Adenoids and Epilepsy.

EDITOR MEDICAL WORLD:-Post-nasal

adenoid growths as a factor in the causation of epileptic seizures have been briefly mentioned in the past by a few writers, Grasskopf, of Germany, reporting a case, and Spratling, in "Epilepsy and its Treatment, saying that such cases have been reported, but that personally he had not, at the time of the publication of the book, seen a case that he could attribute to this condition.

Teachers of embryology suggest that the pharyngeal structures are intimately related to the encephalic structures by means of the pineal and pituitary glands, and pathology has associated morbid states of the pituitary gland with general nutritive proc

esses.

Charles E. de M. Sajous writes as follows: While the general run of symptoms of adenoid growths arise from pressure within the post-nasal cavity, sometimes the symptoms of a veritable disease allied to infections of the blood, gland and lymph systems, will be manifested, and which should be regarded as having a dominating influence in metabolism.

For the sake of brevity I will not go into the symptomatology of adenoids, but briefly outline the complications and symptoms of adenoids that have a bearing on the subject in hand.

Among the complications are suppurative otitis, and mastoid complication as a result of a chronic suppurative process of the middle ear is often seen.

Another condition often seen in association with adenoids is known as aprosexia, or a lack of ability to concentrate attention.

Sleep is often disturbed, and the dull, heavy, stupid facial expression is characteristic.

Almost invariably is also seen the apparent mental deficiency and the impaired or retarded physical development.

Bilhaut says:

Voluminous adenoids are commonly found in cases of scoliosis, and it is likely they are related as cause and effect, especially as removal of them early suffices of itself to bring about cures of the

condition.

This statement should be considered carefully in studying cases that might be classed as reflex epilepsies.

Adenoids may cause such a lowering of the general nervous vitality that they may be rightly considered as the direct cause of some of the epilepsies whose etiology is at present unknown.

The adenoid patient shows a disturbed nutrition and becomes anemic.

The diagnosis of adenoids is easy and is usually best accomplished by the use of the rhinoscopic mirror or by digital examination.

Adenoids are most common between the ages of three and fifteen, as a general rule manifesting themselves about the third year, tho adults are not exempt.

Many an unrecognized potential epileptic has doubtless been saved, unconsciously, from epilepsy, by the early removal of adenoid growths.

the

When removed early in life the outcome is satisfactory, but when allowed to remain unrelieved the consequences incident to these growths are sometimes so far reaching that neither nature's process nor physician's aid can repair them. If recognized early and removed before the system has become involved, reflex conditions disappear, mental and physical vigor increase, restlessness and night terrors become modified or disappear, and general nutrition improves, and if an epilepsy has appeared it will often be arrested.

In cases of long standing, tho one may be forced to believe that the adenoids are, in a great measure at least, connected with the origin of the paroxysms, it is the part of wisdom to promise but little from treatment.

Our most marked case of this kind, already reported, was a boy 16 years old, who had had nightly grand mal seizures of a severe type for years, in whom removal of an extraordinary growth of adenoids wrought a complete cure, now of over two years' standing. DANIEL C. MANN, M.D.

Welaka, Fla.

Modern Treatment in Difficult Cases. EDITOR MEDICAL WORLD:-The true physician and scientist always wishes to follow up his patients, if possible, till recovery or death relieves them of all unpleasant symptoms. In case death should be the victor, a postmortem is held if permitted, in obscure cases to determin, for the benefit of science and future patients, the cause of the disease.

Everyone who has held many postmortem examinations knows how much pathology with so few symptoms is often found in some cases, while many symptoms with such small amount of pathology is found in others, which shows that the power to live and resist disease is quite different in each individual. In this day of commercialism and patent medicin vendors, advertising quacks and so-called "ethical men," who solicit treatment and give free treatments to half of their friends for boosting purposes, it is not always possible to follow one's patients to their ultimate results. Since most all chronic cases must be treated and educated back to health thru several months of patient perseverance, I have kept for the past several years careful records of all cases examined and treated, and thereby have been able to follow many to an ultimate recovery or death.

In this short paper I wish to recount some interesting cases who followed persistently all directions and treatment to an ultimate recovery.

Toxemia and Neuritis.

The first case was Mrs. A. She had good family history and had been in good health until ten weeks before I saw her, when she began with nausea; occasional vomiting, worse mornings; sometimes hematemesis. Had been big eater and rather free drinker of beer; but that history was not obtained from the patient. The same is often true of the snuff history in many cases.

