Art Gillis Proff Gray Feb. 7th 1883 Insanity - a change of an individual due to a disturbed state of the brain- disturbance of the mind by the origin of a delusive state, An illusion is that transformation of one object into another as in cases of weak children- Hallucination is false perception or sence of objects which do not exist- Delusion is imagination of conscious which do not exist & which may [illegible] to their familys & business relations & neighbors- Disease has no respect for the prince or the peasant & arises alike to all. But I have never seen a Case of insanity from disturbance of hectic or nervous system but what recovered entirely if restored to health before organic changes took place in the brain. Melancholia very rarely subsides under 3 months & [illegible] Have of cases lasts 12 months- [illegible] indulgence as vicious habits concealed demoralizes a man to such an extent in some case as to cause some to commit suicide & yet be not insane- sleeps soundly after committing the worst crime- Not so with the insane man- Over toil under feeding- may cause insanity Proff Janeway, Feb. 7th Acute yellow atrophy of liver a rare disease as much so as hydatids- eluants yellow atrophy liver is as a rule atrophied to great extent- but it may be normal size or even larger than normal size- is flattenest the capule wide calls shrinkage by at rinkles- Liver is yellow & red, Lobules loose their appearance cells- granule- gall duct may be free & gall bladder contain no bile- liver cells being broken down a fatty degeneration exists- cells may not be broken down as much as they at first appear to be. [Baller???] said to exist in such [?ain]- Most common leasion is degeneration of Kidney epithelium- Spleen not necessarily enlarged- deep jaundice Occurs usually lecture 20 & 35 years of age- may exist at an earlier or later age- Occurs as much in males as females & in 1/3 in pregnant females- Cause- Phosphorous poisoning- Is attended with 3 condition- deep jaundice decrease in size of liver- & general blood disorder- urine highly colured- May present no other symtoms & patient may be up & about & then rather suddenly get worse go into convulsions & coma- Fever may or may not exist. Hammorrages from nose & other parts of body- least from a few days to 2 months Has been taken for yellow fever & in southern climate- a postmortem examination should be had in a case of suspected yellow fever Jaundice may exist in cirrhosis & thus disease not be present, Leucine & Tyrosine in urine may help us in our diagnosis- Have not been able to conclude that there is need which will relieve it so far as I know Carcinoma of Liver is no infrequent disease as a secondary affection- Is rare as a primary one- may grow in spots in liver- liver may be or may not be enlarged & nodulous in secondary cancer nodules with depression in centre grow degenerative of central portion & the edges raised which may be felt from the outside May have a large primary cancer & several small ones as seconary ones existing in liver- Origin of these cancers from cells or bile- carried by the blood to liver as unliali- Cancer of liver may produce secondary cancer in other parts or vessels- [illustration] carcinoma cells- Begins- depressed condition of health. If cancer exist in any other part and patient comes to you with pain in side & uneasy feeling- you may think of cancer of liver - Jaundice may exist in carcinoma Hectic type of temperature- Hard to diagnose case of this kind- Good sign is perceptible growth of liver- peri hepatic friction fremitus- peritonitis may exist patients get thinner, paler, &c. This condition may be taken for Abscess of liver- by the fluctuation in nodules & the fever- Proff Gray Feb 8th Catalepsy- State in which person sleeps & is unconscious of every thing going on about him- can be nourished fed & clothed in said condition. For Mania Melancholia & necessary, treat the physical condition & place or lay to place mind in that condition most favorable to restore to mental activity- Believe that treatment of insanity should be given to the regular practitioner- instead of giving it to a separate institution We should be careful tho in attention to these cases arrange in some way to prevent suicidal or murderous intents Larger proportion of Melancholia get well than of mania- Proff Welsh Feb 9th Shows us brain of a man who died suddenly from abscess of brain- cause pistol shot grazing, which did not break inner table of bone & fractured external peall very little gave no symtoms of abscess of brain or injury to it between time of injury to death Cause of death- hemmorrage about Pons The fracture of skull was not known until after death at autopsy- Shows us position of operation for an operation for lithotomy performed by Proff Dermot on Feb 3d- patient died was 76 years old- had atheromatous deposits on arteries- &c Prostate gland very much enlarged- rectum was lacerated in extracting stone, Prostate enlargement same as fibroids in female Pathology of Pleurisy- Serous or fibro serous fluid- pus- may exist in pleural cavity- congestion of membrane- followed by exudation of above fluids- in the different stages- fibrin first serum & fibrin second & 3d- white blood corpuscles & pus cells- most usually there is recovery by absorption of exudation but adhesions from new connective tissue will exist afterwards about pleura which also is thickened- Pus should be Easier from Pleural cavity by