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(Written for the MEDICAL BRIEF.) Potential Energy, Irritability and Stimulation, the Indefatigable Factors of Life, Health,
Disease and Death.
BY WM. PROTZMAN, M. D.,
vein (V R). The ureteral pelvis (P) is practically external to the kidney, i. e., it is not in the renal sinus. The kidney (right) has no renal hilum. The left ureter is 11.5 inches in length; the right is fve inches in length. This dislocated right kidney could be well palpated dur. ing life. The bladder possesses numerous diverticuli (DV) and (DV), which were one and one-hall inches in depth, and would retain a tablespoonful of fluid. The bladder wall was hypertrophied, as well as the middle (only) prostatic lobe. The kidneys are drawn from exact measurements. The right was three and onehalf, and left was five and one-half inches in length. The right had about one-half the amount of renal parenchyma of the left. The location and distribution of the sympathetic nerve was also abnormal, as noted in the second illustration. The rotation of the right kidney is due to the larger blood vessels supplying the dorsal 1:p of the renal hilum, which forced the Corsal renal lip ventralward, and finally lateralward.
CONGENITAL DISLOCATION OF THE KIDNEY.
Fig. 2 is an illustration of dislocation of the right kidney on the right common iliac artery. It had a double renal artery as well as duplicate renal veins. The adrenal is normal in location. The left kidney is normal except it is hypertrophied (compensatory). The right kidney is rotated one-quarter of a circle, presenting the calyces and pelvis ventrally. The rotation consists in the dorsal lip of the hilum passing ventralward and lateralward. This is due to the larger blood vessels supplying the dorsal renal lip. The sympathetic nervous system, especially the ganglia, are abnormal in location, dimension and number. 1 and 2, abdominal brain; AD, adrenal; DG, diaphragmatic ganglion; SP, splanchnic nerve. This rare specimen I secured at an autopsy through the courtesy of Prof. W. A. Evans. 100 State Street,
I do not intend this article to be a monumental revelation of the hidden mysteries of nature, neither do I make any great pretensions to psychology or metaphysics, nor that I am possessed of a sagacious or brilliant imagination, clothed with the charms of seducing language, but in an unique and synthetic way I do claim the right through the columns of the BRIEF to awaken the empirical drift, morphology and miragic slumbers of our noble profession upon the dynamic forces and phy. siological laws of nature that govern and control the human body, and if I shall be successful in arousing the potential energy of a solitary molecule in the brain cf a single reader of the BRIEF, I shall feel myself amply paid. I will ask and answer my own questions, and allow you to be the judge. First. What is life? I answer, life is an attribute of three common factors, viz., (1) potential energy, the power of matter; (2) irritability, the distributing and motor power of energy, and (3) stimulation or excitomotor power of irritability; these factors are not confined to the human body alone, but are found in all kinds of matter, whether ani. mal, vegetable, or mineral, in a latent or inactive state (nil) and harmless when undisturbed, but the Creator of all things devised certain means by which these factors could be utilized, uch as food, air, water, chemicals, light, heat, electricity, mental and physical exercise, and many other excitomotor stimulants, some of which are constantly stimulating the fac tor of irritability, the motor power of life that liberates, converts and in disease perverts the factor and liberation of energy. Now then, when we take into consideration that every action and thought, every movement of muscular and nerve fiber, the vibration of every atom and molecule which depends upon the liberation of one or more of these factors, does it not make life a very interesting study
I wish the MEDICAL BRIEF all success. There are too many good things in it to be lost for the omission in sending one dollar a year.-J. C. LOVEJOY, M. D., Bachellerville, N. Y.
for the erudite student of medicine? The exhaustion of potential energy in the hu. man body is certainly very great, as every action and thought, every movement of muscular and nerve fiber depends upon the liberation of this factor; it is the mother of all other energies in the human body, its nutritive resources are derived, according to physiological chemistry, from the proteid or albuminoid food. Now then, cut off the appropriation or liberation of this factor and the human body can not survive a moment. It slands in the same relative position to other en. ergies and functions of the human body as fuel coal stands to a steam engine; whereas, without fuel the engine is dead, unable to turn a wheel and will decay and rot, but if we use a small quantity of fuel the wheels begin to turn, when we add more fuel the wheels increase their revolutions in accordance with the amount of fuel used. So, in like manner, in the absence of liberated energy the body is not unlike the engine without fuel (dead); when there is a normal amount of energy liberated we have health, but where there is an excessive or desiciert amount of energy liberated, we have excessive or diminished oxidation of tissue, and a pathogenic condition for disease.
