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likes appear now, and upon them the temporary as well as permanent choice of mates largely depends.

The predominance of the emotional aspect of adolescence shows itself finally in the attitude of youth toward religion. Reliable statistics have been gathered for the last thirty years which show conclusivly that conversions are most frequent between the ages of 14 and 20. The spirit of the Gospel, which makes sex-love the type and symbol of love of God and man, is thus exemplified by the close parallelism between religion and love. Youth worships ideals; and when in the rude contact with the world and its temptations these ideals are shattered, the eyes dimmed by tears of disappointment and repentance begin to look for a future life of perfection and salvation. Here, again, the emotional contrasts reveal themselves in the two extreme attitudes of youth toward religion, fostered by the right and the wrong kind of religious trainingnamely, as ardent devotion and passionate self-sacrifice, on the one hand, and as selfasserting resentfulness and spiteful hatred on the other.

The general emotional conflicts continue into the post-adolescent period, when they are enhanced by intellectual, vocational, moral and social difficulties, which find their ultimate solution in the foundation of the home. L. R. GEISSLER, PH.D., Professor of Psychology, University of Georgia. Athens, Ga.

A Case Illustrating the Usefulness of the Sphygmomanometer.

EDITOR MEDICAL WORLD:-While you are discussing the subject of the sphygmomanometer the following case should be interesting to the brothers as illustrating the usefulness of the instrument in one type of cases.

Was called three weeks ago at midnight to see Mrs. C., aged 51, farmer's wife, who was suffering from an attack of acute indigestion-severe vomiting, some diarrhea, and pains in stomach and bowels. She had been taken suddenly ill a few hours after eating a hearty supper, and she attributed the illness to her supper, and especially to a raw onion which she ate at that time. It was evident that the vomiting had thoroly emptied the stomach, so I gave her a hypodermic of morphin, 14 grain, and atropin, 1/150 grain. Also bismuth subnitrate and sodium bicarbonate,

the former for its sedativ and antifermentativ effect, and the latter to neutralize any excess of acid that might be in stomach. This treatment gave her instant and complete relief. She also complained of markt dizziness.

The next afternoon I was called, and was surprised to find her in the following condition: There had been no more stomach trouble, but the left side of her face was paralyzed; her right arm and hand were partially paralyzed; she could swallow only with difficulty, and her speech was indistinct, slow and difficult, due to a paralytic condition of the organs of speech. Urin negativ. Family and personal history negativ, only she used snuff, and was

the mother of six children. Now the blood pressure was 246.

The blood pressure test gave us a clear insight into the case, which we could not have had without it.

To my mind it seems very probable that at the time of the vomiting a small blood vessel burst in the brain, with subsequent oozing of blood, which formed a clot, which caused the paralysis. She was put on potassium iodid and tincture of veratrum viride, and a restricted, non-nitrogenous diet and laxativs. At this writing the paralysis has pretty well all disappeared, but the blood pressure remains persistently at 246. I suspect interstitial nephritis, notwithstanding the urin remains negativ.

But the lesson is this: If I had been present at the beginning of her attack, and had taken the blood pressure, I might have been able to have prevented the paralysis (by relieving the vomiting, reducing blood pressure, venesection, or other means). And a further lesson is this: that with such a high blood pressure it will be incumbent upon the patient to lead a wellregulated life, avoiding excessiv exercise, hearty meals, violent emotions or excitement, etc. Also the case should be further studied and persistently treated. These things seem necessary if her life is to be spared very long.

Had the sphygmomanometer not been. used in this case it is possible that the case would have been dismissed soon, and the patient not given any precautions as to her future manner of living, nor any treatment looking toward the reduction of the blood pressure persisted in.

The more I employ the sphygmomanometer the more indispensable it becomes. I

MAY, 1913]

Certain Indications for Blood Pressure Observation

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Certain Indications for Blood Pressure
Observation.

