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the rectum, and give rise to considerable this heading will be the more easy of com: irritation until gotten rid of. They are
They are prehension and the more readily remem. sometimes introduced from without,
bered. usually by patients themselves, or they The circulatory apparatus is composed pass down from above in the form of some of what might be called four sections, the indigestible ingesta. The first case of this heart, arteries, capillaries and veins. The kind that I ever saw came to me from a heart forces the blood through the arteries family physician in Dakota, fully fifteen towards the capillaries, and is assisted by years ago. He sent to me a specimen in the elasticity of the larger arteries and by a small bottle, with the reqeest that I ex- the muscular coats of the smaller ones. amine it microscopically and report my Added to this, is the so-called vis-a-f: onte, findings to him. It looked like a rolled. or the force ahead, in the capillaries that up membranous cast from the gut. It had tends to draw the blood on thru the been passt by an aged lady, after several arteries, and the force is known as capilweeks of rectal irritation, and then was lary attraction.
From the capillaries the taken with forceps by the doctor who had blood passes into the veins, which are sent it to me. Upon unrolling it I found thin, larger than necessary to hold the it to be the stroma of an orange. Further blood volume, and of such limited coninquiry, thru her attendant, elicited the tractile power as to be unable, unassisted, fact that some time before her trou- to propel the blood they receive onward to ble began she had eaten an orange, suck- the heart without extraneous assistance. ing out the juice first, and then chewing This aid they get in several ways. First and swallowing the entire pulp.
of all, they have valves, so that when a Other bodies that may pass from the column of blood has been forced up to a rectum are gall-stones and gut-stones or certain point, no force is required below enteroliths. Gall-stones are readily enough the valve to hold it up. When, however, recognized. If they are from the gall the pressure within the veins is so great as bladder they are usually faceted ; when to sufficiently distend them to separate the from the hepatic ducts, they are not valve segments, there is regurgitation of faceted. When there is but a single stone some of the blood to parts of the vein in the gall bladder, it is not, of course, below the valve. Soon the process is faceted. I have seen, post mortem, many extended to the valve next below, and thus such instances, when death was due to on from one to another till they are all other causes.
separated, and are of no further practical Sometimes food concretions form a com- use in holding up the blood current. Then pact mass in the gut, and this eventually the veins become still more distended and becomes spherical from rolling about in tortuous, and are said to be varicose. If the lumen of the intestine. They grow they are not supported by some outside larger from fecal accretions being con- means, such as an elastic bandage, for tinually deposited upon them. They may instance, they are apt to rupture, causing become so large as to make their passage extravasations of blood under or thru by the rectum impossible without frightful the skin. They also are likely to so intersuffering and severe damage.
fere with the local nutrition as to set up Worms are found, especially in children, ulcerations, and these are known as variwith comparative frequency, but by no cose ulcers. These, as is so well known, means so often as one would suppose by require for treatment, support and stimlistening to the wise (?) remarks of the ulation before they can be made to heal. know-it-all old women one meets in so Besides the valves the venous circulamany cases. The only positive sign of tion is aided by gravitation in favorable worms is to see the parasite in the stools. situations, as in the legs when a person is They have no other significance than that up. Another help is the alternate conthe patient is beset with an enteric para- traction and relaxation of the muscles of site.
the body and limbs. This squeezes the The Circulatory Apparatus.
blood current onward, both within and beAs in the consideration of the diseases tween the muscles. of the digestive organs, it was advisable From all this it follows that the circuto take up the general function of the lation of the blood may be hampered in a entire digestive tract, so it is also now best variety of ways. In the heart itself there to go into the mechanism of the circulation may be trouble with the valvular mechanin order that the points to be made under ism, or in its muscle substance. Of this I
shall say more in detail when I discussment as well as in the determination of the the heart itself. In the arteries there may pulse.quality. be loss of elasticity, as in atheroma, or of Among the many things to be noticed contractility, as in vaso-motor disturb- about the pulse. quality are its rhythm,
Vaso-motor troubles may also in- force, tension or compressibility, consisterfere with capillary attraction, thus les- tence of the vessel wall, shape of the artery sening or destroying the vis-a-frontis. (whether straight or torturous), its size There are other conditions of the circula- or volume, and its frequency. All these tion that cause trouble, but they will ap- qualities indicate either a condition of the pear as each part is taken up in detail. heart or of the artery itself, and it often
tells, especially in connection with other The Pulse.
symptoms, that the heart derangement is The pulse is the beat of an artery. It is due to some defect or irritation of the not confined to the wrist, as so many of the nervous system. All of these things it is public suppose, and, I am sorry to say, as necessary to know in order to make a true so many physicians would seem to think, diagnosis, without which it is impossible judging from the way they persist in get to successfully treat serious cases that are ting the information from the radial pulse, not likely to get well without careful medwhen it can more readily be obtained else- ication and hygiene. where, say, for instance, from the temporal artery.
