« ZurückWeiter »
When the air passages are involved, their upper parts are in reach of local applications by aid of the laryngoscope, the rheinoscope, the atomisers, the probang, etc. But in fevers, as the abnormities of the mucous membrane of the alimentary canal do most complicate our cases, there are many and obvious difficulties in the way of successful local treatment. Instead of to water, as cleansers, we have here to resort to emetics, mild purgatives and enemas. Instead of dry dressings to exclude contact of air and microscopical organisms, resort must be had to such applications as necessarily become moistened by the fluid and semi-fluid contents of the canal, and which protect by their chemical or mechanical action upon the tissues or the secretions there
Of the modus operandi of
CHLORATE OF POTASSA, now much used in catarrhal affections, and in diphtheria, the explanation usually given is based upon the hypothesis, that it gives out its oxygen to the blood, in such a manner as to prevent cyanosis and to promote the solvibility of exudates of abnormal fibrine.
For some years past,
has been used by me with highly gratifying results, in affections of mucous membranes wherein epithelial desquamation exists or is sus. pected. I use it in solution or dry as the patient may prefer and ad libitum. In those cases in which the patient complains that everything he swallows feels hot as it passes the sauces and esophagus, it uniformly relieves or paliates. Could it be made to spread over a desquamated duodenum, jejunum, ileum or colon as it can be made to do over the lining of the fauces, and oesophagus and the stomach, I doubt not many of our cases of fever, wherein those regions of the alimentary canal are the seats of desquamation and its sequela, that now often prove fatal, could be promptly relieved.
The gratifying results wrought with benzoic acid as above stated, is a vindication in part of the practice, in vogue for ages, of prescribing the balsams, in affections of the bronchial tubes and the alimentary canal. If, as is now claimed, benzoic acid is an antiseptic and its therapeutical value in desquamations and ulcerations of mucous membrane is satisfactorily proven, the frequent prescription by practitioners of former generations of Balsam Tolu, in cuugh mixtures and of Co
paiba, in chronic affections of the bowels and urinary apparatus, is fully vindicated. For benzoic acid exists in all the true balsams.
In Texas, owing to the outdoor employment of many of the people, and their almost exclusive diet of bread, meat and coffee, many patients of both sexes and all ages are to be met with whose diseases are complicated and rendered somewhat unmanageable by
The physician whose experience has been confined to civil practice, cannot form an adequate idea of how easily and quickly the blood of patients may become scorbutic, when subjected to its usual provoking
Since I have been in Texas I have met with one case of scorbutic blindness, which yielded promptly to anti-scorbutic diet alone. Scorbutus is an evidence of serious impairment of vital energy—a proof that the vis medicatrix is impaired. In a sparsely and newly settled country, the conditions that provoke scorbutus, are as sedulously to be avoided, as among soldiers and sailors. Yet many practitioners seem not to be aware of the frequency of the presence of scorbutus. But he who would secure reasonable success in the treatment of fevers in this newly settled State, must be ever on the qui vive in regard to it, and prescribed when it exists, with reference to it. Many obstinate cases of ophthalmia, (especially granular conjunctivitis) nasal catarrh, chronic pharyngitis, uterine disorders, chronic sores from slight wounds, etc., may be seen in Texas, that cannot be successfully treated without putting the patient upon anti-scorbutic regimen and diet.
Doubtless the scorbutic element in many cases of common continued and paroxysmal fevers, is the chief factor of fatality; for it always promotes asthenia. A failure to recognize this scorbutic element has helped to produce the popular and professional mania, now so prevalent, to discover new fevers and to give new names to old ones.
In a sparsely settled, and an open country, though long settled, the typoid fever of Louis, and typus gravior of the ancient writers are of rare occurrence. But there we may expect to find the synochus and synocha of Sydenham and Chapman, and the paroxysmal fevers of malarial origin, modified by and presenting various phases of expression, due to circumstances and contingencies, that accompany the topography and the mode of living, the pursuits and hereditary and acquired idiosyncracies of the patients themselves.
Thus malarial hæmaturia is liable to occur in patients exposed to malarial poisoning, and is no more a new disease than obstinate epistaxis, chronic splenic enlargement, purpura, hemorrhoids, and metrorhagia that often result from the same cause, whose best remedies are quinine, the opiates and the chalybeates judiciously prescribed.
Objectionable as is this paper, on account of its length, in conclusion it is proper to remark:
ist. That what has been here uttered was suggested by the conviction that too little investigation is being made, at the present day, into the etiology, pathology and therapeusis of fevers, which must continue hereafter, as in the past, to demand intelligent attention during most of the time spent at the bedside by the general practitioner.
