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different cavities of the heart, but I have failed off and the patient has brought it to the surto discover any constant or general law.
geon. Should it be replaced ? That this may One kind of reflected pain is sometimes met have a chance of success, it is necessary that with in connection with left ventricle distension the wound be recent, very fresh, and the severed or failure, which deserves mention, viz., great end clean-cut, not contused, lacerated or infectcutaneous hyperaesthesia. This may affect the ed. Under these conditions, one may essay the whole praecordial region, and some distance graft. around it, and it may be so acute that the slight- Having washed the tips with lukewarm serum, est touch produces exquisite distress, and per- and also stopped the bleeding, apply the severed cussion is impossible. A somewhat similar con- piece carefully to the stump and fix it with four dition may be met with occasionally where there sutures. Then wait results, examining the finger is acute pericarditis. It is then attributed to frequently. If the detached piece dies, blackens, direct irritation of the branches of the intercos- and especially if it suppurates, the attempt is tal nerves, but I have never seen it so pronounced sure to fail and one better remove the tip. as in the left ventricle cases I have mentioned. To facilitate the cure, many processes have As in these there is no question of pericarditis, been employed. Some have attempted to use it must then be regarded as indirect and reflect Bier's hyperemia to draw arterial blood to the ed. This condition is easily dealt with, for brush- graft and to disgorge the veins. When the color ing the parts over freely with tincture of aconite of the graft shows that circulation is established, quickly allays it, and, once removed, it does not the apparatus may be removed. Leeches have ordinarily recur.
been applied also to the sound part of the mem
ber; thanks to the local hemophilia and incoagWOUNDS OF THE FINGER-ENDS. ulability developed from the bite of the leech, Guibe (Monde Médical) says that wounds of the local circulation re-establishes itself more the finger-ends are very frequent, but usually readily. Also, to cover over the wound, one may badly treated. In mutilations, when the tip is resort to the Thiersch grafts. completely severed, spontaneous cure is very More promising than either of these methods slow. If the bone is uncovered, the projecting is the application to the wound of nuclein. portion is detached only after a long time, through Frankly, were this to fail, the graft might as a process of ostitis lasting for weeks. Cicatri- well be removed at once, thus saving time and zation once made, the skin of the new formation allowing proper measures to be instituted without is fragile, thin, liable to ulceration, and many delay. Guibe acknowledges that his attempts times quite painfully sensitive.
have not met with the slightest success. The cure is speedy in contused wounds. The When the severed end is held by a pedicle that nail falls off in a short while, a new nail form- is not devitalized, do not hesitate to suture it in ing under it, often irregular and deformed; still, place. all is repaired, whether well or badly done.
When restoration of the severed end is not to In wounds at the joint, if these do not contain be considered, re-arrange the lacerated tissues, enough uninjured vessels, necrosis follows and disinfect with tincture of iodine and remove any cicatrization occurs slowly, as in mutilations. At remnants of the nail. Anesthetize the region other times, if the surfaces are not well held with novocain solution, 42 per cent (or, better, in contact and in the right position, there is a with anesthaine). Detach and remove the nail, luxation of the loose phalanx and between the then, with a bistoury, incise circularly the soft surfaces a bloody mass forms that hinders heal- parts to the bone, some millimeters from the ing. This follows in time, but the finger-end is traumatized parts, avoiding reaction; then sever deformed.
the bone. If the cut has been skilfully made, Diverse complications may occur infectious, the lips of the wound will join readily; if not, etc.), varying with the cause of the injury. There remove a little more bone. Assure hemostasis, may be lymphangitis, phlegmons, suppuration of if necessary, by ligating the collaterals. Now the tendinous sheaths (rare), and sometimes even unite the flaps by sutures passed far enough from tetanus may develop.
the edges. Generally, healing is by first intenTreatment: First wash and carefully arrange tion, the finger shortened, but with a linear rethe fragments, remove foreign bodies, and, if sistant cicatrix. the wound has been soiled by manure or else- In simple wounds of the soft parts, asepticize wise, inject antitetanic serum. If the wound is with tincture of iodine; trim the bleeding surclean-cut and without soiling, this is unneces- faces, cut away the debris of tissues sure to sary.
necrose, pick out any soiled bony bits, then suture Sometimes the end of the finger has been cut the restored ends.
