Sidebilder
PDF
ePub

attention is the stomach. I agree that things stretches or dilates the stomacb, and drainage are hardly settled now, but with men like becomes more imperfect. Mayo, Sheldon and others at work, it is The food undergoes fermentative changes, only a matter of time. The drop of exper just as urine does, in a faulty bladder, and ience I may hope to add is the only valid the same irritation takes place in mucous exouse for a paper that must necessarily be as membrane of the stomach. As in the bladder incomplete as this one.

This fermentative material in stomach proInto every office comes those cases giving

duces a gastritis; hence the constant com. lono continued stomach trouble, plaint of pain. There is an inflammatory. They have a history extending back over

thickening, and the pylorus is narrowed, and fifteen or twenty years. They have been to

this vicious cyole is begun. With a condi. almost every doctor in the county, and no tion of fermentation going on within the benefit. They have taken every conceivable stomach, and this partially digested vitiated form of patent medicine, and no betterment. material leaking into the bowels, it is not to They are back to us again with the plea that be wondered at that we have marked consti. we do somthing to relieve them. If we take pation as a symptom. time with them, and we should take time, we The anemia, wbiob is a secondary sympwill find a condition as follows:. They are tom, showing itself frequently enough to be complaining of pain in region of stomach: considered, is the result of improperly prethey are markedly constipated, and always pared food. Assimilation of contents of neurasthenio: they are showing signs of stomach and bowels is practioally impossible, secondary anemia: they have an atonic con- and the impoverishing of blood must be the dition of the muscular wall of the stomach, result. Pearce, Myers, Ranney, Bouchard and a more or less dilated gastric pouch, and will agree that neurasthenia is traceable to an accompanying gastritis more or less acute. poisons, toxemia, to autoinfection and ane. Such cases as above, are beyond the help of mia. The stomach forms a beautiful ma. medioine, but can be relieved by surgical in- ohine for the generation of toxins, and so terference completely and permanently. The does an overloaded bowel. Besides being question of permanenoy that arose with my a perfect incubator, offers the most elaborate first case, is only partially answered in the mechanism for the absorption of its prod. affirmative

uot. Vomiting may, or may not be a conMy limited experience hardly warrants a stant symptom, but eruption of sour fluids

silice statement as to all cases but to some and gases is usual, with occasional attack of those sufferers I am convinced you can of vomiting. The above are prominent offer a cure. We will all admit the fact that symptoms that indicate surgical interference. overwork of the gastrio muscles will produce

All of the symptoms are relieved by gastroatony with an elongation of muscular fibers. enterostomy. If this condition exists for some time, we will

I will cite three cases, as they serve to bave an enlarged stomach cavity, a dilata. bring more strongly the symptoms into tion.

prominence : In these cases your examination of stom CASE I.-N. Colvin, Wyaconda, Mo.; ach sbows the chemistry of that organ to

farmer, aged 53, came to my office in Novembe normal, so far as the digestants are con.

ber, 1907, complaining of stomach trouble cerned. The trouble, as expressed by Mayo,

extending over a period of some twenty years. is that the mechanics of the stomach, and

Early in history vomited considerable blood, not its chemics are at fault. Hence in which had ceased some years previous, an these cases, the administration of any or all

almost constant pain in epigastrium, with the therapeutic agents are of no value, and periodic attacks of vomiting lasting from a the case must be relegated into surgery. Do few days to weeks, when they would suddenly not understand that this condition can exist

cease, only to start again in a few weeks or an indefinite time without showing some se.

months. He also complained of marked con. cretory disturbance, but when they exist, stipation. He was emaciated, and of that they are usually secondary.

dirty bronze color so significant of malignant If you can countenance this statement, involvement. He wae anemio. He was that the primary trouble is motor, as the re- markedly neurasthenic. The stomach exam. sult of atony, then the symptoms follow is ination was negative as to closure of pylorus. this sequence: We have an atony of gastric Free hydrochloric acid found in three of four muscles, as a result of overwork: the stom- examinations. Organio acids normal. Blood ach loses its power to force contents through count showed secondary anemia. Stomach

pylorus; to empty the stomach: the accu. inflated with air showed some dilatation. He wimulation of substances in stomach farther had taken all the chemical and animal diges

