Графични страници
PDF файл
ePub

As an antidote to this strong alkali, rinse the mate matter and to point out to the readers of Clinirial very thoroughly in cold water. Never use cal Medicine the Importance of counteracting chloride of lime for colored articles, or silk, as it in their clientele the unreasonable fear. that turns white silk bright yellow, which discolora- exists among so many classes in this respect. tion can never be removed.

Dr. Knopf will undoubtedly be glad to furnish Wet ink stains—Rub with a piece of ripe to- reprints of any of the many papers which he has mato and then rinse well in cold water; wash and written on the subject, and the writer himself boil, or put a little red ink on the mark and wash; has a number of copies of the journal mentioned the acid dissolves the iron in the ink and sets at the disposal of the “family' for distribution free the tannin or coloring matter, which will boil among their physicians. out.

Although the fact that tuberculosis is infecTea, coffee or cocoa—Borax is best. Pour boil- tious and can be communicated-in fact is coming water through the stain while it is wet, if municated—from person to person cannot be possible; place some powdered borax on and pour gainsaid, being firmly established since the on more water; then wash, boil and dry in the investigations of Villemin (1864) and the dissunshine. Sunshine seldom fails in removing such covery of the tubercle bacillus by Koch in 1882, stains at tea, coffee or scorch marks.

• still, the mechanism of communication is someBloodstains—These should be soaked in salt and what different from that of the acute infectious water for some hours; then wring out and rub diseases, such as the exanthemata, diphtheria in a fresh supply of salt and water. Next wash and influenza. Above all let it be remembered in the ordinary way, with soap and warm water; that a single contact with a tuberculous or conboil, rinse and dry in sunshine.

sumptive person is not sufficient to establish in

another person a virulent infection that invariTHE EXCESSIVE FEAR OF CONTAGION ably is followed by tuberculous disease. Indeed, FROM CONSUMPTIVES.

it has been fully determined by wide clinical Dr. S. Adolphus Knopf, head of the department and experimental experience that not only reof tuberculosis in the New York Post Graduate peated and long-continued exposure to infecMedical School and Hospital, in a lecture before tion, together with a receptive condition of the the German Medical Society of New York, dis- organism, but a predisposition is required to cussed some of the unfortunate phases charac- lead to tuberculous disease. The only excepterizing the present world-wide struggle against tion for this rule, perhaps, is in the case of tuberculosis and again condemned, as he fre- persons whose resistance to the infection and quently does, the unjust and unreasonable fear to the harmful action of the tubercle bacillus of acquiring tuberculosis by the simple contact has been seriously impaired by previous diswith tuberculous patients. This is a most im- eases, such as measles, whooping-cough, typhoid portant subject, the more so, as the “phthisio- fever, and influenza; by prolonged night vigils phobia'—as Dr. Knopf designates this particu- and exertion, as in taking care of a very sick lar craze-has attacked and led astray not only member of the family besides attending to the the laity, but also physicians and municipal, usual duties of housekeeping; by worry, due to state and even federal authorities. In conse- the same cause, or by other devitalizing influquence, the federal law of 1901 still remains in ences. force, under which tuberculous persons are not It remains a fact that, except in the case of permitted to enter the United States, even if such a serious impairment of the resistance, a they desire only to pay a visit to the country, single or even several repeated exposures will thus being placed on a par with patients ill with not suffice to determine an infection productive the plague, cholera, or other virulent infectious of disease. diseases.

Early in the eighties Professor Straus, in The writer well understands and is fully in Paris, found that the medical students and insympathy with the iteration and reiteration of ternes as well as visitors to his hospital and esconservative counsel in this respect on the part pecially to the consumption wards harbored in of Professor Knopf, and he himself has con the mucus of their nares large numbers of tributed here and there to the advice that saner tubercle "bacilli that proved virulent upon inand less extreme precautions should be taken. oculation into cavies. These students and in(For instance, see Life and Health for May, ternes of course were exposed to contact infec1910.)

tior with reasonable frequency, and, yet, owing It may not be amiss once more to discuss this to an efficient resistance, also to the fact that they were obliged to be in the open air more or prevent infection and render it innocuous if it less, as well as to other factors, not one of them should be unavoidable. acquired tuberculosis.

