John Davis Batchelder Collection (Library of Congr.

The Atlantic medical weekly, Volumes 9-10 online

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use of diuretics and diaphoretics. Strych-
nine, digitalis, camphor and strophanthus
will be of utility in stimulating the heart
which should receive the most earnest atten-
tion. Galvanism is some instances affords
excellent results. The prompt removal of
the patient to the mountains, with fresh air,
sunshine, wholesome food and fresh water
will prove the best treatment. Dr. Dabney
thinks that our soldiers will not be likely to
contract this disease unless they fall into
Spanish prisons.

The malarias of the tropics may be divided
into two great classes — the benign (calentu-
ras) and the bad (the pernicious fevers).
The first correspond to our ordinary tertian
or quotidian type, are very mild or moder-
ately severe, and always yield promptly to
moderate doses of the sulphate of quinine
admim'stered per os, in solution or powder.
If, however, these fevers are not treated



promptly they are liable to change their type
and become pernicious. The initial chill
may be wanting but is liable to be severe, and
the liver and spleen are usuaUy enlarged.
The chill usually occurs in the daytime, sel-
dom earlier than 8 a. m. and not often after
4 p. M. The treatment should be vigorous,
beginning with a good purge, mercurial pre-
ferred, and followed by seven grains and a
half of sulphate of quinine every hour or two
until decided cinchonism occurs; usually
three doses will be sufficient. Five grains of
acetanilid or phenacetin seem to enhance
the value of the drug and add to the patient's
comfort. Usually one dose of acetanilid is^
sufficient. The patient should be kept ii>
bed, the bowels, skin and kidneys looked
after, and moderate cinchonism kept up
after the subsidence of the fever. On the
third day seven grains and a half of quinine
combined with five grains of Dover's powder
or acetanilid should be given four hours
before the chill time, and five grains of quinine
every hour afterward, until twenty-five ta
thirty grains have been given. Fifteen grains^
daily in three doses should be administered
for four or hve days and then some bitter
tonic, or iron and arsenic, for from ten days
to two weeks. In many cases less heroic
treatment will succeed but unfortunately it is^
hard to tell at the beginning of the disease
which these may be.

The pernicious form is due to infection
from the aestivo-autumnal or crescentic para-
sites which invade all organs 'of the body.
This is always accompanied by coma. When
these parasites invade the gastro-intestinalr
canal we have intestinal malaria masquerad-
ing under the guise of a vicious dysentery or
choleraic diarrhea. When the meninges and
brain swarm with them, meningitis, delusions,
hemiplegia, etc., are often found. For the
same reason we have the pneumonic, the
gastralgic, and the hemoglobinuric types.
Heroic doses of quinine should be adminis-
tered by the hypodermic needle or by Bacelli's^
intravenous method.

Malaria is insidious but daily examination.



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THE ATLANTIC MEDICAL WEEKLY.



[July i6, 1898.



of the tongues of soldiers will enable one to
predict an attack and by prompt administra-
tion of quinine to abort it. By this daily
examination over fifty per cent, of malarial
paroxysms can be aborted and by heroic
administration of the drug fully ninety-five
per cent, can be cured. Boil all water used,
avoid unnecessary turning over of the soil,
have sleeping apartments dry and beds fully
two feet from the ground, and, above all
things, do not let a soldier do guard duty at
night on an empty stomach. A cup of hot
coffee or grog should be served.

Dysentery, a disease which killed last
year in Cuba, twelve thousand soldiers
and permanently invalided as many more,
deserves a most careful consideration. It
usually comes on under the form of a most
innocent diarrhea. Suddenly large stools at
short intervals supervene, odorless and of a
grayish or yellowish color. The first stool
may be accompanied by griping but the
reverse is usually the case. In some cases
this condition lasts for days or weeks. The
patient does not quit his work but contents
himself with home remedies. In the great
majority of cases, however, the patient pre-
sents himself with every evidence of marked
debility. He complains of no particular
pains, sleeps well, no elevation of tempera-
ture, tongue at times clear but usually covered
with a thick muddy coat. The most careful
examination fails to reveal a grave symptom
yet this disease gives the highest death-rate
of all endemit tropical diseases. The first
attack is usually recovered from, with good
attention, though the recovery is always slow
and invariably interrupted by many relapses,
but should there be a second or third attack
the case is sadly different. He may sink
into a chronic and hopeless cachexia or a
fever lit up and the end hastened. In the
latter case the stools change, becoming fre-
quent and livid in color and violent cramps
occur. The tongue becomes red and pointed,
insomnia sets in, there are vomitings and
-cold sweats, the pulse thready and scarcely
perceptable— ^tVj/ fini.