aspiration- Persons should not go about with much fluid of any kind in plural cavity- The reason why sudden death occurs when it is done apt to be due to paralysis of heart but am not certain Proff. Janeway- Feb. 9th Cave- man- atrophy of adductor muscles of limb & others of right hand has had epileptiform convulsions- memory impaired Abscess of brain- may be acute & chronic will come from Meningitis- but usually from an injury laying bare the bone allowing air to pass in setting up inflamation at that point or under the dura mater- as from a pistol ball- or from an injury on opposite side of head lascerating brain or dura mater- or we may have it from an inflammatory process in the sinuses as of the ear nose- in frontal sphenoidal lateral & other sinuses- In Phthisis- empyema- material may be carried to brain & set up abscess or from ordinary pyemia- or fever the condition rarely resulting from infectious fever- abscess about cheek may cause it or abscess in other parts- More frequent in male & in adult life May be more incapsulated- the surroundinng parts oedemetous- or may be encapsulated & surrounding parts are oedemetus bad odor with pus & fatty cells. Patients may recover for a while from chest abscesses of certain extent Signs- There may be or may not be any special headache chilly sensations with fevers & profuse perspiration- coma &c- may exist in anterior lobe in front of motor tract & not give much pain or symtoms & may if in this or other part of brain give rise to epilepsy paralysis- feeling of vertigo- Difficult to make diagnosis- Internal symtoms are of slower progression- absence of fever Proff. Flint.- Feb 9th- Clinic Patient- woman- been sick 10 days had cough hoarse whispered talk- has aphonia from laryngitis- expectorates- negative results when examined from pleurisy, Pneumonia- Has simple bronchitis with subacute laryngitis- has has some fever- Patient- man- case referred to me with pulsating tumour in Abdomen- I cant find a tumour. If any tenderness in abdomen pressure upon recti muscles will cause tonic contraction of same- which may be mistaken for tumour- We may get pulsation there without a tumour - why, I do not know. If an aneurism we get latteral pulsation as well as upward - Pain of aneurism is boring & persistent This man has dispepsia & has the usual symtoms- with morbid condition of mind- We may have intestinal as well as gastric indigestion- Indigestion of stomach is often a mental disease- I suggest that persons suffering from dispepsea will never cure it by limiting his diet & a man who limits himself from fear of becoming dispeptic, will be sure to contract it by so doing, But for actual dyspepsia I give Saline 10 grs in a glass of water before meals. When persons have an appetite to eat with dyspepsia let them eat what they want to And the reasons clergemen have dyspepsia is because they refrain from eating such things as they like Artifical Food. As a rule, they are worth less- Juice of meat of very little value hence we should not prescribe it. Case of Renal disease with uremic vomiting & convulsions- with Phthisis- coming upon chronic brights disease- women most when stomach is most empty cause uremia gets into stomach- because carbonate of ammonia- which irritating stomach causes the vomiting- gets rid of much of the uremia in this way. As a rule in these cases digitalis with acetate or bitartrate Potass makes the best duretic- A Hydragogue will be apt to assist given over a week if patient able to take it Care of Dermalgia- pain in soles of feet. Man 27 years old- laborer- has had syphilis- rare disease- may result from gun shot injury- is a neuralgic affection. Look into system to see if anything is wrong. Counter irritation good- galvanism good Proff Keyes- Feb. 9th Strictures- may exist without previous inflamation of urethra- Spasm of muscles- Most of the fluid or pus formed in front of bulbus portion will dribble out thro penis- is behind will ooze out into bladder- Tying hemorrhoids may produce stricture- inflamation in prostate gland may cause it Peripheral irritation as from irritating substances applied to privates may cause it. Inflammitory stricture may result from inflamation- Most common forms of stricture is organic & spasmodic- Spasmodic may occur from stone in Kidney- injury to perineum- Tape worms I have known to produce it. Peripheral irritation in any part of body- as modesty, excitement may cause spasm of urethra- Spasm of deep urethra may be ascertained by introducing sound- you cant get a probe into a spasmodic stricture but in 9 cases out of 10 you can get in the largest sound- oiled & warmed & gradual pressure- perhaps for 5 minutes- If you have any doubt about it give patient ether- abberation of mind- as hysteria or Melancholia may cause spasmodic stricture Anatomists say that narrowest point of urethra is at meatus- external orifice & the small meatus is not a defect- unless it is too small which may be the case- Best knife to divide a stricture near orifice is a common straight bistoury Best for cutting deep stricture is Otis's instrument of this city & dont cut but once & cut larger than you want the urethra to be when well- But the best way I think to break a stricture or the safest way at least is by the divulsive that is introducing instrument in stricture & then dilating instrument by means of a screw. Proff Yale Feb. 10th Diseases of Hip joint- Sacroilliac Disease Caries of Ilium & of Ischium. Periostitis