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ETIOLOGY AND DIAGNOSIS.
The Successful Treatment of Tuber
culous Fistulae. There is little or no Three Points of Importance in Intesti.
doubt that oxidation and allied conditions nal Obstruction.- Dr. W. J. Mayo
often act inimically upon aërobic as well (Lancet-Clinic) says: “In acute intestinal
as upon anaërobic bacterial lesions, and obstruction I think there are three points'
the fact that many a chronic case of empyso important that every surgeon of large
ema is hastened in its healing by oxygen experience must have had them brought to
put into the wound by means of a sterilized his mind time and again. First, do not
glass cannula attached to an oxygen give cathartics to a patient if you suspect
cylinder is familiar enough. There are intestinal obstruction. I have noticed par
certain other conditions, however, in which ticularly that the cases that have been
the application of oxygen in this way is brought to us practically in a moribund
less easy, and the use of certain oxidizing condition, have had catharsis early, and thereby their chances of recovery have
agents may be resorted to instead. The
effectiveness of potassium been diminished to a very serious extent.
crystals inserted into a snake-bite imSecond, do not give opium, because it
mediately after its occurrence is known to masks the symptoms, and our only hope of
many people who have lived in the Tropics. recovery from operation lies in getting the
It is probable that potassium permanganate patient to operate on early. Third, do not
acts in a somewhat similar way when it is give food.”
used in the manner advocated by Dr. Scobie for the cure of tuberculous fistulæ.
Amongst other cases he had a male pa
tient, twenty-eight years of age, who sufThe Diagnosis of Trichinosis.1_Thomp
fered from tuberculosis of the left lung
and from two tuberculous areas in the reson says that there should be no difficulty
gion of the anus. These were situated to in determining promptly a correct diag
the left of the anal aperture, each being nosis of trichinosis based upon the ob
half an inch in length and apparently servation of the following symptoms: 1.
healed, but examination in a good light Acute onset usually with vomiting and ab
showed that they were still discharging a dominal cramps. 2. A high grade of eosino
little pus; to the right of the anus there philia, invariably present; usually above
was a bluish unhealthy-looking swelling thirty per cent. and frequently much high
about the size of a bantam's egg, the resier-even above eighty per cent. 3. A high
due of an ischio-rectal abscess which had grade of temperature, often reaching 104°
been incised but which had filled up again. F. or more, and lasting, in lessening de
When opened it discharged a tablespoongree, for two to six weeks. 4. Puffiness of
ful of thick pus. Careful probing of all the eyelids and face, with pains in the eyes
three lesions did not reveal anything in occurring in one-fourth of the cases. 5.
connection with the bowel. The patient Dyspnoa and diaphragmatic breathing oc
was in a very emaciated condition, and curring without cyanosis in about one
would allow of no further operative treatfourth of the cases. 6. The generalized
ment. Crystals of potassium permanganmuscle pains, cramps, soreness, and pros
ate were introduced into the healthier of tration, causing sometimes deceptive ap
the two fistulæ after it had been carefully parent immobility. 7. The sudden oc
washed out. The patient experienced a currence of symmetrical circumscribed cor
sharp pain lasting about a minute, but there neal hæmorrhages in a patient whose blood
was no other discomfort; the treatment vessels are not degenerated, should give
was continued for three weeks, the crystals rise to a suspicion of trichinosis.
being allowed to dissolve slowly in the
feeble discharge. The result was a perW. G. Thompson, M. D., Amer. Jour. of Med. Sciences, Aug., 1910..
The Hospital, July 16, 1910.
