VOL. XXI.

TERMS: ..

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No. 4

his preceptor through the wards of St. Bartholomew, is illustrative: A certain patient had some form of fever. There had been no action of the bowels for several days. Efforts to achieve evacuation were unsuccessful, and the patient became familiar with all the facts. The preceptor introduced a fever thermometer and, after carefully noting the record, withdrew from the ward. Shortly thereafter evacuation followed, and the patient ultimately recovered.

Sick people require cheering up in suggestion. They are pleased with the presence of children, because children bring sunshine. Sunshine, cheering words and smiles solve the equation of the sick

room.

The physician need not tell a patient that he looks bad. To do so is cruel, and wretchedly bad practice, Harm is done by sentimental expressions of compassion.

Amateur discussions on the probable nature and problematical outcome are distasteful in the extreme.

Funereal airs belong to the same category. Words of commiseration, well meant though they be, are a refrain to the patient's despondency. Bread pills and hypodermics of aqua distillatum, fortified by confidence, may do more than compound carthartic pills and morphine. Once the writer left powders of calomel with the directions.

The directions were

carefully read, powders placed on top of the clock and the patient recovered without using them. Reading the directions was the suggestion. A box of salve for pruritis ani has been known to do duty in a similar way. Rheumatic rings, magnetic healing and "divine healing all have their tap-root in suggestion.

Pain, sleeplessness, neuralgia, rheumatism, headache, etc., often yield to suggestion.

Is the practice of hypnotism or suggestion undetrimental to patient and physician? Unquestionably! All proper and effectual means in reach may be employed for relief. If, with ability to diagnose disease and without the aid from coal-tar sedatives and opiates, the physician can relieve such maladies as headache, lumbago, sciatica, anguish of rheumatic joint or bunion, duty imposes the obligation to do so.

Wisely experienced, hypnotism will do no injury. It will not injure practice, rather better it. It is hard to see how such use of hypnotism can be a means of lowering the dignity of the physician or profession. Truth never hurts a worthy cause or occupation; truth elevates and dignifies the physician and the profession alike.

Prove all things, hold fast to that which is good. That the doctrine of hypnotism is true scarcely any one who has given it careful attention can doubt. It has been tested in the crucible of experience. No doubt the unscrupulous divert the most beneficent powers into improper channels, and thereby delay or defeat the accomplishment of the aims of science and benevolence; but the physician who has the best right to use them, never.

Of course, the hypnotist makes use of suggestion to induce sleep, but except for the relief of insomnia may not need to take that step.

Good effects, at least most of them, may be had without. Mesmerism, faith cure, magnetic healing and "divine healing possess little of value except power of suggestion. The physicians need be none of these. However, apparently he owes it to himself, and patient as well, to acquire knowledge in the lore of suggestion, the accepted practice and precepts of hypnotism, to the end that he may become better equipped for the mission of relief.

TOXIC EFFECTS OF BORIC ACID.

Dr. Jameson Evans, of England, who has experimented largely with this drug, says that the administration of 10 to 20 grains of boric acid three times per day has, in cases of cystitis, in his hands produced an erythematous rash on the skin -neck, face and hands-of the patient, and after discontinuing the drug for a day a scaly exfoliation of the cuticle followed. In one case the salivary glands became enlarged and the hair on the head and face fell out, and for a fortnight the man was bald. Six weeks were required for the reappearance of the hair.

He advises that as soon as untoward signs appear, such as above described, to discontinue the use of the drug. Referring to a most excellent littte work of some years ago, "The Untoward Effect of Drugs," we find this subject referred to. We are not prepared to say why one man can take any amount of a drug and it not injure him, and in another even very small doses produce most painful and distressing effects.

The recipient of this number of the SUMMARY, be he a subscriber or not, is earnestly requested to accord it his careful consideration. Its contents are made up of short, practical articles on live subjects of the day, contributed by men who are successful practitioners.

Original Communications.

Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors.

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THE NERVOUS SYSTEM.-ITS INFLUENCE OVER MENTAL DECLARATION.

BY RICHARDS GRAY, M.D., PH. D., F.G.S. (EDIN.)

8

OME twelve years since my attention was drawn to this subject by an essay from the pen of one of the foremost neurologists, and I now give my impressions, the result of observation and practice.

