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tallest are born in August. The investigations of Wahl, in Denmark, and
Wretlind, in Gothenburg, and especially those of Malling-Hausen, in Copen-
hagen, on the deaf show that the length of body of boys from March till
AugujLt increases greatly, but very little from September to February. Dr.
Macdonald attributes this fact to some extent to economic conditions, for
a child born in summer has generally better food and air. A large number



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The American Practitioner and News. 317

of parents are poor, and in winter they are forced to economize on account
of the expense of heating. They generally live also in small and ill-venti-
lated rooms. The influence of such conditions on a very young child would
be much more detrimental than when the child is older and better able to
resist unfavorable surroundings. — Dr, Macdonald^ in Child Study.

Inoculation for Rabies.-— At the Pasteur Institute, in Paris, 1,465
persons were treated in 1898, and all but three were cured. For the thirteen
years from the foundation of the Institute to the end of the year 1898,
13,181 persons were treated in Paris, and out of this number only ninety-
nine died. — Scientific American.

The Causation op Night Terrors.— Dr. Little, in an article in the
British Medical Journal of August 19, 1899, expresses the opinion that
night terrors are, in the great majority of cases, caused by disorders pro-
ductive of moderate but prolonged dyspnea. A preponderating number
of cases are found in rheumatic subjects with early heart disease. A con-
siderable proportion of cases are due to obstruction of the nasal cavities
and fauces. Digestive disturbances do not play the important part in
causation that is often assigned to them. The evidence for their causal
connection with epilepsy or allied neuroses is scanty. The attacks occur
in the subconscious stage of early sleep, and are confined to young children
under puberty. — Medical Record,

A Vegetarian King. — The King of Italy, according to an English
journal, is a vegetarian, and lives entirely on vegetables and fruits. The
doctors have also forbidden him to drink coflFee, so his beverage is claret
well diluted with water. The King never feels so well as when his fare is
bread, potatoes, and oranges, although peaches are his favorite food. The
Queen has made repeated attempts to become a vegetarian, but finally has
given up in despair, being fond of a generous diet.

A Pediatric Physician at King's Coi^lege Hospital. — The London
correspondent of The Therapeutic Gazette says that King's College Hos-
pital, London, has just appointed a special physician for diseases of chil-
dren. In America and in several continental nations this would hardly
seem worthy of comment, but as a fact this is the first appointment of the
kind in a general medical school that has been made at any general hos-
pital in Great Britain.

A Vegetarian Sanatorium in Great Britain.— On the borders of
Epping Forest, a few miles from London, is a sanatorium at which the
fresh-air treatment is pursued together with strict dieting, the consumption
of flesh, fish, or fowl being absolutely prohibited. The results of this
system, it is claimed, are most beneficial to the patients, especially in cases
of tuberculosis, but cases of cancer (in the early stages) are dealt with on
the lines of the experiments tried by the celebrated Abernethy many years



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3 1 8 The American Practitioner and News.

ago. Patients also suffering from chronic dyspepsia, from debility and
wasting are admitted. The hospital was opened in 1895, ^^^ ^as proved so
successful that it frequently happens that applications for admission have
to be refused owing to lack of room.

Physicians in Germany.— The statistical office has just published
returns relative to medical qualifications in Germany, which show that
1,314 candidates became qualified in 1898. Of this number twenty were
foreigners, including eight Russians, four Swiss, three Dutchmen, two
South Americans, one Englishman, one Mexican, and one African. The
total duration of medical study varied considerably with different candi-
dates; 936 studied for nine semesters, 158 for ten semesters, and 211 for
eleven semesters and upward. — The Lancet.

