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Circulation: August, 1902, 27,409; September, 29,718; October, 31,663.

The Medical World

The knowledge that a man can use is the only real knowledge ; the only knowledge that has
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The Medical World

join in securing 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

enut (enough) to the above list, and to conservativly adopt O. F. TAYLOR, M.D., Editor and Publisher.

the following rule recommended by the American Philo

logical Association; A. L. RUSSELL, M.D., Assistant Editor. Drop inal "e" in such words as "definite," " ind

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threats against its members for malpracADDRESS ALL COMMUNICATIONS TO "THE MEDICAL WORLD,".

tise, assist the district attorney in prose1520 Chestnut Street

cuting illegal practicians, and represent PHILADELPHIA, PA.

the Society in all other legal affairs. HowVOL. XX. NOVEMBER, 1902.

No. 11

ever, originality or priority cannot be Language is a growth rather than a creation. The growth claimed, as the New York City Medical of our vocabulary is seen in the vast increase in the size of on dictionaries during the past century. This growth is not Society did the same thing last spring, only in amount, but among other elements of growth the written forms of words are becoming simpler and more and the plan is working nicely over there. aniform. For example, compare English spelling of a century or two centurles ago with that of to-day! It is our This step marks an epoch in the history of duty to encourage and advance the movement toward simple, uniform and rational spelling; See the recommenda- the society, and it is hoped that every tions of the Philological Society of London, and of the American Philological Association, and list of amended other local society will make a similar spellings, publisht in the Century Dictionary (following the lotter 2) and also in the Standard Dictionary, Webster's Dic epoch in its history. This measure binds tionary, and other authoritativ works on language. The tendency is to drop silent letters in some of the most flagrant the members together for mutual protecinstances, as ugh from though, etc., change ed to t in most places where so pronounced (where it does not affect the tion as they were never bound together preceding sound),

etc. The National Educational Association, consisting of ten before. Flourishing insurance companies thonsand teachers, recommend the following:

"At a meeting of tbe Board of Directors of the National now exist for the purpose of insuring med. Educational Association held in Washington, D. C., July 7, 1898, the action of the Department of Superintendence was ical men against suits for malpractise. At approved, and the list of words with simplified spelling adopted for use in all publications of the National Educa- much less cost (the yearly dues are now tional Association as follows: cho (though);

program (programme); $4.00 per year, but they will probably be adaltho (although);

catalog (catalogue); thoro (thorough); prolog (prologue);

vanced to $5.00), the members of the Philathorofare (thoroughfare); decalog (decalogue); thru (through); demagog (demagogue);

delphia County Medical Society will have thruout (throughout); pedagog (pedagogue).

much better protection than an insurance "You are invited to extend notice of this action and to

company can give, for each member will ish, altho the patient is taking more food. have the moral support of the entire

Nature tells us she is replenishing her society, including the help of any members

storehouse for the return of health. If,

in the acute stage, there is a steady and that may be called on to act as expert wit

progressiv diminution of all the solids, nesses, as well as the salaried attorney, death may be prognostigated. Sometimes and all the other advantages of member- a few days bofore death, even less than a ship in the society, all for a single and total of 10 grams are excreted. In acute very moderate annual fee. It is strange

diseases, complicated by serous exudation,

the chlórids are less in quantity than if that this wonderful possibility was not no exudation be present, or may disappear discovered long ago. The binding together entirely. There is less urea in cases of of the members of the medical profession serous exudation, tho it may still exceed for mutual protection against malicious

the normal amount. prosecution is a new and wonderfully pleasing spectacle. Every local society in Scientific Urinary Examination by the General the country can do the same thing. Med

Practician. ical societies in the past have done much There is no function of the human for the profession scientifically and socially,

organism more essential to health than a Here is an additional field of mutual properly working urinary system; and no

other excretory organ is more delicately service and protection. As these features

constituted as the kidney; and perhaps are added to the functions of medical soci

no other organ and its functions are less eties, their membership will increase, until understood and consequently more neg

The every respectable and desirable practician lected by the average practician. is " gathered in."

purpose of this series of articles is to give in condenst form what the best authorities

have to say in their latest issues regarding Febril Urin.

the application of modern tests for the The text-books are generally satisfied, in more common evidences of disease, and to describing the arin of febril diseases, to give it in such manner that any physician say it is "scanty and high colored."

may equip himself for a proper examinahas a much greater importance than the tion of any specimen submitted to him. space given it; it oftentimes gives warn. Office Equipment.-Good light is an essening of the advance of complications; it tial; a clear window by day, and a good even sometimes would presage death if ex- lamp for night work. A sink with close amined properly.

