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6. The first dressing stations and the field hospitals are the legitimate places where the work of the hospital corps and company bearers is to be revised and supplemented. All formal operations must be performed in the field hospitals where the wounded can receive the full benefits of aseptic and antiseptic precautions.
7. Probing for bullets on the battlefield must be absolutely prohibited.
8. Elastic constriction for the arrest of hemorrhage must not be continued for more than four to six hours for fear of causing gangrene.
9. The X-ray will prove a more valuable diagnostic resource than the probe, in locating bullets lodged in the body.
10. Gunshot wounds of the extremities must be treated upon the most conservative plan, the indications for primary amputation being limited to cases in which injury of the soft parts, vessels and nerves suspend or seriously threaten the nutrition of the limb below the seat of injury.
11. Operative interference is indicated in all penetrating gunshot wounds of the skull.
12. Gunshot wounds of the chest should be treated by hermetically sealing the wounds under the strictest aseptic precautions.
13. Laparotomy in penetrating gunshot wounds of the abdomen is indicated in all cases where life is threatened by hemorrhage of visceral wounds and the general condition of the patient is such as to sustain the expectation that he will survive the immediate effects of the operation.
Legislation on the Marriage Question. Quite a number of States already require a license to marry, and impose heavy penalties on both minister and principals for any irregularity in the matter of the application.
The different commonwealths have different qualifications as to age, etc., but in every one of the States having such regulations any inhabitant can secure a license to marry regardless of mental, moral or physical fitness to assume the duties of paternity. Some, forsooth, require the consent of parents when children make application for license; or in lieu of such consent accompanying the application when there is any doubt of the age of the parties in question, their affidavit is sufficient. The evils resulting from such an arrangement are patent to all, and especially to those who personally view the operation of such laws. To the intelligent listener in the average license court, the hum of voices making affidavit seems a weird and ominous music. The syphilitic, venereal wreck, consumptive and epileptic, the feeble-minded and the dipsomaniac stand before the bar of the State, with a brand as plain as that of Cain upon their brow, and asking, receive unchallenged, permission to legally procreate their tainted species.
The well-balanced mind reels with horror at the spectacle, and already efforts are being made to remedy the evil. Numberless sacrifices must be made and years must elapse before even the medical profession comes to realize the enormity of this crime against humanity; but we cannot doubt that in due time popular opinion will crystallize into law that will arrest the evil.
The Paris Court of Appeals has decided that the fact of marrying while suffering from any venereal disease is sufficient cause alone on which to grant a divorce. A bill is now before the German Reichstag providing heavy penalties for the transmission of any venereal disease in any form or manner whatsoever. The State of Texas prohibits the marriage of the epileptic, and bills have been introduced before the legislatures of Massachusetts, Ohio and Maryland prohibiting the granting of licenses to marry to the syphilitic, epileptic, feeble minded, dipsomaniac and consumptive.
It is not expected that they will pass these legislative bodies; the cup of sacrificial blood is not yet full; youth, beauty
nd innocence must still be legitimate rey for disease and lust, but the agitation will not cease till this enormous iniquity s finally blotted out forever.-Charlotte Medical Journal.
[The Senate of North Dakota has passt bill providing for a commission of three physicians in each county for the examinaion of all applicants for marriage licenses.]
Dangers of Blisters.
Dr. Huchard (Bull. de l'Acad. de Méd., No. 7, 1898) states concerning blisters:-1. They often produce an open wound which facilitates secondary infections or the absorption of cantharides.
2. Besides tending to cause inflammation of the kidneys and bladder, they have a general congestive action.
3. Even in those diseases where they are most frequently used, such as pneumonia and pleurisy, they could be discarded, as they induce pulmonary congestion.
4. Blisters tend to arrest excretion by the kidneys, so important in all infectious diseases, and this is especially harmful in those normally causing albuminuria. Instead of aiding the excretion of toxins, blisters are likely to produce a fresh intoxication.
5. The only real use of blisters is in their revulsive and analgesic action, but the effect is better attained by less dangerous means, such as mustard plaster or cold baths.-Gaillard's Medical Journal.
Oil of mustard has been applied with success to the anus as a "keep-awake remedy" in opium narcosis.
Sudden giving away of the legs while walking is a symptom worthy of remembrance as an early sign in some cases of locomotor ataxia.
Heller, of the Philadelphia Polyclinic, has found the addition of small doses of arsenic very efficacious to prevent drug eruptions.