of Trochanter- Psoas- Pelvic Abscess- Psoitis & Peripsoitis- Perinephritis- Perityphlitis- Congenital Dislocation- & Diastasis- Proff. Noyes- Feb 12th Inflamation of lining membrane of external ear due often to lack of cleanliness may be chronic or acute- dermoid flakes may collect & fill up canal- Aspergilus- variety of germ may get into this inflamation & be difficult to get rid off- are as large as yeast germ- Bora are acid powder is almost a specific for these inflammations together with cleanliness Middle Ear- The membrane tympanic & cavity of tympanum- Membrane tympanic is transparent in young people- but becomes more opaque in old age- has two bright spots when seen by a light from without the smaller one being short process of malleus at edge above of tympanum- the larger one the handle of malleus where it is attached to tympanum- dividing it into two portions & the stopes foot closes the fenistra ovalis- the secondry membrane tympanum- Fenestra Rotundum just below the Fenestra ovalis is connected to the vestibule & has a membrane across it also, Aquedut of Fallopius carries the facial nerve & the tensor tympani muscle is attached near its origin & inflamation may produce paralysis of said muscle & hence affect hearing Eustachian tube is muscular lined with mucous membranes with fimbriae on its surface- opening is above bottom of membrana tympani Proff. JL Smith- Feb 12th Case of asthma- from whooping cough in girl 10 years old- has emphysema of lung. Treatment- To produce relaxation of muscular fibres- & relieve the chronic congestion of part. Syrup of ipecac inhalation of warm water 1 part of chloroform & 3 oz of ether inhaled cautiously good Poultices warm over dust, good chloral Bromide of ammonia- as follows- ℞ Brom Ammonia ℥ii Tinct. Comps. Cinchona ℥ii- dose every two or three hours Case of Chorea- from rheumatism- Have been giving him Fowlers solution 6 drops after meals- Bitter Tonics may be given- Case of Stomatitis in child less than a year old- cause- some disturbance in digestive organs- this is ulcered Stomatitis bowels generally constipated- Oatmeal made into a gruel & sweetened with cane sugar good to loosen bowels given with every 2d nursing- The following good also- Ol Morerhue ℥iv Aq Calais Syr. calcis- lactophospas aa- ℥ii- Kneading abdomen & using cod liver oil as an ointment 5 minutes at time three or 5 times a day will open loosen bowels- Lubigs food is also good. [illegible] use in treating mouth condition until cause is removed but the following is good for mouth. ꝶ Sodii borah ℥ii- glycerin ℥ss Aqua ℥j used with camels hair brush every hour or two. Purpura Hemmorragica- a grave disease- have cured about half the cases which I have seen Ergotine, Iron & turpentine or one above may cure it, Case- 2 months child- Mother healthy- has never miscarried- this child was born syphilhitic- no history of syphilis on mothers side [cross out] nor can a history of said disease be obtained from father has gummy tumour on neck- I Do not give mercury in these cases- this child is weak- but I use Mercurial oint- piece about size of pea over sternum two or three times a day- For the coriza in nostrils Citrun ointment ℥ii 1/2 oz Zinc oint with glycerin as an ointment good Proff Janeway, Feb. 13th Case- Man 26 years old- has jerking movements has no power of dorsal flexion- cold feet atrophy of limbs- toes flexed- feet perspiring- hands cold & perspiring- had no rigity in motion- stands & walks with feet wide apart- shuffles along- has to stop every now & then to keep from falling Cant be still standing sitting or lying down Sensation impaired upon pricking feet & legs- certain Amt of anesthesia- Has no better reflex action at knee joint- Has disease deeper than lateral tracts of spinal cord Hands get warm upon exhalation of nitrite of amyl- Has spinal paralysis & paresis- with likely beginning of affection of bulbs as shown by affection of tongue, face throat & talking- one side of lip below hangs down- Suggest galvanizing the flexor muscles of leg- but we cant hope for much good because of contractured state of extensor muscles. Suggest that you never apply electric current to paralytic child until you put them under influence of ether because of the pain of it. Suggest application of Nitro glycerin & all to spine to warm his extremities Case of 3d nerve paralysis- right side eyelid fallen- external strabismus- pupil dilated- cant bring eye beyond medial line inward- tosis- has had it 2 months- comes on gradually, little difference in hearing on each ear- has had syphilis- 8 years ago Proff Doremus- Feb 13th- Phosphorus- obtained in 1669 from urine- is now prepared from bone as for marshes. Phosphoric acid prevents oxidation in marshes, Phosphoric acid obtained from bones by grinding them - Phosphorus produces disease of bone Some forms of marshes have phosphorus on outside of box- glued on with gum & sand- The cracking marshes have sulphur & chlorate potass on ends. In France have poisoning from marshes- Cyanide Potassa used exclusively in dissolving Silver & gold in electro plating- in France & can be obtained readily- Put cut of Phosphor in any bitter & heating so as to burn & varying degrees of combustion we have the different forms of Phosphorus & the bitter white fumes given off at end of combustion will protect bodies from combustion- Tungstate of Soda prevent combustion of cloth- but the Phosphate of ammonia is better- the cloth will burn if flame touches