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PHYSICAL REMEDIES FOR THE RELIEF Dr. Frank A. Davis, Boston, Mass., attributes OF PAIN.
the anodyne action of heat in the rase of neurie There has been so much discussion of the or muscular pains to the fact that it promotes a problem of narcotics, and especially of the dan- better circulation and relieves congestion, which gers of drug habits following their use for medici- lessens the pressure over the painful area. nal purposes, that we have thought it a good time He summarizes the action of electricity in its to have a Round Table discussion of the various various forms in the relief of pain, as follows: physical remedies which can be used for the re Galvanism relieves pain through the physiologiiief of pain.
cal action of the positive pole, which contracts Of course, every reader of the Medical Stand- the blood vessels, produces an acid condition and ard will understand that we do not condemn the relieves congestion; faradism overcomes stasis, use of anodyne medicinal agents. No man un- promotes circulation, etc.; high frequency curderstands better than the trained physician that rents improve nutrition, overcome stasis, etc.; the there are numerous occasions when it is not only static wave current promotes circulation, and important that powerful narcotics should be overcomes stasis and congestion. used, but that it is equally true that to withhold Doctor Davis advises discrimination in the emsuch narcotics upon such occasions is inhuman, ployment of massage in true neuritis. In synocruel and possibly even dangerous to life it- vitis and in the gouty conditions it will relieve
pain to some extent, by promoting a better cirAmong the remedies which have conferred the culation through the area involved and by relieygreatest benefits on mankind, the average physi- ing local congestion. He has also used mechanician will probably place opium first, and yet, cal vibration, radiant light and heat, and the while in its beneficent action it stands at the sinusoidal current, and states that their action head of the list, it, also is one of the most dan- is similar to that of the other methods mengerous drugs we possess. It is not a remedy to tioned. be used lightly. It should be given only in the In the treatment of neuralgic and neuritie face of urgent necessity, and it should be with pains, Doctor Davis employs positive galvanism, held until other simpler, less dangerous reme- high frequency currents, static currents, the dies or expedients have been resorted to. brush spray, etc., varying these according to the
Unfortunately, the average physician is not cause of the pain and the conditions existing. as familiar with these physical means for the Myalgia may be treated by static sparks, starelief of pain as he should be. It is really mar- tic wave current, the sinusoidal current, posivelous how much can be accomplished by the tive galvanism (direct or interrupted), faradism intelligent use of heat, or the application of elec- (mild), radiant light and heat, and occasiontric modalities, by counter-irritation produced in ally by mechanical vibration. various ways (not necessarily with drugs), by In cases of ocular pain Doctor Davis suggests skilful stroking or massaging of certain painful first that an examination be made by an oculist parts. Yet, simple as these remedies are, they and glasses supplied if necessary to correct vision. must be used with the utmost intelligence and If the pain is due to perverted metabolism, the skill. For instance, no doctor would think of cause should be found and corrected. Local treatmassaging an inflammatory area.
ment, in the case of cataract, consists in the With this brief introduction, we leave the use of the high frequency vacuum tube. If the whole question with our readers.
pain is due to eye-strain, he employs galvanism. positive or negative, as indicated. In the treat- fort on movement of the part. No more strikment of headache, positive galvanism is advised, ing instance of pain can be cited than pain due through the operator's hand, or high frequency to to the inflammation of the sciatic nerve at this the base of the brain or over the forehead.
point, and no better example can be given to ilWithout going into detail regarding the treat lustrate the point of view that pressure increases ment of deep-seated or visceral pains of inflam- pain from the two points of view, first due to the matory origin. Doctor Davis declares that ra- exudations in the neuralemma surrounding the diant light and heat, the static wave current and nerve and second from the pressure due to spasm the sinusoidal current often prove useful in such of the pyraformis muscle pressing upon the cases.
nerve. The doctor believes that one of the best physi- “The application of the static wave current cal agents for the alleviation of pain in cancer with a metal electrode directly over the site of is x-ray treatment, properly administered. the lesion produces a relaxation of the pryafor
Finally, Doctor Davis gives the following point- mis muscle and by successive contractions iners for the general practitioner:
duced in the tissues of the nerve relieves the "Don't forget calomel and castor oil in lum- pressure by dissipating the exudation througlı bago, sciatica and general muscular pains. Vera- tbe lymphatic channels. colate is a great liver stimulant and intestinal
"A case of acute sciatica may be invariably tonic.
cured in a few days by the systematic employ"Look out for appendicitis in cases of acute ment of this method. The same is true of the indigestion.
