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J. A. (Joel Asaph) Allen.

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some of its derivatives, and describes the process in the following
words :

The four principal procedures in massage, " kneading," *' strok-
ing," " friction," and " percussion," are each clearly described.
The benefits of massage are to be explained by its power to restore
to a normal condition the ability of the cells to maintain endosmo-
sis and exosmosis. In conditions following sprains, we find the
cells hindered in their power to absorb nutritive and excrete use-
less materials; and by mechanically aiding the cells in the per-
formance of their functions, massage works benefit, and becomes,
therefore, a scientific mode of treatment.

Friction and stroking, with a certain amount of kneading, are
the manipulations commonly employed, and these with both hands.
Adhesions begin to form very early, and these are to be broken
up and exudations dissipated. All isolated indurations and nodules
demand especial attention, and should be entirely removed. The
writer thus describes his method of applying massage :

The treatment is properly begun at a distance from the joint, and
on the proximal side, that nearest the body — and this for two reasons :
First, in order to prepare the absorbents and lymphatics to receive the
exudates which we are about to remove from the Injured parts ; and,
secondly, to gradually accustom the sensitive tissues to pressure. It is
possible that at the first sitting it will not be practicable to treat the
injured part directly at all. It may be necessary, at first, to confine
our efforts entirely to what the Germans call preliminary massage,
which will prepare the way for the direct treatment.

If, for Instance, we are treating a sprained ankle, we begin above



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98 PBOGBESS IN MEDICAL SCIENCE.

the knee, and, encircling as much of the thigh as possible, with the full
hands, stroke upward to the pelvis. Then we start at the middle of
the thigh and knead the muscles, working slowly upward to the pelvis.
Next we subject the lower half of the thigh to the same process, still
working from below up. This is again followed by upward stroking,
considerably firmer pressure being made than at the first time. The
result of this will be that the muscular capillaries and the absorbents
of this large amount of highly vascular tissue will have been stimu-
lated to increased activity, and its capacity for receiving blood aug-
mented. Coincident with this we may be already able to observe that
the tissues about the ankle are becoiping less tense and swollen.

The point is then found nearest to the seat of injury, at which
pressure can be borne without serious pain. Stroking is started from
this point and carried up to the knee. The upper third of the leg,
including the belly of the gastrocnemius, is then kneaded, and the
stroking repeated somewhat more vigorously. It may be wise to stop
at this point for the day. A flannel or pure rubber bandage should
then be very carefully applied, and the patient instructed to keep the
foot elevated. It may be, however, that the sensitiveness will already
have been so much diminished that the patient will fct^ar gentle friction
with the thumb or the fingers about the periphery ^ the inflamed
area. If so, this may be practised with one hand while rb© other per-
forms upward stroking from the same locality. \

Fifteen minutes is sufficiently long for each seance, an# it ^s often
well to give two each day. By thus carefully observing Vnd taking
advantage of the diminishing area of sensitiveness, we shai soon find
that pressure can be tolerated over the entire injured rejjio'^' The
routine will be the same each day. i

About the third or fourth day, movements of the foot mayi ^©^gun.
At first, entirely passive, later on, acto-passive, the patient inVking the
motion while the operator resists. The movements will cTPnsist of
flexion, extension, and rotation. These will, of course, prodjuce pain
at first, but th,e patient must be encouraged to endure this as ^uch as
possible by holding out the hope of speedier recovery.

Douching with hot and cold water alternately is a valuable a^J^^^^t
in restoring tone to the relaxed vessels.

It is not too much to say that the mode of treatment above det^©<^
diminishes the time required as compared with that of fixation, in \^^
ratio of days to weeks, and that the ankyloses and contractions so ofte^
following the latter are almost entirely avoided.

The statistics of the Prussian army, on the surgeons of which a
practical acquaintance with massage is obligatory, are convincing on
this point.

If the sprain is a severe one, it will be well to put the patient on
crutches for a few days, but he should be encouraged to begin to bear



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BBBIBBRI. 99

a portion of his weight on the joint as early as possible. A flrm,
elastic bandage, evenly applied, and, later on, a woven elastic anklet/
will aid materially in preventing swelling and congestion.



^ePecfionA.

THREE SHIPS WITH BERIBERI OUTBREAKS SHOWN
TO HAVE HAD EXTENSIVE FORMATION OF CAR-
BONIC OXIDES DURING THE VOYAGE.

Bt albert 8. ASHMEAD, M. D., New York, N. Y.