Sometimes there is crushing with a deep wound, ritated, shows increased urinary secretion and a and absence of flaps. Here, anesthetize the blood pressure rather high. A vacation with finger at its base, remove the nail always from ligat exercise and more rest is the preventive prethe point to the base, as its presence would sure- scription which he receives. Mrs. Williams, after ly render the wound more difficult to heal. Then being examined by Dr. Smith, undergoes a slight clean the wound with a small curette, removing operation under local anesthesia, and is relieved with caution any splinters, clots, and other of the first and only malignant cells found in debris. Apply liquid iodine, and suture.
her breast. Richard Roe, who is preparing for These precautions will notably abridge the du- a long journey, is vaccinated against typhoid ration of the disability and render great services fever, a disease no longer existent in Dr. Smith's to the patients.
city, since pollution of the water has been dis
continued. John Doe, who is a mineralogical exTHE DOCTOR'S DREAM; OR WHAT MIGHT pert and wishes to do some prospecting in high BE ACCOMPLISHED BY PREVENTIVE altitudes, has his heart examined. MEDICINE.
“There are numerous applicants for pulmonary Here is the story of a dream of a busy doctor, examination. This is done by Dr. Smith and his after a hard day's work, when he had seen some- assistants in a most thorough and up-to-date thing of the terrible results of ignorance, care- manner, and advice is given each according to lessness, over-strain, neglect and vice. The story the findings. It has been many years since Dr. is told by Dr. Victor C. Vaughan, in an address Smith has seen an advanced case of pulmonary given before a group of life insurance company tuberculosis, and the great white plague will presidents. We quote it in part only:
soon be a thing of the past. Everybody goes to “On a certain November day Dr. Smith had a physician twice a year and undergoes a thorbeen unusually busy. Late that night as the ough examination. The result of this examinadoctor sat before his grate he fell asleep, and tion is stated in a permanent record, and no two now he is busy among his patients in a way consecutive examinations are made by the same hitherto quite unknown to him. His waiting- physician in order that a condition overlooked room is filled with people, old and young, of by one may be detected by another. Cases of both sexes, who have come to be examined in doubt or in which there is difference of opinion order to ascertain the exact condition of their are referred to special boards. health. A young man before proposing marriage "The average of human life has been greatly to the woman of his choice wishes a thorough ex- increased and the sum of human suffering has amination. He wishes to know that in offering been greatly decreased. Preventive has largely himself he is not bringing to the woman any replaced curative medicine. Tenements are no harm. He desires to become the father of healthy longer known; prostitution and with it the venechildren and he is not willing to transmit any real diseases have disappeared; institutions for serious defect to them. He tells the doctor to the feeble-minded are no longer needed, because examine him as carefully as he would were he the breed has died out; insanity is rapidly deapplying for a large amount of life insurance. creasing, because its chief progenitors, alcoholThe doctor goes through the most thorough phys- ism and syphilis, have been suppressed. These ical examination and tests the secretions and and many other pleasing visions come to Dr. blood with the utmost care. He understands his Smith in his dream, from which he is startled own responsibility in the matter and appreciates by the ring of the telephone at his elbow. The the high sense of honor displayed by his patient. call says: “Come quickly to Pat Ryan's saloon A young woman for like reasons has delayed at the corner of Myrtle and Second. There has her final answer to the man who has asked her been a drunken row. Bring your surgical instruhand in order that the doctor might pass upon ments.' Then the smiles which had played over her case.