Frequency of the Pulse. I shall not try to define a normal pulse, A good deal is said about the normal pulsebecause I believe it impossible to describe beat, as though there was such a thing. . so indefinite a thing in a way to mean the What is meant is the average pulse-beat, same thing to all men. I shall assume and that is something very different. The that I am addressing practitioners of ex- frequency of the pulse of a new-born child perience enuf to have satisfied themselves is given at near 140, from which point it upon this score. The learning of what gradually falls to about 125 at one year, constitutes a normal pulse can only be 105 at two years, 97 at four years, dropdone by continued attempts at it under the ping to 90 at ten years and 78 at fifteen. supervision of a master. Once this know- During adult life, from twenty to forty-five, ledge has been gained, the deviations of it averages about 70, after which it again which I shall treat are readily detectable gradually rises to 80 at eighty years of and are mostly variations from a personal age. standard. In consultations one often Exercise and change of position alter the notices the discrepancy in the interpreta frequency of the pulse. It is slowest durtion of pulse qualities by the different con- ing sleep and quickest during active physsaltants. One calls it normal, another a ical exercise. And it must not be forgotten little hard, and yet another a trifle soft. that active mental work also increases the Now these are all personal differences that number of pulsations in a given time. The correspond to the personal equation of the change from sleeping to waking causes an observer. One man sees quicker than increase of several beats; it is still quicker another, or one registers an impression in while sitting, more so standing, and still shorter or longer time than another. These greater in walking. It is increased by exdifferences are carefully noted in all indi- citement of all kinds. In examinations viduals making observations in astronomic for life insurance it is specially important, observatories, and are called personal equa- notable in excitable individuals to allow tions. To whatever extent they vary from as much as ten beats for deduction, in an accpted standard they are recorded and consequence of this fact. It is also imporeither added to or subtracted from the tant to avoid an examination of the pulse findings of the observer, for otherwise the as soon as the patient walks into the office. greatest errors in computation would en- They should first be given time to rest and sue, because the difference of a small frac- recover from the increased pulse-beat due tion of a second might mean a difference to the exercise of walking and possible exof millions of miles in estimated distance. citement. It is also well to bear in mind So that when one reads of a pulse that is that the weaker the patient, the greater a little hard or a little some other way, it
the variations in the pulse-beat from any must be taken with some allowance. So of the causes that have been named. The much for the personal equation of the doc- contrary is also true, that the stronger the tor, and it applies in all matters of judg- individual the less is the variation in pulse
frequency from all causes. I have repeat has to be pumped through the lungs to inedly examined the noted George Littlewood. sure proper aeration than would be necesof six-day-go-as-you-please-race fame, after ssry if the proper amount of red corpuscles he had run 30 miles in three hours on a existed in it. quarter-mile track, always finding his Valvular disease of the heart is charpulse either unchanged or beating possibly acterized by a fast pulse for similar evitwo beats more than when he started, dent reasons, except in aortic stenosis, whic was usualiy 70 to the minute. It is and this is an exception, for the reason also a fact that the pulse will rise in fre- that the work is too great to be done quency shortly after exercise is begun quickly. in the strong, only to gradually slow down A fast pulse may be due to peripheral again, perhaps to the usual frequency and paralysis or central paralysis of the pneuremain there during the entire exercise mogastric nerve. It is present in all nerunless the work is increased.
vous conditions and is a part of the general The pulse may be either fast or slow in manifestations of general excitability. disease as compared with the average in And it is faster in all instances of excitehealth, A pulse that is too fast when as- ment, anxiety or pain. sociated with fever or other tangible Finally, there are some individuals, in causes, is what might be called normal for fact, there are entire families, in whom a that condition, but when it is not due to high pulse rate is a constant manifnstaother than a nervous influence it is called tion. I have seen a pulse of over 90 while tachycardia. A pulse- beat below sixty a sitting as an unvarying condition of some minute is called bradycardia.
people, and in one I noticed that it fell A fast pulse is found in all febrile con- ten points by exercise. In this case I ditions unless associated with certain attributed the fall to the tonic effect of brain affections that cause slowing of the exercise upon the heart. During quiespulse. It is unusually fast, all other cence, the heart beats were weak and things being equal, in proportion to the quick, while after active exercise it was height of the fever. In prolonged illness, stronger and slower. the pulse beats faster in proportion as it
A. H. LEUF, M. D. grows weaker.
In acute sthenic diseases, Philadelphia. as in some cases of pneumonitis, it may
[This series of articles will be continued beat fast, strong and furious. It is then
in subsequent issues of THE WORLD. Comthat aconite or veratrum viride are indi
ments are invited by the author.-Ev.] cated, or some other heart sedative. All heart complications in febrile affections, cause increase frequency of the pulse.