Yet, with all this wonderful locomotive power, potential energy has no control over its own functions, is dead, cold, and lifeless; but old Dame Nature provided a mears by which its functions cou'd be utilized, and gave us the factor of irritability, clothed with the phenomeral power to liberate, control, convert and pervert potential energy into kinetic, chemical, physical, heat, and other energies of the body. We also find that the factor of irritability is not unlike the factor of potential energy, has no control over its own functions, will decay and rot, side by side with potential energy when unmolested. But Nature, again, in her wise provision, created a third, or stimulant factor, to liberate the functions of irritability. Now then, this indefatigable law of the different factors we see ex. emplified in the meteoric stone that is floating in space, cold and lifeless, yet full of energy and irritability in a latent state, but when the stone is attracted by
the earth it falls; when it strikes the earth the concussion arouses the stimulant factor that awakens the factor of irritability that liberates a surplusage of potential energy, causing every atom and molecule to vibrate persistently, which produces kinetic energy, and the stone becomes rod hot. Or a keg of powder, full of energy and irritability, will also decay and rot when undisturbed, but when we apply an electric spark we have instant explosion of protoplasm. We also see the effects of the physiological laws of nature exemplified in many different ways. We see them exemplified in procreation, or beginning of life, when the sperm of the male and the germ of the female come in contact; both full of energy and irritability, have no control over their own functions and are cast off as effete matter, unless a third or stimulant factor that is contained in the maternal circulation awakens the factor of irritability that liberates the potential factor, and that moment both life and soul of man are created. I do not believe that the soul of man is hovering in space awaiting an opportunity to vitalize a fecudated ovum. We also see these laws exemplified in the administration of remcdies; the intelligent physician never prescribes stimulant remedies in fever with a temperature of 102.3° or 102.4° F., and why? I answer, the stimulant factor from some intrinsic or extrinsic cause is already unduly excited, from which there is a surplusage of energy liberated that causes excessive oxidation of tissue, on which the heat of the body depends, but when the physician finds a sub-normal temperature, with vital powers ebbing, he (the physician) at once prescribes some powerful stimulant to arouse the factor of irritability and liberation of energy to vivify the circulation by increasing the veg. sels of the heart, and oxidation of tissue to restore the normal heat of the bod. The law of conversion and perversion of energy applies with equal force to mental emotion over organic functiors of the human body; an illustration, take a strong, muscular man with equal strong will power; yet we find in disease surrounding environments a potent factor in his death or recovery. We also read in physiology where scientists experimented
upon the minds of condemned criminals co test the power of mind and its influerce on the human body, when the criminals died at the appointed time set by the scientists without any organic disease of bodily tissues. The physician sees daily examples of will power and mental emotions over the bodily functions when he visits the sick room, the patient at once reads the doctor's countenance, as well as every action and movement of his body, etc. Therefore, the physiological surbeams of a physician's countenance and actions are veritable factors in the presence of a sick patient. They will illuminate fresh hope in a patient's mind, restore tone to his nerve centers, calm hyper-excitability, restore brightness of intellectual vigor and establish co-ordination of the circulation and functions of his body, all of which can only take place through the normal functions of stimulation, irritability and potertial energy. But how often do we see these warnings violated, especially among the noted and rich men of our own country. In proof of this arraignment, when a noted or very rich man is taken sick with a temperature of 103° or 104° F., his friends become alarmed, and at once notify three or four noted physicians to hasten to the bedside of the patient, where they hold consultation after consultation, both day and night, and appoint one or two of their number as watchers to observe every symptom and change that may take place during the night, etc., regardless of the effect upon the patient's mind. Pathogenic microbes, blood, urine and orgaric tissue changes attract their special attention for the newspapers, and to satisfy the clamor of an excited public. During the excitement in and about the sick room, usually the patient is perfectly conscious of surrourding conditions and this, together with the presence of three or four eminent physicians, causes the patient to believe that some grave disease has attacked him, from which he can not recover, etc. When his mental emotions over-stimulate, the liberation of energy raises his temperature two or three degrees, until the factors of energy, irritability and stimulation exhaust them. selves ard the patient dies from physical and mental anemia; whereas, if one or
two competent physicians would give or apply the same remedies with words of guod cheer and encouragement to stimulate his confidential hope, sagacity and physiological laws of nature of his body, the patient would have much better chance for recovery.
