Karl Gottlieb Cramer.

Alabama medical and surgical age online

. (page 37 of 48)
Online LibraryKarl Gottlieb CramerAlabama medical and surgical age → online text (page 37 of 48)
Font size
QR-code for this ebook


izer of the circulation); and, 6th, parasiticide.

It is the great antiperiodic in malarial diseases. The
reason of this, some believe to be its destructive power
to the malarial germ, which they consider to be the
cause of all malarial disease. This theory is very plausi-
ble ; but, whatever its methodus medendi^ whether it
destroys malaria by killing the germ, either by means
of its antiseptic properties as it circulates in the blood,
or by means of its effect through the nervous system ;
or whether it counteracts the poison in some other way;
clinical facts have proven it to be the greatest of all
remedies in the prevention and cure of malarial diseases,
intermittent and remittent fevers, and all diseases of
malarial origin, characterized by periodicity.

The effects of quinine are perhaps most strikingly
displayed in the treatment of intermittent fever, the
non-pernicious and uncomplicated forms of which it
rarely, if ever, fails to control, The mode of using



Digitized by



Google



516 The Alabama Medical and Surgical Age.

quinine for the cure of intermittents has been by one
author given as follows : **The antipyretic is nearly
equally effective, whether administered in the interval
or during the seizure. If time is an element of import-
ance, no delay is necessary in order to give the remedy
in the stage of apyrexia. To save the suffering and
exhaustion of the febrile movement, the attack should
be anticipated and, if possible, prevented. As the max-
imum effect of the quinine is attained in about five hours
after being taken, it should be administered this period
of time at least before the expected paroxysm. As the
elimination of quinine takes place with considerable
rapidity, the maximum curative effect is obtained by the
administration of the whole amount required in a single
dose, rather than by a succession of small doses."

Cathartics, calomel, blue mass, etc., may be given be-
fore the quinine ; but it is not necessary to wait for pre-
paratory treatment, as it has been proven indisputably
that, given during the paroxysm in depressant doses, no
preparatory treatment having been used, the paroxysm
has been shortened, and the disease checked. After
the paroxysm has passed, the object should be to pre-
vent another. Perhaps the best method to accomplish
this is to give 5 grs. during the sweating stage, and re-
peat every three or four hours till cinchoni^m, as indi-
cated by tinnitus auriutn, is produced. Some prefer to
give 10 grs. in the sweating stage, and the same quan-
tity five hours before the time of the next paroxysm.
The antiperiodic property of quinine is increased, and
the cerebral effects of large doses diminished, by com-
bination with morphine. To get the effects of the quin-



Digitized by



Google



driginat Communications. 517

ine quickly, it should be given on an empty stomach and
in solution. If the stomach rejects it, it may be given
hypodermatically or by enema.

The septenary recurrence of the paroxysm should be
anticipated by giving 10 to 15 grs. of quinine, mean-
while giving attention to the organs damaged by the
malarial infection. In the treatment of remittent fever,
some use first emetics, purgatives, baths, etc., to secure
a distinct remission for the administration of quinine.
Others give it in large doses at once without waiting for
a remission, depending on its apyretic effect. The lat-
ter plan is doubtless the becter. Give 20 to 30 grs. in
single dose once or twice a day till the temperature is
reduced to normal.

In the pernicious or congestive forms of intermittent
and remittent fevers, the early administration of large
doses of quinine, in combination with stimulants, is im-
peratively demanded. Here it may be necessary to use
hypodermic injections of sulph. quinine. Quinine is to
be used in all the periodical affections of malarial origin.
In all the neuralgic disorders of the nervous system,
caused by malaria, quinine is beneficial, as tic doulou-
reux, cephalalgia, cervico-brachial, etc. Also, epilepsy,
chorea, asthma and summer catarrh, when produced by
malarial influences. Also, diarrhoea, dysentery and
jaundice, when they are due to the same cause. The
three months colic in infants, that comes on in the even-
ing, is frequently caused by malaria, and hence is re-
lieved by quinine. Some regard quinine as hurtful in
malarial hematuria ; others, and a majority, regard it
as beneficial. As a prophylactic against malarial fevers
it is very efficacious.



