« ForrigeFortsett »
All patients and many pbysicians believe tions were reported as too painful, even in that the cough symptoms should vanish im. very weak solution, for local application, so, mediately on establishing nasal respiration, for several weeks previous to her admission overlooking the fact that the synptom no to the hospital, only sterile water had been doubt in most instances is a long time in de. used locally. She was subject to frequent veloping. However, the time for recovery attacks of great pain, and slept consequently usually takes days, weeks or months, depend. but little. Her appetite was poor, and at. ing upon the degree of irritation set up in the tacks of vomiting frequent. The latter were lower respiratory tract.
probably due to the discharge running down
the throat through a sinus that existed beREPORT OF TWO CASES OF CANCER
tween the lesion and the posterior nares. TREATED WITH TRYPSIN INJECTIONS
The patient was put on local applications, AND LOTIO PANCREATIS LOCALLY.
once daily, of lotio pancreatis 3ss, sterile water
Ziss, on April 30tb, and injections, once ROBERT H. DAVIS, M. A., M. D.
daily, of injectio trypsini gtts. V, sterile wa
ter gtts. V, on May 1st. The injections were ST. LOUIS.
at first made in the face, at various points Case I.-Mrs. F., age 47, came under near the edge of the lesion, but, after several my care April 26, 1906. History.-The cancer, weeks, this was discontinued, on the theory which was of the rodent ulcer type, began that absorption was poor in this locality. about twelve years ago as a small papule sit. The injections were, thereafter, given in each uated at the bair line, im niediately above the arm alternately. The injection of the trypright eye. The papule remained quiescent sin solution was preceded ten minutes by the for a hout one year, and then broke down, and injection of ten minims of 1% solution of grew slowly, for a second year before any eucain hydrochlorate. After the local applitreatment was instituted. Then it was treated cation, above mentioned, the lesion was coylocally by various physicians, for a period of ered with a wet pack (2% borosal), and this three years, with no improvement. This was alone was used at night. Injections were followed by about one year's local and gen. given daily to the present time (July 5th) exeral (tonic) treatment, also without improve. cept during the periods from May 8th to May ment, the lesion slowly growing worse all the 15th, May 19th to May 27th, and June 13th time. It extended chiefly down the forehead, to June 20th, when difficulty was experienced and the edge bad, by this time, reached the in getting a supply of injectio trypsini. The right eyebrow. She was now put on X-ray injection was increased to R injectio tryp. treatment, and followed tbis line of procedure sini gits vii, sterile water gtts. vii, on May faithfully under two competent physicians, 15th, and to B injectio trypsini gtts. viii, successively, for a period of five years in all. sterile water gtts. viii, ou May 30th; and The exposures were three times a week. The finally to R injectio trypsini gtts, x, sterile tecbnique of them is unobtainable, but, as water gtts. x on June 20th, which dose has stated, they were given by experienced ray been since continued. The strength of the ists. The cancer, however, continued to borosal solution was increased to 6% on May grow, and becoming discouraged, she discon. 10th, but this caused considerable pain, so tinued treatment six months agc. After re. so it was reduced to 4% on May 15th, and maining at home about three months, with continued at this strength till May 24th, when local dressings, tonics and anodynes as the a saturated solution (121%) was first applied. measures employed, she came under my care. This was, then, well borne, and was, accord. as stated, on April 26th of this year. Her ingly, thereafter used. The strength of the condition then, both local and general, was lotio pancreatis application was increased to, very bad, and no permanent improvement B Lotio pancreatis 3ss, sterile water Zi on could be hoped for. The lesion involved al. May 22d, and this strength was used till July most the entire right cheek, the upper two. Ist, when, R Lotio pancreatis, sterile water thirds of the nose, the forehead on the right aa zi, was applied, and has been since in side, the scalp for about one inch beyond the use. From May 21st on, irrigation with hair line, and the inner half of the left eye. sterile water alone was made each morning. The right eye was entirely gone, the globe This was followed by the application of the hanging as a small necrotic mass in the or- pancreatic solution, and the wound covered bital cavity. The discharge was profuse and with a dry dressing. At night, tbis was rethe odor very offensive. The patient had moved, and a wet borosal pack applied, and been confined to bed for almost a year, and covered with rubber tissue. The pack was was greatly emaciated. Her temperature, on moistened with borosal solution, of the April 26, was 100.6 deg. F., pulse 96 and strength indicated above, once during the very weak. All of the usual antiseptic solu. night.