, Vol. V., No. 8. fect healing of the fistula. Dr. Scobie, dose of calomel or grey powder before thus encouraged, packed the other in the commencing the saline treatment. Castor same way twice a week, and in two months' oil is well known as a very safe aperient, time it also healed up finally. The ischio- but has the disadvantage of intensifying rectal abscess was now washed out with the constipation if used in occasional doses. hot, freshly made permanganate solution, In spite of this it is invaluable when it is the interior being thereafter filled with necessary to clear away curds in milk dyscrystals of permanganate of potash. The pepsia, and it can then be followed by mild cavity being larger than the others had salines. If a small and delicate infant has been, the patient experienced more pain, to be treated, the castor oil can be given and this lasted about an hour after the with an equal part of pure olive oil. Castor crystals were inserted, but the effect on oil has another useful function in young the discharge was
considerable and children, when there is irregularity of acmarked. The general health of the pa- tion of the bowels. In this particular class tient continued good, and the cavity of cases there is at one time constipation, at steadily shrunk up until presently there another diarrhea. Small doses of this was no pus visible except at intervals of drug given once, twice or thrice a day will a week or ten days, and in due course the often correct either of these irregularities. wound healed as the others had done. Five minims given in a mixture with a
carminative twice a day is an average dose
for a child of 12 months. Constipation in Childhood. To combat When the constipation is associated with constipation in infancy, Poynton says it
deficient hepatic action, indicated by pallor may be quite sufficient to use manna, which of the stools, grey powder is a useful remshould be dissolved in hot water and edy, and this may be combined with powstrained through muslin. This remedy, no dered rhubarb as follows: doubt, often fails, but it is very satisfactory
gm. or cc. when effectual, and for this reason worthy
Pulv. hydrargyri cum creta. 06 of trial. Some light massage along the
gr. ss. colon will help these cases. Salines are
2 most valuable remedies. The secret of the
Fiat pulv. successful use of salines lies in their reg
To be given at night. ular employment, in sufficient dosage to Poynton has used phenolphthalein in a produce a thorough relief of the bowels. considerable number of cases of constipaThe initial dose must be an experiment,
tion in mentally deficient infants and chilbut once ascertained, it should be persisted dren, and he has found it sometimes very with until a regular habit had been estab
convenient and efficacious in these cases in lished and then should be diminished doses from 34 of a grain to 2 grains. cautiously. If too little is given, griping pains and distention may result, and if too much, the motions will become unduly fre- Tuberculosis of the Elbow.1- Sever conquent and liquid.
cludes his valuable paper as follows: A likely prescription for a child 2 years Tuberculosis of the elbow occurs early of age would be:
in life and often after trauma. R
There is an equal chance in a given case gm, or cc.
of abscess formation. The disease may Magnesii carbonatis 166
gr. X appear in the head of the radius or in the Sp. choloroformi
113 mii olecranon or in the lower end of the huSyrupi
mxv merus, and later invade the joint. Aquæ
The best treatment is rest and fixation To be taken twice a day—after meals. with the arm at a right angle and the foreIt would be necessary, if there has been
midway between pronation and constipation of some standing, to give a supination. Ankylosis is to be expected in
'F. J. Poynton, F. R. C. P., London, Practi- H. M. Sever, M, D., Boston, Med. and Surg. tioner, May, 1910.
Jour., May 19, 1910.
at least one-half of the cases, with very used and continued for many days if a slight to good motion in the other half. large area of the surface of the body is
Resection of the joint is only to be done burned. after careful consideration of individual 3. Protection of the tissues and prevencases and when the whole joint is disor- tion of infection demands our greatest efganized from disease, or ankylosed in a forts and must be kept in mind from the bad position.
beginning. Nature puts forth her greatAnkylosis is to be expected following re- est efforts, and the system will exhaust its section of the elbow joint.
entire resources to accomplish this end; The average course of the disease is but Nature cannot prevent the invasion of about two and one-half years.
pus-producing micro-organisms—the surgeon can.
I wish here to condemn two things of
ten done, and at least sanctioned by most The Treatment of Burns. There are of our text-books: first, puncturing blisters four things to demand attention in the suc- immediately after a burn and second, the cessful treatment of burns, says Fancher, use of carron oil and other remedies of its any one or all of which may be required in kind as a protecting dressing. . a given case; first, to combat shock if it A blister is a non-irritating protection exists; second, to relieve pain and nervous to the delicate underlying structures, and excitability; third, to prevent infection and the surgeon can furnish none. to protect exposed living tissue; and When the patient is fairly comfortable fourth, to assist Nature in her work of the bath may be discontinued, and the repair.
burned area with the surrounding surface i. Shock, which often occurs as a re- sprayed or mopped with peroxid of hydosult of severe burns, is treated on general gen. The entire surface should then be principles too well known to the profession mopped dry with gauze. Then strips of to be discussed in this paper. Some one gauze which have been previously soaked has said, “Shock is shock," meaning that in the following solution should be applied regardless of its cause, shock must be over the entire area. treated in the same manner under all con
gm. or c.c. ditions.
