atrum viride and morphine are also useful,
and in asthenic cases strychnine and nitro-
glycerine.
Place something between the teeth to
prevent the patient from biting her tongue.
For the bowels use croton oil followed by
an enema of turpentine, salts and glycerine
in water.
Hot air bath or wet pack to the skin.
Is Fever a Conservative Force?
This question is answered in the nega-
tive by J. W. Embree, in the Texas Medi-
cal Journal for March.
Fever means loss, waste and injury and
as such cannot be a conservative process.
There is no temperature at which the func-
tions act better than at the normal and
when elevated above this there is destruc-
tion.
The range of a fever temperature cannot
burn out the pathogenic microorganisms,
but on the contrary we find that fever is the
temperature of their most productive
growth. A sufficient degree of tempera-
ture to destroy the organism would in like
manner destroy the cells of the body. , J
He is convinced that by any means we are I
able to maintain the temperature at normal
or thereabouts without depressing the heart,
we would render our patients more com-
fortable, all the functions would carry on
their work better, the disease would be
shortened and the mortality lessened.
Hydrotherapy so far has produced the
best results, particularly in typhoid fever
and pneumonia. He is perfectly conscious
of the fact that fever is only a symptom, but
until we can treat the cause it is one of our
most important symptoms and we are forced
to treat most of our cases symptometically.
Some Points in Therapeutics of Heart
Disease.
The indications for treatment diflfer wide-
ly in the diseases of the heart, according to
W. H. Thompson in the Medical Record
for March 17th.
In the acute inflammatory states, rest is
the all important indication. When the
heart is beginning to fail in acute cardiac
inflammation, the condition will only be
aggravated by administering heart stimul-
ant. The proper treatment is leeches to
the precordium, then poultices of flax-seed
meal with extract of hamamelis and lauda-
mun poured on just as the cataplasm is
applied and then covered with oiled silk
and kept covered without a single exposure
night or day.
Aconite takes the lead of all other medi-
cines in acute inflammations of the heart.
In acute parenchymatous degeneration as
in diphtheria use alcohol to the limit,
strychnine, caffeine and above all camphor
hypodermically in sterlized oil (8 grains of
camphor to 20 of oil) as often as necessary.
Digitalis is not indicated and is dangerous
in such cases.
After severe rheumatic attacks, prolonged
rest in bed and aconite may prevent an
irremedial damage to the heart.
In myocordial degeneration after mid-
dle life, the treatment is general and
every organ in the bodp must come to the
help of the diseased heart.
In closing he emphasizes the fact that the
physician should not forget that all nervine
medicines such as digitalis, strophanthus,
nitroglycerine, strychnine, caffeine, spar-
teine, and the rest can never be other than
temporary makeshifts. All that they can
THE CHARLOTTE MEDICAL JOURNAL.
377
do is to relieve symptoms, and that only for
a while. They may be of great service in
warding off" immediate dangers, and as
adjuvants to the real remedies which act
upon nutrition ; but if a progressive degen-
erative process is going on, they are power-
less to cure it. One of the chief reasons for
ultimate failure in the treatment of many
chronic heart diseases is to be found in too
great a reliance on such drugs. Permanent
improvement is to come from other agents
and measures which restore nutrition rather
than stimulate function.
And fresh air is the first of these, iron,
mercury, the iodides and arsenic are also
useful. The iodide of sodium should be
given in preference to the potash salt.
The Static Current in Paralysis.
The electrostatic treatment of some forms
of paralysis is discussed by W. B. Snow in
the Postgraduate for March.
Except when syphilitic conditions are
present, poisoning or pressure which the
surgeon may relieve, the treatment of paral-
ysis is apt to be symptomatic. In connec-
tion with any specific treatment, attention
to the local condition is indicated as well.
He considers it an established fact that
the static current will restore nutrition and
lessen hyperemia and congestion.
Large muscles should be treated with
long sparks, and short muscles with short
sparks.
He concludes that in all cases of paralysis
the nutrition of the parts should be main-
tained by an agency that will preserve the
balance of the nutrition of exercise and the
nutrition of restoration that degeneration
may be retarded.
Such agents must be searching, potent,
aud of a character that will induce no
chemical or unfavorable alterative action of
the tissues.
Electrostatic sparks and currents, having
high voltage and infinitesimal quantity or
amperage, exercise the parts, promote met-
abolism, and thereby maintain the parts in
the best condition when systematically ap-
plied.
