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become numerous, it will be hard work to give each the attention absolutely necessary, much less what you would like to give them. And then is the time for you to take an assistant, and start him in the same way of doing thoro work.
I see in the papers that there is another great rush for lands where the Government is opening a small Indian reservation. About 50,000 people are struggling and fighting, murdering, to get possession of homesteads enuf to supply one twentieth of that number. Do you ever think how much the prosperity of our country has depended on that homestead law, and how scarce suitable land has become? We used to sing in school that "Uncle Sam is rich enuf to give us all a farm." But the boundless West has had its bounds set, it is full, and there remain only the dry lands that require capital in large masses to establish irrigation plants. And so we are losing hundreds of thousands of our farmers to Canada. But in the South there are millions of acres of good land still available for the homesteader; cotton and timber land open for entry. Why is it neglected? The state of things described by Tourgee, in his "Fool's Errand," no longer exists, if it ever did exist. The South welcomes the northern immigrant; it seeks to attract him, and gives him a hearty welcome. It is no longer considered disgraceful for a white man to work there at any decent occupation. Mechanics get big wages and have plenty of work. Lands are easily obtained, by lease or purchase at easy terms. The opportunities for investment of small sums plentiful-the South presents numberless openings for business. Take this example: In our trip down the Mississippi and residence in Louisiana and Mississippi this past winter, we never once got as much milk as we needednot at a price below ten cents a quart. They use Holsteins, because they give so much milk. We askt one man why he did not get some cows that gave richer milk, like the Alderneys; but he askt why he should, when he could sell all the poor thin milk he could supply at the above price.
Do cattle thrive there? A bunch of fat cattle sent from Louisiana to Chicago a few months ago made a sensation by their high quality. Are they expensiv to feed? A field of alfalfa opposit Baton Rouge was cut eight times last year; and plowing goes on the year round in Louisiana.
We made a calculation that a forty acre farm a mile from Baton Rouge-offered with buildings for $4,000-could be bought and stockt with Alderneys for $5,000, and that it would pay a gross income of that much every year. We saw peach trees blooming in February, whose fruit weighed thirteen ounces
each, and brought five cents each in New Orleans. Plant that farm with peaches and other fruit trees, and let them grow up while it is used for pasture; and in time a second crop would be afforded.
The price mentioned for land is not unusual. There is plenty to be had at any price from two bits an acre up to $250.
How about doctors? I think there are enuf there for the income-half the present population of the South is not to be counted on as able and willing to pay, so that the allowance of thirteen white and three colored doctors for Baton Rogue, with 15,000 inhabitants, is not to be lookt upon as too little. But as the country attracts immigration there will be room for many more doctors. And if there is any prejudice against northern men there now, it kept carefully out of our sight. We found the country and people very much to our liking.
Snap Shots at the May WORLD'S Quiz Department.
Dr. Taylor, page 212, should examin his pneumonia patient's sputa for tubercle. Give mercury and arsenic iodids, iodoform and phytolaccin, steadily, and you will find one of the most powerful and effectiv absorbent combinations ever put together.
"Mich.'s" thyroid case, page 213, will improve if he stimulates the menstrual flow, not otherwise. Give sanguinarin, three granules four times a day; alternate weekly with same dose of senecin; activ emmenagogs at periods.
"Dysmenorrhea," page 213. It will do no harm to paint the lacerations with tinct. benzoin.
Gallstones (page 213):-After failing with all ordinary remedies for this, we have used soda succinate for twenty years with few failures. Give it with boldin and chelidonin; and treat paroxysms with hyoscyamin, glonoin, strychnin arsenate and dioscorein, aided by hot enemas. Keep them up for a year and cure your cases.
If there is a specific for albuminuria (page 214) it is arbutin, that priceless medicament rescued by the alkaloidists from its enveloping masses of tannin in the crude drugs. Give one to ten grains a day, with suitable dietand watch the steady improvement.
Dilation of the veins (page 216) may be relieved by hamamelin and hydrastin, taken for long periods, if care is taken to avoid the causes of relaxation, such as the excessiv use of fluids and an idle luxurious life. Beer drinkers are incurable. Ice water swillers ditto.
Dr. McCall's eye pain (page 217) may indicate accommodativ imperfection and strain, or uric acid storms, or malaria-brow ague. This is a very nice case for study and investigation, but the data are not given here. However,
the great alkalometric, antispasmodic triadhyoscyamin, glonoin and strychnin arsenatewill relieve. Possibly the eye may be the place of lowest resistance, in which autotoxemia shows its effects.