Health.-In addition to what has already been said in regard to the functions of energy, irritability and stimulation, we find their attributes or accessory or. gans, called leucocytes and phagocytes, that are constantly standing guard to protect the human body in every respect against poisons, contagious and infectious germs, especially exemplified in immune persons.
Disease.—I do not wish to be understood by the readers of the BRIEF that disease, whether mental or phy. sical, is entirely due to the perversion of the afore-named physiological factors of the human body, as I am well aware that a want, or perversion, of the elementary principles of tissue, viz., iron, potassium, magnesium, phosphorus, lime and sodium, are not only contributing, but primary causes of disease. Sometimes, also, pathogenic microbes, chemical and other poisons will produce disease. How? I answer, by causing molecular changes that stimulate the irritable and potential factors that increase the circulation and oxidation of tissue, with increased local and general heat of the body. Now then, while the physiological factors of the human body are not directly responsible for every disease, yet without their cooperation disease could not exist.
Death.-Death, we are told by physiolo gists, is the last effort of muscle plasma, and the formation of sarcolactic acid. In addition, I will add, a cessation of atomico-molecular changes and proliferation of cell growth and development, caused from want or appropriation of the ele mentary constituents of tissue that are controlled by the three principal factors of the human body, viz., stimulation, irritability, and potential energy.
And now, in concluding these unique, syrthetic and, perhaps, miragic or lucubrative thoughts, etc., allow me to say that, while I have no implacable desires or malevolent feelings against any theory or school of scientific medicine, I ask the
readers of the BRIEF, with its forty-odd thousand subscribers of educated men, are we not daily prescribing remedies empirically, instead of physiologically? Do we not prescribe remedies because our experience and our books have taught us to prescribe them without a moment's thought or reflection how those remedies antagonize pathological tissue changes, or how they affect the physiological laws of the human body?
(Written for the MEDICAL BRIEF.)
A Queer Case.
BY JOHN C. WEAVER, M, D.,
On June 10th, six weeks later, I was again summoned, as she had now reached the full term. I found her in labor with a breech presentation. The delivery was quick, but, of course, the child was dead. In previous pregnancies the placenta had always been retained, and she suffered from great loss of blood.
On this occasion she and her husband were both delighted that the placenta had come away entire, and not the least loss of blood. I will state also that she had no afterpains, and her breasts gave her not the least trouble.
Query.-1. Were those convulsions uremic?
2. Could the child have remained in the uterus six weeks dead without having undergone decomposition, or having set up uterine contraction?
3. Is it not possible that the child could have received through the placental cr umbilical cord enough sustenance to keep it viable, and yet not enough to give it strength for movement?
4. Was I justifiable in my course of action as regards this particular case, or should I have brought on premature labor, as many would have done?
5. Would not the forcing of labor have been more detrimental to my patient than the leaving of it to Nature?
I trust the BRIEF readers will throw some light on these questions, as they are really interesting and important.
On April 23, 1905, I was hastily summoned to Mrs. H., aged twenty-eight, white, multipara; approaching her bedside, found that she was having convulsions, and had had, up to the time of my visit, five very hard ones, com. ing on at ghort intervals. Being alarmed at the situation, I resorted to venesection, taking about a half-pint of blood from the left arm. I also used chloroform inhalations during paroxysm, and afterwards veratrum viride hypodermically. This treatment seemed to control the spasm, as there was no return.
I found this woman seven and one-half months advanced in pregnancy, with general anasarca, and most of the secretory organs inactive. I got the bowels and kidneys acting freely, and the sweling was soon reduced. For two or three days following the convulsions she was, to a great extent, unconscious, not knowing even her husband or children. When consciousness was restored, she com. plained of being blind, and could not believe that she had been sick. Everything appeared to her as a dream.
During a!l this time she suffered no abdominal pain, and no uterine contraction took place.
Up to the time of the convulsions she felt the motion of the child, but since then there had not been the least move. ment. Within a week from the date of the convulsions, she was up and about her usual vocation, seeming well ard hearty, with a good appetite, and not the least swelling about the body.
