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-of before rupture actually occurs, so as to relieve the blood-pressure,
the danger of rupture may be averted, and I believe in many instances
apoplectic seizures might be avoided if measures of this kind were
resorted to promptly.

Dr. T.- S. Bullock: How do you know when a patient is threatened
with apoplexy?

Dr. F. C. Wilson: When a patient comes to me complaining of
headache confined to one side, accompanied by a numbness of one arm
and leg perhaps, the opposite side from which he complains of head-
ache, I conclude at once that there is a congested condition of that side
of the brain ; and if at the same time there is flushing of the face, it
^eeras to me that I am justified in believing that there is too great full-
ness of the vessels of that side, and that there is danger of rupture. A
little exertion on his part which would increase the blood-pressure
would seem to me to be liable to actually break a small vessel, with the



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336 The American Practitioner and News.

outpouring of blood resulting in an apoplectic seizure. Under these
circumstances, if we can lower blood-pressure in any way, it seems to
me we will accomplish good, and this was my aim in the management
of the case referred to.

Dr. William Bailey : I would like to call attention to the discovery
of a lost art, as stated by Gross in 1875, whether or not some good
results have not been accomplished by free saline purgation in this
class of cases, getting the benefits without the loss of the corpuscular
elements of the blood, lowering tension by diet, by the amount of
liquids taken, and the abstracting of serum by means of saline catharsis,
giving remedies that have an influence in lessening congestion of the
brain. This would be the course that I should rely upon, not knowing
of any circumstances under which I think it is necessary to abstract
blood from the patient.

Dr. Turner Anderson : I do not feel it incumbent upon me to
remain silent upon a matter of so much importance. I belong to a
class of doctors who believe that phlebotomy is a proper therapeutic
measure under certain circumstances. I think Dr. Wilson was justifi-
able in practicing bleeding in the case reported, and if bleeding were
employed more freely, perhaps the conditions which the doctor encoun-
tered in this case might be avoided. Very recently I was called to see
a patient who had had several convulsions. I found a muscular
individual, evidently a very full-blooded person, and as I entered the
room he went oflF into a most terrific spasm. A ligature was applied
around the arm, and a vein opened. I did not stop at a pint, but
allowed the man to bleed until quite a large quantity of blood had been
withdrawn. The ligature was then removed. This man did not have
a single convulsion afterward. A few days ago I was driving along the
street, and was hurriedly summoned to see a woman who had fallen on
the sidewalk and was carried into a neighboring house. She was a
very large woman, and had fallen in a convulsion. She was bled freely,
and her convulsions ceased. In this case I opened an artery. I later
returned to take oflF my bandage, and learned that the woman was seven
months pregnant. She was very obese, plethoric, she was seized on
the street with vertigo, perhaps threatened apoplexy, and the arteriot-
omy seemed to afford complete relief. I am not sure that there are
not cases in which arteriotomy or phlebotomy will be of decided
advantage. I simply make these remarks in support of what Dr.
Wilson has said in regard to cases of threatened apoplexy.



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The American Practitioner and News. 337

Dr. T. S. Bullock : I have seen Dr. Anderson perform this little
operation in several cases, always with a happy result. I am rather
inclined to believe the indications for it are somewhat marked if we
have not time to produce free catharsis, and I also believe there are
cases in which it is a proper therapeutic measure.

Dr. William Bailey : The early part of this week a lady came to see
me ; she had what appeared to be BelPs paralysis, facial paralysis, and
inquiry developed the fact that she was about six months pregnant. I
had her send me the next day a sample of her urine, which I found to
be highly albuminous. Is it common for women with such a condition
of the kidney, as would favor at least puerperal convulsions, to have
paralysis? Is there any condition about the kidney in which there
would be due to it a lesion producing this paralysis? Or may it not
be that the cause of the paralysis is external to the skull and simply a
coincidence ? In other words, is the cause of the paralysis peripheral or
central ?

Dr. Louis Frank : Perhaps Dr. Bailey could determine whether the
cause is peripheral or central by applying the electric test. I remember
a case of facial paralysis in which Naunyn insisted that the patient had
sjrphilis until he applied the electrical test, when he decided that it
was peripheral and not central.