Digitized by



Google



518 The Alabama Medical and Surgical Age.

The preparations of cinchona stimulate the gastric
juice, and are much used as stomachic tonics. In atonic
dyspepsia they promote the flow of gastric juice. In
gastric catarrh, and particularly that of drunkards,
they are useful in combination with the mineral acids.

Quinine is a most valuable reconstituent tonic in cases
of debility. In moderate doses it promotes constructive
metamorphosis. This is due, perhaps, to its stimulant
effect on the digestive function, and the retardation of
the combustive process. To produce this, it is best to
be given with iron and arsenic. As a stimulant in
shocks it is inferior to alcohol, but more lasting in
effect. Hence, it is of greatest utility in shocks after
grave surgical operations.

The depressant or antipyretic power of quinine ren-
ders it very valuable in conditions of pyrexia. In such
states it is best given in large dose, repeated when
necessary.

It has been used in typhoid fever ; but it should be
administered only in tonic doses in this disease, as it
tends to increase the intestinal inflammation.

It is useful to arrest inflammation in its formative
stages, as it retards the migration of white corpuscles.
Given at proper time, a commencing fibrinous pneu-
monia, or a pleuritis, may be suppressed by a full dose
of 20 to 40 grs. It is useful to abort a common cold.
In these cases it should be given in combination with
morphine.

In septicaemia, pyaemia, erysipelas, and puerperal
fever, large doses — 15 to 20 grs. every four hours — are
beneficial.



Digitized by



Google



Selected Articles. 519

Selected) articles*



" A MEDICAL STUDY OF THE JURY SYSTEM."
Dr. Crothers, of the Popular Science Monthly y says:
The uncertainty of jurors, and the capricious, whim-
sical character of their verdicts, are accepted as inevita-
ble, and explained as part of the natural weakness of
the mind. It is assumed that, if the facts are clearly
presented, a jury will give a common sense verdict,
which will approximate the truth and human justice.
Where they fail, it is due to the confusion of testimony,
the misrepresentation of counsel, and the general per-
version of facts. Many thoughtful men consider the
judgmennt of twelve men, who are disinterested, su-
perior and, on general matters of dispute, of far more
reliable character than the judgment of one trained
man. Yet literally, the verdicts of twelve men, based
on the same set of facts, differ widely, and can never be
anticipated ; and, whether wise or unwise, are clearly
due to other influences than the commonly supposed con-
flict of facts and motives of truth and justice.

While it would be difficult to doubt the motive and
intent of the average juror to be just and fair in his
conclusions, it would seem that certain conditions and
surroundings make it impossible in most cases to either
understand the case in question or the principles of
equity involved. From a medical and scientific point of
view, the average twelve men who are appealed to by
the counsel and judge to wisely determine the issue of a
case are usually incompetent naturally, and are general-



Digitized by



Google



Alabama Medical and Surgical Age.

n the worst possible conditions and surround-
!rcise even average common sense in any dis-

sd trial at Hartford, Conn., out of a panel of
>, twelve men were finally selected, after a
:hing inquiry. Five of them were farmers,
id hard every day in the open air, men who
customed to think or reason, except in a nar-
ilong their surroundings and line of work.
1 all swore that they had not read any details
i, although it occupied a large share of public
and had been discussed freely in all the papers.
I muscle workers, with but little mental exer-
f oh coarse, healthful food, and sleeping from
ing to early morning. Of the rest of the jury,
jlacksmith and two were mechanics, all steady
one was a horse trader, one a groceryman,
ed farmer and trader, and the last man was
bad man who had no business. Every one of
vas accustomed to be in the open air, and had
etails of the case, although he had heard it
r. Not one of these men would have been
take charge of any trust, or to decide on any
:side of his every-day life — simply because, on
inciples and from common sense observation,
lave been considered clearly incompetent. For
liis jury was confined from five to six hours a
ing to the testimony of the mental capacity
ss of the maker of a will that was disputed.
, they disagreed ; arid had they reached a
, verdict, -its wisdom and justice would have
Ltter of accident.