Picric acid ..... ........41 gi 2. To relieve pain and nervous ex- Alcohol ...............641 or Zii citability, it is usually necessary to give a Water .................72 0.iss hypodermic injection of morphin and Over this a thin layer of cotton should atropin and then to immerse the burned be applied. The dressings should be kept area, if it be on an extremity, in cold wa- in position by loosely applied adhesive ter to which has been added a tablespoon- strips or a roller bandage. This dressing ful of bicarbonate or chlorid of sodium to soon dries and may remain for several the gallon. It is not necessary for the wa days, or until it becomes soiled ; at which ter to be ice-cold. A temperature of from time remove all soiled or wet dressings, 50 to 60 F. is preferable.
spray with peroxid, mop dry and reapply If the burned area cannot be immersed fresh gauze soaked in the picric acid soluin water on account of its location it may tion. be covered with a light smooth cloth which After the third day the larger blisters has been dipped in the solution; then by should be opened and the fluid contents gently and continuously mopping this cloth mopped away and fresh dressings applied. the same result will be obtained.
This treatment is applicable to all burns This water-bath may be continued for whose severity is not great enough to cause some time or until the systemic effect of sloughing. the morphin is manifest.
If sloughing does occur as a result of In institutions where trained assistants charred tissue or later as a result of inare always at hand the whole bath may be fection, the dead tissue should be removed 'H. L. Fancher, M. D., Chattanooga, Tenn., as rapidly as it becomes separated
as rapidly as it becomes separated, and the Jour. A. M. A., July 2, 1910
underlying exposed surface sprayed with
. gr. L
peroxid, and mopped with the picric acid one or two movements, such as a teaspoonsolution; over this should be applied small ful of Epsom salts, Carlsbad salts, sal strips of rubber tissue which have pre- hepatica, phosphate of sodium or seidlitz viously been soaked in 1:1000 bichlorid so- powder. These not only remove any hard lution. The dressing should be finished as irritating fecal matter that may be in the before suggested.
bowels, but they exert a beneficent effect The picric acid solution, by its slight upon disease of the liver and portal sysastringent action, limits the exudation of tem which is so frequently associated with serum by constricting the congested su- hemorrhoids. perficial capillaries, and does not interfere The local treatment consists in reducwith the development of new epithelium. ing the inflammation and strangulation of Its germicidal action prevents infection, the piles as soon as possible. To accomand in my hands has never produced any plish this the patient should be put to bed, systemic toxic effect.
and hot poultices or ice bags applied to the The rubber-tissue strips furnish a non- parts, whichever feels the most comfortirritating covering to the denuded surface, able, or soothing applications may be used, and do not interfere with granulation in as lead and opium wash or witch hazel. I their removal. If the rubber tissue is ap- have frequently had good results from the plied in narrow strips, the edges being al- application of antiphlogistine when the lowed to overlap, the dressing more per- piles have been external and strangulated. fectly conforms to the irregularities of the The following ointments may be employed : surface. The dressing should be changed
R Morphin. sulph.
...gr. V as often as it is necessary to keep the sur
Ung. zinci oxid. face clean and free from pus.
.Z i R Bismuth. subnit.
3 ii Hydrarg. chlor. mit. Morph. sulph.
.gr. V Zinci oxidi
.3 ii The Non-Operative Treatment of Hem
Vaseline orrhoids.1 — By the proper use of certain Sig. Apply to parts morning and evening. measures the pain can be relieved, inflam- Dr. Gant, of New York, recommends : mation diminished, and the size of the piles
R Morph. sulph.
..gr. viii reduced, and they may remain so for weeks
Hydrarg. chlor, mit....
3 i or months, until some cause starts up the Sig. Apply freely in the rectum to the tuinflammation again. Nothing can be expected from this line of treatment in the Dr. Andrews recommends this supway of a permanent cure. It is only
only pository: palliative at best, but a great deal or al- R Pulv. opii, most entire relief can be afforded for some
. aa gr. X 01. theobrom.
.q. S. time; therefore it is proper to adopt this Divide into five suppositories. Sig. Intreatment if there is any good reason, sert one when required. owing to the condition of the patient, why the hemorrhoids should not be removed.