Chronic constipation, and multiple neuritis, worse in legs the last six days, with rather severe pains. Not able to walk at all now. She was slightly jaundiced. The urin showed a few casts and urobilinogen, which when present in jaundice is more favorable for recovery than if absent. The blood count showed 2,500,000 reds, some nucleated and 8,000 whites; hemoglobin 60%.

The test meal showed 30% of solids, no free acid and only 4 of total acidity, some

mucus. The sudden onset, loss of appetite, test meal and blood picture pointed toward carcinoma, and the Kellings serum test for carcinoma was positive.

The multiple neuritis and the chronic constipation led me to diagnose her case as a toxemia and advised baths for increased elimination; wave current and galvanic for the pain and nerve symptoms; strychnin, iron and arsenic for the blood; and small doses of castor oil for the alimentary drainage. She took treatment five weeks, kept up her strychnin and galvanic from a home-made battery for some time afterward, and now seven months after her first treatment, she is about her normal self, having gained about thirty pounds.

Progressive Weakness.

She was

The second case is Pauline G. about 19 years old, and in good physical condition every way except a gradual weakness, progressively worse in feet, and also hands, until she could scarcely walk; no pain at all; no knee jerk in one knee and slight in the other.

No involvement of sphincters. Family history negative. No signs or history of alcohol or lead poison. This case looked rather hopeless, but by five months of static wave and negative galvanic to the spine she now walks about very well and is one of the happiest patients I have ever treated.

It was not a spinal sclerosis, but perhaps one of those peculiar cases of neuritis that has no pain. Two years later she is still well, married and has a healthy child.

Parenchymatous Nephritis.

The third case was one of parenchymatous nephritis in a lady of about 30 with no apparent history except constipation and high protein diet so far as I could determin. She began in June four years ago and was seen July for a few days and got some better, but soon returned home, became much worse and returned in September, weighing 182 pounds from the great edema, while her normal weight was only 110. The urin became solid in the tube when boiled and had hyalin, granular and epithelial casts. The quantity was only 2 to 4 ounces per day, with intense pain over the kidneys.

She was given low protein milk and cream diet, no salt at first, nor fluids, salts each morning to moderate purgation, Lloyd's apocynum, 2 drams, drams, lithiated

sorghum comp. for elimination, and the large 500 candlepower lamp over the kidneys and body for diaphoresis.

She took six weeks' treatment, kept up her diet and according to her friends' report, tho I have not been able to get her urin recently, she is in good health five years now since leaving the sanatorium.

High Blood Pressure.

Mr. J. M. J., a traveling man in apparently fine health, came into the office for a slight giddiness and numbness in one hand and leg. Gets up at night once or twice to void urin, uses tobacco and eats everything he can get. No history of lues or rheumatism. Few tube casts, trace of albumin, blood pressure 210 systolic, 170 diastolic. Gave him some sweats, cut out his tobacco, and meats only once daily; after one week's abstinence gave him autocondensation two weeks, and his blood pressure was 125 and is still that several weeks later.

About half the cases of high blood pressure with unpleasant symptoms by this treatment will have the pressure reduced materially and be relieved of the unpleasant symptoms, and most of those who do not have the pressure reduced will be made to feel better if they will continue the low protein diet and be temperate in all things.

Some of the authorities contend that tobacco will not raise the blood pressure, but I feel sure that its continued use will prevent your reducing it.

Warfield gives it as one of the most potent factors in causing arteriosclerosis. The ultrascientific physician who makes his experiments on healthy dogs and guinea pigs and tries to dictate by that means alone what effects medicins will have on the diseased organs of human beings is too theoretic to be of much practical benefit to suffering humanity.

Such experiments are of benefit along the line of chemotherapy and infectious diseases, but of very little benefit in nervous and chronic troubles.

Digitalis has but little effect upon the normal heart, and acetanilid does not reduce the normal temperature in moderate doses, yet both have a profound effect in diseased conditions.

The above cases are not specially selected, but are a few of many similar cases taken to show what may be accomplished in those who have judgment enough to follow definite lines of treatment for several weeks or months and not listen to every

free medical adviser in their circle of acquaintances and thus change the treatment each time the weather changes.

They show also that the family physician more than all others by that sacred relation he bears to the family can assist better than any one else in carrying out the treatments necessary to an ultimate recovery after a correct diagnosis has been made.

J. W. TORBETT, B.S., M.D.

Marlin, Texas.

Circumcision and Masturbation. EDITOR MEDICAL WORLD:-I am glad to see that your readers have taken up the subject of circumcision, for nothing is settled until it is settled right, and the subject of circumcision has not yet been settled right, as is clearly seen from the fact that there are still a number of physicians who oppose it.