In Science^ November 18, 1892, I contributed an account of the
outbreak of beriberi on board the bark H. B. Cann, from lio-ilo^
Philippine Islands, with a cargo of raw sugar. The cargo
fermented during the trip, stifling fumes filled the ship, and the
beriberi outbreak was considered the consequence of this state of
things.

In an article, which will shortly appear in the Medical NewSf
entitled luTCStigation of the Outbreak of Beriberi on board the
bark Paz, from Ceylon, with a Cargo of Graphite, I show that
from the deficient packing of 1,200 tons of graphite, the cargo
was exposed to the moist air encountered on a tropical voyage, all
but six of a crew of nineteen were stricken with beriberi.

The bark J. C. Warns, from Java and Macassar, with a
cargo of green coffee, arrived in New York, June 23, 1890. The
captain and three men had died of beriberi. The coffee had been
picked and shipped too green. Mr. Tobias, consignee of the
cargo, showed me a sample of it ; it was charred, carbonized, and
almost destroyed. The coffee had fermented. The outbreak of
beriberi on a ship from Java, where the coffee has been carbonized,
is a regular occurrence. Java coffee owes its value, in our market^
to its color ; in order to obtain this color, the captains take their
cargoes quite green, which favors a slight fermentation during the
trip. Sometimes they go too far ; the coffee is too green, and the
fermentation too violent ; in such cases there is always carboniza-
tion ; the grains stick together in great masses, and abundant
fumes (carbonic gases) fill the ship.

The iron ship Glenmorag, Captain Currie, 133 days from
Colombo, Ceylon, with 1,100 tons of graphite on board, 800 tons
of oocoanut oil, etc., arrived July 1 7 th in Neiy York. This ship



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100 SELECTIONS.

loaded in Colombo alongside the Paz (mentioned above), trav«
eled the same course, at an interval of two weeks. She lies now
at the Atlantic dock, in Brooklyn, again alongside the Paz.
She had no beriberi outbreak. From her first mate I have the foK
lowing information :

Crew, twenty-eight men ; captain's wife and two children on
board ; or all, thirty-one. She is a Scotch Glasgow boat, and the
crew is English and Scotch. Before taking this cargo, this ship
had carried from Barry Dock, near Cardiff, a cargo of coal to
Buenos Ayres, South America, and taken a ballast of sand to
Colombo, Ceylon. Before these trips she had been in the wheat
trade from Tacoma, Washington, to Havre, France. She is remark-
ably dry, and the cleanest ship one would wish to see. I went
down her hold and ezamined every part of it ; there is not a smut
nor a stain anywhere about it. The iron part is especially clean ;
no trace of incrustation of carburetted iron, which might have
indicated the action of hot, moist air on the carbon. None of the
barrels containing the graphite was broken. The packing was
ezceedingly good ; the tonnage consisted of sticks and cocoanut
hulls, so that it was impossible for the barrels to roll and break,
and thus ezpose their contents to the action of the air.

The diet bill was about the same, or even poorer than that of
the Paz. Nine casks of salted beef and seven barrels of pork
were consumed during the trip. Fresh beef (tinned) three times
a week, one-half pound to a man, and a half pound of salt meat
on the same days ; other days a full pound of salt meat a day.
One-half pound of rice for each man on Saturdays ; no vegetables^
ezcept onions, with the soup three times a week. The ship being
Scotch, oatmeal made part of its fare for two and a half months
after starting, when it ran out. No sickness whatever during the
voyage. One death by accident. The captain attributes the con^
dition of his cargo and his crew to the-change of winds and cooler
weather, which he enjoyed from the Cape of Good Hope to the
North Atlantic. His log is, indeed, very different from that of
the Paz.

In Science^ Vol. XXIL, No. 545, p. 16, Venable states :

The metallic carbides are usually formed by the action of intense
heat upon the metal in the presence of carbon. The form of this car*
bon is capable of being greatly varied. Graphite, amorphous carbon,
and many hydrocarbons may be used. The heat of the ordinary fur-
nace is sufficient to form the carbides of the metals already mentioned.



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BEBIBBBI. 101

%inc, copper, and, notably, iron. All of these carbides, under certain
tx)nditions, fifive off their carbon in the form of hydrocarbons. The
same smell can be. detected in all during^ their decomposition. In some
cases, as iron and zinc, the decomposition is caused by the action of an
acid. The carbides of the earths (0/ which graphite is one, in conjunc*
iion with iron,) decompose in most air, and more rapidly in water.

