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THE

THERAPEUTIC GAZETTE

A MONTHLY JOURNAL

OF

PHYSIOLOGICAL AND CLINICAL THERAPEUTICS.

EDITED BY

HORATIO C. WOOD

AND

ROBERT MEADE SMITH.

WHOLE SERIES, VOL. XI. THIRD SERIES, VOL. III.

GEORGE S. DAVIS,
DETROIT, MICH., AND PHILADELPHIA, PA.

1887.

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General Considerations on the Dietetic
Treatment of Diseases of the Stomach
and Intestine. By Professor Dujar-
din-Beaumetz.......
Critical Observations and Experimental
Studies on the Influence of Pharmaco-
logical Agents on Peripheral Vessels.
By Prof. R. Kobert.......
Pneumato-Therapy. By Solomon Solis-
Cohen, A.M., M.D.

A Case of Basilar Meningitis. By W.
G. Winner, M.D.....
Galvanism and Bromide of Quinine in
the Treatment of Chronic Catarrh of
the Middle Ear. By J. A. Patterson,
M.D.

Therapeutic Indications in Different
Temperaments. By W. G. Kemper,
M.D......

PAGE

The Use of Boracic Acid with Vaginal
Tampons......

40

PAGE

New Investigations on Cholera.....
Peroxide of Hydrogen in Diseases of the
Eye..........

4I

42

Urethan an Antidote to Strychnine, Re-
sorcin, and Picrotoxine...........

Pathology and Therapy of Fevers...
A New Operation for Hypospadias
Thallin in Diseases of Children..
Medication of Nerves..

PAGE

53

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Phenylhydracin a Sugar-Test in Urinal

ysis

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The Treatment of Chronic Diarrhoea by
Sulphocarbonated Water

43

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The Treatment of Intussusception by
Inflation and Massage.....

Physiological Treatment of Cholera...... 56
Boracic Acid as a Local Antiseptic.......
The Action of Solanine.....

14

24

The Effects of an Overdose of Cocaine.
The Pharmaceutical Uses of Saccharin.
Bichloride of Mercury in Diphtheria....
The Movements of the Heart and Intes-
tines, Illustrated by Photography...... 45
Liquor Ferri Albuminati..

44

Iodine Irritation

45

The Alkaloid of the Tulip............

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56

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45

Treatment of Typhoid Conditions by
Benzoic and Salicylic Acids...

57

Treatment of Anal Fissure..

58

46

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47

Multiple Abscess of the Liver. By J. A.

Bach, M. D......

The Causes of the Poisonous Effects of
Chloric Salts....

30

48

Permanganate of Potassium in Amenor

rhoea. By Dr. H. I. Boldts...........

An Improved Trocar for Paracentesis of
the Abdomen....

31

48

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The Effect of Large Doses of Cocaine
upon the Central Nervous System...... 48
Rare Lesions produced by Bromide of
Potassium...

The Influence of Cocaine upon the Skin.
Treatment of Substantive Emphysema. 59
Reviews........

Correspondence.

Ice-water Enemata.........

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59

61

Toxic Effects of Tea.........

32

49

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35

Note on the Treatment of Thread-
Worms in Children.....

49

Substitution of Drugs...

36

Mentholeate, or Solution of Menthol in

Oleic Acid.....

36

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Influence of Drugs given to Nurses or
Mothers on their Suckling Infants...... 50
Milk as a Prophylactic against Renal
Albuminuria in Patients with Scarla-
tina...
Hydrastis Canadensis not an Oxytocic
in the Human Subject.........
Methylal......

Pills and Syrup of Sparteine......

Chemical and Physiological Action of
Drugs...................................

Notes and Queries.

Pilocarpine in Rheumatic Tetanus........
Fatal Result of Peroxide of Hydrogen
Injections.....

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67

Eulylyptol.......

50

Infant Feeding....

An Intestinal Antiseptic..........

50

Compound Liquorice Powder...

37

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Oleum Santali Ostindicum as an Anti

Uses of Hyoscyamine....

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Treatment of Goitre....

51

The Cause of Circular Gastric Ulcer.....
Treatment of Eczema in Children.........

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Mytilotoxine....

71

A Cure for Warts...

72

53

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Binoxide of Manganese in Amenorrhoea. 72
How to Prescribe Hyoscine.........
Tapioca-Root as an Antiseptic...........

this subject of diet in diseases of the stomach. It may be affirmed that the majority of gastric affections are tributary to an exclusive treatment based on hygiene, and that in the therapy of these diseases pharmaceutical agents play only a secondary rôle.

To give method to what I have to say, I shall proceed after the following order: I shall begin by establishing the bases on which you may institute the dietetic regimen of diseases of the stomach, and this will be the theme of the present lecture. Then, in another lecture, I shall apply these general considerations to each of the stomach disorders in particular.

Two modes of procedure are at the disposal of the practitioner to guide him in the study of affections of the stomach,—the clin

ical methods, properly so called, and the more strictly scientific methods, which are addressed at once to the stomach. The clinical methods were the only ones which we possessed till Kussmaul's discovery enabled us to study directly the gastric functions. They consist in the palpation and percussioh of the stomachal region, in an attentive interrogation of the patient, and in an examination of the vomitus and dejecta. We thus used to obtain the only signs that could guide us in the diagnosis of gastric affections.

These signs, from the particular point of view of the functional working of the stomach, were, it must be admitted, of doubtful exact

ness.

The patient can give you but very uncertain information concerning the precise duration of the stomachal digestion, and the repugnance which he often experiences for certain articles of food is especially a matter of habit and custom, or, it may be, of a particular idiosyncrasy. I once knew a patient who could not eat veal kidney without veritable symptoms of poisoning; others experience similar effects from eggs, and the list of cases of the kind might be considerably augmented.