Many of these cases would recover if taken



in time but soldiers hate the hospital and will
often conceal the disease for days. There-
fore, treat all cases, especially diarrhea.quickly,
actively and continuously.

This disease often lakes a gangrenous form.
You will recognize it by the nose as well as
eye. The terrible tenesmus of the first few
hours is fearful to witness, yet some of the
cases, strange as it may appear, recover.
The liver is always involved and should be
closely watched. Chills at intervals, especi-
ally at night, intermitting fever, pain in right
hypochondrium or right shoulder nearly
always denote abscess. An aspirating
needle will confirm your diagnosis, which,
when once made, leaves you no option but
evacuation. A very free opening should be
made. If the hepatitis is acute and not sup-
purative you must endeavor to cause the
subsidence of the hyperemia by the adminis-
tration of small doses of calomel, by dry cups
and by a strict milk diet for a few days. A
most valuable remedy is the nitro-hydro-
chloric baths night and morning. Take one
ounce of the undiluted acid to one or two
gallons of warm water. Place the feet in the
bath and sponge the legs, insides of the thighs
and the region of the liver for fifteen minutes.
If the bath bites too much, diminish the
quantity of acid. The treatment of acute
amoebic dysentery will vary somewhat accord-
ing to the case. Of all remedies, ipecac has
given the best results and opium the worst.
For ipecac to be effective it must be given in
the first few days before much destruction
has occurred. Powdered ipecac rapidly
loses its virtue in hot climates so use only
freshly powdered roots. A bolus containing
from thirty to sixty grains is the usual dose.
Thirty drops of laudanum should be admin-
istered half an hour before and a sinapism
applied over the epigastrium. The patient
should be kept in bed and but little fiuid
allowed while taking the ipecac. This dose
should be repeated in from four to six hours
for one or two days. One dose of from ten to
fifteen grains of the sulphate of quinine should
be given for four or five days in every case of
dysentery unless the microscope fails to detect
the Plasmodium malariae.

When the character of the stools change,
subnitrate of bismuth in fi-om fifteen to thirty-
grain doses seem to have a happy effect ; also
salol in five-grain doses. When the cases
become subacute good results are obtained
from a high enemata of nitrate of silver, thirty
grains to the quart and not less than a quart
should be given, preferably two, and shoukl
not be repeated oftener than once a day.



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Jui,v i6, 1898.]



THE ATLANTIC MEDICAL WEEKLY.



45



^ SELECTIONS and ABSTRACTS ^

FROM

CURRENT MEDICAL UTERATURE-



GLOSSITIS IN TYPHOID The cases of the occur-
FEVER. WITH REPORT rence of this complication
OF A CASE. j„ typhoid fever reported in

the literature appear to be very few, the condi-
tion itself being a comparatively rare one. In
over 700 cases of typhoid feyer treated in the
Johns Hopkins Hospital, this is the 6rst time
that this condition has been found. In the case
to be reported it is of especial interest, in that
it occurred during convalescence from the
original attack and ushered in a relapse.

There are numerous references by the older
writers to the association of glossitis with the
eruptive fevers. Thus, Kerr, writing on glos-
sitis in a Cyclopedia of Practical Medicine, pub-
lished in London, in 1833. speaks of ** tumefied
states of the tongue which occur in typhoid and
various fevers attended with an atonic condition
of the system.*' There are numerous refer-
ences to glossitis coming on during the course
of or in convalescence from acute febrile dis-
eases. Clark, in his work on the tongue says,
•' Indeed, slight attacks of intercurrent glossitis
are not infrequent in the course of eruptive
fevers.** But, neither he nor Butlin in his
•' Diseases of the Tongue,*' refers to any
instances in which it occurred with typhoid
fever. No reference to the association of the
two was to be found in any of the text-books of
medicine. Hoffman in his book on the patho-
logical conditions in typhoid fever does not
speak of it. Sorel, in his statistics of 871 cases,
does not report its occurrence, nor Freundlich,
in a statistical report of cases in Freiburg.
Renou and Gallety-Bosviel, in special articles
on the tongue and mouth in typhoid fever, do
not mention glossitis. The reports of Berg,
Jenner, and Studer, embracing the reports of
the examinations of 1984 cases, do not speak of
it Holscher, in the statistics of 2000 cases,
speaks of *• purulent infiltration *' of the tongue
in three cases, while Dopfer in 927 cases found
the same condition in two cases.