application to a sprained ankle. The stasis “Take the blood pressure in all cases over forty which promptly occurs following accident is the vears of age. D'Arsoval currents are the best first thing to be removed, and there is no agent treatment for high blood pressure not due to so active in doing this as the static methods, the valvular compensation.”
static wave current, static brush discharge, and William Benham Snow, New York, writes: “I static sparks whereupon the pain immediately am very much interested in the subject of your disappears and the patient who comes on crutches Round Table for the next meeting, but I the first time walks out with little or no pain think there is one important point in the con- after treatment. In no case in which fracture sideration of pain that should be first explained of ligaments or bones has not taken place should from the point of view from which I consider it require more than three or four days to abit in nearly all cases, i. e., that pain is almost in- solutely restore a sprained ankle to normal. I variably due to pressure and wherever we have bave done this in more than one hundred cases infiltration or exudation accumulated in an in- each of sciatica and sprains, and am fully justiflammatory field the condition of stasis which fied in making the statement which may seem holds the infiltration at a status quo is the cause to be an exaggeration to those who are not faof pain either upon the addition of more pressure miliar with the methods to which I refer. or without the addition of pressure, depending “The great principle which surgeons and physiupon the degree of pressure.
cians have ignored is the fact that local stasis or “Inflammation also causes local muscular the accumulation of infiltration and exudation spasm and muscular spasm increases pressure in a localized field of inflammation is the conand pain. For example; in sciatic neuritis with stant cause of tenderness or pain in that area, the infiltration with inflammation of the nerve and also at remote points where a nerve injured at the sacro-sciatic notch, the most exposed site or pressed upon is distributed, as in the case of of the sciatic nerve where it emerges from the sciatica. The relief of pain therefore in most pelvis, the nerve at this site is crossed by the instances must depend upon the relief of local pyraformis muscle and whenever the neuritis stasis by the romoval of infiltration and exudaoccurs the muscle contracts. At this point pain tion. This is the principle on which the static may be referred along the extremities to various current is employed; for no other means or methpoints but will always be due to the pressure at the od will so effectually drain an infiltrated area site of the lesion. When such inflammation does as the static current by the induction of sucoccur the spasm arising in the pyraformis muscle cessive tissue cell and mass contraction throughproduces additional pressure upon the inflamed out the infiltrated area. Thus tissue drainage nerve. The condition then becomes a vicious removes the pressure, permits or rather induces circle in which each condition tends to make the restoration of circulation with the recovery the other worse increasing the pain in the periph- of tissue metabolism and repair. This is the ery even to the point of causing great discom- basic principle for the treatment of inflammation where infection is not present, and will some return even though the indurations were temday be generally established as it is proved be- porarily relieved. Massage in no sense equals yond question in the hands of hundreds of men in this respect the application of the static curwho are now using the static current intelli- rent and other methods. gently
Radiant light and heat, the x-ray, and mechau“I am sending you under separate cover the ical vibration are likewise effective in their peReport of the Committee on Standards of the culiar way to conditions as indicated effecting American Electro Therapeutic Association, in the relief from the causes of pain. Radiant light preparation of which I bave taken an active part and heat is one of the most valuable agents for and if you find time to read it, you will, I am the relief of local infection relieving the pain and sure, recognize our point of view.
curing the condition in the pre-pus stages of “I have endeavored to answer the questions on otitis media, boils, and carbuncles, and effectivethe little sheet which you sent me as fully as ly curing the condition with arrest of the disspace would admit inferring that you, having charge in chronic otitis media when the ossicles placed it in this limited space, expected to have are not necrosed. It is also effective in mastoidmy remarks confined to that space. If, however, itis before pus. Long applications made from you care to publish the statement that I have focussed radiations or intensified radiations by made in this letter you will do so. Personally moving the reflector rapidly about over the inI believe that herein lies the secret of the treat- fected area approximately for one hour at each ment of pain in noninfected inflammations." application with an intensity as great as can be Doctor Snow's statement follows:
borne is the essential technic. The earache ceases The action of beat for the relief of pain may within the first half hour, the pains of boils and be explained as due to two actions, first the re- carbuncles are assuaged and if applications are laxation of the tissues with expansion which re- made energetically and frequently before pus the Lieves pressure. Otherwise the employment of local phagocytosis induced and the depressing dry heat, as to an infected arm, or limb with effect of radiant energy upon the germs termhigh temperatures ranging from 450° to 500° F. inates the affection. Heliotherapy or sunlight apEmploying bandages of turkish toweling to pre- plied daily for several hours under favorable vent collections of fluids which would boil and conditions and for a long time to tubercular joints blister the patient, increases the general meta- and local tubercular affections has produced rebolism and phagocytosis besides depressing the markable cures, particularly in the higher altigerms, and destroying them when septococcic and tudes in Switzerland but is undoubtedly applicastaphylococcic infection is present.