Foreign Bodies in the Air-Passages. Dr. J. M. Ray : I have seen
two cases within the last few months of foreign bodies in the air-pas-
sages that were of special interest to me :

Case I. I was asked to go to an interior town. I found a child
eighteen months old without any history beyond the fact that for ten
days previous to my visit the child had been breathing heavily, with a
little cough, and that it had lain practically in one position for ten days.
Its head was thrown back, respiration very rapid, no fever ; the child
was perfectly conscious, and complained of no pain unless moved out
of the position mentioned, lying on the nurse's lap with its head
thrown backward and breathing rapidly.

Examination showed no foreign body in the upper air-passages.
However, in examining the child's chest I found a spot in the right
lung where there seemed to be some obstruction, a peculiar noise pro-
duced by the incoming and outgoing air. The lung was not collapsed^
and there was no particular amount of dullness on percussion. I gave
it as my opinion that there was a foreign body in the bronchus, and'

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338 The American Practtitoner and News.

suggested that the best thing to do was to try and locate it by means
of the X-ray.

Two days afterward the child was brought to this city and taken
to Dr. Butler for the purpose of having him make an X-ray picture.
This was done, but the photograph showed nothing. The patient was
then seen by Doctor Marvin, who agreed in my diagnosis, that there
was a foreign body in the right lung ; that nothing could be done except
to wait developments.

This condition remained the same for a week or ten days longer,
when the condition gradually cleared up and the child recovered without
any bad symptom.

Now, exactly what there was in the bronchial tube is a mystery to
me, unless, as the mother said, that the child was very fond of crawling
around the room, and that it had on one or two occasions crawled
out into the yard and gotten hold of some clover blossoms ; she had
noticed several times the child had taken them in its mouth.

Case 2. I was asked to see the next case at the Sts. Mary and Eliza-
beth Hospital by Dr. Galvin. The history was that the Thursday before
the boy was eating some kind of preserves and swallowed a piece of
glass ; he had remained at home without any doctor until Sunday after-
noon, when Dr. Galvin was sent for. There was then no difficulty in
breathing, but the boy had been unable to swallow any thing. The
doctor examined the throat as well as he could, and, not finding any thing,
the boy being unable to take any nourishment, was sent to the Sts. Mary
and Elizabeth Hospital. I saw him on Monday, at which time the only
thing he complained of was difficulty in swallowing. There was no
obstruction to breathing, and no interference with his voice. I exam-
ined him carefully, making a laryngoscopic examination, and found
nothing visible in the upper respiratory passages. I then took a soft
rubber tube, similar to that used in washing out the stomach, and
passed it through into the stomach without meeting any resistance
whatever, and immediately afterward the boy expressed himself as
relieved. He immediately drank a glass of milk, and that evening ate
some soft food, eggs, mush, etc.

I saw nothing more of the patient until Thursday, when I was tele-
phoned to come out to the hospital at once, that the boy had had a
suflFocative attack ; that he came very near dying of suflFocation. I found
him breathing rapidly, twenty-six to the minute, with a little fever,
temperature 101° F. I examined his chest again, but could make out



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1 he American Practitioner and News. 339

no evidence of a foreign body in the lung. Dr. Lucas happened to be
in the insiitution at the time, and was called in and asked to examine
the chest. He did so very thoroughly, and failed to locate a foreign
body in the lung. The next day the boy had another suflFocative attack,
and a tracheotomy was performed. Relief was not brought about by the
operation, and the boy died two hours afterward with evidences of
■obstruction lower down.

Exactly why, if there was a piece of glass in the bronchus, more
symptoms were not present when I first examined this boy, I am unable
to understand ; and why the passage of a rubber tube into the stomach
produced immediate relief to the apparent obstruction is equally
puzzling.

I would like to have the benefit of the advice of other members
upon these two cases.

Discussion. Dr. T. L. Butler: In regard to the first case reported,
we could find nothing with the X-rays, except, as I told Dr. Ray at the
time, that the heart shadow was entirely on the right side. I believe,
from my examination of the patient, that there was a foreign body in
the right lung, and if it was of the character that Dr. Ray has described,
■of course the X-rays would not show its presence.