When the character of the lesion does not
preclude the possibility of recovery, the
early treatment will prevent degeneration,
hasten recovery, and give excellent final
results.
There is no contra-indication at any state
of a paralysis for the intelligent adminis-
tration of electrostatic treatment, because it
lessens hyperemia and congestion, relieves
nervous irritation, and tends to restore a
normal equilibrium of the system in general,
and of the parts affected.
The Treatment of Hemorrhoids.
W. A. Kickland, in the Denver Medical
Times for March, prefers the ligature.
In external piles covered by skin, the
skin is put through around the base of the
tumor which is then tied with a fine paraf-
fined silk ligature placed in the cut. The
pile is then cut off leaving only enough
stump to hold the ligature in place. In in-
ternal hemorrhoids the ligature is placed
around the mucous membrane, without the
incision, by threading it on a needle, trans-
fixing the tumor at the base and tying each
half separately and lastly together.
The bowels are moved on the fourth day.
He condemns the injection method as un-
safe, the Whitehead and American opera-
tions as too severe for the conditions pre-
sent.
The ligature he considers the easiest,
quickest, safest, and in every way the best
method.
He reports no experience with the clamp
and cautery.
Diagnosis of Urethral Diseases.
In speaking of simulated stricture, Ferd.
C. Valentine in the International Journal
of Surgery for March, makes the following
points in the differential diagnosis of stric-
ture and uretrospasm.
In exploring with the bougie-a-boule it is
arrested in the penile urethra in stricture
while in urethrospasm it is most frequently
arrested just before the membranous por-
tion. Fingers on the perineum feel the
bougie arrested ; the finger then inserted
into the rectum does not feel it but in spasm
the fingers on the perineum before the in-
ferior extremity of the pubic arch do not
feel the bougie's head but the finger then
inserted in the rectum does feel it arrested
at the membranous portion. In stricture,
bougies of decreasing calibres successively
inserted penetrate more deeply into the ure-
thra in accord with their decreasing calibre
while in urethrospasm bougies of all calibres
sink to the same depth. On withdrawing
the instrument its sharp shoulder distinctly
leaps over the obstacle giving a more or less
distinct twitch in accord with the size and
character of the stricture but in spasm the
withdrawal of the bougie conveys the sen-
sation that its head is grasped or that it pos-
ses through a species of increasing narrow-
ings and then widenings, as it traverses the
parts spasmodically contracted.
On withdrawing the bougie in stricture
we feel the distinct, firm resistance of the
hardened tissue while in spasm the sensa-
tion is that of dilating soft and supple tis-
sues.
378
THE CHARLOTTE MEDICAL JOURNAL.
The Mosquito as a Definite Host in Malaria.
The important part taken by the mosqui-
to in the causation of malaria is now estab-
lished, that is so far as certain species are
concerned. Wm. B. Burns in the Mem-
phis Medical Monthly for March, after re-
viewing the history of the relation of the
mosquito to malaria, lays down the follow-
ing rules of their destruction.
Of the whole period of the cycle of devel-
opment of mosquitoes the stage in which
they are most easily destroyed are those of
larvag and of the aerial mosquito ; and larvae
are most easily killed the younger they are.
To kill the larvs, among numerous sub-
stances experimented with, there will be, in
decreasing order, culicidal action in : (a)
Mineral : sulphurous oxide, permanganate
of potash with hydrochloric acid, common
salt, potash, ammonia, carburet of lime,
corrosive sublimate, chloride of lime, the
bisulphites, sulphate of iron, copper, lime,
bichromate of potash and sodium sulphite,
(b) Organic: powders of the unexpanded
flowers of chrysanthemum, tobacco, petro-
leum and oils, formalin, cresol, certain ana-
line colors (gallot, green malachite), coal
tar. Owing to the great cost, the vegetable
powders, petroleum and analine colors will
be those excluded.
To kill aerial mosquitoes, we have odors,
fumes and gases. Among the odors are :
turpentine, iodoform, menthol, nutmeg,
camphor, garlic ; among the fumes are to-
bacco, chrysanthemum powder, fresh leaves
of ecucalyptus, quassia wood, pyrethrum
powder; among the gases, sulphric oxide.
