Paris, France, the medical fraternity petitioned the government to give them the privilege, for an experiment, of disposing of a criminal who was condemned to be executed, at the same time pledging themselves to use no cruelty. Upon the petition being granted, they tied the criminal into a chair, bandaged his eyes, then his arm for venesection, telling him that he was to be bled to death. When all was ready his arm was slightly prickt, when one of the doctors set a small stream of warm water flowing into a vessel so the subject could hear it flow, then they commenced making preconcerted remarks about the flowing blood, and when at last they spoke of the flow diminishing by degrees, and finally said that in a few more minutes all would be over, and then they remarkt, "at last it is finisht," when to the surprise of all, the criminal was dead in earnest-killed by suggestion, proving its power. Has any doctor who is consulted by a suffering human being the right to discourage such being? I emphatically say no. Our duty is to cheer and encourage, no matter how serious and questionable the case appears, or is in reality. A patient who has faith in the attending physician will watch the expression of the face during examination as well as listen to the words of the doctor, and the effect of either is left after the visit. Just one case as proof: I was attending a lady every other day; when she was improving I lengthened the time between the visits. Then her husband called on me, wishing to know why I came so seldom. I answered, "because it is not necessary to see her oftener," when he remarkt, "I am far from rich, but I will gladly pay you if you will come every second day, as then my wife will get well and strong much quicker, as she feels cheered and encouraged in every way after your visits." Dr. Summers and others like him would do well to try encouragement as a part of treatment, besides medication, instead of predicting death. GERTRUDE HAMMOND HARPER, M. D. Spring Valley, New York. Osteopathy:-General Origin and Distribution of Nerves and Lesions Other Than Spinal That may Produce Disease. No. 3. In our two preceding articles we showed that various spinal lesions of vertebrae and softer structures produce reflexly secondary disorders of other tissues and viscera; also that spinal lesions may result secondarily from such eccentric disorders. We have also shown that these primary and secondary lesions bear an exact anatomical and physiological relation to each other. With a comprehensiv knowledge of anatomy and physiology these spinal lesions therefore become valuable means of diagnosis. In other words the exterior of the body, especially the area along the spine, is an index to the internal condition of the body. With a spinal lesion at a given point we may expect diseases or a predisposition thereto in those organs or tissues having reflex nervous condition with this point. Conversely, with disease of a given viscus, we may expect to find certain spinal centers and areas affected. The nature of these secondary lesions however cannot always be determined by the character of the primary affection. This method of diagnosis is yet in its infancy but even now sufficient valuable data are at hand to enable us to profit greatly by its application. Space forbids an extensiv review of the origin and distribution of the various cerebrospinal and sympathetic nerves and the centers controling individual organs and functions. Information on this subject may be found in standard works on anatomy and physiology. A few facts on the subject may be cited with profit. Nerve fibers from as low as the fifth dorsal vertebrae pass upward, both in the cord and in the cervical sympathetics, supplying motor, vaso motor, secretory, and other fibers to the various tissues of the head and neck. Other fibers from the same source thru the middle and the inferior cervical ganglia pass to the thorax supplying viscera and tissues there. The pneumogastric nerve and also fibers from the spinal accessory nerve, supply tissues in thorax and abdomen. The varied distribution and importance of these fibers is concisely stated by Gerrish as follows: The gross anatomy of the cervical sympathetics gives no idea of its true anatomical relation as revealed by physiological experiment and pathological phenomena. The physiological connection as at present understood may be summarized as follows: 1. Pupillo-dilator fibers pass by white rami communicans from the first, second, and third thoracic nerves, ascending in the sympathetic cord to the superior cervical ganglion to form arborizations around its cells. Thence grey fibers to the Gasserian ganglion and reach the ophthalmic division of the fifth and long ciliary nerves. 2. Motor fibers to the involuntary muscles of the orbit and eyelids from the fourth and fifth thoracic nerves follow a similar course. 3. Vaso-motor fibers to the head, secretory fibers to the submaxillary gland, and pilo-motor fibers to the head and neck are derived from the upper thoracic nerves, and reach their areas of distribution after similar interruption in the superior cervical ganglion. 