Furthermore, it is a well-known phenomenon TREATMENT OF THREATENED ABORTION. that physicians and nurses, even if they ex- From the many excellent papers submitted to clusively care for consumptive patients, very the prize contest of the New York Medical Jourrarely acquire the disease, not because this is nal, on the subject of abortion, we select that not contagious, but because ordinarily adults of Dr. Alfred Costales for reproduction in the are sufficiently resistant to be able to overcome Medical Standard. He says: . the results of an exposure to this infection. When called to attend a case of threatened

It is true that in the case of children, and abortion, after satisfying ourselves that the paespecially of infants, conditions are not quite tient is really pregnant, as ascertained by the as favorable and that the little ones are all too history obtained, and by a very careful and comfrequently infected by consumptive attendants, plete physical examination, at the same time whether they be brotþer or sister or mother or noting the probable duration of gestation-we nurse-girl. Yet, even in such cases the infec- order the patient to bed, keep her in the recumtion need not necessarily lead to an immediate bent position, and proceed as follows: Washdisease, but may remain latent until puberty, ing and scrubbing the hands and arms. with soap when a superimposed infection or a weakening and hot water, carefully disinfecting the same of the organism through undue exertion or with bichloride solution, one in 2,000, or alcohol through disease may arouse the latent infection full strength, touching the ends of the fingers to a virulent progression.

with tincture of iodine and smearing the fingers There are other reasons why at the present and the whole hand thoroughly with some antitime the contact with consumptives, at least septic lubricant, we make a vaginal examinawith such as have received the benefit of ex- tion and feel the condition of the os uteri and pert advice and have the good sense to follow cervix. it, is not necessarily dangerous. These patients. If the os is found undilated and the cervical are informed that they may become a source canal unexpanded, the hemorrhage being slight of danger to those with whom they live if they and the pains controllable, we have to deal with are not careful in regard to their expectorations. a threatened abortion and recommended absolute They are taught never to breathe or sputter. or rest in bed, forbidding all excitement, etc. The talk into the faces of other persons, always indications are to arrest the further progress to cover their mouths with a cloth or a bit of of the case by giving the patient a hypodermic tissue paper when coughing and these to be injection of morphine, 1/4 grain, and atropine, burned afterward, always to wash their hands 1/150 grain; or pulveris opii, 14 grain, and gallic if these have become contaminated with spu- acid, three grains, every three hours, for a few tum, and in other ways to do all in their power doses only, to arrest hemorrhage and pain; or to avoid communicating the germ of their own one drachm of the compound tincture of viburdisease to others.

num opulus (National Formulary) every two or Of course, it is only the careful consumptive three hours. In the majority of the cases we and the tuberculous patient whose sputum does will not succeed because the patients will not not contain tubercle bacilli who is not a source carry out our orders, as in the present epoch of danger. The careless and inconsiderate, pro- they prefer to get rid of it. miscuous spitter is a criminal who needlessly If the case becomes one of unavoidable aborendangers the life and health of his neighbors tion, as indicated by a dilated os, profuse hemorand should be isolated in an institution, while rhage accompanied by sharp uterine pains, and tlie advanced, progressive, bed-ridden consump- the os and cervix are dilated enough to admit tive who is too feeble and ill properly to take one or two fingers, we at once proceed to evacucare of his expectoration is isolated eo ipso and ate the uterine cavity by peeling off the memmust be taken care of as any other patient suf- branes and removing the entire uterine confering from an infectious disease.

