case; each case should be carefully examined and studied, and the effects of each remedy used carefully watched. The results of treat ment will depend largely upon the nature and extent of the organic lesions L In cases of ascites, dependent upon cirrhosis of the liver, much may be accomplished by purgatives and diuretics to prolong life and over come the constant tendency to the accumulation of serous fluid in the abdomenal cavity; and when these measures fail, we must remove the fluid by the trochar. In many cases of cirrhosis and ascites, caused by excessive spirit (alcoholic) drinking, we have frequenty removed, by successive tappings, hundreds of pounds. Sooner or later, these cases of ascites perish from the exhaustion caused by the repeated tappings. In one case of cirrhosis of the liver, occurring in an Irish laborer, who had consumed enormous quantities of rum, gin and whisky, it was necessary to evacuate the serous fluid from the abdominal cavity almost every seven or twelve days-from one to two gallons of serous fluid were evacuated at each operation. The patient died at the end of the sixth operation. Throughout his illness his intellect was clear. In ascites resulting from the cirrhotic condition of the liver, death speedily ensues, if the distended abdomen of the patient is not relieved by the trochar. Under all circumstances, and even in necessarily fatal cases, the physician may accomplish valuable service by relieving suffering and prolonging human life.- Va. Med. Monthly. False Accusations Against Physicians. Dr. J. G. McCoy, of Springfield, Ohio, has recently disagreeably experienced a legal peril which environs the conscientious physician's life. He attended man for venereal disease and, not very wisely, trusted him. Payment of the bill was refused, whereupon suit was brought. Dr. McCoy was thereupon indicted for criminal abortion on the evidence of his debtor and a courtesan. The courtesan broke down on crossexamination, and admitted she asked Dr. McCoy to perform an abortion, who refused, and advised her to marry. The trial jury honorably acquitted D McCoy. False accusations of abortion, some of them even antemortem, are often made out of revenge against physicians who refuse to perform abortions, by the women who have them done unskillfully elsewhere. This mental peculiarity of women who have abortions done should always be token into account in judging of the validity of any abortion accusation against a reputable physician. Med. Standard. Sodium Bisulphite in Tonsillitis and Coryza. Excellent results are reported from the use of sodium bisulphite in aborting tonsillitis and coryza. Tablespoonful doses of a saturated solution may be given every hour or two for twenty four hours, or even longer if necessary. The disease is usually controlled in twenty-four hours under this treatment.-Notes on New Remedies. Sir Morrell Mackenzie finds that by exciting a rival reflex, the laryngeal spasm is at once overcome. By exciting a paroxysm of sneezing, immediate relief is procured. This is best done by the inhalation of a pinch of snuff into the nares, or pepper may be used in the same way. It is sometimes possible to produce sneezing by tickling the nasal mucous membrane.Med. and Surg. Rep. Physicians in Japan. An ex-attache writes: "Perhaps the most charming manner of compensating physicians for their care and attention is that which is customary among the natives of Japan. Physicians do not charge for their services, but on the contrary decline to name an amount, and protest against any idea of remuneration. Patients on their side are too proud to accept such services free, and send to the physician, not as a fee, but more as a friendly gift or token of gratitude, a giver, with some piece of silk, bronze, or lacquer sum of money, proportionate to the means of the work, the idea being that medical attendance is by far too important and elevated a character to be desecrated by barter for filthy lucre." What a pity that our western civilization, with all its commonplace vulgarity and lack of delicacy, will not admit of adoption of such a charming method of intercourse between the medical man and his patients.-The Medical Age. Treatment of Arterial Hemorrhage From the Palm cr the Hand. Most of our readers have probably discovered that hemorrhage from the palm of the hand is troublesome, more particularly from a punctured wound. When the vessel can be found and ligatured, or twisted, the result is generally satisfactory. The most painstaking surgeon, however, will often have to give over searching for the two ends of the wounded vessel. Before proceeding to apply a ligature to the brachial artery (a practice which in neglected cases, may be called for at once). Dr. Chalmet, of Landerneau, France, in Revue Générale de Clinique et de Therapeutique, advises a combi 2. Moderate pressure over the wound (previously bathed with an antiseptic lotion), by a compress of salicylated absorbent cotton, which is retained by a bandage. 