4. The accelerator fibers to the heart are derived from the upper thoracic spinal nerves, and end similarly in the middle and lower cervical ganglion; grey fibers in the cervical cardiac nerves complete the connection. Thus we see that lesions as low as the fifth dorsal vertebra may be responsible for disorders of the head, neck, and thorax, while lesions as high as the cervical region may, thru the pneumogastric and sympathetic fibers, give rise to thoracic and abdominal disturbances. Lesions affecting the ciliary center situated at a point between the second and third dorsal vertebrae, or a lesion affecting the fibers anywhere between this center and their distribution in the eye, may produce disease in that organ. Similarly, lesions affecting other fibers and centers will produce abnormal conditions in the eye, nose, throat, and other parts of the head and neck, as also cardiac and other disorders of the chest. Lesions affecting the vaso-motors of the brain and head may indirectly affect any or all parts of the body. The splanchnics from the lower thoracic region, together with the lumbar and sacral nerves innervate the abdominal and pelvic viscera and tissues, and the lower extremities. Lesions in these regions will therefore affect directly their associated internal tissues and reflexly many other tissues may be involved which have no direct nervous connection with the center primarily affected. The most prominent symptoms not infrequently emanate from tissues not directly associated with the initial lesion. Lesions other than those along the spine are also productiv of pathological conditions. These eccentric lesions may, in many cases, be the result of some centric lesion. These eccentric lesions may also involve the osseous tissue or may affect only the softer structures. Aside from vertebral subluxations, deviations of ribs are perhaps the most common of the osseous lesions. The ribs as a whole may be down, i. e., the sternum may be deprest, carrying the anterior end of the ribs down with it, thereby materially lessening the capacity of the chest and decreasing the intercostal spaces. The center of the costal shaft may be deprest or elevated, causing slight twisting or rotation of the rib upon its articular surfaces. Such depression or elevation will cause approximation with or separation from the shaft of the rib below, if in its normal position. Such approximation by affecting the interposed intercostal muscles, nerves, and other tissues, may cause not only local trouble, such as intercostal neuralgia, neuritis, pleurodynia, herpes-zoster, etc.; but may also cause disorders in any other part having reflex nervous connection with these tissues. In order to affect the intercostal nerve, it is not necessary that the ribs be approximated so that they impinge directly the intercostal nerve, tho the elevation of the shaft of a rib not infrequently allows its upper border to pass internal to the lower border of the rib above. Such position will permit pressure upon the intercostal nerve which lies in an almost imperceptible depression called the intercostal groove. This depression is scarcely visible save at the angle of the rib. Impingement or irritation of the branches of the intercostal nerve is sufficient to affect the nerve trunk itself. One or more ribs may be deprest as just described. When affecting the upper thoracic region, especially on the left, such lesions are apt to be associated with cardiac disorders. In a case of heart failure during the course of an acute illness when the heart beat was imperceptible and respiration had almost ceast, elevation of these ribs by drawing the arms strongly above the head and applying a forward pressure on the angle of these ribs, restored the patient to consciousness, and gave permanent relief in a few moments. A rib may also be rotated upon itself, lessening the intercostal space at one end and increasing it at the other. Deviations of ribs are not infrequently associated with subluxations of the vertebrae to which they are attacht. One of the most common and most hurtful costal deviations is elevation of the first rib. Any cause which will produce a contraction of the scalenus anticus, or medius muscles, which insert into this rib, will produce such a lesion. These contracted scaleni muscles may be due primarily to lesions of the cervical vertebrae. An elevation of the first rib may take with it the second rib also; or a contraction of the scalenus posticus may draw the second rib up carrying before it the first rib. As would be expected from the nerves and centers involved, lesions at these points are frequently associated with heart and lung troubles as also with goiter, and other troubles of the head, neck, and upper extremities. Elevation of the first rib may exert pressure upon the brachial plexus which surrounds the subclavian artery and its continuation, which artery lies in a groove on the first rib. Such pressures may cause disorders in the arm by direct nervous influence, or reflexly may affect not only the arm, but any or all of the tissues receiving their nerve supply from the fifth, sixth, seventh, and eighth cervical nerves, and the first dorsal-the origin of the brachial