Page images
PDF
EPUB
[graphic]

A Monthly Journal of

PRACTICAL MEDICINE, NEW

PREPARATIONS, ETC.

R. H. ANDREWS, M.D., Editor and Publisher, 2321 Park Ave., Phila., Pa.
One Dollar Per Annum in Advance. Single Copies. 10 Cents

Vol. XXXV.

Philadelphia, February, 1914

No 12

SUBSCRIPTION RATES. $1.00 per year, in advance, to any part of the United States and Mexico. To Foreign Countries and Canada, $1.25. NEW SUBSCRIPTIONS may begin at any time during the year.

HOW TO REMIT: A safe way to remit is by postal money order, express order, check, draft, or regis. tered mail. Currency sent by ordinary mail usually reaches its destination safely, but money so sent must be at the risk of the sender.

RECEIPTS: The receipt of all money is immedi ately acknowledged by a postal card. CHANGES OF ADDRESS. Subscribers changing their addresses should immediately notify us of their present and past locations. We cannot hold ourselves responsible for non-receipt of the Journal in such cases unless we are thus notified. DISCONTINUANCES: The Summary is continued to responsible subscribers until the publisher is noti fied by mail to discontinue, when payment of all arrearages must be made. If you do not wish The Summary continued for another year after the time paid for has expired, please notify us to that effect. Address,

"THE MEDICAL SUMMARY,"

[blocks in formation]

Learned

NEURASTHENIA.

dissertations on the pathology (?) and clinical phases of this affection are constantly being written and published. We really know less about the thing than we attempt to make folks believe when we speak and write We know that it is a condition of "tired nerves," and that its clinical manifestations are protean. In the treatment we are coming to know that a diversified therapy is a sine quo non. Some patients need rest while others need action;'a diversion or change of some sort is usually desirable. Some require more food and others should have their dietary restricted. Variety should be the keynote of the patient's life; a variety of foods, pleasures, work and interests. So far as possible the physical or mental causes of neurasthenia should be checked. Nearly always there is present phosphaturia and phosphaturia and phosphorous deprivation results in a deficiency of musculo-nervous power. The body is better supplied with needed phosphates through elimination than through pharmaceutical phosphates which are uncertain of assimilation. The foods which furnish phosphates in the greatest abundance are milk and milk products, eggs, fish, brains, and cereals. Nothing removes from the urine the excess of urates, phosphates, creatin, indican and even traces of albumin so much as living a life in the open with cares and worries reduced to their lowest terms.

MEDICAL EXHIBIT AT THE PANAMAPACIFIC EXHIBITION.

One fact alone would make the exhibit in medicine and surgery at the Panama-Pacific Exposition the most important of any similar display at any preceding exposition, for when the world comes to San Francisco in 1915 to celebrate the completion of the Panama Canal, it will be divided in admiration of the two men who perhaps above all others are responsible for the successful termination of the gigantic work. And these two men are representatives of highest honor from the science of engineering and the science of medicine: Dr. Wm. C. Gorgas, colonel in the U. S. Army Medical Corps, is the physician who undertook to preserve the lives of the canal builders in a land of malignant disease, while the toilers were operating under the guiding genius of the great Colonel George Goethals of the Corps of Engineers of the U. S. Army.

Representatives of the science of medicine and surgery from every land under the sun will be present during the exposition to pay tribute to the doctor and incidentally to study the processes whereby the ravages of a disease-ridden zone were stayed and the camp of the canal builders became the abode of health. The element that alone would lend a distinctive character to the exhibit is the featured presentation of the methods whereby the deadly mosquito was fought in his native haunts of morass and jungle; the application of specially devised sanitary processes by which Dr. Gorgas and his men were victors in their struggle with deadly fevers, enervating malaria and others of the swarm of maladies that wait for men who penetrate those miasmic lands "where even the birds forget how to sing."

The Emergency Hospital will be a model of its kind and its equipment will be provided by exhibitors. Where a million people meet there will be, in spite of all precautions, cases of sickness. Hence the necessity for an emergency hospital.

Two superb examples of the skill of the manufacturers of automibiles will be installed and an X-ray apparatus will be placed in the X-ray ward. The hospital will be equipped with all medical and surgical needs for all of the most trivial ail

ments up to and including minor and major surgical cases.

BICHLORIDE POISONING.

For a year or so THE SUMMARY has been calling attention to the large number of persons being poisoned accidentally or with suicidal intent by chloride of mercury. We are glad to note that our agitation of the matter and the general agitation that has arisen has led the Government to take some action in inhibiting the sale of this deadly drug

We are also, in this connection, pleased to note that a safe way of presenting this toxic drug has been devised by the Wm. S. Merrell Chemical Company of Cincinnati. Corrosive sublimate is incorporated into antiseptic leaves consisting of an oblong piece of special paper of porous character, each containing enough of the drug to make a solution the same strength of that produced by the tablet. The solution is as quickly made as by the use of tablets, and the antistepic leaf not only cannot be eaten by mistake, but not even through design. Each leaf bears a poison label prominently printed on both sides.