3. Moderate compression of the radial and ulnar arteries by two little compresses kept in position by a bandage; a third compress should be placed at the bend of the arm and fresh turns of bandage applied pretty tightly. 4 Fixation of the arm in a square sling stitched together, so that the arm shall be be pressed to the side of the body, the elbow elevated, the forearm flexed, and the hand laid supine on the sternum (which should be partly uncovered so as to permit observation). 5. Complete rest, avoiding all effort, daily examination of the dressing, which should be removed about the eight day. Dr. Chalmet does not claim originality. As he says, "direct compression is known to every one; placing compresses over the radial and ulnar artries is Nelaton's invention; flexion of the forearm on the arm has been pointed out by Bichat; Gosselin recommended elevation of the arm with pressure at the wound, and also at the bend of the arm; humero-costal pressure (bring ing into play the weight of the body) has been employed by Schiverlbein." The combination, in spite of Dr. Chalmet's modest disclaimer, may be considered a happy one, and may be recommended on the express conditions, however, however, that the wound is kept in a thoroughly aseptic condition, and the wound and the wounded one kept under continual observation.-Dominion Med. Monthly. Collodion for the Treatment of Incontinence of Urine in Childhood and Youth. The mechanical treatment to which attention is called is the treatment by collodion. It is. most easy of application, occupies scarcely a minute, and can be carried out at school, college, or elsewhere, in perfect privacy. All that is necessary is while the prepuce, slightly curved up, is held with the left hand, to smear over the little cup thus formed by the extremity of the prepuce with collodion by means of a small camel's-hair pencil or blunt end of a penholder. Almost as fast as applied the collodion solidifies. In contracting it draws closely together the edges of the prepure, and thus the exit for the escaping urine is closed. A boy of eleven years of age has after one lesson, been able to use the collodion, and has used it every night carefully and diligently, so anxious has he been to cure himself of what he considered a race. A fortnight's use is sometimes sufficient for the cure. A relapse is easily dealt with. A solution of guttapercha in chloroform would seem at first sight to be equally applicable, but it is not. The solution of guttapercha is much longer in hardening, and it possesses no contractile powers. When the child desires to pass water, the little wedge or cap of collodion is easily removed with the finger nail. When I first used this collodion application, my expectation was that the bladder would act so forcibly against it as to cause sudden pain, and oblige the patient to jump at once out of bed and quickly remove the collodion, and that he should then repeat the application before returning to sleep. I was greatly disappointed. There was no pain; no awakening; but on rising in the morning the prepuce was found slightly distended with urine, and the collodion was removed without difficulty.-J. E. Powers, M.D., in Mass. Med. Jour. Within half an hour after the application the urine yields a strong reaction of salicylic acid. The result of twenty quantitative examinations showed that the total amount of acid eliminated in the twenty-four hours varied from twenty to eighty four centigrammes (3 to 14 grains). For the last two years every case of acute rheumatism admitted into Prof. Bourget's wards is treated by the application of this ointment to the exclusion of all other treatment. No salicylate administered internally. The results are as follows, Pain disappears a few hours after the application of the olntment. Swelling usually diminishes as early as the second day, Temperature comes down between the third and fifth Standard. Thus, in all countries, the lines are being rapidly drawn between the really "dangerous classes"-the few idle and often vicious wealthy para-ites upon society-on the one hand, and on the other, the many useful, earnest, productive members of society, who alone, by industrious toil and intellectual activity, produce the wealth of the world and who, alone, contribute to its progress. The physician belongs to the latter class, and he may well be proud of it. The sooner we recognize our identity as members of that grand "industrial army" whose honorable labor of hand and brain is the only support of the present and the only hope of posterity, the sooner we can intelligently co operate with our fellows in changing those conditions which create the artificial division into "classes," with unfair privileges and supercilious distinctions. The time must come soon, when the noble, the true of earth can no longer be dominated by those who have no other