tants singly and combined, with no effect. usual details of his stomach trouble. He had We used stomach tube, and taugbt patient its pain at pit of stomach. He did not vomit use. Relieved some of pain, and the wash. but was frequently belobing sour Auids and ings got away with large amounts of glairy gases. His bowels never emptied themselves mucus with no permanent results. The star. except under whip of large quantities of salts vation plan tried. Kept everything off stom- and the enema. He was always worse during ach, and fed per rectum for two weeks. No the winter; was for a number of years fairly results. I then proposed to make a junction comfortable during the summer, but the last between stomach and loop of bowel and see two years saw little difference between the wbat drainage would do for him. He ac. seasons. He was pale, cadaverous and ane. cepted, and in January it made a union be- mic; showed that weird collections of ner. tween the posterior wall of stomach and vous symptoms known as neurasthenia. The jejunum. I operated by means of the Mur- examination showed some dilatation, and by phy button. Fed by rectum first six days. giving patient a sharp shake, you could get For first three days gave nothing by the that diagnostic splash. Chemical examinamouth, after that time allowed a little water tion showed free acid constantly present, but in and some milk. Patient made a very rapid small amounts; fermentative material abund. recovery, passing button on thirteenth day, ant. Removal of test meal three hours after and leaving hospital one week later. At eating found stomach practically full. Under tbe time of operation, I found stomach dila. air and water stomach was found dilated. ted, and walls somewhat thinned. A slight Operated November 17. Stomach thin, muthickening at pylorus, but no occlusion, only cous membrane highly injected and some a little narrowing. A careful search failed narrowing at pylorus. I used the Monprofit to reveal any soars form an old ulcer. The method of operation. I had no regurgitation man has been free for over a year of any in the two previous cases, but felt I might symptoms of old trouble. He has gained expect it. So as patient was in good condiand held his weight, and a letter a few weeks tion, I made the double anastomosis, as a ago states that he can eat anything and feel safeguard. All symptoms subsided almost good afterwards.

immediately upon operation. The man was CASE II.-H. Rodgers, operator of lineo. in hospital about five weeks. One button type, age 28. Came to office at time No. 1 was passed four weeks after the operation, was under treatment, complaining of indi. The other one is still within the patient; it gestion; the beginning of trouble dated back is causing no symptoms. It may have fallen eight years, first year's work on machine. back into the stomach. It is a possibility we He attributed bis trouble to antimony used inay expect in using the Murphy button. It in the type metal. He had the pain in epi. is not the technic of operation, but the cause, gastrium: he never vomited, but at different I have here under consideration. times during the day rifted up a mouth full I appreciate that from three cases hardly of sour fuid. He was anemic, constipated any conclusions can be drawn that are posi. and neurasthenio. Examination showed tive. But to the three cited here we can add under air distension the stomach dilated. Sheldon's and Pond's case, and the results Test meal given showed motor power of stom- are worthy of consideration. ach lacking. Free hydrochloric acid present. That certain cases of chronio dyspepsia are Diagnosis was an atonic condition, with at not amendable to internal medicine, but can least partial retention of the food. 'Operation be cured by gastro-enterostomy is certain. proposed, and consent with beld, pending re- The choice of operation the choice of the sults of case No. 1. Operated January 20, doctor in obarge. made a posterior-gastro-jejunostomy without I leave the paper with you, in hopes that loops, after Mayo's method. Used button. you may find something of interest and help Button passed at end of third week, and patient in caring for at least some of your chronio was back on full diet by the fifth week. From dyspeptios. second day allowed light soups and milk by mouth, supplemented by reotal feeding. ADULTERATED COMMUNION WINE. — The There was no loss of flesh while in bed. At Health Commission of New York City had present man is well, weighs 147 pounds, as some “communion wine'' analyzed and found against 115 before operation. Pain gone, wood alcohol, hard cider and anilin dves to constipation relieved and neurosis entirely be the chief ingredients. absent. He works and eats as well as ever

SANITARY CARS.—The Obio State Health in his life.

Board now requires all companies operating CASE III.-W. Kimbrough, Carthage, Ill., steam or electric cars, not entirely confined to aged 35. Symptoms of stomach disturbance one municipality, to provide ouspidors for extending over eighteen years. He gave th the travelling publio.

The MEDICAL FORINIGHTLY

ing this question when it is under discus. sion in a criminal court.

Grasset then further discusses medical reIssued Tenth and Twenty-Fifth of Every Month. sponsibility, and shows that there are three Under the Editorial Direction of

sets of mental diseases, as it were, in each of FRANK PARSONS NORBURY,

wbiob the responsibility is quite different. THOS. A. HOPKINS, CARL E. BLACK.