joints and a waste pipe long enuf to conThe color of febril urin depends upon vey the drainage sufficiently far away the height of the fever, the state of met- from the office. Hot and cold water pipes abolism and tissue waste, and the amount are convenient, but in lieu of them a large of toxemia present. It is, furthermore, bucket answers the purpose. Such things due to the fact that the normal solids, are found in every well equipt office; so especially urea, are both relativly and we will speak of the special equipment: actually increast, while the watery element

1. A dozen assorted test tubes, in a rack, with a brush or is diminisht. The area has been known swab with which to cleanse them. (The rack is quickly

made by a block of wood and a few augurs, and there to reach as high as 85 grams per day. At is no better cleanser than a piece of sponge wrapt the outset of a given disease the color is

around a small stick and tied firmly with a few turns

of fine thread.). high, the quantity small and the reaction 2. A spirit lamp and a little alcohol.

3. A futed urinometer or specific gravity bottle, with cerintensly acid. The chlorids are always absolutely diminisht. In acute febril at- 4. A few wine glasses or graduates to be used only for

urinalysis. tacks of short duration there may not be 5. A urea apparatus.

It

tificate.

6. A large and a small glass fuppel. any albumin present, but if the fever

7. Some filter paper cut in circles of 4 and 8 inches is very high and the attack prolonged,

8. Some red and blue litmus paper. albuminuria always exists (Ogden). As 9. A few glass rods.

10. A few pieces of assorted sizes glass tubing. the temperature falls the amount of urin

11. An evaporating dish. increases, and polyuria is not an infre- 12. A few watch glasses.

13. Platinum wire in a glass rod. quent accompaniment of convalescence. 14. A piece of platinum foil.

15. A set of 50 cc. burettes graduated in to cc. As convalescence begins, the solids dimin

16. A burette stand with clamp.

diameter.

17. A retort and stand.
18. A tripod and cover of copper gauze.

Diminisht quantity is due to :
19. A water bath.
20. Wooden test tube holder.

1. Small amount of fluid ingested. 21. A 500-centimeter wash bottle.

2. Excessiv perspiration, 22. Three pipettes, 5, 10 and 50 cc. 23. An Esbach's albuminometer.

3. Fever. 24. A good thermometer.

4, Diarrhea. 25. A good microscope with objective such as Leitz 3, 5 and 5. Excessiv vomiting.

7, and eye pieces 1 and 3; an Abbey condenser; and a 1 inch oil immersion lens, with glass slides and cover

6. Activ hyperemia of kidneys. glasses, cedar oil, and Canada balsam in solution. 7. Passiv hyperemia of kidneys. 26. A centrifuge ; not absolutely necessary, but convenient. 27. A record book and pencil.

8. First and second stages of acute diffuse 28. An ounce of chemically pure sulfuric acid.

nephritis. 29. An ounce of chemically pure pitric acid.

9. Subacute glomerular nephritis. 30. An ounce of chemically pure hydrochloric acid. 31. An ounce of chemically pure acetic acid.

10. Approaching death in all diseases, 32. Ammonic hydrate. 33. Sodic hydrate.

Increast quantity is due to: 34. Fehling's solution. 35. Esbach's reagent.

1. Large quantity of fluid ingested. 36. Distilled water (obtain from exhaust pipe of engin or

2. Diuretic treatment. mill if not convenient to make or purchase.) 37. Caustic soda.

3. Nervous excitement and some diseases of 38. Common salt.

the nervous system (frequent in hysteria and 39. Chromate of potassium. 40. Sulfate of ammonia.

temporary in cerebral hemorrhage). 41. Sulfate of magnesium.

4. Diabetes mellitus. 42. Containers for the drugs, with ground glass stoppers and 5. Diabetes insipidus. glass labels.

6. Convalescence from acute diseases. Not all of the above are absolutely neces- 7. Convalescence from acute diffuse nephritis. sary, but all are needed at times, and 8. Chronic nephritis; both interstitial and

diffuse. except the microscope, inexpensiv, repre

9. Amyloid infiltration. senting an outlay within the reach of any practising physician.

The Technic of Vaccination. Yvon & Berlois have constructed the following table as representing the average

Most physicians become highly indigconstituents of the urin passed each

nant when their ability to perform vaccitwenty-four hours :

nation properly is called in question, but

we have seen many more vaccinations MALE.

FEMALE. Quantity......

faultily done than were rightly performed. ...........1,360 cc. 1,100 Specific gravity .........1,022

1,021

All know that death from scratches and Urea, per liter...

21.5 grams

19.0 grams Urea, per day......

