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A Compact, concise Vocabulary, inclnding all the Words and Phrases used in Medicine, with their proper Pronunciation and definitions.

BASED ON RECENT MEDICAL LITERATURE,

By GEORGE M. GOULD, A. B., M. D.,

Ophthalmic Surgeon to the Philadelphia Hospital, Clinical Chief
Ophthalmological Dept. German Hospital, Philadelphia.

It is not a mere compilation from other Dictionaries. The definiions have been made by the aid of the most recent standard text books in he various branchesof Medicine. It includes,

[Several Thousand New Words not Contained in any Similar Work.

It contains TABLES of the ABREVIATIONS used in Medicine, of Square 8vo, Hf. Morecco, with Thumb he ARTERIES, of the BACILLI, giving the Name, Habitat, CharacterPlain Dark Leath., without thumb istics, etc., of GANGLIA, LEUCOMAINES, MICROCOCCI, MUSCLES, 3 25 NERVES, PLEXUSES, PTOMAINES, with the Name, Formula, Physiological action, etc., and the COMPARISON OF THERMOMETERS, of all the most used WEIGHTS AND MEASURES of the world, of the MINERAL SPRINGS OF THE U. S., VITAL STATISTICS, etc. Much of the material thus classified is not obtainable by English readers in any other work.

FROM PROF. J. M. DACOSTA.

"I find it an excellent work, doing credit to the learning an discrimination of the Author.'

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Read before the Lyon County Medical Society, own pupils, and said he thought of taking

February 3, 1890.

BY CHARLES GARDINER, M. D., EMPORIA.

quarters in an asylum. A few years later he died insane." Inequality of the pupils is almost characteristic of the general paralysis of the insane. The inequality changes sides and (Continued from September number.) varies from time to time, and may continue In order that a reflex may be valuable in a thus from a few weeks to three years before diagnostic sense it must be found in nearly the final outbreak of insanity. That condiall healthy individuals and must present well tion of the pupil, the eye being otherwise marked deviations from the normal in disease. normal, where the light reaction is lost, but Only two of the reflexes mentioned in this the power of accommodation retained indipaper come within these requirements. The cates degeneration of the medulla and upper pupillary reflex and the patellar tendon reflex. The eyes of all normal persons respond to light. The pupil changing in diameter to correspond to the intensity of illumination.

part of the spinal cord. This condition is well marked in locomotor ataxia when it involves the cilio-spinal axis. In retro-bulbar neuritis, when the optic nerve is completely These alterations take place with a certain involved there will be iridoplegia and loss of degree of celerity and under ordinary circum- the power of accommodation at the same stances the pupils of both eyes are equal in time. size. Certain drugs interfere with the move- The pupils are effected by those brain. ments of the pupil and in estimating the value lesions which cause irritation, and by those of this reflex, and of all other symptoms, in which produce palsy. A one sided, irritative diagnosis we must eliminate all, those acciden- lesion will excite pupillary disturbances in tal causes which might mislead us. Some- both eyes. If but one pupil is affected there times there is loss of light reaction, the pupil is a lesion producing paralysis by pressure on neither dilating nor contracting under any the nerves controlling the iris and the lesion is beam of light. Myosis may be present, caused by opium, calabar bean, cerebral congestion, diseases of cervical region, of spinal cord; as meningitis, myelitis or sclerosis. The myosis may be bilateral or unilateral. Pressure on the sympathetic nerve by tumor, aneurism, etc., will cause unilateral myosis.

on the same side as the affected pupil. In case of large tumors or profuse hemorrhage; the pressure might be transmitted, but, then there would be other symptoms to guide us. If the pupilis dilated and there is an injury on the same side, even if there is no hemiplegia, there is almost certainly a clot from rupture of the middle meningeal artery of that side. We must bear in mind the fact that the pupil may be abnormal in patients suffering from thoracic disease. Some writers claim that in pneumonia, The pupils may be of unequal size and then the pupil on the diseased side is always larger in the absence of local or other causes as than the other, and that after resolution is esmentioned above, it points to serious organic tablished, the reverse is true. My experience brain disease. On this point Norris quotes has been very limited, but such as it is, it has

Mydriasis may be the result of inflammatory lesions of the brain, or, be caused by a paralysis central or peripheral or due to drug action.

not yet afforded a case that would support this be diminished, varying in degree from slight view.

Berge examined 1,409 healthy persons, and found the patellar tendon reflex in all but twenty-two.

impairment to total abolition. Second, they may be exaggerated. Produced by slight causes recurring too frequently or persisting to long. It is a very difficult matter to define

Blochi failed to find the reflex in five out of the words normal and exaggerated, as applied 694 school children.

Nelizæns after experimenting on 2,403 school children and failing in six examined these after the manner advised by Jendrassik, and the knee jerk was present in all of the 2,403.

