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Southern medicine and surgery [serial] (Volume 105 (1943)) online

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expect the immobilization of limbs swathed in soft
and compressible cotton by a rigid bandage outside
the cotton. Supposing fixation to be efficient at
first, it is soon destroyed by subsidence of swelling,
and later, by tissue atrophy that always takes place
in an idle limb.

c. It is destructive of the functions of injured
joints by preventing the timely application of pas-
sive motion to them.

d. Plaster dressing prevents the surgeon's ready
inspection of the parts treated — a condition not
tolerated in any ordinary wound, and which, for as
grave reasons, should not be tolerated in fracture
cases.

//. — Wood-fibre Splinting

The material is made in large sheets, of two
thicknesses, to serve all kinds of splinting. A splint
can be made by cutting a suitably shaped splint
blank from a sheet of the material, moistening it
with water, and bandaging the moistened splint
form over the part to be splinted.

The shape of the splint blank varies with the
case treated. The correct shape for the blank is
readily gotten by cutting a paper pattern so as to
enfold the parts in the manner we wish the com-
pleted splint to enfold them, and then, following
this pattern, cutting the splint from a sheet of the
splint material. The splint, having been made and
applied correctly, will hold the parts to which it be
applied in fixation, from the moment of its reten-
tion by a roller bandage. It should be let dry upon
the limb, and after twelve hours, the author's prac-
tice is to remove it and then to reapply it, thus
getting ocular testimony as to the condition of the
parts.

a. Wood-fibre material is adaptable to the treat-
ment of fractures of all the limbs, it being mould-
able directly upon the patient's limb.

b. It produces immobilization of the parts, be-
cause moulded directly upon them and retained
thereon, without the intervention of cotton-batting,
which defeats our object, if it be fixation. This
efficient immobilization is easily maintained by
keeping the roller bandage snugly applied over the
resilient splint; thus, subsidence of swelling, or



tissue atrophy, need not interfere with the fixation
produced by wood-fibre.

c. It permits the surgeon to inspect at any time
the fracture he is treating, by the simple unwind-
ing of a roller bandage. The reapplication of the
splinting is easy — there being no pads or com-
presses to become disarranged.

d. This ready removal of the splinting permits
the timely application of passive motion.

e. Wood-libre splinting is lighter than any other;
no complaint is heard from the patient because of
its weight — even in cases where the hip and knee
are both immobilized.

/. Wood-fibre material is strong, rigid and dur-
able — splints made from it having been worn in
some cases (hip fixation) for eleven months. The
material is clean, porous and does not irritate the
skin. In many cases, splints have been worn for
weeks immediately in contact with the skin, and
without excoriation of the skin resulting.

g. No padding is required in splints moulded
from wood-fibre material, in most cases it being
applied directly over the skin.

k. Wood-fibre material permits of rigid antisep-
sis in the treatment of compound fractures, both
of the wound, always accessible by removal of the
bandages, and also of the splint material, by mois-
tening it with a strong solution of corrosive sub-
limate.

i. The mastery of wood-fibre splinting readily
comes to one possessing a modicum of mechanical
ability, and who faithfully follows the instructions
given. No more skill is required to attain it than
is necessary to recognize and manipulate ordinary
bone and joint injuries.

Though this mastery of the material may be
difficult to attain, it would be well worth the effort
for the compensatory complaisance which the prac-
titioner enjoys in the conscious power to be able
to splint any case that presents itself, he moulding
the splint to meet the indications of the individual
case. Such splinting is scientific, for it presupposes '
that the practitioner knows the indications thati
should be met in a given case, and that he knows
how to meet them. It contrasts strongly with the
employment of manufactured splints.

MIND THERAPY IN GENERAL PRACTICE

It is no new thing for doctors to recognize
and speak against the inclination to treat lightly
the patient showing no physical signs of disease.
Fifty years ago a small-town Alabama doctor. Dr.
John P. Stewart, spoke* instructively on this sub-
ject.



*Read before the Tri-State Medical Association of Alabama,
Georgia and Tennessee, in Nashville. October 12, 1897. Ab-
stracted from the Fa. Med. Semimonthly, Dec. 24th, 1897.



