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THE CHARLOTTE MEDICAL JOQRNAL.
lUl
TABLE OF CONTENTS FOR JANUARY, 1900.
Original Communications
Endometritis, by Dr. W. P.
Whittington, Asheville,
N. C 1
Headaches: Does the Phy-
sician Place Sufficient Im-
portance upon Eye Strain
as a Causey by Herman H,
, Brown, M. D., Chicago. . 4
Early Recog-nition of Carci-
noma Mammae, by Wil-
liam Francis Campbell,
M. D., Brooklyn, N. Y.. 7
On the Therapeutics of He-
roin, by Dr. Eugenio Me-
dea 10
A Study in the Treatment
of Urethritis, by Dr. A.
B. Clayton, Norfolk, Va., 15
Diphtheria, by T. T. Fer-
ree, M. D., Ashboro.N.C. 18
Esophageal Stenosis and Its
Surgical Treatment, with
a Report of a Number of
Cases, by James G. Hunt,
Utica. N. Y 20
Double Ruler Diagnosis, by
^B. T. Whitmore, M. D.,
cLL.D 28
The Mental Obliquities of
Moral Degenerates, b y
Samuel Knox Crawford,
M. D., LL.D., Chicago,.. 29
On the Close Relation Be-
tween the Nasal and Cra-
nial Cavities and Some of
the Dangers of Such Re-
lationship, by William C.
Krauss, M. D., Buffalo,
N. Y 31
Research into the Effect of
Prolonged Manipulation
of the Brachial Plexus
and the Nerves Supplying
some of the Muscles of
Respiration : R e s e a rch
into the Effect of Filling
the Chest with Fluid, by
George W. Crile, A. M.,
M. D., Cleveland, Ohio.. 35
A Note on the Artificial
Production of Fatty De-
generation of the Liver,
by Dr. Julius Pahlman,
Buffalo, N. Y 38
Editorials.
Meeting of the Tri-State
Med. Association, Feb-
ruary 20th, 1900 39
Medical College Diplomas. 39
Vital Statistics of Massa-
chusetts 39
Medical Society of the State
of North Carolina 40
Conclusions 40
Quacks in Pennsylvania. . . 41
State Laws and the Prac-
tice of Medicine 41
Book Reviews,
Sajous' Annual and Analy-
tical Cyclopedia of Prac-
tical Medicine 42
Operative Surgery, by Jos.
D. Bryant, M. D 42
Thorington, Refraction and
How to Refract ; includ-
ing Sections on Optics,
Retinsoscopy.etc. , bv Jas.
Thorington, A.M.,'M.D. 43
A Text-Book of Embryolo-
gy for Students of Medi-
cine, by John Clement
Heisler, M. D 43
Progressive Medicine, edi-
ted by Hobart A m o r y
Hare, M. D 43
A Double Thread, by Ellen
Thorneycroft Fowler 44
Transactions of the Iowa
State Medical Society. . . 44
Transactions of the New
Hampshire Medical So-
ciety, May 25-26, 1899. . . 44
Literary Notes
The Cosmopolitan, 44
New Lippincott Magazine
for January. 1900 44
Forum for January, 1900. . . 45
January Review of Reviews 45
Abstracts.