Jendrassisk failed to find this reflex in one case out of one thousand examined, and that one was suffering from diabetes mellitus.

to reflexes, because there is no standard. Race, temperament, education, social position, stature, all have a modifying influence. We must study the phenomena in a considerable number of healthy persons, and then assume that what we find in the average individual is the normal reflex manifestation, and that anything in excess of that is exaggerated. In this way we establish a standard for ourselves by which we can compare cases and reach trustworthy conclusions.

Reflex phenomena are abolished under the foliowing pathological conditions, assuming that only the part of the reflex loop mentioned is involved.

Dr. Genner caused 2,106 persons, all adults, of whom 275 were females, to be examined for the patellar tendon reflex. Many of these people were inmates of alms-houses and insane asylums. Of the whole number the reflex was absent in twenty-eight. Of these five had fully developed locomotor ataxia, and twelve were in the early stages of the same disease, so that the failure to find the reflex was accounted for in all but eleven cases out of impressions. Third, paralysis, section or

2,106.

First, paralysis from any cause, or section of the afferent nerve. Second, inability of the center to receive, transmute and transmit

other interferance, with the conducting Since this subject was assigned to me in May properties of efferent nerve. Fourth, paralysis last by our committee on program, I have of peripheral organ. These conditions can made tests for the knee jerk in two hundred be brought about by drugs, poisons and male adults. After putting them in the proper disease.

position the tendon was struck a smart blow Cocoaine inhibits the reflexes when the irriwith the ulnar edge of the hand. If the reflex tation is not intense. Profound anæsthesia was present this ended the examination. In abolishes the reflexes because the sensory four cases the reflex could not be elicited in nerves are, for the time, incapable of transthis way. I then made another trial on the mitting impressions. We make use of this naked legs, by striking the tendon in different fact when ever we administer chloroform. directions and with varying degrees of force, The conjunctiva is touched, and if there is no the patient making voluntary muscular effort reflex closing of the orbicularis palpebrarum, as advised by Jendrassisk, and having the at- we know the patient is nearly ready for the tention diverted from the knee. In this way operation. The bromides are in daily use to I found the reflex in all but one of the two diminish reflex irritability. In New England hundred examined. All these persons were Medical Monthly for December, 1889, Dr. so far as I know free from nervous disease or Hagerman reports a case of fracture of femur abnormal condition of quadriceps extensor in a boy eleven years old. The muscular and its tendon. Several observers have failed spasm was very violent and the pain intense. to find the reflex as often as those quoted The new hypnotic sulphonal was ordered and above, but even their statistics would place by mistake the boy took seventy-five grains the knee jerk at the head of the reflexes, as aids in diagnosis.

Reflex manifestations deviate from the normal in one of two directions. First they may

in about two hours. The reflex muscular spasm soon ceased and the boy slept for four days and then awoke without any evil effects from this enormous dose.

The knee jerk is absent in the following disease. In locomotor ataxia especially when it begins at its most usual starting point, at about the level of the fourth lumbar vertebræ, then the reflex disappears very early in the disease.

Woorara poison abolishes the reflexes by from these diseases. In the early irritative paralyzing the motor nerves, and lead pro- stage of neuritis and myelitis, there is increasduces the same effect by paralyzing the mus- ed reflex, but after the disease is developed cles. the reflex is lost. We find the knee jerk exaggerated in all those diseased conditions which prevent the inhibiting action of the cerebrum and in all those lesions which interfere with the conducting power of the spinal cord, such as hemiplegia, pressure from injuries, hemorrhage, tumor and transverse myelitis. In this connection we must not forget that Any lesion which excites the cord without there are a few well authenticated cases in destroying the motor ganglionic cells, will which the diagnosis of ataxia was confirmed have exaggerated tendon reflex as a prominent at the autopsy, and the patellar tendon reflex symptom. Subacute myelitis comes under was never absent until a short time before this head. In sclerosis of the lateral columns death. the knee jerk is so violent and is so easily excited that it is hard to believe that the patient is not re-inforcing the reflex by voluntary

The knee jerk is abolished in diffuse myelitis affecting the posterior or central portion of the spinal cord.

movement.

[Concluded.]

Treatment of Eclampsia.

In acute central myelitis involving the gray matter of the cord. In acute poliomyelitis, which causes destruction of the motor cells. The Merits of Verratrum Veride in the In disease of the motor nerves, such as injuries, neuritis, tumors and as the result of diphtheritic poison, which inhibits the conducting power of both motor and sensory nerves. In pseudo-hypertrophic palsy when the muscle has undergone fatty change. In diabetus mellitus.

Reflex phenomena are increased under the following circumstances, the inhibiting influence of the cerebrum being active, and all parts of the nervous arc, except the one mentioned being normal. First, irritative lesion or conditions of afferent nerve. Second, a similar state of things in the center. Third, any condition increasing the irritability of the efferent nerve. Fourth, any cause increasing muscular irritability. When the inhibiting influence of the cerebrum is withdrawn exaggerated reflexes will be developed from slight causes, even when the reflex arc is otherwise normal.