tents, making downward counter pressure on As a whole, we may safely assure our patients the uterus through the brim of the pelvis, with and their sisters and cousins and aunts that the other disengaged hand, so that it will be there is comparatively little danger of contact helpful in our manipulations; or we can introinfection from tuberculous patients, that effi- duce an irrigating curette properly sterilized, cient care on their part and a proper hygienic and remove all rough surfaces found therein by mode of life on the part of the well will both gently curetting and using at the same time a

and removun ward count the pelvis, wilhe

hot intrauterine bichloride douche, one in 5,000 FRACTURE ABOUT THE ELBOW. at about 115° F., or using the tincture of iodine The X-ray has become almost indispensable, one drachm, to llie quart of hot water. If neces- says Dr. W. D. Haines, in the Lancet-Clinic, in sary, we may bring down the uterus with å for- the diagnosis of fractures, about which he gives ceps or a tenaculum, thus facilitating our pur- some very interesting and helpful points. Fracpose. Give the patient one dram of fluid extract ture of the olecranon is the most frequent varof ergot, every three hours, for a few doses. iety near the elbow joint. Fortunately it is usu

If the os and cervix are not dilated, we must ally a clean break. Tilting of the upper fraghave recourse to dilatation by mechanical means, ment is caused by an uneven tearing of the exas follows: After introducing a large vaginal panded portion of the triceps attachment, and speculum and locating the os and cervix, we tliere is a tendency to rotation which is hard insert Hegar dilators in succession, or use any to overcome. good cervical dilator and gradually dilate the One of the chief symptoms of fracture of the canal until it is large enough to admit of pack- olecranon process pertains to the patient's ining, say one quarter of an inch or more. We ability to fully extend the arm. This function then pack the cervix and vagina with long strips may be partially or wholly lost, depending upon of iodoform or other antiseptic gauze or, if pre- the damage which the ligament has suffered. ferred, we may insert, to advantage, a medium Do not be deceived by gravity extension; by or a large sponge or tupelo tent instead, which fixing the forearm, ask the patient to extend it will have tiie effect of at once arresting the while the examiner resists the attempt. Palpahemorrhage, however severe, and in from four tion will reveal the line of cleavage when this is to six hours we will find either the fetus ex- perceptible, and when it is not to be felt tenderpelled into the vagina, or the cervical canal so ness may be elicited by pressure over the line pervious that operative measures are at once of the break. This examination will reveal the available, either with the fingers (always to be above features best if the patient's forearm is preferred) or with the curette. A correct pro- fully fexed, but in seeking crepitus better recedure in these cases, where hemorrhage is sults will be had with the forearm fully ex- , alarming and the cervix undilated or nearly so, tended during the examination. would be to call an assistant, anesthetize the Our results have been so favorable in the treatpatient, and proceed at once by manual dilata- ment of fracture of the olecranon by the straight, tion to evacuate the womb, using an abundance anterior, long, shoulder-to-wrist splint that we of sterilized lubricant for the hands, which will continue to employ and commend this form of greatly facilitate the operation, never forgetting dressing. There is in the vast majority of this to use the hot antiseptic douche of bichloride, or type of fractures but a slight degree of separathe tincture of iodine, as mentioned, and, if need tion of the fragments. Surely, nothing is to be be, a hypodermic injection of ergotin, thus: gained by subjecting such a case to operation. R: Ergotini. .......

In some cases in which the fragments are widely ouini. .......................... Aqua destillatæ, .......

..... separated, the deformity may be overcome by M. Sig.: Sixteen minims for hypodermic in the use of morphia, hot bath and massage, the jection in buttocks, every three hours until ef- arm dressed in full extension and displacement fectual.

of fragments prevented by the application of Or the following:

adhesive strips. We are assured by the pathR Cotarninæ hydrochloridi, ....

ologist that ligamentous union is the most we Ergotini ....

may hope for by this method, that the union Aquæ destillatæ ...............

will stretch when subjected to severe muscular Strychninæ sulphatis, .......

strain and impair the function of the forearm. M. Fiat capsula No. i. Tâles doses No. xii. If operation is to be performed it were better One every three hours.