The safety of the antiseptic leaf is apparent. Children cannot mistake it for candy, and could not eat it if they did. They cannot be taken for medicinal tablets and cannot be swallowed with suicidal intent. None of the fatalities that have been reported in the daily press could have occurred with these leaves. They are packed twenty-five in a bundle, which is wrapped in self-sealing water-proof paper and enclosed in a carton, which is light and convenient for the physician to carry with him.

RHINITIS.

The term "catarrh" is employed very loosely, and is applied to the abnormal state of any organ or cavity which is lined by a membrane. Usually when the word "catarrh" is mentioned we think of chronic rhinitis or nasal catarrh. Both hypertrophic and atrophic rhinitis are troublesome conditions, although their importance is always exaggerated by quacks and quack literature. Rhinitis has very little relation to tuberculosis, although the statement that

"catarrh runs into consumption" is constantly flaunted before the lay world. Catarrh remedies are made and sold by the car load, many of them under a "guarantee." One of them having great popularity and of wide sale is said to be nothing but common table salt. In almost every community some doctor holds out the fact that he gives special attention to "catarrh." To this end he decorates his office with a shining compressed air outfit and is ready for business. A great deal of damage to the middle ear has been done by too strong a pressure with these instruments, and they have about fallen into disuse. A hand atomizer is safer and better.

The treatment of chronic rhinitis should consist mainly in building up the general health, improving nutrition and rendering the body immune to colds and cold-taking. Taking "blood medicine" is a thing to be discouraged. Occasionally an alterative. like potassium iodide may be indicated, or in children the syrup of iodide or iron. Locally, the nasal cavities should be kept clean with the well-known Seiler or Dobell alkaline solution. The solution should not be too strong or used too frequently lest harm be done. Crusts should be soaked loose by the insertion of vaseline or other emolient at night. This is often desirable in atrophic rhinitis. In this form the mucous membrane needs feeding, and in many cases the most valuable remedy that can be used is liquid vaseline employed with an atomizer.

In the ill-smelling condition known as ozena remedies of a stronger antiseptic and deodorant character are indicated. Very often a rhinitis is dependent upon mechanical obstruction in the way of spurs or spiculi or enlarged turbinate bones. Again, the catarrhal condition may be due to enlarged tonsils or adenoids. Obviously, the first matter in dealing with a rhinitis is to make a positive diagnosis.

Some cures of leprosy with chaulmoogra oil are reported from the Philippines.

Vomiting of pregnancy is often due to acetone and diacetic acid. If such are found in the urine alkalis are indicated. Bicarbonate of soda or its combinations may act well.

RECTAL HINTS.

Use the cautery to open a tubercular fistula. If a knife is used it means opening up the lymph channels and the possible entry of tubercle bacilli into the blood stream from the fistulous tract.

Prolapse of the rectum is not uncommon in children. Searing the prolapsed mucous membrane with the cautery followed by reduction is a simple and efficient procedure and frequently results in a permanent cure.

Painting the tongue with glycerin helps to allay the thirst in typhoid fever and in surgical cases where water must be denied. A little oleum menthol added to the glycerin increases its efficiency.

In the beginning symptoms of cold on the chest-constriction, soreness, cough and oppressed breathing-heat should be applied persistently for two hours. Always employ heat in such cases and never cold.

CROUP.

We have laryngismus stridulus or false croup and true croup. True croup is supposed to be accompanied by a membrane. In the latter event the membrane is supposed by modern pathologists to usually be diphtheritic in character. The writer does not believe that said membrane need necessarily to harbor the diphtheria germ. We have occurring in the thoats of children pseudomembranous and muco-purulent conditions caused by other organisms than the diphtheria bacilli. In many cases of hoarse and croupy conditions it is impossible to make an exact diagnosis without the microscope; it is absolutely impossible if no membrane is in evidence and the mucus accumulations are scant. In every severe case of croup the throat should be carefully scrutinized for evidence of membrane, and if such be found a bacteriological examination made as soon as possible. It has been the writer's experience to find croup and croupy conditions so often exist independent of diphtheria.

The treatment of croup is so old that a mention of it is "carrying coals to Newcastle." Secure a relaxation. Wring cloths from water to which a little ammonia has been added. Apply these to the throat. The ammonia aids the respiratory function.

The child should be placed in an atmosphere surcharged with steam. The fumes of vinegar and other agencies made by putting them in water may be created about the patient. Fumes of menthol and amyl nitrate are sometimes serviceable. Calcidin, the iodized lime preparation put up by Abbott, is a good remedy in croup and its use will aid in preventing recurrent attacks. If the paroxysm is severe an emetic should be given of which there is none better than ipecac. In every case of croup there is indication for calomel in generous doses.

