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but little can be done to make the patient's thoroughly annointed with this, covered with brief existence at all bearable.
absorbent cotton, the cotton kept in position The treatment of burns and scalds will vary by a roller bandage. with the severity of the injury. The first in
It is often very difficult to so lay the patient dications, are to relieve pain and overcome shock, later to guard against congestions and that the burned places are relieved of presinflammation of internal organs; and still sure, and it is frequently necessary to allow later to counteract exhaustion, to support the him to remain in the sitting posture, somepatient by the use of nourishing food, by times for several days, with support for chin, quinine, iron and the mineral acids.
by suspending him by means of wide strips The treatment of shock should be conduct- of muslin passing under the chest or abdomen, ed as in other cases of shock, by artificial
the strip being fastened above. Dr. Fuller of
Neukinchof, recommends that the patient first warmth, and by enforced rest. In severe cases a hypodermic injection of morphine and be treated to a warm bath. The burnt suratropine should be given at once.
faces are then washed with an aqueous solution be repeated until pain is controlled. If an
of thymol, 1 to 1,000 followed by the applicaanæsthetic is necessary great care should be tion of a thymol spray for several minutes. taken in its administration.
The blisters are not disturbed, but handled
with extreme care. The raw surfaces then Hot coffee, beef tea and milk punch, should
painted with a one per cent. thymolized linbe given when reaction has commenced. Also
seed oil. The patient is then laid on a waterlime water if the stomach is irritable. Thirst which is usually intense, shouid be allayed by warm. The application of thymol should be
proof mattress and the room kept comfortably small pieces of ice, or small quantities of champagne, or carbonated water. Great care ten minutes, using large, soft haired paint
repeated at first, less frequently later, every should be used in dressing, to avoid unneces- brushes, and as it relieves pain very remarkasary exposure of injured parts, and consequent bly the patients themselves call for it. chilling. Saline laxatives or mild aperients
Since the sad accident which occured last should be used as indicated. Cerebral hyperæmia, tetanus, gastro-intestinal irritation, bron- month at the refinery of N. K. Fairbanks & chitis and pneumonia, should be treated as in Co., doubtless many of you have asked as to ordinary cases. Vesicles should not be broken the cause of death from burns and scalds. but punctured at their lowest point. In the various theories have been advanced from
time to flexures of the joints, between the fingers,
time in answer to this question. about the face and neck, great care should be Dupuytren thought that immediate death was taken to prevent adhesions. Time would
often caused by excessive pain, the irritation fail to tell of the innumerable number of of the nerve terminations inducing a paralysis
of the centres. remedies that have been employed in the treatment of burns and scalds. Flour and
Others have regarded it as due to an arrest soda are the chief remedies, that are always at of the cutaneous perspiration, consequent uphand, and for temporary use, much might be on the destruction of a large extent of integsaid in their favor. Then there is the water ument. Others again have maintained the dressing, white lead, castor oil, and the old so-called "mechanical hypothesis,” according time carron oil. The latter is a very efficient to which there is a dilatation of the cutaneous dressing, but the offensive odor, the unsightly capillaries and a consequent loss of heat, leadappearance of the patient, and the destruction ing to vaso-motor paralysis which extends to of clothing and bedding make it very the great vessels and the heart itself. objectionable. Much has been said in favor of Sonnenburg claims that instead of the asthymol, and iodoform, but my preference is sumed loss of heat there is an increased temdecidedly in favor of carbolized cosmoline. perature, even during the period of capillary Cosmoline with fifty per cent. of crystalized dilatation, and further, that this dilatation corbolic acid. The injured part should be was rapidly succeeded by a contraction of the
vessels when the burning was long continued Alimentation in Adynamic Conditions. or of great intensity. Tappeiner found a notable diminution of
BY H. O. BEESON, M. D., BIRMINGHAM, MO. the watery constituents of the blood, with an increase of hæmoglobin and red corpuscles.