it, but these substances will prevent a flame- the stronger the solution, the less apt the cloth is to burn which is soaked in it- The ammonia is discharged by the heat leaving the phosphoric acid- Bisulphide of carbon will dissolve phosphorus so will ether & alcohol to some extent- dissolve phosphorus in the above substance of carbon & pouring out on paper evaporation will take place leaving the phosphorus acid while fire spontaneously spontaneously. Phosphorus is soluble in oil when warmed- & when rubbed upon body will give a luminous appearance Sulphuric Acid- Found in urine associated with cases forming the Sulphates- Any salt of Barium as chloride or nitrate will give a Nurse white precipitate- called the white sulphate of Barium- Magnesia used same effect. Take sulpheric acid & dilute & by adding the Barium we have the white precipitate will do it with phospate of Soda solution. In urine we have sulpheret phosphoric acid- titrated Solution of Barium 30.5 grms Barium Chlorate Sal Chloride dissolves in 1000 cc Water- 1 cc= 0.01 grams SO3- Sulphuric acid Take tall glass vessel filled with water & bit of phosphite of Barium dropped in- combustion takes place & phosphoreted hydrogen is given off Proff Flint. Feb. 13th- Typhoid & Typus fevers are self limited diseases- average duration of typhoid 18 days of typus less- mode of dying by asthenia Treatment- good alimentative nourish as much as possible- better to introduce more than too little nourishment & commence at beginning of fevers & if it is retained & produces no trouble is evidence that it is absorbed- Milk first then eggs As a rule the artificial food as beef &c are worthless- "Leibigs meat soulution" is the only one to have any confidence in is good for rectal as well as per mouth alimentation- Should not give food at too short intervals unless patient takes only a small amount a time- Do not regard patients disgust for food, & vary it so as to not give patient one kind too long- Look into the matter of food & eating ourselves Solid food may be given in the convalescence- Stimulants as the sources & alcoholics are to be given- Under all circumstances almost giving that kind which has the best affect upon patient as ascertained by pulse & action of heart. A frequent feeble pulse indicate their use, & if the frequency is decreased & pulse strengthened we can conclude that the stimulant is having the desired effect Should not be given so as to intoxicate- Since claim that too much cannot be given, because there is an augumented tolerance of alcohol in these fevers- but this tolerance varies in different individuals- can determine the tolerance by not giving at too short intervals- Be our own judge as to time to commence alcohols- better be too soon than too late, Eggnog is a good way if not objectionable to patient- Do not consider or pronounce case of above fevers hopeless, as long as life exists unless there is positive evidence that patient cannot survive- Give patient an oz or two & wait an hour or two & if patients condition is improved- you can decide that stimulants are indicated- Intermittent Fever- Are benign & Pernicious- Intermissive applys to the time between each paroxism- The interval- the tonic tubular die paroxisms- Temperature 106 or more or less- fever lasts from 3 to 8 hours & remaking stage 3 or 4 hours- Absence of blood in Peripheral blood vessels in the chill likely due to spasm & vaso motor system of nerves- Condition of blood different in cold & hot stage, "Periodical fever"- relate to their periodicity- Malarial fever to the cause Paroxisms as a rule are uniform- Double Quotidian- 2 in 24 hours Double Tertian- Duplicated Tertian is a rule the paroxism occurs in 1st part of day- if left to itself in some cases will occur earlier each time & in others later called anticipating & retarding- Blood becomes impoverished speedily anemia jallows- pallor- sallowness Malarial cacexia- Spleen enlarges- General dropsy preceded by Oedam- Breaking out about mouth as Herpes Zona occurs- Latent intermittent fever has been applied to a low stage of fever determined by thermometer Internal organs present appearance of Pigment- from distruction of red blood corpuscles - is seen in blood at as- Semi Coma- Gastralgia- & in children - convulsions may take place or be associated with the cold stage- Cause is not formed in body- is from the soil- is not contagious- Occupies certain districts- malarial being different from typhoid fever in this respect which may occur any where Is not produced under 60 degrees of temperature- is in new soil it disappears after long cultivation of soil - from newly turned soil- is close to surface of earth- (Liver dulness evidence of tympanitis in typhoid fever is not all to perforation- also tympanitic resonan in region of liver) [cross out] Proff Bryant Feb. 14th- Sayres Radical cures of hernia- so called is a deception- The treatment is of two kinds Palliative & curative- Bichloride of Mercury I believe to be as good or better germicide as carbolic acid- 1 to 2500 parts- & I think for disinfecting wounds, better Chace the acid because the acid may posion & smell is objectionable- The mercury will on produce slight salivation Performs operation for hernia on a man 65 years old by making incision from near anterior spine of Illeum- to near the bottom of scrotum- 5 or 7 inches long- the opening in abdomen from the hernia near 4 inches longer. Proff. Janeway. Feb. 14th- Carcinoma of