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cases. The fluid extract of viburnum prunifoliatum, in dram doses every two and a half or three hours, is an old remedy, and is always useful as an adjuvant. Scarification of the cervix just previous to the appearance of the flow is frequently practised in Germany. A hot sitz bath of twenty minutes' duration, on the appearance of the flow, often gives grateful relief, especially if the patient retire immediately afterwards to a warm bed for twelve to twentyfour hours.
A New Treatment for Gonorrhea.
The best proof of the general dissatisfaction. which exists among the profession with the present approved (?) methods of treating gonorrhea is the avidity with which new theories and treatments are seized. In most instances we do not make editorial note of such "cures " unless to call attention to some flaw in their theory or to warn the too enthusiastic reader. We are proud to recall that we tried to check the too credulous when the profession went wild over the irrigation treatment. Yet the treatment of which we now speak, altho too newly promulgated to have allowed extended test, is so strictly rational and in line with common sense that we cannot avoid mentioning it. It is an emanation from the brain of Dr. W. H. Whitehead, of Atlanta, Georgia, who reported it fully in the Therapeutic GaThe Doctor is very zette of September last. anxious that his treatment be given a thoro test under varying conditions in different sections of the world, and we abstract from his article, giving the working formula in full without much comment or theorizing.
The Doctor was dissatisfied with the results he obtained from the recognized plans of attack against the gonococcus, and began experimenting with pepsin and paw-paw extract as a local application to the urethra, with the intention to dissolve the plugs of germ breeding mucus which lodge in the crypts and follicles of the mucous membrane, his observations thru an endoscope having satisfied him that no injection or mode of application now in use really removed these plugs. He insists upon the fact that only that part of the urethra which is actually involved should be treated, and that in the ordinary case the disease progresses backwards with the duration of the disease. Thus :
"My rule is this: patients coming to me at once, on the first appearance of the malady, I treat only the first third of the urethra-two or three inches-and endeavor not to put the salve any deeper from day to day. A one week old case is apt to involve the middle third also, and I put the charge out at the peno-scrotal junction. I take it for granted the disease has extended back to the "cut off" muscle, and treat the entire anterior urethra, depositing the charge into the bulbomembranous portion, allowing it to work forward. In
all cases that have had irrigation I suspect deep involvement. After washing out the anterior urethra I have these "irrigated" patients pass a little urin into a glass and finish in a second glass; the urin in number one usually shows shreds, and it is not so clear as in number two glass. This means deep involvement and post urethritis. I use a special salve depositor, but any ordinary rubber catheter with a snipe nozzle "P" syringe will do as well. The treatment is by instillation with the salve, and the internal treatment, or sterilization of the urin. Take a given case: A young man comes to the office with a plain case of gonorrhea; was exposed five days ago; first noticed a little sticking of the mouth yesterday, drop of matter this morning; 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 bat of absorbent cotton over the penis to catch the salve that comes back, tie it on loosely, instruct the patient to keep the dressing on until he is compelled to urinate, and to come back twice daily for the insertion of the salve, morning and evening. Give internally this compound :
. 6 drams
Benzoic acid, of each
. I ounce
Mix and make mass. Divide into 30 equal parts; put each into a cachet or cold wafer.
Direct one before
meals and at bed time.
The salve that I use is composed of :-
Powdered scale pepsin
Powdered caroid, of each Albolene
Water, of each ..
. 2 drams
. 2 ounces
The working formula of this salve is: "Dissolve the oxids of mercury and silver in the oleic acid and albolene; to do this it is necessary to triturate the oxids in a large mortar, dry, then add oleic acid, and continue the trituration till the mass begins to stiffen ; then add the albolene quickly, and the trituration must be continued till a uniform paste is obtained. Then add the lanolin and rub it well into the mixture; finally, having dissolved the pepsin and caroid in the water, and filtered it thru a lightly plugged funnel with absorbent cotton (this is necessary as the caroid has grit in it), add this aqueous solution to the salve in the mortar, and triturate the whole till it is a uniform creamy paste. These details are important, and any departure will result in a lumpy, uneven mass that is not only inelegant, but is much inferior therapeutically. The salve is penetrating, owing to the albolene, which is a purified kerosene oil. It is germicidal, owing to the mercury and silver. I claim that it digests the tufts and exudates out of the follicles, and permeates these otherwise inaccessible germ-infected recesses. The long contact of the medicament gives ample time for the digesting process and for thoro germicidal action."