the face of the doctor in his dream were dis“Here is the doctor's old friend, William placed by lines of care, and he went forth into Stone. Mr. Stone is in the early fifties. He the darkness of ignorance and crime.” has been a highly successful, honorable business It has been proposed that the life insurance man, has accumulated a sufficiency and enjoys companies represented here seek to prolong the the good things which his wife prepares for the lives of their policy holders by offering them table. A careful examination of the urine leads free medical re-examination at stateù intervals. the doctor to caution Mr. Stone to reduce the It has been shown that in all probability this carbohydrates in his food. Mr. Perkins, a law- would financially benefit the companies in the inyer who throws his whole strength in every case creased longevity of their policyholders and the he tries, and of late has found himself easily ir- increased number of premiums they would pay. This is a business proposition, and I hope that reflex. Superficial reflexes were absent. She had the companies will inaugurate it and thus dem- perfect control over her bladder and bowels. onstrate that the lessening of sickness and the Her pupils were widely dilated but responded deferring of death will pay. Let the insurance to light and accommodation. The response, howmen join the doctors and help in the great work ever, was not well sustained. An electrical exfor the uplift of the race through the eradica- amination disclosed no reaction of degeneration tion of unnecessary disease and premature death. in any of the different groups of muscles. In this way we can hasten the coming of the While in the hospital, Delehanty gave a clinic better man by making the doctor's dream a on her to a body of medical students and in her reality. I am confident that you will do this, presence explained that there was no known ornot because it will pay, but because it is the ganic disease of the nervous system that could inighest service you can render humanity.
give rise to the condition she presented, and Now, is this a wild dream?
that it was a pure case of traumatic hysteria. Is it absolutely impossible that part of this The effects of the linic seemed to have prodream might not come true?
duced a profound impression on her mind, for
on the next day she was able to move her exTRAUMATIC HYSTERIA.
tremities and take her food through the natural Just to illustrate the power of suggestion to channel. cause (or simulate) disease we reproduce from The paralysis, anesthesia and the aphonia bad Colorado Medicine the report of a case of trau
almost entirely disappeared before she was aware matic hysteria, as given by Dr. Edward Dele- of the results of the trial. hanty.
An indulgent jury awarded her some $6,000 as The patient was a young woman who was balm for her fancied injuries. In less than a thrown from her carriage in a collision with a week's time after entering the hospital on a wagon belonging to a wealthy corporation. At stretcher she was able to walk about and left first she felt no inconvenience except the gen
with her physician for her home in the mouneral shock, but accompanied her mother (who tains. was also injured) to a hospital. For three
"I have been advised," said S. Delehanty, months she was able to work, but suffered at 66 óthat she has never been the same as before the times with pain in her back. She finally consult accident.' Here suggestion was supplied, uned a physician, who examined her back, also test- consciously, no doubt, by her family physician. ing her legs for anesthesia and loss of power. Each examination which he made suggested new At that time there was no evidence of cord in- symptoms, which later appeared, and when she volvement, but in the course of a week she be- became completely paralyzed he hypnotized himcame completely paralyzed in the legs. It was self into the belief that her condition was due not long until her arms became involved, and to some obscure degeneration in the columns of finally the special senses. She lost the use of the cord, for under oath he testified that she her voice and had difficulty in deglutition so that would never be able to walk and probably would it was necessary to resort to rectal feeding.
not live a year.” For three months she lay in bed, completely Litigants of this class usually look to the famparalyzed. During this time a damage suit was ily physician to support them in their fight being instituted against the company for $25,000. against heartless corporations, and court records She was brought to Denver on a stretcher to at
show that they are seldom disappointed. tend the trial. She was taken to a hospital and The best service which could have been renat the request of the defendant I made an ex
dered this girl would have been plain speaking amination. She was pale and anaemic, and bore very early in the case. Had she been taugbt to the appearance of having passed through a long turn a deaf ear to her distorted sensations, been siege of sickness.
discouraged in her desire to obtain revenge and There was complete paralysis of legs and arms. reward by instituting a damage suit, she would Anesthesia was complete to all forms of sensa- have been saved much pain and anxiety, and tion except about the anal and genital regions, avoided the demoralizing effect, which invariably where sensation was present, but diminished. follows in the train of damage suits. Unexpected jabbing of needles into her body caused no expression of pain on her face. Her To Prevent Mosquito Bites.-Acetic ether, 10 body could have been made a veritable pin cush- grams; tincture of eucalytus, 20 grams; tincture ion without any remonstrance from the patient. of pyrethrum, essence of mint, of each 60 grams;
The knee jerks were increased, but equal. water, enough to make 1 liter. Label: Apply There was no Babinski, Oppenheim or Gordon as a lotion, to prevent the attacks of insects.
