« PreviousContinue »
A woman, aged forty-one years, complaining of pain in the region of the stomach, loss of flesh, clay-colored stools, and vomiting, with evidences of malignant disease of the liver, was explored by abdominal section. The liver was found to contain numerous cancerous nodules. The wound was closed. Recovery from the operation was rapid, but death occurred some months later.
Six cholecystotomies for gall-stone are detailed, five of which made good recoveries ; the sixth died from sepsis.
Dr. Richardson places most weight on the history in making a diagnosis of gall-stone, while but little is attached to physical examination. A history of recurrent attacks of pain, with transitory jaundice, persistent discomfort for a long period of time, with a general cachexia, would point to cancer. The best incision, in the opinion of the author, starts a little to the left of the linea semilunaris, an inch from, and parallel to, the margin of the ribs, and carried across the fibers of the external oblique. If the gall-bladder is loose and presenting, it should be stitched to the abdominal wall before being opened ; but if it is contracted and adherent, a glass drainage-tube is to be introduced and packed around with gauze. Siphonage may be made use of.
[The vertical incision is preferred by many operators. Tait, whose experience has been exceptionally large, always uses it. I have found that it gave an almost equally good exposure of the operative area, and could be much more equally closed than the oblique incision.-J. W. W.]
In compliance with a request from a medical brother, I send you the formula I use in treating gonorrhea in the male. But before proceeding with my favorite way of treating this disorder, I will give a formula which I have used many times with much success: R Bals. copaibæ, one ounce; tincture cubebæ, one-half ounce; salol, eighty-four grains; ol. gaultheriæ, one dram; syr. acaciæ, q. s., ad., three ounces. M. Sig.: Teaspoonful two hours after meals, three times a day. To be well shaken.
The above formula is the best I ever used, until I devised
the following treatment: Ry Lithiated hydrangea (Lambert), four ounces. Sig.: Take two teaspoonfuls in water, with six drops of oil of gaultheria, three times a day, two hours after meals. Ry Morph. sulph., four grains; zinc. sulpho-carbolate, forty grains; peroxide hydrogen, four and one-half drams; aquæ dest, q. 8., ad., four ounces. M. Sig.: Use syringeful, after urinating, three times a day.
In writing for the above, I write three prescriptions, one for lithiated hydrangea, one for ol. gaultheria,and one for injection.
I always instruct my patient to exercise great care, when using the syringe, to press the urethra with thumb and fore. finger to prevent the fluid from being thrown too far back. A little caution right here will prevent the intense irritation that so commonly follows the use of the syringe, in causing irritation at the neck of the bladder.
In the hydrangea we have, par excellence, the remedy for the painful urinating, combined with the lithia, which is as pleasant a diuretic as is needed. The oil of gaultheria can well serve the same purpose as the balsam of copaiba, while the injection will quickly exterminate the exciting cause.-B. F. Price, M.D., in Med. Brief.
Nitro - glycerin in Nephritis.
Dr. Geo. L. Peabody, Practitioners' Society of New York, relates the following cases: A blacksmith, sixty years of age, who had marked diffuse nephritis, mitral insufficiency, and general thickening of all the superficial arteries. The renal history and the cardiac history extended over four or five years. The urine was always abundant, always contained granular casts and albumin, and the pulse was always of high tension until he was put upon nitro-glycerin. On January 12th he was given one-hundredth grain of nitro-glycerin every four hours. It was rapidly increased until, in February, he was receiving a grain every two hours, or twelve grains in the twenty-four hours. By February 21st, he received two grains every two hours. It was only under two grains every two hours, day and night, that dyspnea disappeared, the strength increased, and he was able to go out of his ward. He improved so much that he insisted on going to his daughter's
in Buffalo, and in order to enable him to undertake that journey without receiving such large doses of nitro-glycerin when not under observation, the dose was gradually diminished. He left in March, while taking two grains every four hours. There had been absolutely no unpleasant symptoms attending the use of the drug, but very decidedly beneficial effects. He afterward learned that, at Rochester, the man became so ill that he was taken to a hospital, where he was recognized by one under whose care, as house physician, he had been in New York. This gentleman spoke of the large doses of nitro-glycerin which he had been receiving in New York, but the hospital physicians were so horrified that they allowed him to renew them only on his own responsibility. The second day sufficient amount of the drug was obtained, and improvement. followed at once upon its use.