In discussing the merits of ver. vir. as a remedy in the treatment of eclampsia, I shall not stop to speculate and theorize on the causes of, and the pathological condition present, nor enumerate the symptomatology, for I feel assured that the youngest practitioner, although he may not have met with a case before, will find no difficulty in diagnosing and distinguishing the disease, though possibly he may mistake or miscall some more trivial convulsive condition-eclampsia. Yet, when he actually meets with a genuine case, he will not halt between two opinions as to what he has to contend with. But I shall simply give my experience in the use of the remedy, and the apparent results in a number of cases during the last twelve years.

I think the old and generally authorized treatment, consisting mainly in blood letting, the administration of narcotics, nerve stimulants and anæsthetics, has never been very satisfactory to the profession; at least it was not to me.

Strychnia and opium cause exaggerated reflexes. Electricity may increase or diminish nerve irritability, depending on the kind of current and the mode of application. In some acute and chronic diseases, the knee The fatality attending this disease has aljerk is exaggerated as we see in typhoid fever ways been high, and even in the proportion and in phthisis. The same is true in regard of cases that did live through the terrible orto the superficial reflexes in patients suffering deal and survive, after having perhaps from

20 to 70 convulsions in an interval of time, lasting from eight (8) to twenty (20) hours.

I think the most self-sufficient practitioner, though he might claim, and in fact feel that he had saved the life of his patient would hardly have the temerity to claim that his treatment had been very abortive.

I first used the remedy in this disease in 1879, not because I expected any specific or positive effect from it in controlling convulsions, for at that time I had never seen nor heard of anything in print advocating its use here, nor until I had employed it in several cases afterward with a more confident expectation of benefit than could be derived from the use of any other remedy.

I first used it to meet the rational indication in controlling the heart's action, and thus relieving the circulation, and with the general understanding that when the lancet is indicated verratrum is then the best substitute we have for that means.

In the above named year I was called to attend Mrs. B, a primipara. Saw her at 10 o'clock, p. m.. Found the patient was nervous and restless; os very slightly dilated. Gave a small dose of morphia. Pains subsided, and the first stage of labor was rather tediously completed. She was taken with a convulsion at this stage, between 3 and 4 o'clock, a. m. I asked assistance, and Dr. Perkins, our worthy president, promptly came to my aid. She was relieved of twins at about 4 o'clock, a. m.

made on the convulsions, and that the intervals were longer than at any time previously. She had had about 60 convulsions in twelve (12) hours time. In about half an hour I repeated the dose of verratrum, when I was convinced that the convulsions were subsiding, but was uncertain whether from the effects of the verratrum, or from the great amount of other medicine that had been administered.

The convulsions continuing, I gave a third small dose of the remedy as before, when they entirely ceased, and in due time the pa-. tient made a fair recovery.

The more I considered the effects of the remedy in the case cited, the more hopeful I became that in verratrum we had a remedy of great potency and value in the treatment of this heretofore uncontrollable disease. one swallow does not make a summer, neither can the apparent successful effects of a remedy in one or a number of cases establish its reputation, or remove it from the field of experimentation.

I decided in my own mind that if I had another case of the disease I would give it a further trial, by using it immediately at the commencement of the attack, and in very much larger doses. The opportunity presented itself in 1882, as follows:

Mrs. W―, first pregnancy; slight build and nervous temperament; had had premature pains for some days, and but very little restful sleep. I was called early in the evenThe patient was immediately put under the ing: found the os slightly dilated, pains seinfluence of chloroform at the commencement vere, labor progressed very tediously. The of the convulsions, which was continued a first stage of labor was completed in about six good deal of the time for some hours. Gave hours; pains continued, but progress of the bromide potassa very freely, in repeated doses; head ceased; patient complained of great pain also chloral and morphia in as large doses as in the head; was very restless. I thought justifiable. The convulsions were very frequent, with but short intervals. The patient becoming entirely comatose, face swollen and very much cyanosed. I gave a great deal of medicine, and in the best manner possible under the circumstances, till about the middle of the afternoon, when I first made use of Norwood's tincture of verrat. veride in the ordinary medicinal dose of 6 or 7 drops, with the hypodermic syringe, when I thought I could see that a greater impression had been

I became satisfied that we would have to complete the delivery with instruments. I sent the husband after assistance, and about 4 o'clock. a. m., he brought Dr. Wiley. Shortly after that hour she was taken with a very hard and long-continued convulsion. By the time she came out of the spasm we had a hypodermic syringe, charged with from 20 to 25 drops of Norwood's tincture of veriatrum, and immediately used it. It speedily brought the pulse down to about 50 per minute.