THE BUTTERMILK GERMS.
Dr. Harold B. Wood, Providence, Rhode Island, While buttermilk has been used as a food for says that because the germs of sour milk are centuries, and in all kinds of forms, only within useful therapeutically, buttermilk can scarcely recent years has it been suggested as a medicine. be claimed, a priori, to be a valuable food for Such use of the lactic-acid bacilli really dates normal constitutions. In certain intestinal infecfrom Metehnikoff's adaptation of Massol's dis- tions or fermentations it may be used to change covery of the Bulgarian germ, which differs from the existing flora. The palatableness of butterother similar organisms (1) in its power to pro- milk, as with castor oil, is relative. Dr. Wood duce a very large quantity of the lactic acid, doubts if all people can be made to enjoy it. The and (2) in its extreme viability when in con- Bulgarian buttermilk may or may not be as tact with other germs, which, in the main, it bas objectionable as other makes. He has never used the power of "overriding' when in contact there- the Bulgarian bacillus, his work having been with with.. Metehnikoff popularized this micro-organ- diphtheria cases and carriers, in which a ism with astounding rapidity-thanks to his sug- centrated spray of the bacillus lactici acidi, isogestion that it had the power of producing long lated from ordinary sour milk, was used.
In life. The Bulgars were aserted to be peculiarly preparing the spray a two to four day culture prone to remain a long time on this troublesome of the organism is washed off by agitation with sphere, and the fact that they used Bulgarian sterile normal salt solution; this is diluted to (Massol-germ produced) buttermilk as a bever- an opaque, heavy suspension, and used in a sterage was asserted to be the cause.
ile atomizer. Spraying of the throat may be While the claims at first made for the lactic- done several times daily. Since lactic-acid germs acid germs were undoubtedly extravagant, in later in themselves are nonpathogenic it seems safe years we have been learning that they are ca- to apply them to mucous surfaces. Dr. Wood pable of doing good in a variety of diseases. In has learned of no contraindications; however, he addition to their direct action upon various mor- would hesitate to use them in gastric hyperacidity bid conditions of the alimentary canal-diarrheas, not bacterial in origin, and also in inflammation colitis, and the like—we are finding them of value of the ureters. in diseases only remotely referable to disturbance Dr. Wood says that in its influence upon inin this portion of the body. For instance, Bev- testinal conditions he would classify the lacticeredge and Boston are reporting excellent re- acid bacillus not as an antiseptic but as an oversults following the use of Bulgarian bacilli in rider which, by its excessive growth and prodiabetes, and recently a southern physician, duction of acidity checks and prevents the dethrough the columns of the Journal of the Amer- velopment of other bacilli. Its usefulness is, ican Medical Association, declares he has ob- therefore, limited to those cases in which it tained good results with them in treating pell- comes in direct contact with the infecting pathoagra.
gens. He has had no experience with these Of special interest is Dr. Wood's report (given organisms in the treatment of typhoid fever, but below) of the use of sour milk and ordinary sour- he would be willing to prescribe sour milk in milk germs in the local treatment of diphtheria early cases of this disease. In the diarrheas he and diphtheria carriers. We recommend that thinks lactic-acid bacilli will have more usefulthis be given very careful consideration.
ness in acute than in chronic or mucous colitic The subject is a very interesting one, and we conditions. sincerely hope a perusal of the papers that fol- In diphtheria.cases, Dr. Wood says that he has lows may elicit further discussion.
used sprays of the ordinary brew of lactic-acid
bacilli when membranes were present in the The doctor uses the bacillus Bulgaricus either throat; also in convalescents and in diphtheria in the form of fresh tablets, or in bouillon. Orcarriers.
