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of which one electrode is connected. The battery being so arranged as to give a very weak current, the patient applies one finger to the sponge of the other electrode ; two or more fingers may be placed upon the sponge, if the patient does not find the application too strong to be borne with comfort.
Faradization of the nerves leading to the wound may be conducted in a similar manner; the parts in the vicinity of the sore being stroked with the sponge of one electrode, whilst one or more fingers are placed upon the other.
Patients very soon learn to manipulate in such a way as to avoid painful muscular contractions in the neighbourhood of the ulcer, and can then be trusted to make subsequent applications for themselves; in the intervals the sore may be dressed with oiled lint. The pain at first soon recurs after each faradization, and for a few days the patient will frequently have recourse to the use of the battery ; but the period of relief gradually becomes longer after each application, and at the end of eight or ten days the sore is not more painful than an ordinary nonspecific ulcer.
In the meantime the appearance of the ulcer has not undergone any corresponding improvement, its base still being covered with adherent sloughs, its margins raised and occupied by a brawny infiltration, although the excessive sensibility has entirely disappeared. At this stage there are many remedies which will act beneficially, but of these the nitrate of mercury deserves the preference. It may be used in the form of an ointment, eight grains to the ounce. At first this application causes a slight smarting, but nnder its iufluence the ulcer soon cleans rapidly, its raised edges sink, and the healing process makes rapid progress, so that in from fifteen to twenty days the cure is completed. Treated in this way a phagedænic ulcer as large as a twenty-dollar gold-piece will heal in about a month. A phagedænic ulcer is more difficult to treat when a patient is at the same time suffering from periosteal pains, for in these cases the relief afforded by the faradaic current is not so complete. Under these circumstances injections of the nitrate of mercury are extremely
serviceable. They are less harmful than injections of the
A 3 xiv.
On the abortive treatment of Syphilis -By Dr. GUSTAVE E. WEISFOLG, from Virchow's Archives, Vol. LXIX, 1, p. 143.—The author, who appears to think the abortive treatment of syphilis is quite within the bounds of possibility, says that whoever believes at all in the efficacy of medicines must also admit that we have only to find a suitable remedy or method of treatment in order to prevent the first local manifestation from passing on to a general or constitutional affection. In support of this proposition, he points to the fact that there is always a considerable interval between the appearance of the local disease and the symptoms denoting general infection, and maintains that during the interval it should be possible to anticipate and prevent the process of general infection. One of the chief difficulties to be overcome is to form a correct estimate of the actual value of any course of treatment pursued with this object in view, since several years must necessarily elapse before any decisive results can be attained.
Certain it is, however, that those remedies which are known to have a curative effect when given internally for constitutional syphilis, do not, when given in the same way, possess the power of preventing general infection. This indicates at least one direction in which there is nothing to hope for from the abortive plan of treating syphilis. The author adheres to the generally accepted doctrine that infection takes place through the medium of the lymphatics—though doubts as to the correctness of this view have recently been raised-and lays great stress on the experiments of Broca. The latter attempted to prevent general infection when there was a syphilitic sore on the penis and swellings of the inguinal glands, by incising and injecting them with iodine, thus setting up an acute inflammation of the glands in question.
He was led to this from the common observation that sores followed by suppurating bubo seldom give rise to constitutional infection, and he hoped to attain the same result by imitating nature. Although the author finds this plan of treatment useless as an abortive measure, he maintains that the principle upon which it is founded is correct, only it is essential to be beforehand with the syphilitic poison and grapple with it before the general lymphatic system is impregnated by it. He, in fact, attains the object which Broca had in view, but by a different method of treatment. The author directs attention to the curious fact, that the watery solution of nitrate of mercury mentioned in the previous article, may be injected under the skin of a healthy part without even setting up purulent inflammation, but that if the part be already inflamed, such an injection invariably produces an abscess, and he has utilized this peculiarity of action in such a way as to prevent the spread of venereal poison from a primary sore through the inguinal glands to the system. In any doubtful case he injects some of the solution subcutaneously, between the sore and first convolution of inguinal glands likely to be infected by it. If these glands, or the lymphatics leading to them, are not already in an inflamed condition, no abscess is formed, and if the injection is repeated every ten or twelve days till the primary sore is healed and the induration has disappeared, constitutional syphilis never ensues.