WILLIAM F. WAUGH, M.D.
Chicago, Ill. [Read in "The Story of New Zealand" how that country disposes of its public lands; particularly read contrasts between their system and ours on page 699. Let me add this remark: If any WORLD Subscriber purchases "The Story of New Zealand," and is dissatisfied with his investment after reading the book, we will return the purchase price upon return of the book in good condition, and receipt of a written statement to the above effect.-ED.]
Osteopathy:-Subluxation of Bony Tissues and Their Relation to Disease.
The consideration of sensitiv areas along the spine, as well as muscular and ligamentous lesions when accompanied by soreness, together with the cause and effect of these conditions, brings us to the point where we may intelligently consider subluxation of bony tissues and the relation of such to disease process.
The existence and importance of such lesions, which is a fundamental teaching of osteopathy, may at first thought appear unreasonable; but a little meditation and study of the skeleton from the living and the dead subject will convince anyone that such lesions can and do exist, and that they demand consideration and treatment.
Let us first understand what the osteopath means by a subluxation. A subluxation is usually defined as a partial or incomplete dislocation. While this is true it does not always convey the same idea to all physicians. Every movable articular surface has some position in which the muscles, ligaments, blood-vessels, nerves, synovial membrane and other tissues connected therewith are free from abnormal tension, pressure, and irritation. This position, which the joint may maintain for a long period of time without injury to the part, may be considered its normal position. All the various positions from the slightest deviation from this normal to the point of complete dislocation are but varying degrees of subluxations. Any deviation from this normal position will produce tension, pressure and irritation of the tissues involved. Such deviations are therefore limited both as to degree of motion possible, and degree of time that this motion may be maintained without serious damage to the part. Within certain limits deviation from the nor
mal may be had without injury, providing this position be not too long maintained. For a certain degree of abnormality of position the body has compensated by elasticity, anastomosis, and lubrication of tissues. This degree of compensated subluxation we speak of as normal motion. This normal motion if retained for an abnormal degree of time becomes abnormal. Who has not awakened with "a crick in his neck" from lying too long in an abnormal position. A few moments of such a position would have produced no such results. The condition resulted more from an abnormal degree of time than of motion. By excess of time the normal becomes abnormal- the physiological becomes pathological.
Most of the subluxations that we as osteopaths find are abnormalities of time rather than of position, and as such are usually more common and more pronounced in the direction of the freest motion of the joint involved. These osseous lesions like those of the softer structures are more common and more important along the spine, tho by no means confined to this part.
The spine as a whole is an elastic structure composed of bony segments between which are interposed elastic cartilaginous discs. These bony segments are held together by ligaments, muscles, and other soft tissues, the elasticity of which allows no small amount of normal motion between the articular surfaces. The degree and direction of this motion is limited by bony processes and softer structures which also, in a measure, prevent dislocation. This spinal column is not a straight structure. It has, normally, posterior dorsal and sacral curves, and compensatory anterior curves in the cervical and lumbar regions. The motion allowed normally between the vertebrae differs in degree and direction in different parts of the spinal column. Flexion, extension, lateral flexion and rotation are permitted in all parts of the spinal column; the lateral flexion in the dorsal and rotation in the lumbar regions are but slight. Accordingly any vertebrae may be deviated and retained (or subluxated) in any of these positions. The effect upon the contour of the spinal column will depend upon the degree and direction of the subluxations and the number of vertebrae involved.
Hyper-extension of the vertebrae in the upper dorsal region reduces or obliterates the normal posterior curve in that region, giving rise to the "flat upper dorsal; associated with this there is a corresponding decrease of the compensatory anterior curves in the lumbar and cervical regions, producing a "straight spine." This condition causes an approximation of the spines in the dorsal region and separation of them in the cervical and lumbar
regions. An increast posterior dorsal curve produces the opposit condition in these regions. Two or more vertebrae may be thus involved without affecting the others. Approximation of two spines necessitates increast motion of the articulations above or below, resulting frequently in separation of the spine at these points. These breaks are particularly liable to occur between the twelfth dorsal and the first lumbar and between the fifth lumbar and the sacrum. The depression or elevation of an individual spine, particularly in the dorsal region, may give the appearance of an anterior or posterior subluxation of that vertebra if we judge alone from the spinous processes.