In the matter of dealing with infectious and He found no changes in the red corpuscles. contagious fevers and other diseases, the first L. Van Lesser, was led by his investigations place in point of importance is conceded to to results differing from both Sonnenburg and prevention. However, the usual duty of the Tappeiner. The latest and most ingenious physician is to treat the malady after its detheory is that of Catians of Berlin, who be
velopment, and he has often to do this in the lieves the symptoms all point to an affection
presence of the conditions which produced it. of the cerebro-spinal centres, especially of the
In the case of fevers we have long been medulla oblongata. He also says that the
taught the theory of self-limitation, and that sweat is normally of acid reaction by reason to preserve the strength was the true principle of the formic acid which it contains and which of rational practice. To accomplish this deis neutralized on the skin by ammonia, form- sirable result, we are told to feed the patient, ing the voluble formate of ammonium, N H, thus supplying the place of matter which is CHO,. This salt becoming quickly heated supposed to be destroyed by the pyrexial congives up its water and becomes hydrocyanic
dition. acid. He claims that the symptoms following
It has been the practice to employ antiextensive burns and scalds are the same as pyretic agents to reduce high temperature, in those of prussic acid poisoning. Lesser rejects order to avoid as much of such waste as possithe views of Sonnenburg, Billroth and Lücke, ble. It has not been satisfactorily demonand claims that death after extensive burns is
strated, however, that either waste of tissue or caused by a reflected dimunition of vascular loss of strength is prevented by forcing the tonicity. Basing his views on a large number
temperature down. of carefully conducted experiments upon
However that mooted question may be in animals, he is convinced that the sudden death fact, it is acknowledged that we are unable after burns is produced by a relative anæmia, to materially contract or shorten the duraor rather an acute oligocythæmia.
tion of an attack of specific fever, and are conAfter careful study of the various theories tent to treat it entirely upon the expectant advanced by as many observers, we are forced plan, relying upon light medication and good to the conclusion that nothing definite is nursing to carry the patient through. In our known, that a theory only confronts us, and text-books and medical journals much importhat in replying to the question, what is the tance is given to the matter of nourishment, cause of death in burns and scalds? truth all advising liberal allowances of milk, soup, compells us, as in answering many other broth, egg-nog, etc. In the light of our presquestions to say we do not know.
ent knowledge, this is undoubtedly the correct Undoubtedley however, the chief factors in treatment, but we are not furnished with a dithe cause of death are the cessation of the etary adequate to the demands. Our bill of functions of the skin as an eliminator, its fail- fare is too limited to enable us to suit the taste ure to throw off carbonic acid with the gen- of the patient, and our knowledge of how to eral emanations, the interference with cuta- select is not equal to the task. Much attention neous respiration and with perspiration, the has been given to the observation of the physloss of the natural protection, and heat regula-jological action of remedial agents, but little tor of the body, and (as a natural result,) is ever said about the selection of food. We internal congestions.
can certainly improve our practice by a closer
attention to the details of the preparation and It is claimed that atropia hypodermically in- selection of food for fever patients. jected before the administration of chloroform The primary cause of a specific fever is the sustains the heart's action.
entrance into the blood of a materies morbi. And every case tends to recovery, not com- tion of the various aliments at his command. plicated, and would manifest the same tenden- We have been urged to believe that milk furcy without medicine.
nished all the elements needed. And have we It is usually a complication that causes an not fallen into the error of taking it for exacerbation of fever, and probably go per granted, without pausing to consider whether cent. of such complications are referable to or not it practically supplies those needs, in the alimentary tract. This state of affairs form suitable to the requirements and capacipoints out the importance of avoiding all pos- tjes of, the body, regardless of the needs sible sources of irritation of that capral. , Infof the system and the composition of food? The all cases of fever of a specific nature/of, 'what-pioposition is true that the best food for an ever type; the alimentary tract is supposed. to infant or an invalid is the food that agrees be in a condition very similar to that of the best. A food which meets all of the requiretongue, viz., hyperæmic or anæmic, sluggish ments of theory, may be not only useless, but from enervation and exudative thickening Harmful, practically. We are governed largely the natural secretions perverted, acrid and of- by fashion, and may have gone to the extreme fensive, becoming a foreign factor, productive, in our substitution of milk for almost all other by absorption as well as local irritation, of ag- foods. Perhaps we are too hard on beef-teagravation of the original disorder. Each type following the fashion. At all events, we can of fever presents its own peculiar local lesion, not speak too confidently of the composition but for all practical purposes the same general of milk, for it is unknown to-day. What conline of treatment is to be observed in all, and stitutes normal milk can not be told, hence the same necessity exists for proper selection our theory will not stand the test of analysis, of food.