Too often the fact that a man has a body as well as a mind is forgotten, or, if thought of, the latter is deemed the most important. But to the earnest scientific and philosophic student the former calls for serious interest and attention.

I do not wish to be understood as believing that by some wondrous potency a physical action becomes a mental evolution, but that the centers from the nervous system, from the lowest to the highest, are, each and all, instigators to some effort of some kind, though still remaining distinct and different.

If this idea can be established, then mental states must be influenced, more or less, by any deviation from normality in the nervous system, since the most intimate relationship exists between the two -the former giving expression to the latter.

We differ much in our views of the structure of the nervous system and its functions from our fathers, since greater facilities as well as opportunities for examination and comparison have been afforded us, therefore it would be most derogatory to our education and position, as well as our knowledge, to say nothing of our practice, were we not in advance of our predecessors.

The increased acquaintance possessed by us of the workings of our bodies has, to a large extent, improved our knowledge of mental phenomena, and this may be increased ad libitum.

The entire nervous system, so delicate, minute and complicated, acts on the brain in a most powerful manner, and also the brain acts on it (the nervous system), the mental tone depending, in a great degree, upon the normality of the bodily organs as well as the nutrition derived from food itself.

Dr. Ferrier has handled this subject with great clearness, and his researches have given great impetus to both observation and inquiry. How different is the opinion entertained nowadays as to the brain cortex to that of 50 years ago; thus our opportunities being more numerous and our knowledge greater, it follows that our responsibility is increased in a corresponding ratio.

The powers of the nervous system are most varied, and also mutually opposed in many instances. Intellectual feebleness, decay of memory and incapacity for thought may be present and the body remain strong and healthy, and vice versa. It appears as though there existed a distinct power of the nervous system which may not fail when the intellect declines, or may cease whilst the intellect continues unimpaired, a function in individuals very unequally manifested.

And is it not forced on us that there is in the nervous system a limit of tension? To reach that limit every step is an increase of pleasure and enjoyment; exceed it, and a complete change of experience is produced-uneasiness, irritability and positive pain.

Physiologists have given great care and attention to the analysis of the brain cortex as a whole, from the standpoint "as a concentration of energy and power," indispensable to thought, to feeling and to movement, and they have shown beyond a doubt that these ideas are correct; but they have gone further, including in such analysis a discrimination of the functions of its various centers or divisions.

Of mind, apart from body, we have no knowledge. The mental and physical forces of building up or destruction may be looked upon as twins, in most cases, proceeding together.

No organ can be active without blood. The amount of iron in this life current in

creases or lessens the amount of magnet

sm in our system. Deficiency here, either in quality or circulation, is not only felt by the brain itself, but causes a depletion of the nervous system in general. A center may be defective from two totally different and distinct causes, viz: either from loss of substance or from lack of proper nutrition; the system, when in either of these conditions, resembling a chime of bells which have lost tone and quality.

The disposition of the nerve threads or fibers is most wonderful in its arrangement, fulfilling such distinct services, without confusion or disappointment; in one case acting as conductors to transmit the mandates of the will to special muscles, and also centripetally the impressions made on the organ of sense to the brain. Here is telegraphic and telephonic declaration. Does not this faint

idea of its (the nervous system) service lead us to apprehend the great disturbance ensuing upon any defect in such supply.

How amazing the influence of mental activity. It guides the pencil of the artist, directs the chisel of the sculptor, enables the engineer to tunnel mountains, whilst, by means of the telescope the astronomer sweeps the heavens and examines the stars, and the through his microscope, gains a clearness of insight into nature's secrets.

scientist,

Again, what advantages "localization of brain function" has given to both physicians and surgeons in diagnosing mental ailments. Now there is no more difficulty in locating mental disturbance and disorder than is found in laying the finger on the arteries or nerve ganglion.

Peculiarities of distribution and deficiency in volume, whenever present, must cause serious results in a greater or less degree. It therefore becomes imperative that we should address ourselves both to the influences they wield as well as to the primary or continued alterations they may effect.

Changes in the brain cortex are frequently found complicated with epilepsy, general paralysis of the insane, or similar conditions. It behooves us, therefore, to give greater attention than we have al

lowed in the past to these great and telling issues resulting from the disturbance of the equilibrium.

These thoughts are merely suggestive. A subject of such extent cannot be dealt with in a few papers. We hope that others will give us their impressions, extending the compass and widening the experience.

