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termination of the physiologic action of the of cocain. The formula tbus constituted is proprietary remedy in question.
the nearest approach in my opinion to the Primarily, one must study the nasal mu- proprietary remedy in question. I contend
a center for the discbarge of re- that the theory of asthma must not be based flexes. Some years ago in an article on, alone on a spasm of the circular fibres of the "Heretofore Undescribed Neuroses of the broncbi, but on an inability of the weaker, Lungs" (New York Medical Journal, June longitudinal fibres of the bronchi being un. 13,1896), I stated the premises upon whiob able to expel residual air imprisoned by the my conolusions were formulated. The first circular fibres. The effect of the proprietary proposition was, tbat there are conditions of remedy, like other efficient antispasmodics in nasal reflex genesis manifested by dilatation arresting the asthmatic attack, is caused in and contraction of the lungs. The second my opinion, by the contraction of the longiproposition was that the pulmonary neurosis tudinal fibres of the bronchial musculature of lung dilatation can be invoked in every which are no longer antagonized by the circuhealthy individual by any irritation of the lar fibres. The action has its analogue in the nasal mucosa.
At that time I maintained bladder musculature when, in consequence of that the vagus contained fibres whioh could
a spasm of the sphincter vesicae, the weak dilate or contract the bronchi. Auld of detensor vesicae, cannot expel the urine and London, England (Lancet, October 17,1903), ischuria spastica results. Everything speaks referring to the epoch-making researches of for the correctness of this theory. Thus, in Dixon and Brodie, says, “It undoubtedly asthmatics, owing to the feeble development belongs to the credit of Abrams, to bave of the longitudinal bronchial muscular fibres, proved at least seven years since by a sim- or to the excessive development of the circu. ple olinical observation, that the pagus must lar ones, it is impossible to elicit the long recontain bronoho-dilator as well as broncho- flex of contraction, or at any rate, it is but constrictor fibres." Now, when the proprie- feebly expressed. My tracheal traction test tary remedy is sponged into the nose even is practically lung contraction induced by of a normal individual, it will be noted, that vagus stimulation when the head is tbrown after a few minutes the normal lung reson- forcibly backward, during which time perance on percussion will be supplanted by cussion of the obest is executed. It will be dullness and, in some chest regions, a flat found that in health this test is positive, i.e., percussion note is elioited (Abrams' lung re- when the head is thrown back or forcibly to flex of contraction). The same reflex phe- the right or left, percussion over the manunomenon was observed in asthmatics. It brium sterni and lungs contiguous thereto, may be noted parenthetically, that bypoder will yield a dull or Aat percussion sound, mic injections of adrenalin possess the same which is rather felt than beard (palpatory peraction in translating lung resonance into cussion). dulness or fatness. Adrenalin subcutane- This test is positive in health and in all ously only, is perhaps one of the most effi- cardio-pulmonary affections, but it is not cacious remedies for arresting a paroxysm present in all instances of idiopatbic asthma. of asthma. I employ the adrenalin chloride I have already shown that in balations of solution (1 in 1000) of Parke, Davis & Co., amyl nitrit (American Medicine, January 3, of which 8 to 15 minims are injected. It is 1903), which often succeed in arresting astb. rarely necessary to repeat the dose. I have
matio paroxysms, induce the lung reflex of found it equally serviceable in many forms contraction. This remedy recently so highly of dyspnea even when morpbin was without vaunted for the arrest of hemoptysis, owes effect. It remains to be seen how far experi- its efficacy in my opinion, not to any alteramental adrenalin atheroma will influence the tion in blood pressure, but to the production clinical employment of the drug.
of a veritable lung zeflex of contraction. the hypodermio use of adrenalin chloride to Amyl nitrit in hemoptysis may justly be reBullowa and Kaplan (Medical News, Octo- garded as a specific. In individuals who ber 24, 1903).
suffer from asthma of presumable nasal geneNext I ran the gamut of all the recognized sis, I have frequently found, that stuffing antispasmodics to determine their effect on both nostrils with coiton will precipitate a lung resonance by nasal instillation. I oon. typio asthmatic attack. Even though a par. cluded in brief, that employed alone, they oxysm may not be induced, one may Lear on induced lung dilatation (Abram’s Lung Re- lung auscultation, after the cotton test, the flex of Dilatation) and only when combined rales peculiar to asthma. Two factors, psy. with cocain was it possible to obtain the same chic and reflex, operate in this test.