March, 1943



SOUTHERN MEDICINE & SORCERY



Hitherto, our good, honest, scientific and un-
compromising doctor has poo-pood every com-
plaint, every tale of woe, or story of suffering
poured into his unsympathetic ear, which failed to
show sufficient cause for disease; and the timid
neurotic has sought and found a place to carry his
woes and dollars in the legion of quacks that wait
without the walls of legitimate medicine. And so,
it behooves us not to stand idle all day, while the
harvest is waiting. Let none go by that seek our
help. And if it takes flowers instead of bitter-
herbs, attar of roses instead of assafcetida, it should
not only be our duty, but our pleasure, to give
them, red-hot or ice-cold, sugar-coated, gilt-edged,
and soft-soaped, to that degree that will give satis-
faction to the mind, tastes and fancy of our pa-
tients. This will make them comfortable and
grateful.

Psychiatry has long been a deep study with
scientific men. From the days of Plato, Socrates,
Aristotle, Hippocrates, and Galen, on down, such
poor afflicted mortals have been a phenomenon to
the profession. They have been possessed of gods,
devils, demons, witches and what not, from age to
age. We have some psychical manifestations that
fill the soul of the spiritualist with felicity. Each
individual case must be studied out and treated
according to its own peculiarities. Yet, there is
one thing to be remembered: Those in this condi-
tion must not be classed with the imbecile, de-
mented, or insane. Their minds are bright — some-
times remarkably so; their ideas fine, their conver-
sation intelligent, they have a lucid idea of the
cosmology of things, and an appreciation of their
natural eternal fitness. "Yet, upon one thing the
cog slips and the loose screw goes rattle-a-tap, till
you wonder, as you gaze into the face of your
whining patients, if they are crazy. Here is where
we must have patience with our patients, smile our
sweetest, and listen with great interest and deep
concern to their long-winded and tiresome tales of
woe. Look wise and say much, using all the medi-
cal terms that can be agglomerated into verbose
and long-drawn sentences. Have a deep and learn-
ed name for every ache and pain; and prescribe
some anodynal placebo, until you have time to
study your case. Get the history of parents, broth-
ers, sisters, etc., and learn all the surrounding cir-
cumstances, habits, etc., if it takes months. When
master of the situation, you can, by using little
medicine and lots of "sphengalism," effect a per-
manent cure. A strong mind is good medicine for a
weak mind; some people love witchery, mystery
and myth; they feed on it with gusto. Give them
all they want; don't let them go away dissatisfied;
if you do, they will hunt a cure in some other doc-
tor's office.



It is a smart doctor that keeps the modus oper-
c,ndi to charm this class and knows how to work it
for their mutual good.

A cure should always be attempted in these
cases. These are the kind that fill divorce courts,
and make marriage a failure. Healthy love is of
slow growth, enduring and lasting. The majority
of our suicides are caused by wild, abnormal, mor-
bid adoration; the whole being is consumed with
the one idea. We must it intelligently and serious-

ly-

I know that there are many who are ready to
say that these cases are only the temporary rattle-
brain folly of youth. But during the temporary,
rattle-brain folly of youth there have been said and
done things that marred the whole life current
thereafter, and caused what otherwise would have
been a useful career to be diverged into the by-
ways of degradation, sin and vice. Our prisons,
hospitals, asylums and slums are filled with neg-
lected cases of temporary rattle-brain follies of
youth.

We must shoulder the responsibility largely of
the moral as well as the physical health of this
neurotic clientele. Many physicians are responsible
for whiskey, morphine and cocaine habituation;
and there are other more demoralizing and degrad-
ing practices for which the profession has been
held responsible.

No one should take upon himself the duties of
a doctor unless he fully understands and has a
true heart, a strong mind, a healthy body, Atlantan
shoulders fit to bear the weight of mightiest mon-
archies.

The vocation of our science is to throw a pro-
tecting wall around the healthy, and by quaran-
tine, sanitary and hygienic regulations, make the
human family healthier, stronger, wiser and hap-
pier. Then, perchance, should dread disease in any
form make a successful attack upon our walls and
storm the citadel, our duty is to fly to their relief,
and take up any weapon that will successfully
combat the enemy.

Reading the ideas then expressed warns us, just
as today's neurologists do, of the error of thinking
or telling the patient it is all imagination; also, it
brings up in our minds the question of how far an
honest doctor may go in adopting the practices of
those who "wait without the walls of legitimate
medicine."

A few months later a Washington surgoen. Dr.
I. S. Stone, spoke* along the same lines. He well
emphasizes the fact that mind-cure is practiced
more or less in every case of illness.