It is however to be noted that for these
fumes to exercise their culicidal action they
must fill or saturate the whole ambient,
otherwise they produce only apparent death,
or at most only a culicifugal action, which
sometimes in houses may be useful in pro-
tecting man from being bitten by mosqui-
toes, and preventing the latter infecting
him when they have sucked the blood of
malarious persons.
The problem of the destruction of mos-
quitoes is experimentally soluble ; but prac-
tically it will only be so when economic in-
terests desire it. In this latter sense it is
remarkable that the old larvicidal use of pe-
troleum has not become much diffused in
those places where it is very cheap. The
chrysanthemum plants might be grown on a
large scale, this making the malarial place
itself produce that substance which frees it
of the mosquitoes that infest it.
The oppportune season for killing the
larvas is the winter when they are in least
numbers in the waters, and new generations
are not born ; this also is the season for their
destruction in houses, for they come here
for a warmer abode. Their habits and
places of nesting should be studied to this
end. This may not be accomplished on a
large scale as easily as some boast ; never-
theless, after the treasures spent by nations
and individuals for preserving vines and
vegetation from the ordium, the peronospo-
ra and the phylloxera, we may hope that
something may be done for protecting the
life of man from the mosquitoes of malaria.
Pulmonary Tuberculosis.
In speaking of the treatment of this con-
dition, S. Edwin Solly, in the Internation-
al Medical Magazine for March, says that
the central fact is hygiene and while climate
is of secondary importance to hygiene and
supervision, yet when applied with intelli-
gence and knowledge, change of climate is
the most powerful therapeutic agent we
possess in the permanent arrest of the pro-
gress of phthisis. But climatology is not
taught and studied as it should be and so,
too often the doctor advises the patient to
travel that he may not die on his hands.
The forms of phthisis, in considering the
question of climatic change, are best group-
ed under the three heads of tuberculous,
catarrhal, and pneumonic, admitting, of
course, that all are tuberculous, and most
have more or less catarrh.
The tuberculous covers those cases in
whom the tuberculosis, pure and simple,
seems to overshadow the other conditions.
These have usually a marked feebleness of
resistance to infection, and generally an in-
heritance of the disease, or of the tendency
toward it. In these cases it is found quite
frequently that there is anemia and imper-
fect development of the heart and lungs.
The catarrhal group comprises those who
are subject to frequent catarrhal attacks,
and whose histories show tuberculosis fol-
lowing one of them, and in whom exacer-
bations are generally preceded by a recur-
rence of catching cold. In these, obstruc-
tions, or defects of the nose or nasopharynx
are very common, and attacks of bronchitis,
probably as a result of them, are frequent.
They have a tendency, owing to their fee-
ble leaction, more often to chronic conges-
tion than to inflammation.
The pneumonic group embraces those
cases in whom an inflammatory process has
usually preceded a tuberculous invasion, and
in whom the disease advances by leaps and
bounds following recurrent catarrhal pneu-
monias. During the intervals there is often
decided, but too usually only temporary, im-
provement. The persons of this group are
of the erethistic temperament, and especial-
THE CHARLOTTE MEDICAL JOURNAL.
379
ly subject to nervous irritability and high
temperatures.
The type, of course, may vary w^ith the
stage of the disease ; and a climate beneficial
at one period may not be at another.
Change of climate also, purely as change,
is often demanded. The tuberculous as a
rule do best in high climates w^hich are sun-
ny, but in which the air is dry and cool,
rather than warm. The catarrhal cases also
do, on the whole, best in a high climate,
where the air is also sunny and dry, but
preferably warm to cold. The pneumonic
group are better off in a climate of medium
elevation, with plenty of sunshine, moder-
ate warmth, and dryness, but not on the
excessive dryness of high plateau or the low
desert.
Injuries About the Shoulder at Birth.
Injury to the brachial plexus is by far the
most important factor according to J. S.
Stone, in the Boston Medical and Surgical
Journal, for March 15th., while direct in-
jury to the joint and bone is of only secon-
dary importance. The following points
are brought out in the paper : True conge-
nital d'slocation of the shoulder, that is de-
fective development of the scapula and
head of the humerus, is of extremely rare
occurrence. True traumatic dislocation of
the shoulder at birth or in early infancy is
of extremely rare occurrence. Obstetric
paralysis, which as has been long recog-
nized, is of Erb's type, is due to a stretch-
ing and in some cases a rupture of the two
upper roots of the brachial plexus, as is
proved by anatomical study.
