumptive should not allow the heat of his room to be above 60°, so that he shall not experience too great a change of temperature when leaving his apartment. The heating of the room should
not be obtained by means of a stove which produces a dry heat. In dry, hot air, consumptives experience a sensation of oppression, and are not able to expectorate, and, since the expectorated matters of consumptives contain a considerable quantity of purulent and toxic matters, the retention of these matters in the system gives rise to fever. When a consumptive is obliged to live in a dry atmosphere, or if the external air becomes suddenly very dry, he should hang up in his bedroom wet napkins which will moisten the air by evaporation, or should add moisture by means of an atomizer. As soon as the expectoration reappears, the fever and oppression will cease, the matters forming the sputa, which have been agglutinated to the surface of the bronchial tubes, easily detaching themselves when brought in contact with moist air. In the house of a consumptive, the heaters should be placed in the hall or ante-room, the bath-room or basement. The sitting-room, the sleeping-room, and the dining-room should be warmed by indirect heat. The dining-room should not be lighted by gas jets placed overhead. I have seen many consumptives become so much congested that they even raised blood when placed under gas jets at the table in the dining-room of a hotel.
Friction and sponge-baths should be a part of the regular hygiene of the consumptive, for the purpose of stimulating the activities of the skin. Excitations of this great nervous surface react with great energy upon the general nutrition. Every morning and every evening the whole surface of the body should be rubbed with a stimulating lotion, as aromatic alcohol or essence of turpentine. After the moist friction, dry friction should be applied with both hands grasping a piece of flannel. When a patient has become chilled during a walk or a carriage ride, he should be placed in a bed, as Dettweiler has shown us, and be made to perspire by dry friction applied underneath the covers, and by this means the bad effects of the chilling may be avoided. Dry, moist friction should be applied at night, in cases in which night sweats occur. They may be applied with the patient in bed, without removing the covers, or the patient may sit up and expose for treatment the different portions of the body successively. The friction.
should be applied rapidly, and completed in four or five minutes. The temperature of the room should not be, at the time of the treatment, lower than 54°.
When the patient has a light evening fever, or a general debility, it is well to order for him a saline or vinegar sponge bath every morning. For this purpose the patient kneels in the center of a bath tub, when the attendant squeezes upon the back of his neck two large sponges previously moistened in water containing salt in the proportion of a tablespoonful of salt to a quart of water, or one part of vinegar to five of water. After the sponges have been partly emptied by compression, the whole trunk should be vigorously rubbed with them. The water should first be at a temperature of 73°, and should be gradually lowered to 54°. After the bath, the patient should be rubbed vigorously, rolled in a blanket, and placed in his bed in 15 or 20 minutes. These cool baths cannot be prudently prescribed to consumptives who are rheumatic. In such cases Lasegue advises a short immersion in a bath the temperature of which is five or six degrees below the temperature of the body.
Cold douches not less than from four to ten seconds are prescribed by Brehmer and Sokolowski. In the establishment at Goerbersdorf, in 106 cases treated by cold water during six months, they observed 39 cures, 34 cases of marked improvement, 19 cases of improvement, 10 in which the disease advanced, and 4 deaths. But these crude statistics are of no value. The douche should not be applied to all consumptives, as is done by Brehmer and Sokolowski. I am intimately acquainted with two rheumatic consumptives who suffered from pleurisy following the application of the cold douche given by an experienced specialist. Rheumatic or gouty consumptives should not receive the douche. The same is true of those who are suffering from fever and those who have extensive pulmonary lesions. Even in vigorous patients the employment of the douche should not be insisted upon, unless marked improvement is speedily apparent under this treatment.
A hydropathic means greatly employed in Germany and Russia, is a heating compress (compresse échauffante), which cannot be too much recommended for consumptives who suffer from painful points,
between the ribs, or other thoracic pains. Over the painful point, a napkin wrung out of cold water is applied, over which is placed a triple layer of flannel, and over all, a piece of oil-silk or India rubber, the whole being secured in place by a bandage placed firmly about the chest. A few minutes after the application of this compress, the patient feels a gentle warmth, the skin becomes strongly reddened, and an hour after, if the moist napkin is removed, it will steam as if it were taken out of boiling water. The heating compress holds an intermediate place between the poultice and the plaster. It is quickly and easily applied. Respiratory gymnastics must be recommended to those consumptives who have atrophy of the thoracic muscles and that narrowness of the chest, and that prominence of the sternum called "chicken-breast," but should not be prescribed to patients suffering from congestion, fever, or developing lesions. These exercises produce excellent effects in patients suffering from cicatrized lesions, with surrounding emphysema. They cause the pure air to enter the depths of the aircells, removing the carbolic acid gas and the accumulating infectious secretions.
