« PreviousContinue »
THE MEDICAL WORLD
The knowledge that a man can use is the only real knowledge; the only knowledge that has life and growth in it and converts itself into practical power. The rest hangs like
dust about the brain, or dries like raindrops of the stones.-FROUDE.
The Medical World
gecuring the general adoption of the suggested amendments IRVING SHEPARD, Secretary."
We feel it a duty to recognize the above tendency, and to adopt it in a reasonable degree. We are also disposed to add enui
(enough) to the above list, and to conservativiy adopt the followC. F. TAYLOR, M.D., Editor and Publisher ing rule recommended by the American Philological Association :
Drop final "e" in such words as “definite," "infinite," A. L. RUSSELL, M.D., Assistant Editor
“favorite," etc., when the preceding
vowel is short. Thus, spell opposit, "“ preterit," "hypocrit," "requisit," etc.
When the preceding vowel is long, as in polite," "finite," SUBSCRIPTION RATES: To any part of the United States,
unite," etc., retain present forms unchanged. Canada, and Mexico, One DOLLAR per year, or FOUR YEARS We simply wish to do our duty in aiding to simplify and rationfor THREE DOLLARS; to England and the British Colonies, alize our universal instrument-language. Five SHILLINGS Six PENCE per year; to other foreign countries in the Postal Union, the equivalent of 5s. 6d. Postage
Treatment of Dysmenorrhea. free. Single copies, T&N CENTS. These rates are due in advance.
The time is now past when the well informed HOW TO REMIT: For their own protection we advise that
practician deems every case of dysmenorrhea our patrons remit in a safe way, such as by postal money order, express order, check, draft, or registered mail. Currency sent an indication for dilation and cureting. In by ordinary mail usually reaches its destination safely, but such cases as really need it, it is a valuable money so sent must be at the risk of the sender,
feature of the treatment, but the procedure is We cannot always supply back numbers. Should a number fail to
reach a subscriber, we will supply another, if notified before by no means the whole of treatment even when the end of the month.
indicated. The neurasthenic frequently forNotify us promptly of any change of address, mentioning both old
gets her dysmenorrhea under appropriate treatand new addresses. If you want your subscription stopt at expiration of the time paid
ment for her disordered and distorted nervous for, kindly notify us, as in the absence of such notice we will system and its vagaries. Endometritis due to a understand that it is the subscriber's pleasure that the subscrip
sedentary life, aggravated by vicious habits of tion be continued, and we will act accordingly. Pay no money to agents unless publisher's receipt is given.
the bowels and indiscretions in diet, yields
more happily to other measures than the curet. ADDRESS ALL COMMUNICATIONS TO
The pallid and anemic woman would better be “THE MEDICAL WORLD"
toned up, fed, and given plenty of exercise in 1330 Chestnut Street
Philadelphia, Pa. the open air, rather than be further reduced by the scraping process.
In married women, inVOL. XXII. FEBRUARY, 1904.
tra-uterin treatment by the negativ pole of the Language is a growth rather than a creation. The growth of
galvanic current or by faradism, is of proour vocabulary is seen in the vast increase in the size of our diction. nounced benefit. Cases of malposition should aries during the past century. This growth is not only in amount, but among other elements of growth the written forms of words are
be dilated and cureted, and then the uterus becoming simpler and more uniform. For example, compare Eng: should be replaced and kept in proper position. lish spelling of a centnry or two centuries ago with that of to-day! It is our duty to encourage and advance the movement toward Every case of dysmenorrhea should be given simple, uniform and rational spelling. See the recommendations of the Philological Society of London, and of the American Philo.