Lateral flexion of the spine produces scoliosis if it involves a sufficient number of the vertebrae, and may or may not have a compensatory curve in the opposit direction in other parts of the spine. In this condition there is an approximation of the transverse processes of the vertebra on the concave side, and a separation of them on the convex side. This lateral subluxation may also involve as few as two vertebrae, giving somewhat the appearance of vertebrae slightly rotated, judging from the spine alone, which is due to the approximation of the transverse processes on one side and a separation of those on the opposit side.
Rotation of the spinal column as a whole is produced by slightly rotating each vertebra upon the one next below. This produces a lateral deviation of the spinous process of each vertebrae and an anterior deviation of the transverse process on that side away from which the vertebrae are rotated, and a posterior prominence of the transverse process on the other side. One or more vertebrae may partake of this same motion, in which case its spine and transverse processes will assume the position as given above. These rotary lesions are more common in the cervical and dorsal region. Only very slight rotation of the last two dorsal and lumbar vertebrae is possible, owing to the positions of the articular processes. Subluxations, like normal motion, may be in only one direction or may combine two or more; e. g., a vertebra may be rotated and flext both anteriorly and laterally at the same time. Vertebrae retained in positions of normal motion are the most common subluxations with which we have to deal, tho there are other subluxations of vertebrae which are of a different character. A vertebra may be subluxated posteriorly upon the vertebra below without partaking of the normal motion of the articulation. This is true of all the vertebrae excepting the atlas, which is prevented from such posterior deviation by the odontoid process of the axis. By abnormal separation of the vertebrae or their spines
a degree of deviation directly anterior may be obtained, especially in the cervical and dorsal regions. Again a vertebra may be rotated laterally on the one below it on an axis corresponding to either of its articular processes. This subluxation necessitates a lateroposterior motion between the bodies of the vertebrae which does not normally exist, and is only possible owing to the elasticity of the intervertebral cartilage. Such rotation can occur only toward the side opposit the articular process around which such rotation takes place. These three latter varieties of subluxation being deviations in directions other than that of normal motion, are subluxations of degree as well as of time.
Another spinal lesion frequently found is subnormal mobility between two or more vertebrae. This condition is due to the contraction, inelasticity, and increase of tissues connected with the articulation-a sort of fibrous ankylosis resulting, which partially or completely prevents mobility of the parts. This condition may or may not coexist with the subluxations previously described.
The articulation between the atlas and occiput deserves special consideration. vertebra having no body, articulates only by the articular processes. The motion allowed in this articulation is according to Morris, ginglymoid, directly lateral and anteroposterior; consequently the occiput may be subluxated in any of these directions. The character and position of this articulation makes it especially liable to such deviations. This with the close proximity of its transverse processes to the important nerves and vessels passing thru the jugular foramen, as well as its relation to the vertebral arteries and the first spinal nerve, makes subluxations at this point both far reaching and important in their effects. Subluxations of the fifth lumbar vertebra on the sacrum are also especially frequent and important. Such lesions make chronic invalids of many women and cause sexual organs to be sacrificed on the altar of surgery. The coccyx too may be subluxated anteriorly or laterally.
The pressure, tension and irritation resulting from the prolonged retention of an articulation in an abnormal position produce symptoms of local temperature, tenderness, contractions, and pain; such symptoms in fact as Hammond and others have described as characteristic of spinal irritation. Vertebral subluxations are sometimes found in which no soreness is present. Such lesions are probably of long standing, and by its marvelous powers of adaptability the body has readjusted the parts so that the new condition is as nearly normal as possible with the subluxation still
remaining. A similar process is observed when an unreduced dislocation of the head of the femur forms for itself a new socket and acquires a degree of normal function with a decrease of subjectiv symptoms.
These bony subluxations and the coexisting lesions of the associated softer tissues may produce pathological conditions elsewhere by direct mechanical obstruction and irritation to the blood and nerve supply, or the local pathology may reflexly produce similar conditions. Such pressure and irritation may stimulate, inhibit, or otherwise modify the activity of the parts affected; or a primary stimulation may be followed by exhaustion or paresis from over stimulation, the result varying with the nature and intensity of the pressure or irritation. Pressure upon a nerve may be sufficient only to obstruct the free circulation of the nutrient fluids within the nerve sheath, and yet by such may produce far reaching effects.