Liver- We may have Jaundice from obstruction fever occasionally present. Prognosis- fatal- Treatment can only be palliative- Jaundice is frequently seen- due to absorption of bile- & decomposition of blood - blood changes- Cause- must by decided upon, after a very careful survey of symptoms- Source cases of Jaundice is caused by obstruction in common bile duct or hepatic duct. most frequently where it enter intestine- Catarrh of bile duct causing swelling of membrane, may occlude duct plug of mucous may fill it. Billiary Calculous- Gall stone is often cause of jaundice- but must be in common or hepatic duct & not in cystic duct unless it gets lodged in mouth of cystic duct. Inflamation of croupous nature routine obstructs duct very rarely Foreign bodies- as worms may obstruct- Tumour or Carsinoma- may obstruct duct about Pancreas- or in intestines, Glands about liver as in waxes may obstruct passages Growths within ducts themselves may cause obstruction Phenomena of obstructive jaundice depends upon cause- comes on in 3 days after obstruction first seen in eyes urine. Acute yellow atrophy may be mistaken for jaundice obstructive never expansive for Jaundice by goo or any yellow light. Comes on gradually & continues to increase. Itching of skin more or less general may exist. Slowing of pulse & lowering of temperature apt to occur in some cases- Liability to flatulence- May or may not be sleeplessness- loss of peristaltic action of bowels & constipation. Jaundice causes blood dissolution- as nose bleeding- from bowels & under skin- By the urine much of the bile is eliminated- & they become irritated by passage of bile pigment- setting up nephritis. This condition occasionally goes on for years- Patient may die from results of process setting up the jaundice Where a line from point of shoulder to symphysis pubis crosses lower rib is where we will find bile duct. Pain apt to come on after meal- May be preceded by dull vomiting & fever Pain is intense- patient changing position in paroxisms, & when stone is passed relief is obtained- & then jaundice follows Calcula may be found in the faeces afterwards- will not float when moist- but will when dry- but every thing passed looking like calculi, may not be calculi & should therefore be examined, Calculi may be sand like blackish looking- Squeezing feces thro muslin may give the calculi. May be voided thro a fistula which has been made by inflammation or they may enter all into intestine Impacted gall stone may set up catarrh in duct between it & in liver & from there extend to stomack pleura & lungs & also Perotonitis- Sometime gall bladder burst May irritate & be discharged thro bronchi &c. Treatment of Hepatic colic- Morphia by skin & chloroform per mouth acting together best for the pain- Counter applications as warm water alkaline- Proff Leoremus Feb 14 Zinc Nitrate of silver used to act the basic properity of phosphates or phosphoric acid Phosporus acid obtained by nitric acid & phospherous & is in this associated with 1 part of warter- Ozone obtained from bichromate Potash & Sulphuric acid- Purify the phosphorous obtained from bones with it. Amorphous Phosphorus- obtained from air- Phosphates soluble in acids- Lests for sulphates in urine- Chlorate or of Barium- or the Nitrate Proff Smith A.A. Feb. 15th Man 30 years old has dull aching in loss of back of head worse in evening, it sometimes after eating has water brash soreness & swelling in stomack Syphillitic headache may come on about bed time & as this man having had syphillis, is likely that indigestion with this, is cause of headache- Syphillitic headache may be due to gummy tumor exostosis of vessels atheroma of vessels or anemia of brain- Treatment- relieve headache first- give Bromide Sodium give nux vomicia- 1/40 of a gr of Calomel given every hour for 10 or 12 hours before time of occurrence of headacke of syphillis I find has a good effect towards relieving it. May only have to repeat at two or three days- Washing out stomack with pump very often relieves this headacke of indigestion by dissolving the mucous which has accumulated there from the chronic gastritis- Sometimes an acid as muriatic may reduce that kind of headache. Hypertrophy of heart gives rise to headache in some cases by causing arterial congestion- Fatty degeneration with ammonia may cause mucous congestion & thereby some headache Woman been in hospital 8 months came in for intensive hemmorrage- has been relieved of the hemmorrage- has pain in back, has headache- at night- is worse two or three hours after eating- mostly when lying down at night- Is rather nervous- Here to reflex irritation due to uterine displacement or irritation. Nervous Headach common to business men from amid exhaustion- Temporary stimulants not good Rest made better as it affects vaso motor supply- If digestion impaired remedy that, Brom. of Chloral for 2 or 3 nights & no more may relieve it & produce sleep- Avoid use of tobacco as it affects nervous system Proff Doremus- Feb. 15th- We get sulphurous acid in burning a match in air- SO2 SO2O=Sulphuric acid, Obtain Sulphuric acid by burning sulphur- or bisulphide with nitric acid or nitrate & androus corrode=also adding Sulphur [cross out] acid to copper tacks & heating- Books & paintings may be ruined by sulphur in the gas burned for illumination in our houses- by depositing when uniting with the air, the sulphuric acid, * colorless nitros oxide will be formed & which by uniting