American Electro-Therapeutic Association. — The ninth annual
meeting of the American Electro-Therapeutic Association was held in
Washington, D. C, at Wiilard's Hotel, on September 19, 20, and 21, 1899.
The convention was successful in point of attendance and interest, and a
number of papers were read and discussed. The programme included thirty-
six papers and the reports of seven standing committees on scientific ques-
tions relating to the medical application of the electrical current, with the
best electrical apparatus extant. The proceedings of the convention will
be found in their annual Transactions, to be published at an early date.
The officers elected for the tenth year are : President, Walter H. White, M.
D., Boston; First Vice-President, D. Percy Hickling, M. D., Washington,
D. C; Second Vice President, Charles O. Files, M. D., Portland, Me.; Treas-
urer, Richard J. Nunn, M. D., Savannah, Ga.; Secretary, George E. Bill, M.
D., Harrisburg, Pa. The next annual meeting will be held in New York
on September 25, 26, and 27, 1900. — Boston Medical and Surgical JourncU,

Phototherapy and its Possibilities. — During the past few years
there have been occasional rumors of the possibility of the light-rays being
used as a therapeutic agent, especially in skin diseases. It is well known
that the violet rays of the spectrum aflFect bacterial growth unfavorably.
Some years ago Finsen, of Copenhagen, pointed out that the scars left
after an eruption of smallpox were much less, serious if the patient were
protected from the action of the rays of light belonging to the violet end of
the spectrum, as these produce irritation of the skin when concentrated,
and in inflammatory conditions, such as smallpox, naturally aid in the
destruction of tissue, and consequently intensify the subsequent pitting.

After demonstrating that his theory was correct and that the bad effect
of these theories could be eliminated. Professor Finsen experimented
further with the idea of making use of the violet and related rays for thera-
peutic purposes. The results of his experiments were followed with great
interest. Nearly two years ago Lesser, professor of venereal diseases and



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The American Practitioner and News. 319

dermatology at the University of Berlin, in a lecture which appeared subse-
quently in the International Clinics, said that the most promising thera-
peutic agent against lupus vulgaris, providing it proved as successful in other
hands as in those of the discoverer, was Finsen's phototherapy. Finsen's
demonstrations at the congress for tuberculosis in Paris last year did not
come as a surprise, but they did succeed in convincing the most skeptical
of the important therapeutic power residing in rays of light.

Finsen*s assistant. Dr. Valdemar Bie, of Copenhagen, describes in the
British Medical Journal for September 30, 1899, the methods and results of
Finsen's treatment. The only indications for treatment are that the disease
be superficial, local, and of bacterial origin. So far the light treatment has
been applied to lupus vulgaris, to lupus erythematosus, and to alopecia
areata. In lupus vulgaris, as the pictures of patients before and after treat-
ment attest, the result is probably better than that secured by any other
method of treatment. The application is painless, and the liability to re-
lapse is slight. In lupus erythematosus the effect is not so satisfactory, and
relapses are rather frequent. In alopecia areata the results have been most
encouraging and seem to demonstrate, beyond all doubt, that that affection
is of bacterial origin.

The method of treatment consists in concentrating on the affected parts
the violet and ultra violet rays of light. The sunlight of a bright day, or
the light of a strong electric arc-light of 50 to 80 amperes, is employed to
furnish the white light. From this all rays except those chemically
most active are filtered out by means of a blue lens. A hollow glass lens
filled with a proper colored blue solution, as a dilute solution of ammoni-
ated copper sulphate, helps to cool the rays as they pass through to the
skin. For the electric arc. lenses of quartz are used, because they allow
the violet rays to pass more readily than do those of glass. The patients
are protected from the heating effect of the concentrated light by a small
hollow glass disk, pressed close against the skin, through which cool
water is allowed to circulate constantly. A little experience soon gives
facility in managing the apparatus, and the danger of accident from the
concentrated rays is very slight.

Professor Finsen's work deserves to be known and his suggestions to
be put in practice on a much wider scale than has yet been attempted. —
Medical News.

A Paris Doctor of Pharmacy.— The degree of Doctor of Pharmacy
has just been conferred by the University of Paris for the first time. The
recipient is M. Lacourt, who presented a graduation thesis entitled, " His-
torical, Chemical, and Bacteriological Study of the Versailles Water." — Ibid,

LooMis Sanitarium Burned.— The Loomis Sanitarium at Liberty,
Sullivan County, New York, for the treatment of tuberculosis, was destroyed
by fire October 14th. No lives were lost. The sanitarium was built in



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320 The American Practitioner and News.