Digitized by



Google



Selections. 521

In a noted murder trial at Portland, Me., it was evi-
dent that the jury had been impressed favorably to the
prisoner. The prosecuting attorney suggested to the
sheriff that he invite the jury to church Sunday evening
to hear a noted preacher. The topic of the clergyman
vi^as *' God's Hatred of Sin, and Divine Judgment."
The attorney knew the topic and the intense dogmatism
of the preacher, and calculated its effect on the jury. A
verdict of conviction followed, due almost entirely to
the sermon. The personal characteristics of the jury
are often the only doors through which they can be in-
fluenced. Religious, political, and social or personal
prejudices are often considered by counsel in the pre-
sentation of the evidence. In reality, the average jury-
man becomes more incapacitated to rise above his pre-
judices, or to reason impartially, every day he is con-
fined to the court room. At the end of a long trial he
is utterly unable to form any new views, and nothing
remains but his old prejudices, and these are often more
fixed than ever.

The following record of a juryman's experience was
made by a carpenter of more than average intelligence.
He put down each night his impressions : The first day
he was impressed with the magnitude of the case and
the sadness of the prisoner He did not sleej) the first
night, for the reason that four men occupied one room.
The air was bad, and two men snored loudly. The sec-
ond day he tried to remember all that the witnesses
said, and its bearing on the case, and at night was very
weary and went to bed early, but was wakened and dis-
turbed by the other jurors. The third day his head



Digitized by



Google



522 The Alabama Medical and Surgicat. Age.

ached, and he could with difficulty follow the testimony
His appetite was poor, and he was drowsy. The fourtl
day he was antonished to hear opposing evidence; state
ments which had been made by apparently honest mei
were affirmed to be false. He was shocked, and his firs
impressions and personal interest were disturbed. Hii
head ached, and he felt weak and nervous ; his appetit
and sleep were broken. The fifth day he gave up al
efforts to follow the testimony, or to understand wha
was said. He felt stupid and excessively tired. Th
other jurors began to complain of the food and the sleep
ing rooms, and had several quarrels with each other oi
religious and political matters. Foolish stories wen
told, and card-playing and personal boasting filled u]
the evenings. They all manifested disgust at the trial
and longed for the end, and declared they would nevei
be caught in a similar case. On the sixth day the cas^
was closed. The arguments of attorneys and the judged
charge seemed very dull and wearisome. He felt sick
looked forward to a release, and his interest in the casi
had died out. He could not understand why so mucl
was said that was contradictory, and why the judg<
should not tell them the real facts of the case. In th<
jury room no discussion took place ; each one votec
** guilty" or *' not guilty,'' and when they found th(
majority was ** guilty," most of them followed th<
majority. Two of the minority became angry, and re
fused to vote for over a day, except in favor of th(
prisoner. They gave no reasons for their belief, onli
saying that they were right and the rest of the jur]
were wrong. Finally, one of these men was accused o:
having some personal object in voting for the prisoner
and after a short altercation he changed, and the othei
man followed him, and the verdict * guilty" wasagreec
upon. — Med. & Surg. Reporter.



Digitized by



Google



Selections. 523

Selections.



The Dangers of Antitoxin.— What seems to
us the strongest argument yet brought against the em-
ployment of antitoxin as a specific for diphtheria, is
conveyed as follows in a recent communication to the
Medical Journal^ by Dr. Samuel Treat Armstrong :

Those that heard Dr. Winters' very comprehensive
criticism of the value of antitoxin serum in diphtheria,
at the meeting of the Academy of Medicine on the 4th
inst., cannot but feel that an important factor has been
overlooked in the consideration of the treatment with
this substance ; and that factor is the globulicidal power
of alien serum on the blood of an animal into which it
is injected.

In a monograph on Transfusion of the Blood, pub-
lished in 1875, L. Landois reported that the serum of
the dog, the horse or the rabbit, dissolved the red glo-
bules of other animals with great rapidity. And in
the last edition of Professor Stirling's translation of
Ladois^ Physiology, there is the statement that, if the
serum of one animal is transfused into an animal of
another species, the blood corpuscles of the recipient
are dissolved, and if there is a general dissolution of
the corpuscles death may occur.

Dr. G. Daremberg {Arch, de Med. i^;^/., 1892) stated
that his experiments showed that, while the serum of
an animal of one species did not destroy the red corpus-
cles of an animal of another species. If warmed to from
122^ to 140° F., or exposed to the light for several days,
the serum lost this globulicidal power.