To Charcot, perhaps more than any other mod-

•Rcad at a meeting of the Medical and Surgical Society of the
District of Columbia, January 6th, 1898. Va. Med. Semimonthly,
Feb. 2Sth, 1898.



SOUTHERN MEDICINE & SURGERY



March, 1943



ern physician, belongs the credit for having res-
cued the practice of mental therapeutics from the
deep sea of fraud and imposition, to which it was
consigned by an honest, if not a discriminating
profession. The phenomena of hypnotism, so
closely allied to mental therapeutics, were never
placed on a practical or rational basis until this
wonderful man gave the seal of his approval. Alien-
ists and neurologists have no monopoly of the prac-
tice, and all successful physicians must practice it,
and often more than they know, rely upon its po-
tent influence for good.

Our neurotic subjects are those best adapted to
the process of cure by suggestion. Many nervous
woven demand some application of the mind-cure
in every variety of disease, just as they manifest
a neurotic type of every illness. The prescription
of valerian or asafoetida, without the odor or name,
would fail lamentably. The use of suggestion in
these cases does not preclude the administration of
suitaljle other remedies.

The author's method does not necessitate a re-
sort to hypnotism, for he has rarely found his cases
to have need for the induction of sleep. He relies
upon suggestion very largely. The physician should
inspire confidence, through his ability to master
every situation, but should rarely, if ever, ask for
implicit faith. Let the patient have all possible
faith or confidence, yet without the suggestion that
this is a prerequisite to success.

Nearlv all of such patients are victims of many
psychical disturbances. Each case must be studied
carefully. We must never be satisfied to say, "Your
disease is imaginary." This error is fatal to suc-
cess. These peoples are sick, and are unable to
obey the command, "Rise up and walk." The most
striking defect is lack of will power. There seems
to be a paralysis of the will in some cases. The
desire to recover is almost or entirely lost. We
must first test the patient's ability to comply with
our demands. There may be real and not fancied
loss of power. Our treatment will fail if we do not
correctly estimate the real desire to recover. Does
she prefer to remain in bed, to be nursed and per-
haps petted and spoiled? Or does she find in your
presence and influence something she recognizes as
superior to her own will, or perhaps her clever and
astute conceit? Many of these invalids deceive
themselves and others. The physician, at times, is
in despair at the frequent and exacting demands
upon his resources, which are taxed to the utmost
if he succeeds in overcoming the foibles of these
chronic invalids.

Let us remember there is no need of any clap-
trap or nonsensical or undignified practices. Our
aim should be to proceed cautiously, and be very
sure of our ability to cure, before we promfse^the



patient much. The administration of tonics or any
drugs will as a rule prove useless. This is quite as
true of the antispasmodics. Many of the most per-
plexing of these cases have contracted a drug habit.
Dr. Weir Mitchell says he would not undertake to
cure a case of morphine addiction without massage.

As nearly all of these poor suft'erers are the vic-
tims of one or perhaps many delusions, our first
duty should be to study how to minimize the evil
effect of the delusion rather than make a prolonged
attempt to change the patient's opinion by any
process of reasoning. They are not willing to be
convinced and besides have very strong and reso-
lute, if erratic opinions.

The whole plan of treatment may be summariz-
ed thus: First, obtain a dominant influence over
the patient, and then indicate the entire course of
her life, at least while under treatment. The phy-.
sician's will, and not that of the patient, must be
supreme. This is a good rule in any event, or un-
der any circumstances, for it is impossible to prac-
tice the mind-cure without it, and the writer con-
siders it the most important of all influences at our
command.

A definite amount of exercise, or a duty to per-
form at a certain hour each day, with unvarying
and unrelenting persistence, will often make a pa-
tient walk in a few weeks who had not stood alone
for years. These invalids ought to be cured if they
have no organic disease. It is of course useless to
make any rash claims for the mind-cure.

Now that nearly everybody smokes cigarettes,
we seldom hear them called coffin-nails; and, in-
stead of condemnation of cigarettes as worse than
cigars or pipe, we see representations of the com-
paratively harmlessness of the various brands of
cigarettes.

It was not always so. Here is a sample^ from
the medical literature of 50 years ago:

And here another:^

Twenty years after these two papers were pub-
hshed at least one State of our Union had a law
more or less in force prohibiting the sale of any
cigarettes within its borders. Then legislators
smoked pipes, chewed or dipped. Now most of
them smoke cigarettes 1



ONLY A FEW SPECIES OF SPIDERS TO BE
FEARED

(R. W. Thorp and W. D. Woodson. Los Angeles, March issue
of Hygcia, The Health Magazine)

The banana spider is a tropical species which appears
in the United States hidden in bunches of bananas. . . .
The creature is not related to the large, hairy tarantulas of
Southwestern United States. ... The bite of this spider
may be sharply painful but not dangerous. . . .