25.6
20.5

abrasions are not unknown. Uric acid, per day......

call it the simplest of operations, but it is Phosphoric acid, per day... 3.2

an operation, and the modern method is The entire quantity passed in the twenty. vastly different from that in vogue ten four hours should be mixt and accurately years ago. We no longer have the right measured. Care must be taken to keep to scrape, cut and stab our writhing the vessel clean and perfectly free from patient till a large area has been denuded dust or other foreign substances. It should of cuticle. be kept cool and must be examined It is just as easily done right as it is within twenty-four hours unless some pre- done wrong. Wash a small area with servativ (which should only be used in case soap and water and dry with aseptic abof necessity) be added. If a preservativ sorbent cotton. Use no antiseptic of any be necessary, three drops of formalin or kind during the operation. With a clean an ounce of a saturated aqueous solution of needle or a scalpel denude I to square boric acid will suffice. In certain small pro

inch of surface until the serum commences portion of cases it is desirable to collect to appear; then stop before the blood dows. and examin the urin of the day and that If the tube is used, allow the serum to flow of the night separately, in which case each gently upon the denuded area; if points bottle should be carefully labeled and kept are employed, the virus is gently rubbed separate. The normal variation in quantity into the scarification, for any force will may be stated to be from 1,200 to 1,600 cause the blood to flow and imperil the centimeters (in the male adult), owing to results. The serum should be allowed to fluids ingested and other circumstances. dry, caution being used that it is not conIn renal disease it is often necessary to taminated by any external object. It may make daily measurements for a period of then be covered with a piece of steril from one to three weeks before an accurate gauze bound over the wound.

A conestimate can be made of the average daily venient plan is to lay a small clean cork quantity.

on either side of the wound and run a

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strip of adhesiv plaster over them in such no other possible reward than notoriety a way that it is held up from the abrasion ; and the instigation of morbid curiosity, the whole is then covered with the gauze seldom tempered by any real sympathy. bandage. With this method absolutely The hysteric patient is repulsiv to most nothing can touch the wound, not even practicians, and even the laity appreciate gauze. Others use large bunion plasters our disgust so much that we do not dare and cover them with a strip of adhesiv to use the word in the presence of the paplaster. Others employ the commercial tient or the friends. He was a medical protectors, sold by all manufacturers of genius who coined the word “neurasthevirus, but these should be condemned, un. nia ;” it is genteel, and no stigma attaches less the protector is covered by aseptic to it. gauze. Otherwise, the holes left for ven- We regret that the word “hysteria" tilation admit lint from the underwear, has passed into disrepute, even if “neuwhich is very likely to infect the wound. rasthenia” will cover all cases, for both The wound should be protected; and these hysteria and neurasthenia exist as sepa80-called “protectors " are really traps for rate and distinct conditions. Until our infection, in the way they are usually coarse and blundering tools of microused. Really, there is nothing better than scopes" reveal to us the flight of thought simply a piece of aseptic gauze bound di- and motive, we should be satisfied to pose rectly on the wound, or held in place by as physician students rather than selfstrips of adhesiv plaster.

constituted judges. One of the best definiVaccination is the only method recog- tions of hysteria is given by Thompson, nized by authority for stamping out the in Practical Medicin, publisht by Lea dreaded smallpox. Not only Pennsyl. Brothers & Co., Philadelphia, where he vania, but many other states are report- says, on page 865: “Hysteria is a state ing large numbers of cases, and it is the of the nervous system resembling a comduty of every doctor to perfect himself in bined psychosis and a neurosis in which this simple procedure. The doctor and the exaggerated ideas result in inhibition of patient are oftener at fault than the virus. mental volition and alteration in funcThe Pennsylvania school law now allows tions. The condition appears to be purely the school board to compel vaccination of functional, as no organic lesion exists." every child every five years, or to exclude The pampered child of wealth is apt to the child from school, or a fine of $1.00 develop hysteria; it is seldom seen in per day, or imprisonment of the parent the homes of the poor except as a sequel refusing to comply. With the cooperation of alcoholism or heredity. It is by no of doctors who can vaccinate properly, means rare in the male, but is most frethe disease should be controled.

quently seen in neurotic and anemic fe

males between the period of puberty and Hysteria.

the age of 30, only a very few cases develThe true nature of hysteria has long oping after that age, and then they are been one of the mysteries of medicin, and generally connected with a natural, abits treatment is one of the most vexing normal artificial menopause.