A psy. percussional lung effects as from the proprie chio stimulus sets up directly an altered vistary remedy previously referred to. Hence ceral condition. Thus the firm impaction to ibe formula suggested by Bertiam add 3% of cotton in the nasal cavities creates the con
ST. LOUIS, MO.
cept of air hunger which is followed by the POSTMORTEM REPORT OF A CASE OF automatio employment of agencies which tend RUPTURE OF THE STOMACH, DUE to combat it. The reflex factor is undoubtedly TO GASTROMALACIA.* predominant, insomuch as previous cocainization of the nasal mucosa, will with the cot
J. A. HARTMANN, M. D. ton test in most instances inbibit any tendency toward a paroxysm. In the employment of agents by the pasal route for the arrest of The following case is of considerable inan asthmatio attack, I cannot deny the pos- terest because of its rarity, and because of its sibility of absorption. Thus in experiment- etiology which is unusual.
etiology which is upusual. I regret that the ing with various antispasmodics, I often in- records are far from complete; the examinaduced physiologio and even toxic action of tion was made under most unfavorable au. the drugs in question. In several instances spices, in the home of the deceased, on the intractable emesis followed the insufflation of undertaker's cooling board, and with such apomorphin. These observations taught me limited facilities as were at hand. The stomthe very important fact, that the nasal mu. ach only was removed for demonstration to cosa is a suitable obannel for the introduction the coroner and for chemical analysis. of medicaments into the body. Thus with On July 22d, 1906, the case was reported apomorpbin, nausea and emesis in several to the coroner, and early in the day I was orinstances were induced by less of the drug dered to make a post-mortem, as death octhrough the nose than by the stomach. The curred suddenly and without medical attend eventual mastery of asthma will be accom- ance, and the cause of death as given by plished along the lines of least resistance. It the family (heat-stroke), did not seem tena. will not be a subjugation of spasm, but of ble as the night previous had been but conditions which can antagonize spasm. In moderately warm, and the death had occurred other words, spasm in the presence of cirou- in the early morning. The police evidently lar and longitudinal fibres is an expression of inclined to the theory of self-destruction, as enfeeblement contending with strength, and did the reporters for the daily press who to annihilate this anomaly, we must direct our were present. The residence was remote efforts toward toning up the longitudinal from my office, and I arrived at 5 p.m. and fibres of the bronchial musculature. This immediately proceeded with the examination. is not an impossible task, if we but appreciate The body was that of a young woman of 25 the fact, that the lung reflex of contraction years, Jewish, a native of Hungary, and for can be evoked.
six years a resident of St. Louis. A very incomplete family history could be elicited; her mother died at the age of about 50 of
heart disease; ber father lived to the age of COEDUCATION was roundly condemned by 78, the cause of his death was said to have President G. Stanley Hall, of Clark Uni. been senile debility. Three brothers living, versity, in his paper recently read before all in good health; one dead, his death at 37 the American Academy of Medicine, in having been due to brain fever. A brother Boston. From his profound studies of ado- stated that the deceased had never been really lescence, Dr. Hall is entitled to considera- siok in her life; she had had the hardy rosy tion and his opinions will have great weight cheeks, and such color as is the picture of in the present tendency to separate the sexes health and is found in many foreigners on in the public schools after 12 years of age. their arrival in America. Her occupation It is quite likely that the vast majority of the had consisted in general housework and care medical profession already agree with Dr. of her brothers' home. She first complained Hall though from different motives. His
of indisposition three years ago, when sbe opinion is based upon the fact that the life attributed her trouble to her heart. She had role of men requires a set of mental charac- taken on flesh rapidly, a matter which disteristics, the opposite of those of women, and turbed her considerably, and which seemed a that to modify either sex by training it in the contributory cause for periods of depression atmosphere of the other, is to unfit it for its and melancholia, her imagination centered struggle for existence. A compromise of on the point that she was getting too stout. methods is unsuitable for either. Boys must This was aggravated by members of the fambe trained to greater manliness and girls to ily twitting her of being fat. To counteract greater womanliness, so that each will be
this tendenoy to superfluous flesh, she had able to supplement the other. Coeducation begun at a time about two years previous to may nct produce long haired men and short her death, to limit her diet as closely as pos. haired women, but its tendency is that in that direction.-Am. Med.