Nichols has reported a case of *• septic infec-
tion in typhoid fever,*' in which two days
before death, swelling of the right half of the
tongue was noted. The case came to autopsy,
and the tongue was found red. swollen, and



glazed in its right half. On section it showed
hemorrhages and small abscesses. Cultures
showed streptococci, staphylococci and the colon
bacillu.s. This may. perhaps, be the same con-
dition as Holscher and Dopfer have spoken of
as ** purulent infiltration ** of the tongue.

The case reported is from Dr. Osier's clinic
in the Johns Hopkins Hospital:

W. U , aged twenty-seven, white, dredger.
Admitted on November 27, 1897, with a mild
attack of typhoid fever. The previous history
was unimportant The attack was quite charac-
teristic; fever, rose spots, enlarged spleen, and
the Widal reaction all being present. The
temperature fell to normal on the sixteenth day
and he made an uninterrupted recovery. He
was discharged on December 31, 1897, on the
thirty-seventh day of his disease, and after
twenty two days of normal temperature. He
seemed perfectly well on discharge.

On January 3. 1898, the fourth day after
leaving the hospital, he was readmitted, com-
plaining of pain in the throat with soreness and
swelling of the tongue. He gave a history of
having felt well until January 2, when he had a
chill, soon followed by pain in the head and
throat. Swelling of the tongue and behind the
jaw accompanied by pain on swallowing also
came on. There was no history of the taking
of mercury or the application of any irritant.
His condition rapidly grew worse until his
admission.

On admission, — temperature 104.2**, pulse
100, face flushed, the neck full and swollen at
the angles of the jaws. The mouth presented
a striking picture. The tongue was much
swollen, protruding between the teeth and pre-
venting the closing of the mouth. There was-
a profuse constant flow o( saliva. The tongue
was red, inflamed, symmetrically enlarged,
markedly tender, and somewhat indurated as
far back as could be felt. No spot of softening
could be found. The throat could not be seen.
Swallowing was difficult. Cultures were taken
from the left half of the tongue, by Dr. Gwyn.
Bleeding followed the punctures. On the fol-
lowing day the swelling was less, and the left
half was rather smaller than the right, due,.



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46



THE ATLANTIC MEDICAL WEEKLY.



[July i6, 1898.



probably, to the bleeding following the punc-
tures. Two days later there was less swelling,
less pain, and the mouth could be closed.
Three days later the tongue was practically
normal.

The temperature, which on admission was
204.2°, fell to normal on theday after admission
and then rose gradually each day until it reached
104^ on January 7. With this he had a typica
relapse, with continued fever, rose spots, and
enlarged spleen. This lasted for about two
weeks, and was mild throughout. The tem-
perature fell to normal on the sixteenth day of
the relapse, and he was discharged well on Jan-
uary 26. The cultures from the tongue were
negative.

In this case after twenty-four days of normal
temperature the glossitis seemed to be first
symptom of the relapse. The relapse itself was
mild save for the severe onset, and as soon as
the swelling subsided the patient had no further
trouble in swallowing or distress of any kind.
The diminution of the swelling in the left half
of the tongue after the blood removed in taking
the cultures, supports the value of the treat-
ment advised in severe cases: namely, free
incisions into the substance of the tongue.
Thomas McCrae, M. D. , in Johns Hopkins Hos*
pital Bulletin,



HOSPITAL STAFFS
SHOULD BE PAID.



