Page images
PDF
EPUB

(g.) Putrefaction is an absolute sign of death. Better delay for it than run any risk of burying alive.

From Foreign Bodies in Air Passages.-If round and smooth, invert the patient and strike on the back; laryngotomy: tracheotomy.

of the New-Born.-Clean the mucus out of nostrils and throat; cathe. terize the trachea, and suck up the mucus. “Marshall Hall's method :" by placing child on abdomen, then bringing into lateral posture, repeating slowly and deliberately. “Schultze's method :" by placing the thumbs upon the anterior surface of thorax, the indices in the axillæ, and the other fingers along the back, the face of the child being from you; rotate the child, by swinging upwards, so that the inferior extremities turn over towards you. In a moment re-rotate to the original position. Do not support head or legs in the forward rotation; their bending upon or towards the abdomen gives a forced expiration.

CLINICAL EXAMINATION OF THE URINE.

NOTE.–Use morning urine, or a sample of all passed during the 24 hours.

| Pale (and copious), 1.032+ indicates Sugar.

Pale (and copious), below 1.018 " Hysteria and convulsions, of arine and froth, very yellow

nervous disease.
or greenish.

Bile, Rhubarb.
Bright yellow to crimson..........

Santonin.
Dark, odor of violets........

Turpentine.
Color {High (scanty), sp. gr. +........... Fever, Uric Acid Dia.

thesis. High (scanty), sp. gr. —....

A grave symptom of

Bright's Disease.
Dark, muddy, smaky........

Blood, strong Coffee.
Black.......

Putridity, disintegrated

Blood, Tar, Creasote. į Fragrant ......

Cystine, Sugar, etc. Smell Fetid.........

Alkalinity. (of violets..........

Turpentine.

Quantity (in 24 hours). Normal about 50 A. oz., from which there may be considerable variation either way, according to the quantity of sweat, the fiuidity of food used, etc.

Specific Gravity. If possible, take the mixed urine. Normal is about 1.018, i.e. 18 grains of solids in each fl. oz. If sp. gr. is high, suspect sugar; is low, suspect albumen.

Reaction, in health is always acid in 24-hours' urine. It may be alkaline from medicine, or disease, or shortly after a meal. If excessively acid, er. amine for crystals of uric acid. If alkaline, let the test-paper dry, so as to ascertain whether the alkali be fixed or volatile.

Albumen by Heat and Nitric Acid, With Acetic Acid, or dilute Ammonia, make the urine slightly acid. If a precipitate appear on boiling, it may be Albumen or Phosphates. Add a drop or two of Nitric Acid. If the precipitate dissolve, it is Phosphates ; if not, it is Albumen. If a deposit or turbidity disappears on heating, it consists of Urates : if not, add a drop of Nitric Acid. If now dissolved, we have Phosphates ; if not, Cystine. Other Tests are the Potassio. Mercuric Iodide, the Sodium Tungstate, Potassium Ferrocyanide, and Picric Acid Tests; but the above described one, if care. fully done, will give as good results as any.

Bile Pigment and Acids, if necessary. Vogel's color-table. Marechal: Test, as follows: Put 3j of urine in a test-tube, and pour one or two drops of Tinct. lodi. to trickle down along the side of the tube, held horizontally nearly, so that the two fluids may touch, but not mix. If bile pigment be present, a fine green color will at once be developed below the red lodine layer. Noel's Test, Petten koferis Test, Nitric dcid Test, O.ride of Silver Test.

Sugar, if necessary. Urine containing sugar is usually light-colored, froths readily when poured from one vessel to another, and has a high specific gravity. Fihling's Test, as follows: Add to the boiling urine a few drops of freshly-prepared solution of Potassio-Cupric Tartrate (Fehling's Solution). If sugar be present, a yellow, orange, or red precipitate of Cuprous ()xide will form, 10 cubic centimeters of the solution being reduced by 0.05 gram of diabetic sugar. To prepare Fehling's Solution, dissolve 34,639 grams of pure, crystallized Copper Sulphate in about 200 grams of Distilled Water; also 173 grams of chemically pure, crystallized, neutral Tartrate of Sodium in 500 or 600 grams of a solution of Caustic Soda, of specific gravity 1.12, pouring the first solution into the latter, slowly and a little at a time. The clear, mixed fluid is then diluted with distilled water up to a litre. This solution soon spoils, and must be kept in a dark, cool place. Much more convenient are Dr. Piffard's Cupro- Potassic Paste, and Dr. Pavy's Cupric Test Pellets (see Tyson on Urine, page 57); and still more handy are Wyeth's Compressed Tablets for preparing Fehling's Solution of Potassio-Cupric Tartrate, U. S. P. 1880, a box of which costs 50 cents, and may be obtained from any good drug-store. The writer has used these Tablets for some two or three years, with extreme satisfaction.