ble to conditions in any climate. Electricity is employed for the relief of pain The direct d'Arsonval current or the passage in accordance with two principles. (1) The em- of the high frequency current from the d’Arsonval ployment of the static current over infiltrated circuit with the poles placed upon opposite sides areas with interrupted impulses, as with the of an infected area produce uniform thermal efstatic wave current, static sparks, and static brush fects throughout the tissues intervening between discharge, removes local stasis and pressure by the electrodes with a resulting hyperemia thereforcing out the exudations through the lymph by increasing metabolism, nutrition, and phagochannels and (2) coincidently improves the cir- cytosis in the heated field. By this means inculation with restoration of tissue metabolism flammatory conditions that are caused by infecand repair. Pain being due in these cases to tion are greatly relieved and often cured with the pressure the relief of stasis relieves pain both at relief of pain coincident to the tissues relaxation the site of the lesion and if upon a nerve, at the with the heat produced. peripheral distribution. This method is only ap- The non-drug methods used for the treatment plicable where pus or other infection is not pres- of neuritis are principally the static methods as ent as it would otherwise cause metastasis.
in sciatica, brachial neuritis, and tic douloureux. If massage is employed in painful conditions its In these cases the static wave current and static chief indication is the relief of muscular spasm sparks administered in a manner to produce sucsurrounding the local area, working up gradually cessive contractions in infiltrated areas at the to the site of the induration and as far as pos- site of the lesion effectively relieve the pressure, sible inducing circulation throughout the indu- and in acute cases effect a cure in a very few rated tissue. Direct application however to the days; whereas in chronic cases of neuritis the inflammatory area to a degree mascerates the same methods tend to relieve adhesions and after tissue and is certain to be followed by a prompt a longer period of treatment completely reliere pressure and pain. Neuralgia is an expression, controlling the pain and in sarcoma may still therefore, of a localized neuritis and its treatment further inhibit the progress of the disease. The is the treatment of neuritis.
X-ray likewise is remarkably efficient in relieving Myalgia may be cured or relieved by different other deep-seated pains and is particularly apmethods. Very long applications of radiant light plicable to the treatment of pelvic inflammations. and heat from five hundred candle power lamps The pains of dysmenorrhea and the nervous sufapplied over the affected muscles is often effective. fering of subinvolution may be more effectively The method, however, par excellence is the static relieved or cured by the use of the static wave method referred to in the treatment of neuritis. current applied directly to the uterus through the Acute myalgia may be uniformly cured with one rectum. This method of treatment for dysmenoror two twenty-minute applications of the static rhea is one of the most remarkable additions to wave current with a large metal electrode and the gynecological methods. We can report many long spark-gap followed by a thorough applica- more than one hundred cures in these patients in tion of static sparks; thereby relieving the mus- from one to two months. cular spasm and producing elimination of the ex- The pains referred to here are probably more udations which are filling the infiltrated tissues. effectively relieved by the use of the X-ray and The d’Arsonval current by the method described radium than by any other means, and the future placing a large distributing electrode connected of the treatment of these conditions must look to one side of the d’Arsonval with the patient to these measures as a part of the treatment of lying on the d’Arsonval couch will effectively re- all cases with the assurance that with the comlieve the trouble. In chronic cases of myalgia bined use of the Roentgen ray and radium with applications of static sparks and the static wave surgery or other measures for removal, the proscurrent will effectively improve the conditions. pect of not only removing the macroscopic but Dry hot air energetically used may also help. also of destroying the microscopic disease cells is
The treatment of headache is a very complex often possible, thereby removing and alleviating subject. There are cases of gastric origin for the pain and suffering. which the only treatment is the correction of the
The time has passed for the general practitioner alimentary conditions. There are cases which
or specialist to rely upon opiates and anodynes have their origin in pelvic conditions. Many of
for the relief of human suffering except in exthese may be corrected by correcting the pelvic
treme cases of malignancy when other measures trouble. Others may persist through the life of
have utterly failed. The agents enumerated in the individual, particularly during the menstrual
answering the preceding questions require nothperiods. There are others which may be more or
ing like the technical skill that most men attribless due to spinal cord conditions, especially in
ute to them, and yet a knowledge of the fact is the upper cervical regions. Many of these may
necessary that pain can be relieved by these measbe corrected by the systematic employment of
ures, and that conditions can be cured which are mechanical vibration and other modalities which
generally left to Nature which at best fails in relieve local muscular spasms and congestion.