THOMAS L. BUTLER, M. D., Secretary,



See our Special OfTer to new subscribers on one of the advertising pages.



.foreign (Eorrcsponbcncc-



LONDON LETTER.

[FROM OUR SPECIAI, CORRBSPONDBNT.]

Hospital Abuse and Its Reform ; A New Fever Hospital; Treatment of Con-
sumption; Sleeping Sickness; An Archbishop at St, George's Hospital;
Increase of Lunacy ; The New Entry of Medical Students,

At the two days' conference on '* Hospital Abuse and Its Reform/* held
under the presidency of Dr. W. Knowsley Sibley, the most interesting^ sub-
ject under discussion was the inquiry system in connection with applications
for medical aid. Sir William Broadbent, M. D., said that unless inquiries
were made at all hospitals, and on a uniform system, the result would be to
simply shift the undesirable and undeserving applicants into those districts



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340 The American Practztzoner and News,

where the inquiry was most lax or wanting. He felt strongly that some
general method was necessary, as the revelations consequent upon the
investigations of applications for charitable relief were startling. It was
found that in many cases at present the poor and needy were excluded from
that which was intended for them.

The Metropolitan Asylums Board have completed another of their fever
hospitals which now encircle London. There are now twelve fever hospi-
tals and two convalescent homes in working order; these provide accommo-
dation to meet slightly more than normal needs, and it is hoped that,
allowing for the rapid increase of population, further extension will not be
required for some years. It is a subject of remark that wherever the hos-
pitals have been placed, there populous streets have closed round them.
The Asylums Board have to deal with from 5,000 to 6,000 cases weekly.
The hospital just opened occupies about twenty-two acres, the various
blocks being connected by long open corridors, lighted as a whole by elec-
tricity, and providing accommodation for five hundred and twenty-eight
patients.

The medical registrar of the North London Hospital for Consumption
states that 183 cases of consumption have been treated on the open-air
principle since January last. Of these, 43.7 per cent left the institution to
return to work, 32.3 per cent considerably improved, 7.6 per cent slightly
improved ; 4.3 per cent did not improve, and 3.9 per cent died. He states
that it is a usual occurrence for patients who enter the institution with
extensive signs of tuberculosis to leave aftdr nine or ten weeks with no
active signs of the malady and an increase of fourteen pounds in weight.
In every case the disease, when taken in its earliest stages, improves rapidly
under treatment. A large number of patients who have left the hospital
keep up a correspondence with the medical staff, and no one who markedly
improved and followed out the hygienic principles taught has shown any
signs of relapse.

Dr. Mott, at a meeting of the Pathological Society of London, related
his investigations of the central nervous system in two cases of Congo or
sleeping sickness. He examined in each patient the brain and spinal cord,
pituitary body, and spinal ganglia. There was found in one case that the
tissues to the eye presented but little change beyond some thickening of
the pia-arachnoid. The cerebral convolutions were complex and not
atrophied, the brain weighing fifty-four ounces. The fluid was normal, and
the two hemispheres were of the same weight. In the other case the dura
mater was seen to be adherent to the calvaria. An abnormal quantity of
cerebro-spinal fluid was present. Over the convolutions the pia-arachnoid
was somewhat thickened and opaque ; the same membrane was in like con-
dition at the base of the brain. The brain weighed thirty-six ounces. In
neither brain was there flattening of the convolutions, erosions on stripping
the membranes, or dilated ventricles with granular ependyma. The nervous
tissues were removed before any post-mortem change had taken place.



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The American Practitioner and News. 341

Upon examining microscopically stained sections of the hemispheres, cere-
bellum, pons, medulla, and cord, both examples exhibited like conditions.
There was a lepto-meningitis and encephalo-myelitis. All the perivascular
limits throughout the whole nervous system were distended with mono-
nuclear leucocytes. Dr. Mott from his investigations concluded that the con-
vulsions from which patients suflFer were the expression of the increased
irritability prior to death of the cortical motor neurons; the characteristic
drowsiness and lethargy, and the progressive weakness in body and mind,
unaccompanied with distinct paralysis or mental disability, was accounted
for because the metabolism or functional activity of the neurons, as a whole,
was affected injuriously either by some toxic product circulating in the
blood or existing in the cerebro-spinal fluid ; this toxic agent gave rise to
great proliferation of mono-nuclear leucocytes beneath the pia-arachnoid
and in the perivascular lymphatics.