In the first place, he distinguishes clearly With the following staff of Department Editors

those affections of the superior mind (mental 0. E. LADEMANN, Internal Medicine.

diseases) from those of the inferior mind JOHN MCHALE DÉAN, Surgery. R. B. H. GRADWOHL, Pathology and Bacteriology.

(psychic diseases). Herein be shows that W. H. VOGT, Obstetrics and Gynecology.

the terms pscybic and mental are not synonWALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics.

ymous. Psychio is synonymous with corW. T. HIRSCHI, Therapeutics.

tical and is therefore far more general in its
A. F. KOETTER, Otology.
HERMAN STOLTE, Laryngology and Rhinology. significance than is mental, which in signi.
F. P. NORBURY, Nervous and Mental Diseases.
T. A. HOPKINS, Genito-Urinary Diseases.

fication, is rather more limited and refers ROBERT H. DAVIS, Dermatology.

functionally only to the prefontal lobe.

Irresponsibility accompanies the diseases

of the superior mind, the true mental dis. EDITORIAL

eases; responsibility or partial responsibility accompanies always the diseases of the infer

ior mind, the mere psychoses. THE question of responsibility in mental

Mania is an

illustration of the former, hysteria of the disease bas ever been a diffioult problem, both for the physician and

latter. Psychic maladies that complicate

mental affeotions must also presuppose irre. the lawyer to solve. The PhysioThe old traditions

sponsibility. The mentalization will of pathological

course be abnormal in both mental and psy. founded upon the time. Problem of

chio diseases as well as in their mutual comworn precedents of the Responsibility.

plications. The medical expert may oonsislaw where the right and

tently testify to this fact and indicate, as wrong test seems all

shown above, how responsibility, from the sufficient for the jurists, has not been found

medical point of view, may accompany one sufficient from a purely medico-psychological

set of diseases, attenuated responsibility anstandpoint.

other set, and complete irresponsibility still Of late there is renewed interest in these

another set. It is not for him to assert, in perplexing problems, and along this line a scholarly contribution by J.Grasset (Journal

his capacity as medical expert, how pbilosu

phy or law is to regard the degree of respon. de Psyobologie, Normale et Pathologique;

sibility in there respective conditions.” Journal Nervous and Mental Disease, Vol.33,

This is a decided step for advancement in No. 2, p. 135) on “The Physiopathological

medico-legal soience, which physicians will do Problems of Responsibility,” in which the

well to observe and follow in practice. author says there is much confusion among

To

successfully draw the lines of difference in medical witnesses regarding the degree of re

degree; in other words, to fit the responsi. sponsibility and in seeking an explanation

bility to the individual not the crime will ne. he says, “There is a superior (conscious) and

cessitate a training in mental disease both an inferior (subconscious) mind. The med.

clinical and pathological greater than is given ical witness should, at first, seek to carefully

to the average physician separate the pbilosophical question of respon.

Again, a broad

philosophical knowledge of the characteris. sibility from the medical or psychophysiolo.

tics of man must be an accomplishment of gical question. He should limit himself strictly to the latter. Can he do so? Yes, for

the would be medical expert, in order that he

may with cultured ability recognize, discrim. it will be conceded by court and expert alike

inate and differentiate degree of responsi. that abnormal mentalization must be de.

bility. pendent upon abnormalantomo-physiological

F. P. N. conditions, and a discussion of these condi. tions is the medical expert's particular prov. ince. The disease of legal responsibility that is to be associated with these abnormal states CHANGE IN DATE OF BOARD MEETING, of mentalization, borne witness to by the The State Board of Health of Missouri has medical experts, is a question solely for the postponed its meeting in Kansas City to court to decide. Medical responsibility is, or April 16, 17, 18. An examination of appli. may be, something quite different from legal cants will be held at the Barnes Medical Col. responsibility, hence the confusion surround. lege, St. Louis, on April 10, 11, 12.

THE REVIEWER'S TABLE Books, Reprints, and Instruments for this department, should

be sent to the Editors, St. Louis.

REPORTS ON PROGRESS comprising the R Comprising the Regular Contributions of the Fortnightly De

partment Staff.

DISEASES OF THE NERVOUS SYSTEM.