1895 t)y J. P. Morgan, in remembrance of the late Dr. Loomis, of New York
City. The main building was constructed entirely of stone and closely
surrounded by a number of cottages. The fire will cripple but not destroy
the usefulness of the institution, for accommodations remain for many
patients in the cottages and annexes scattered about the grounds. The
total- loss, including contents, is about $100,000, on which there is about
$50,000 insurance. — Boston Medical and Surgical Journal.

Physician Robbed in Chicago.— -Dr. Oscar W. Hubbard, a Chicago
physician, was waylaid by two highwaymen on the morning of October
14th, just after he had visited a patient. Revolvers were pressed to his
head, he was dragged into an alley, thrown to the ground, and robbed of a
gold watch and diamond pin. One of the robbers was caught and identified
by Dr. Hubbard. — Medical News.

Fatal Case op Tetanus. — A fatal case of tetanus is reported in a child
of four years in Williamsburg, Brooklyn, in which the disease was the result
of wounds of the face inflicted by the bill of a rooster. — Boston Medical and
Surgical Journal.

California Not to Bar Consumptives. — The State Board of Health
has decided not to quarantine California against the consumptives of other
States. It has adoped a resolution, however, recommending that in all State
institutions those afflicted with tuberculosis be separated from the other
inmates. This is a very sensible modification of the radical measures of
absolute exclusion of all consumptives at first proposed. While tuber-
culosis is undoubtedly contagious, it is not so to such a degree as to make
quarantine regulations advisable. — Medical News.

The Influence of Americans in Cuba. — El Epoca, of Havana, says:
" Contact with a race which does not tolerate the shirking of daily labor,
and among which, before every thing, a man is the legitimate child of his
own merits and his own deeds, must be to us a powerful stimulant for
discarding once and forever the accumulation of habits which constitute
the unfortunate inheritance of a regime based upon the exploitation of the
negro by the white, and the native-bom white by the peninsular white, and
all by the government." — Ibid.

Some Enormous Tumors. — The Lancet has lately presented some
remarkable records of tumors. The largest known uterine tumor
weighed 195 pounds, described by a Bucharest physician. Hunter, of New
York, removed one weighing 140 pounds from a woman whose weight with-
out the tumor was 95 pounds. The largest fibroid is said to have weighed
106 pounds. The record for ovarian tumor is held by a Chinese patient,
who had one weighing 169 pounds; without it she weighed 77 pounds.
For mammary tumors a case is recorded in which the growth in one breast
weighed 46 pounds and in the other 40 pounds. — Ibid.



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THE



American Practitioner and News.



"NEC TENUI PENNA,*



Vol, XXVIII. Louisville, Ky., November i, 1899. No. 9.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the
fewest possible words, or his reader is sure to skip them ; and in the plainest possible words, or his
reader will certainly misunderstand them. Generally, also, a downrig^ht fact may be told in a plain
way ; and we want downright facts at present more than any thing else.— Ruskin.



0riginal Ctrticlcs-



DYSTOCIA DUE TO THE FETUS-*

BY THOMAS S. BULLOCK, M. D.

The common cause, as well as the most serious, is intra-uterine
hydrocephalus. Fortunately this disease is comparatively rare; its
gravity as regards the mother is shown by the statistics of Dr. Thomas
Keith, who found that sixteen cases out of seventy-four collected were
accompanied by rupture of the uterus.

The diagnosis of the disease is very difficult, and it is rarely dis-
covered before delivery. Other forms of dropsical eflFusion may give
rise to dystocia, as hydrothorax, ascites, and a distended bladder.
Tumors of various kinds may occasion dystocia, as malignant growths^
tumors of the kidney, liver, or spleen. Other deformities, as anem-
cephalous fetus, defective development of the thorax or abdominal
parietes, allowing protrusion of viscera, are likely to cause delay and
embarrass the diagnosis.

In addition to these morbid conditions, difficulties may arise from
undue development, especially from excessive size and advanced ossi-
fication of the skull. Large size of the body is still more rarely a cause
of difficulty. Hirst searched the records of more than one thousand
cases of the Maternity Hospital of Philadelphia before finding one
that weighed more than twelve pounds. Weights as high as twenty-
eight and three-fourths pounds have been recorded.

•Read before the Louisville Medico-Chirurgical Society, September 22, 1899. For discussion see p. 331.