Internally, the patient was put on hol. The results were: (a) decrease of pain; adin grs. . t.i.d., on April 29th. Tbis (b) no ill effeots either local or general. was increased to ten grs. t.i.d. on May 6th, Pusey (Jour. A. M. A., June 9, 1906) re. and continued at this for one week. It was ported a series of seven cases of inoperable then discontinued till May 28tb, after wbich caroinoma, and one inoperable, round celled from 10 to 20 grs. were given daily, divided sarcoma of the thigh, treated by this method. into two doses, one at 4 p.m., and one at bed. He had one apparent cure. In the other oases time. The morning dose was omitted, be. he believed appreciable harm was done, as cause of an occasional attack of nausea at either abscess resulted at the site of injection, that time. The patient was also put on vari. or cachexia developed rapidly, or both these ous tonics, at different times, but all were harmful effects were produced. None of tbese discontinued after a few days' to a week's results ocourred in the cases repcrted, and I trial, as they seemed to ocoasion attacks of believe Dr. Pusey's trouble was due to a too vomiting.
rapid increase of the amount of injection, or Results of treatment were as follows: to setting the dose limit too high. In soveral (a) A decided decrease in the discbarge instances he injeoted 60 m. daily. He does after a few days; (b) a marked lessening of not give his technique in detail as to dilution the fetor. This at times is entirely removed; of the injectio trypsini before administration. (c) a great relief from pain, and a consequent Both he and I used Fairobild's sterilized ability to sleep, with improvement of the trypsin solution, with the commercial name pulse, appetite and spirits; (d) the cancer re- of injectio trypsini. mained practically stationary from the time of In a subsequent case, now under treatthe commencement of the treatment until
ment, I find that the preliminary injection about June 26th. Since then it has slowly of eucain is unnecessary. spread and deepened; (e) there has been no un.
It seems that the method carried out as toward symptom of any sort, either local or
above reported, is harmless, and affords congeneral, from the applications or injections.
8. siderable relief to the patient. Of course, with The amount of discharge of course, varies from
the present meagre evidence before us, it day to day, but is, as stated, much less on the
sbould be used only in inoperable cases, or in average, than before the treatment was insti.
conjunotion with the X-ray, and should, in tated. There was, also, a decided increase of
no case, be relied upon as a means of oure the fetor during those periods when the local
where a radical operation is possible. trypsin applications were unobtainable. Oc. casional attacks of pain were controlled by B Pbenalgin grs. 27, morphine sulphate gr.
The salicylate of strontium is an intestinal Case II.-Mrs. T., cancer of the peritone antiseptic and anti-rheumatic, dose 10 to 15 um, the whole peritoneal surface being in grains. volved. This lady, a patient of Dr. E. W. New BUILDING FOR INSANE HOSPITAL Saunders, was also hopelessly ill when the OPENED. The second new building at the treatment was first available, an amelioration
ration North Texas Hospital for the Insane, Terrell,
North Texas Hospital of symptoms alone being hoped for. Local
was opened June 28. The building is in. applications being impossible, trypsin injec
tended for white male patients exclusively, tions, and holadin interally, alone were used.
and will nocommodate 250. The third addi. The trypsin. Djections were preceded ten tional building will be ready in a few weeks, minutes, as in the previous case, by an in
and will furnish accommodations for 500 ad. jection of 10 m, of a 1% solution of eucain hydrochlorate. The trypsin dose was 10 m. with sterile water 10 m. from the beginning. HEALTH PAMPHLET ISSUED BY THE ILLI. These injections were begun April 24th and NOIS STATE BOARD.-The Illinois State continued until June 26th, a period of 63 Board of Health has issued a new pampblet, days. During this time 56 injections were written on the same general lines as one pub. given. They were never given more fre. lished last summer, containing information quently than once a day. Holadin grs. V, on how to take care of the babies. Sugges. t.i.d., was given during this period, except tions are given for the nursing mother, arti. for one or two short intermissions, necessi. ficial feeding is fully discussed, and the adtated either by the difficulty of obtaining vantages and disadvantages of the various in. the drug, or a transient objection of the pa. fant foods are carefully considered. This tient to taking anything. The injections pampblet is issued for gratuitous distribution, were discontinued on June 26th, as increas- and those who wish copies should apply to ing weakness made giving them too great & Dr. James A. Egan, secretary of the board, at strain on the patient's strength.