Alcoholism in Its Relation
to Heredity 52
Alexander Operation in
Retrodeviations of the
Uterus 53
Abdominal Surgery in Pri-
vate Houses 57
Abortive Treatment of Gon-
orrhea 58
Appendicitis in a Hernial
Sac 64
Amputation of the Fallo-
pian Tubes 64
Aseptic Catheterism, 65
Blood in Chorea 51
Bacteriology of Gonorrhea 62
Contagiousness of Acute
Suppurative Inflamma-
tions of the Middle Ear. . 48
Conservatism in Pelvo- Ab-
dominal Surgery 49
Cancer 52
Cystinuria and Its Relation
to Diaminuria .58
Deformity Following Exci-
sion of Knee 47
Differentiation Between the
Bacillus of Syphilis, of
Tuberculosis and the
Smegma Bacillus 54
Disinfection with F o r m-
aldehyde Gas 60
Diet in Typhoid Fever 64
Diabetes and Its Constitu-
tional Treatment.. 66
Exploration of the Abdo-
men as an Adjunct to
every Celiotomy 50
Early diagnosis of Tuber-
culous Joint Disease 52
Eclampsia 53
HtToct of Certain Occupa-
tions on the Pharynx 53
Empyema in Infants 55
Epithelioma of the Lip 59
Flagellated malarial Plas-
modia 57
Food Problem of Infancy . . 59
Fractures 03
Gall Stone 57
Government Sanatorium
for Consumptive Soldiers 58
Gonorrhea in Women 59
Glanders in Havana, 63
Glycosuria in Spinal Disease 63
Hemorrhagic Malarial
Fever 49
Hydrorrhoea Gravidarum
and Hydrosalpinx 54
Hay Fever 60
Hemorrhage in Pregnancy 62
Hydriatic Measures in Fe-
brile Disorders of Infan-
cy and Children 66
Hygiene of -Pregnancy and
Parturition, 67
Injuries of the Head 46
Intratympanic Surgery in
Chronic Suppurative and
Sclerotic Conditions of
the Middle Ear .50
Immediate Hermetic Seal-
ing of Wounds. Is It
Safe? Is It Advised? 56
Intubation in the Adult ... 58
Injections of Carbolic Acid
for Tetanus 61
Leprosy, 47
Localities of Continued
Fever and Prevention. . . 54
Ligation of the First Portion
of the Left Subclavian
Artery for Aneurism 60
Malarial Infection as a
Factor in Causing Eye
Disease 46
Mind in the Treatment of
Disease 62
Neurasthenia 51
Nerve Mechanism of the
Pelvis and Associated
Regions 58
Nerve Cells in Health and
Disease 61
Operations in Appendicitis 46
Operative Treatment of
Obstipation 48
Operative Treatment of the
Nose and Throat 55
Oophorectomy, 63
Pathology of Tuberculosis . 46
Philippine Observations by
an Army Surgeon 46
Puerperal Infection 47
Profuse Diarrhea Follow-
ing Laparotomy 48
Parturition Among the
Eskimos 49
Pleuritis 61
102
THE CHARLOTTE MEDICAL JOURNAL.
Physiological Common
Sense and the Drinking
of Alcohol 51
Pus Involving Pelvic Vis-
cera and Adjacent Stric-
tures 53
Pyorrhea of the Maxillary
'Sinus 54
Prognosis and Treatment
of Nephritis 59
Prevention and Treatment
of Puerperal Eclampsia. 60
Pseudo-Diphtheria 65
Stigmata of Hysteria 48
Surgical Treatment of Ute-
rine Fibroids 51
Shock Attending Parturi-
tion and Its relation to
Hemorrhage 51
Some Medico-Legal Aspect
of Railroad Injuries 65
Surgery of the Bile Passage 57
Splenic Anemia 57
Suppurative Ethmoiditis. . 60
Simulation of the Symp-
toms of Other Maladies
by those of Chronic Renal
Disease, 61
Syphilis and the Birth Rate 62
Salpingitis 64
Sudden Death in School. . . 65
Surgical Antisepsis 66
Separation of the Lower
Epiphysis of the Femur, 67
Typhoid Ostitis 45
The Early Diagnosis of Tu-
berculosis 45
Trichinosis 47
Toxic Human Milk 47
Tracheal Shock in Aneurism 47
Treatment of Eclampsia. . . 48
Tuberculosis of the Hip
Joint 49
Typho-Malarial Fever 50
Treatment of Placenta
Previa 50
Tuberculous Ankylosis of
the Hip Joint 51
Treatment of Typhoid
Fever 52
Thyroid Gland and the
Menopause 61
Treatment in Diphtheria. . 63
The Tonsillar Ring 65
The Treatment of Gunshot
Wounds of the Abdomen
with some Statistics 66
Treatment of Fractures
without Apparatus Im-
mobilization, 66
Treatment of Serous Effu-
sions 67
Urethral Stricture 48
Urethral Exploration 62
Veratrum Viride and Vi-
burnum Prunifolium. . . . 67
Miscellaneous.