Pavy's Solution is a modification of Fehling's, is equally good for qualitative and volumetric testing, and is intended for those who prefer the apothecaries' weights and measures to the metric system. It is made in the same manner as Fehling's, 100 minims corresponding to Ya grain of diabetic sugar, and consists of-Copper Sulphate, gr. 320; Potassium Tartrate (neutral), gr. 640; Caustic Potash, gr. 1280; and Distilled Water, 1 320.

Other Tests for Sugar are Bottcher's Bismuth Test, the Fermentation Test, Moore's, Trommer's, the Picric Acid and the Indigo-Carmine. They are all useful, but will not be detailed here, as one good method is all that the average practitioner wants.

Chlorides. Add a drop of Nitric Acid, and then Silver Nitrate until a precipitate ceases to form. Thus estimate the amount of Chlorides.

Urea.- Place a drop of urine on platinum-foil, and to it add a drop of Nitric Acid, and leave undisturbed in a cool place for a minute or two. If the urea is in excess, crystals of Uric Nitrate form immediately.

Mucus and Pus resemble each other so nearly under the microscope, that it is almost impossible for any one, except an expert, to distinguish between them thereby. Mucus is more cloudy and Mocculent to the naked eye than Pus, which latter is generally of a stringy consistence and thickish yellow appearance at the bottom of the vessel. The supernatant liquid being poured off, and an equal bulk of Liquor Potassæ added, the deposit, if containing much pus, becomes gelatinized, and so tough that it cannot be poured out. If Mucus, Acetic Acid added coagulates it, forming delicate molecular fibres.

Other Deposits are best examined with the microscope, and compared with good plates, rather than with printed descriptions. The plates in Hoffman and Ultzman on Analysis of the Urine, will answer the wants of most general practitioners, but the text follows the metric system. The urinary deposits may be classified thus :

[blocks in formation]

Necessary Apparatus. A dozen test-tubes. Alcohol lamp. A small porcelain dish. 2 watch-glasses. A sheet of platinum foil, 24 inch square. 3 pipettes of different sizes, to be used only for urine. A 2-oz. graduate. Urinometer. Blue and red litmus-paper. The reagents mentioned above, A little Grape-sugar, for use in testing the Fehling's solution.

The foregoing directions comprise all that the average practitioner will usually perform in the matter of urinary analysis. For fuller directions, the reader is referred to one of the numerous manuals on the subject, among which may be mentioned Da Costa on Medical Diagnosis, chapter vii.-Tyson on the Practical Examination of Urine,-and Sir Henry Thompson's Clinical Lectures on Diseases of the Urinary Organs, Lecture xxiv.

APhysician's Pocket Reagent Case," intended for urinalysis at the bed. side, is put up by Parke, Davis & Co., and sold at the low price of $1.50. It contains a set of Dr. Oliver's Test Papers, a color scale, specific gravity beads, two test tubes, a pipette, and full directions for the use of the reagents which are absorbed by the test papers.

ETHICS.

The Hippocratic Oath.- I swear by Apollo, the physician, and Æsculapius, and Health, and All-heal, and all the Gods and Goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation :-to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, should they wish to learn it, without fee or stipulation ; and that by precept, lecture, and every other mode of instruction, I will impart a knowi. edge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath, according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from what is deleterious and mischievous. I will give no deadly medicine to any one, if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and holiness I will pass my life, and practice my art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath unviolated, may it be granted me to enjoy life and the practice of the Art, respected by all men, in all times! But, should I trespass and violate this oath, may the reverse be my lot! [Adams's Genuine Works of Hippocrates, Sydenham Society, London, 1849.]