It is a sad fact, but none
the less a fact well recog-
nized by all of us, that the
medical profession of to-day does not as a whole
receive that respect which is due it as a learned
and philanthropic profession. It is also true that
as a consequence of this deficiency of respect
the profession finds it all but impossible as a
whole to secure the remuneration for its services
which would be in keeping with that of the
other professions, let alone the true value of the
services to the community. This lack of respect
is not often spoken of among us, and yet each
one of us sees more or less evidence of it every
day. There is no need to specify the ways in
which thi«» is shown, as we all know them but
too well. The cause and the remedy are the
matters of importance. One great cause, if not
the chief one, is, we believe, the lack ot respect
the profession shows for itself in bartering away
its services for little or nothing and in submit-
ting to freely presenting our knowledge to vast
numbers of people. As an abstract humanita-
rian principle it is right for us to succor the sick
poor without price, but as a sociologic act it is
a grave question if our doing so is not a serious



factor in promoting poverty, shiftlessness and
weak dependence, as well as a great damage to
ourselves. It is wholly and absolutely wrong
and immoral, and should be considered unpro-
fessional conduct, for any physician to give his
services free of all charge to any hospital, dis-
pensary or other corporation organized for the
care of the sick and injured. If one of us
chooses to give his services freely to a sick indi-
vidual, all well and good, but it is a curious and
sinful distinction that has arisen in our insti-
tutional work where nurses, superintendents,
attendants and all other employees, except the
physicians, whose work is the most important
and essential, are paid for their labor. Charita-
ble organizations should pay their physicians
just as they do their nurses or their gardeners.
There is no justification whatever for the pre-
sent method of conducting these institutions.
If the physicians attached to these institutions
were paid as they should be we would hear no
more of the superabundance of hospitals and
dispensaries. Herein lies the true remedy for
the ''dispensary evil, '* which is being fought
so hard now in the eastern cities. Here also
is the only remedy for the lack of respect shown
the profession. How can a sensible and hard-
headed public be expected to regard as rational
beings men who deliberately throw away their
best services, not for the sick poor, mind you,
for we can do all that in our offices, but for
some corporation organized to care for the sick
in the easiest and approved fashion — a corpora-
tion which expects to pay good wages to all its
employees except those whose services are abso-
lutely essential, its physicians. And why does
not the corporation expect to pay its physicians?
Simply because we are fools enough to think
we can increase our private practice by borrow-
ing something from the luster of the institution
to which we are attached. It is purest mock-
heroics to say we do it for charity, because it is
not true and because charity is far better done
in another way. Yet the nurse is said to give
her life, or some years of it, to "charity, " but
she gets her week's wages, as does the clergy-
man whose whole time is thus taken up. Charity
organizations can just as well raise money to
pay their physicians as to pay their nurses, and
if this resulted in fewer such org^anizations
neither the profession nor the deserving poor
would be the losers thereby. Until the medical
profession grasps this fact, which should be self-
evident and not even need stating to be accepted
as true, just so long will the public look upon
us, and more correctly than should be. as a set



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THE ATLANTIC MEDICAL WEEKLY.



47



of harmless idiots of some use to the sick but
whose opinions are to be received with a raising
of the eyebrows and a compassionate aside. In
our own hand lies wholly our attaining that
respect which all acknowled ^e is due our calling,
and the abatement of the overabundance of hos-
pitals and dispensaries, which increase the
number of paupers and render more helpless
those already such, which sap the vitality and
self-respect of the profession, which cause nine-
tenths of intraprofessional strife and '* politics, *'
which detract from the dignity of the profession,
and which rob the old as well as the young
physician of the cases and remuneration that
are his by right An awakening is at handi
and the present generation of physicians will
live to see steps taken to at least initiate the
correction of these evils. — Editorial in Cleveland
/oumai of Medicine.




We take pleasure in calling the attention of
our readers to tlie advertisement of the solu-
tion iron and manganese peptouate (Wyeth).
"This combination has proved to be an invalu-
able agent in building up debilitated anaemic
•conditions. As a blood maker, tonic, and
general roborant, we know of no preparation
that has proved so generally and unexcep-
tionally efficacious.

Dr. Frank Billings has accepted the position
of Professor of Medicine and Clinical Medicine
in the Rush Medical College of Chicago, the
affiliated Medical College of Chicago University.



Mistress: Why do you bring back that pre-
scription instead of the medicine ?

Maid: Because I couldn't read it and didn't
know what to ask for. — Fliegende Blaeiter,



The medical examining boards at Washington
have played havoc with the crack regiments of
the National guard throughout the states.
Many regiments were made up almost entirely
of athletes and great was the astonishment
when the examining surgeons culled out
champion boxers, champion foot -ball players,
and men apparently the most robust of any
presenting themselves for muster. — Phil, Med,
Jour.

