Abstracts. THE MEDICINAL TREATMENT OF APPENDICITIS.* BY DR. PAUL MOOSBRUGGER, PHYSICIAN-IN-CHIEF OF THE LEUT KIRCH DISTRICT. THE Confusing dissension of opinion as to the indications for operation in appendicitis, incited Moosbrugger to publish his brilliant results from its medicinal treatment, both of the acutest and of the more chronic forms. His experience therewith during the past five years is in sharp contrast to that with the usual treatment, and he recommends his method, which consists exclusively, or almost so, of the liberal employment of collargolum, only after most careful observation and consideration. In mild cases that have perhaps for days suffered from colicky pains, with irregularity of the bowels and tenderness on pressure but without abdominal distension, he applies flaxseed poultices and administers fifteen grains of collargolum in six ounces of water, a tablespoonful every half hour or hour. In more advanced cases with vomiting, distended abdomen, bad subjective condition, he gives thirty grains of collargolum in six ounces of water, two and one half drams every hour, and orders thirty grains of unguentum Credé to be inuncted for thirty minutes twice daily into the flexor surfaces of the arms and legs. When vomiting interferes with the retention of the solution, he gives seven and one half grains in two ounces, and in bad cases fifteen grains in four ounces, in one or two enemata. Children get a teaspoonful of a one half per cent. or three-fourths per cent. solution every half hour, and if they vomit, the drug is injected rectally, and unguentum Credé is inuncted. Cathartics and narcotics he regards as harmful. If collargolum is used early, the general condition improves on the second day, the temperature falls, the patient passes flatus, and a spontaneous black stool, whereupon he usually feels relieved. In bad cases, when the exudate has reached the general * Abstracted from the Munch. Med. Wochenschrift, Sept. 12, 1905. abdominal cavity, and a diffuse peritonitis threatens, recovery is much slower, and only single symptoms, such as patient's facies and the prolongation of the disease, prevent rendering an unfavorable prognosis. If there is already a local peritonitis with encysted abscesses, the cure is much slower, and persistent collargolum administration for weeks is required. Even apparently hopeless cases may be saved by the energetic employment of the drug. It should be continued even after the acute symptoms are apparently overcome, or relapse may occur. In his series of seventy to eighty cases of varying severity, only two ended fatally, and in both diffuse peritonitis had set in when he was called. This mortality contrasts quite favorably with that under other methods. He now feels justified in rendering a good prognosis in all appendicites which have not progressed to a diffuse peritonitis and in which profound general infection is not present. Early correct diagnosis is of course important. Yet even if only recognized when perforation has occurred, the results will be better when collargolum is used. He does not hesitate to state that every early recognized appendicitis, no matter how acute or malignant, can be cured by collargolum without surgical intervention. Only two of his patients had another attack, both after about a year. In the great majority of his cases the disease focus was entirely cured. To determine if collargolum could exert a detrimental effect, he had seven ounces of unguentum Credé inuncted into his skin, and took a tablespoon dose of a strong solution (up to sixty grains in seven ounces of water) every two hours. No untoward effect was seen, excepting diarrheal evacuations, with perhaps a little tenesmus, and these symptoms disappeared when the remedy was discontinued. If the disease is just beginning in the appendix, or is still limited thereto, when operation is least dangerous, there is not the slightest doubt that collargolum is just as effectual as appendectomy. If there are abscesses in the abdominal or pelvic cavities, and these are localized or adherent to the anterior abdominal wall, there is no need of a hurried operation, and we may be able, by means of collargolum, to see the absorptive peritoneum dis pose of the pus, and possibly of a gangrenous piece of appendix. If the pus focus is not properly walled in, there is great danger that the surgeon will infect the rest of the peritoneal cavity while searching for and opening the abscess. Surgical intervention and the energetic use of collargolum at one and the same time are indicated only when there is a general peritonitis. In these cases it is advisable to establish an artificial anus, taking off the mechanical and chemical strain from the peritoneum and removing the source of autointoxication. This with collargolum medication will revivify the absorptive power of the peritoneum. As to the mode of action of collargolum, it is well known that it has strong antiseptic properties, while it is entirely nonpoisonous. That it has a curative