EDITOR MEDICAL WORLD:-There is not the slightest doubt that we can give our patients better and more intelligent treatment by routinely taking their blood pressure, and, even tho we have to treat symptoms, at times these may be treated all the more intelligently.

While it is not always possible to interpret the findings or to account for an excessivly high or low pressure, "we have a condition and not a theory confronting us." These conditions have to be met whether we then or at a future time arrive at the correct underlying cause or not. All of us at times, whether so desiring or not, are compelled to treat symptoms.

From routinely using the blood pressure as a means of studying and treating conditions we observe some very peculiar and interesting phases of disease which the following cases illustrate:

Case 1.-Mrs. H., aged 47, married, no children, never pregnant. Menopause at 45. Well nourisht, indeed; plethoric. General health would be considered good.

For five or six years has had occasional headaches, which have been severe. Eyes refracted twice in five years.

These headaches start at the base of the skull and radiate upward to the crown of the head and downward along the entire neck, with a decided tendency to retract the head.

About one year ago had such a severe attack and which was so persistent that leeches were used and the wounds were allowed to bleed profusely. This gave almost immediate relief. This, with purgation, relieved the condition for months.

In February of this year she came to the office complaining of the same symptoms. Her blood pressure was 215 m. m. She opposed bloodletting in any form if it could be avoided. Aconitin and nitroglycerin, with free purgation, were instituted and in three days the blood pressure was

203

180 m. m.; the headache having subsided, the same treatment was continued and in three days more the pressure was 135 m. m., the patient was able to attend to her usual household duties and feeling perfectly well.

Case 2.-Mrs. B., aged 64, widow. Had always remember enjoyed good health; could never being confined to bed excepting when her children were born.

February 15th had a rather severe nosebleed and a severe coronal headache. Used all ordinary household remedies, but the nose continued to bleed, and this bleeding was controlled, partly, I think, thru the patient sitting up in bed and holding the nose the greater part of the night.

The patient was seen about 6 a. m. February 16th. There was considerable bleeding from both nostrils, but neither seat of hemorrhage could have been more than 11⁄2 inches back. Both sides were packt fairly snugly with cotton saturated with peroxid solution. This seemed to control all bleeding until the same afternoon, when I was again sent for. The cotton plugs were then acting as lampwicks and a little stream of blood was trickling from each nostril. The blood pressure was taken on this visit and was 165 m. m.

The nostrils were again packt; but more tightly and adrenalin solution was used to saturate the cotton instead of peroxid. The hemorrhages were again controlled for several hours, when the cotton again began to act as lampwick drains, aided by secondary dilatation after the adrenalin contraction. This was at midnight of the 16th. The blood pressure was then 160 m. m.

Larger doses of aconitin and nitroglycerin were given and the nose repackt. There was a tendency for slight oozing that night and the next day, when there were several copious and liquid bowel movements from the purgation. On the 18th the blood pressure was 140 m. m. and the headache had subsided. The packing was removed and not again applied. The mucus from the nose was blood stained for several days, but there has been no hemorrhage or headache since. The lowest pressure observed in this case was 135 m. m. Since the arteries were inelastic aconite and potassium iodid have been continued since. I feel it is a very fortunate thing that this patient had a nosebleed, and that it was her nasal instead of her cerebral vessels which bled.

Case 3.-Mrs. L., aged 71. In the evening about 9 p. m. stated to her daughter, with whom she lives, that she felt queer, her tongue was thick and she couldn't talk right. She was given a purgativ and put to bed, but was restless and sleepless. The family watcht her closely during the night, and in the morning they all observed her articulation was worse and she was unable to keep her false teeth in her mouth, tho accustomed to a full upper and lower set for years.

At 9 a. m. her temperature was normal, pulse 80 but slightly irregular, as it has been for several years. The bowels had moved three times. The pupils equal and reacted normally to light and accommodation.

There was unequal loss of power, motion or sensation in the extremities and patellar reflexes were normal and equal, the Babinsky being absent.

The family was much alarmed at the condition, and, of course, feared an apoplexy.