In those cases in which, on account of already existing inflammation, abscesses formed, the patients still remain free from syphilis. The author has practised this abortive treatment, during the last five years, in thirty-two cases of indurated and mixed chancres. Of these, abscesses formed on both sides in fourteen cases, on only one side in six cases. The final result was followed up in twenty-eight of these cases, all of which remained free from syphilis, as did also their children.
This method of treatment is based, according to the author, upon the law that “ mercury exercises its specific action as an antisyphilitic most effectually when it comes in direct contact with the chancre poison in the tissues primarily affected ;” and this occurs when those tissues are impregnated with mercury, which contain the lymph vessels connecting the chancre with the general lymphatic system. The author concludes the articles by earnestly inviting the profession to give the proposed method a fair trial.
Paracentesis Abdominis by gradual drainage with a single fine Cannula.By Reginald Southey, M.D. Oxon., F.R.C.P.—The unusual relief of the distressing symptom of anasarca which I found follow the employment of fine drainage-cannulas encouraged me to employ nearly the same apparatus in the treatment of ascites; and now that my experience has extended over a fair number of cases, enough to satisfy me that this mode of proceeding is attended by no extra risks, I venture to lay it as briefly as I can before the profession,
Apparatus.—The trocar and bulb-headed cannula required for the purpose of gradually drawing off ascitic fluirl, by the help of a capillary tube, differs very little from that employed by me for anasarcous limbs. Both instruments are equally fine. The calibre is the No. 1 exploring trocar of the surgeon. One long needle-trocar, measuring an inch and three quarters in length from bilt to point, has appeared long enough for all the cases hitherto tapped by me. Three or four cannulas of different lengths, adapted to the thickness from fat and oedema of different abdominal walls, are required. The cannulas may be perforated with as many as six or eight side holes—the more the better, so that their strength is not interfered with The mouth end of each cannula should be armed with a small silver
plate or shield, to obviate any risk of the cannula head sinking beneath the surface of the skin when this is highly oedematous ; and, simple as it may seem to contrive an armature which may thus secure and help to maintain the cannula in position, I may say that I have not yet quite mastered the matter. As to the length of the shield or cross-beam, one inch appears ample -i.e., half an inch each side of the cannula. The shield may be round or square with rounded edges, or, as I have had mine made, as elongated plates, one inch long by a quarter of an inch broad, and about a thirty-second of an inch thick. Whether the cannula was best fixed immovably to the shield or otherwise, was the next point to decide. It was found that the immovably fixed shield, held fast by two strips of plaster, by dint of the movements of the abdominal muscles in respiration eithrer worked away from its plaster moorings or tended to work out the cannula end from the peritoneal cavity. Messrs. Ferguson therefore contrived a shield for me which held, but allowed the cannula a limited play in every direction, and in practice this has worked admirably. One instrument I had made for those particular cases in which, although the ascites has been considerable, and its relief urgent, the presence either of cancerous tumours in the abdominal cavity or an enlarged liver has rendered a hard and pointed body, like the cannula end, abutting on the peritoneal aspect of the abdominal parietes, undesirable ; for as the fluid drains away the abdomen collapses and the parietes sink, and large, soft-surfaced masses, moved up and down by the descent of the diaphragm, might be torn and fretted against the cannula, and made to bleed. To meet this emergency a cannula which merely traversed a shield-plate, and was not fixed at all, appeared best adapted. If anything pushed it from within, out it could come.
Mode of operation.— Trivial as this is, it appears to me from experience that there is a right and a wrong way of introducing the cannula. Instead of driving the trocar in quite perpendicularly, it is best to slope the point downwards somewhat towards the pubes, and to avoid making the cannula point upwards towards the sternum. The wound made is so slight