an aperient just before the date of the expected logical Association, and list of amended spellings, publisht in the appearance of the molimen, and should be kept Century Dictionary (following
the letter 2) and also in the Stand. ard Dictionary, Webster's Dictionary, and other authoritativ
in bed for the first twenty-four hours of the works on language. The tendency is to drop silent letters in some flow. Morphin gives the quickest and most of the most flagrant instances, as ugh from though, etc., change ed tot in most places where so pronounced (where it does not affect
certain relief, but there is great danger of the the preceding sound), etc. The National Educational Association, consisting of ten thous
habit being contracted if it is given continuand teacbers, recommends the following:
ously for many months. Two grains of acet"At a meeting of the Board of Directors of the National Educational Association held in Washington, D. C., July 7, 1898, the
anilid and three grains of carbonate of amaction of the Department of Superintendence was approved, and monia given every hour for three doses is said the list of words with simplified spelling adopted for use in all publications of the National Educational Association as follows: by Professor Hirst to be the next best thing to tho (though);
program (programme); morphin. Apiol is but seldom of any use. altho (although);
catalog (catalogue); thoro (thorough): prolog (prologue);
The bromids and valerianate of ammonia may thorofare (thoroughfare); decalog idecalogue);
be combined with other measures, and are of thru (through);
demagog (demagogue); thruout (throughout); pedagog (pedagogue).
undoubted utility in such combinations, but "You are invited to extend notice of this action and to join in they are only effectual alone in the milder
The fluid extract of viburnum pruni- all cases that have had irrigation I suspect deep foliatum, in dram doses every two and a half
involvement. After washing out the anterior urethra I
have these "irrigated" patients pass a little urin into a or three hours, is an old remedy, and is always glass and finish in a second glass; the urin in number useful as an adjuvant. Scarification of the cer- one usually shows shreds, and it is not so clear as in vix just previous to the appearance of the flow
number two glass. This means deep involvement and
post urethritis. I use a special salve depositor, but is frequently practised in Germany. A hot any ordinary rubber catheter with a snipe nozzle "P" sitz bath of twenty minutes' duration, on the
syringe will do as well. The treatment is by instilla
tion with the salve, and the internal treatment, or appearance of the flow, often gives grateful re
sterilization of the urin. Take a given case : A young lief, especially if the patient retire immediately man comes to the office with a plain case of gonorrhea ; afterwards to a warm bed for twelve to twenty
was exposed five days ago ; first noticed a little sticking
of the mouth yesterday, drop of matter this morning; four hours.
now has a drop, and stains on the clothing ; has used no injection. Have the patient urinate, and instil
dram of the salve down the urethra two inches, put a A New Treatment for Gonorrhea.
bat of absorbent cotton over the penis to catch the salve
that comes back, tie it on loosely, instruct the patient The best proof of the general dissatisfaction
to keep the dressing on until he is compelled to urinate, which exists among the profession with the and to come back twice daily for the insertion of the present approved (?) methods of treating gon
salve, morning and evening. Give internally this
compound : orrhea is the avidity with which new theories
6 drams and treatments are seized. In most instances Powdered cubebs. we do not make editorial note of such “cures
Benzoic acid, of each
Powdered pepsin . unless to call attention to some flaw in their
Mix and make mass. Divide into 30 equal parts; theory or to warn the too enthusiastic reader. put each into a cachet or cold wafer. Direct one before We are proud to recall that we tried to check
meals and at bed time. the too credulous when the profession went
The salve that I use is composed of :
Yellow oxid of mercury. . 20 grains wild over the irrigation treatment. Yet the
I ounce treatment of which we now speak, altho too Oxid of silver.
2 drams newly promulgated to have allowed extended
Powdered scale pepsin
Powdered caroid, of each . 4 drams test, is so strictly rational and in line with
Albolene common sense that we cannot avoid mention- Lanolin
. 2 ounces ing it. It is an emanation from the brain of
Water, of each Dr. W. H. Whitehead, of Atlanta, Georgia,
The working formula of this salve is : “Dissolve the
oxids of mercury and silver in the oleic acid and alwho reported it fully in the Therapeutic Ga- bolene ; to do this it is necessary to triturate the oxids zette of September last.