I may point, again, here to those broken barrels of the PaZ|
which exposed the carbon to the influence of tropical air.

I have examined, microscopically, the blood of four of the sof
ferers of the Pax, and obtained the following results :

Captain Geeseicke, sick since May 16th with beriberi ; 800 diame*
ters, one-twelfth of an inch oil-immersion objective ; red discs, irregru*
lar in outline, cong^regated in masses, with ragged edges, not inclined
to form rouleaux ; quite plastic ; colored streaks, or rays of pink and
red, showing the presence of biliary matter, biliverdin crystals ; black
spores, not free, but entangled in the hummocks of corpuscles. It may
be noted that the edema of this patient^ s legs only left him two days
before this examination.

Henry Oelrichs (second mate), German, 27 years old. Has been
fourteen days sick with beriberi. Examination of the blood : 500
diameters, one-eighth of an inch objective; red corpuscles, very plastic,
aggregated in hummocks. Many black spores are seen floating about,
free in motion. Fibrin in excess, light in texture, and lumpy. Blood
very thick, syrupy, and plastic. No motion, showing want of circula*
tion. Excess in the coloring matter. This same case examined with 900
diameters, one-sixteenth of an inch objective immersion lens, shows
excess of fibrine in ropes, biliary matter in great excess ; no crystalline
formations ; blood quickly oxidizes and forms a solid mass. The black
spores, above mentioned, are quickly held by the fibrin ; the red discs
are distended, bladder-shaped, and have very ragged edges. The
meniscus-shape is lacking, there being great irregularity in outline and
color, some are even square-shaped. Some discs have an excess of
color; some very pale. On the edges of the corpuscular mass the color
quickly disappears, in consequence of rapid coagulation.

Isaac Hegglund, a Swede, 27 years old, has had beriberi since
crossing the equator, six weeks ago. Legs are now very thin, but still
some soreness remains ; knee reflexes still lost. First soimd of heart
prolonged. Microscopical examination of the blood, 900 diameters,
one-sixteenth of an inch objective, shows rouleaux well formed, no
spores, no filaments, slight feverish condition shown by spiculated out-
lines of some of the red corpuscles. Fibrine is assuming a normal
form, showing meshes very regular ; no distension of red corpuscles.

Emil Jensen, a German, 19 years old, sixteen days sick with berl-
berL Black spores in active motion and very plentiful ; freely scat*



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103 SBLBCnONS.

tered in the field of observation ; circulation very torpid ; fibrine very
Irregular, light in texture ; biliary matter freely scattered ; blood disca
distended, and with ragged edges ; red corpuscles congregated in
masses : fibrine forming in heavy clots ; blood rapidly coagulating;
black spores are quickly fastening in the fibrine.

We have here, in the fourteenth day and the sixteenth day
oases, black spores in active motion and biliary matter in both
cases, and the corpuscles distended, bladder-shaped, in ragged^
edged condition ; the fibrine quickly clotting. And, in the cap*
tain's case, which was the worst of all, we have still black spores^
biliary matter, and ragged-edged corpuscles.

In the sixth week case, a much milder case, moreover, than any
of the others, it is reasonable to assume that in some way the
patient has quickly eliminated the poison. There is no biliary
matter in his blood, no black spores, no abnormal fibrine, no dis^
tension of red corpuscles ; the latter are perfectly formed in rou-
leaux.

Examination of urine of Henry Oelrichs (second mate, bark
Pax), July 17, 1893 (fourteenth day of beriberi) :

Odor, light, aromatic, and feverish.
Color, light (yellow) amber.
Reaction, excessively acid.
Appearance, transparent.
Specific gravity, 1.032+.
Weight of a fiuid ounce, 470.27 grains.
Solids in a fiuid ounce, 85.06 grains.
Nature of deposit, mucus.
Quantity of deposit, trace.
Bile, coloring matter not present.
Salts, not present.
Sugar, Fehling^s solution, trace.
Chromate solution, trace.
Ny lander' 8 solution, trace.
Sacchrimeter grammes in a liter, O.OO-f.
Albumen, nitric acid, 1 fl. ^, not present.

Picric solution, trace.

Touret's solution, trace.

Bichromate solution, not present.

Bichloride solution, trace.

Millard's solution, trace.
Polariscopic grammes in a liter, O.OO-f .

Microscopical appearances :
Pus corpuscles, trace in quantity.



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BBBIBEBI. 103

Epithelium, bladder, trace in quantity.