Obstetrical parlysis is usually recovered
from entirely in the course of a few weeks
or a few months. If recovery does not oc-
cur within this period the prognosis is very
much more serious, although improvement
may occur even after the lapse of many
years.
After an infant's arm has been held in
the position of inward rotation for some
months the posterior part of the capsule
becomes so stretched as to permit the head
of the humerus to slip out of the glenoid
cavity posteriorly, while the anterior por-
tion of the capsule and the pectoralis major
are shortened. This backward subluxation
is always made easier by a tearing and
stretching of the posterior part of the cap-
sular ligament through the same trauma
which stretched the upper cords of the
brachial plexus.
A dislocation of this sort is easily re-
duced by measures which stretch the in-
ward rotators of the arm, but when thus re-
duced it is held in place with extreme diffi-
culty, because the cause which originally
produced the dislocation, that is, the unop-
posed action of the inward rotators, is still
present.
Any abnormality in the shape of the
head of the humerus or in the glenoid in a
case accompanied by paralysis or lack of
development of the deltoid and supra and
infra-spinatus muscles is probably secon-
dary to the paralysis, and if accompanied by
a dislocation is not to be looked upon as
primary cause of the dislocation. Lack of
bony development of a paralyzed arm may
become very marked after the lapse of
years, and this lack of bony development is
not in any way to be regarded as proof of a
congenital defect.
All early cases of obstetrical paralysis are
to be treated by sling or bandage which
will support the paralyzed muscles and pre-
vent dragging on the ligament and injured
nerves.
In cases which persist without improve-
ment there is reason to hope that surgical
intervention looking to a union of the torn
ends of the fifth and sixth cervical roots at
a point from a quarter to three-quarters of
an inch from their emergence from the ca-
nal may be of benefit.
The subluxation resulting from the paraly-
sis is to be treated by stretching or section
of the contracted muscles and ligaments,
by osteotomy, arthrodesis, or muscle trans-
fer, according to the conditions present in
each case.
Excission of the Shoulder Joint.
A case in a woman, aged 30, is reported
by A. R. Shands in the Virginia Medical
Semi-Monthly for February 23d.
At the age of five years the patient re-
ceived a severe injury in the left shoulder
which soon developed into a purulent syn-
ovitis.
After discharging for some time the
opening closed, but when between 8 and
9 years old abscesses began to form over
the axilla, shoulder and arm. These were
treated conservatively for years, during
which time many small pieces of necrotic
bone came away.
Operative measures were advised and
accepted, and seven and one-half inches of
the humerus was excised through a longi-
tudinal incision. The periosteum was dis-
sected back before sawing off the bone.
The glenoid cavity was thoroughly curet-
ted and all the diseased bone removed.
The wound was closed with draina.ge,
and healed firmly in four weeks, when it
was put up in plaster. There was little or
no shock following the operation. Hemor-
380
THE CHARLOTTE MEDICAL JOURNAL.
rhage was profuse, requiring many ligatures
and hot water freely.
The patient made a rapid and uneventful
recovery.
The tissures above the proximal end of
the humerus contracted several inches, con-
siderable bone formed from the periosteum
which was left in and this stiffened the arm
considerably, giving the patient a very use-
ful arm.
Gonorrheal Rheumatism.
A. Wang, in the Medical Dial for March,
gives the following characreristic features
of gonorrheal rheumatism which distin-
guishes it from ordinary rheumatism,
Urethral inflammation, no history of cold
or exposure.
Rarely observed in women.
Non-febrile, or less so than rheumatism.
Symptoms limited to a small number of
joints.
Less movable than simple rheumatism.
Local pain relatively moderate, but very
indolent.
Frequent tendency to hydrororthrosis.
No sweating.
Urine not modified.
Blood not furnishing a marked buffy coat,
not showing such excess of fibrin as in sim-
ple rheumatism.
Cardiac complication not so common.
Complications of special ophthalmia, in-
flammation of sheath of tendons.
Relapse when attacked by gonorrhea.
Prolapse of the Bladder and Uterus during:
Pregnancy.
A case of pregnancy in a syphilitic with
prolaqse of the bladder and uterus, is report-
ed by Thomas S. Bullock in Obstetrics for
March. He induced premature labor at the
eighth month, the fetus was dead when
born. It was a breech presentation with
the cord around the neck. The placenta
was adherent and it was necessary to
remove by hand.
The puerperium was uneventful.
Bichromate of Potash Poisoning.