before the Macoupin County (Ill.) Medical Association at Carlin ville, October 16, 1906.
sible to acid foods; eating pickles and drink. dences of gastric ulcers, past or present, but ing vinegar and other acids for their sup- there was an irregular tear along the fundus, posed therapeutic effect, and avoiding all fat following the greater curvature and situated producing foods. Tbis bad been continued anterior to the gastro-splenic omentum; this up to the time of her death.
was about four inches in length, the peritoOn the evening of July 21st, she had neum was retracted from its edge, and at the seemed in usually good health, she had spent edge the stomach wall was of the thickness of the evening with a brother and his family in thin paper, and over the rest of the stomach a distant part of the city; he states that they was but slightly thicker.
The examination noticed that she was in unusually good spir- of the other viscera sbowed the liver and gall. its. On ber return home she retired without bladder normal, the common duot patulous; complaining of feeling ill. In the morning the intestines were empty,a chronic catarıbal she arose at supposedly the usual time (about duodenitis was discovered, but there was no 6 a.m.) and walked to the bath-room, a dis- other pathological lesion of the intestines.' tance of about ten feet, and in the bath-100m The pancreas was normal; the left kidney was fell forward striking ber forebead on the edge movable, but the kidneys were otherwise norof the tub causing a contusion described be- mal as were the ureters. The bladder showed low. The family, on hearing the fall, bas- a mild cystitis at the trigone, it contained tened to the room and found her lying on about two drams of clear, light colored urine. ber face on the Hoor. A physician was bas- The uterus showed a subserous fibroid, about tily summoned and pronounced life extinct. one inch in diameter, situated on the posterThe case was reported to the police, and they ior wall, near the fundus, it was otherwise
, in turn reported to the coroner, who ordered normal. Both ovaries were cystic. the post-mortem examination.
The sternum was then removed, and the The body was that of a white female, thoracic organs were found in normal posi. height 5 feet 31 inches and weight about 140 tion; the pericardial cavity contained about pounds; well nourished, but very anemic, an ounce of citron colored fluid, the heart having the waxy color, indicative of possible was normal in size and showed a slight deinternal bemorrhage. There were no external gree of fatty degeneration.
gree of fatty degeneration. The semi-lunar evidences of violence, except a small super- valves of the aorta were slightly thickened. ficial circular contusion about three-fourths The arteries were markedly atheromatous. of an inch in diameter, situated on the fore. The plural cavity showed pleuritio adhesion head, above the left eyebrow, close to the mar. on both sides, but no effusion. The lungs gin of the hair, and which was so insignifi. were normal. The mucous membrane of the cant tbat it could have played no part as a esophagus was silver white in color, very cause of death. There were no burns about thin and easily torn. the lips, tongue, or mouth and no odor was The scalp and skull were normal, the cordiscerned.
erings of the brain and the brain itself were A median incision was made from the su. normal. This narrowed the examination pra-sternal potch to the symphysis pubis, ex- down to a consideration of the conditions posing the abdominal viscera; the left side presented by the stomach. of the abdominal cavity was filled with altered Owing to the extreme thinness of the walls blood clots, and pure blood, much of which of the stomach and the congestion and dark had to be removed before the viscera could be color of the mucous membrane of that organ, examined; the blood clots covered both the a chemical analysis was made of the stomach anterior and posterior walls of the stomach substance, there being no contents, for the at the fundus, completely surrounded the following poisons with results noted; the regspleen, and a considerable quantity was found ulation tests being used. anterior to the left kidney. The space be- Carbolic acid-negative. tween the diaphragm and the left lobe of the Corrosive sublimate-negative. liver and between the left lobe of the liver Caustic potash-negative. and the stomach was filled. The hemorrhage Caustic soda-negative. area being the left side of epigastrium, left Pbosphorus-negative. hypochondrium and the left lumbar regions. Nitric acid – negative.