with oxygen of air is converted into Sulphuric acid- deoxidize sulphuric acid by sulphate of copper by extreme heat, Boiling of the Common Sulphuric acid is made strong by boiling which requires great heat- boiled in glass or platinum vessels- is apt to break glass- Specific gravity # 124. All sulphuric acid apt to contain lead. Sulphates not so important as phosphates- Sulphuric acid produces reddish stain on clothes, so never dried & if vessel partly filled with it, it will fill in time by getting moisture from atmosphere- blackens wood & dries it- will not be neutralized by ammonia. [illustration] All the Soda in soap or used for bread is obtained in making sulphuric acid- will drive off any other acid. Is the "King of acids" as Roscoe Conkling says- Anhidros Sulphuric acid has no water water in it & is white- Sulphate of iron put in a retort & distilled we get the Sandhausen Oil of Vitriol=H2O (2SO3) Sulphates of urine are soluble enough to be washed out of bladder Heat bit of Platinum Red hot & put in dish of sulphurous acid- Ingest a body which you want to preserve with sulphurous acid- bisulphide of soda or lime will do it also- giving a ruddy cheek many days after death- Take arsenic sal, yellow antimony red & puss Sulphic rolled hydrogen thro it we have yellow & red color &c- Proff Welch- Feb 16th Use Lugols solution- Tinct Iodine diluted with sal. Iodide Potassa- to test waxey liver- Potts disease is a process of tubercle, Phthisis affects Kidney called Renal Phthisis Cancer or Tumour on head of pancreas may compress common bile duct & cause distension of gall bladder- giving rise to Jaundice- Prepneumothorax- results mostly from Tuberculosus- but may be from traumatism abscesses in surrounding organs stomack & oesophagus bronchi liver diseases of mammary glands or color &c- Proff Janeway Feb. 16th Cerebral Hyperemia & anemia hyperemia may be active or passive- continued use of substances which will dilate arteriole cappillary vessels may cause constant dilatation of these vessels Nitro glycerine & nitrite of amyl will cause pressure hyperemia of brain - but hardly think Quinine will do it. Anemia may result from congestion of brain Cerebro spinal & peri vascular fluids may be displaced towards canal & permit hyperemia of brain by blood to take place and this must occur before one can have congestion or this perivascular fluid may be absorbed & give place for the extravasation Constant study & over anxiety as for an examination rude as is before you gets up an excitement in brain producing certain amt. of congestion- not so much the work as the worry- Full stomack- use of tobacco- shock them to produce hyperemia- & may produce oposite effect. Signs- flushing of face- ringing in ears & photophobia- Stronger action of carotids- may have illusions & hallucinations vertigo, nausea & vomiting- & by going further may produce delirium & convulsions or comatose state, the stertorous breathing not being very great. In all people this condition apt to be done to atheroma & degeneration of vessels Multiple Sclerosis- tumour or abscess may cause it. Beginning of Brights disease with small Kidney which causes sometimes and arteries may lead us to diagnose congestion of brain Hypertrophy of left ventricle may be cause of conjestion, Insomnia restlessness spots before their eye- signs Excessive Sexual intercourse may cause it. Treatment- first find cause & remove it. Over feeding may cause it If from worry of mind- advise rest from it. Bromides in large doses of satisfied by hyperemia, if Anemia- give more- Hyosciamia by skin 1/40 to 1/2 oz a grain better- Chlorals good to produce quiet- Ergotine in 3 gr doses or Fluid Ext. Good- (counter irritation may relieve Pulmonary Hemmorrage) So counter irritation to back of neck good, if acute- purgatives & bathing feet in hot water good Sending off on a voyage good idea to rest a man from his business- If coma exists when you see- it first get bowels to act &c- Quiz- if abscess of brain about pressure of Rolands have paralysis or opposite Hemiplegia- Proff Flint Feb 16th- Clinic Negro- was taken with pain in back & legs headache throu cough pain inside fever- has diarrhaea- & pain in bowels few crepitant rales on right side- on left has subcrepitant abundant rales- expects yellowish matter with streaks of blood in it. Has symtoms of Pluerisy of Pneumonia & Bronchitis & Tuberculosis- No dulness over chest subcrepitant rales over whole of each lung low pitch absence of heart disease leads us to exclude oedema of lungs - Has bronchitis affecting smaller smaller tubes White Mass- Recent observations have discovered tuberculous micrococci or bacillus in the sputa & in breath- an incongruity between metalogial & clinical observations- for this mans parents lived to be over 90 years old & he is fifty having manifested no signs of said disease until after his wife died which was of tuberculosis- Patient- Negro- Perotonitis- 23 yrs old Last Saturday- had hard chill followed by fever pain in right illiac region feet face & hand little swelled- vomits greenish matter- bowels loose- has headacke we cant get much from temperature in perotonitis- Given 20 drops in Murine mixture of opium every hour until him relieved- Hot flaxseed poultice over bowels- The urine amber colored & hot when passing- Signs of Perotonitis tenderness in right illiac region mostly rigid recti muscles- tympanites- Perforation of Intestine acts up acute- peritonitis- If air or