Abnormal Self-Conscious-
ness in Children 68
A Diplomatic Doctor 69
American Cigarette 70
A Black List of Non-Paying
Patients, 81
A $10,000 Suit Settled for
$900 89
A New Method of General
Anesthesia 98
A Case of Misplaced Con-
fidence 99
All's Well that Ends Well, 85
Coroners' Duties — Physi-
cians' Reputations 78
Competition for the Senn
Medal 79
Competition for the Ameri-
can Medical Association
Medai 92
Death of Dr. E. R. Axtell . . 70
Death of Sir James Paget, 70
Deduction 70
Diet in Typhoid Fever. ... 71
Doctor's Ass, 71
Dr. William Osier to Medi-
cal Students 72
Don't Worry 82
Danger f I'om Samples of
Medicine 85
Diphtheria and Antitoxine 96
Epidemic in Japan 71
Emergency Call 81
Fracturps of the Femoral
Neck 78
Fee of the Doctor 68
Health Hints 75
Have your Family Physician 79
Help for Struggling Young
Physicians 8b
Horseless Vehicles for Phy-
sians 94
Harmless Disinfectants. .. . 102
Irresponsibility of Prescri-
bing Druggists 96
Longevity 71
Medical Profession in South
Africa, 77
Mr. Shivvers Tries Heroic
Treatment, 76
Mother Goose up to Date. . 79
Medical Meetings and Med-
ical Papers 81
National System of Mortal-
ity Registration 73
No More Osteopathy in
Kentucky 80
Prompt Diagnosis of Small-
pox, 73
Pathology of Lobar Pneu-
monia as a Basis for
Treatment, 74
Plague at Manila 79
Plague at Honolulu 86
Proper Food for School
Children 96
Professor Schenk Removed 96
Right of the Dead to Live, 69
Some Results of Enthusiasm 77
The Czar's Physicians, 67
The Rhyme of the Bramble
Bush in Real Life 73
Treatment of Pneumonia. . 82
Treatment of Wounds 83
Testaments and Tobacco.. 86
Use of Fats in Wasting
Disease, 88
Vapor Massage 85
Wm. A. Hammond, M.D. . . 72
Warfare and Wounds 80
Why is the Negro Black. . 84
Weather in Medicine, 94
Yellow Fever in Cuba 83
Harmless Disinfectants.
Physicians should remember, and should
so instruct the lay public, that there is no
harmless disinfectant. All chemical sub-
stances, possessing the properties that are
essential to the destruction of microscopic
life, are capable of destroying the living
cells of the human body.
Formalin is often referred to as a harmless
germicide. It is only relatively so. Less
caustic than the mercuric bichloride, and
less dangerous than sulphurous acid gas, it
16 still capable of producing death.
Recently, at a farm connected with a
state institution for feeble-minded youth, an
employe was using a four-percent, solution
of formalin for the purpose of destroying
fungi on seed potatoes. Leaving his work
for a few moments- an adult feeble-minded
person drank from one to three ounces of
the solution. Spontaneous vomiting im-
mediately followed. Albumin dissolved in
water was freely administered, and further
emesis produced by hypodermic injections
of apomorphia. The vomited matter con-
tained blood. For a time it seemed that the
means instituted to save life would be suc-
cessful, but at the end of twenty-four hours
the patient died. The autopsy showed a
part of the stomach highly inflamed, and a
part bearing very much the appearance of
old leather.
Formalin is largely used as a food pre-
servative, especially in milk and butter. Its
use is certainly deleterious.- CA/co^o Clinic,
The Charlotte Medical Journal.
CHARLOTTE, N. C, FEBR-UARY, 1900.
Vol. XVI.
No. 2.
The Safest and Host Effective of
Hypnotics.