G. Haymen, in his monograph on the blood, states
that the serum of the ox more or less profoundly changes
the blood of the dog, producing in it small emboli that



Digitized by



Google



524 The Alabama Medical and Surgical Age.

may involve the functions of organs, or even life itself.
Microscopically, these emboli consist of degenerated
elements of the blood, the hemotoblasts and the red and
white corpuscles being altered by the serum. He spe-
cifically states that horse's serum produces phenomena
similar to those caused by ox's serum. He further states
that the urine is habitually suppressed and the kidneys
are congested.

The tendency of alien serum to produce emboli has
also been noted by C. Lazet {La France Med. 1891),
who found that if the serum of a dog was mixed with
the blood of a man, or vice versa, there were produced
more or less pronounced alterations, and solid concre-
tions were formed from the metamorphosed elements.

The author believes that it was this tendency of alien
serum to form emboli, that caused the death of the
seventeen year old girl in Brooklyn. And this toxic
influence of serum per se explains all the unusual and
untoward phenomena that have been reported in diph-
theria patients treated by antitoxin serum. The post-
mortem lesions found in the five year old child, whose
clinical history is reported in the British Medical
Journal for March 30th, correspond throughout with
those observed by Haymen in dogs that died from the
effects of alien serum injections, though the animals
were given forty times as much serum as the human
being.

Bmpircism that has bacfteriology as its sole founda-
tion is as condemnable as any other form of that cult,
and as prognosis is not yet a lost art, it seems absurd
that the medical profession should accept the dictum
that all persons whose nasal or faucial secretions con-
tain the Klebs-Loeffler bacilli, should be injected with
antitoxin serum. There are many recorded instances in
which the bacilli have been found in the secretions of



Digitized by



Google



Selections. 525^

healthy individuals, and there are some recorded in-
stances in which these bacilli have not been found in
patients who clinically presented the phenomena of the
disease, even to the secondary paralysis.

While antitoxin serum probably has a field of useful-
ness, it is evident that nice discrimination is necessary
to designate wherein it lies. — Med. Times.



A Simple Expedient for the Treatment of
Nocturnal Enuresis.— Stumpf, in the Munchener
Med. Wochenschrift for June 11th, gives an account
of a simple and apparently rational expedient, which he
has successfully adopted in the treatment of nocturnal
enuresis, especially in older children. He was led to
try it on the basis of the fact, that the passage of even
a few drops of urine through the sphincter vesicae ex-
cites the action of the detrusor to such an extent that
the call to urinate becomes almost imperative. It is
well known how difficult it is to restrain the act of
urination after even a small amount of urine has passed
the sphincter vesicae and entered the urethra. . His
theory is, that during sleep the sphincter of the bladder
is apt to become relaxed, so that, as the child lies hori-
zontally in bed, a little urine passes the spincter and
enters the deep urethra. The irritation of this urine
causes at once strong reflex action of the detrusor, and
the bladder at once empties in a full, strong stream. It
is a well-known fact, that in nocturnal enuresis in chil-
dren, the urine does not leak away gradually, but the
bladder is emptied at once, a point which is in support
of this theory.

In order to prevent the passage of the urine into the
urethra when the sphincter becomes relaxed during
sleep, a simple expedient is adopted, namely, the eleva-
tion of the pelvis, so that an accumulation of urine of
3



Digitized by



Google



526 The Alabama Medical and Surgical Age.

ordinary amount in the bladder will gravitate back and
distend the fundus, and not press against and tend to
pass the sphincter. The elevation is secured by allow-
ing the child only a single, small, flat pillow under the
head, and placing- one or two ordinary pillows under the
thighs so that they lie at an angle of 130° to 150° with
the horizontal spine.

This simple expedient was entirely successful in cur-
ing two inveterate cases, one of a boy of nine years, and
one of a girl fifteen years old. It was then tried in
twelve cases, and was uniformly successful. It was
usually necessary to continue the treatment for three
weeks, after which time the children were able to re-
turn to their former sleeping position without re-
lapsing.

The writer has found it unnecessary to have recourse
to the time-honored measures of limiting the amount of
liquids, frequent waking up during the night, etc. The
chief difficulty about the treatment is to see that the
children maintain the position throughout the night.
Small children, particularly, are apt to wriggle and toss
about, and have to be watched, put back in positioo, etc.
The method is therefore especially adapted to older
children, in whom the position can more easily be main-
tained.