and we have at last to resort to empiricism. Often we make our morning call and find Practitioners of thirty years ago condemned the patient has passed a restless night; per. the use of milk in fever. They also conhaps has had troublesome diarrhæa, nausea, demned cold water. The latter was a theoretvomiting etc.; bowels tympanitic, tongue ical objection, while the former was based heavily coated and tremulous ; the mind un- upon the observation that the ingestion of settled by dreams and hallucinations; we look milk was often followed by an exacerbation of at the patient and say this is a very bad case, fever, hence they argued that milk produced the malady has appeared in an aggravated fever, while, in fact, such was only the case form, and it will require an iron constitution when the digestive apparatus was unable to to outlive it. We seldom pause to determine digest the milk, and it became a foreign subwhat part our treatment has played in pro- stance, creating the irritation by its presence, ducing this turn for the worse. Perhaps we and not by its absorption into the system. I have been following the rut as laid down for speak of milk first because it is the best of our guidance in the text-books and journals, the convenient articles to be had in a family, giving milk till the alimentary tract is a stream and should always be tried first; but the misof festering milk clots, mucus and ammoniacal take should be avoided of supposing it the matter. We tell the friends the patient is only diet at our command. If it disagrees, much worse, and must be fed without fail. try the following, which has stood the tests of Give four tablespoonfuls of milk and whisky analysis, theory and practice : equal parts of every hour. The symptoms grow worse and milk, cream, lime water and weak arrow-root the sufferer is relieved by death.
water. This mixture will frequently be well It is my purpose to call attention to some borne, when milk alone is inadmissible. Eggs, articles of diet, to the end that good may re variously prepared, meat soups, broils, etc., sult. To intelligently select and apply suitable belong to the list of albuminous foods, and nutriment the physician must first realize the the physician should be able to direct their state of the digestive apparatus as well as indi. preparation, and make them acceptable to the vidual idiosyncrasy. He must also know the taste and stomach of the patient. requirements of the system and the composi- Heretofore but little attention has been The process
given, in this connection, to other than this class belong Mellin's, Hawley's, Horlick's, class of foods. It is manifestly irrational to Hasby & Mattison's and Moore's Foods, and assume that a diet chiefly nitrogenous can sup- Baby Sup, numbers one and two. The first ply the needs of an impoverished system. three are dried foods, in brown or granular Physiology teaches us that our principle diet masses, very sweet, resembling powdered canconsists of carbo-hydrates, starch, sugar and dy. Mellin's has an acid reaction, while Horoil. It shows us that without these we can lick's and Hawley's are alkaline. not live. Then why not observe the same of manufacture is approximately as follows: precept in sickness, and supply such
at flour and barley malt are macerated, of food as the system demands, 918 changing wity eat bran, in an alkaline solution until its mode of preparation and fofup to suit the the starch is all converted. It is then strained case in hand.
MAR 2 nüthe liquor evaporated in vacuo, the residue There are now to be found in the marketessinated and reduced to powder. The other twenty or more manufactured da BAHAY this class contain some unconverted which are scientifically prepared with merch. Baby Sup No. i consists of malted oats, to meet the requirements of an infantile or and contains a comparatively small amount enervated digestive apparatus. Physicians of starch. It requires cooking, but is very have had little opportunity of becoming ac- palatable without, and is very soluble in the quainted with these preparations. Their use saliva. Baby Sup No. 2 consists of malted has, for the most part, been the result of ad- barley and wheat flour. It requires a little vertising. I propose to give an approximate more cooking, and contains a little more unoutline of the principle components of the converted starch. Hasby & Mattison's food is leading ones, and feel confident that they can a thick syrupy liquid, and is probably a neuoften be used to great advantage, both in in- tralized extract of malted barley. It is a very fants and adults.
palatable food and its usefulness has been These foods may be divided into three amply demonstrated. Class 3, milk foods, difclasses : ist, Farinaceous Foods; 2d, Liebig's fers from the Liebig's foods in containing a Foods: 3d, Milk Foods.
much smaller quantity of grape sugar and less The predominating ingredient of the first soluble carbo-hydrates, and a greater per centclass is starch, somewhat changed by thorough age of cane sugar and starch. The albuminbaking. Well selected barley and wheat are oids are also more abundant. To this class ground to a flour, mixed in various prepara- belong Nestle's, Gerber's, Anglo-Swiss and tions, made into a dough and thoroughly American-Swiss foods. All of these milk baked; then it is dessicated and ground into a foods consist of cereals specially prepared in powder, which usually keeps well, aided by combination with milk. They possess a highthe addition of sugar. In the baking process er percentage of albuminoids, fats and salts a considerable portion of the starch is con- than the previous classes. This is a highly verted into soluble carbo-hydrates. This class serviceable class, especially when prepared contains from five to ten per cent. of albumin- with condensed milk, by which troublesome ous, and a small percentage of grape sugar. In coagulation is avoided. this class belong Blair's Prepared Wheat Condensed milk differs in composition from Food, Hubbell's Prepared Wheat Food, Impe- the milk foods in containing a greater perrial Granum and Ridge's Food, A. B. C. Cereal centage of fats, milk sugar and albuminoids, Cream, A. B. C. Cereal Milk, and Robinson's and a lower per centage of soluble carbo-hyPatent Barley, are mixtures of wheat and drates. Cane sugar is added in abundance for barley but little changed by cooking, to which its preservative effect. are added sugar and albuminoids.