The peritoneum was found normal, the Silver nitrate--negative. stomach collapsed empty, and markedly con- Hydrochloric acid could be detected, though gested, its mucous coat was dark brown, there not in abnormal quantity. A digest of por
A was an entire absence of rugae; this even ex- tions of the stomach was made which showed tending to its pylorus; its walls were very acetio acid very definitely. Test was made thin and slimy und were translucent when for acetic acid by digesting the stomach subheld to the light, showing an evident atrophy stance with distilled water and filtering, the of the muscular coat. There were no evi- color of the filtrate was light straw with de
oided acid reaction; the odor of acetic acid In looking over the literature on this sub. was marked. Neutralizing with ammonia jeot, I find according to Cattell, † that when water and ferric chloride test solution added the contents of the stomach are found in the a blood red color proved the presence of acetio peritoneal cavity, care must be taken to de- . acid, this was confirmed by the color being termine whether the escape was due to (a) dispelled on the addition of sulphuric acid. post-mortem digestion, or autopepsia; (b) to The examination left us with a confirma.
trauma; (c) to perforation from a gastric
ulcer, or from chemical erosion by poison, tion of the opinion that death was due to the development of the condition by violence of
etc. ; (d) to the presence of (b) and (0) with diet. We were told that the deceased has not
the factor (a) as the real cause.
In the first only used an aoid diet, and that for a long case, the ingesta are usually widely distributed
, time, but that she had been known to drink
throughout the abdominal cavity, though pure vinegar, and that at frequent intervals.
more plentifully in tbe immediate neighbor
hood of the perforation; the rent is large and The chemical analysis of the stomach.con- irregular and the walls are soft and slimy, firms these statements and demonstrates the while in disease the opening is apt to be small morbid effect thereof. Whether or not the and circular and surrounded by evidences of rupture of the stomach occurred before, at hemorrhage and peritonitis, undigested food or after death, is a matter which we cannot
enters the peritoneal cavity through a breach definitely determine; its cause may bave been in the gastric wall. hemorrhage in the stomach, or an accumula- Auto-digestion is especially frequent in tion of gases, the presence of either may cachectic abildren. I think while there is a have occasioned her arising and going to the possibility of there having been a certain bath-room where in falling the stomach was
amount of post-mortem auto-digestion, after ruptured or the rupture might bave 00- a part of the stomach bad ruptured, the precurred from the same cause
vious history of acetio acid poisoning which she arose from her bed. It would seem we found so clearly before and after death, that spontaneous rupture of the stom. would correspond to the cause of rupture by ach rarely takes place, then only as Cattell under (o) chemical erosion, and the a post-mortem condition, or in the agony just positive evidence of recent hemorrhage. preceding death (Stengel). * In this case we Unfortunately the specimen passed out of bave absolute cause for the malacia by chem. my control before I made a mioroscopic exical examination and the previous bistory of amination, but the fact of such extremely the case. The fact that the deceased retired
thin walls is in itself proof of atrophy of the in what was considered by her family normal muscular and the mucous coats which was health, in conjunction with the fact that undoubtedly the result of the diet. there was no terminal edema in either lung, My thanks are due to Mr. A. P. Leftwich proved conclusively that death was sudden.
for his painstaking chemical analysis, and It seems possible that there may have been a also to Dr. Jules Baron, coroner, for allowtear in the mucous membrane, or that an ar- ing me the privilege of reporting this case. tery ruptured in the stomach wall (the arteries is being atheromatous) causing hemorrhage
1228 South Broadway. into the stomach, and that the weight of this blood and the effort of the stomach to get rid of it could have resulted in a rupture at the
REST CURE.-Six weeks in bed was the
old treatment for acute articular rheumatism. thinnest part, which in this case was at the fundus. Had gases suficient to cause the
Six weeks in typhoid, six weeks in iritis, six tear been generated in the stomach, one
weeks in gonorrhea at its best, and six weeks would have expected to find distention of the
in so many other infections, all suggest that abdomen, which was not present. Such a
perhaps here there is the basis for some kind condition would in all probability have oc
of a generalization. Perhaps the organism casioned great distress and caused the de really requires six weeks to gather its forces ceased to gain relief, either by changes of po
and manufacture its supplies to defeat an sition or by direct pressure.
In either or
army of invading parasites of certain species both attempts, the stomach could have been
and repair the damage they inflict.
It is a torn. Another interesting fact brought out
thought well worth following up. Even if in this case was the marked atheroma of the
there is no such general law possible, it is a arteries in one so young, which no doubt was
good rule to impress upon patients even in occasioned by the peculiar acid diet, bearing
the most trivial complaints--a cold-an inout the theory that the condition was pro
fluenza--a depression from overwork.-Am.