In each case there was rapid and dinarily he administers five to 10 Cc. of bouillon marked improvement with almost immediate dis- one-half hour after the breakfast, which is the appearance of all diphtheria bacilli and of sub- principal starchy meal of the day. When tabsequent infectiousness. As a result of this he lets are used, six to ten tablets are administered recommended (in the Journal of the American three times a day. This dose is maintained Medical Association) the use of douches of ordi- until there is marked evidence of improvement nary sour milk. Excellent results with this meth- and the indican has disappeared from the urine, od were soon reported by Michael and later by this usually requiring from a week to ten daysNicholson, Wessinger, and others. The sour milk rarely two weeks. The treatment is then disis not a substitute for antitoxin but should be continued for a week, after which it is again in
an adjuvant and for clearing up the stituted for a week or ten days. parts infected with diphtheria bacilli. In diph- For local application, Doctor Biehn uses the theria with asthma, where anaphylaxis is almost bouillon in full strength, and also the tablets, certain to result from using antitoxin, the sour crushed, as a powder, without any diluent whatmilk and lactic-acid bacillus should constitute the only treatment.
Up to the present he has not found any conDr. J. F. Biehn, Chicago, writes that, in his traindications to the use of bacillus Bulgaricus, opinion, the principal advantages possessed by nor has he seen any mentioned in the literature. buttermilk over ordinary sweet milk are: first, Doctor Biehn has found the bacillus Bulgariin buttermilk the casein has been precipitated cus to be an efficient intestinal antiseptic, at least and the curd being very fine, a much greater in so far as it prevents putrefaction, making conamount of surface is presented to the gastric ditions unfavorable for the growth of anaerobic juices. Digestion is, therefore, necessarily much putrefactive bacteria. Whether this action is more rapid, as a result of which the large curdy due to the lactic acid which this organism promasses are not formed, which are either so irri- duces (it produces on an average of four per tating to the stomach as to cause vomiting, or are cent of lactic acid), or whether it is due to some so large that they pass through the entire gas- other cause, he is not able to state. trointestinal canal without being completely di- He has not used the bacillus Bulgaricus in the gested. Further, buttermilk does not usually treatment of typhoid fever, except for the avowed contain the many varieties of bacteria, some of purpose of preventing putrefaction in cases which them harmful, that are found in ordinary milk, showed a marked fetor of the stools. He emwhile the bacteria which sour milk rapidly drive ploys bacterins in the treatment of typhoid fever, out the other bacteria, as a result of the produc- and has practically no failures with this method, tion of lactic acid.
combining it with the ordinary remedial measDoctor Biebn states that he experiences no difficulty whatsoever in preparing bacillus Bul- The doctor states that all cases of infantile garicus buttermilk. He proceeds as follows; One gastroenteritis and bacillary diarrhea are amenquart of milk is boiled, and then allowed to cool able to bacillus Bulgaricus treatment. In chilto a temperature of 115° F. It is then inocu- dren he administers calomel or castor oil as an lated, either with bacillus Bulgaricus tablets, or initial purge, after which he gives either the a bouillon culture, and set aside, either in the bouillon, with milk sugar or in the regular food, incubator or in a fireless cooker, for eighteen or the tablets. In these cases the bacillus Bulhours. If at the end of twelve hours, the tem- garicus, either in bouillon or tablet form, is given perature in the fireless cooker has fallen below every two to four hours. Practically the only 98° F., the milk is again heated to a tempera- cases in which a cure is not noted are those deture of 115° F. At times it may require as long veloping an intractable condition of malnutrias twenty-four hours for sufficient coagulation tion. Formerly the milk diet was not maintained, to take place. The milk is then thoroughly but now the regular diet of the child, provided stirred, to make it homogeneous (although there the child has been gaining weight on it before should be little or not separation of whey) and the illness, is continued during treatment with set on ice. Occasionally the bacillus Bulgaricus the bacillus Bulgaricus. will produce ropy milk. This is one of the def- Doctor Biehn has also employed the bacillus inite characteristics of the organism, and aside Bulgaricus and found it efficient in several cases from its appearance, there is no objection to the of mucous colitis, in combination with boldine, ropy form.
A temperature of 110° to 115° is although most of these cases require from three absolutely essential.
to six months' active treatment. He has found