March, 1943



SOUTHERN MEDICINE & SURGERY



135



The tarantulas have earned an awesome reputation.
Scienists and la3men for many years held the opinion that
such huge spiders surely possessed venom with a potency
dangerous to man. This was negatively answered when
human beings in several instances induced the creatures to
bite them, and the resultant pain proved to be equal to
about that of two or three bee stings. . . .

Within the United States sixteen species of trapdoor
spiders have been discovered, eight of these exclusively
from CaUfornia. . . . Naturalists marvel at their ability in
excavating a burrow, Hning it with waterproof silk and
closing it with a hinged door. Scattered, unverified reports
through the year mention much suffering, and even death,
resulting from their bite. Scientific investigation has dis-
counted this conclusion. Symptoms resulting from their
bite under normal conditions will be local, and they as a
class cannot be considered as greatly harmful to man.

Most widely distributed of the spiders dangerous to man
are those of the genus Latrodectus. In Latrodectus mac-
tans is included the ill-famed black widow.

A cause for bewilderment to many has been the fact
that some victims of the bite of the black widow experi-
ence no ill effects, others only mild effects and still others
agonizing pain. Most significant reason for this is that the
striated muscles which surround the poison glands of the
black widow spider function only when she chooses. She
may thus inject her fangs into a human being and deposit
no venom, or may secrete the maximum contents of her
poison sacs.

The banana spider, various species of tarantulas and
their relatives, the trapdoor spider . . . have all caused
varying degrees of injury to man. Only these and spiders
of the genus Latrodectus, of which the black widow is a
heralded member, need to be feared.



THERAPEUTICS

J. F. Nash, M. D., Editor, Saint Pauk, N. C.



VITAMIN DEFICIENCY DISEASE USUALLY
MULTIPLE

In our e.agerness not to lay ourselves liable to
the charge of practicing polypharmacy, we may err
in prescribing too few vitamins for a patient. An
excellent article by one of our own authorities' em-
phasizes this important fact.

Vitamin deficiency disease may result from in-
dulgence in dietary fads, alcoholism, prolonged and
severe restrictions in diets prescribed for the relief
of allergic conditions or gastro-intestinal and bil-
iary disturbances. Of equal importance with in-
adequate or improper diet is failure of absorption
or utilization of vitamins when the intake seems
sufficient. Common "intrinsic" causes of avitamin-
osis are gastric achlorhydria, chronic diarrhea of
any etiology, biliary and hepatic diseases, and fre-
quent vomiting. In the same category may be in-
cluded the various conditions which create an in-
creased demand for vitamins, such as fever, preg-
nancy, unaccustomed work or hyperthyroidism.
The use of dextrose solutions given intravenously

M.D., Augusta, Ga., in Jour. Mich.



for long periods is also a common cause of severe
acute avitaminosis.

The general pattern of vitamin deficiency is
usually determined by a lack of thiamine hydro-
chloride, niacin (nicotinic acid) or riboflavin. The
majority of patients manifest symptoms of multi-
ple vitamin deficienc}'.

The early symptoms of thiamine deficiency are
fatigue and anorexia and may be asosciated with
nervous irritability, forgetfulness or confusion;
others are doughy calf muscles, a burning sen-
sation of the soles, and pain on pressure to the
muscles, often loss of pain sensation over various
skin areas, and tendon reflexes exaggerated, glos-
sitis, maybe hyperesthesia of the buccal mucosa.
Frequently a slight pellagrous dermatitis and cor-
neal vascularization develop.

Wet beriberi is common and is usually diagnosed
as heart failure not responding to digitalis or diu-
retics; abdominal distention with constipation and
a "silent abdomen" are characteristic. Achlorhy-
dria, anemia and hypoproteinemia are no more
common in patients with frank beriberi than they
are in those with pellagra.

Of niacin deficiency (pellagra) dermatitis is a
late and rare manifestation which may occur in
the absence of other specific signs. In mild cases
psychic symptoms may precede all other signs.
Frequently gastric discomfort and constipation ac-
company the initial nervous syndrome. Anorexia
and constipation are complaints at this stage, diar-
rhea at intervals for a day or two. Stupor and the
signs of "nicotinic acid deficiency encephalopathy"
are seldom seen in the presence of typical derma-
titis, though glossitis or vaginitis is present in
almost every instance.