Sandgate, Kent, Eng.

THE TREATMENT OF ERYSIPELAS.

BY A. G. ELLIS, M. D.

HE prophylaxis to be observed in cases of erysipelas is that of infectious diseases in general, although this is a less contagious disease than many others. The patient should be isolated, the dressings burned and the room in which he stays should be subsequently disinfected by the liberation of sulphurous acid or, still better, by the use of formaldehyde.

The treatment also is the general management of fever, probably best by the expectant symtomatic method. A free purgation is not only useless but even deleterious. Mild laxatives may be given if thought necessary. Cold water should be given freely internally and also used for sponging. An occasional bath or cold pack may be very acceptable to the patient. A cold compress applied to the head is very useful in allaying headaches, excitement, etc. If it is necessary to combat the fever by drugs, the modern analgesics should be used, but they are to be discontinued just as soon as the symptoms for which they are used abate.

Specific medication is advocated by many of the profession, as large doses of quinine. The more we see of its use the less inclined are we to this medication. The use of the tincture of the chloride of iron is another very general method of treatment. When used it is given sufficiently diluted in Basham's mixture, or combined with sweet spirit of nitre and glycerin, equal parts. In some of these ways the tincture is very widely used. Some believe it is of great value, while others question this because cases side by side to which it is not given do practically

the same. Then again, atropine has been used without definite effect. On account of the sthenic forms of the affection, with strong heart, tension of pulse, etc., aconite, camphor, pilocarpine, etc., have been given.

I must say that I am not very enthusiastic about the use of any of these drugs. Some cases I have treated purely expectantly. Alcohol freely, in the form of milk punches; plenty of water, morphine, if needed for rest, etc. This is probably as good a method as will be found. To other cases I have given the tincture of the chloride of iron and have been unable to see any advantage from its use. One thing is sure that alcohol should be used with a liberal hand. probably this acts only to a limited extent as a food, but it is a stimulant to the nervous and circulatory systems, and at all events plays a great part in cambating

the disease. Nourishment should be of the proper kind, as in all fevers, and should be given with a free hand, but in stated amounts at regular intervals.

These

In the treatment of the local lesions many remedies have been used. fall under two classes: first, remedies to protect the parts from the air, such as starch, rice flour, etc.; second, emollients, as poultices, ointments, anodynes, narcotics, stimulants, antiseptics, astringents, etc. These are named only to be discarded.

There are two agents which, at the present time, are thought to affect the patient favorably. Their is a doubt as to their shortening the time of the process or distinctly controlling the extension of the disease from the focus of infection.

The two agents referred to are ichthyol and cold water. The former in a 10 per cent. ointment with lanolin is greatly favored. I am of the opinion that while these remedies diminish the discomfort of the patient they are of very little use in controlling the spread of the affection. I I have tested, side by side, ichthyol, cold water, and a third case by no treatment, except some ointment to keep the skin soft. For this purpose the animal fats are better than the mineral derivatives.

The results show that in ordinary cases, with conditions favorable to recovery, the

active process ends at about the fourth day from the time it begins at any one place, and at that time more or less complete resolution takes place under any of these methods of treatment. The local treatment then should aim at relieving the discomfort of the patient and the tension of the part and at keeping the skin soft. For these purposes either ichthyol, an ointment of lard or other animal fat, or cold water, will answer equally well. The choice is to be determined by selecting the one most pleasing to the patient.

Philadelphia, Pa.

PNEUMONIA AND PNEUMONIA.

BY GEO. J. MONROE, M. D.

BELIEVE there are at least two kinds

of pneumonia. We have what I call

genuine pneumonia, then we have pneumonia following or connected with la grippe. I will give three cases, illustrating what I mean.

Mrs. W. and daughter, both naturally very healthy women, and hardly knew what it was to be sick, for several days had a tired, worn out, sleepy condition, some backache, headache, loss of appetite and were constipated. About three days after they began having this depressed feeling they each had a severe chill. This chill occurred with both at the same time. They now began to sneeze, their eyes watered and there was a profuse discharge from the nose.

At this time I was sent for and found them both suffering with the la grippe. Temperature, 103 degrees; pulse, 120. They complained of being sore all over. I prescribed for eachB. Calomel...

Blue mass.

.gr. v .gr. xv