Med. duced by dietetic causes.
#Hy. W. Cattell's Post-Mortem Pathology, 1905 edition, Alfred Stengel's Pathology, 1903 edition, page 529.
THE MAN WITH WHOM YOU MUST LIVE. more eloquent plea. Or the request may
come from some respectable married lady, A. L. BENEDICT, M. D.
of wealth and influence, who has nothing to fear as to reputation but wbo, as a matter of
health, or convenience, or economics, or III.-TALKS TO RECENT GRADUATES.
whim, wishes to limit her offspring. T'he
request may come from some male acquaintSome one bas said that everyone should try ance, perhaps your former chum, who is up to live in the society of his superiors and against it-it may be bis fiancee is involved some one else has asked what would happen or some other girl, when his wedding day is if the said superiors should, themselves, adopt already set. Perbaps the request comes the same rule. In a broad sense, however, from some older man or woman, to whom every man is, at one time or another and in you bave looked up for years, as an adviser, che respect or another, the supericr of every a model of good morals, an active church other man. It does not seem a wise, certainly worker, a professional colleague. not a generous policy, always to seek the so. From whatever source the request comes, ciety of those who can help us and yet, in the bear in mind two important facts: You long run, it is both wise and just to select do not need to explain the iniquity of an associates who will draw us upward rather abortion nor its serious risk; everyone who than downward. Every man has one asso- has any sense at all, realizes these points. ciate whose society he cannot avoid, with Neither can you summon any logic nor elowhom he must spend more time than with quence that can equal the need and the anyone else-himself.
earnestness of the person who wants the Right here, we wish to state that this arti. abortion performed. One more fact may be cle is not exactly a sermon, although it might stated: an abortionist who is aseptic and not be prefaced with one of a number of Bible too clumsy, can enjoy a lucrative practice, texts, and that it is not a report of one's own with very few deaths and the man who refuses oase. The physician who reports his own to perform abortions will lose a good deal of case, does not always have the proper per
practice and will make enemies of many inspective and, besides, we dislike to report a Auential persons. case which has turned out not altogether suc- Now, having these facts clearly in mind, cessfully, and in which we are not even sure make up your mind tbat you will not perform that the diagnosis is accurate.
your first abortion, refuse to discuss the It is scarcely necessary to state that this matter with applicants, and stick to your man with whom we must spend the greater principle, which is simply a corollary of the portion of our lives, ought to be decent and sixth commandment, regardless of financial honorable. We do not want to be tied down losses. It isn't pleasant to live with a mur. to the society of an abortionist, for example. derer, however successful his practice; and, Very early in your professional career, you besides, the professional murderer is bound, will be asked to do an abortion. The request sooner or later, to be found out. may come from a prostitute or a woman who, Abortion is about the only out and out without mercenary motives, leads a rather crime, to which the physician is particularly promiscuous sexual life. Such a woman has tempted.
tempted. You will read in detective stories already had so many abortions that she thinks of physicians who administer poison to assist nothing of them, if she cannot induce you to in securing life insurance, who run slender perform the necessary operation, sbe will go needles into the medulla oblongata in order to this or that other physician, perhaps nam- to hasten the execution of wills, who chloroing one of good standing and repute. At any
form disagreeable relatives, or who prepare rate, as the abortion is going to be brought cultures of cholera spirilla to bring about a about anyway, you might as well perform it. change of political regime. But, whereas Or, the case may be the one of the melodrama any physician, however good his standing, or of the sexual morality lecturer or of the will be importuned to perform an abortion, novelist: the innocent girl betrayed and every few months, the average physician will struggling to maintain her reputation. Her never in his life, be asked to perform postargument is still more cogent and eloquent. natal murder. Neither will be, more than There is nothing that you can say to her any other man, be sought to perform other that she does not know and realize to be
gross crimes. correct on general principles but, in regard You will, however, probably be tempted to to her particular case, there is not an argu- do many acts that, while not strictly criminal ment or an appeal to conscience or a cold. nor in gross violation of divine law are un. blooded statement of practical danger that
ethical and dishonorable. If you are a relig. she cannot meet with a better, stronger and ous man, don't imagine that you can live