EXTRACTS FROM THE CODE. Consultations should be promoted in difficult cases. During them no jealousy or rivalship should be indulged. Candor, probity, and all due respect should be exercised towards the physician in charge. The attending physician should first question the patient, the consulting one afterwards putting such other questions as may seem fit to further elucidate the case. The discussion should take place in a private place, and no opinions delivered which are not the result of concurrence. In discussion, the attendant delivers his opinion first, the others in the order in which they have been called.

A Regular Medical Education furnishes the only presumptive evidence of professional abilities and acquirements, and ought to be the only acknowl. eriged right of an individual io the exercise and honors of his profession. No one can be considered a fit associate in consultation, whose practice is based on an exclusive dogma, to the rejection of the accumulated experience of the profession.

Punctuality should especially mark the keeping of these engagements; if one of the parties be delayed, the other should wait a reasonable time, and then, if the attendant, prescribe; is the consulting, he should retire, unless the case is urgent or he be called from a distance, when he should either prescribe for the emergency or leave a written opinion under seal. All theoreti. cal discussions should be avoided. Should diversity of opinion prevail, the majority should rule; should the numbers be equal on each side, the decision should rest with the attending physician. The consulting physician should always justify, as far as may be consistent with truth, the course pursued by the attending one, and no hint impairing confidence in him, or his reputation, should be thrown out. A double fee should be expected in all consultations,

Interference.-A physician should not visit or prescribe for a patient who has been under the care of another for the same malady, unless in, ist, a case of emergency; 2d, of consultation ; 3d, of relinquishment, by the physician, of the case; 4th, or a regular notification to him that his services are not longer desired. When the case is assumed by another, he should indulge in no insinuations against the former attendant. If called because the family

physician is not at hand, or is sick, he should resign the case to him on his arrival. In case several physicians are simultaneously called, as in accidents, the first arriving should take full charge of the case, unless the family attendant be present, when he should assume the charge; if not present, he should be sent for, and the further treatment resigned to his hands.

Miscellaneous.-A case should never be abandoned because it is supposed to be a hopeless one.

Contumelious and sarcastic remarks relative to the Faculty, as a body, should always be avoided. “It's a foul bird that fouls its own nest."

It is held unprofessional to resort to “ public” advertising, to hold a patent upon an instrument, or to dispense or prescribe a secret nostrum.

*Gratuitous services should be given to an afficted brother practitioner. If compelled to temporarily suspend his practice, on account of sickness, the physician who has been invited to take charge of his cases should turn the accruing fees over to the sick one, save in surgical or obstetrical cases.

NOTES ON SOME NEW REMEDIES.

AND SOME OLD ONES WHICH HAVE RECENTLY COME INTO

PROMINENCE.

Antifebrin, Phenyl-acetamid (CGH NHC,H,O,),-is the latest gift of the German laboratories to the antipyretic list of drugs (pp. 151, 421) It is a white, odorless and crystalline powder, almost insoluble in water, cold or hot, but freely soluble in alcohol and diluted alcohol. It has neither acid nor basic properties, and resists the action of most reagents. It is employed in doses of gr. iv to gr. xv, dissolved in wine, or enclosed in wafers, up to a maximum of gr. xxx in 24 hours. Its antipyretic power is stated in general terms as about four times the strength of Antipvrine. Its effect upon the body temperature begins to become manifest at the end of an hour after its ingestion, reaching its maximum in about four hours, and passing off, according to the size of the dose, in from three to ten hours. The pulse-rate falls proportionately with the decline of temperature. It produces no nausea, even in large doses, nor have any other untoward symptoms yet been caused by it. In many varieties of disease with high temperature it has already proved efficient, including acute rheumatic fever, erysipelas, typhoid fever, septicæmia, and phthisis pulmonalis,--and has the additional advantage of being a cheap drug selling at wholesale for about 25 cents per oz. If these claims of Drs. Cahn and Hepp, of Strassburg, become strengthened by further experience, we may have found at last the long-sought substitute for Quinine in pyrexia ; though the reported discovery of a synthetical method of making Quinine itself by Dr. C. Hewitt, of London, is true, would seem to leave nothing to be desired in this respect. After all the experiments with other antipyretics, the experience of the profession, as voiced by Dr. Carter at this year's meeting of the British Medical Association, is that Quinine must be placed at the head of the list. (See ante, page 421.)

In a recent publication on the comparative value of the various antipyretics,

« PreviousContinue »