Recall to your mind in this connection the modifications which pregnancy effects in the digestibility of certain alimentary substances, also the still stranger tolerance or intolerance which some nervous and hysterical persons manifest for certain articles of food, and you will agree with me that if the ordinary clinical processes are of use in the study of the way the stomach performs its functions, they lack precision.

Hence it is that we gladly welcome the more scientific methods which come to us from Germany, and of which Leube has been the most ardent and able expounder,―methods which consist in directly examining the

mucous membrane of the stomach and its contents. All these processes are based on the employment of the stomach sound and explorers, and comprehend two distinct acts,— examination of the duration of digestion and examination of the gastric juice.

Let us commence with means used to ascertain the duration of the digestion. According to Leube, a healthy stomach ought in seven hours to have digested a plate of soup, a large slice of beefsteak, and a small wheaten loaf. The liquid of a lavage of the stomach, made after that lapse of time, ought to be absolutely clear, if the stomach is doing its work well. Kretschy makes a single reservation to the rule laid down by Leube,-during menstruation in the female the duration of the digestion may exceed seven hours.

But the examination of the gastric juice requires multiple and somewhat difficult processes, and we have here to study, on the one hand, the acidity of the gastric juice, and, on the other, its digestive power. Before entering on the consideration of these two questions, I must briefly point out the methods in use for obtaining gastric juice, and here again we shall have to study the two following points: how to extract gastric juice from the stomach, and how to make the mucous membrane of the stomach secrete this juice.

To obtain gastric juice from the stomach we have two methods,-that of the sound and the sponge method. If you wish to use the sound, the ordinary siphon-tube will answer the purpose, or, better still, the stomach-pump. I here place before you the one which I ordinarily use. This instrument, constructed by Collin, is very simple and very ingenious, and it suffices to turn the swivel which fixes the syringe to make it communicate either with the stomach or with an outward receptacle (Fig. 1).

FIG. I.

Leube employs a soft rubber sound, six millimetres in diameter, the parietes of which are two millimetres thick, which is introduced

into the gastric cavity, and by means of the stomach-pump, with which it is connected, the contents of the stomach are extracted.

Ewald makes use of a very handy method. He passes down into the stomach a soft rubber catheter scarcely larger than a good-sized urethral sound, and seventy centimetres long. This is introduced nearly the whole length, when he causes the patient to make an effort at vomiting, and at the moment that the liquid appears at the upper extremity of the sound, he seizes the latter with his fingers and quickly withdraws it from the stomach. He then blows into a wineglass the liquid which the catheter contains.

I have myself constructed a stomach-explorer, made for me by Galante, and which I here place before you (Fig. 2). It compre

FIG. 2.

hends, as you see, a stomach-sound precisely similar to the tube of Debove, having a length of half a metre. In the interior of this tube is a little glass bulb, perforated at both ends, to whose lower extremity is attached a little rubber tube to put the bulb in communication with the mucous membrane of the stomach. The narrow upper extremity of the glass bulb is adapted to another rubber tube, which is much longer, and ends in a flask-shaped rubber ball similar to that which makes a part of an ordinary spray-producer. Finally, a stout string enables us easily to withdraw the glass reservoir. The mechanism of this apparatus is easily understood. You introduce the tube into the interior of the stomach, then, by means of the rubber ball, you exhaust the air in the glass bulb, which then admits gastric juice; then you withdraw the sound. When once the tube is out of the stomach, you remove the glass bulb by means of the string, and empty the gastric juice which you have extracted into a watch-glass by means of pressure made on the rubber ball. The ap

paratus is one of the most simple, and its introduction and removal are exceedingly easy, especially in individuals who are used to the stomach-tube.

In connection with the foregoing methods, consisting in stomach catheterization, the sponge method deserves mention, being a process which is very simple, and very much employed in Germany, and which we owe to Edinger. Little bits of sponges enveloped in gelatin are attached to the extremity of a long thread. The patient swallows the sponge while fasting. It is allowed to remain half an hour in the stomach, then is withdrawn by means of the thread, and the contents squeezed into a watch-glass for testing.

If you have not the prepared sponges, such as are made in Germany, you can very easily replace them by the following means. You take one of those gelatin-capsules, divided into two parts, encased the one in the other, and known under the name of Lehuby capsules. You place in the interior of the capsule a little sponge, to which is firmly attached a long silk thread, which is made to pass through the second part of the capsule, and the two hemispheres of the capsule are then firmly joined together, and are ready for use. The gelatin-capsule is soon dissolved in the stomach, and becomes impregnated with the gastric juice.

The sponge process is more painful than that of the sound. The object of resorting to this method is to do away with the necessity of the introduction of a tube into the interior of the stomach, but the deglutition of a sponge held by a thread, and which has to remain half an hour in the stomach, produces more nausea and vomiting than the sojourn of a sound. I have tried these sponges on a good many patients and on myself, and I have reason to abandon the method.

Now that you know the means employed to obtain gastric juice, I will tell you what you must do in order to provoke the secretion of this fluid. You know very well that the stomach, at the moment of your exploration, ought to be entirely empty, as the presence of food in that cavity considerably modifies the reactions of the gastric juice. You must, then, operate when your patient is fasting, and to stimulate the flow of gastric juice, you may employ three processes,-mechanical, chemical, and thermic.

The mechanical processes consist in irritating the gastric mucosa by a foreign body, as the point of a sound or a sponge. The chemical processes consist in the employment

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