The Doctor is very
in a large mortar, dry, then add oleic acid, and con
tinue the trituration till the mass begins to stiffen ; then anxious that his treatment be given a thoro add the albolene quickly, and the trituration must be test under varying conditions in different sec
continued till a uniform paste is obtained. Then add
the lanolin and rub it well into the mixture ; finally, tions of the world, and we abstract from his
having dissolved the pepsin and caroid in the water, article, giving the working formula in full with- and filtered it thru a lightly plugged funnel with out much comment or theorizing.
absorbent cotton (this is necessary as the caroid has
grit in it), add this aqueous solution to the salve in the The Doctor was dissatisfied with the results mortar, and triturate the whole till it is a uniform he obtained from the recognized plans of at- creamy paste. These details are important, and any tack against the gonococcus, and began experi
departure will result in a lumpy, uneven mass that is
not only inelegant, but is much inferior therapeutically. menting with pepsin and paw-paw extract as a The salve is penetrating, owing to the albolene, which local application to the urethra, with the in- is a purified kerosene oil. It is germicidal, owing to tention to dissolve the plugs of germ breeding tufts and exudates out of the follicles, and permeates
the mercury and silver. I claim that it digests the mucus which lodge in the crypts and follicles these otherwise inaccessible germ-infected recesses. of the mucous membrane, bis observations thru
The long contact of the medicament gives ample time
for the digesting process and for thoro germicidal an endoscope having satisfied him that no in- action." jection or mode of application now in use "The salve is painless, all discharge is arrested by a really removed these plugs. He insists upon
two or three days' use of it, and radical cures are
often obtained by one dozen applications-six days' the fact that only that part of the urethra which treatment. When all discharge has ceast for 48 hours is actually involved should be treated, ard that
and the first urin is clear, I suspend the local treatin the ordinary case the disease progresses
ment, but continue the internal treatment for a week
or ten days longer. If the discharge returns, use the backwards with the duration of the disease. instillation treatment for one dozen applications, by Thus:
which time the discharge will have disappeared
entirely." “My rule is this : patients coming to me at once, on "In treating the female, first locate the infection ; the first appearance of the malady, I treat only the first if it is a recent infection, and is confined to the vagina, third of the urethra-two or three inches-and endeavor use the same salve, making only one application each not to put the salve any deeper from day to day. A day, but use a much larger quantity, putting a plug of one week old case is apt to involve the middle third absorbent cotton that has been dipt into the salve well also, and I put the charge out at the peno-scrotal junc- up the vagina, thru a speculum, and leave it in for tion. I take it for granted the disease has extended 24 hours. Have the woman remove this on the followback to the "cut off' muscle, and treat the entire an- ing day, and take a very hot salt water douche just terior urethra, depositing the charge into the bulbo- before she comes to the office for the next application. membranous portion, allowing it to work forward. In If her urethra is involved, I give her the internal treat
ment, and also deposit some of the salve into her impossibility of declaring from examination urethra each day ; if the urethra is not involved, these
within that time, of a body said to be dead by measures are unnecessary. If you have reason to suspect cervical or uterin involvement, deposit the drowning. whether or not life may yet exist. salve in the cervical canal, or even into the cavity of the When newborn babies fail to breathe, it is well uterus, daily. The result of this treatment in the female is even more satisfactory than in the male, as
known that they may be coaxt to begin respirathe contact is longer, and the sterilization consequently tion many minutes after birth; some obstetrimore thoro. I have seen a profuse discharge, with the
cians teach that efforts should be continued. accompanying vaginal and labial imflammation, completely removed by one application. Whether the for three quarters of an hour. pepsin and caroid have germicidal powers, or simply Syncope often presents features sufficiently dissolve the exudate and let in the known germicides, I am not able to say, but that the combination does ali
alarming to the uninitiated to lead them to I claim for it only needs a test to prove that it is the believe i hat death has occurred, yet the condirational remedy for gonorrhea."
tion is usually so temporary that no great danThe difficulty has always been to get patients ger of serious results actually exists. Permato attend the office frequently enuf, but if one nent heart failure may, however, succeed the can promise them a cure in one to two weeks, temporary faint unless prompt and rightfully it ought not to be difficult to get their consent directed measures are instituted. Death has to be punctual and faithful in attendance. resulted during or immediately following syndeem the matter of sufficient importance to ask cope, and indeed the result of treatment is often those who try the treatment to report briefly necessary, in aggravated cases, to determin upon the results they secure.
whether or not life has ceast.