Preserved milk contains no cane sugar. Liebig's Foods, the second class, are almost Decomposition is prevented by the addition free from starch, and contain a larger percent of burnt wheat or barley flour. age of grape sugar and soluble carbo-hydrates: Thus we have at our command, in fact, a while that of fats is extremely low. In this quite extensive dietary, while in practice but
one class, the albuminoids' is drawn upon, and ber that about a month ago I removed an enthe unfortunate patient must get well on milk larged gland from the inguinal region in your or not at all. We must bend to the require- presence. Before then and since, he has sufments of fashion, and not fashion to the needs fered from pain referred to in thetesticle which of his condition. It is absurd to assume that gland I hesitated to remove because the diagthe digestive organs of a fever patient are like nosis was imperfect and incomplete. Since those of an infant, or are in a condition in any the time above referred to I have examined respect similar, and therefore the infant's nat- the removed gland under the microscope, and ural diet, milk, is most appropriate. Two find the morbid condition to be epithelioma, things could scarcely be more unlike. And that is to say the patient's original trouble again, milk does not contain the nutritive re- was epithelial cancer, and the glandular enquirements of the adult, for physiology and largement is secondary. I now feel that I every-day observation teach us that we live should remove the testicle that he may have mostly upon starch, sugar and oil, with a com- his life prolonged, and possibly the last deparatively small per centage of nitrogendus posit of this morbid material extirpated. matter.
He is an American, 40 years old, unmarried, One or more of these foods can always be and (as far as I can determine) of good family found on sale, even in small country drug
history. He has been in the hands of several stores, and the cost is such as to be within the doctors, who have treated him as progressive reach of every one. The manufactured article
surgery directs. He states that Dr. Bibbe, of possesses the decided advantage of being more this city, operated on him for local trouble on palatable than the home-made preparations of penis, September 9, 1887; that Dr. Briggs, the sort. And they are otherwise more to the of St. Louis, operated on him for like trouble, purpose than anything the average family December 23, 1887; that on March 6, 1888, cook can or will prepare. With attention on Dr. Avery, of Troy, Mo., operated on him the part of the medical attendant as to the
about the same as the others named ; that on needs of the patient, few cases will be found May 23, 1888, Dr. Purdy, of this city, ampuin which benefit can not be obtained by selec- tated the penis; that on October 12th, 1888, tion from prepared foods to be found in the Dr. Jackson, of Kansas City, removed a nummarket.
ber of enclosed glands in the inguinal region ; And further, a knowledge of the manner of
that on March 17, 1889, Dr. Mudd, of St. preparing these foods and of their composi- Louis, repeated the operation of Dr. Jackson. tion, will enable the physician to direct the On November 23, 1889, the operation first preparation of many a dish pleasing to the referred to in this lecture was made in the palate and strengthening in its effect.
presence of this class, and to-day I propose to For much of the information as to the com
remove both testicles, and as you will see, I position and preparation of manufactured shall make the first incision from the lower foods herein contained, I am indebted to the margin of the external abdominal ring, and Medical News.
with one sweep of the knife divide the integ
ument to the dependant part of the scrotum, Antiseptic Surgery.
to the end that drainage may be perfect. I
shall now expose and tie the cord by transfixSynopsis of a Lecture delivered at St. Francis ing it, not with cat-gut as most of the books Hospital, Wichita, December 7, 1889. direct, but with antiseptic silk, for reasons
that I tried to make plain to you in a previous BY W. A. JORDON, M. D., PROFESSOR OF OPERA- lecture. You will observe the removal of the TIVE AND CLINICAL SURGERY IN WICHITA gland from the scrotum and the great care
maintained in cleansing the wound. The
drainage tubes, which are thoroughly aseptic, GENTLEMEN :—The patient now before you will now be inserted, the wound stitched with is one you have met before. You will remem- cat-gut and dressed antiseptically, and the un