A case in which a comparatively small
dose produced unmistakable toxic symptoms
in a strong, well-nourished adult is reported
by J. D. Thompson in the Regular Medical
Visitor for March.
The drug was given for atonic dyspepsia
of a very chronic type after everything else
had been tried with only temporary benefit.
The dose was one-fifth of a grain in a
dram of water. There was some nausea
shortly after taking the first dose, but not
sufficient to cause alarm. About an hour
and a half later the patient was found
nearly exhausted from continued vomiting,
part of which was streaked with blood.
Pulse feeble and rapid, marked pallor and
clammy perspiration.
Raw eggs and digitalin were used and
the next day the man was up and about.
The doctor adds in a note that the dyspepsia
was markedly improved by the ordeal.
Tetanus.
Four cases of this disease with one re-
covery are reported by T. A. Mitchell in
the Cincinnatti Lancet-Clinic for March 3d.
He concludes that, as with many fevers,
so with tetanus, it has a definite course to
run and so an important indication is to
support the patient's strength and vitality
in every possible way.
He recommends constant watching day
and night, absolute avoidance of all causes
of excitement or disturbance as drafts of
cold air, the preservance of equable temper-
ature, and as for drugs opium and chloral
hydrate.
Of all the remedies that he has used more
reliance is placed upon chloral hydrate than
any other, together with sustaining liquid
diet and open secretory functions.
Electrical Treatment of Hemorrhoids.
Two cases of hemorrhoids, treated by
galvanism, are reported by John V. Shoe-
maker in the Medical Bulletin for March.
He used the negative pole of the galvanic
battery as it increases the diameter of the
blood-vessels as well as of the rectum and
with good results.
He then considers it the best treatment
for the recession of a protruding and neces-
sarily somewhat strangulated hemorrhoidal
mass.
Hospital Treatment of Typhoid Fever.
The hospital treatment of typhoid fever
may be classed under three general plans
says Frank S. Johnson in the Medical Age
for March loth. Expectant, intestinal
antisepsis, and heat reduction.
After a careful study of the statistics of
a number of the more important hospitals
for several pears past, he concludes that un-
der expectant treatment the mortality rate
is nearly 20 per cent., varying widely how-
ever, in different epidemic or endemic con-
ditions. Under intestinal antisepsis the
mortality was reduced to two-thirds of the
natural expectancy. Under bath treatment
or bath and antiseptic treatment combined,
the mortality has been reduced to about
one-third of the natural expectancy.
THE CHARLOTTE MEDICAL JOURNAL.
381
Operation for Hernia.
Jos. C. Bloodgood reports 459 cases of
hernia in the Johns Hopkins Hospital
operated on from June 1889 to January
1899 and the report is abstracted by M. B.
Clapton in the Medical Review for March
3rd.
The typical Halstead operation consists
in a skin incision made high on the abdo-
men at an angle of 35 degrees to Poupart's
ligament.
The incision varies in length from 6 to 12
cm. This high incision avoids the region
of the pubic hairs, insuring sterililitv,
restraction dow^nwards brings the incision
directly over the inguinal canal. The
aponeurosis of the external oblique is divid-
ed in the direction of its fibers and the in-
ternal oblique at right angle to its muscular
bundles, taking care not to fray the edges.
This giues a muscle-lined wound through-
out, of prime importance in the closure.
The coverings of the sac are opened, the
sac divided at its neck and closed with fine
silk continuous suture. In certain cases
the large peripheral veins are separated and
ligated. The vas deferens is lifted from its
bed and the mesocord divided with a blunt
instrument, while the cord is transferred to
the outer side of the wound. Five buried
silver sutures, are used one above and two
below the transplanted cord.
Suture No. i, to the outer side of the
transplanted cord, includes the aponeurosis
of the external oblique and the belly of the
internal oblique muscle, just at the point of
division, and is placed after the manner
known as the "Halsted mattress suture,"
Suture No. 2, below the cord and about
I cm. from suture No. i, includes (i) the
aponeurosis of the external oblique, (2) the
divided internal oblique (upper medial por-
tion), (3) the internal oblique (below the
incision, in the lower outer flap), and (4)
Poupart's ligament; and returning includes
the same structures in reverse order.
Suture No. 3 and 4 includes the aponeuro-
sis of the external oblique and the transplant-
ed internal oblique, on the upper side of the
wound and Poupart's ligament on the lower
side ; it only occasionally being possible to