WESTERN MEDICAL REVIEW Per Published Monthly by WESTERN MEDICAL REVIEW COMPANY, Omaha, Nebr. Annum, $2.00 The WESTERN MEDICAL REVIEW is the Journal of the Wyoming State Medical Society and is sent by order of the Society to each of its members. OFFICERS: Dr. A. G. HAMILTON, Thermopolis. President DR. W. H. ROBERTS, Cheyenne, Secretary All matter for publication in this section should be sent to FRED W. PHIFER, M. D., Editor, Wheatland. Wyo. COLLABORATORS-SUBJECT TO REVISION. Pestal, Joseph. Douglas; Keith, M. C.; Casper; Marshall, T. E., Sheridan; Nelson, N. D.; Shoshoni; Wicks, J. L., Evanston; Wiseman, Letitia, Cheyenne; Young, J. H., Rock Springs. Vol. XVI. CHEYENNE, WYO., MAY, 1911. EDITORIAL. Sleep for Children. No. 5 Some remarkably interesting treatises have been recently published relating to the scientific phenomena of sleep. The authors of these works, while agreeing in the main with the efficacy of "sleep as nature's sweet restorer," still hold the opinion that too much sleep is decidedly harmful, and that the majority of people indulge in the habit to a greater extent than is goor for their health. Their views, as expressed on the subject in regard to young children, are both instructive and novel, and in brief are somewhat as follows: that even infants at the breast are allowed too much sleep; that they need not only time to sleep but time to wake if their intellect is to be awakened. The tendency to sleep shown by children and the uneducated is explained on the ground "that their psychic world is so poor that it is almost impossible for them to take any interest in their own thoughts and ideas. It is argued that even during the first four or six weeks of life there ought to be two waking hours during the day, and as the baby grows the duration of wakeful period should gradually increase. All methods of putting children to sleep artificially by means of monotonous sensations are strongly censured, including the crowing of lullabies and the rocking of babies in cradles or simply in the arms. Rocking the child in the arms or cradle is said to produce sleep partly because consciousness is fatigued by a series or monotonous sensations and partly because at the same time artificial anemia of the brain is provoked. Finally the approximate period of sleep necessary for children at different ages is given. Between the ages of one and two years there should be from six to eight waking hours; between two and three years, seven to nine waking hours; between three and four years, eight to ten waking hours; between four and six years, twelve to fourteen waking hours; between nine and thirteen years, fourteen to sixteen waking hours." There is much common sense in the foregoing remarks, but there is also a tendency to rather unduly press the point as to the harmfulness of oversleeping, particularly in the case of very young infants. Rocking a child in the cradle to any great extent is doubtless harmful, but it is difficult to understand in what manner the "crowing of lullabies" can affect the health of a baby. It is also no easy matter to fix the amount of sleep that a person-child or adult-should take by any hard and fast rule; a large degree of latitude must be allowed in this respect, as it is an absolute fact that individuals of different temperaments and constitutions require varying periods of sleep. ABSTRACTS. Tonsilitis and Genito-Urinary Disorders. G. L. Hunner, Baltimore (Journal A. M. A., April 1), after referring to the recent enumeration of ailments ascribed in certain cases of tonsillar disease by Rosenheim (Bull. John Hopkins Hosp., November, 1908, xix), says that those treating diseases of the urinary organs in women are familiar with the so-called rheumatic urethritis. There are many cases in which gonorrhea can be ruled out to a practical certainty and some in which we are at a loss to ascribe the symptoms to anything but a rheu matic cause. His experience with these patients is that they respond more readily to local treatment than do those with chronic gonorrhea, and as a rule they relapse within a few years or months. His impression also is that in these cases we find the inflammation more frequently in the posterior third of the urethra rather than in the anterior third, where it is more frequent in gonorrhea. Several illustrative cases are reported and discussed. He finds the evidence of their connection with tonsillar disorders sufficient to warrant a more careful study of chronic urethral cases for, if we can relieve them by tonsillectomy, as he has done in several of his reported cases, we will make an important advance in therapeutics. The possible connection between tonsilitis and ureteritis has been brought to his attention only recently, and he reports two cases of this type, in one of which the tonsils had been removed. A suggestive feature in one of these is that the patient had a sore throat and hoarseness following each attempt to catheterize the ureter. He believes that this new theory of tonsillar infection or toxins producing ureteral strictures may be found to explain some otherwise obscure cases. While not himself familiar with male genito-urinary work, he is informed that many cases of posterior urethral inflammation canont be traced to gonorrheal infection. Dr. Geraghty of Johns Hopkins hospital tells him that he has seen cases of acute prostatitis with abscess formation occur during or immediately after tonsilitis, and he thinks that it is not improbable that some cases of chronic urethritis may have a like origin. Therapeutic Effect of Oxygen and Alcohol Vapor. Wilcox and Collingwood (British Med. Jour.) say that in combination of oxygen and alcohol vapor is a powerful cardiac stimulant in cases of heart