The blood pressure was 160 m. m., and measures as in the former cases were taken to reduce it. In two days, it reached the 140 mark, and the patient at once was much improved, and in a week was up. The lowest pressure observed in this case was 135 m. m., but at last accounts she was feeling well and enjoying life.

The heart action became slightly more irregular as the pressure fell, and, since the vessels were hard, potassium iodid, gr. v t. i. d., was ordered.

J. C. ATTIX, M.S., D.D.S., M.D., P.D.,

Professor of Chemistry and Toxicology in the Departments of Medicin and Pharmacy, of Temple University, Phila.

2355 N. 13th Street, Phila.

Rigg's Disease is Curable. EDITOR MEDICAL WORLD:-Rigg's disease, or pyorrhea alveolaris, often starts about one tooth and spreads to all the others.

For many years it was considered incurable and is so yet by the majority of the dental profession. Many an unfortunate person has lost all his teeth from this cause. It often falls to the lot of the physician to lose all his teeth in this way, and sometimes he is appealed to for advice, as many dentists can promise no relief.

Of recent years a treatment has been evolved which will save most of the teeth, even if the disease be far advanced and the teeth very loose.

The cause is the formation of tartar around the necks and roots of the teeth. This sets up an irritation which loosens the gums and suppuration in mild degree occurs, which soon ruins all the teeth, they loosening and decaying or coming out.

The curativ treatment required is a thoro scraping of all the tartar from the teeth and a polishing of the surfaces so that there will be no rough places to start the accumulation of tartar again. This may lead to considerable bleeding of the gums while operating, but that is of no consequence. After a thoro cleaning and polishing it is not important what antiseptic and astringents are used to bring about adhesion of the gums again. Sometimes very little gum is left, but if it adheres as usual the tooth becomes firm again. Treatment may require one or several weeks.

The bifluorid of ammonium has been highly recommended to dissolve tartar and cause regeneration of gum and bony processes. It is well for every one to have the tartar cleaned from a tooth whenever there is a slight irritation or loosening of the

gum, as a scrape in time will save nine (teeth, or more).

Every physician should know these simple facts, as they add to his influence, and will put many an old fogy dentist in a toothsaving and money-making line of work. There was a valuable article by Dr. Joseph Head, of Philadelphia, in the June, 1911, Medical Council on the use of the bifluorid of ammonium. C. C. CARTER, M.D. Lancaster, Ohio.

Delinquent List for Dead-Beats. EDITOR MEDICAL WORLD:-We have a little scheme in this county that may help some other community as it has this, so I will pass it along. To begin with, we got only $5 for ordinary obstetrical cases, so we met and organized "The Floyd County Medical Society," fixt our minimum obstetrical fee at $10, and adopted a "delinquent list" that is revised every 6 months. physician is allowed to do work for one on this list until he brings a receipted bill from the one that put him on, unless it is an emergency; then he is allowed to make one visit for cash or its equivalent. The party is notified 3 months or more as to when his name will be put on by using the following letter, stating that his name will go on unless settlement is made:

FLOYD, VA.,

...191..

No

DEAR SIR-I have sent you a statement of your account quite a number of times and have heard nothing from you. I must ask you to settle this account in some satisfactory manner at once.

Under the rulings of the Medical Society, we are compelled to report your name to the Secretary, who will furnish all the Doctors within your reach a list of the men that refuse to pay.

When your name is so reported, it will be impossible for you or any of your family to get any medical attendance until settlement is made. I hate very much to do this, but the By-Laws compel me to do so. It will be a very disagreeable thing for me to do, and very unfortunate for you. Please do not neglect this and make settlement at once.

Yours very truly,

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tion, then his name could be put on in such case even tho it could have been made if collected in time. This committee will not allow an account to be placed on above list if it is a widow or one not really able to pay or where an account is in dispute until such dispute is settled.