Pulmonary gymnastics may be employed without apparatus. Each consumptive should take, in the open air every fifteen minutes, a few deep inspirations and expirations as complete as possible, breathing through the nose. Nasal respiration is preferable to mouth-breathing, because it is slower. Increased fullness of respiration allows diminution in the number, thus lessening the mechanical work.
To deep breathing, slow and rhythmical movements of the arms may be added. Dailly requires that the patient should place himself erect against a wall, either in the open air, or in a room with open windows. The arms should then be brought forward to a horizontal position, then separated, then slowly moved in a horizontal plane to the sides, making the form of a cross, care being taken to develop the chest as much as possible. The arms are then returned to the first position, and the exercise repeated five or six times. The exercise may be varied by raising
and extending the arms laterally from the position of rest by the sides to extension above the head.
None of these exercises should be violent, and they should not be practiced in gymnasiums, which are generally badly ventilated and full of dust. All should be taken in the open air. Boating and horseback riding can be permitted, and then only with great moderation to consumptives who have been apparently cured, for many years. Fencing must be absolutely proscribed.
(To be continued.)
Reflections on the Prevention of Rabies. A note by Messrs. Kelsch and Vaillard in the "Archives Medicale Belges," page 191, relates the case of a young Algerian of twenty years of age, originally from Tunis, who was bitten in both hands in May, 1892, at Sfax, by a wandering dog. The patient was sent to Val-deGrace on the 21st of May, and the treatment began on the 22nd at the Pasteur institute. The first symptoms of hydrophobia appeared early in June, that is, twenty-six days after the bite, and fifteen days after the beginning of treatment. He died June 11 at four o'clock in the morning, after having exhibited all the characteristics of the classical furious rabies. The autopsy revealed no special lesions besides the sub-pericardial ecchymosis.
The bulb and different nerves of the diseased regions inoculated in rabbits and guinea-pigs, produced hydrophobia in these animals in a very short time. The same day that this unfortunate man succumbed to the attack of rabies, a report of the autopsy of the dog which had bitten him arrived, relating that nothing had been found to conclude that this animal had hydrophobia. The symptoms and cadaveric lesions are, therefore, considered insufficient by the author to establish a positive diagnosis; as has been well established by the researches of Pasteur, inoculations by trephining, or by injection in the interior chamber of the eye, with rabic virus contained in the bulb of the animals, are the only exact methods of diagnosis.
[THE notes appearing in this department are abstracts or translations prepared expressly for MODERN MEDICINE AND BACTERIOLOGICAL WORLD, from original sources.]
Infectious Nephritis Due to the Coli-Bacillus.- Drs. Chantemesse and Widal in La Médicine Médicale of Jan. 4, 1893, report a case of pyro-nephritis observed in a woman of 42, following a case of typhoid fever. Microscopical analysis of the urine demonstrated the colibacilli in this secretion in great abundance, causing marked fermentation of lactose. From the latter fact alone it follows that this bacillus was not the typhoid bacillus of Eberth, which cannot produce lactose. Furthermore, this germ does not grow a second time in a medium in which it has already lived. It is also possible to make distinction by the fact that the bacillus of Eberth shows, when young, a dozen or more flagella, while in the coli-bacillus their number is smaller, four to six, sometimes eight. J. H. K.
Bank Bill Bacillus.- According to the Chronica Medico Quirurgica de la Habana, Drs. Acosta and Grand-Rossi have recently made some interesting discoveries respecting the bacteria which accumulate on bank notes. It has long been noted that bank bills increase in weight with their circulation, on account of the foreign matters which accumulate in and upon them. These bacteriologists have discovered that virulent microbes of a most deadly character, which kill animals. very rapidly when inoculated with them, are often to be found upon bank bills. One which was particularly deadly, they named from the effect of its association, the "Bacillus Septicus Aureus." The germs which produce tuberculosis, diphtheria, and erysipelas are also found. The danger of repeatedly moistening the finger while counting bank bills is thus clearly apparent. It is probable that some of the most terrible maladies have been communicated in this way. It occurs to us that it might be a good plan if all banks were required to submit the bank bills passing through their hands, to some efficient form of disinfection, so that the currency of our country might be kept as free as possible from these dangerous enemies to life.
Biology of the Cholera Bacillus. The Berliner Klin. Klin. Wochenschrift publishes the following interesting report, translated by the Medical News. We produce the article without change.