The signs of ariboflavinosis occur more fre-
quently than those of any other avitaminosis. The
characteristic signs may occur without signs of
deficiency of other vitamins of the B complex. In
advanced cases fissures about the angles of the
eyes, septal fissures and ulcers in the nose and
severe keratitis with vascular invasion of all layers
of the cornea have been noted. Itching dermatoses
of the genitals and perineum are common. Such
patients have shovm symptoms or signs of thia-
mine and nicotinic acid deficiency.

Much more striking as an example of polyavita-
minosis is the so-called "tropical avitaminosis" —
soreness and desquamation of the lips followed by
fissures in the commissures of the lips, conjunc-
tivitis with fissures at the canthi, photophobia,
dimness of vision, glossitis, and an eczematous
dermatitis of the genitals. In addition there may
be calf tenderness and hyperesthesia of the soles
and severe corneal vascularization.

The treatment of the various manifestations of
avitaminosis remains empirical. Because of organic



SOUTHERN MEDICINE & SURGERY



March, 1943



changes in the gastro-intestinal tract which are the
result of prolonged vitamin deficiency the amounts
of vitamins required for effective treatment are apt
to be greatly in excess of theoretic requirements.
The administration of a single vitamin of the B
complex in large amounts may produce rapid im-
provement, but if continued, characteristic mani-
festations of other avilaminoses will appear. The
probable cause of this phenomenon is the exhaus-
tion of reserves of stored vitamins used in chain
reactions made possible by an ample supply of one
of the series.

The basis of treatment of all avitaminoses is an
adequate diet. For rapid cure, then, the diet should
be supplemented with ample amounts of synthetic
vitamins and also with yeast or crude extract of
liver. Every case of severe avitaminosis is a medi-
cal emergency which must be treated as actively as
diabetic coma or mercurial poisoning. Since the
water-soluble vitamins are rapidly excreted in the
urine it is necessary to give large daily doses, in
relatively small aliquots, at frequent intervals.
' When retention or absorption is doubtful intraven-
ous or intramuscular injection is the route of
choice. Patients respond more rapidly when crude
extract of liver is used in conjunction with syn-
thetic vitamins. The optimal dose of injectable liver
extract is from 3 c.c. to 5 c.c. daily.

In beriberi, thiamine hydrochloride should be
given, 10 mg. from three to ten times daily, de-
pending on the severity of the manifestations. In
the less severe forms of vitamin Bi deficiency from
3 to 10 mg. daily may be adequate. In addition at
least 3 mg. of riboflavin and SO mg. of niacin
should be administered until all evidences of avit-
aminosis have disappeared. In ariboflavinosis it is
extremely difficult to predict the effective dose of
riboflavin; from 6 to 15 mg. is the average daily
dose. At least 3 mg. of thiamine hydrochloride
and 50 mg. of niacin should be included.

In pellagra and specific cerebral manifestations
of niacin deficiency, from 600 to 1800 mg. of nia-
cin each day until a cure is effected. The comple-
ment of thiamine hydrochloride should not be less
than 6 mg., and of riboflavin at least 3 mg.

The role of pyridoxine in human avitaminosis is
still unknown. It is possible that this vitamin has
to do with the utilization or mobilization of other
members of the vitamin B complex group. No defi-
nite dosage can be prescribed, but experience sug-
gests amounts of 5 mg. daily.



causes of "yellow jack," while Finlay patiently reiterated
his accusations against the mosquito. Studies of his own
convinced Finlay that Stegomyia jasciata was the chief
culprit, but sufficient funds to conduct the necessary ex-
periments that might have proved the point were not
available to him.

— Clinical Excerpts.



DERMATOLOGY

J. Lamar Calloway, M.D., Editor, Durham, N. C.



Dr. Carlos Juan Finlay in 1881 postulated before the
Havana Royal Academy of Science the theory that the
mosquito carries "a transportable substance, perhaps an
amorphous virus, or a vegetable or animal germ" from
the yellow fever patient to a new victim. This theory was
given little credence. For two decades physicians continued
to fight the straw men of miasma and filth, the supposed



Online LibraryNorth Carolina. Comptroller's DeptSouthern medicine and surgery [serial] (Volume 105 (1943)) → online text (page 26 of 109)