gas in any quantity exist in perotoneum we have resonance over liver or resonance where we had dulness before best we must not decide that this resonance is in perotoneum- it may be in colon or lungs just above which gives rise to the resonance, Porferation may possibly reoccur? Opium universally relied upon in treatment of Perotonitis to arrest peristaltic movements, One important diagnostic sign of Perotonitis is not using diaphram in respiration- Extreme tolerance of opium in perotonitis, to acertain- this commences with ordinary dose & in an our or two give another dose if first does not effect. Do not narcotise with opium. Do not reduce respirations below 12 or 14 to the minute, we can decide what effect tis going to have after 1st dose- We should see patient with this disease often- Do not give a cathartic- If accumulation in rectum be painful relieve as easily as possible Death comes on in this disease by asthenia. McMuno Mixture about half as stong as Laudanum. Proff Doremus Feb. 16th Anhydras Sulphuric is white- Organic- matter as bit of straw will color pure sulphuric acid- Sulphureous acid lower order of sulphates- Showed us action of sulphuretted hydrogen on metallic solutions by smoking pisture Sulphurated Hyrogen turns plaster or pounding red & then black- Sulphide Zinc will give white color or oxide Zinc Sulphuretted Hydrogen bubbles up from earth or springs of sulphur, has good effect or rhumatism- Scad hydrogen is very rich in sulphur- Sulphur yellow in rolls or in powder [cross out] called Flowers of Sulphur- occurs naturally was offered or burnt as a sacrifice to the gods- as a sweet incense- Obtained from Sicily- volcanoes- melt & mould in wooden moulds- Can impregnate water with sulphur by passing sulpheretted Hydrogen thro it, Sulphur poor conductor of electricity- Also of heat, By warming slowly will liquify of bright yellow color, but by increasing heat it is burned into molasses looking substances- Healing but of india rubber [cross out] with sulphur makes it malleable but by heating more is made exceeding by elastic- Vulcanized rubber is made by mixing sulphur with india rubber & applying heat as basting- Small amount of sulphur is used. Gutta Percha is indispensable in coating electric or telegraph wires. Pouring the Syruply looking substance result of melting brimstone- into water- makes it elastic- the sudden change of temperature being cause- Treating Sulphur with charcoal by heat we have gas given off- Bisulphide of Carbon- when liquified looks like water Sulphur found in every part of body in finger nails hair &c. Sulphur attack spoons & Spectacles &c turning often dark with black oxide of silver Lead &c Chloride of Sodium Increased from 10 to 20 times in urine as in diabetes. In inflamitory diseases fevers of all Kinds diminished Test- Salt of Silver - the chloride- Take common salt, dilute & add the silver a white precipitate is given which will darken exposed to sunlight This is chloride Silver. Shirts marked with nitrate of silver with soda- Chloride Silver- [cross out] soluble in ammonia insoluble in nitric acid To test for chloride of silver in urine- first add nitric acid- But best is to Pour out Silver & yellow chromate potash add water- a red fluid is obtained by Take 1 drop nit. Silver- Silver Nitrate Sal- 29.075 grms silver nitrate dissolved in 1000c water 1ce = 0.06 grms Chloride Sodium - 1ce = 0.006065 Chlorine- Proff. Keyes- Feb 16th 1883 Stone in Bladder- Mother liquid is urine from which stones form according to some- As a rule persons of sedimentary habits who live high uric acid stone is more apt to be found & towards old age. Rich people are those which suffer most from prostatic disease- which produces congestion & fatty degeneration of bladder giving rise to deposit of stone the phospates mostly in some places oxalate of lime uric acid more common in young persons- Then milky urine is evidence that phosphates are not forming in bladder- Carbonate Phosphate of lime uric acid &c calcite, will crystallize in certain & waters & form, with or without heat. So uric acid will form in circular needle like crystals in urine &c, Hence the quality of media or urine influences the nature of & formation of stone. Some stones after formation may become disintegrated or broken up by change of consistence or quality of urine- Phosphates & urates may pass in thick urine & yet person have no stone in bladder- A blood corpuscle or clot may form a nuclei for formation of stone Flu Ext of Hydrangea opium prevents formation of stones of some kind- if from colloid material in children Crushing operation most popular treatment of stone in bladder- Cutting for stone- many kinds, Operation for stone in bladder under 16 years or age very seldom attended with fatal results, if you cant get out stone at perineum- make the supra pubic massive- Is a grave operation in old age Proff. Yate. Feb. 17th- Potts disease- arises in all cases from the bodies of verterbra & not from ligaments between a periostitis may first occur under periosteum & may give rise to pain & be confined to bones of one vertebra for a time; but the inflamatory process may extend to the joint of vertebra & unless aborted may form an abscess- which is rarely the case. Absess mostly breaks out in front of vertebra because of strong ligament behind- The disease also mostly affects the front of vertebra & the parts of bone which is destroyed giving way produces the distortion of