There are a hundred arguments in favor of circumcision, but to speak of them all in detail would require a book or at least a good-sized essay. At this time I wish to touch merely upon one point, the relation of the prepuce to masturbation.

I am convinced that the prepuce is one of the great factors in causing masturbation in boys, and many cases of masturbation cannot be treated successfully until the prepuce is removed. Here is the dilemma boy to pull the prepuce back and cleanse we are in: If we do not teach the growing the glans there is the danger of smegma collecting and of adhesions and ulcerations forming, which in their turn will cause irritation likely to lead to masturbation. If we do teach the boy to pull the prepuce back and cleanse his glans, that handling alone is sufficient gradually and almost without the boy's knowledge to initiate him into the habit of masturbation.

While masturbation is not the terrible

calamity that it was once thought to be, and while we recognize the fact now that most children recover from it without permanent effects, still we want to avoid

everything possible that may be a factor in the cause of masturbation, and the prepuce unquestionably being such a factor, it should come off.

puce! That the operations should be perTherefore, once more, off with the preformed with the utmost aseptic precautions and by skilful hands goes without saying but this is not the point under discussion. WILLIAM J. ROBINSON, M.D.

12 Mt. Morris Park W., New York.

Circumcision is Beneficial. EDITOR MEDICAL WORLD:-I have been reading with much interest the "Antis' views on circumcision. I would suggest to the doctor who told the neurasthenic woman her troubles were caused from her husband being circumcised (page 352, August WORLD) that he had better try a circumcised penis himself before stating the glans becomes so hardened. While studying medicin thirteen years ago the foreskin around my glans became infiltrated and sore. I had no venereal disease at all, but after being bothered about two months that way I was advised by our G. U. man to be circumcised, which I had done. By the time. the line of circumcision healed I was O. K. I have since been twice (happily) married. Neither of my wives has been bothered with neurasthenia. My first wife died four years ago of tuberculosis. My present wife is the happy mother of a 1-month's old girl baby.

I am 32 years old, the father of 4 children, and will say that my glans is as sensitive as any glans should be.

The greatest causative factor I believe of trouble in wedlock (outside of venereal diseases) is the man does not make a partner out of the wife. Remember, she is the same sweetheart courted before marriage. As a matter of cleanliness alone I believe circumcision will always have its place

Authority and Circumcision.

EDITOR MEDICAL WORLD:-Please let me briefly touch upon the letter of Dr. E. W. Feige in the September WORLD, page 351, criticising my letter on circumcision in the August issue.

It seems to me a little singular, if not inconsistent, that the doctor should berate me for daring to take exceptions on authority like Dr. Robinson and straightway should himself make bold to doubt an authority like Bluhm that I had quoted.

His question directly following would aptly apply in either my case or his when he asks, "Who and what constitutes authority?" As for me, I usually have the courage of my convictions as per my ex

perience and observation. Whether the authorities are big or little it matters not to me. I take the chance of being called indiscreet rather than have an authority proscribe my freedom, and I judge from appearances that Dr. Feige does the same when the sign comes right. No, Dr. Feige, I do not KNOW that the long list of troubles you mention are with any constant certainty either aggravated or produced by a redundant prepuce, nor do I believe he does, because probably he doesn't wait to find out before performing the surgical act that to my mind affronts Nature in all but a minority of cases.

The statement he makes that he don't see how any "sensible person" can entertain such views as mine rather precludes feasibleness of my discussing the matter with him, so I will end by saying that the letter underneath his entitled, "A Result of Circumcision," details something to which I can shout amen, since it has been duplicated in my practise. A. P. REED, M.D.

Boston, Mass.

Circumcision.

EDITOR MEDICAL WORLD:-In reply to Dr. M. D. Pass in June WORLD, page 227, "Shall Circumcision be Abolished?" I would state that I was circumcised at 27 years after I became a doctor. Large sums of money could not pay me to return to my ancient uncleanness. I supposed all doctors knew the danger of venereal diseases among the uncircumcised. Often have I had clean Jew patients escape the presence of gonorrhea and syphilis hardly possible to uncircumcised.

You have seen masturbaters cured by circumcision; also frequent epilepsy.

Surely it is a sanitary and health measure. And reasonably this consideration antedates its religious observances. Just as the Sabbath was first of all a physical and mental necessity, and therefore became a moral one-no criss-cross in the eternal purposes or fitness of things. Liquor is bad for the whole_of_man. Atlanta, Ga. E. C. CARTLEDGE.

Origin of Circumcision.