plexus. Hilton, in his "Rest and Pain," cites two cases where slight hard swelling on the first rib produced sensory disturbances and gangrene of the arms and fingers from pressure on brachial plexus. Lesions of other ribs directly or thru the associated nerves and nerve centers produce gastric, hepatic, pancreatic, splenic, intestinal, and other disorders. Deviations, especially approximation of the third to the sixth ribs, by reflex nervous influence and by mechanical obstruction to arterial supply and venous drainage may produce disease of the mammae in the female. Lesions of the first rib, clavicle and associated fascia and muscular tissue have been found as causativ factors in cancerous conditions of the breast, probably by obstruction of the lymphatic drainage. Removal of these and other causes will relieve many a suffering woman and rob the lancet and knife of many a victim. The eleventh and twelfth ribs are frequently deprest at their free anterior extremity, especially in the female. Such lesions are the cause of many a pain of an obscure origin, and from their close proximity to the ovary and appendix have led to mistaken diagnoses. Lesions of these two ribs and their articulated vertebrae are frequently associated with appendicitis. These costal lesions, like those of the vertebrae and other tissues may be primary or secondary to internal disorders. Whether primary or secondary these lesions, like others, are none the less important factors in the treatment of a disease. The clavicle is also subject to subluxationssubluxations of degree-at either end. Such lesions may cause disorders mechanically by pressure and irritation to adjacent structures, or by reflex nervous influence. Some time ago I examined a patient who for eight years had suffered from a terrible cough, and was a miserable dyspeptic. He had suffered many things of many physicians in their earnest endeavor to make of him an undesirable dwelling place for the bacillus of tuberculosis but all to no avail. After removing a large blister, placed by a physician over the apex of the left lung to relieve the soreness and pain there, I saw plainly by inspection that the head of the clavicle was back of the manubrium of the sternum instead of in its normal position. Palpation showed the articulation abnormally movable. Backward pressure on the clavicle would produce violent fits of coughing, perhaps from irritation of the pneumogastric nerve. At first the patient could recall no cause for the condition which he could plainly see after his attention had been called to it. The next day he came back to tell me that shortly before his trouble began to develop he remembered being struck there during a boxing bout and being quite sore and spitting up blood for some days after. I never saw him again. I mention this case only to show how even such prominent subluxations escape detection unless we look especially for them. Subluxations of the sacro-iliac articulation is another lesion which osteopathy has emphasized as a causitiv factor of disease. Not only are many abnormal conditions of the extremities, such as shortness of one leg, lameness, sciatica, varicose veins, milk-leg, etc., the result of lesions of this articulation, but pelvic disorders may also result from such a lesion. Subluxations of other articulations, particularly of the small bones of the wrist and ankle are occasionally found. "Lame wrist" may frequently be cured by the reduction of a subluxated carpal. Inspection frequently shows an abnormal prominence of one of these bones in such a condition. In obstinate cases of "rheumatism" of the foot, it is well to look for a more tangible and definit cause than the "rheumatic diathesis or "auto-intoxication." Subluxations will sometimes explain why the rheumatic diathesis or auto-intoxication occurs only in one joint. Incomplete dislocations of the femur at the hip are occasionally found where positions and measurements will not show a typical dislocation. In one case of this kind, treated for four months as a sprain, I found head of femur resting on the superior-posterior edge of the acetabulum. The toe was but slightly everted and measurement with legs extended and also at right angles to the body showed affected limb to be somewhat less than one inch shorter in either direction with abnormal prominence of the greater trochanter. Lesions of the softer tissues of the extremities may cause disease here as elsewhere. Contraction of the pyriformis muscle across the trunk of the sciatic nerve may be the cause of sciatica. Contraction of the tissues about the saphenous opening by obstructing venous and lymphatic drainage may give rise to milk-leg, varicose veins, etc., just as a contracted sphincter ani may cause constipation and a multitude of reflex disorders. We have now arrived at the point where we may consider how osteopathy may successfully treat diseases in general; we will discuss this subject in our next article. Peoria, Ill. W. A. HINCKLE, M.D. [To be continued.] QUIZ New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous treatment Please notice that our query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to "boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity. Only such queries will be publisht as are likely to interest and Instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us. Mild Epilepsy. Editor MEDICAL WORLD:-J. C., a strong, robust girl 14 years of age, dark complexion, quick about her work, studious in school but dull to learn, well grown for her age and good looking, good health except about every four, five or six weeks, when not under treatment, she has from one to six light convulsions during a day, described as “choking spells" by her mother. Says she chokes and can't get her breath nor speak for a little while; always calls for water as soon as she can speak; sometimes passes water during the convulsion, and frequently goes to sleep after convulsion passes off. When an infant, would hold her breath at times when crying, and the first convulsion came on while holding her breath. It lasted six or eight hours, followed by paralysis of one side for several days; was not a year old then. The next day after the convulsions she is as well as usual. Her menses appeared over a year ago; they are normal and regular. As long as the diet and digestion are lookt after the attacks are less frequent and lighter. She is almost entirely free when she is taking the following: a long course of treatment might cause a final disappearance of the symptom. It is certain that the fact of your being able to keep her free from them is encouraging, and we should not think it would be difficult to persuade her to persist in treatment. It is equally probable that if treatment is but indifferently followed, that in time the attacks will become more frequent and that the severity will be augmented. We compliment you on being able to hold them in abeyance, and can only suggest that digestants and laxativs be added to the treatment, and that she be instructed in hygienic methods of keeping her bowels acting regularly. Will any of the family having any comments write the doctor direct?-ED.] Possible Chronic Arsenical Poisoning. Editor MEDICAL WORLD:-I was called to see Mr. B. On examination I obtained the following: Two years ago Mr. B. was lecturing in Buffalo in a college of embalming, and on his return home he had a stroke of paralysis affecting the entire right side, and organ of speech, but recovered without medical aid. But since that time he has had a number of similar attacks, and has been confined to his room for over a year. Physical examination: Age 37 years; weight 190 pounds; weight increasing, appetite good; bowels regular; sleeps well; difficult and painful urination. Urinalysis sp. g. 1022; acid reaction; no albumin, no sugar; prostate glands enlarged; amount of urin normal. Tongue normal; does not deviate to either side when protruded. At times the right pupil will be dilated and the left contracted, and in a short time they will be vice versa. Hearing deficient since last attack, three months ago. Heart action full and strong, 96 per minute. No fever. Deglutition sometimes difficult. For two months after last attack had no control of urin or bowels, but is all right in that respect at present. No pain; no girdle sensation; has been very intelligent, but now his actions are that of a baby. Everything he gets hold of he puts in his mouth. He says he knows he shouldn't do it, but says he can't help it. His memory is good; he can remember everything in the past, can converse intelligently on most any subject, but at times he can't say what he wants to. At times he repeats his words and sentences a number of times. One minute he will be crying and the next minute he will be laughing. No history of syphilis nor any venereal disease. He is still paralyzed on the right side. Family history: Mother and his mother's mother died of paralysis (both of them in old age). Father died at the age of 56 of carbuncle. Mr. B. has followed embalming as a trade for a number of years. Says he used formaldahyde 10 percent and arsenic as an embalming fluid. He has been the rounds, and has taken most all kinds of medicin. When I saw him he was taking the following proscription: Potassii iodid . 4 oz. 4 oz. Essence of pepsin . Directions as follows: Dessertspoonful after meals, and increasing to tablespoonful. Has been taking this prescription for months without any disturbance of stomach or any eruption of the skin, but has not improved any; in fact not so well. I put him on f. e. ergot, bromids, aa 4 oz.; teaspoonful four times a day; also 1-60 gr. of strychnin 4 times a day. What is the matter with him, and what is the proper treatment for him? Gravity, Iowa. LLOYD REED, M.D., [Altho the case presents features diverging widely from the classical ones of the text-books as regards arsenical poisoning, chronic in type, we believe that to be the origin of the trouble. That has evidently been the diagnosis of your predecessor who prescribed the potassium iodid. We would suggest electricity, and an increase in your dosage of strychnin to at least grain four times daily; we have often workt up to grain, and once saw a patient taking grain who had gradually reacht that enormous dose after several months' treatment. Massage of the affected muscles would be indicated. Further than this we cannot advise; perhaps some of the family may wish to contribute. If this proves to be a case of chronic arsenical poisoning, it will be an interesting one when completed, and we would like to have you get it up for THE WORLD.