To obtain good results from this line of Treatment of Ringworm.- The several treatment, it is necessary, as far as pos- antiseptics advocated for outward applicasible, to correct any existing disease of the
tion in cases of ringworm are far from satheart, blood vessels or liver, and any de- isfactory, the prolonged duration of the bilitated condition of the system which may disease proving their inefficiency. In exist, but all medication should be avoided
dealing with the numerous cases of pedicuthat will induce constipation. Remove any losis in fever wards, E. Lynn Jenkins reobstruction of the colon or rectum, which ports in the British Med. Journal that he may exist from pressure by other organs and his associates always employ the esor' from constipation. If necessary to sential oil of sassafras, which, without exovercome the latter, give a small dose of a
ception, they find acts as a specific in such saline cathartic every morning to obtain cases. *W. H. Hodson, M. D., Int. Jour. of Surgery,
When both pediculosis and ringworm Aug., 1910,
occurred in the same scalp, it was noticed
that the latter disease also reacted favor- abscesses may be completely dispersed by ably to this preparation.
the following method, which has been very This led them to test the possible use- successful for abscesses in the neck. The fulness of the oil for ordinary cases of skin having been scrubbed with a boiled ringworm, and so far the results have nail-brush, several layers of gauze soaked been most happy. The hair is cut closely in ether are placed upon the prepared area around in order to identify the patches, the and the compress covered with oiled silk application of the oil being made twice and bandage. Frequently a corner of the a day by means of a camel-hair brush. dressing is raised and enough ether poured This is continued for a few weeks, as the on to moisten the gauze. In a few days case indicates. No irritation is produced, cure may be looked for almost with cerwhile the preparation is most pleasant to tainty. use. Not only is the spread of the infection prevented, but that the fungus is being destroyed with certainty is recognized Alum and Ingrowing Nails.- Accordin two or three weeks, by commencing de- ing to the American Journal of Clinical velopment of fine hairs.
Medicine, every case of ingrowing toe-nail can be cured in five days by the free application of dry powdered alum. No pain
attends this form of treatment, and the THERAPEUTIC NOTES.
destruction of the diseased tissue results in the formation of a hard resistant non
sensitive bed for the nail with a cure of An Antidote for Alcohol.-Hennell, in the ingrowing tendency. The non-toxicity the Electric Medical Journal, lays great of the alum, its easy application, and the stress on the good results which can be ob- good results obtained from it render it the tained by the use of ammonium chloride treatment of choice, at least in cases where in the treatment of alcoholism in all its no operative measures are contemplated. phases. According to the author, 30 A soap-and-water fomentation is first apgrains of the drug dissolved in a drachm plied for twenty-four hours, and then the of water and given at one dose, followed alum is applied to the space between the by a copious draught of water, not only nail and its bed; a tampon of cotton-wool will counteract the effects of the alcohol is next placed on the alum, and the appliand sober the patient rapidly, but will pre- cations repeated daily. Suppuration rapidvent the onset of delirium, and overcome ly ceases, the parts dry up, and pain and the craving for alcoholic stimulants. If discomfort vanish almost at once. after the ingestion of the drug the patient rate, the method would seem worthy of has not quieted down in the course of two trial, or three hours, some hypnotic, such as chloral hydrate. or a bromide mixture, should be given. As a rule, when the pa- Trichinosis.- Oedema with slight erytient awakes after this treatment there will thema (The Hospital) over the swollen be felt no craving for alcohol.
tender muscles is very suggestive. In its thor points out that while 30 grains may most characteristic form the ædema occurs seem a
a very large dose of ammonium in the eyelids and over the eyebrows, and chloride to give in view of the gastro- when this appears early in the disease its intestinal irritation which it is said to pro- diagnostic value is considerable. In the duce, when given as an antidote for alco- hands and feet ædema usually occurs late. hol only a single large dose is administered and that this is followed by a copious draught of water.
Camphoric Acid and Night Sweats.The night sweats of phthisis (The Hos
pital) are probably due to a variety of facThe Treatment of Multiple Abscesses. tors, acting directly or indirectly through -In many cases it has been found that the nerve centres. Camphoric acid, given