"The salve is painless, all discharge is arrested by a two or three days' use of it, and radical cures are often obtained by one dozen applications-six days' treatment. When all discharge has ceast for 48 hours and the first urin is clear, I suspend the local treatment, but continue the internal treatment for a week or ten days longer. If the discharge returns, use the instillation treatment for one dozen applications, by which time the discharge will have disappeared entirely."
"In treating the female, first locate the infection; if it is a recent infection, and is confined to the vagina, use the same salve, making only one application each day, but use a much larger quantity, putting a plug of absorbent cotton that has been dipt into the salve well up the vagina, thru a speculum, and leave it in for 24 hours. Have the woman remove this on the following day, and take a very hot salt water douche just before she comes to the fice for the next application. If her urethra is involved, I give her the internal treas
ment, and also deposit some of the salve into her urethra each day; if the urethra is not involved, these measures are unnecessary. If you have reason to suspect cervical or uterin involvement, deposit the salve in the cervical canal, or even into the cavity of the uterus, daily. The result of this treatment in the female is even more satisfactory than in the male, as the contact is longer, and the sterilization consequently more thoro. I have seen a profuse discharge, with the accompanying vaginal and labial imflammation, completely removed by one application. Whether the pepsin and caroid have germicidal powers, or simply dissolve the exudate and let in the known germicides, I am not able to say, but that the combination does all I claim for it only needs a test to prove that it is the rational remedy for gonorrhea."
The difficulty has always been to get patients to attend the office frequently enuf, but if one can promise them a cure in one to two weeks, it ought not to be difficult to get their consent to be punctual and faithful in attendance. deem the matter of sufficient importance to ask those who try the treatment to report briefly upon the results they secure.
Simulation of Death.
One may imagin that it is possible in the haste of burial after battles or during devastating plagues, for persons to be buried alive; yet it is beyond the bounds of credulity when an intelligent person is expected to believe it possible that burial while yet living is so common as "hearsay" would indicate. The customs prevailing among civilized people all over the world in disposing of their dead, preclude such accidents in any but the rarest instances, and even then only under the most extraordinary circumstances. Nevertheless, because of the actual fear which exists in the minds of many, even among the intelligent and educated classes, it becomes the duty of every practician to inform himself regarding several points in this connection. The real danger is not that people may be buried alive, but that in some cases of apparent death the appropriate measures for resuscitation may not be undertaken soon enuf to save life.
Apparently complete cessation of respiration and circulation may occur in catalepsy, partial asphyxia, syncope, and trance. In the aggravated cases of catalepsy there is total loss of consciousness, generally coming on suddenly. The muscles are often rigid, but the limbs may be moved and placed in various positions, where they will remain for a time. Superficial reflexes are abolisht, and sensibility to touch or pain may totally disappear. The temperature falls, and the respiration and heart's action may be imperceptible. The condition is not at all like actual death, and the differential diagnosis should not be difficult to any practician.
Partial asphyxia may simulate death. Bodies have been resuscitated after remaining under water for an hour, and this fact teaches one the
impossibility of declaring from examination within that time, of a body said to be dead by drowning, whether or not life may yet exist. When newborn babies fail to breathe, it is well known that they may be coaxt to begin respiration many minutes after birth; some obstetricians teach that efforts should be continued for three quarters of an hour.
Syncope often presents features sufficiently alarming to the uninitiated to lead them to believe that death has occurred, yet the condition is usually so temporary that no great danger of serious results actually exists. Permanent heart failure may, however, succeed the temporary faint unless prompt and rightfully directed measures are instituted. Death has resulted during or immediately following syncope, and indeed the result of treatment is often necessary, in aggravated cases, to determin whether or not life has ceast.