The Archbishop of Canterbury gave the prizes recently to the various
students at St. George's Hospital Medical School. During his address the
Archbishop said, while professing the deepest reverence for the medical
profession, he was yet tempted to doubt whether the art of medicine was
as successful as the science of it, and whether the faculty had reached the
point beyond which it would be impossible to go. At the same time, his
Grace fully admitted the blessing conferred upon humanity by the medical
calling as among the greatest that the world could boast, though he some-
tim.es — especially in his old age — deplored the fact, as a free and liberty-
loving Englishman, the doctors should be such " terrible tyrants."

The London Hospital inaugurated the new session with a dinner.
During the past year the medical school buildings attached to the hospital
have at the cost of ;^8,ooo been considerably enlarged and fitted up to meet
•every possible requirement of present-day medical education. Professor
Haffkine, the discoverer of the anti-plague serum, was the guest of the
evening.

The Asylums Committee of th^ London County Council in their most
recent report show a considerable increase in pauper lunatics. The first
reliable statistics of pauper lunatics in the newly formed county of London
were obtained on January i, 1890. The number at that date was 10,100.
On January ist last the number had increased to 14,645. Certified lunatics,
the committee point out, are increasing at the rate of 600 per annum.

St. Bartholomew's Hospital again has the largest entry of freshmen, the
numbers being one hundred and fifteen who have entered for the full cur-
riculum, fifty-two who have entered for special courses, and seventeen who
have joined classes for preliminary instruction.

Dr. Dickinson says that the tendency of the age is to enlist in modem
medicine the service of the great forces of the external world rather than
place their chief reliance on the druggist, and he predicted that every
zymotic disease would be found to have an extraneous origin.

London, October, 1899.



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342 The American Practitioner and News.

Ctbstracts an5 Selections-



Pure-Food Legislation. — Unless the matter be forcibly brought to
our attention it is not easy to realize how generally we are imposed upon
by those whom we may properly call the manufacturers of food. At a re-
cent meeting in Boston of the Farmers' National Congress, Hon. H. C.
Adams, Dairy and Food Commissioner of Madison, Wis., presented facts
which are well worth our serious consideration. From his showing it
would appear that practically all of our food staples may be and often are
adulterated, or actually made outright from substances far removed from
the advertised finished product. No doubt the possibility of defrauding the
public in this matter increases year by year, as methods of chemical analy-
sis and synthesis are coming to be more generally recognized and under-
stood. It is an easy and a tempting step from such knowledge to its fraud-
ulent use in the manufacture of products which are foisted on the unsus-
pecting buyers to their detriment and to the great gain of manufacturers.
Some of the possibilities in this line we quote from Mr. Adams' remarks :

** The clumsy wooden nutmeg of Connecticut, that even a policeman
might detect, has given way to artificial eggs which no hen would recog-
nize, and to artificial butter that never knew milk. The universal demand
for cheap things brings a supply. Wheat flour is adulterated with com
flour ; buckwheat with wheat middlings. Vermont maple syrup is made
that never saw Vermont, and is made from the sap of trees that grow in
Chicago. Glucose has dethroned cane syrup. Cider vinegar is distilled
from grain. A good portion of the strained honey of commence never pro-
duced any strain upon the bees. Milk is robbed of its cream, filled with
lard, and sent all over the world to ruin the reputation of American cheese.
Oysters are partially embalmed with chemicals. Lemon extracts are made
without lemon oil, and vanilla extracts without vanilla. The hogs of the
North compete with cheap cotton-seed oil of the South, and mix in the same
tub under the banner of lard. Artificial smoke is made for hams out of
poisonous drugs. Jellies colored in imitation of the natural fruits and sold
as fruit jellies flood the markets, although they are almost as destitute of
fruit juice as a bar of pig iron. The embalmed-beef business has been ex-
aggerated, but we do not need any for either soldiers or civilians. Canned
fruits are preserved with antiseptics which delay the digestive processes.
Baking powders under various misleading names crowd the markets.
Spices enriched with pepper hulls and ground cocoanut shells are manufac-
tured and sold by the ton. The close partnership which has existed for so
many years between coffee and chicory does a thriving business in many
States under the firm name of coffee. Cheapness is secured by these adul-
terations and false labelings, but the people are defrauded. " '^