Alproblems which confront the practician. most any symptom may develop in the Formerly, hysterics were deemed only course of hysteria, but the manifestations silly fools who took a fiendish delight in are mach milder when the patient thinks troubling busy doctors, neglecting to pay herself unobserved, and always disappear their bills, and abusing their medical completely under complete anesthesia. counselor between attacks. We now The possibility of extremely high temperaknow that if many are to be blamed and tures in hysteria is admitted by some treated harshly because they are senseless clinicians and denied by others; the use simulators, others are to be pitied and re- of an anesthetic should determin any lieved with the greatest tenderness. given case. Those who sham hysteria generally have, Organic nerve lesions are the only conif any, only minor complaints and suffer ditions from which hysteria is difficult to little except when they realize that they differentiate, the latter presenting the have not în fooled” the doctor. The true globus hystericus, anesthetic or hypereshysteric suffers honest agony, and view- thetic areas, limited visual field, possible ing her torture, one can not appreciate paralysis, and in severe cases contractures, how she would prolong it voluntarily for together with an unmistakable mental

or

condition; the symptoms promptly re- of the nervines do so well as the old. turning after complete disappearance fashioned asafetida and valerian in full under anesthesia.

doses. The various mild salines are the In contra distinction, the patient with best laxativs. Avoid hypnotics and anoorganic nerve lesion is not affected by dynes as the plague. Make all examinaanesthesia further than the effects of the tions of females in presence of some relidrug itself extend. If paralysis be pres- able female attendant who knows how to ent, it is apt to be unilateral, and the re- keep quiet; always under some covering, flexes are exaggerated or annulled. If the and avoid genitals, abdomen, and breasts hysteric has never heard of reflex tests, except when absolutely necessary, and they are readily elicited; if they have even then be quick and chary. Never been the rounds of any number of good use finger, speculum, or probe thru vagdoctors, they can simulate or retard or inal canal except in case of emergency, emphasize or hold in abeyance any of the and never use the catheter under any circumreflexes. If lesion exist, there will be in- stances; better anesthetize and allow the somnia and intense pain, or delirium or urin to flow. Inveterate cases are best coma. The hysteric patient can not ma- excluded absolutely from the admission of nipalate the pupils, and she signally fails any but the attendant and physician, no an temperature when it is taken in the members of the family being admitted, axilla. Organic lesions frequently give and no books or papers allowed. subnormal temperatures, while the hys- Probably the most successful treatment teric patient always works up an eleva- of hysteria is that used so successfully by tion if thermometer be placed in mouth, Prof. S. Weir Mitchell, the principal fearectum, or vagina. If blindness be com- tures of which are briefly outlined: The plained of, the patient with a lesion can patient is placed under the care of a skilled not see an object that may hurt them, nurse in an isolated room, and at absolute while the hysteric always does. Organic rest in bed. She sees none but her attendanesthesia or hyperesthesia always follow ant and physician. She is allowed no diet the defined nerve tracts, while hysteric bat milk, and if she will not take it, symptoms so referred are located anywhere she takes nothing but water until she the patient deems best. The hysteric can “gets hungry." She is treated with all not accurately simulate the spastic or para- gentleness, and is bathed and massaged plegic gait. If the hysteric complain of regularly; but her complaints and convulloss of taste, the ingenuity of the physi. sions are passed over with a kindly word cian will provide a dose nauseous enuf to or are completely ignored. The physi. provoke complaint or grimace, when true cian's visits are not frequent and are cases swallow it unmoved. Anesthesia short, and he consults the nurse and chart and subterfuge will separate any case of much more than he does the patient. If hysteria from organic nerve lesion.

pains become unbearable he applies the The successful treatment of hysteria Paquelin cautery with gentle touch demands patience, kindness, a judicious and words of solicitude. If anesfirmness, and absolute control of the pa- thetic areas become extensiv and partient by the practician: all obtainable only alysis ensue, an aseptic needle inserted after entire confidence and cooperation of deeply and attached to a battery accomthe patient and friends has been won. plishes a cure in a few hours. Few cases The hysteric of comfortable means should resist such treatment many weeks, and be placed on tonics, digestive, nervines, the resultant cure is generally permanent. and saline laxativs; the poverty stricken The practician in the country can never, should embark in the ambulance for the without skilled assistance and the conearest hospital, or have a commitment operation of friends, hope to cure chronic obtained to the “county home.” In other hysteria ; but, if such aid be obtainable, words, nursing and environment with

nearly every patient will recover. enaf and not too much attention will aid Presuming that they are convalescent, drugs in caring hysteria of acute or amuse them by outdoor exercise, a little chronic type; but neither will ever do it needlework, having the nurse read letters alone. Iron, arsenic, strychnin, and man- or quieting books, drawing or painting in ganese are desirable tonics in anemic great moderation; but all the time insist cases. Any palatable digestant of known on isolation from any but two attendants. efficiency will do well in any case. None It is the only successful cure for hysteria.

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