By John Buxton Carr, M. D., Old Sparta,
North Carolina
The two essential properties in an hyp-
notic are, first, its safety, and second, its
efficacy. Having liad more experience
with trional possibly than some of the pro-
fession a few facts in regard to its action
may not be amiss. I can assert most posi-
tively that trional is safe, and am equal'y
positive of its efficacy. It will produce
bleep in a great many cases where morphia,
chloral or the bromides fail completely.
Occasionally we meet with a patient who
has a weak nervous heart, so that we are
afraid to give chloral ; another in whom
morphia is contraindicated for various
reasons, and who is weak and almost pro-
strated for want of sleep. In these cases,
if trional be employed you will find it to
act more than happily. I have often been
surprised in giving trion;<l that the heart
bears it so kindly; instead of depressing it,
it seems to give it a better tone. I have
never found trional to depress the heart. It
seems remarkable, therefore, that in a re-
cent article in Merck's Archives, Dr. H.C.
Wood, of Philadelphia, should have at-
tempted to cast discredit upon the safety of
trional, by collecting nine cases from the
literature in which poisonous symptoms are
alleged to have followed its administration.
This cannot but appear strange to an un-
biased observer, in view of the fact that
trional has now been used in thousands of
cases with perfect safety. Moreover a care-
ful investigation of these alleged cases of
trional toxemia shows that in almost all the
drug was employed in excessive doses, or
during long periods, with total disregard of
the well-known directions applicable to its
use in protracted insomnia. Professor v.
Mering, one of the foremost neurologists of
Germany, several years ago undertook a
collective investigation, both clinical and
experimental, as to the effects of trional.
In his article published in the Therapeutis-
che Monatshefte, August 1886. he quotes
the observations of Beyer, who says : "It
may be called a brilliant result that, out of
the many thousand patients in every locality
who have been treated by trional during the
past five years, toxic effects, so-called, have
been noted in only a bare half dozen, the
aspect is still further improved if we sub-
ject these six cases to a closer examina-
tion." In commenting upon this statement
Professor v. Mering says: "That Beyer's
view of the subject of poisoning by trional
is correct is supported by the fact that,
while the use of trional has increased to a
manifold extent, the number of unfavorable
experience with this hypnotic has not
risen." In another place in his article he
says: "I have not been able to recognize
any unpleasant sequelae from trional, al-
though I have used it about a thousand
times. In some cases it has been continued
for three to four months in doses of 15 to
35 grains every two to three days without
any injurious effect."
When it is remembered that the clinicians
who contributed to this collective report
include such distinugished neurologists and
alienists as Professor von Krafft-Ebing, of
Vienna, Professor Hitzig, of Halle, Profes-
sor Kahn, and Professor Van Noocden, it
must be assumed that trional, if properly
administered, is, practically speaking, a
perfectly safe hypnotic.
In this country trional as an hypnotic
has been constantly gaining ground.
Among those who recommend its use, I
would cite such well-known authors as
Weir-Mitchell, B. Sachs, R. E. Edes, II.
P. Loomis, W. B. Pritchard, R. Bellamy,
D. Inglis, and R. Ferguson.
In a recent article in Merck's Archives,
II, P. Coile, Professor of Clinical Medi-
cine, Tennessee Medical College, states,
that in his extensive experience with trion-
al he has never seen any unpleasant or
dangerous symptoms attending its use, and
believes that in reasonable doses it is free
from danger. The safety of trional is
moreover shown by its extensive use in the
sleeplessness of children, in which it has
proved a perfectly innocuous hypnotic.
As regards the appearance of hemato-
porphyrinuria after the administration of
trional, it would appear from the experi-
ments of Bakoen on animals that this con-
dition cannot be produced experimentally,
even under the use of enormous doses, (see
Drews, Die Ileilkunde, 1898). Von Mer-
ing's experiments which were undertaken
104
THE CHARLOTTE MEDICAL JOURNAL.
on a large number of animals also showed
that hematoporphyrinuria cannot be pro-
duced intentionally, nor even under condi-
tions in which the nutrition is depressed.
This author moreover believes that with the
exercise of a little caution hematoporphy-
rinuria can be surely avoided.