—ED ] GOMBAULT'S CAUSTIC BALSAM. Gombault's Caustic Balsam states on its labels that it is a safe, speedy, and reliable remedy for curb, splint, sweeney, poll-evil, grease-heel, capped hock, strained tendons, founder, wind-puffs, mange, skin diseases, old sores, dropsical affections, inflammations, throat difficulties, swellings or ulcerations, lameness from spavin, ringbone, and other bony tumors, and many other diseases or ailments of horses, cattle, sheep, and dogs; will quickly remove all bunches or blemishes, without leaving any scar or other injurious effects. It can also be reduced with sweet or raw linseed oil, and used as a most valuable liniment for all kinds of simple lameness, strains, etc. The following formula makes a preparation which replaces the secret article to good advantage: Take of Croton oil Cotton-seed oil. Oil of camphor. Oil of turpentine Oil of thyme. Kerosene Sulfuric acid. To the mixture of croton and cotton-seed oils add the sulfuric acid, stirring continually, then add the other constituents. After standing a few days it resembles the original preparation fairly well. -Western Druggist. Bright's Disease. Editor MEDICAL WORLD:-I have Bright's disease. Can you send me a cure thru THE WORLD? Asheville, N. C. A. CRAWFORD, M.D. [Doctor, we regret that it is not possible to cite you to a cure for Bright's disease; yet much may be done to alleviate the condition and to prolong life. Send $1 to E. B. Treat & Co., New York, N. Y., mentioning WORLD, and ask for Von Noorden on Nephritis. In this little work you will find much of interest and benefit.-ED.] I take four other medical journals, but look upon THE MEDICAL WORLD as being the closest friend to the busy practician. Thompsonville, Miss. A. L. Chapman. Palatable Solution of Epsom Salts. Editor MEDICAL WORLD:-On page 523 of November WORLD, 1903, you give a formula for a palatable solution of Epsom salts, to-wit: Magnesium sulf., 1% lbs.; granulated sugar, 1⁄2 lb.; ess. peppermint, 1⁄2 oz.; ext. orange peel comp., 1⁄2 oz.; tinct. Jamaica ginger, 1⁄2 oz.; dist. water, % oz.; tinct. cudbear, enuf to color. Mix the salts and sugar, and dissolve by heat; then add the aromatics and stomachics. Now it appears to me that you have omitted something. How much water should be added to this in order to get a solution? I gather by the prescription that the sugar and salts are mixt dry, then dissolved by gentle heat. I have tried this, and I find it cannot be done. I soon had a burned crust of the ingredients on the bottom of the kettle. I added 4 oz. of water, and still I have not a clear solution. What is the amount of water that should be added? McConnelsville, O. H. L. TRUE, M.D. [The sugar and the magnesium sulfate are the essentials, and enuf water is added to make the solution and give the desired dose to each tablespoonful. Thus the amount of water will be varied by different compounders, according to their various needs. The peppermint, orange peel comp. and ginger are calculated to be sufficient flavoring to conceal that amount of salts, and the cudbear may be varied to give sufficient color to the amount of fluid desired, whatever that may be. It is best to add the water slowly, while subjecting the mass to heat. With care, it will not burn, if enuf water is employed at first.-ED.] Destruction of Abnormal Growth of Hair. Editor MEDICAL WORLD:-I have two patients, sisters, with a superabundance of hair on upper lip and chin. Those on chin scattering, but large and long. They are young women and they are very desirous of getting rid of it. Is there any treatment aside from electrolysis that will remove it, so it will not return? Will you or some of the profession give us some definit treatment, either medicinal or electrical? Can they be treated successfully at home? or will they have to go East to some specialist? They would much prefer to have it done at home, if possible. Waitsburg, Wash. A. D. MAHOFFAY. [There are several methods recommended as reliable in extermination of hair, but we have no knowledge of any except electrolysis which absolutely destroys the hair. After the use of other agents, the hair returns. The hair is removed by inserting a needle into the follicle of each individual hair, and turning on the current. When done by an expert it is not so painful but what it can be borne, some even claiming entire painlessness of operation. Any battery and needles. practician can do it, when provided with battery and needles. Naturally one acquires skill with practise. You should get a book on electrical treatment, and read up on it, before either purchasing a battery or attempting treatment. It is said by some authorities that the repeated application of undiluted peroxid of hydrogen will cause the hairs, in time, to gradually lose color, become finer and finally disappear altogether. We have not had any personal experience with the method. Hydrated |