A MANUAL OF MATERIA MEDICA AND PHARMACOLOGY, COMPRISING ALL ORGANIC AND INORGANIC DRUGS WHICH ARE TO HAVE BEEN OFFI. CIAL IN THE U. S. PHARMACOPOEA. Together with Important Allied Species and Useful Synthetics. Especially Designed for Students of Pharmacy and Medicine, as well as for Druggists, Pharmacists and Physicians. By David R. M. Culberth, Ph.G., M.D., Prof. of Botany, Materia Medica and Pharmacology in the University of Maryland, Dental, Medical and Pharmaceutical Schools. Fourth edition, engraved and thoroughly revised, with 487 illustrations. Philadelphia and New York: Lea Brothers & Co., 1906.

FRANK P. NORBURY, A. M., M. D.

The Treatment of Cerebro-Spinal Meningitis. • -(0. T. Osborne, M. A., M.D., N. Y. Med.

Jour., Feb. 17, 1906.)—Á rather optimistio The fourth edition of this book contains

paper, in which the author advocates "ice, the changes of the last U. S. Pharmacopoia,

ergot and morphine" as "the treatment that and every subject has either been rewritten

will save and has saved many patients from or decidedly modified. The numerous ex

this disease." His treatment in brief is as cellent illustrations of plants, animals, etc.,

follows: "The almost constantly beginning affords the reader a good opportunity to be.

sore throat is treated with antiseptic, with come more familiar with them. The syno.

antiseptio gargles and sprays. Conjunctiv. nyms are given in the Latin, Amerioan, Brit

itis should be treated by sample boric acid ish, French and German language, thereby

drops. A calomel purge in the beginning. enhancing its value as a reference book par.

Painful joints are to be treated by being ticularly to the druggist or other reader who

wrapped with cotton and kept warm. Puin may be familiar with the substance in one

in general by the use of morpbine by mouth language but not in another. The methods

or hypodermioally, and in sufficient doses to of manufacturing the various pharmaceutical

give relief. Food should be light, and when preparations is also given in a clear and con.

nausea and vomiting occur withdrawn until cise way. The microscope and its use in

these symptoms subside. Nausea and severe materia medica forms part VI, giving the

vomiting may be relieved by injection of reader tbe essentials of this subject. This

morphine. To quiet cerebral excitement and book will be found a valuable addition to any

delirium and also pain, and to diminish the one's library who may be interested in the

necessity for large doses of morphine, ergot subjeots with which it deals.

is recommended. It contracts the blood ves. sels, is of value in cardiac weakness with soft

pulse and dilated arteries, and is a decided VON BERGMANN MADE SENATOR.—The sedative to the central nervous system, as it noted surgeon, von Bergmann, was recently seems to relieve congestion in the cerebral appointed by the Kaiser member of the up and spinal vessels. A patient who does not per house for life.

sleep well with a large dose of morphine will

be found to sleep well after a dose of ergot DISINFECTION IN TORONTO.--Hereafter all

has been added. Immediate and best achouses in which tuberculous patients have

tion of ergot is secured by hypodermio in. died, in the city of Toronto, will be disin- jection and preferable in the region of the fected by the local health officer.

deltoid muscle; the frequenoy of injeotions New Ruling.–The Iowa State Board of

depending on the symptoms. An indication Medical Examiners bus made a ruling that

that too much ergot is being used is a high after July of this year no diplomas will be

tension pulse and a too greatly slowed heart. recognized that are ganted by schools giving

Ice.—The ice cap to the head and the spinal advanced standings for work done outside of

ice bag are necessary. The ice applications medical schools. Minnesota has had such a

are more or less constant, depending on posi. rule for some months past.

tive discomfort of the patient, and subnormal

temperature. If the temperature is subnor. "THE JEWS IN ROUMANIA” is the subject mal or the surface of the body is cold, bot of a paper by Carmen Sylva (the Queen of applications are certainly of advantage. The Roumania) in the March Century. The general care of the patient should be the Queen pleads that Roumania is not in hospi. same as in typhoid fever-a light, airy room table, but so absolutely poverty-stricken that the patient quiet, no talking, except such the soil cannot support foreigners; and she as is necessary. The bowels must move daily. begs at least a hearing for the people of her The diet should be nutritious after the first "sorely afflicted country” before they are few days. Avoid alcoholics, avoid strychnine censured for considering first their own and quinine. Massage and eleotricity during children and their necessities.

con valescence.