merit than that they have succeeded in speculation or been born into great possesssons. The example of Rush, Warren and many other illustrious physicians in past struggles for human freedom justify the belief that, in any future struggle, and also in the gradual process of social evolution constantly going on, the members of the medical profession will be found ever active and on the right side-that of humanity in its widest sense. A Case of Pneumonia Cured by the Subcutaneous Injection of the Essence of Turpentine. The interesting case of a young man, 29 years of age, suffering from a most serious attack of pneumonia, as a consequence of hard drinking is reported by Gingeot (La Médecine Hypodermique, August, 1892), as cured by the hypodermic injection of the essence of turpentine. Among the symptoms exhibited by the patient there were delirium, a temperature of 104°F, diarrhea, albuminous urine, sputa charged with pneumococci, streptococci, and other cocci, the whole lung being invaded. On each extremity one gramme of the drug was injected. Two hours afterwards the bodily temperature fell to 102°F., and continued to descend on the following days. Amelioration became permanent, and a complete cure was effected. The local reaction, however, was a violent one, as abscesses were formed. Gelineau, commenting on the case, says that if the results of this medication, as reported, are confirmed by future observations, it becomes necessary to endeavor, for the sake of our patients, to render the injections less painful and offensive. The abscesses, continues the writer produced by the injections and sidered as fixed or derived abscesses, as they are accompanied by an amelioration, cannot be concalled by Frochier and Dieulafoy, respectively, and which have been referred to by Frochier as a novel argument in favor of the method pro posed by this author, which consists in artificially producing phlegmons to enhance the happy termination of the infectious diseases, such as puerperal septicemia, pneumonia, erysipelas, and others.-Therapeutic Gazette. Symptoms of Mental Dissolution. At the meeting of the Royal Society of London, March 20, Dr. Savage presented a paper upon this subject with the following preliminary remarks: "I have taken as the basis of my paper chiefly my experience of seventeen years at Bethlem, leaving out tables of all patients over sixty, these tables being useful only as general indicators of the way in which the senile dissolution shows itself. Natural decay follows certain lines, but these differ in individuals Premature decay occurs in certain diseases, such as general paralysis of the insane. It also follows certain toxic conditions, such as those due to alcohol. No single symptom is pathognomonic of mental dissolution, though loss of memory is the most common. In all stages of dissolution there is loss of mental power which may be shown in different ways and different degrees; there may be loss of power or loss of self control. Dissolution is early shown by a reduced power of acquisition, next by a reduction of the power of retention of recent impressions, next by defect of co-ordination, later by loss of control and of judgment. Dissolution is on the whole the reverse of evolution, but does not follow quite in the same lines. (Dr. Savage then dealt first with dissolution as seen in general paralysis of the insane, next with disorders of control of a general kind, such as hysteria, epilepsy, mania, melancholia and dementia, taking in fact the groups of symptoms before the individual symptoms, specially noting the danger of impulse in the maniacal, suicidal and melancholic states.) Of the special or individual symptoms of dissolution, loss of recent memory, varying much in kind and degree, is the most important; loss of emotional control is next in frequency, and is even more important as leading to sexual faults. There is a tendency to collect objects of all kinds which may depend on several different errors of reason. There is frequently also a disregard of cleanliness which is difficult to understand. Judgment may remain for a long time after memory is weakened and the control defective." -Med. Progress. Huge Carbuncle with Temporary Glycosuria, Rapid Recovery_Under Carbolic Crystals Treatment. BY PURSON SINGH, H. A. In Charge Sholapur Dispensary. Mr. B., a contractor, aged 55, admitted on the 8th January, 1893, with an extensive carbuncle situated on the neck, involving the whole occiput and reaching down to the third dorsal vertebra. The whole neck was involved in the swelling, save the larynx. The carbuncle seemed extending rapidly every day, and it had several small sinuses on its surface. There was severe pain and restlessness. In consultation with Mr. V. R. Kirloskar, L.M., & S., medical practitioner at Sholapur, it was first decided to make extensive incisions and to squeeze out the pus, but before undertaking such measures we thought it best to