Qantitative examination :

Urea, proportion per fluid ounce 6.605 grains.

Percentage of 1.404

Total, quantitative examination. . . 66.050

Chlorine 960 grains.

204
9.600 grains.

Sulphuric acid 992 grains.

210
9.920 grains.

Phosphoric acid 1 .024 grains.

201
10.240 grains.

Carbonic acid gas 1.120 grains.

237
11.200 grains.

Results on a net basis :

Urea 1.40

Water .-.. 95.00

Sugar 0.00+

Foreign 2.76

Albumen 0.00+

Chlorine 20+

Sulphuric acid 21

Phosphoric acid 20

Carbonic acid gas 23



100.00
Traces of sugar and carbonic acid gas are commonly observed
in the urine of beriberi patients.

Dr. Wallace Taylor, Osaka, Japan, sends me three interesting
tables, which he made from examinations of 134 cases of beriberi.
These examinations were made with Hayem's hematometer and
Gower's hemacytometer. The average corpuscular richness for
the 134 cases is ninety-four per cent. This, he says, corresponds
to the clinical experience in cases of beriberi. Most of the cases
of beriberi seen by the general practitioners are well-fed, well-
nourished, fall-blooded appearing men. The ill-fed, poorly-nour-
ished, weak constitution cases are the exception. During the past
few years he has kept a record of the physical condition of the



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104 SKLEOTIONS.

beriberi patients, and he gives this record, together with another
record, of a beriberi hospital in Tokio :

Beriberi
Taylor. Hospital. Sum.

Of strong constitution, 323 593 916

*• average " 15 27 42

*• weak •* 9 6 15

Thus, in a total of 973 beriberi patients, there were ninety-four
per cent, of strong constitution, (a result almost identical with that
given in his tables,) and only six per cent, of average and weak
constitutions.

" These numbers," says Taylor, " are large enough to be conclu-
sive, and anemia is not one of the pathological conditions of
beriberi."

In his table No. 3 there is shown a general diminution of the
hemoglobin. The average hemoglobin in 101 cases is eighty-one
per cent. In some of these cases the amount is very low, being
below sixty-five per cent., and with but few exceptions the per
cent, of hemoglobin is below the per cent, of corpuscles, showing
a deficiency of the individual corpuscles in hemoglobin.

The appearance of biliary matters, which I have shown in my
analyses of the four cases of the bark Pax, would show by itself
a deficiency of hemoglobin.

In the Tribune M^dicale, September 10, 1891, Messrs. Bertin-
Sans, and Moitessier show that it is the presence of hydrogen and
carbonic acid in oxicarbonized blood that prevents the total
destruction of hemoglobin.

By sweeping their solution of oxicarbonized blood and water
with a current of hydrogen and carbonic acid gas, and an addition
of sulphide of ammonia, they obtained the spectrum of reduced
hemoglobin. They thus show that oxicarbonized hemoglobin
can be readily transformed into a mixture of methemoglobin and
oxide of carbon. It is, therefore, reasonable to suppose that in an
outbreak of beriberi, where we have the presence of oxides of car-
bon and a deficiency of hemoglobin (observable in all cases of
beriberi), the latter is the effect of the former.

In Japan, the universal burning of charcoal produce? the
oxides, which held down in the low places by the moist atmos-
phere of the beriberi season, there is produced on a large scale,
and continually during the moist season, what happens on board
of each of those ships which come to us from the East with car-
bonized cargoes and beriberi-sick crews. — Science, July, 1893.



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8UMMEB DISEASES. 105

SUMMER DISEASES.

The hot weather is here, and with it the beginning of bowel
troables. While the heat is a factor in the causation of some of
these troables, because of its depressing effect when long con-
tinued, yet it is only a small factor. The principal cause is the
kind of food ingested, but more particularly the quantity, quality,
and character of the food. An excessive amount taken, or when
taken green, or overripe, or stale, will act as an irritant to the mucous
membrane of the alimentary tract, or poison the blood, and thus
bring on gastric or enteric troubles.

In the treatment of these cases the physician must impress
emphatically upon the patient's mind, and that of the attendant,
that diet and hygiene are the essential factors in the cure and in
preventing the occurrence of another attack. At the time a simple
diet must be taken. Easily digestible fluids and solids, known to
agree with the patient, such *as milk, eggs, toast, etc., should be
given, and cool or hot water, as the appetite may crave — at least,
the temperature should be such as not to cause pain in the
stomach or bowels.