done at once, as early operation gives much betOr pituitrin may be given hypodermically. ter results, in that one does not have to contend

Dr. M. Auslander, of New York, observes that: with shortened muscles and undo the previous Treatment should be directed to overcome the efforts at bone repair and call for a repetition tendency to abort, and later to avert a recur- of the reparative processes. If operation can rence. The inmediate treatment for a single not be performed on the day of the accident, case is about as follows: The patient is placed better results will follow the application of heat in a room alone to insure quiet for mind and and massage for ten days preceding the operabody She should re

tion, at which time the lymph and blood clots

sacrifice to some of these great teachers; but that it will eliminate the objectionable advertising feature of a university professorship, and add to the value and thoroughness of instruction, there seems little doubt. We hardly think, however, that such a plan would "go” in Chicago. There are still far too many little professorial hatchets to be ground here.

will be partially organized and the local resistance to germ invasion at the time of operation will be increased. Practical experience proves this practice, but the explanation may or may not be correct. With the field well exposed by an incision so placed as will do least damage to the ligaments, blood vessels and nerves, the clots are thoroughly removed by the use of gauze, hot salt solution and curette. The fragments are drilled and a piece of kangaroo tendon is drawn through the holes, and, by placing the arm in full extension, the fragments may be readily brought in close relation and secured by tying the ligature. Suturing the torn triceps attachment has always seemed to the writer to be of didactic rather than practical import.

The arm should be placed at rest for two weeks, at which time light passive motion may be begun and light exercise at the end of six weeks. Heavy work should not be undertaken by the patient under two months from the time of operation.

Dr. Hanies commends the operation in all open fractures of the olecranon, and in those cases wherein the fragments can not otherwise be kept in close apposition.

The von Pirquet Test.-The von Pirquet skintest for tuberculosis is declared by F. H. Smith (Charlotte Med. Jour., Feb., 1913, p. 85) to be entirely harmless. The local complaint is of a trivial character, while no general reaction has ever been provoked by it; also, it is simple, inexpensive, and can be made by any physician. Out of 42 cases reported in which the reaction was sought, there were 16.66 per cent demonstrable cases of tuberculosis in which the reaction was not obtained. On the whole, Dr. Smith states that the von Pirquet reaction has been helpful to him in 76 per cent, and confusing ir. 24.

A FAMILIAR FORM OF CYSTITIS. There is a form of cystitis quite familiar to the general practitioner. It occurs in females, old and young, with apparently normal pelvic organs, generally after a chilling. There is an abrupt onset with frequent micturition, tenesmus, and perhaps dysuria. The acid urine contains the infecting organism, usually a colon bacillus, pus, and often blood. Rest in bed, local warmth, light diet, free catharsis and sanmetto are the measures employed, and in a few days the severity of the attack subsides, and generally in two or three weeks the patients are as well as ever.

Yeast in the Treatment of Vaginitis. Since the acid secretion of the vagina affords the most certain protection against infections, the clinical should be careful to promote this, rather than to destroy it by alkaline douches. The acid reaction of the vaginal secretions is the result of biologic processes. Since sugar offers an excellent medium in this respect, because it renders many germs, especially the usual inhabitants of the vagina, productive of acid, the sugar which is introduced in the yeast-treatment of vaginitis performs a useful purpose. In like manner the glycerin-treatment of this distressing condition is according to F. Kuhn (Centralblatt f. Gynaekis according to ologie, Bd ?37. 1913. S. 228) of value because

logie, in the cleavage of the glycerin molecules acid products are likewise formed.