examine the urine. Next day the urine was examined. Its sp. gr. was 1035, and it was loaded with sugar. This result prevented us undertaking the larger operation, and we made only small punctures here and thereto let out the pus, and filled these openings with pure carbolic acid, dry antiseptic dressing being applied and changed twice a day. The general mass of the tumor was painted with liniment of iodine once a day. Internally we gave him quinine and iron. The day after the incisions the patient began to make steady progress towards recovery, and the spread of the swelling and inflammation were arrested. Recovery was so rapid that it seemed almost an impossibility in the case of a diabetic patient. After a week we examined his urine again and were very much surprised to notice that its sp. gr. was s1008, without a trace of sugar. As far as we could ascertain there were no symptoms of glycosuria previous to the onset of the carbuncle. This case is remarkable from the spontaneous disappearance of sugar from the urine, without any apparent treatment, and the rapid recovery of the patient from such an extensive carbuncle. -Indian Med. Record. Pheneucalyptol. J. Roussel (La Médecine Hypodermique, August, 1892), calls attention to the above substance as the best combination for the administration of phenic acid. He employs pheneucalyptol with good results in the treatment of phthisis, even in the third stage of the disease. He first uses in these patients eucalyptol by itself, and after one or two months he injects the new combination for a period of two weeks. When adenitis, arthritis or periositis is present, the injections are applied interstitially. Phenic acid or pheneucalyptol is injected superficially and often in solutions of the strength of twenty per cent. in cases of anthrax, pustules, epitheliomas and tubercular lupus. These injections do not produce the violent effects caused by Koch's tuberculin. The writer recommends the following solutions: 1. Eucalyptol, 10 parts; phenic acid, 10; vegetable oil, 100. 2. Eucalyptol, 15 parts; phenic acid, 15. vegetable oil, 100. 3. Eucalyptol, 20 parts; phenic acid, 20 parts; vegetable oil, 100 The injections made with solutions containing ten and twenty per cent of phenic acid are painless, and produce no local effects. The dose of such solutions may be put down as one cubic centimetre.-Therapeutic Gazette. The Palmo-Plantar Sign in Typhoid Fever. Dr. Filipovitch, of Odessa, Russia, according to the St. Louis Medical and Surgical Journal has demonstrated that one of the earliest phenomena observable in typhoid fever is "a peculiar callous look and an orange-yellow or saffron-yellow hue of all the prominent parts of the palms of the hands and the soles of the feet-parts which, as is well known, are more or less rosy in health and become bluish in cases of cyanosis. The phenomenon is explained in the enfeebled action of the heart, a diminished amount of blood in the capillaries, and the dryness of the skin. The sign disappears as soon as convalescence begins. The sign is however an expression of certain states of hepatic exhaustion rather than simply typhoid fever." It is our opinion that this may be observed in many other low febrile states. Bichromate of Potassium as an Expectorant. "It was during the winter of 1875 that I was in attendance upon a child two years of age, who was ill with bronchitis. Though seventeen years have elapsed I well remember the child as it lay then, breathing at the rate of 90 respirations per minute, pulse too rapid and feeble for me to count it, countenance cyanosed, veins of forehead and neck prominent and turgid, and a cool moisture covering the little sufferer's body. The child was suffocating and seemed to me to be dying. I called for consultation, and my friend Dr. Alexander Hutchins, responded. He produced from his pocket a powder, telling me that it contained 1 grain of the bichromate of potassium, triturated with 9 grains of sugar of milk, directing me to place it n a tumbler with 20 teaspoonfuls of water, and give of the solution a teaspoonful to the child every ten minutes till the symptoms were modified. That was in the evening, and in less than two hours the symptoms of suffocation were so much relieved that I was able to leave the child for the night with directions that the medication should be kept up at one hour intervals. The change in the condition of the child when I visited it the next morning was surprising. The respirations had dropped to less than 40; the child had been able to sleep and take some nourishment; the cough, which before was dry and barking, had become looser, and the lung, which the night before hardly admitted any air, was now filled with loose moist bronchial rales. The aspect of the case was changed from that of a child evidently dying from what we than called capillary bronchitis to a plain case of brouchitis, which went on to successful recovery." |