My experience with trional has comprised
most of the forms of insomnia in which its
use has been found indicated. From the
large numbea of cases I have observed in
my private practice, and connection with
asylum, as reported by its superintendent,
Dr. Geo. L. Kirby, I have selected only
two for the sake of illustrating the efficacy
of trional in a class of cases which are not
readily amenable to the influence of hyp-
notics.
C. B. J., aged 36, had been drinking
heavily for several weeks, and was in the
habit of letting himself down as easily as
possible with morphine. His nervous
system was thoroughly racked, and the
morphia failed to have the desired effect.
He had slept only about three hours in
seventy-two. One dose of 20 grains of
trional produced refreshing sleep, and after
repeating the dose for three nights his
nervousness completely disappeared.
J. T. D., aged 46, was sufferiug from
the effects 9f a debauch, nausea, extreme
weakness, marked nervousness and insom-
nia. Chloral seemed to increase the nerv-
ousness"; under morphia administered hypo-
dermatically he remained wakeful with eyes
wide open. I ordered trional in 20 grain
doses, to be repeated in one hour if not
asleep. The dose was repeated at the end
of the hour, the patient dropping into a
quiet sleep, which lasted about four hours.
On the following night 25 grains of the
drug were administered, and the patient
fell asleep in twenty minutes, obtaining
seven or eight hours of refreshing sleep
during the night.
I know that trional is used with much
success in the Keely Institutes throughout
the country in those obstinate and tedious
cases of morphia withdrawal. 1 mention
this fact, not that I approve of Mr. Keely
or his methods, but to show that he is not
slow to appreciate the virtue in this drug
as an hypnotic. I think that I can safely
assert that if trional will produce a quiet
and refreshing sleep in a habitue, whose
portion of morphia is being withdrawn, it
will act most satisfactorily and beautifully
in a large majority of all other cases where
an hypnotic is indicated.
I am convinced that in the above class of
cases an hypnotic is subjected to a most
searching trial, and for that reason I have
referred them. I have used trional in
fevers, malarial and typhoid, and in numer-
ous other cases wherever an hypnotic was
required and have always found it to act
most satisfactory. It is administered either
in tablets, capsules or powders. I prefer
the dissolve the dose of powder in a cupful
of milk, thereby assisting the flow of blood
from the brain to the stomach. The by-and
after-effects of trional so far as my observa-
tions go, are nil. I have frequently ad-
ministered as much as 30 grains at a dose
without any bad effect, though as a rule, 20
grains is amply sufficient.
I believe, as is claimed for trional, that
it possesses a large number of advantages
over other hypnotics, in that it exerts no
deleterious effects upon the intellectual,
respiratory, or circulatory functions, and is
free from injurious effects upon the kidneys
or_ digestive organs. Taking it all in all,
I believe that trional should head the list of
our hypnotics, for it is among the few that
can be administered for a week at a time,
and cause no habituation ; and as I have
said before, it is safe as well as effectual.
Cholelithiasis, with Clinical Reports.
By J. W. P. Smithwick, M. D., LaGrange, N. C.
This is a condition attended by the
formation of calculi within the gall-bladder.
These calculi may be small and numerous
which may be passed with no inconveni-
ence ; or they may be large and few in
number and give very marked symptoms
in their passage down the common bile
duct. The greater portion of the individual
stone is made up of cholestrin, principally,
arranged in concentric layers. Salts of
lime and magnesia, bile salts, fatty acids,
and traces of iron and copper are also
found in them. Their mode of formation
is by no means thoroughly understood, but
it is known that when bile is retained in
the gall-bladder its concentration favors the
deposition of cholestrin.
It is a well known fact that about three-
fourths of the cases of gall stones occur in
women. Sedentary occupations and over-
indulgence in eating are important etiologi-
cal factors. The subjects are often stout,
and fond of saccharine and starchy mate-
rials ; in short, the conditions which induce
the formation of uric acid favor the develop-
ment of gall-stones.