THE LAST DAYS OF THE CONSUMPTIVE.

More people die from tuberculosis than from any other disease; more and more it is becoming the disease of the age. The passing of many of its victims is attended by no great degree of suffering, no harsh complications. Uncomplicated pulmonary cases decline so gradually that in the majority of cases the end comes to the individual without much physical suffering or mental anguish. Not infrequently, however, the person well advanced with tuberculosis may develop a number of painful symptoms and severe lesions. Fissures and ulcers of the rectum and peri-rectal abscesses cause much suffering. Much relief may be obtained if such cases be given careful scrutiny and proper treatment instituted. Abscesses should be incised and pile tumors cared for. Fissures should be cocainized and touched with nitrate of silver. Edema of the feet and legs is often a condition that ensues during the last weeks, and is due to anemia and failing heart. In such conditions fairly good results may usually be obtained from the local use of normal salt

solution. Soak gauze compresses in this solution, wrap around legs and cover with a thick layer of absorbent cotton held in place by bandages. The dressing should be left on over night. The feet should of course be kept elevated so much as possible. The fight of the dying consumptive for air is pitiable. He is willing to freeze his body to satisfy his respiratory apparatus. When it is impossible for the sufferer to have the air in his environment similar to the outdoor atmosphere, a few drops of strong ammonia on cloths or in water about

him has a softening effect upon the air and in some measure aids breathing. There is only one drug that will have any pronounced effect in making the patient breathe better and that will add to his general comfort. That drug is some opium derivative; perhaps codeine has fewer disagreeable bysymptoms. It should be withheld as long as the patient's life is tolerable; it takes these sufferers only a day or so to annex a fierce narcotic habit. Then life is made miserable for all persons concerned. But when the end is near and the patient is suffering the tortures of the lost, morphine is indeed a godsend. The physician must exercise wisdom and discretion when to resort to opiate drugs in these cases.

JUST A REMINDER.

While THE SUMMARY volume commences with the March number, and not with January, as most journals do, many subscriptions expire with this issue. Although a large number have already paid up for 1914 or to the end of volume thirty-six, still there are quite a few on our list who have evidently neglected to attend to this matter. It is from these we trust to hear now or soon.

We reiterate what we have often stated before, that you need not write a letter, simply write a check for amount, the most convenient way, as most doctors have a bank account, or procure a postal money order. A bank note, wrapped, neatly folded and enclosed in an envelope, properly sealed and addressed sent by mail is generally safe.

All you have to do, doctor, is to make the proper enclosure and with it your card or letterhead, or simply your name and address on a slip of paper, and on its arrival you will receive due acknowledgment.

While 1913 has not been generally a good business year, nevertheless we received many more new subscriptions during the past year than during any previous year. We trust to do better still during the present year, and this will be easily accomplished by just a little help from our present patrons. May we ask you, doctor, to pass the good word along, and thus help to increase the value and usefulness of THE SUMMARY?

Brief and practical articles, short and pithy reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department. Articles contributed for the Summary must be contributed to it exclusively. Write plainly and on one side of the paper. The Editor is not responsible for the views of contributors.

A RATIONAL CONCEPTION OF DISEASE.

By A. T. CUZNER, M.D. What is disease?

A concise answer to this question would be any departure from the normal.

But seeing that there is no exact and unvarying standard of normality for the body, by which we can measure its health, we cannot obtain a clear conception of diseased conditions, and without such conception our efforts of cure, or relief, will be made in the dark.

In fact, in the practice of medicine, much of our treatment must, in the nature of things, be largely emperical.

However, we can greatly increase our

power over disease by obtaining clear and precise knowledge of the functional activity of the body, as a whole, and of its several parts, organs and tissues in particular.

For this a clear conception of animated nature as a whole is necessary.

Biology teaches that our living world is made up of innumerable living organisms, or cells. These in turn go to form living tissues and organs.

Where one form of life weakens and dies, other forms feed, fatten and proliferate on debris.

These again fulfil their life history, and in their turn die to be succeeded by other forms in the cycle of molecular change that is the heritage of every particle of living matter.

Hence the preparatory studies of the student of medicine

In a mental review of the different advances made in medical investigation during the past 50 years towards the goal of perfection, much valuable information has been obtained, of the nature and workings of our bodies, both in health and disease.

This not only of the body as a whole, but of its ultimate cells, which are its morphological units.

Each of these units have a life history of their own, but are in association with other units of their particular kind.

They, as a whole, and as individuals, are influenced by their environment and by excitation from without.

This may be by poisons generated by, and during their individual activities.

Among the exciting causes of disease the parasitic germs hold a very prominent place.

The following may be summed up as representing the conclusions of medical thought on the subject of parasitic produced disease:

[graphic]
« PreviousContinue »