We quote the above statement as an example of what is going on aboat
us, from which the poor, who need legislative protection most, are the



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The American Practitioner and News. 343

chief suflFerers. The manufacture of oleomargarine as a substitute for but-
ter is a case in point. The necessity for legislation as applied to this prod-
uct is said to be recognized now by thirty-two States, which have prohibited
its sales under the guise of butter. Massachusetts has been a pioneer in
the movement for improved laws, and experience has shown that State
laws are usually sustained by the courts. Mr. Adams feels very strongly
that we need a comprehensive national pure-food law, which shall so regulate
the general question of food that its adulteration for the benefit of the few
will no longer be possible. It is evident that such legislation must be
somewhat slow in coming; that it will be bitterly opposed and vigorously
contested in the courts by the manufacturers of adulterated foods. In the
mean time, however, it is desirable that our attention should be called to the
matter, and that both as individuals and as a profession we should do what
lies in our power to combat what is clearly a growing evil of very great
magnitude. — Boston Medical and Surgical Journal.

A Case of Cerebro-spinal Rhinorrhea. — Dr. St. Clair Thomson,
of London, presented recently before the London Laryngological Society
a case in which he succeeded in demonstrating to the satisfaction of
his brother specialists that the practically continuous rhinorrhea was
really a discharge of subarachnoidal fluid. The discharge, except for the
annoyance of its continual dropping, did not inconvenience the patient in
the least. On the contrary, vague pains in the head from which the
woman suflFered before the establishment of the discharge have since
ceased, and only return when for some reason there is a temporary obstruc-
tion to the flow. Dr. Thomson has succeeded in finding in medical litera-
ture reports of some twenty cases, which he thinks should be classified in
the same category with the one he has had under observation. Most of
them have been described simply as persistent *' dropping of watery fluid
from the nose." Beyond the fact that this is an actual cerebro-spinal rhin-
orrhea, very little is known. Dr. Thomson himself thinks that it is prob-
able that the fluid finds its way from the subarachnoid space at the base of
the skull, within the perineural sheaths of the branches of the olfactory
nerves, though of course the possibility of its finding its way by some other
route can not be denied. He thinks that the condition is always associated
with increased intracerebral pressure. Of the twenty-one patients, includ-
ing his own, no less than seventeen presented some cerebral symptoms, and
eight of them showed retinal changes. — Medical News.

Mosquitoes as Carriers of Malaria. — The expedition sent to Sierra
Leone to investigate the habits of the mosquitoes of the genus Anopheles
has arrived at certain definite results, some of which are given by a corre-
spondent in the British Medical Journal for September 30th. The distin-
guishing marks of this variety as contrasted with Culex are very marked,
not only in the adult forms but also as a larvae, which appears to be of



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344 ^^ American Practitioner and News.

more practical importance ; the larvae of both varieties breed in water, but
with the following difference :

" CtUex larvae, when disturbed, immediately wriggle down to the bot-
tom of the water. On the other hand, Anopheles larvae can move not only
in this manner but with a few rapid jerks along the surface ; indeed, this
seems to be their more common kind of progression unless much disturbed,
when they sink to the bottom. These details, trifling as they may appear
to be, are probably of first importance as regards tropical sanitation, because
it follows that pools which contain flat-floating, surface-moving mosquito
larvae may be considered to be foci of malaria.

" Culex larvae live everywhere in warm countries — in almost every pot,
tub, well, cistern, broken bottle, empty sardine tin, or anywhere where a
little water lodges. It must be observed, therefore, that the sources of
CtUex can not well be removed by drainage of the soil, being dependent
more on slovenly domestic arrangements than on any thing else. In fact, the
common species of Culex are essentially domestic animals. Neither are



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 93 of 109)