2d. Our progress during the last half century in the study of the pathology of fevers has not been pari passu with our progress in study of genecology, ophthalmology, laryngology, or some other departments of special pathology. Yet the honor, glory and usefulness of the medical art must at least find their most comprehensive and potent vindication at the bedside of fever patients.
3d. If the effect of the utterances of this paper shall be to wake up any considerable number of the busy practitioners of Texas to the importance of the accurate study of every case of fever they are called on to treat, with a view to correct and minute diagnosis, which is essential to successful treatment, the time and labor employed in giving expression to them will be amply compensated for.
4th. After more than four decades devoted to the study of medicine, the writer is compelled to record his conviction that the literature of fevers is unsatisfying to a lover of scientific truth ; and to express the regret that beyond the boundary of our knowledge of them there is an extensive field of the unknown, which, in this age of specialists, too few are zealous to explore.
The subject of fevers comprehends the whole field of pathology, and is too wide and too broad for cultivation for pecuniary profit, as compared with the small flower gardens in which specialism revels in luxurious ease and comparative intellectual indolence. Their therapeutics comprehends all of medical theory and medical art. The general practitioner, who gives earnest and intelligent attention to the study and treatment of fevers, and, day and night, from year to year, at the bedside vindicates the claim of scientific medicine to the confidence of the people, is a true representative of our humane profession.
NATURAL HISTORY OF CESTOIDEA.
C. M. RAMSDELL, A. M., M. D., LAMPASAS, TEXAS.
NESTOIDEA is a name given to a very large family of parasitical U worms, some members or other of which infest individuals in all the grand divisions of the animal kingdom, beasts, birds, reptiles, batrachians, fishes and insects.
The whole cestoid family bear such a close resemblance one to another, and are so closely allied in their habits, manner of propagation and characteristics in general, that a careful study of even a few species will give a clear conception of the whole family, and enable one to recognize any member of it at a glance.
In the present paper, only those species will be discussed which are known to infest the human body. Before entering upon a description of the human entozoa of this family, I will give a brief account of its general characteristics.
As the name indicates, the cestoid is a thin, ribbon-shaped worm. That is to say, it has that form in the stage of complete sexual development, for it has three states of existence, and it is only in one of them that it bears any resemblance to a ribbon or tape. The egg is very minute, having a diameter of from one six-hundredth to one-thousandth of an inch, or about three to five times that of the human blood corpuscle.
In order to be hatched, this egg must be taken into the stomach of some living animal. Once there, the embryo quickly comes forth, a slender grub, microscopic in size, its head armed with a crown of hooks so arranged and of such shape that by alternately extending and retracting them, giving a motion somewhat similar to that of a man's arm in the act of swimming, the larva is able to force its way through the soft tissues into any part of the body. It frequently enters the veins and arteries, and is carried by the blood current into all parts of the system, sometimes even into the brain and the eye. In this larval state the creature is without sex. When it reaches a place suitable for its purpose, it ceases its wanderings, burrows no further, but becomes encysted, assuming the form of a globule with a depression, at the bottom of which is the head. Squeezing the cyst will cause the head to protrude. Once encysted, the creature loses all power of locomotion, and remains for an indefinite period locked up in its prison. In this, the cystic stage of existence, it is as in the larval stage, without sex. Unless the cyst is taken into the stomach of some other animal, this is its last form, and it perishes along with the animal which it infests. If, however, the flesh, or whatever tissue it chances to be imbedded in, becomes the food of some carnivorous animal, the cyst wall is dissolved by the action of the digestive juices, and the cysticercus comes forth, once more endowed with powers of locomotion. It fastens itself by means of its hooks to the mucous membrane lining the intestinal canal, and takes on a new growth. The head protrudes from its cavity, the neck becomes elongated and wrinkled, and as the growth continues, transverse segments are formed, and in these segments are developed both male and female sexual organs. The cestoid is a true hermahprodite. The segments continue to increase in number and size, till, having reached maturity, they become detached and are passed out from the body, alone or mixed with the natural evacuations. When thus passed they are full of eggs, and even before they are detached from the main body the eggs are being extruded from the genital orifice of each segment in great numbers, so that they may be found at all times in the evacuations. Van Benedin has given to these segments the name proglottides, and by this appellation I shall hereafter designate them. Each proglottis is seen under the microscope to contain both ovaries and testicles, and in the fully developed ones the ovaries are filled with an almost innumerable multitude of eggs. The proglottis has the power of crawling about, of elongating and retracting itself, and if kept warm will retain its separate vitality for a considerable period of time, but it has not the power of putting forth new proglottides. This power seems to exist in the capital extremity alone.
The head, or scolex as it is called, is armed in most species, as before stated, with a crown of hooks. In many species these continue, but in some they are lost when the parasite enters upon its third stage of existence. The scolex is also provided with one or more suckers, through which it takes in nourishment, although it is probable that