Exophthalmic Goitre and Its Treatment. it. He concludes this very excellent leo. Geo. R. Murray (British Medical Journal, ture by saying, We must on the whole Nov. 11, 1905, the Bradshaw lecture.) In a conclude that at the present time in the very complete lecture Murray, who by the great majority of cases the best results are way is one of the foremost workers in this obtained by general hygienic treatment field of medioine, suggests the systematio ap- combined with the use of eleotricity and plication of the faradio current after the man. certain drugs, and that as yet no serum. or ner proposed by Sir Victor Horsley, as the other animal product can be considered to most satisfactory treatment. Two flexible give better results than these older methods electrodes, 2x4 inches, covered with flannel of treatment." or wash leather are moistened with a' warm

The Underlying Principles of Treatment of salt solution, and one is applied over the

Epilepsy.-W. P. Spratling, M.D. (Annual goitre in front and other at the back of the

Report of Craig Colony, 1905, p.3.) The first neok. The electrodes may be held in position

essential in the treatment of epilepsy is the by straps. The secondary circuit of a dry

treatment of the individual. To ignore the cell battery is used and a water rheostat used

person and treat only the symptoms is not a to control the current, wbich should be strong

cause that invites best results. At Sonyea enough to produce a prickling sensation to

(Craig Colony) the first efforts are devoted to the skin. The treatments should be for one

the individual in toto. By doing this it is hour twice a day, and in some cases three or

possible to overcome seemingly fundamental four hours in a day. The patient can learn

defects that on exclusive method of combat. to apply the current and should recognize

ing could even rectify, and while this is the the importance of continuous day after day

first factor it is far from being all of it. No treatment. Stuady improvement and recovery

claim is laid to originality in its use, except has resulted in many cases treated in this

to apply it in the treatment of epilepsy. The manner. The drug treatment is advisable,

same course has been used in treatment of but the limitations of drug treatment are reo.

pulmonary tuberculosis. When epilepsy is ognized. Arsenio is the most useful for daily

as rationally treated as is tuberculosis the routine treatment. A useful method is to

percentage of cures in epilepsy will be as high order four or five minims of the liquor arsen.

as they are in insanity, 25% to 30% or more. icalis, three times a day, excepting one week

No argument is made for the similarity of each month or during the menstrual period.

tuberculosis and epilepsy; the two diseases This should be continued from six to twelve

are widely dissimilar in every respect. The months. To reduce the pulse rate the tinc

only argument is that the epileptic is a viotim ture of convallaria from ten to fifteen minims

of a deep-seated condition, the eradication of with the arsenic. If extreme nervousness is

which cannot be aocomplished by a single in evidence, then the bromide of potassium

narrow line of treatment. in ten grain doses, may be added. Bella. donna is useful in cases presenting excessive The Nervous Manifestations of Rheumatism. perspiration, but not for prolonged treatment. - Poynton and Paine (London Lancet, Dec. Iodide of potassium is unsuitable and only 16, 1905) first discuss the etiology of rheuin many cases aggravates the condition. matism, saying it is a definite infectious disThyroid extraot also is not desirable as it ag. eases, due to the diplococcus rheumaticus. gravates the condition. Suprarenal and In support of this view they explain the co. thymus tablets have been of service in some incidence of this bacterium as found asso. cases. The red iodide of mercury applied lo. ciated with arthritis, endocarditis, perivardi. cally has also been of service in some cases. tis, subcutaneous, nodules, pleurisy, pneuFor the special symptoms special measures monia, peritonitis and nephritis, and that are needed, thus in diarrhea, rest, liquid diet they are able to produce similar lesions in and a mixture containing laudanum and di. animals. They summarize in the clinical part lute sulphuric acid will be of service. Persist. of the paper, as follows, realizing their belief ent vomiting, frequently uncontrollable and that rheumatio chorea is a local infection of may produce death, is best relieved by hypo- the nervous system, and that most of its symp. dermio injection of morphine. The serum toms are the result of a slight meningio.en. treatment is slowly meeting with favorable vephalitis and possibly meningo-myelitis, results, especially in the cases presenting viz: 1. They have isolated and cultivated the acute mental symptoms, Schultes reported diplococcus from the cerebro-spinal Auid in such a case. Thyroidectin, Moebeus's serum, four cases of fatal rheumatism, in three of eto., have not been used sufficiently to report which there was ohorea at the time of death. their full therapeutic value. The risks of 2. They have produced twitching move. surgical treatment are unfortunately 80 ments, arthritis, endocarditis and pericarditis great that Murray hesitates to recommend by intravenous injections of the diplocoocu s

« ForrigeFortsett »