failure. When the alcohol vapor is inhaled into the lungs with oxygen, it is conveyed direct to the heart, and all the alcohol absorbed by the blood passes immediately through the heart, so that the full effect of the drug is obtained on the only organ on which it is known to have a beneficial action. Moderate doses only should be given, for in large doses alcohol undoubtedly depresses the circulation. If given in the form of vapor with oxygen at ordinary temperatures, the amount of alcohol administered (1 to 2 grains per litre of oxygen) is so small that it is impossible to give an overdose. The exhibition of this combination is pleasant and non-irritating to the patient; no ill effects to the lungs or bodily system are produced. The good effect on the circulation is seen by the slowing of the pulse, with marked improvement in its force and volume, and by the rise in blood pressure. The full effect is not maintained indefinitely, and it is thus necessary to repeat the administration. Among the conditions likely to be benefited are cases of pneumonia with cardiac failure, pleurisy, cases of heart failure following chloroform anesthesia and various surgical operations, angina pectoris, attacks of asthma with heart failure, septicaemia, typhoid fever, myocardial degeneration, dilatation of the heart, valvular lesions of the heart, collapse after epidemic diarrhoea, etc. The apparatus suitable for the clinical administration of the remedy is described. New Treatment for Abdominal Surgical Shock. Take out two skin sutures as near the umbilicus as the wound will permit, then pry apart the continuous sutures in the fascia and peritoneum. One can now see if hemorrhage is present. This procedure is not difficult nor very painful; because when patients are in shock they are more or less insensible to the causes of ordinary pain. See that a nurse has ready very hot and cold normal salt solution, reservoir with four feet of rubber tubing, together with a glass tube or canula six to eight inches long. Both rubber and glass tubes should have a diameter of one-third to one-half inch. Have a quart of saline solution at temperature 112 degrees F. in the reservoir, which should hang three feet higher than the abdomen. Now have the wound held open so that you can see omentum or intestines, also see that the tube and the canula are now full of the hot solution, then insert the long canula beneath the omentum, if possible, pushing it upward so that the glass tube penetrates to the posterior peritoneum up behind the transverse mesocolon to the neighborhood of the posterior wall of the stomach, getting as near to the solar pleus as possible. The solution, still at 112 degrees F., is now alowed to run in as rapidly as it will. Probably a pint will fill the abdomen and be enough. This will take only five or six seconds. Now during the first two or three seconds of this time the patient feels little or no pain; he only feels that the hot solution is permeating among the intestines; but the remaining two or three seconds are different--the pain is very severe, for then the splanchnic nerves, the solar and hypogastric plexuses are being strongly irritated by the heat and pressure of the hot salt solution. They are well known to be very sensitive. As the patient is not under an anesthetic the reflexes are not depressed by it. Now the irritation of the splanchnic nerves and sympathetic ganglia produced by the heat and pressure at once cause contraction of the intestinal arteries, veins and portal vein and thus a marked rise in blood pressure. A reaction is produced by the sudden pressure of this hot solution on this great and important part of the vasomotor nerve mechanism, and is a sudden reversal of the phenomena of surgical shock. The radial pulse returns or its pressure is markedly increased. The glass tube is taken out quickly; a small piece of gauze is laid over the wound and a strip of adhesive plaster applied, then a tight abdominal binder to sustain the pressure. If this treatment should not succeed, it should be repeated in one or two hours. In addition to the above treatment hot salt solution per rectum, ten ounces every two hours, principally on account of getting the heat near the hypogastric plexus and splanchnic nerves should be given; also full glasses of hot water to drink for similar purposes; otherwise do not disturb the patient with hypodermics or by even raising the foot of the bed. Colorado Medicine. The Post-Operative Use of Radiant Light and Heat. There is probably no measure more deserving of general recognition in the after management of surgical cases than the employment of radiant light and heat. The degree of comfort produced by prolonged applications, made with a fifty candlepower incandescent lamp, having a parabolic reflector, or the larger lamps, over the site of the operation, is remarkable. This application may be either direcently to the surface, immediately following operation, or, as it is usually applied, over light gauze dressings. It should be used two or three times daily on the first and second days after the operation, and to a degree daily until the wound is healed. If this is done, it will be found that there will be very little demand for anodynes in minor operations and great comfort added, with more rapid healing of the line of incision in all cases, than if left, as has been done, to Nature's course. This acceleration of the process of repair is effected through the induction of hyperemia in the tissues. Another effect is to lessen the liability of the formation of scar tissue at the site of the wound. These effects warrant a more general recognition of the value of a measure so simple of application, and so safe in all cases. |