This method is certainly so simple, and apparently so
reasonable, as to merit extended trial, especially as the
time-honored methods of treating this pernicious habit
are in so many cases unsuccessful.

It will be rather interesting if the elevation of the
pelvis, which Trendelenburg introduced into abdominal
surgery, and which has so extended and facilitated work
in that field, should also prove of service in preventing
children from wetting the bed. — Boston Med. & Surg,
Journal,



Digitized by



Google



S>et.eddon$. 527

A Case of Hepatic Colic Cured by the Inges-
tion of Olive Oil. — Gubb writes a note in the Brit-
ish Medical Journal for April 20, 1895, in which he
points out that a great deal of scepticism has been felt
and expressed in regard to the benefit alleged to have
been derived from the ingestion of tolerably large quan-
tities of olive oil in the treatment of hepatic colic. The
fact that the oil, during its passage through the intes-
tines, undergoes changes therein, and is voided in masses
which bear a striking superficial resemblance to gall-
stones, has on various occasions been used as an argu-
ment against the oil having had any share in procuring
the expulsion of genuine gall-stones. A case which
recently came under the writer's observation seems,
however, to show that benefit can be, and is, derived
from this treatment, whatever may be its modus ope-
randi.

The patient was a gentleman, aged forty-six, who
had a first attack of trouble in the region of the gall-
bladder in June, 1890. It began with sharp pain associ-
ated with sickness, relieved only by repeated hypoder-
mic injections of morphine. The pain recurred in
paroxysms for a week, during which period he remained
in bed. There was no jaundice, but the motions were
markedly light in color. No search was made for a
gall-stone. A week later the symptoms recurred along
with the vomiting, and this time he was systematically
purged by means of mineral waters, turpentine stupes
and poultices being applied freely to the painful region;
and the diet carefully regulated. No relief from the
pain resulting, except by the aid of morphine, he was
ordered hot baths every night for a quarter of an hour,
and told to wear a piece of spongiopline over the liver.
The symptoms having partially subsided, he was sent
to the Bngadine, with directions to take plenty of exer-



Digitized by



Google



528 The Alabama Medical and Surgical Age.

cise, and in six weeks he returned free from trouble.
He remained free from pain until November, 1893, when
the old symptoms returned, associated with intense
jaundice. This condition persisted, at first with inter-
vals of comfort for three weeks, until February, 1894.
The intervals gradually became shorter, until at last he
was never free from pain for more than thirty or forty
hours at a stretch. Needless to say, that during this
period the diet was carefully regulated, but without any
effect either on the pain or the jaundice. On one occa-
sion he tried the experiment of abstaining from food
altogether for three days, but he felt worse after than
before. The patient's condition was rapidly becoming
one of some gravity, for he had lost nearly three stone
in weight, and was practically incapacitated from at-
tending to business. The gall-bladder was greatly dis-
tended and tender, and hard bodies could be felt on pal-
pation. He was gradually becoming reconciled to the
prospect of surgical interference as the only means of
overcoming his trouble, when the author suggested the
olive-oil treatment, without, however, any belief in its
efficiency. The patient gladly agreed to try it as a last
resort before having recourse to a surgeon, and towards
the end of February he began treatment, taking 5 grains
of calomel at night, followed by 8 fluid ounces of pure
olive oil in the morning. He experienced no difficulty
in swallowing the oil, which never provoked nausea,
still less actual sickness. After the very first dose the
pain ceased, and the motions became darker, evidently
containing bile. In the course of two or three days
they resumed their natural appearance. At the same
time the urine, from a dark brown, became quite light
in color.

It is now a year since he began the treatment, and
eleven months since he discontinued it, and he has never



Digitized by



Google



SeteciionL 529

had the slightest return of the symptoms, in spite of
the fact that he has long since abandoned all restric-
tions as to diet, though on the writer's advice he became
an enthusiastic cyclist, and, weather permitting, takes
daily exercise. No stone was ever detected in the
faeces, though for a time, at any rate, the patient made
diligent search, which was rendered very tedious by the
presence in the motions of concretions of cheesy consist-
ence, evidently due to the partial saponification of the
oil. Nothing can at present be felt in the region of the
gall-bladder, and the patient is in every respect in the



Online LibraryKarl Gottlieb CramerAlabama medical and surgical age → online text (page 37 of 48)