Trance is the nearest similitude of death Simulation of Death.
known to the medical profession, and not infreOne may imagin that it is possible in the quently terminates in death. Consciousness is haste of burial after battles or during devastat- lost, and the face has a death like pallor. The ing plagues, for persons to be buried alive; yet muscles and limbs may be either rigid or flacit is beyond the bounds of credulity when an cid. The reflexes may be lost and the pupils intelligent person is expected to believe it pos dilated immovably. Sensation may be retained, sible that burial while yet living is so common and hyperesthesia has been recorded. Both as “hearsay ” would indicate. The customs respiration and heart action may be impercepprevailing among civilized people all over the tible. If trance lasts many hours, the diagnoworld in disposing of their dead, preclude such sis requires more than a casual glance. Gowaccidents in any but the rarest instances, and ers calls attention to the following points: even then only under the most extraordinary There is no evidence of decomposition. circumstances. Nevertheless, because of the 2. The eye preserves its normal opthalmoscopic actual fear which exists in the minds of many, appearance at the fundus. 3. The muscles even among the intelligent and educated classes, continue to respond to electrical stimulation. it becomes the duty of every practician to There should be no hesitancy in making an inform himself regarding several points in this absolute diagnosis in any case, if the practician connection. The real danger is not that peo- but apply the most elementary knowledge, and ple may be buried alive, but that in some cases keep the case under continuous observation for of apparent death the appropriate measures for a sufficient period. The ludicrous efforts of resuscitation may not be undertaken soon enuf the hysteric could only delude the novice. to save life. Apparently complete cessation of respiration
Safety in Anesthesia. and circulation may occur in catalepsy, partial
One might imitate the school boy's compoasphyxia, syncope, and trance.
In the aggra
sition on “Snakes in Ireland;" this began, vated cases of catalepsy there is total loss of consisted solely of, and finisht as follows : consciousness, generally coming on suddenly. “ Snakes in Ireland : there are no snakes in The muscles are often rigid, but the limbs may Ireland.” So, truly, there is no safety in be moved and placed in various positions, anesthesia. One of our greatest medical where they will remain for a time. Superficial teachers is accustomed to say to his medical reflexes are abolisht, and sensibility to touch or classes: “Gentlemen, remember, when you pain may totally disappear. The temperature administer an anesthetic to a patient, you are falls, and the respiration and heart's action taking them into the very valley of the shadow may be imperceptible. The condition is not of death.” Yet there is a relativ safety, when at all like actual death, and the differential the anesthetist is careful in his selection of the diagnosis should not be difficult to any practi- agent which he employs, and is careful and cian.
competent in its administration. This relativ Partial asphyxia may simulate death. Bodies safety, in most instances, depends more on the have been resuscitated after remaining under anesthetizer than on either the anesthetic water for an hour, and this fact teaches one the employed or on the patient's condition.