Trance is the nearest similitude of death known to the medical profession, and not infrequently terminates in death. Consciousness is lost, and the face has a death like pallor. The muscles and limbs may be either rigid or flaccid. The reflexes may be lost and the pupils dilated immovably. Sensation may be retained, and hyperesthesia has been recorded. Both respiration and heart action may be imperceptible. If trance lasts many hours, the diagnosis requires more than a casual glance. Gowers calls attention to the following points: 1. There is no evidence of decomposition. 2. The eye preserves its normal opthalmoscopic appearance at the fundus. 3. The muscles continue to respond to electrical stimulation.
There should be no hesitancy in making an absolute diagnosis in any case, if the practician but apply the most elementary knowledge, and keep the case under continuous observation for a sufficient period. The ludicrous efforts of the hysteric could only delude the novice.
Safety in Anesthesia.
One might imitate the school boy's composition on "Snakes in Ireland;" this began, consisted solely of, and finisht as follows: "Snakes in Ireland: there are no snakes in Ireland." So, truly, there is no safety in anesthesia. One of our greatest medical teachers is accustomed to say to his medical classes: "Gentlemen, remember, when you administer an anesthetic to a patient, you are taking them into the very valley of the shadow of death." Yet there is a relativ safety, when the anesthetist is careful in his selection of the agent which he employs, and is careful and competent in its administration. This relativ safety, in most instances, depends more on the anesthetizer than on either the anesthetic employed or on the patient's condition.
Any practician may be called upon at any time to administer an anesthetic, either in his own practise or to help dentist or brother practician. Hence the man who proposes to keep clear of danger from anesthetics in his own practise by not employing them, is the very man who is apt to be caught in the perplexing quandary of confessing that he is afraid of attempting to give an anesthetic, or of attempting to give it and of making an indifferent job of it. We know of many activ practicians today who do not give an anesthetic when they can avoid it in their own practise, and who dislike to give it for any one else. These are not ignorant or idle men, either; but busy men with good practises. They are opposed to the use of anesthetics in obstetrics, and only use them when their use can not possibly be dispenst with. They are honest, but inexperienced; yet it must be confest that one would hardly call a patient taking an anesthetic under their supervision, safe. They have been thoroly taught the way to distinguish the indications calling for the various anesthetics, but thru lack of use they have forgotten everything connected with the matter except the warnings of danger given out by their preceptors, and the records of sudden and distressing accidents happening in the hands of the anesthetist. There is another class of men, those reckless and imperfectly taught practicians who take up the ether cone with as little thought or care as they would label a box of charcoal pills, and give the anesthetic without more than an occasional casual glance at the patient, giving their main attention to what is going on about the field of operation. In the hands of such men, surely a patient is far from safe, even tho the anesthetic has been properly selected, and the patient's organs and condition are the best.
Both such classes need warning: the first, to learn again the methods of giving an anesthetic properly and of combating emergencies when they arise; the second, to be more cautious, prepared, and watchful of the slightest divergence from the normal in the patient whom they are guiding thru the very valley of the shadow of death. Such study and application could not but result in alleviation of suffering and of augmentation of the relativ safety in administering an anesthetic, together with a healthy decrease in the death rate.
It is not our purpose here to attempt teaching the whole manner of obtaining all the safety possible in selecting and administering an anesthetic; every modern text-book on surgery and on therapeutics does all that. But we do wish to impress upon our readers that there are boundaries of comparativ safety that are ignored by both classes outlined above,
and that our patients are suffering because of such ignorance and carelessness.
The Retained Placenta.