26



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322 The American Practitioner and News.

The causes of overgrowth of fetus are prolongation of pregnancy,
oversize and advanced age of one or both parents, and multiparity.
Rarely it is inexplicable. The same author states that six per cent of
pregnant women may be expected to be prolonged beyond the three
hundredth day, and each day beyond the usual time the fetus increases
in size and weight above the normal. He advises that no woman be
allowed to go more than two weeks beyond the normal duration; a
good rule if it were possible in all cases to accurately determine the
duration of gestation. Ordinarily, if the head can be delivered the
body follows with little difficulty ; still there are a few authentic cases
recorded where it was impossible to extract the fetus on account of the
unusual bulk of the shoulders.

Of such a nature is the case I wish to report to-night.

On the morning of September 19th I was requested by Dr. Ed
David to see a woman who had been in labor for more than twenty-
four hours. I found a large German woman, over thirty years of age,
in labor with her first child. The pains seemed vigorous, and recurred
every four or five minutes. Examination revealed a cervix about the
size of a silver dollar but soft and dilatable, the vertex presenting in
third position. I advised the exhibition of chloral hydrate in fifteen-
grain doses at intervals of a half-hour, and arranged to see the patient
later in the day. At 3:00 p. m. was recalled. The chloral had failed to
produce sleep, but the patient had been more comfortable. Examin-
ation at this time revealed a cervix about two thirds dilated, but no
further advance.

Delivery with forceps was decided upon, and the patient was
catheterized and cleansed in the usual way, Dr. Blitz giving the
chloroform. The forceps were applied with very little difficulty.
Traction \ is made at appropriate intervals for nearly an hour, when it
was evident that no advance was being made. The forceps were
removed. After cleansing hand and arm, a thorough examination was
made by introducing the hand. It was then found that there was
obstruction at the pelvic inlet. The fingers could be swept around the
head, which could not descend on account of the impaction at the
brim. The child was still alive, and I determined to turn if possible.
This was accomplished with moderate ease. The body was delivered
until inferior border of the scapula was visible, when an attempt was
made to bring down the arms.



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The American Prctctttioner und News. 323

Here the real difficulty and delay m the case was encountered and
the life of the child lost. It seemed for a time that delivery without
extensive mutilation of the fetus was impossible, but with the assistance
-of Dr. David, the body of the fetus being carried well toward the
abdomen of the mother by forced flexion, the posterior arm was
brought down, the wedge dissolved, and the anterior shoulder was
brought down without trouble. The head followed promptly, as a
partial laceration of the perineum was made in delivering the posterior
shoulder. It was at once repaired.

The child was one of the largest I ever delivered, and I tried my
best to gain possession of it but could not. It was not weighed or any
measurements taken, there being no facilities at hand, which I regret
■exceedingly, as I feel sure they would have greatly exceeded the
normal. No information was obtainable as to the date of last menstru-
ation or quickening, the woman being very ignorant, and having arrived
in this country from Germany only a month preceding her accouche-
ment. The delay in the first stage and the failure of the os to fully
•dilate and the absence of advance under great traction were due to the
•disproportion between the bisacromial diameter and the oblique
diameter at the brim of the pelvis, so that the shoulders could not
-engage.

An additional feature of interest is the fact that the patient was a
primipara.

Note. — The patient made an uninterrupted recovery, except a
■cystitis of short duration from repeated use of the catheter, catheter-
ization being necessary because of paralysis of the bladder, due to the
protracted and difficult labor.

Louisville.

TREATMENT OF SCARLET FEVER-*

BY R. B. GILBERT, M. D.
Clinical Professor of Diseases qf Children^ Medical Department University of Louisville.

Scarlet fever, like measles and smallpox, is a self-limited disease,
and therefore at first glance it would seem that the treatment of the
"disease were a very simple matter. However, when we consider the
many dangerous complications and sequelae that are liable to occur,
many of which may be prevented by judicious management of the

« Read before the Section on Diseases of Children, at the Columbus Meeting of the American Medi-
•cal Association, 1899.



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324 The American Practitioner and News.

primary disease, the matter of treatment of scarlet fever at once
becomes an important one.