Any practician may be called upon at any and that our patients are suffering because of time to administer an anesthetic, either in his such ignorance and carelessness. own practise or to help dentist or brother practician. Hence the man who proposes to
The Retained Placenta. keep clear of danger from anesthetics in his Many practicians, the younger element more own practise by not employing them, is the especially, are prone to become mentally very man who is apt to be caught in the per- perturbed if the placenta does not appear plexing quandary of confessing that he is promptly, or if Crede's method fails to speedily afraid of attempting to give an anesthetic, or dislodge it. This unwarranted alarm often of attempting to give it and of making an induces one to act rashly, when no occasion indifferent job of it. We know of many activ
We know of many activ exists for haste or rough manipulations. A practicians today who do not give an anesthetic famous obstetrician once said that the best way when they can avoid it in their own prac- to treat a retained placenta was to go to sleep tise, and who dislike to give it for any one and wait for it. If the woman's pulse is good, else. These are not ignorant or idle men, and her appearance is all that it should be, and either; but busy men with good practises. there is no hemorrhage, one may safely take the They are opposed to the use of anesthetics in time necessary to make a thoro examination by obstetrics, and only use them when their use palpation of the abdominal wall. Vaginal mancan not possibly be dispenst with. They are ipulation is undesirable, and is but rarely honest, but inexperienced ; yet it must be con- necessary. If the bladder contains urin, that fest that one would hardly call a patient taking viscus should be emptied before taking further an anesthetic under their supervision, safe. steps. The distended bladder will interfere They have been thoroly taught the way to dis- with a thoro examination, and possibly with the tinguish the indications calling for the various necessary manipulations determined upon; and anesthetics, but thru lack of use they have for- the act of emptying the bladder is frequently gotten everything connected with the matter accompanied by ample uterin contractions. If except the warnings of danger given out by palpation show that the upper part of the uterus their preceptors, and the records of sudden is empty, it may graspt thru the abdominal and distressing accidents happening in the wall and prest downward in the axis of the hands of the anesthetist. There is another pelvis in such manner as to expel the placenta. class of men, those reckless and imperfectly When the placenta appears in the vulvar opentaught practicians who take up the ether cone ing, it is graspt and twisted with a rotary motion with as little thought or care as they would so that the following membranes will have label a box of charcoal pills, and give the anes- added strength to resist tearing. If palpation thetic without more than an occasional casual reveal the fact that the placenta is yet in the glance at the patient, giving their main atten- upper segment of the uterus, that organ is to be tion to what is going on about the field of massaged firmly thru the abdominal walls, and operation. In the hands of such men, surely if simple massage fails to dislodge the placenta a patient is far from safe, even tho the anes- after fifteen minutes, one may compress the thetic has been properly selected, and the uterus in an antero-posterior direction. If this patient's organs and condition are the best.
pressure fails to release the placenta, it is wise to Both such classes need warning: the first, desist, and to carefully sterilize the hands in to learn again the methods of giving an anes- preparation for manual extraction. This sterthetic properly and of combating emergencies ilization should include the arms, since it is not when they arise; the second, to be more cau- possible to tell beforehand how far it may be tious, prepared, and watchful of the slightest necessary to insert the hand. The external divergence from the normal in the patient genitalia should be washt in an antiseptic soluwhom they are guiding thru the very valley of tion, if at hand; but in any event at least with the shadow of death. Such study and appli- water. One hand is placed over the abdomen cation could not but result in alleviation of to exert counter pressure, and the other is suffering and of augmentation of the relativ inserted into the uterus until the placenta can safety in administering an anesthetic, together be pusht from the uterin wall. When the with a healthy decrease in the death rate. placenta is freed, do not be in too great haste
It is not our purpose here to attempt teach- to extract. Get the placenta under the hand, ing the whole manner of obtaining all the in the palm, and withdraw hand and placenta safety possible in selecting and administering slowly, and with a scooping motion, following an anesthetic; every modern text-book on up with the external counter pressure, and surgery and on therapeutics does all that. But remembering to rotate the placenta so as to we do wish to impress upon our readers that twist the membranes as soon as the hand emerges there are boundaries of comparativ safety that from the vulva. are ignored by both classes outlined above, Before laying the placenta aside, it should be
placed in a basin of clean water and examined Decline in Temperature in the Recent Dead. thoroly to see that none of the membranes have In cases where dead bodies have been disbeen torn off and been left in the vagina or covered, it is common to ask the medical atuterus. If it is not found whole and intact, it tendant who is summoned, “How long has will be necessary to again explore the uterus. this person been dead?” It is a most perThe socalled hour glass contraction of the plexing question, yet one which if the doctor uterus may be so resistant as to require an fail to attempt to answer will certainly brand anesthetic for purposes of relaxation, yet this him in the bystander's mind as an ignoramus. condition will generally yield to steady pressure Very frequently a “wild guess" is hazarded, with the tips of the fingers shaped into a cone, and later developments cause much chagrin on if continued long enuf.