The second case was one of Bright's disease under his care in the New York Hospital, with pulse of very high tension, occasional attacks of profuse and painful vomiting. The patient said that for two years he had suffered from vomiting before rising from bed in the morning; was then able to get up, but could not work. There was hypertrophy of the left ventricle. About November 1st, he began giving one-hundredth of a grain of nitro-glycerin, gradually increasing the dose, until he was receiving by the end of the month one-fifth of a grain every hour. On January 1st, he received half a grain every three hours, then half a grain every two hours, then a grain every three hours, day and night, for several weeks. The pulse improved in tension very much, but occasionally it would return to its original tension, and then he would have attacks of persistent vomiting, lasting, perhaps, three days, and controlled only by enormous doses of morphine, administered hypodermatically. During the vomiting attacks, the nitro-glycerin was administered in the same doses subcutaneously.—Medical Record.
Administration of Arsenic.
Arsenic is one of our most useful remedies in a large number of chronic diseases, more especially the chronic scaly-skin affections. It is not only indicated under these circumstances,
but also as a nerve tonic. Those who have had occasion to use arsenic to any appreciable extent, have noted that, while its action is in the main a beneficial one, it not infrequently exercises an irritant action upon the stomach, and may possibly exercise its toxic symptoms. In order to avoid these disagreeable symptoms, iron is added, the combination being borne a much longer period of time, and acting as well as the arsenic does when taken alone. The arseniated iron water made by Dr. Enno Sander is one of the best combinations, being pleasant to take. In sixteen ounces of carbonated water, it contains: R Arsenious acid, grs. .125; iron pyrophosphate, grs. 3.657; sodium do, grs. 2.608; sodium chloride, grs. 2.294. Eight ounces should be taken daily, one-third of the quantity after each meal, and for this reason it has been put up in eight-ounce bottles. There being no ferruginous taste or odor, it forms a pleasant beverage during meals. The combination, with the iron and soda salts, makes it an easily digestible preparation, thus insuring against any gastric symptoms. St. Louis Medical and Surgical Journal.
The Treatment of Obstinate Hiccough.
'It is doubtless perfectly true that the treatment of hiccough has not received much notice at the hands of the writers of textbooks in this country. But the reason of this probably is that the symptom seldom attains to any serious proportions in this part of the world, so as to call for relief by the medical man in attendance. When, however, hiccough acquires an obstinate persistency, for the relief of which therapeutic aid is urgently needed, difficulties may be met with. A case in point is recorded in an Indian contemporary, where a retired officer, aged seventy-six, who had been suffering from acute congestion of the liver, became affected with obstinate hiccough, which set in as a most alarming and distressing symptom. Everything was tried in the way of drug treatment which could be suggested, but without avail. One day, however, some beef tea was taken, which incidentally caused the patient to vomit. For a time, in consequence of this, the hiccough was relieved; whereupon the practitioner determined to try an injection of apomorphine, and the result was that
vomiting was produced, and the hiccough ceased permanently. Altogether, the symptoms persisted incessantly for seventytwo hours, and caused much distress to the patient. Physostigma has been recommended as useful in these cases.-Med. Press and Circular.
Extract from New York Medical Journal of July 2d from article of Dr. Thomas S. K. Morton, read before the Philadelphia County Medical Society :
If healing of an ulceration is retarded by the presence of sloughs—and sloughs are very slow to separate in the absence of an active suppurative process—it may be expedient to hasten their separation. If already loose at the edges, they may usually be dissected off without pain by scissors and forceps. Otherwise the best plan is to digest them out by means of pepsin or papoid. When pepsin is used for this purpose, I build a retaining wall of tough cerate about the ulcer, and then pour into the little reservoir thus obtained enough of the following solution to cover the ulcerated area: R Pepsin pure, gr. j; water, 3j; hydrochloric acid, mj. M.
Allowing this to act for about an hour, occasionally renewing the solution, the sloughs will as a rule be found almost or quite digested and liquefied, or so loosened up as to be itadily removable by scissors and forceps. But much more convenient than this will be found the dusting of a minute portion of papoid (vegetable pepsin) beneath the protective strips and allowing it to act until the limb is redressed the next day. This succeeds well, because papoid acts best in a concentrated medium of any reaction whatever-pepsin only in a dilute acid solution.
This new disinfectant and antiseptic is recommended as promptly arresting the development of micro-organismis. It has been advised in the treatment of rhino-pharyngeal and laryngeal diseases, as well as in affections of the middle and external ear. It is obtained by dissolving the fraction of tar oil which boils between 190° and 200° C., in fat, and subsequently saponifying with alcohol. It is a clear brown, oily