action at a distance upon lesions, such as wounds, can readily be seen by watching its effect on a suppurating wound of the leg, for instance, when it is inuncted into the arm or administered internally. My observations show that collargolum combines with or otherwise neutralizes a certain proportion of the re-absorbed toxins in the blood or the tissue fluids; this is evident from the patient's improvement in color and facies and the betterment of the general condition, and undoubtedly goes together with the organism's increased power of self-help. There is also a direct favorable action on the disease focus and the neighboring tissues, shown by the following case: During my vacation absence my substitute in the District Hospital operated on a hygroma of the palm by incision and drainage. The patient did not do well; there was fever, and repeated incisions and curettings had to be made. After three months' treatment there was still a quarter-sized ulceration, with bad granulations, which nothing seemed to heal. I began to give him collargolum inunctions, and after the second one there was a distinct change in the condition of the wound. The granulations looked more vigorous, and there was less secretion. Simultaneously his general condition improved. On the twelfth day the wound was almost closed, and patient demanded his discharge. A plausible explanation of the action of collargolum was given by Schade lately. He proved that heavy metals, under certain conditions of oxidation, act in the human body as carriers and transferrers of oxygen, and that, without change in chemical constitution, they play the part of the so-called ferments, the organic oxygen bearers. Under these conditions they rob ptomaines of their toxicity, since these substances are readily oxidized. For the general practitioner especially, collargolum is an indispensable remedy, its certainty of action placing it side by side with diphtheria antitoxin. TREATMENT OF CEREBRO-SPINAL MENINGITIS CHIEF STAFF SURGEON SEHRWALD reports in the Deutsche Med. Wochenschrift, No. 35, 1905, a sporadic, typical, and quite severe case in which all usual methods were employed, with only transient effect at the most. He then proposed daily inunctions of two drams unguentum Credé into the trunk, after cleansing with soap and alcohol. The effect was striking. With the very first inunction the clinical picture improved, and after four of them the patient was bright and cheerful and almost wholly free from subjective difficulties. As the treatment had not been altered in any other respect, there can be no doubt that the favorable turn in the disease was due to the silver salve. The author warmly recommends this simple and safe method to all practitioners. Prof. Björkmann recommends the following treatment in cerebro-spinal meningitis: Inunctions of unguentum Credé are given, at first twice, and then once daily. At the same time the hair of the scalp is closely clipped, and moist borated gauze drenched in a one and one-half per cent, formaldehyde solution, acetanilid and one-tenth per cent. kresamine, is continually kept over the whole head from the root of the nose backward down to the neck and on the sides, leaving the ears free. The pack is covered with a cap of oil-cloth and renewed as soon as it becomes dry. Merck's Archives, January, 1905. Dr. Mitour contributes (Bulletin gen. de. Therap. med., July 15, 1905) a paper to the silver therapy of cerebro-spinal meningitis. For a woman with severe meningitic symptoms he ordered on the third day of the disease four inunctions of unguentum Credé. On the following day the convulsions ceased, and the patient regained consciousness. Under two or three inunctions daily the temperature returned to normal on the ninth day of the sickness, and though the pulse was still a little rapid, the general condition and appetite were excellent. Complete cure followed. The author also reports a case of febrile eclampsia cured by the same therapy. Clinical Reports. CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL. STATED MEETING HELD OCTOBER 2, 1905. HEART CASES. THE President, Dr. J. J. MacPhee, in the Chair. Dr. F. R. Beal showed two cases with mitral stenosis and one with mitral regurgitation. He said his reason for showing them was because many doctors do not know whether the murmur which accompanies such lesions is systolic, presystolic, or diastolic, or where it occurs in the rhythm. A murmur caused by mitral stenosis must be presystolic, and only that, and cannot occur at any other time. To determine the time of a murmur, it is absolutely necessary to differentiate the first heart sound from the second. When a murmur is heard at the apex, the second sound is louder at the base. During diastole the blood is flowing. simply because it has no reason to stop. Systole begins in the great vessels, even above the auricle, the wave of contraction passing downward toward the apex of the heart. As the wave passes along the auricle, there is just enough muscular fiber |