Many practicians, the younger element more especially, are prone to become mentally perturbed if the placenta does not appear promptly, or if Credé's method fails to speedily dislodge it. This unwarranted alarm often induces one to act rashly, when no occasion exists for haste or rough manipulations. A famous obstetrician once said that the best way to treat a retained placenta was to go to sleep and wait for it. If the woman's pulse is good, and her appearance is all that it should be, and there is no hemorrhage, one may safely take the time necessary to make a thoro examination by palpation of the abdominal wall. Vaginal manipulation is undesirable, and is but rarely necessary. If the bladder contains urin, that viscus should be emptied before taking further steps. The distended bladder will interfere with a thoro examination, and possibly with the necessary manipulations determined upon; and the act of emptying the bladder is frequently accompanied by ample uterin contractions. If palpation show that the upper part of the uterus is empty, it may be graspt thru the abdominal wall and prest downward in the axis of the pelvis in such manner as to expel the placenta. When the placenta appears in the vulvar opening, it is graspt and twisted with a rotary motion so that the following membranes will have added strength to resist tearing. If palpation reveal the fact that the placenta is yet in the upper segment of the uterus, that organ is to be massaged firmly thru the abdominal walls, and if simple massage fails to dislodge the placenta after fifteen minutes, one may compress the uterus in an antero-posterior direction. If this pressure fails to release the placenta, it is wise to desist, and to carefully sterilize the hands in preparation for manual extraction. This sterilization should include the arms, since it is not possible to tell beforehand how far it may be necessary to insert the hand. The external genitalia should be washt in an antiseptic solution, if at hand; but in any event at least with water. One hand is placed over the abdomen to exert counter pressure, and the other is inserted into the uterus until the placenta can be pusht from the uterin wall. When the placenta is freed, do not be in too great haste to extract. Get the placenta under the hand, in the palm, and withdraw hand and placenta slowly, and with a scooping motion, following up with the external counter pressure, and remembering to rotate the placenta so as to twist the membranes as soon as the hand emerges from the vulva.
Before laying the placenta aside, it should be
placed in a basin of clean water and examined thoroly to see that none of the membranes have been torn off and been left in the vagina or uterus. If it is not found whole and intact, it will be necessary to again explore the uterus. The socalled hour glass contraction of the uterus may be so resistant as to require an anesthetic for purposes of relaxation, yet this condition will generally yield to steady pressure with the tips of the fingers shaped into a cone, if continued long enuf.
In cases of severe hemorrhage, no time should be lost in making external examinations, but the hand must be immediately introduced into the uterus; grave cases even warranting the obstetrician in dispensing with sterilization. The woman might easily bleed to death while you were washing your hands, and she may escape infection even if the hand be very dirty; yet only the rarest of cases warrants the physician in taking such risks.
If there is no hemorrhage, concealed or external, take plenty of time and keep cool, and very few cases will present any difficulty. If the exploration reveal a truly adherent placenta, it must be separated from the uterin wall by a series of pinching motions of sufficient power to crush thru the retaining particles.
When To Operate In Appendicitis.
Stevens in his Manual of the Practise of Medicin, publisht by W. B. Saunders & Co., admirably sums the pro and con of this mooted point as follows:-"An operation should be urged: (1) At once in all cases in which the onset is very severe, the symptoms indicating special severity being markt right sided tenderness and rigidity, distention, and vomiting, with or without fever; (2) in cases of moderate severity which manifest no improvement after the lapse of forty-eight hours; and (3) in cases in which the symptoms, after decided improvement, return. On the contrary, operation is rarely required, at least during the attack; (1) in cases of a mild type, in which the pain is unaccompanied by rigidity, distention, nausea, or vomiting; and (2) in cases of moderate severity in which improvement is noticeable in 48 hours. Operation during the quiescent stage, when the element of danger is almost entirely removed, is to be commended: (1) When an acute attack has been followed by persistent tumefaction and tenderness, intestinal disturbances, or impairment of the general health; (2) when there have already been two attacks, even of moderate severity; and (3) when mild attacks occur with such frequency as to induce disability.
A tablespoonful of turpentine in a half pint of water kept simmering over a lamp is a splendid adjuvant to other therapeutic methods in bronchitis of children.
