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in half-grain doses at first, if the patient be an adult. The wound should be incised several times and injected with a strong solution of potassium permanganate for the purpose of eliminating any poison that may be unabsorbed in the tissues contiguous to the wound.

Rattlesnake venom is deep green in color and has a very high specific gravity and is comparatively slow of absorption, hence the necessity of incision, injection of permanganate, etc. However, when the fangs enter an artery or vein its toxic effect is almost instantaneous. The permanganate solution is said to be chemically incompatible with snake venom and to decompose all the venom that it comes in contact with in the tissues and blood.

The adrenalin chlorid solution (adrenalin chlorid 1 part in 1000 parts of physiologic or normal salt solution, with 0.5 per cent chloretone) should be administered in small doses and frequently repeated until its physiological effect is obtained, after which it should be administered just often enough to maintain its physiological effect. It is the effect of the venom circulating in the blood. that we counteract by giving adrenalin chlorid. It can be given in larger doses and repeated oftener in snake-bite, because snake venom neutralizes its action upon the heart and circulation, like pain neutralizes the action of morphin. Until antivenin or some other potent remedy is produced, our main reliance in treating snake bites of all kinds, lies in the early and careful administration of adrenalin chlorid solution in conjunction with other appropriate remedies.

History of Case.-Augustine Vela, Mexican, age 43; weight, 210 pounds; height, six feet and two inches; fine physique, muscular and in perfect health. No history of syphilis or tuberculosis. Occupation, laborer, grubbing or clearing new land. While at work, about 9 a. m., January 10, 1905, was bitten on the right hand by a large diamond-back rattler, measuring ten feet. He was bitten over region of first and fourth metacarpal bones, the snake's fangs entering the superficial veins and being one and one-half inches between points of entry. The man was in a squatting position when bitten, when he raised up and walked a few steps and sat down. His American foreman, seeing what had happened, had the other workmen lift the sick man into a wagon which was standing nearby and they drove under whip to Kingsville, where my office was lolated, a distance of about a mile. However, before they started, they corded the arm at the wrist and again at the shoulder and applied some coal oil, which was all they had in the way of medicine.

On arrival at the office his pulse was 50, weak, irregular and intermittent, and almost imperceptible over radius. Mind wandering, and in great agony, and extreme muscular weakness-not being able to stand or walk-respirations rapid and superficial, cold, clammy sweats, faintness and nausea. His hand and arm were much swollen and ecchymotic.

Treatment was begun immediately by giving a large draught of whisky, one-half grain of morphin for the pain, ten drops of adrenalin chlorid solution, 1/1000 in normal salt solution, and 1/20 grain strychnin sulphat, hypodermically. Four deep incisions on dorsum of hand and many injections of a saturated solution of potassium permanganate, followed by cupping glass with air-pump attachment. The injections of adrenalin chlorid solution and morphin were repated a number of times in the afternoon. The patient vomited a number of times and complained of severe pain in abdomen. On the fifth day the swelling and ecchymosis began to disappear, and by the fourteenth day had entirely gone.

In the administration of adrenalin chlorid solution, care should be exercised in the size of the dose and its repetition. The age and weight of patient should be considered, as well as the condition it is given in. Repeated doses of this active agent will produce anatomical alterations. Immediate results are a marked elevation of arterial tension, with intense vaso-constriction and increase of cardiac energy. It acts with greater rapidity when injected into veins, and is more toxic when given in this way. Adrenalin chlorid solution is contraindicated when arterial tension is already elevated, when the cerebral arteries are brittle or degenerate and when there is an arterial aneurism. When fatal doses are injected into blood vessels, pulmonary edema rapidly follows. Parenchymatous injections into lung tissue or trachea are also very dangerous.

Vela's arm, hand, shoulder, side of neck and right side down to the hip, were a solid black. After a tedious convalescence of three weeks he went back to work.

For Texas Medical News.

What Constitutes an Authority in Ophthalmology? A Letter to Mr. Spectacles.

In the September issue of the TEXAS MEDICAL NEWS, under the caption, "The Reception Tendered the Honorable Mr. Spectacles on His Return From a Tour Around the World," the editor seems to think he has said the last word on the wearing of eye-glasses.

No doubt the doctor was indulging merely in a bit of humor, but for fear some one might have taken him seriously, this brief reply to his "letter" is offered, simply as a small endeavor to establish a little more "truth in medicine." The popular medical fallacies of the day, legion in number and peculiar in origin, are often unmeaningly fostered by physicians; and each and every member of the profession would do well to read Dr. Hirshberg's article on this subJect recently published in the American Magazine (October, 1906), as well as an editorial ("Medical Fallacies") in the Journal of the American Medical Association for October 6, 1906.

