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. 1 ounce
The Auid 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 is 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 The best proof of the general dissatisfaction
that comes back, tie it on loosely, instruct the patient
to keep the dressing on until he is compelled to urinate, which exists among the prosession 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
Benzoic acid, of each
4 drams 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 :-
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
. 2 ounces 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 The Doctor was dissatisfied with the results
grit in it), add this aqueous solution to the salve in the
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
the mercury and silver. I claim that it digests the
tufts and exudates out of the follicles, and permeates mucus which lodge in the crypts and follicles these otherwise inaccessible germ-infected recesses. of the mucous membrane, his 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
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, and 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 Kifice 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 measures are unnecessary. If you have reason to
within that time, of a body said to be dead by 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 accompanying vaginal and labial imflammation, com
cians teach that efforts should be continued pletely 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 ihat 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. to 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 rightsully it ought not to be difficult to get their consent directed measures are instituted. Death has to be punctual and faithful in attendance. We 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 Alacit 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 1. 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 caresul 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 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
They are ipulation is undesirable, and is but rarely honest, but inexperienced; yet it must be con- necessary. If the bladder contains urin, that test 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 be 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 12 hrs cian in taking such risks.
10.4°F. 98.2° F. 90.3°F. 100.4° F. If there is no hemorrhage, concealed or Minimum...............
70.50 F. 62.6° F. external, take plenty of time and keep cool, Average.
96.9° F. 90.2° F.
77.9° 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 pre
mature. It is to be hoped that more tangible results tumefaction and tenderness, intestinal disturb- may yet accrue. Meanwhile, vaccinate as of yore. ances, or impairment of the general health ; (2) when there have already been two attacks, even
Please read the standing notices at the beginnings of
departments, particularly at the head of Quiz depart. of 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.
ORIGINAL COMMUNICATIONS over the South and West), to which I have
not been able to reply; and as many of these
are pathetically urgent, and as the paper has Short articles of practical help to the profession are solicited for not yet been publisht, may I beg space in your this department.
forthcoming issue for a reply to these queries ? Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.
Almost the entire number of inquiries has Copy must be received on or before the twelfth of the month, for
been concerning the treatment of morphin or publication in the issue for the next month. We decline opium cases; apparently the alcoholics are not responsibility for the safety of unused manuscript. It can as anxious to be relieved. usually be returned if request and postage for return are
received with manuscript; but we cannot agree to always do so. In treating a morphin or opium habit case, Certainly it is excellent discipline for an author to feel that he must
there are two methods which may be pursued : say all he has to say in the revest possible words, or his reader is sure to skip them; and in the plainest possible words, or his
the one, which I prefer, is to discontinue the reader will certainly misunderstand them. Generally, also, a drug wholly and at once; the other, which the downrighe fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. subject would prefer and also, probably, most
physicians treating such cases, is to gradually CONPARE RECORD
but rapidly discontinue the drug until by the
end of the first week the amount given will Consumption and the Opium Habit.
te so small that it may then be wholly disconMy Dear Dr. Taylor:- The question raised tinued. in your journal, whether morphin takers are If the drug is immediately and wholly disliable or immune to consumption, has brought continued there must be especial preparation out many interesting facts. Dr. Barbour's let- against the reaction, that will begin at from ter in the January World describes the con- twelve to thirty-six hours after the discontinuditions very clearly, and in his statement that ance. The use of the ergot should be begun opium masks the symptoms but does not stop at once, a half dram of the solution injected the degenerativ features, there is great signifi- hypodermically every two hours, or less frecance and reality. Recently a study of the quently, according to the quantity of the drug causes of death in ten cases of morphin takers used. showed the following: Acute tuberculosis, 3; Only fluid nourishment should be given, and pneumonia, 5; and two cases of nephritis. A that of the most easily digestible character, physician who has had very large experience and not food extracts in alcoholic menstruum. writes me that cerebral hemorrhage has ap- The nourishment should be given every three peared very often in cases under his observation, hours. followed by acute pneumonia, or tuberculosis, In all cases I would give ten grains of blue with death in a few days or weeks.
mass the night before beginning the ergot posed cases of immunity from consumption and treatment, followed in the morning by suffiother acute inflammations of the lungs by the cient saline to thoroly clear the bowels, and use of opium is open to question and doubt. every night and morning, during treatment, That it might occur is certainly possible, the one to two drams of fluid extract of rhamnus same as exceptions to all rules are found. But frangula should be given so as to secure two or this fact can only be establisht by a rigid analy- three mushy stools each day. sis of the symptoms and history of the case. If the subject is calm at the end of fortyThere is one fact about which there can be no eight hours, the ergot may be given a little less doubt : that all use of opium lowers the nutritiv frequently; but it should be continued to the functions and lessens the vital powers, both extent of at least two doses a day for a couple mental and physical, and that the germ
of weeks, and at least one for one or two weeks sumption finds most activ soil in low conditions longer. of vitality and nutritiv force.
There are three important helps that should Hartford, Conn.
T. D. CROTHERS. not be neglected in the extremer cases, and
they are always valuable. First, galvanization
of the sympathetic ganglia, by stroking with Ergot Treatment of the Opium Habit.
hand electrodes from occiput to sacrum, one Editor MEDICAL WORLD:-It appears that electrode on each side of the spine, the two in the current issue of your journal you made separated about four inches. The current some reference to a paper which I read before should be ten to fifteen milliamperes and the New York State Medical Association, in continued twenty to thirty minutes, daily or October, on the treatment of drug habits by oftener. ergot. I do not know what you said, but it Second, dry cupping, by means of the valve seems to have been enuf to excite inquiry with cups exhausted by an air pump, along both sides out answering it, with the result that I have of the spine and sides of neck. been deluged with letters (especially from all Third, shock, applied by means of hot and