Vicissitudes of Medical Life. This is simply because the weakened con- Editor MEDICAL WORLD :-I have been dition of the heart, with its resulting lower in active medical practice since 1846 and force, has to be made up by increased fre- am now seventy-six years old. Had I not quency of beat.
From this it follows that tried to increase my capital after ten the relative frequency of the pulse-beat is years' practice, I would not now be almost a fair index of heart strength, so that the a pauper. I was induced to take stock in general rule may be laid down that the a silver mine in Colorado, and came out weaker the heart the quicker the pulse- of it with a clean loss of $2,000. Next, I beat, and vice versa.
brought stock in the oil wells of PennsylVierordt claims that an adult pulse vania, putting several thousand in them. above 120 requires special consideration, I came out with a lot of stock certificates, and that one of 140 is grave. To this I but made another loss of over $3,000. My may add that a patient with pulmonary next venture was in California. It was a tuberculosis and a pulse that remains at grand gold mine, but I came out of that or above 100, despite efforts to pull it venture holding 30,000 certificates that the down, is doomed. I have watched this press assured me would pay. Last year I for a long time, and in many cases, and was bankrupt and sold out. Nothing in have yet to see it fail. There may be it. My next venture was building a streetexceptions, but I have not seen or heard car line in this city. This company has of them.
been so managed that it will be sold out in Anemia has a fast pulse, for the simple a few months, another clean loss of my reason that the heart is weak and the stock of $18,000. And lastly, I put about lood is so poor in oxygen that much more $3,500 in a brick plant. That failed over
a year ago and the stock had to double up. Superstition, faith curers, etc., are rife That, with over $12,000 I paid by going in this section. I will briefly give an exbail to help my friends, constituted my perience I had only yesterday. I took a losses. So, altho I made all this ill-spent meal in the country, and it is well for money in the practice of medicine, now, physicians to do this occasionally amongst at my age, I am penniless. Should you patrons who are so constantly sick. It often find it proper, give this article a place in leads to the discovery of the secret of THE WORLD as a warning to all my medi- their ill health. This particular man bas cal brethren to never give their bard. a son, 18 years of age, who has been an earned money into any company as I have invalid from childhood. I was given his done or it thus may go as mine has. history and treatment. Among the latter
J. M. H., M. D.
he told me he had used the “pumpkin cure."
From his crude explanation I
learned the theory was the latent develNasal Catarrh-Chloroform in Labor-Fetich
opment in the pumpkin would be transism-Use of Stimulants.
mitted to the child by the eating of this Editor MEDICAL WORLD:-In treating vegetable. This not succeeding, he bored nasal catarrh, acute or chronic, I find it a hole in a hickory tree, placed a lock of very necessary to have the nasal cavity the child's hair in it, drove in a pin and cleansed frequently with disinfectant so- left the child, till finally in its agony it lutions, and I find soda biborate most ex- would tear loose. This failing, he hapcellent for the purpose. This cleansing pened to see an advertisement of a rheushould precede the various local sprays, matic cure, and thinking that was what etc., which are to-day in use. Did it ever ailed the boy, sent for the cure. He called occur to you how negligent the human my attention to it, and asked for an family is with regard to the nasal cavity? opinion, at the same time passing his With clysters, la vage, Turkish and other fingers thru the sawdust packing and unbaths, we would think man pretty well covering a small package. In his surprise washed within and without, but this neg- he said: “Why I have been feeding him lected cavity goes with occasional with that sawdust for the past week!” "shoveling out."