For the nausea that so often follows the use of opium or morphine, Garrod says nothing is better than coffee, or caffeine, tea or saline aperients.
Dr. Fruitnight (Archives of Pediatrics, August, 1897), states that recurrent epistaxis in children is frequently significant of organic heart disease.
In all forms of congestion and inflammation of rectum, hot water enemata, medicated or otherwise, are indicated for their soothing and depletant effect.
Dr. David Riesman has found strontium bromid, in conjunction with massage, a curative remedy with two obstinate cases of rheumatoid arthritis.
The American Medical Review recom
mends the following spray to be used thrice daily for hay fever: An ounce each of eucalyptol and glycerin, two drachms of laudanum, distilled water to make six
A Point in the Differentiation between
Central and Peripheral Deafness.-Dench calls attention to the practical value of the fact that in disease of the perceptive auditory apparatus the upper tone limit is lowered; whereas in conductory disorders the lower range of the notes become inaudible.
The Effects of Tobacco Smoke.—Pediation and deterioration of the red blood trics enumerates the following: Diminucorpuscles; functional irregularity of the heart; impairment of sight and of accommodation; salivary over-secretion, producing dyspepsia and loss of appetite; pneumokoniosis; in extreme cases paralysis and convulsions.
Spyhilis-How Shall We Stop its Alarming Spread?
Syphilis, one of the oldest and one of the greatest curses of mankind, has steadily gathered new victims, and now at this late day, the great syphilolographers of the world are to meet at Brussels, Belgium, to devise some means by which to check its alarming spread.
The history of syphilis is a most appalling acknowledgment of gross disregard of its serious nature, and an unpardonable delay in a systematic and continual warfare against its propagation. It shows that the disease is most extensively met with in large cities in the very heart of civilization, and has on its muster roll not only the prostitute and the habitue of the slums, but the aristocrat and those of the higher intellectual sphere; that it does not visit its wrath exclusively upon those who wilfully subject themselves to the danger, but also upon the innocent, for its mode of infection is not limited to direct venereal contact, but on the contrary, all objects which come in contact with the secretions of the mouth of a syphilitic may be the means of its transference from one person to many others, and that even infants may, thru the medium of the nurse, fall victims to this dread disease.
Effort to check the spread of syphilis is more the duty of the law than medicine. The physician has learned its origin, its nature and its treatment; he, from his position, can give no plan other than offer suggestions which must be accepted and acted upon by our legislative bodies. So far, legislation in relation to syphilis has been of but little benefit on account of the impracticability of the laws passt.
Houses of prostitution are the most virulent centers, and the first blow must be struck at them. The total abolition of prostitution, tho devoutly to be wisht, is, at the present day, beyond the hope of man, and attempts which have been made towards accomplishing such an end present thruout centuries an uninterrupted series of defeats, for the sexual passions, the strongest impulse of human nature, has invariably asserted itself, and other laws have been violated; seduction, criminal abortion, illegitimacy and infanaticide, with impairment of morality, have followed the experiment.
Inspection of prostitutes by medical examiners has been enforced in many cities, and as often as it has been tried it has proven a failure; for as everyone knows, who possesses any knowledge of venereal diseases, it is folly to believe it possible to prevent the danger of infection by weekly examinations of the prostitutes of a city, as the inspector may find the woman free from disease on the day of inspection, only to have it appear during the interum; furthermore, it is not always possible to detect the primary lesion of syphilis, and in consequence of these facts the system is rather more of a danger than a safeguard, for many young men, thru a false sense of security, on learning that the prostitute possesses a certificate of health, will indulge in the sexual act when otherwise they would not.
Laws must be passt of so rigid a nature as to force the prostitute, thru fear, to place a higher value on her health, and when the fight is once begun it must be persistently carried on with sufficient vigilance and energy to accomplish good results, by alarming the prostitute into
viewing this condition in a more serious light. Strike at their freedom and you will gain their co-operation, for they will look upon syphilis as being something far more serious than a skin disease, and regard the probability of infecting others as worthy of consideration. Reckless of their health, devoid of any feeling for their fellow-being, they are jealous of their liberty and, as do all criminal classes, entertain the profoundest respect and fear for the law.