On general principles, the bowels should be emptied by a
cathartic which will not be drastic in its nature, such as salts of
magnesia, with a little camphorated tincture of opium, or a few
drops of the extract of hyoscyamus, after which the hyoscyamus
and a little tincture of opium, sufficient to control the pain and
irritation, should be given, and entire rest should be enjoined.
Flushing the colon, in some cases, is essential, and if there is
periodicity, a sufficient quantity of quinine should be given to
overcome the malaria. The skin should be kept clean and pro-
tected from the sudden changes from draughts of air. Thin
flannel should be worn next to the skin. With attention to the
food, skin, and hygiene, but little medication will be required, and
the mortality lessened. — Kansas Medical JoumaL



Berlin has 183 polyclinics. Lately a number of medical men
met to discuss the situation, which was regarded as militating
against the profession. A committee was appointed to study the
question and report as to the proper steps to check the encroach-
ments of the polyclinics.



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106 ABSTRACTS.



©K^AtractA.



EAR COUGH.

Too OFTBN neglect of detailed examination leads to diagnostic
errors and unsuccessfal treatment, when symptoms are directly
manifested ; and far too often does this occur when disorders at
remote points ^are manifested through the reflexes.

It is believed that the occasions are infrequent when the aurist
should be consulted for the explanation of cough. This I believe
to be true, but that there are more cases than generally observed,
I also believe to be true. During the last thirteen years of gen-
eral and special practice, I have in many cases found it quite
impossible to examine the ear without exciting a cough, the pres-
sure of the speculum alone many times causing quite a paroxysm
of coughing. I have also observed many cases where inflamma-
tion of the auditory canal has kept up an irritable cough, which
has subsided upon the proper treatment.

One very interesting case of ear cough, which I wish to report,
in order to add to the literature upon this subject, is that of Mrs.
L., a clergyman's wife, who consulted me in June, 1886, for deaf-
ness of the right ear. I observed, during the consultation, that
she suffered from a harsh rasping cough. She informed me that
she had been coughing for a year, and had consulted several phy-
sicians, each making a different diagnosis, and that at the present
time she was under the care of a gynecologist who pronounced it
of reflex uterine origin. Upon inspection, I found the auditory
canal filled with what seemed to be inspissated cerumen. I suc-
ceeded in removing the mass, which I found to be a cockroach
entirely incrusted with cerumen. Her deafness was, of course,
relieved, the cough ceased immediately, and has never returned. I
think it advisable, in all cases of intractable cough of apparent
unknown origin, to which is applied that vague and unscientific
appellation, '< irritable cough," that the auditory canal should be
examined. I have observed that most individuals suffering from
ear cough have been neurasthenics, but, as in reflex affections of
other organs, where the cause seems skeptically slight, so in this
affection we must give due attention to the reflexes of aural origin.
The exciting cause in all cases coming under my observation has
been pressure causing irritation. Opportunities for studying aural



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SPIlffAL CONCUSSION. 107

reflexes have been very limited for specialists in otology, as the
oases fall more frequently into the hands of the general practi-
tioner. The subject is not, nor will it ever be, as voluminous as
that of some other reflexes, but it is interesting and will add its
mite to the general study of reflex phenomena. — A, G. Aldrichy
M. D,y in Ophthahnic Hecordy August, 189S.



SPINAL CONCUSSION.

In bkalitt spinal concussion is a temporary condition and ordin-
arily of brief duration, lasting a few hours, or days at most.

Authors have erroneously considered under this heading many
of its consequences, such as the psychoses and secondary inflam-
mation of the cord and its membranes.

For the sake of convenience only, and in order to be in fashion,
I have included under " concussion " the primary shock as well as
the subsequent sequences after spinal injuries.

Spinal concussion, as thus considered, has no demonstrable
pathology attached to it, and all secondary inflammations should
be designated as myelitic or some variety of meningeal inflamma-
tion, and should be treated as such.

In this disease the injury is thrust upon the sympathetic sys-
tem of nerves through the perceptive centers of the brain, and not
through any inflammatory process of the cord ; so that persons
asleep or intoxicated at the time of an accident, and those whose
attention is riveted upon some grossly injured member of the
body, are always the lightest sufferers after such accidents.

In its nature, spinal concussion is a true hypochondriasis, and
is kept alive by morbid suggestions and evil forebodings from
self and others, as well as perpetuated by a lack of self-confidence
and a neglect of proper exercise, both physical and mental.

Being a disease with few if any objective symptoms, it is often



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 11 of 78)