When a stone forms in the gall-bladder
and begins its passage to the duodenum, if
large, it excites violent symptoms known
as biliary colic. The attack comes on
without premonition and is accompanied
with agonizing pain in the region of the
THE CHARLOTTE MEDICAL JOURNAL.
105
liver, which radiates to the shoulder. Often
there is a chill with a rise of temperature.
There are vomiting, great depression of the
circulation, and profuse sweating. In a
certain number of cases jaundice develops,
though this is not a necessary symptom antl
only appears when the stone is passing
down the common duct. An attack may
last only a few hours, or it may be pro-
longed for several days or even weeks.
The attacks may be repeated at short inter-
vals, and finally when the stone passes an
end is put to all the symptoms at once until
the next attack. If the stone becomes im-
pacted along its course surgical interven-
tion must be resorted to or a fatal result
will ensue.
To rationally treat this condition one
must get at the cause; that is, correct the
morbid process in the economy of the body
which favor the concentration and inspis-
sation of the bile. All intestinal, especial-
ly duodenal, indigestion should be correct-
ed. The habits of the patients should be
studied and regulated. The regulation of
the diet should receive attention, and the
starchy and saccharine elements of the food
restricted.
During the attack there is nothing that
can be done but give sufficient morphia to
control the pain, and apply hot fomenta-
tions over the region of the liver. A few
whiffs of chloroform may be necessary
before the morphia has time to take effect.
The bowels should be thoroughly moved
by Calomel and soda.
It is after the attack that treatment can
do the greatest amount of good by prevent-
ing the recurrence. Acting upon the
advice of theories many physicians have
been lead to use the different salts of
sodium, especially the sulphate and phos-
phate, in doses of one or two drachms
daily. This has failed to give the desired
relief in the majority of cases in my hands.
In the course of experimental study I was
lead to try the citrate of lithia in conjunc-
tion with the phosphate of sodium, for its
laxative effect, from the relationship of
this trouble to that of the uric acids diathe-
sis, and have noted some very happy
results. At the present time I use the laxa-
tive salt of lithia — thialion — which pre-
cludes the necessity of giving the sodium
salt.
To illustrate the value of and the results
obtained by the above method I herewith
detail the histories of a few cases.
Case III. F. E., aged 63 years. I found
this man suffering all the agonies of pain
that could be induced by an attack of
biliary colic. I used the hypodermic syringe
and gave him a few whiffs of chloroform as
quickly as possible. In thirty minutes I
repeated the hypodermic injection, and in
fifteen minutes more he was perfectly easy.
I left some calomel and soda for administra-
tion. Returning the next day I found him
doing well, having passed a stone early
that morning. At that time I elicited the
following history: That he had been
troubled with these attacks for the last
twenty years, but of late they had increased
in frecjuency and severity, so much f-o tiiat
his life was a burden to him. He had tried
everything that had been recommended for
such troubles and failed to get any relief
whatever. I put him upon the laxative
salt of lithia in teaspoonful doses in half a
glass of hot water after meals and at bed
time. This treatment was kept up for
four weeks, and then the dose was taken
only at bed time. Since he began the
treatment he has enjoyed complete health,
has had no symptoms whatever of the
return of the colic, and says he feels better
than he has for several years past.
Case XIII. Mrs. A. N., aged 28, applied
for treatment. She had been raised in all
the luxuries of life, rather stout physique,
and had had three attacks of biliary colic.
At that time there was some tenderness
over the region of the gall-bladder, though
it was not enlarged. Stated that she was
a large eater and especially fond of sweets.
Was greatly troubled with constipation. I
prescribed the laxative salt of lithia in tea-
spoonful doses in half glass of hot water
after meals, and asked her to report at the
end of a week. She did so, and informed
me that she had been doing well. All the
soreness had disappeared, bowels had be-
come regulated, and said that she felt better
generally than she had in a long while
before. I advised her to keep up the treat-
ment for one week longer and then reduce
the number of doses a day to one, which
was to be taken at bed time. At present
she is doing nicely, not having felt any of
the symptoms of her former troubles since
she began the treatment.
These patients are very grateful to me
for the benefit I gave them through this