the part of the luckless practician who has In cases of severe hemorrhage, no time should guest away wrong. The following observabe lost in making external examinations, but tions of Niederkorn are worth saving for referthe hand must be immediately introduced into ence; one may commit them or file them the uterus; grave cases even warranting the where they can be consulted before giving an obstetrician in dispensing with sterilization. opinion. After observing 135 cases, he found The woman might easily bleed to death while the variations in the axillary temperatures to you were washing your hands, and she may
be: escape infection even if the hand be very dirty; yet only the rarest of cases warrants the physi
Temp. of body
a to 4 hrs. 4 to 6 hrs. 6 to 8 hrs. 8 to i hrs cian in taking such risks.
100.4°F. If there is no hemorrhage, concealed or
62.6° F. external, take plenty of time and keep cool,
81.7° F. and very few cases will present any difficulty. The same observer noted that the rectal If the exploration reveal a truly adherent pla
temperature in six cases averaged 90.6° F., centa, it must be separated from the uterin wall
6 to 8 hours after death, and 89.2° F., 12 to by a series of pinching motions of sufficient
14 hours after death. The rate of cooling is power to crush thru the retaining particles.
stated to be 3.5° F., during the first three
hours, in robust cases and 4.5° F., in the When To Operate In Appendicitis. emaciated; during the second three hours, Stevens in his Manual of the Practise of Med
3° F. in both; and about 1° F. an hour, as icin, publisht by W. B. Saunders & Co., the temperature of the body approaches that admirably sums the pro and con of this mooted
of the air. point as follows :-“An operation should be American Medicin quotes the record of a case of urged: (1) At once in all cases in which the small pox in Cleveland where three persons in a family onset is very severe, the symptoms indicating
of five were found suffering from small pox, and the
fourth victim was the family dog, which was also taken special severity being markt right sided tender- to the pest house. We do not remember having seen ness and rigidity, distention, and vomiting, any previous record of small pox in an animal, but we with or without fever ; (2) in cases of moderate
have repeatedly urged the quarantining of household
pets in infected houses with all the inflexibility with severity which manifest no improvement after which the human inmates are retained, because it can the lapse of forty-eight hours; and (3) in cases
not be questioned that the hair of such animals would
form an admirable method of dissemination of the in which the symptoms, after decided improve
contagion. ment, return. On the contrary, operation is rarely required, at least during the attack; (1)
The discovery of the germ of small pox (?) so widely
heralded by the lay press and by certain of our conin cases of a mild type, in which the pain is temporaries, now proves to have fallen far short of a unaccompanied by rigidity, distention, nausea,
complete discovery and solution. The peculiar cells
said to be the cause of small pox, and which have been or vomiting; and (2) in cases of moderate sever- known to exist in the eruption of every case at certain ity in which improvement is noticeable in 48 stages, obstinately refuse to conform to the most imhours. Operation during the quiescent stage,
portant of Koch's postulates; i. e., they do not produce
the disease in a susceptible individual when he is inocwhen the element of danger is almost entirely ulated with them. Their study is highly creditable to removed, is to be commended: (1) When an those who engaged so enthusiastically in it, but the acute attack has been followed by persistent claim of a bona fide discovery was unfortunately pretumefaction and tenderness, intestinal disturb- may yet accrue. Meanwhile, vaccinate as of yore. ances, or impairment of the general health ; (2)
Please read the standing notices at the beginnings of when there have already been two attacks, even
departments, particularly at the head of Quiz departof moderate severity ; and (3) when mild attacks ment. They are placed there to be read , yet our coroccur with such frequency as to induce disability.
respondence shows that many do not read them.
Half a grain of codein every half hour till three or A tablespoonful of turpentine in a half pint of water four doses are taken, is a pleasant remedy in gastro. kept simmering over a lamp is a splendid adjuvant to intestinal pain of moderate type. It does not leave other therapeutic methods in bronchitis of children. nausea nor unpleasant sensations.