Subluxation wherever found produces tension, pressure and irritation both intra- and extra-articular; but aside from this local pathology, vertebral subluxations are particularly injurious from the number and importance of the nerves and vessels subject to involvement. Approximation or rotation of a vertebra, especially in the dorsal region, decreases the size of the intervertebral foramina, causing irritation of and pressure upon the important structures found therein; viz. : The anterior spinal nerve roots, the posterior spinal nerve roots, and their ganglia, the recurrent nerves, sympathetic fibers, and blood vessels. The cord itself may be affected and systemic disturbances, apparently much out of proportion to the cause, may result, from such lesions irritating and obstructing the afferent. and recurrent nerve fibers and the blood vessels passing thru these foramina.
The causes of these lesions are numerous. Trauma, which Hammond credited with being the chief etiological factor in producing spinal irritation, plays a very important role here. It is surprising how many troubles, especially chronic ones, can be traced directly to strains, falls, blows, etc. Faulty position is also a factor. Many of these subluxations are undoubtedly secondary to lesions of the softer tissues. We have shown how unilateral afferent impulses, unless of great intensity, beget unilateral contractures, relaxations and other secondary lesions along the spine and elsewhere. Such unilateral contractions or relaxations from this or any other cause exerts an influence upon the osseous tissue which may result in subluxations. Contractures of the muscles along one side of the spinal column will produce lateral flexion of the vertebrae,
even to scoliosis. Contractions of the rotatore spina will produce rotation of the vertebra to which it is attacht. Bilateral contractions will produce rigidity or approximation of two or more vertebrae, and by so doing may change the general contour of the spinal column. Such contractures in the lumbar region by approximating the posterior edges of the vertebrae will produce lordosis. Similar conditions in the upper dorsal region will lessen or obliterate the normal posterior curve in that area producing a "flat upper dorsal" which decreases the capacity of the chest and often gives rise to a long train of systemic disturbances. The result of contractures along the spine resolves itself into a matter of mechanics, the condition produced being but the result of the totality of the forces acting.
Dorsal and lumbar vertebral deviations can frequently be seen, if the subject is not too fat, by having him sit upon a stool with bare back curved posteriorly and shoulders drawn well forward, thus bringing the spines prominently into view. If there is much muscular or adipose tissue, inspection will show little and resort must be had to palpation. Subluxations in the cervical region cannot be inspected. With patient on his back and the neck thoroly relaxt, the anterior, lateral, and posterior surfaces of the transverse processes may readily be felt.
The general origin and distribution of nerves with tissues affected by lesions of certain centers will be considered in my next article, as also lesions and subluxations other than spinal that are productiv of disease. Peoria, Ill.
W. A. HINCKLE, M.D. (To be continued.)
Please understand clearly that we freely admit that Dr. J. J. Lawrence, of the Medical Brief, has as good a right as anybody to make, advertise, and sell proprietary medicins; and with the Listerine people, Battle and Co., and any business connection that he may have body's business whatever, except his own and any other business concern whatever, is nothose immediately concerned. But when he persists in pushing proprietary medicins to the medical profession in an unethical, unjournalistic, unbecoming, and objectionable manner, it becomes the business of the medical profession and of the journalistic profession.
American Medical Editors' Association.
The annual meeting of this Association will be held in the parlors of the Hotel Dennis, Atlantic City, N. J., at 2 P. M., June 6th. A most interesting program has been prepared, and many instructiv papers upon medical journalism and allied subjects will be presented. All medical editors are most cordially invited to attend.
New books as they appear, are sent to our Assistant Editor, Dr. A. L. Russell, of Midway, Washington Co., Pa., for review As the Doctor thus has all the late books for reference, and is made familiar with them by reviewing each one carefully as it reaches him, he is unusually equipt for answering queries. Therefore it has been our custom for a long time to send queries to him for reply. In fact, the Doctor made a special request that this be done, as he enjoys this work. It now occurs to us that time will be saved if you will send directly to Dr. Russell matter intended for the Quiz Department, which has grown so much under his vigorous treatment Please notice that our query department is not used to "boost" proprietary remedies, almanac fashion. THE MEDICAL WORLD has no interests other than to give to the medical profession the greatest amount of honest service possible. It has absolutely no interests in any proprietary preparation nor any medical supply house. Other medical editors have become, and are becoming, wealthy, by using their pages to increase the sale of preparations that they are interested in; but we prefer to render service to our subscribers that is above suspicion of personal pecuniary interest. How can a man interested in the sale of certain preparations render the best service? He is always trying to push one of his preparations in. That is commercial journalism. We prefer ethical journalism-and so does the profession, for THE MEDICAL WORLD is growing in popularity faster than ever before-and our subscribers are paying ones. They must be, for we have no medicins to "boost," nothing to sell, nothing to depend on but pure journalism; but doctors that want honest, straight journalism are willing to pay for it-they are glad of the opportunity.