[Written for the MEDICAL BRIEF.) A Fow Jottings from Arkansas.
BY W. S. ROBINSON, M. D.,
First, in all cases of sickness the phy. sician must be master of the situation, and should be well-grounded in physical diagnosis. From day to day he should have in his mind's eye a clinical picture of diseased conditions, and remember that the supreme element in all diseases is rest. Especially in typhoid fever, complete rest in bed is imperative from the first day that the disease is suspected. The bowels should always receive prompt and careful attention from first to last, keeping them aseptic, if possible. A few
small doses of calomel given early and sometimes later in the course of the disease, I believe are helpful. Active elimination through the kilneys is always necescary. A generous supply of pure water usually attends to that point. As to the different plans suggested in the treatment of typhoid fever, they are as many as there are "boodlers" in hades, and every fellow reports success. I am in favor oi & great dealof common sense and very little medicine in this disease. In the matter of nourishment, a moderate amount of liquid diet is allowed, buttermilk be. ing my favorite food. A good nurse and no visitors are always desired.
In penumonia, watch the heart carefully, as it is the index to prognosis and treatment, the main point of the latter bcing to judiciously sustain the heart and treat other factors symptomatically. A:1 caces should not be treated alike. "Indi. vidualize your patients, gentlemen."
In malarial hematuria, I believe that quinine is indicated, as in all other malarial Ciseases, but it should be given intel. légently. I often find articles written on the treatment of malarial hematuria wherein the writer is a great advocate of quinine in this disease, but whose views do not conform altogether with mine in its use. I never give quinine until elim. ination is well under way.
As a vaso-motor stimulant in surgical shock, atrophine is the first thing to use.
The less the doctor knows of aseptic rules in obstetrics, the more cases of puerpcral fever he will have. The most common infection is saphrophytic, or the görms of decomposition. As a general thing the patient seems to do well for forty-eight hours after labor, then becomes somewhat restless, with slight elevation of temperature. In a few hours it rüns up to 101° or 105° F., with swelling and tenderness of the abdomen, Under gross carelessness, as a general thing, you hève let your patient get into this condi. tion. Now what are you going to do? As for my part I would treat her the same a3 I wou'd infection of a wound from any other cause. Clean out the vagina and uterus thoroughly, with dull curette, and thoroughly irrigate with a hot solution of permanganate of potash, hot as tissues will bear; give chlorate potash internally,
and apply turpentine stupes over the bowels.
In these so-called “congestive chills,” I give calomel in small doses, to eliminate waste matter, and to prevent a subsequent chill after elimination is sufficiently ad. vanced, as shown by the tongue, skin and mental condition, begin with quinine in solution, with diluted hydrochloric acid. If you will keep your patient under the influence of hypodermics of atropine for the first forty-eight hours, until you can get in your quinine, he will not have a second chill.
Atropine will stop a chill and is one of our best hemostatics.
“Bed wetting,” the diagnosis of Incontinence of urine, is not a difficult matter, but to determine the precise cause of this incontinence is often far from easy. In the treatment by far the most successful drug I can use is belladonna. A dose of Ive to ten drops of the tincture may be given to a child three times a day. It is remarkable how resistant children are to the action of belladonna. In dribbling cf urine, in the agcd, as well as incon. tinence in children, I have found the following prescription to be exceert: B Thuja Oc. Fld.....
1% drachms, Tinct. Belladonna
.30 drops. Aquæ......q. s.
4 ounces. M. Sig.: Teaspoonful three or four times a day.
Pain extending over the entire abdom. inal region and tympanites is very char: acteristic of peritonitis. Now, as regards treatment: As a local application I recom. mend turpentine stupes. As an internal romedy I prescribe some good preparation of opium.
I am opposed to treating cancer by the knife, when seventy or eighty per cent cie. Here is a remedy I have been using ia my practice when a case presented it. sclf for treatment, and I do not remember of a single instance where it failed to cure. It is this: Take galangal root, grate to fine powder-sufficient to make several p'asters—then take zinc chloride, add a little water, and allow the zinc to become thin by heating in warm water; then add the zinc chloride to the pulverized galangal root; make plaster and apply to the cancer. Renew every day for three or four days, until the cancer begins to break locse all around, then discontinue the plaster of the galangal and apply any