SENILE ARTERIO-SCLEROSIS. . When we examine an individual suffering
from sclerosis, we find on palpation that the GEO. E. ROSENTHAL, M. D.
nodules are inore prominent distally tban
proximally in the extremities, and that this QUINCY, ILL.
condition, beginning at or near the body SENILE ARTERIO-SCLEROSIS is a general sys. wbere it is of a minor degree, grows proteipio disease essentially chronic in charac. gressively more grave until the artery ter, producing a thickening of the artery branches for its final ramifications. Thus in wall with secondary changes therefrom in the the upper extremity the axillary artery may tissues. Of the viscera, the heart, kidney and show a mere smoot fibrosis, the bracial exbrain suffer the most profound impairment. bibits minor prominences along its wall, while
Etiology.-Broadly as to etiology we lay the radial is extravagantly beaded. safely include all toxio principles, both auto. An artery is, in normal health, a thin. ohthonous and exogenous; the poisons of walled elastic tube containing a fuid of a syphilis, of the eruptive fevers, the products specifio gravity of 1010.1080. When sich of bacterial activity generally, of intoxica- a tube is swung in an arc of a circle there tions and auto-intoxications.
is a longitudinal and transverse stretching, It is undoubted that hard, laborious oc- greatest at its distal end. In an individual cupations with attendant exposure are fac performing manual labor the arteries of the tors of the greatest importance in its devel. extremities are swung through arcs of ciroles opment, when occurring in connection with many times daily, and thereupon the above some of the conditions above mentioned. In mentioned phenomena of longitudinal and the twenty-two cases analyzed there were transverse stretching occurs, the stress inblacksmiths 4; farmers 6; carpenters 4; la. creasing in proportion to the distance from borers +; railway engineers 1; coal miners 2; the trunk.. painters 1. The average age was 71. The But with suoh distortion and increase in oldest individual was 84. The youngest was endo-arterial area there follows functionally 56. These are all occupations demanding a slowing of the blood stream, a stasis inimsevere exertion continued over long intervals, igal to proper economy results, with organ. pursuits in wbich the arduous labors de. ically an arterial rarefaction or thinning veloped great appetites for food, drink, to. which predisposes to aneurism. This slowbacco, etc., and these were babitually satis ing of the blood stream is the exciting fied to satiation, with certain attendant in cause for the compensatory endarteritis. By toxications and auto-intoxications.
this process (the endarteritis) the normal Those suffering from this arterial disease arterial area for the part is restored through were in middle life almost invariably, large. the laying down of new tissue in the intima. boned muscular individuals fitted by nature A year perhaps is consumed in the profor their occupations, and further developed cess, but now instead of the straight smoothby them. In their sepility they find that ly lined tube we are confronted with one they have outlived many of their less which is much less perfect. Irregular masses rugged companions.
of cells project from its walls into the Etiologic factors of senile sclerosis bear lumen, causing cross and counter currents not directly, but indirectly upon this con- and throwing a greater burden upon the dition, they produce arterial neuro-muscular left heart which must undergo a compensaweakness, which permits dilatation of the ar- tory hypertrophy to cope with its increasing tery wall. This is the condition which ne. labor. In this way compensation is twofold, cessitates a compensatory arteritis.
intimal and cardiac. Eventually as the years When the system is saturated by toxines go on the expansile artery of health becomes instead of the exact reciprocity between the stiff and almost immovable, responding feesupply of and the demand for the blood bly or not at all to stimuli. Its walls are stream by means of a varying arterial luipen firm and inelastic, its coats are thickened, as required by the activities of the individ. nodules of lime salts are deposited in its subval, the adjustment shows imperfections. stances, it is incapable of responding to the The artery, after an exertion wbich has de. many adjustments needed by the varying acmanded the maximum of arterial pabulum, tivities of the structures which it supplies. fails to contract promptly when the demand The nervous governance is seriously im. ceases, and after many repetitions a perma. paired, whence comes the vertigo upon sudnent dilatation results. This failure to resume denly arising from a sitting or recumbent a normal calibre is due to certain toxic prin. position, the cold extremities, the anginose ciples afloat in the blood stream and influ. pains, tbe dysbasias and dyspragias. enging the nervous and muscular system of It is generally agreed that arterial sclerosis the blood vessel.