It is now pretty generally admitted that there is a specific scarlet-
fever microbe, bnt its exact nature is not yet definitely settled. The
time may be near at hand when we shall have the bacteriology of the
disease satisfactorily settled and the specific microbe isolated and
demonstrated. We may then reasonably expect that a specific germi-
cidal remedy will be found which will as eflFectually rob scarlet fever of
its death-dealing power as has vaccination that of smallpox. Then,
indeed (but not until then), will the treatment of scarlet fever be a
trivial matter.

Dr. E. M. Landis, of Chicago, has recently reported a case of scarlet
fever treated by him successfully by two injections of anti-streptococcus
serum. He says the temperature fell from 106.5° F. to 100° immedi-
ately after injecting ten cubic centimeters of the serum. He says he
did not discover any unpleasant symptoms following the use of the
serum. We will wait with interest the developments along this line.

Since there is no known remedy that will abort the disease, we
must be content to conduct it to a safe termination, and at the same
time make our patient as comfortable as may be under the circum-
stances. Besides the welfare of the patient under treatment, there is
another equally important matter that the physician should attend to,
viz : to prevent, as far as possible, the further spread of the disease by
infection and contagion. May we not with propriety, under the caption
of Treatment of Scarlet Fever, include also prophylactic treatment?

It may be briefly stated that the leading indications in the manage-
ment of scarlet fever are to guard against infection, hyperpyrexia, pro-
found anemia, and complications.

The milder forms of scarlet fever need really no treatment other
than keeping the patient in bed and the enforcement of prophylactic
precautions. We must, however, remember that the danger of infection
is just as great in the mild cases as it is in the severer forms. Although
the danger of infection is not so g^eat early in the disease as it is in the
latter stage, yet measures to prevent the spread of the disease should
be promptly adopted. As soon as the diagnosis is made, the scarlet-
fever patient should be carefully isolated. The room in which he is to
remain should be divested of all curtains, carpets^ cushioned furniture,
books, papers, toys, etc. Dogs and cats should be rigidly excluded
from the room, as they readily transmit the germs of the disease in their



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The American Practitioner and News. 325

fur. All the excreta from the patient should be received in a receptacle
containing a strong antiseptic solution.

By far the greatest danger of infection and contagion is from the
exfoliations of the skin during convalescence. Each minute epithelial
scale, scarcely visible to the unaided eye and light enough to be wafted
about in the air, carries with it numerous scarlatinal microbes. These
epithelial scales are exfoliated in the form of furfuraceous dust, and
when they are once set afloat in the atmosphere they are beyond con-
trol. They entangle themselves in the clothing, especially of woolen
goods, and may be carried long distances and be kept for many months
and still retain their vitality.

The simplest and yet most efficient means of dealing with the
cutaneous desquamations is to keep the skin thoroughly anointed with
hog's lard or olive oil, which may be scented with some aromatic oil if
desired. The application of lard has a very soothing effect upon the
skin ; it allays the itching and burning, and gives a sense of comfort and
quiet to the patient. I have often seen the temperature fall a degree
or more in a few minutes after free inunction. The exfoliating scales
are thus loaded down with grease and will not float about in the air,
but are rubbed off" in rolls and drop on the sheet, from which they can
be easily gathered up and cast into the fire.

By thus preventing the fine particles of epithelium from floating
about in the room, the attending physician's clothing is less liable to
become infected. It is a well-known fact that the germs of the disease
have frequently been carried from house to house in the clothing of the
careless and unsuspecting doctor. All bedding and clothing that have
been used about a scarlet-fever patient should be thoroughly disinfected
before being used again. This can be done cheaply and effectually by
submitting them to the action of boiling water or ** live steam " for a few
hours. This method of disinfecting is more reliable than fumigations
with sulphur or formaline.

What shall we do for hyperpyrexia in scarlet fever? Any temper-
ature above 103° F. should be regarded as dangerous on account of the
derangements so liable to occur to the nervous system and glandular
organs. When antipyrin was first introduced it was my custom to give
it for reducing temperature in scarlet fever, but on several occasions I
have had serious threatening of heart-failure from its use, and now I
never use it. Quinine combined with phenacetin and caffeine in



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 91 of 109)