Decline in Temperature in the Recent Dead. In cases where dead bodies have been discovered, it is common to ask the medical attendant who is summoned, "How long has this person been dead?" It is a most perplexing question, yet one which if the doctor fail to attempt to answer will certainly brand him in the bystander's mind as an ignoramus. Very frequently a "wild guess" is hazarded, and later developments cause much chagrin on the part of the luckless practician who has guest away wrong. The following observations of Niederkorn are worth saving for reference; one may commit them or file them where they can be consulted before giving an opinion. After observing 135 cases, he found the variations in the axillary temperatures to be:
American Medicin quotes the record of a case of small pox in Cleveland where three persons in a family of five were found suffering from small pox, and the
fourth victim was the family dog, which was also taken to the pest house. We do not remember having seen any previous record of small pox in an animal, but we have repeatedly urged the quarantining of household pets in infected houses with all the inflexibility with which the human inmates are retained, because it can not be questioned that the hair of such animals would form an admirable method of dissemination of the contagion.
The discovery of the germ of small pox (?) so widely heralded by the lay press and by certain of our contemporaries, now proves to have fallen far short of a complete discovery and solution. The peculiar cells said to be the cause of small pox, and which have been known to exist in the eruption of every case at certain stages, obstinately refuse to conform to the most important of Koch's postulates; i. e., they do not produce the disease in a susceptible individual when he is inoculated with them. Their study is highly creditable to those who engaged so enthusiastically in it, but the mature. It is to be hoped that more tangible results claim of a bona fide discovery was unfortunately premay yet accrue. Meanwhile, vaccinate as of yore.
Please read the standing notices at the beginnings of departments, particularly at the head of Quiz department. They are placed there to be read, yet our cor
respondence shows that many do not read them.
Half a grain of codein every half hour till three or four doses are taken, is a pleasant remedy in gastrointestinal pain of moderate type. It does not leave nausea nor unpleasant sensations.
Consumption and the Opium Habit.
My Dear DR. TAYLOR:-The question raised in your journal, whether morphin takers are liable or immune to consumption, has brought out many interesting facts. Dr. Barbour's letter in the January WORLD describes the conditions very clearly, and in his statement that opium masks the symptoms but does not stop the degenerativ features, there is great significance and reality. Recently a study of the causes of death in ten cases of morphin takers showed the following: Acute tuberculosis, 3; pneumonia, 5; and two cases of nephritis. A physician who has had very large experience writes me that cerebral hemorrhage has appeared very often in cases under his observation, followed by acute pneumonia, or tuberculosis, with death in a few days or weeks. The supposed cases of immunity from consumption and other acute inflammations of the lungs by the use of opium is open to question and doubt. That it might occur is certainly possible, the same as exceptions to all rules are found. But this fact can only be establisht by a rigid analysis of the symptoms and history of the case. There is one fact about which there can be no doubt that all use of opium lowers the nutritiv functions and lessens the vital powers, both mental and physical, and that the germ of consumption finds most activ soil in low conditions of vitality and nutritiv force.
T. D. CROTHERS.
Ergot Treatment of the Opium Habit. Editor MEDICAL WORLD:-It appears that in the current issue of your journal you made some reference to a paper which I read before the New York State Medical Association, in October, on the treatment of drug habits by ergot. I do not know what you said, but it seems to have been enuf to excite inquiry without answering it, with the result that I have been deluged with letters (especially from all
In all cases I would give ten grains of blue mass the night before beginning the ergot treatment, followed in the morning by sufficient saline to thoroly clear the bowels, and every night and morning, during treatment, one to two drams of fluid extract of rhamnus frangula should be given so as to secure two or three mushy stools each day.
If the subject is calm at the end of fortyeight hours, the ergot may be given a little less frequently; but it should be continued to the extent of at least two doses a day for a couple of weeks, and at least one for one or two weeks longer.
There are three important helps that should not be neglected in the extremer cases, and they are always valuable. First, galvanization of the sympathetic ganglia, by stroking with hand electrodes from occiput to sacrum, one electrode on each side of the spine, the two separated about four inches. The current should be ten to fifteen milliamperes and continued twenty to thirty minutes, daily or oftener.
Second, dry cupping, by means of the valve cups exhausted by an air pump, along both sides of the spine and sides of neck.
Third, shock, applied by means of hot and