is a compensatory process, the artery is com.
pensated for its loss in mobility, elastioity trition supplied to the belly wall by the and thickness by a building up its weakened narrow lumen. Some one of the abdominal wall. But the exigencies of circulation de. weak points under a tension wbich previously mand a rapid buttressing of the struoture, had been well resisted and sustained now a lower grade of tissue more prone to de. gives way, allowing an abnormal breach in generation forms the arterial patchwork. its continuity. The artery which needs compensation is The presence or absence of symptoms in never thereafter as strong in its resistance of the senile solerosis depends, we believe, upon tension, its resilience is diminished and its nu. the degree of compensation, intimal and cartrition is impaired by obliteration and ob. diao. If complete we may have an almost struction of its vasa vasorum.
symptomless inalady (until cardiac compen. The compenastion is against hemorrhage sation begins to fail). If faulty we may have as well as aneurism. It is true that com. any or all of the accredited manifestations. pensation is neither full nor absolute, for Vertiginous attacks are a frequent and in the majority of individuals suffering baffling symptom and are most aggravated on from the sequelae of cerebral hemorrbage, arising from bed. Some amelioration is ob. the arteries are markedly solerosed, but were tained as the day advances until at evening it not for the solerotic patobwork the aver. it may be of very slight degree. The vertigo age age for cerebral hemorrhage would be is a subjective one, and though violent the advanced some one or two decades and falls therefrom are infrequent, as the individ. aneurism would not tben be a comparatively ual learns to suppport himself with his stick rare manifestation. Furthermore, compen. and by abduction of the thighs to form a sation does not invariably occur. We may wide base in walking and standing. A sudhave cardiac compensation without intimal, den descent in barometrio pressure and elecand then the consequences are most disas. tric potential (the invariable precursors of an trous. Again we may have neither cardiao approaching storm) intensifies the vertigo as nor intimal compensation, which would make it does the joint pains and paraesthesias of for an immediately grave prognosis.
the disease. Symptoins.-The sclerotic individual is Sensations variously described as tingling, usually emaciated, bis skin falls in folds about as if the skin were being pricked by many his wasted muscles and prominent bony frame. needles are somewhat common, or a persist. work; his color is anemio; his head is bald, ent and intolerable burning of the skin may over the sunken temporal regicn we notice the exist. A patient will complain of a scalp temporal artery in its tortuous course, the which seems persistently on fire, applicacheeks are sunken also, and the pupils show the tions of cold water affording but little rearcus seniles. The ocular bulb is compara- lief. Another will tell that his feet are so hot tively prominent. In the upper extremity that in severely cold weather the bed coverwe notice the radial artery presenting from ings must be removed to render sleep possi. among the loose folds of redundant skin ble, though persistently cold extremities are (the fatty areolar tissue having undergone the rule. almost complete absorption). The brachial Formication is a common manifestation. artery is even more prominent because of Pruritus is not infrequent and may involve its bolder course unflanked by osseous struo. the surface of the entire body. Cramps of ture. Both brachial and radial exbibit con both upper and lower extremity, more fresiderable facility for lateral movement in quently the latter, are of common occurrence their beds, a kind of subluxation, sometimes and seem to bear no relation to the activity as much as half an inch of movement in each of the individual, for at times the sufferer direction.
will be awakened from a deep sleep by these The back is stooped, the chest flattened painful muscular spasms. Persistent bead. anterio-posteriorly and the ribs, clavicle and aches and hemicranias occur, the pains may scapola are startlingly prominent Fre. be described as tearing or rending, though quently the emphysematous chest is noticed. the majority are less severe. Tinnitus aurThe belly may be pendulous.
ium is another aggravating symptom, this Aneurisms of the radial artery appeared subjective disorder may become a terrific in two cases of this series, as did varioose roaring or explosive sound, likened to that veins in two. Hypertrophy of the left heart made be escaping steam from a nearby looo. is the rule.
motive. The incidence of recent hernias is re. Deafness was a oomplication in four cases. markable, this and the pendulous abdomen Persiatent lameness is a very frequent symp. are merely other phases of the protean man. tom. Many of our cases which we diagncse ifestation of arterio-sclerosis. The occur. as obronic muscular rheumatism are in rence of bernia is due to the deficient nu. reality manifestations of arterial solerosis
the pain being due to the involvement of cyamus, up to one-half dram daily serves Paccinian oorpusoles in the solerosis or well." arterial spasm.