"Uffelmann reports the results of a study of the life history of the cholera bacillus when exposed to various conditions. He found that the organisms may continue to live in still water, not exposed to the rays of the sun, for one or two days, or even for five or six days; if the water has a temperature of from 60° to 70°, multiplication of the bacilli may take place in the first fifteen or sixteen hours. The bacilli may survive for a day or two days in cow's milk, even though acid fermentation has taken place; at temperatures between 64° and 72°, multiplication may take place in the first twelve or sixteen hours. Upon slices of rye bread, unprotected from the air, cholera bacilli may survive for a day; if the bread be wrapped in paper, the organisms may survive for three days; and if the bread be kept under a bell jar, the organisms may survive a whole week. On the surface of feebly acid butter, the organisms survive for from four to six days; in the interior of butter, a shorter time. On roast meat, protected from drying by being placed under a bell jar, they may survive for at least a week; upon smoked fish, kept under similar conditions, they may live to the fourth day. On the surface of fruit, the organisms, after drying, live from twenty-four to thirty hours; kept under a glass jar, to the end of the fourth day; on fresh cauliflower, from one to three days. Upon the printed pages of a book they live, after drying, for at least seventeen hours; on writing paper enclosed in an envelope, at least twenty-three and a half hours; upon postal cards, for at least twenty hours. Upon copper and silver coins and upon copper plates, the bacilli die in from ten to thirty minutes. Upon textures that are apparently dry, they may survive for four days; upon moist goods, for as long as twelve days, perhaps longer; under the condition last named they may even multiply. Flies may remain infectious for two hours after having been brought in contact with moist cholera matter. The organisms may live for an hour, but not for two hours, upon the dry hand."
MODERN MEDICINE upon the country with reference to the im
provement in public highways, will result in benefit to the country at large, amounting in pecuniary value to many times the cost of all the bicycles which have ever been made or will be made. If the bicycle does no more for the present century than to reform our roads, its mission will be one of incalculable value. But the individual benefit which the bicycler himself derives from the proper use of his wheel, is the thing in which the physician is particularly interested. In this land of plenty, the prevalence of sedentary habits has come to be one of the most widely spread causes of chronic disease. This, intelligent physicians have not been slow to recognize, and have found no small difficulty in the majority of cases, in getting rid of those underlying causes which constitute the foundation for the great majority of stomach and nervous disorders, namely, the excessive indulgence in rich and highly seasoned foods of all kinds, and deficient exercise.
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THERAPEUTIC VALUE OF THE BICYCLE.
DR. EGBERT, A. M., M. D., Lecturer on Hygiene in the Drexel Institute, Philadelphia, recently published in the University Medical Magazine an article entitled, "The Bicycle and its Relation to the Physician." Dr. Egbert considers the bicycle not simply a means of recreation, but as a most valuable and efficient means of securing physical development, and regards the general favor with which the bicycle has been received and the great rapidity with which it has come into use, not as a mere fad, but as the natural outgrowth of a great necessity and the presentation of a satisfactory means of meeting a recognized want. Those who are unacquainted with the bicycle and its possibilities as an exercise apparatus, may regard the views of Dr. Egbert as somewhat too sanguine; but any person who has himself experienced, not simply the physiological effects afforded by this fascinating form of exercise, but the increase of vigor and endurance, sharpening of the mind and the clearing. of the intellect, by a ten-mile spin on a good wheel, will be quite ready to join the doctor in his enthusiasm. The bicycle, Dr. Egbert believes, has come to stay, because it is a necessity, and he predicts that its use will increase with the improvement of the public roads.
The influence which wheelmen and manufacturers of bicycles are exerting
The famous Dr. Boerhaave said that more dyspeptics would be cured by climbing a bitter-wood tree than by drinking the bitter decoction of its leaves. The great Napoleon depended on fasting and exercise to cure him of acute illnesses of whatever sort. Gladstone keeps himself young by felling four-foot oaks at Hawarden. But there are few men who have the moral courage to resort to such means of cure. It is so much easier to swallow a nerve tickling or fuddling tonic or hypnotic or a dose of pills, than to take a ten-mile "constitutional," swing an ax for a few days, or work at chestweights or a rowing dummy at stated intervals in a dingy gymnasium.
The bicycle offers advantages to the sedentary man, possessed by no other form of exercise. It brings into activity every muscle of the body. When properly used, it develops the muscles of the trunk, thus promoting correct carriage, though unfortunately many riders assume