I blush when I say this is only one of Catarrh, acute or sub-acute, of the nose, many such instances occurring right here ears or eyes, is quickly relieved by insuf- in “old Mother Cumberland county, Pa.' flation of boracic acid to the nasal cavity I would ask your family of readers to and eyes. The ears can be packed with what extent they prescribe and find use the powder. 1
in practise for whisky and other alcoholic Chloroform in labor is a most humane beverages. I will instance a few cases procedure. Our present civilization de- wherein I have prescribed spiritus frumands it. Physicians need have no fear menti, a few times uncombined, generally in its administration. It never did nor tho in combination with nox vomica never can do other than relieve the intense strychnia, aromatic spirits of ammonia, or suffering of child-birth. The only precau- capsicum. I have gotten most excellent tion needed is to procure the confidence results in elderly people in chronic bronof your patients and dispel any fear they chitis or purely functional cough from the may have. With most patients the mere use of whisky. In cases of dipsomania I mention of chloroform, or the first inhala- have cared for patients thro the entire tion of it, arouses fear, frequently in- night, administering frequent doses of tensely so. We all know the depressing whisky combined with ammonia strychnia, power of this emotion, how it lowers and etc., to keep up action of the heart. I unsteadies the action of the heart. The have tried other means to relieve these objectors to the use of chloroform in labor unfortunates, but find the above the only are found principally amongst two classes sure relief, often enabling them to return of persons—doctors who are unwilling to to work the following day. A very bright take the pains to become experts in its man of this town would take charge of his use, or who underestimate the importance classes in the high school the next day of their patient's suffering, and the ma- after an attack if treated thus. A former jority who, now exempt from the pains of patient of mine from an adjoining town child-bearing by age, can see no good called early one Sunday morning. reason why the younger women should appearance indicated distress of body and be saved from what they once suffered. mind. He held out a trembling hand and
pleaded for a little stimulant to help him It begins with a chill, often severe, and a get home. His pulse was extremely fee- burning and itching of the skin of the ble. I prescribed a bottle of medicine right hand, which soon becomes red and containing tr. capsicum, nox vomica and greatly swollen. There are no vesicles, whisky. During my past two years of pustules or bullae on the skin, but it looks practice I have seen indications for this like an erysipelas. The inflammation subor similar treatment in about ten or fifteen sides in about three days and the epidercases, and these constitute about one in mis peels off.
mis peels off. During the attack he loses ten of those who have applied to me for entirely his desire for food, takes nothing whisky, the rest being refused, as I did but cold water, and is inclined to heavy not think it indicated or needed, or thought and prolonged sleep. I have not learned that fraud was back of it.
that any one has taken his temperature at I would like to know if this practise is such time. regular and if I have violated any law The joints of the hand are almost encovering the dispensing of alchoholic tirely free from soreness, but I learned liquors. From malice I have been arrested by careful questioning that he had a little and bound over to answer at court for soreness of the thumb and wrist joints doing what I believed conscientiously to preceding the last attack, which may have be my duty. I only fear the laity will not come from the strain of husking corn. appreciate the trying ordeals which we as Laboring men here are usually liberal, physicians have to face. Are we as physi- though not luxurious, feeders. I do not cians to reject means which we have know as to his habits of eating meat. I learned from experience will relieve suffer- have not learned that any examination ing the quickest and safest ?
has been made of the urine. He has not I myself am a “teetotaler," but we find asked me for treatment. Says that the many perverted appetites and constitu- doctors do not help him. tions which tax the physician's resources. Capopolis, Mich. T. W. ANDERSON. M. R. PETERS, M. D.
[The case seems one of angio-neurotic Boiling Springs, Pa.
edema.-Ed.] [We do not know of any law to which you would have become amenable under
Fracture of Neck of Femur-Placenta Pre. the circumstances you relate. A physi
via. cian's prescription is especially exempted
Editor MEDICAL WORLD:- In 1882 in all laws we can recall concerning the
I was called in consultation to sale and dispensing of liquors. You seem to be having pretty hard lines, but there
examine a school boy who, with other should be no doubt of your speedy tri boys, was playing by jumping on umphing over your difficulties.-Ed.]
each other's backs. This boy was well grown and about twelve years old. He
was crushed down and his legs spread wide A Peculiar Case of Recurrent, Localized
apart. He did not complain of any parErythema.
ticular pain, except near the knee. He Editor MEDICAL WORLD :-I have lately could not walk or use his left leg to step, met with a case peculiar and interesting to except to greatly increase the pain. I told me, and I submit it for publication, if you the doctor in charge that he had a fracture think it may be of interest to others. of the cap of the femur, tho only a very
The invalid is a male, American, single, slight crepitation could be discovered and a farm or mill laborer, as work offers, aged only a shortening of about one-fourth of 42, of good family, and of good deport- an inch. I advised that the foot and leg ment and habits. So far as I can learn, should be well supported to natural posihe does not use wine, beer or other alco- tion and that he should prevent eversion holic drink.
by use of sand bags on each side. He has been afflicted at intervals, for the This was neglected and the boy repast twenty-two years, with a dermatitis of covered, and to-day the toe points outward the right hand, extending often nearly to and it is with difficulty that he can walk the elbow, The attacks recur at intervals over rough ground, or at a good speed. of from two or three weeks to four or five Mrs. C., aged 40, mother of five or six months. He has a greedy appetite for two children, very poor, called me for severe or three days preceding the attack, and flooding. On examination I found she after a hearty meal is soon hungry again. was in the fifth month of pregnancy and