Large quantities of water should be ordered The symptom complex variously named in. for these patients as they habitually take too termittent olaudication, dysbasia anigoscler- little fluid. otiac or dyspragia, bas been fully exploited
We have noticed no benefit from the use of late, and in this conneotion I wilī men of artificial blood sera, such as Trunevek's. tion in passing a case in this series, of olaudication of the lumbar muscles. The patient was quite comfortable when sitting or lying on bis bed, but suffered excruciat. DIET IN ARTHRITIS DEFORMANS.—Thompingly after walking briskly for a few min. son (Med. Rec.) recommends forced feeding utes, yet gaining complete relief by a tem with a full diet of animal food, the fats preporary returu to bed.
dominating. The ordinary meals should The renal symptoms are those of the scler
be supplemented by two or three luncheons otic or contracted kidney, there is an in
during the day. Biliousness can be precrease in the frequency and quantity of vented largely by the use of simple bitters urination. The urine is clear, of low specific
before meals, dilute hydrochloric acid with gravity and albuinen is rare in cases uncom. nux vomica after meals, drinking much Wilcated hv avatitis and nrostatitis but it is water and the occasional use of a cathartic. the exception to find a normal prostate and
ntion to find a normal prostate and -Denver Medical Times. bladder in these individuals. Casts will re
APPENDICITIS REMEDIES.—The treatment ward a patient research.
bere, as in ordinary cases of acute appendici. Constipation is frequent, but is attributa
tis, was simple but effective. Opium in ble only in part to arterial disease, faulty
arterial disease, faulty any form is worse than useless, dangerous in mastication from defective teeth, a sedentary so far as it masks symptoms and arrests inlife and ingestion of small amounts of water testinal aotivity. Hyoscyamine, gr. 1.250. are other factors. Cbronic bronchitis may and strychnine arsenate, gr.1-134, were given be the exciting cause for the late hernias, in a little hot water, and aloin, podopbyllin some degree of bronchial irritation appear and calomel, of each gr. 1.6, were given every ing in each cases. This and asthma are the thirty minutes till four doses were taken. two most frequent respiratory complica. The 'byosoyamine and stryohnine were retions.
peated at hourly intervals till the pupil dilated Therapeutics.—The efficient therapy of
and pain lessened, when the former was arterio-sclerosis may be summed up in one omitted, the latter being continued at twoword: Prophylaxis. When a man presents bour intervals. One bour after the last dose himself with arteries firm, tortuous and
of aloin, etc., a hot saline draught was given nodular, even the most bopeful and optimis. and in two hours another, the last dose being tic therapist will not promise to remove the
followed in a short time by a copious foul nodosities. Though he may confront the
stool. Olive oil carrying five grains of gall-stone for its medicinal dissolution with
papayotin to the ounce was now given every amazing fortitude, the repair of the artery is three hours and three pints of an alkaline an. more than he will assume.
tiseptio solution thrown into the colon with Prophylaxis is accomplished by ineans of the tube, patient in knee-chest posture. The regular living, a sufficient dietary, no more; motions were passed into a bedpan, it not moderate indulgence in meats, the interdic- being deemed wise to allow the ereot posture. tion of alcohol and tobacco, mild and regular Half-hourly, gr. 1-6 of calcium sulphide was exercise, tepid bathing and abundant sleep. exbibited from the first, and after the first
In failing compensation the rational treat. stool, pupils being dilated, the byoscyamine ment must be rest in bed. The effect of vaso. was dropped. A second stool bearing the dilators is nil in those cases exhibiting a concretons and plugs passed some hours later, lime infiltrated artery. The iodides, the and, as stated, the case was practically well nitrites and trinitrin are useless. Rest in from that time. Light hot applications were bed, massage, and possibly the cautious ad- applied over the abdomen constantly. After ministration of digitalis, its congeners, or the bowel had acted and palpation revealed nux vomica are our most efficient agents. the reduction of induration, small repeated
In early cases the vertigo will respond to doses of bydrastin and juglandin were given, nitroglycerin or a course of calomel at times every three hours, podophyllin gr. 1-67 being gives good results.
added to every other dose. Gentle massage For the paraesthesias and insomnia gradu. with camphorated oil was made over the iliac ally increasing doses of the tincture of byos. region.- Am. Jour. Clinioal Medicine.