Only such queries will be publisht as are likely to interest and instruct many others as well as the one asking help. No charge has ever been made, nor will any charge be made, for this service to our subscribers. However, those who wish an immediate and personal reply by mail may obtain the same by inclosing two dollars to Dr. Russell. This is really a consultation in the interest of the patient, and should be charged to the patient-two dollars being a very moderate consultation fee. The Doctor agrees to give full, careful and immediate attention to such consultations. We reserve the right to publish in this department any such consultations that may be interesting and helpful to our readers. Name and address will be withheld if requested. Come freely for help, but read up as fully as you can before coming to us.
Editor MEDICAL WORLD:-I have three cases of goiter; two in women 32 to 37, and one in a girl 17 years old, the daughter of the last named. This daughter is very nervous, and during any excitement the gland enlarges very much, and any excitement will cause her menstruation to come, regardless of time. Have been giving her iodid of potassium internally, oxid of mercury and ichthyol externally, with very little success. Have tried thyroid extract with little benefit. Would be pleased if you can give me any thing to cure these cases. INDIANA.
[You should have stated the duration of the disease, and the length of time you had adhered to treatment of a given kind. Effect of medication is always slow, and nearly imperceptible in goiter.
In severe goiter, especially in those in which the nervous symptoms are well markt, no treatment is so effectiv as complete rest in bed, massage, liberal milk feeding, and electricity: In other words, the well known S. Weir Mitchell "rest cure." Belladonna, continued just short of the maximum physiological effect, for several months, has workt well in numerous cases. Hydrastis canadensis has many cures to its credit. Arsenic, in the form of Fowler's solution, is useful in nearly all cases. Suprarenal gland, in tablet form, has been administered with benefit. Digitalis is the best drug to quiet tumultuous heart action. The ice bag, locally applied, will give service in emergen
Beside seeking a method or combination of
drugs "to cure the goiter," you must learn to treat the case symptomatically, and to keep it in the best hygienic condition. Fatigue must never be allowed. Indigestion and constipation must be corrected. They must be removed from all opportunity for excitement of any kind. Vary the preparations of digitalis as distaste arises for the drug; and at the very outset of the treatment it may be laid down as a safe rule, to never allow patients to know what they are taking.
There is no absolute cure for every case of goiter; study each individual case, and you will probably derive benefit for each from a different method.-ED.]
Labor Complicated by an Ovarian Cyst.
Editor MEDICAL WORLD:-I have just been reading in a medical journal as to an ovarian cyst and pregnancy being present in the same patient at the same time, and as to the probable effect or cause of such a condition. Years ago I was consulted by a lady who had noticed an enlargement of the abdomen. I found a cyst, supposed to be ovarian. It was not large, but still it was quite noticeable. In a few months this lady became pregnant, when she had two growing tumors. They continued about equal size until about the seventh month, when the womb became and continued the larger. Of course the abdomen was over sized, but the patient got along quite well. I feared that when labor should come on, the abdominal contractions might burst the cyst, with fatal effect. So at this time, when the cervix was sufficiently dilated, the forceps were applied to assist the effect of the pains, and at the same time chloroform was administered to keep the patient as quiet as might be. A twelve pound boy was born, who is now attending our public school; and, altho ten years have elapst, the lady is still coddling that watery cyst, being about as large as a pregnancy at term. Her health is fairly good. Pierre, S. Dak. O. N. HOYT, M.D.
[Both the patient and yourself are to be complimented on the happy termination of the labor, as labor complicated by ovarian cyst is frequently a very serious matter. If she were to again become pregnant, we would not advise risking the expectant plan again, as your "luck" might fail you. The accepted teaching in such cases is to remove the cyst as soon as the pregnancy is positivly diagnosed. Such operation rarely causes an untoward interruption of pregnancy. In 17,382 births in the Berlin Frauclinik, but 5 ovarian cysts were found. Of 321 pregnancies complicated by ovarian cyst, 55 underwent premature expulsion of the fetus. In 271 cases of delivery complicated by an ovarian cyst, there was a maternal mortality of over 25 percent and a fetal mortality of 66 percent. In version without puncture, in forceps deliveries, and in puncture, the maternal mortality has been about 50 percent (Hirst).
The lack of trouble in your case may have been due to the cyst being in the upper part of the abdomen, where it could not fall into the bony pelvis to obstruct the presenting part.-ED.]