You will see that this is not intended to affect those that are unable to pay, but only those that can and will not, but are in the habit of changing to the other fellow when he gets in debt to you. This breaks up the habits of the "medical tramps." I might add that this plan is not original with us, but has been used by other county societies before. It was this system that the "Rt. Hon." Edmond Parr was driving at in the Virginia Senate last session that was mentioned at the time in THE MEDICAL WORLD. Best wishes for THE WORLD. Floyd, Va.

M. L. DALTON, M.D.

New Uses of Epsom Salt. EDITOR MEDICAL WORLD:-During recent years many old and well-known drugs have been put to new uses in the treatment of disease. Probably in no other drug is this shown more clearly than in the new uses to which magnesium sulfate has been applied.

In works on materia medica and thera

peutics, of as recent a date as 1900, there is no reference to the use of this drug in the external treatment of disease. Wilcox and White's "Materia Medica," under date of 1904, dismisses the external action of the magnesium salts with this brief description, "none." Today one medical writer after another tells of the many advantages and excellent results found in the use of this well-known salt, when applied as external medication.

In an inflamed joint of a rheumatic nature the use of a hot saturated solution of magnesium sulfate is an excellent remedy. It should be applied with a goodly supply of gauze and the heat maintained by dry towels and further prolonged by hot-water bottles. In mild cases such treatment continued for twenty-four hours is all that is required.

In contusions of the large muscles of the limbs in which the skin is broken and in which the use of lead water and laudanum or a phenol solution is dangerous, the above solution of magnesium sulfate acts very well.

In painful conditions of the feet in

which only the muscles are involved, the same solution applied for thirty minutes in the same manner as a hot foot bath gives markt relief.

While a student in medicin, I recall the reference made to this drug by one of my instructors, in which he urged his students to give it a trial, if it fell to their lot to deal with erysipelas.

On this point, it is interesting to note that the Journal of the American Medical Association, March 4, 1911, refers to this matter, and the writer therein suggests that an aqueous saturated solution be applied to the part by means of gauze or cotton, the same extending well beyond the inflamed area, and covered with oiled silk or wax paper. He further suggests that the dressing be kept wet and that it be removed once in twelve hours for inspection and immediately reapplied and that the area should not be washt during

treatment.

Some practicians have resorted to the use of this drug in the treatment of tetanus. Dr. George Parker, Peoria, Ill., tells in above-named journal for June 8, 1912, of his success in treating this condition. He administers the drug subcutaneously, employing a 25 per cent. aqueous solution, injecting from 2 to 6 drams, repeating the following day if necessary. ENOS H. LEAMAN, M.D.,

3406 A Street, Phila.

Treatment of False Labor Pains. EDITOR MEDICAL WORLD:-I have just read with great interest the article in April issue, pages 152 and 153, by Dr. W. H. Gum, of Buckhannon, W. Va., telling THE WORLD of his experiences along the line, and I expect many of the readers could relate similar ones.

I am often called in to see patients that are in a similar condition, or at least say that they are having labor pains, and after making the usual vaginal examination and I find no dilatation of the os and a hard cervix, I always give a guarded prognosis, saying to my patient that "So far you have not had any true labor pains, and I can't say when you will. It may be soon or it may be several weeks or days." Then I would give the patient a hypodermic of morphin, 4 grain, and atropin, 1/150 grain, to relieve the pains and then give some cathartic, and possibly also place her on the ordinary uterine sedativs, such as viburnum, etc.,

requesting them to report to me at any time they noticed any more pains, which would likely occur at any time, and advise them that they soon would create regular labor pains if we could not control these false

ones.

Had there been a non-ethical man near this patient they might have called him in in the absence of Dr. Gum and then he would have knocked on him, but the better class of physicians know how these things go and we are all apt to make a like prognosis, but we are not careful enuf in that respect. We should always give a guarded diagnosis and prognosis at all times to be safe. Essex, Mo.

J. P. BRANDON, M.D.,

Pres. Stoddard Co. Med. Society.