The law must make a stern and relentless crusade against the syphilitic, striking first at the prostitute, and where found, forcing her to a place of confinement, where she can be kept under proper treatment until free from possibility of infecting others. It is a well-known fact that but few of these will take the proper treatment long enough to do much good, and it is very essential, to the accomplishment of our purpose, that some place be established to which syphilitics may be sent. We have the Isle of Molokai for the leper, why not find some such place for the syphilitic? The mere existence of such a place will have a greater moral effect than all the pulpit oratory and clinical teaching of the world combined. The search must extend beyond the bagnio, and find those men, "The Rounders," who are ever a source of infection for the prostitute; these also must be forced to take treatment which will relieve all danger of their spreading the disease.
To be successful, the strong arm of the law must strike wherever syphilis exists, and should even enter the church, and strike at hyman's altar, not permitting any man known to be syphilitic, to embrace in connubial bliss, the pure and healthy girl whom he wishes to make his wife. The marriage certificate should carry with it a clear bill of health, which should be the cardinal clause in its requirements.
It may be said by some that such interference with the liberty of the individual is illegal; yet we claim that the State has the right to protect the health of its citizens by every avaible means. Our quarantine laws against yellow fever, smallpox, etc., interfere with individual liberty, and the same should apply to syphilis, which, while not so dangerous to life, is still a terrible menace to health, and on account of it being, as it were, a concealed danger, with many modes of infection, it is greatly to be dreaded. Why
should we hesitate to make open and relentless war upon these women who, lost to all sense of morality, and so long permitted to practice their nefarious occupation, unmolested by the law, unnoticed by sanitarians, feeling no concern as regards the danger of their sexual companion, and who stand an awful menace to our young men and an indirect cause of untold suffering to the pure women of society, and the origin of a hereditary taint, which follows thruout generations, when we imprison the poor wretch who steals a loaf to keep off hunger? Is it a greater crime to pick a pocket than to steal your health, and that of your wife and your offspring?
The laity must be told the unvarnisht truth, and warned of the many dangers of infection. The mock modesty of the law maker, and the unsound religion of the pulpit must be changed. Prostitution, tho in a sense greatly to be deplored is, in a way, absolutely essential; it should be under control of the law and kept clean as possible.-Louisville Med. Jour.
Alcohol Versus Acetic Acid.
At a recent meeting of the New York State Medical Association, Dr. E. R. Squibb said that it might be of interest to learn of the work being done in the way of retiring alcohol as a menstruum for exhausting drugs. A good deal has been accomplisht in this direction in the last two or three years. Of the other menstrua experimented with up to the present time, that which had given the best results was acetic acid in various strengths. It had been discovered that a ten per-cent. solution of acetic acid was almost universal in its exhausting powers. There were now in use in veterinary practice and in some hospitals, extracts made with acetic acid. They were made according to the requirements of Pharmacopea except that acetic acid was substituted for alcohol. Acetic acid when used with alkaloids gave the physicians certain advantages in prescribing, owing to there being fewer incompatibles. In small doses the percentage of acetic acid in the extract was so small as to be hardly appreciable, and when larger doses were required the acetic acid could be neutralized by the addition of potash or In commenting on Dr. Squibb's statements, Dr. H. D. Didama, of Syracuse, said that it did not seem to him that the use of alcohol by the profession had been abandoned, either socially or othervise, a view of the case which so far as it
applied to the legitimate use of alcohol in pharmaceutical manufacturing met with the unanimous indorsement of those participating in the discussion. This scheme of substituting acetic acid for alcohol as a menstruum has long been advocated by Dr. Squibb, but it will meet with but little favor in the medical profession.-Gaillard's Medical Journal.
At the recent examination of candidates by the New York State Board, there were 123 applicants, of which 94 were successful.
University of the State of New York-Medical
[From the Med. Review of Reviews (rearranged).]
1. Explain the preparation and preservation of animal ligatures and sutures.
Answer: By preparation and preservation of ligatures and sutures, we mean their sterilization. The processes employed vary with the material, as follows: Catgut, soak in ether 24 hours to remove the fat; with sterile hands wind it on clean glass spools, and boil it in alcohol 1 hour; store in boiled absolute alcohol in sterilized glass vessel.
Chromicized catgut, soak for 48 hours, 200 parts, by weight, of the gut in a mixture of carbolic acid 200 parts, boiled water 2,000 parts, and chromic acid 1 part. It is then boiled in alcohol, and stored as above.
Silkworm-gut is simply boiled in alcohol 1 hour, and stored in boiled absolute alcohol.