· Primarily, it must be admitted that opticians and fakirs are reckless prescribers of spectacles; but it is just as true that a correct and scientific glass, prescribed with pupils dilated by an expert oculist, has saved countless thousands from a life of blindness. Take progressive myopia (near-sightedness) alone: nearly 10 per cent of avoidable loss of sight is due to this affection or its immediate consequences. Cohn, in one clinic, in one year (Wiesbaden, 1887) cites 12,452 myopes among 70,174 cases. One-half of these (6226) could have been saved had the proper glass been sufficiently early prescribed. Note the expression, "sufficiently early." This means in young childhood, when, according to the editor, "they should be permitted to go out and play upon the lawn, tumble in the grass, look at a distance, develop the sight by far-seeing, and read at close range, and focus the eyes by means of the muscles." He says further: "Educate the people up to the high importance of allowing their children's eyes not to be interfered with too early, but allowed to develop in the proper way, and if glasses are absolutely required, consult an up-to-date oculist of known ability." This is the worst possible advice, first, because you can not interfere "too early"; if you wait, the harm is done and can not be undone; second, because by the time a layman decides that glasses are "absolutely necessary," the fundus changes may have increased to such a degree that glasses can not relieve them.

Another fruitful example is mixed astigmatism. No device of any character, no treatment of whatsoever kind will enable these sufferers to see till accurate glasses are fitted. Not only so, but the eye develops better, the red lids and blinking disappear, the tugging ciliary muscle is given work it can do instead of being allowed to attempt something it absolutely can not do; and last, but most in point, the all-important retina gets the chance to take on its proper function and does not give up the battle-which it finally does if left unaided to itself.

A third instance where glasses are decidedly essential in childhood (and we might multiply instances, but will let this be the last) is high hyperopia (so-called "far-sightedness"). In this category, a glass will, in nearly every case, prevent the oncome of squint ("cross-eye"), which is such a common and unsightly defect. I have at present two cases, one of 2 years and one of 4, both wearing glasses with much ease and comfort. In one, aged 4, a latent muscular error of 45° (esophoria) disappeared in nine weeks. (She is wearing O. U. +2 S.) This would soon have become a manifest error (squint); and, indeed, the mother did say that a friend had on one or two occasions noticed a "cast" in one eye.

Again, the author states: "When man or woman had reached the age of 40 or 50, their sight, the most important of all senses, began to fail. They were denied the pleasure of reading, the enjoyment of the play, the exciting sport of horse-racing, and other things of great interest to mankind, for the reason that their eyesight had failed them." This is ridiculous. These people do need a weak glass for reading; but who ever heard of their complaining about not being able to see plays, horse-races, and the like? These are as easily seen as they ever were; for rays from a distance are parallel; and for their focusing on the retina no accommodation is needed.

* * *

Further on we come across this statement: "Then it was that our old friend, Mr. Spectacles came to their rescue and brought to them what is known as their 'second sight.' This is also erroneous; "second sight" is a temporary improvement in vision due to a slight increase in the refractive power of a swelling lens in beginning cataract.

The doctor also declares that glasses are "splints." This may, in a certain degree, be true, for they do sustain the eyes till assisted, and nature can establish a cure; but, unlike a splint, they can not be discarded in a few weeks without the eyes returning to the old, diseased condition.

Finally, "Mr. Spectacles" did not, as is suggested, go out from our little America to conquer all the world. Glasses were invented about 1280 (probably by a Florentine monk), more than 200 years before America was discovered.

H. B. DECHERD, M. A., M. D.

Questions Given by the Board of Medical Examiners, Houston, Texas, October 16, 17, 18, 1906.

PRACTICE.

1. What is intestinal obstruction and its pathological anatomy? 2. In acute indigestion resulting in cholera morbus, what would be your first plan of treatment?

3

What are biliary calculi, their cause and treatment?

4. How would you diagnose and treat a case of gastric cancer?

5.

What is sciatica, symptoms and treatment?

6. What are the symptoms and treatment of acute catarrhal laryngitis?

7. How would you diagnose and treat a case of diphtheria? 8. What are the methods employed in making an examination of the heart? Describe the same in normal condition.

9. What is epilepsy, its cause and varieties?

10.

What is interstitial nephritis?

11.

12.

What is anemia, its causes and pathological anatomy?
How would you diagnose a case of croupous pneumonia?
D. J. JENKINS, M. D., Daingerfield, Texas.

GYNECOLOGY.

1.

2.

3.

What is vaginismus, and how would you treat it?
Describe a choice operation for recto-vaginal fistula.
What are the symptoms of gonorrheal vaginitis?

What complications arise from gonorrhea in the female?

5. What symptoms are produced by a prolapsed ovary?

6. How should a case of retroversion of the uterus with adhesions be treated?

7. What treatment would you adopt for antiflexion of the uterus associated with painful menstruation?

8. After the menopause has passed, what may account for the recurrence of bloody vaginal discharge in some women?

9. Upon what clinical history, symptoms and physical signs would you make a probable diagnosis of tubal pregnancy before rupture?

10. What are the disadvantages of uterine fixation operations in young women?

11. Describe Emmett's operation for lacerated perineum. 12. What are the disadvantages of vaginal hysterectomy?

A. C. SCOTT, M. D., Temple, Texas.

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