Buxbaum (Carlsbad) recommends the use of
photography in searching for gall stones. The
patient is placed upon his face with the photo-



graphic plate under the abdomen and the tube
just over him. In this way clear- cut pictures
of the gall stones in the gall bladder may be
obtained. The possibility of making these dis-
coveries is of great value in medicine and opens
up another field of usefulness for the X-rays. —
Revue Mid. de Therapeut.

The United States Supreme Court, April 18,
iSgS, affirmed the constitutionality of the act
of the New York Legislature of 1895 prohibit-
ing persons who have been convicted of and
punished for a crime from practicing medicine
in the state, the opinion being delivered by
Justice Brewer. The question arose in the case
of a man named Walker, who had served ten
years in a penitentiary for an offense committed
in 1878, and after his release set up as a physi-
cian. The court held that it was within the police
power of the state to enact such a law. Justice
Harlan delivered a dissenting opinion, saying
the law in effect added to the man's punishment
and was ex-post faclo.^ Buffalo Med. Jour.



The right of a clergyman ( Texas Medical
News) to attempt to heal by prayer and the lay-
ing on of hands has been questioned in New
Orleans, where a Catholic priest has been
prosecuted for a violence of the State medical-
practice law and of a city ordinance relative to
clairvoyantSf unlicensed practitioners, and the
like. The clergyman, while willing to pray
over those who desired his services, did not pre-
tend to be able to cure disease and did not
demand any payment for his services, although
accepting such small sums as his callers choose
to give him. The charge of violating the state
law was dismissed but a fine of twenty-five
dollars was imposed for violation of the city
ordinance. — Buffalo Med. four.



By the will of the late Caroline Croft, daugh-
ter of the late Gardner Brewer, of Boston, the
sum of |ioo,ooo is devised to be expended
under the direction of Drs. Henry K. Oliver
and John Collins Warren to encourage the dis-
covery of some method of curing carcinoma,
pulmonary tuberculosis and other diseases that
are now regarded as relatively incurable. At
the death of the physicians mentioned, the
money reverts to Harvard Medical College to
prosecute the work. If the university refuse to
accept the charge the bequest is to go to the
Massachusetts General Hospital, for the erec-
tion of a ward for cases of carcinoma, in which
a fair and impartial irial shall be given of any
remedy which it may be thought will influence
the disease favorably. — Phil. ^'led. Jour.



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THE ATLANTIC MEDICAL WEEKLY.



[July i6, 189S.



In examining the shoulder for injuries the
following method of procedure should be
employed: Stand behind the patient and
examine the two shoulders consecutively— one
with each hand. Starting at the interclavicular
notch, pass the fingers out along the clavicle to
the acromial process, and then draw the hands
backward along the spine of the scapula. Now
have the patient put his hands high against his
back, and follow down the inner edge of the
scapula and around its angle, which will be
prominent. Next grasp the shoulder, placing
the thumb on the acromial process and the fin-
ger on the coracoid. The head of the humerus
should be between them. Place the finger in
the axilla with the thumb on the acromion and
have the arm moved in diflFerent directions. —
Dunglison's College and Clinical Record.



M. Boucheron {Tribune Midicaie, May 4th)
refers to Landouzy*s opinion that true asth-
matics not infrequently have an element of
tuberculosis, slight, indeed, but positive; and
states that if this opinion is well founded, there
is reason to think that other toxines may also
promote the asthmatic symptom-complex, and
especially the streptococcus toxin. Hence an
explanation of the cure of asthma in certain
cases by anti-streptococcus serum. The search
for streptococcus rhinitis is suggested as a conse-
quence of the results obtained by M. Boucheron
in a case of asthma where he used the anti-
streptococcus serum on that account. — Ex,



Mathews declares that pruritus ani is the
most intractable of all the diseases of the anus
or rectum. A permanent cure can be secured
only by the removal of the exciting cause or
causes. Among the local causes, the Maryland
Medical Journal mentions pediculi, eczema,
erythema (in fat people), thread worms, lack of
cleanliness, hemorrhoids, fissures and eczema
marginatum— the last being readily cured by
rubbing well into the parts night and morning
for a week or so an ointment containing from
ten to thirty grains of chrysophanic acid to the
ounce of vaseline. Among reflex or constitu-
tional causes are stone in the bladder, chronic
inflammation of the deep urethra, urethral
stricture, pelvic tumors, uterine derangements,



Online LibraryJohn Davis Batchelder Collection (Library of CongrThe Atlantic medical weekly, Volumes 9-10 → online text (page 83 of 117)