2. Describe an operation for the radical cure of bunions.
Answer: After all aseptic preparations, a free incision is made on the inner side of the joint, any excessive inflammatory tissue removed, and enuf of the base of the first phalanx removed so that the toe can be brought into its normal position, and, while held in place during healing, bony ankylosis shall not result. The dressing of the wound, temporary and subsequent, follows the special indications, as to presance or absence of pus, etc., as in any operation.
3. Give the procedure for producing cocain anesthesia during the removal of a small tumor of the skin.
Answer: Use a 2 per cent. solution of cocain hydrate in a clean hypodermic needle. After the skin has been sterilized inject a few drops just under the surface, stopping
when blanching appears. After withdrawing the needle reinsert farther on where the blanching has already occurred, and advance it little at a time, injecting the solution drop by drop in what is to be the line of incision. If the tumor is in a pendant portion, a ligature applied so as to retard the circulation in the part will serve to render the anesthesia more prolonged. 4. Describe morbus coxarius and give its treatment.
Answer: Tubercular disease of the hip joint produces chronic suppuration with the formation of fistulas and necrosis, or plastic effusion with ankylosis. Symptoms: Pain, often in paroxysms, at night, and referred often to the knee; muscular atrophy, rigidity and contraction producing deformity; stiffness of the joint, and spinal curvature.
Treatment.-Extension during acute symptoms, followed by immobilizing apparatus. Aspiration of or free incision into the joint, if the collection of pus is great. Sometimes excision of the joint or division of the bone, to correct deformity.
5. Give the indications for amputation in compound fracture of the thigh. Describe the operation and its details.
Answer: (1) Such crushing of the limb as to amount to avulsion, or when the parts are so lacerated as to render restoration of their life impossible.
(2) When the blood-vessels are destroyed, cutting off the nourishment so that gangrene certainly will or has already developt.
(3) Destructive disease of the bone supervening upon an unuited fracture.
The operation.-Preliminary antiseptic and aseptic preparations as usual. In general the operation is one of a long anterior and a short posterior flap, with the bone divided some distance higher up. In detail, after the blood supply has been cut off by an Esmarch bandage an incision thru the skin marks out the anterior flap, in length one-third, and in width at the base almost two-thirds the circumference of the limb. The muscles are then divided upward and backward, making the flap not too thick. The posterior segment of the limb is divided transversely, the bone cleared and divided an inch or two higher up and its anterior edge beveled. The flaps are then brought together and sutured, drainage being inserted first after the blood-vessels have all been caught and ligatured. The usual aseptic dressing is then applied.
6. Give the etiology, diagnosis and treatment of chronic blennorrhea of the lachrymal passages.
Answer: Chronic blennorrhea of the lachrymal passages is almost always secondary to inflammations of (a) the nasal mucous membrane or bone; (b) or of the eyelids. Of these, various causes-e. g., chronic catarrh, the exanthemata, syphilis, in the former class; blepharitis, ciliaris, trachoma, or most frequently conjunctivitis, in the latter. Another factor is often any obstruction in the lumen of the passage.
The disease is very rarely primary, due to traumatism or other irritation.
Diagnosis. Made by noting the possible causes, the locality of the swelling firmly situated behind the palpebral ligament by pressure upon which a muco-purulent secretion mixt with tears is evacuated from the canaliculi. The skin is movable over the tumor.
Treatment.-First. Against the cause. Second. Favor relaxation of the distended sac by slitting one of the canaliculi and subsequently probing the nasal duct. Third. In resistant old cases a portion of the wall of the sac is to be excised that the secretions may not be so readily retained.
7. Describe two methods of sterilization of the skin.
Answer: For sterilizing the skin one method is to simply wash it thoroly with green soap and water, shave if necessary, and wash with bichlorid solution 1 to 1,000 and then with alcohol and ether.
A better method twenty-four hours before operation: Wash the surface and apply green soap poultice for twelve hours. Substitute wet bichlorid (1 to 5,000) dressing which is to be removed only after the patient is on the table. Then wash with ether followed by bichlorid or chlorin water.
8. Differentiate fibrous union from nonunion following fracture of the shaft of the humerus.
Answer: Fibrous union is where the ends of the fractured bones are united by fibrous tissue-not calcified and therefore allowing some false motion.
Non-union means that the ends of bone have failed altogether to unite.
9. Describe an operation for circumcision.
Answer: Cleanse the part thoroly. Catch the foreskin in a clamp ahead of the glans and cut off the redundant portion. move clamp and make dorsal incision in