EDITOR MEDICAL WORLD:-In the June WORLD, page 227, Dr. Pass asks for the opinion of WORLD readers on circumcision as practised by the Jews on their eight-day-old male infants. Venereal diseases in the time of Moses were prevalent. Therefore when Moses found sores on the foreskin, he cut it off and, in order to make the parents submit to it, he told them it was a religious rite, and the Jews still think that the inhabitants of Heaven are all circumcised, and those who have gone to that other place are being tormented because they were not. Yet physicians often find it necessary to dilate the prepuce or slit it up and break up adhesions, in adults as well as infants. But circumcision as practised by the Jews is only a relic of a barbarous age. DR. H. WHistler. Wilmington, Ohio.

Cupping for Sciatica. DEAR DR. TAYLOR:-I note Dr. C. F. Graves' report of his case of sciatica (page 235, June, 1915, WORLD). In years gone by I have met with many cases of this very painful affection. Nothing gives quicker relief than cupping, dry or wet. As to age and condition of patient, in plethoric or robust. Wet cupping over the sacrosciatic and following down to the knee if necessary, but usually it is not. I have never found liniments to do much good. Some six years ago I was called to the bedside of a farmer 48 years old. He had been scarcely able to get out of bed without assistance for 31⁄2 months; had been treated by a physiomedic M.D.; had taken much medicin, tinctures, fluidextracts, etc., and liniments locally, by the wholesale, as I noticed the many bottles on a table.

I applied three dry cups, one over the sacral plexus, the other two along the sciatic, and I will say these were not little bits of cups, but large tumblers holding two-thirds of a pint. My way is to place the tumblers in a pan of real hot water a few minutes, remove, wipe dry, then dip a small bit of paper in alcohol, at one end only so you hold the dry end between thumb and finger.

Have the glass ready to turn quickly on the parts. After setting the bit of paper aflame, toss it to the bottom of the glass, press the glass down firmly till it sucks up nearly half full of skin, or blood if wet cupping is the rule, and in that case scarification must be made.

I visited this man two days after and found him walking around the sitting and dining room. Said he had but little pain; could get out of bed and dress himself. I cupped him only twice after that, four days apart.

Internally I gave him salithia, a teaspoonful in a glass of warm water mornings before eating, and 1/134 grain colchicin in a teaspoonful of syrup of hydriodic acid before eating. This man went to work on his farm in a few days and has been in good health ever since.

I have many cases on my memoranda I can refer to and never failed to relieve promptly. About 30 years ago I had a severe siege of sciatica and was cured by cupping. My preceptor, Dr. Bowen, treated

me.

Now, if Dr. Graves will try my way I believe he will find his way out of sciatica. Would like to hear from him.

J. C. DREHER, M.D. Battle Creek, Mich.

Healing in Burns.

EDITOR MEDICAL WORLD:-I read in an article on burns in a recent publication: "Open the blister" in order to evacuate the contents. More than thirty-five years ago I wrote an article in contradiction to this method of treating such blebs. There was a time, not so far removed, that some of those in active practise do recall what might appropriately be termed the antiphlogistic period, when the sheet anchors in medicin consisted in bleeding, purgation, diaphoresis, emesis and last, and by no means least, vesicants or counter irritants. During that period in the recognized treatment of deep-seated inflammatory troubles, especially those invading the pleural cavity and lungs (pleurisy and pleuro-pneumonia), vesicants, especially Spanish-fly, were frequently applied over the chest and the blebs were incised (usually with the family scissors or sewing needle) and the contents evacuated, because it was held that this serum represented the poisonous elements subtracted from the deep. And while the theory was far fetched, the result was generally relief from the stitchlike pain. If the statistics are any criterion by which to be governed, I am not too sure but this method would be of advantage in the progressive medicin of to-day.

Nature, in her effort to minimize the traumatism, sends a larger amount of blood to the part, produces a hyperemia or congestion (the first degree burn) and if the insult is continued further, blisters are the result, which act as cushion and nonconductor, thereby forming barrier No. 2 to the heat. The vesicles contain an aseptic serum which again aids in healing the injury [autoserotherapy-ED.]; hence should be retained until a new covering is thrown out to protect the deeper-lying structures. Unfortunately it frequently happens that on first seeing the patient the vesicles have been broken either intentionally or unavoidably.

My experience has been that if it is possible to prevent rupture of the blister healing is much more rapid and less painful.

One needs only to recall his own experience of a burn or chafing of the skin sufficient to produce a blister. As long as the blister remains intact there is little or no pain, and when the blister is broken it immediately becomes inflamed and painful. This may seem a trivial matter, but it means much to the comfort of the patient. Pittsburgh, Pa. M. J. BUCK, M.D.