Licensing of Mechanotherapists. August Jaffe, of Cleveland, Ohio, writes that mechanotherapists belong in the same class of assistants to physicians as the pharmacists. He states that they are as well prepared to do their work as the pharmacists. The pharmacists are examined and licensed by special state boards for the purpose in order that incompetents will be prevented from practising an art for which they are unfitted. He feels that the mechanotherapists likewise should be examined and licensed to practise their art of massage. He states that they know the physiology of massage, Swedish movements, exercise, hydrotherapy, kinesiology, psychotherapy and hygiene; also anatomy, physiology and pathology. Having been especially trained in his work, the mechanotherapist is properly skilled.

Then he inquires: "Why should a valuable science like this be left alone? Why should every shoemaker that knows of rubbing claim that he is a scientific masseur?" And adds: "The true mechanotherapist knows his limitations . . and never attempts to cure all diseases by his methods. All he wants is recognition as a masseur, as one that is always willing to follow the physician's prescription."

We, too, are of the opinion that the mechanotherapist should be examined and licensed to practise massage, and that others untrained should be prevented from using it. Properly restricted, such a class of workers would find ready employment thru the medical profession. The trouble heretofore has been in getting that class of mechanotherapists.

Phylacogen in Acute Articular Rheumatism.

EDITOR MEDICAL WORLD:-I send here a report of a case of acute articular rheumatism which I treated successfully with phylacogen:

Miss L. T., age 22. First attack of acute articular rheumatism, with wrists, elbows, ankles and knees involved. She was unable to move her hands or feet, running a temperature of 100° to 102°. The usual treatment was administered, without improvement for ten days, before phylacogen treatment was begun.

First dose of rheumatism phylacogen was given on December 20, 1912, 5 c. c. subcutaneously, at 11.30 a. m. By 3 p. m. her temperature had begun to rise and by 5 p. m. was 105°, but rapidly_subsided and was almost normal by 8 p. m. Complained of severe headache and pains thru body, and severe local reaction at site of injection. Next morning she was feeling better than before the injection, with less pains in joints and able to move hands and arms a little. This dose was given in left arm near insertion of deltoid.

Second 5 c. c. given December 21st subcutaneously in muscles of abdomen at 12.30 p. m. This was followed by chill in three and one-half hours, temperature going to 104 2/5° and then subsiding. Rather severe local and systemic reactions. Patient still better next morning, still less pain in joints and able to turn in bed without help.

Third dose, 10 c. c., given December 22d, 2. p. m., subscutaneously in left thigh; followed by chill and temperature in a few hours to 105 2/5o. Not so much local reaction, tho general aching all over body. Some nausea, but no vomiting. When fever was at about its highest the patient had a feeling of great bodily weakness and depression, which lasted for several hours. Next morning she was practically free of joint pains, tho still very stiff.

Fourth dose, 10 c. c., subcutaneously in right arm at 11.30 a. m., December 23d, and at 3 p. m. a chill lasting one hour, with temperature going to 105 4/5° by 5 p. m., which subsided in two or three hours. This was not accompanied by weakness as on the day before.

Reaction was so very great that I decided to wait 48 hours, when I gave the fifth dose, of IO C. c., at II a. m., December 25th. This was followed by chilliness and a rise of temperature to 104 2/5 by 5 p. m., which soon subsided and patient spent a very comfortable night. Very little local reaction.

Sixth dose, 10 c. c., at 10.30 a. m., December 26th, followed by chilliness at I p. m., temperature rising by 4 p. m. to 105 4/5°. Very little local reaction. The systemic reaction being so great, I decided to give only 5 c. c. next dose, which I did at II a. m., December 27th. Reaction was not so pronounced as with other injections, tho temperature rose to 104°.

Eighth dose, 5 c. c., at 10 a. m., December 28th, followed by severe chill at 2 p. m., with temperature going to 105 2/5° by 4 p. m.

This making the 60 c. c., I decided to wait a few days and see what the results would be, as patient had not been able to take sufficient nourishment during the treatment. Pains in joints seemed to subside with each dose, tho stiffness persisted in joints for about two weeks after discontinuing treatment. No other treatment was

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