most inflammatory conditions. These with the Each case is a study in itself, and in many the
adoption of the rational life in point of diet and conditions are so vague that it is impossible to
exercise as prophylactic measures and when conlocate the cause. On general principles every
ditions bave gone wrong, as curative ones as well, thing should be done which tends to restore nor
will accomplish for human suffering what canmal functional metabolism in every part and
not be accomplished by surgery or drug methods correct local causes.
alone. The indications in such cases if for the treatment of visceral inflammation. If visceral inflammation is not of infectious origin the same “Could you do something for a poor old sailprinciple of treatment obtains as for the treat- or?'' asked the seedy looking wanderer at the ment of inflammation elsewhere. The relief of gate. infiltrated, non-malignant, non-infectious condi- “Poor old sailor?'' echoed the lady at work at tions calls for the restoration to normal of cir- the tub. culation and metabolism, as in hypertrophy of the “Yes’m; I followed the wotter for sixteen liver from cirrhosis, or splenic enlargement from years.'' malaria. The application of the static wave cur- “Well," said the woman, after a critical look, rent will reduce enlarged viscera to normal in "you certainly don't look as if you ever caught most early cases. In deep seated malignant tu- up with it!” mors the Roentgen ray has remarkable affects in Then she resumed her labors.
THE MONTH IN BRIEF.
HINTS FROM THE THINKERS AND DOERS IN MEDICINE.
Death from Ratlesnake Bite.--About four in the afternoon, says Crutcher in American Medicine, D. J., a bright, energetic boy, aged seven, residing near Kenna, New Mexico, was struck by an enormous rattlesnake (Crotalus adamanteus, most probably), both fangs entering the ulnar side of the right forearm about three inches above the wrist. The injured extremity was corded at once and the parts incised. The Hon. Arthur J. Evans, M. D., of Elida, was summoner, arriving at the bedside of the patient five and a half hours after the receipt of the injury. Dr. Evans found the patient delirious, pulse 108, temperature nearly normal, with persistent vomiting. The corded arm was greatly swollen, with many vesicles present. The parents of the boy had given him about half a pint of whiskey during the first hour after the accident. Dr. Evans administered strychnia grs. 1-30 hypodermically every four hours, and applied a strong solution of potassium permanganate to the wound. Some improvements followed these measures, but the patient sank gradually and died at 10:20 a. m. following the injury.
It was most unfortunate that skilled assistance could not be obtained until after a delay of several hours, and the administration of such a quantity of alcohol by the parents was doubtless greatly against a favorable outcome.
In cases of this sort I believe that the prompt administration of a full dose of morphin would prove of great value in mitigating the effects of mental shock, which must certainly be a decisive factor in many instances. I have now under my care a girl of 15 who was stung ten years ago by a copperhead (Agkistrodon contorrix). Both fang marks are perfectly distinct. The local symptoms at that time were trivial, but I am told by the girl's mother that grave symptoms of shock nearly proved fatal and that life was saved only by the most energetic efforts on the part of skilled physicians.
of which for some time may cause progressive adynamia. He wishes to secure the tonic effect of calcium, and therefore submits a combination which is alleged to be very useful:
In the first place he lessens the quantity of sodium chloride to 650 in place of 750 to the 1000, and adds a definite quantity of potassium and of calcium. This is not only tonic, but increases the coagulability of the blood. Moreover, since surgical operations are peculiarly prone to develop the initial phenomena of an acidosis, he adds bicarbonate of soda and finally glucose because of its diuretic, tonic, and cardiotonic properties, which are peculiarly inherent in this substance. His formula for intravenous injection is as follows:
Chemically pure chloride of sodium, 6.50;
Distilled water, 1000.00. If the solution is for the purpose of rectal instillation, the quantity of glucose is increased from 142 to 50 grammes and pure ethyl alcohol is added in the proportion of 15 grammes. Schiassi distinctly prefers the rectal method of injection because substances being absorbed by the portal circulation undergo a proper transformation in the liver. Moreover, a greater quantity of liquid cannot be introduced by this route than is actually called for by the needs of the general circulation.
Treatment of Heroin Addiction.—Many cases of heroin addiction are being reported, and this drug is said to be second only to cocaine in its harmful effects. However, it can be cured according to T. D. Crothers, who, writing in the Medical Council, declares that in the treatment sulphate of magnesia in 10- or 15-grain doses three or four times a day, unless the bowels become very irritable, is probably the best drug.
Humulus is another drug which can be given with great satisfaction in an infusion. This will produce a mild sedative action without complicating or producing any possible addictions. If
A New Saline Solution.-Schiassi (Semaine Medicale) has, he thinks, improved upon the commonly used physiological salt solution, the use