A New Plan at Johns Hopkins.—The General Little Pat and big Mike had had a dispute, Education Board, founded by John D. Rockefeller, when Mike in contempt said: “Ye little runt, Oi has provided the Johns Hopkins Medical School bet I could carry yez up to the fifth story in me with a bequest of $1,500,000 with which to under- hod.” take a new venture in medical instruction. Here- Pat immediately took up the bet, saying: “I'd after the professors of medicine, surgery, gyne- loike to see ye thry thot same. I'll bet yez fifty cology and obstetrics, the so-called practical cints on it." branches, will be placed upon salaries and will be Before he knew it, Mike had him in his hod pledged to devote their entire time to the university and was going up the ladder. When he got to work. They will be permitted to treat outside the fourth story his foot slipped and he almost patients, but not for private fees. It is expected fell. He regained his footing, however, and that this arrangement will still further raise the reached the fifth story in triumph. standard of clinical teaching at Johns Hopkins, the "Oi win!” he said. staff being free to devote their efforts to the hos- "Yez did thot,” said Pat, “but Oi had high pital work. It will, of course, involve considerable hopes when yer foot slipped.”

[merged small][graphic][subsumed][subsumed][subsumed][ocr errors][subsumed][ocr errors]

EXPECTORANTS.

ing to this class are practically all of the balThis being the time of year at which the sams, benzoins, turpentine, terebene, creosote, average physician is more interested in the cure guaiacol and iodine and its preparations. These of colds, coughs and bronchitis than anything undoubtedly have some action upon the bacterial else, we thought it advisable to have a discussion flora and are of greatest value in the more adof the subject of expectorants and similar rem- vanced stages when there is still considerable exedies for the control of these conditions.

pectoration with the possible exception of Expectorants are usually roughly divided into iodine, which seems to be useful at almost any two general classes. First, those which are nau- stage. seant and depressant. Second, those which are Still another class of remedies includes those stimulants both of the circulation and of the used to dry up secretion. Their employment is excretion of mucus.

restricted mainly to capillary bronchitis occurThe depressant or nauseant expectorants are ring in children in which it is necessary to limit given to cause relaxation of the capillaries, and the amount of mucus to prevent the child from especially those of the bronchi, permitting of a being “drowned in its own secretions." Bellafreer flow of blood to the parts and freer se- donna and hyoscyamus and their alkaloids are cretion of mucus, at the same time causing the principal remedies of this class. diaphoresis, bringing the blood to the surface To check cough, opium and its alkaloids and of the body and facilitating its more equable derivatives are most employed. However, in distribution and thereby relieving respiratory mild cases sufficient sedation may be obtained congestion. The principal remedies of this class by the use of such remedies as menthol, cannabis are ipecac, apomorphine, tartar emetic and indica and chloroform; or by the use of emollobelia.

lients such as licorice, flaxseed, Irish moss, and The remedies which stimulate expectoration the like. include principally the ammonium salts, which These different remedies are variously comalso probably have the effect of liquefying the bined to meet special indications which may be sputum and rendering it more easy to raise. present in any instance. Potassium iodide also liquefies the sputum, but with this introduction we will permit our conis rarely given at the early stage of these dis- tributors to tell their experiences.. eases, usually being reserved for the delayed Dr. Albert F. Fuchs, Loyal, Wis., says that his cases, those in which there is considerable tena- favorite nauseating expectorant is wine of ipecac cious sputum which is raised with difficulty. and he uses this particularly in treating children. Other remedies which stimulate expectoration are He never uses apomorphine as an expectorant. senega, squill and sanguinaria. These are re- He tried it in two cases of capillary bronchitis served mainly for cases in which the secretion in adults some thirty years ago and in both inis rather profuse but is raised with considerable stances bad symptoms followed. Stimulants such difficulty, especially when there is debility or as whiskey and ammonium carbonate brought senility. These remedies are not to be used about a reaction in one case five days later, with ordinarily in the acute stages of respiratory ca- profuse expectoration and recovery. tarrhs, but rather in the late stage.

To break up a cold, Dr. Fuchs' favorite remStill another class of remedies which is of edy is a full dose of Dover's powder with plenty considerable value are the antiseptics. Belong- of hot lemonade, putting the patient to bed.

« ПредишнаНапред »