spine. Occasionally abscess points backward- If no pus formed, good nutrition & proper application may abort a disease but if Pus has formed- Thickening of processes or abscess may lead us to diagnose Potts disease, In said disease we have deep constant pain- disposition not to move spine by refusing to bend it in doing anything- Pain may be felt in the parts supplied by distribution of nerves coming off from part of column affected- cough may be set up- In this disease look for traumatism- but in a child of no strenuous diseases have I ever seen a case of it See how child walks if he cries when moved about on lap of mother or nurse Strip him & let it run about & if suffering from this disease you will see some trouble in his movements- Treatment- If ostitis it cannot be removed- but repair constitution- give rest to the spine- change of air & circumstances if necessary.- Nature does cure Potts disease as seen on our streets- No medicine I know of which has a special effect upon ostitis Were curass goood to secure rest with very small children but it often does not secure the required immobility of spine, Plaster joints good in feet I pad it best of all is cheap & can be recommended- First have a good fitting shirt under it so as to put close to skin- avoid a seam in it pocket draped according to condition of child - Proff Noyes- Feb. 19th 1883- Pathology of inflamation of middle ear- Accumlations may cause a bulging of Drum membrane- making it necessay to open it- But it should be done very cautiously & with a very fine instrument. A physician of Ohio says this is an obsolete operation- but Im sorry he said so. for I know that it is an operation which gives very decided relief to Patient- If pain great & conjestion exist of middle ear- Oleate of morphia & Belladonna- glycerine good- Warm water injections good, Hot fomentations to external ear good. Leeches may be applied to tragus good. After scarlet fever the drum membrane may be destroyed - & disease of bone apt to exist. & if bulging of mastoid process take place from the inflamation you may with a strong knife cut down thro periosteum & if bone spongy you may- make an opening down to the abscess with a pointed instrument- Morphia per mouth may be given for the Pain & Dovers powder seems to do more than relieve pain- Hot Boracic acid solution good to keep washed out A persistent perforation of Drum head may occur from chronic diarrhea, Granulation tissue & Pollipoid growths in ear mean same thing- to destroy the granulation tissue blowing boracic acid powder into ear good. diluted alcohol equal parts of it & water made stronger gradually as used, no good also- if neither one of these succeed a wire small 36 or 8 no. of concealed wire thro a canula, may be used to remove these by cutting off - Proff J. L. Smith- Feb 19th- Vomiting one first sign of Scarlet fever incubative stage 6 days average- may be one day only Redness & soreness of throat a symptom with the fever, Occurs mostly between ages of 6 months & 10 years is seldom observed in child under six months. Contagious properties of this disease not so volatile as that of whooping cough or measles- can be carried thro clotting as was case in one of these children. Should not allow child with this fever to go about even with mildest form- Keep in bed- have temperature no higher than- 70 degrees- not use any more clothing than is necessary to keep them warm- Tinct of Chloride of Iron- Moderate amt of Quinine may be given. For the faucial inflamation the following good R Acid carbolic ʒss use every 2 hours Potass Chloride ʒii Tinc water ℥ vi Glycerine ℥ ii mix- Oil of Theobroma, or carbolic acid until sweet oil or vaseline good for the itching & puritus of scarlet fever. This fever is contagious as soon as rash occurs- To prevent renal complication keep child close until desquamation entirely disappears- no medicine which will prevent it. To reduce high temperature I prefer using cold to head sides of neck & elongated useages along course of large vessels, & do not use the cold bath or sheet. Child 8 years old has scarlet fever 4 years ago, since then has swelling of feet 4 or 5 days every month- has mitral regurgitant of heart. The scarlatina nephritis it use the following: ꝶ Potase Acetate ℥ ii Infusion Digitalis oz vi - every two hours- Ergot may be given every 3 or 4th hour- Excite Respiration by steam &c This apply above- to acute cases- ꝶ Podophilla gr i Search Alb. 1 oz- divide in short No vi given every 4 hours good if above disagrees with stomack, or ꝶ Pilocarpin- 1 gr- Aqua 2 1/3 ℥- may be good when Potash & digitalis disagrees with stomack. Proff Flint Feb 19th 1883 Cause of [cross out] intermittent fever must be produced from day to day as patient is free of sickness between the paroxism- has certain period of incubation which term was used long before the germ theory of intermittent fever was advanced, But she cannot affirm that this fever is due to an organism as held by many. Refers us to Dr Mildrells work on Cryptogamous origin of Disease- Philadelphia 40 years of more ago. But this I know, that the blood contains considerable pigment matter in this fever- Restriction of red blood corpuscles are destroyed by these germs [cross out] held by some- Refers us to McClaggins work on germ theory of today- Is remarkable as acted upon by Quinine- this drug being sufficient to abort & control this disease. Twas formerly thought that preparatory treatment as bleeding cathartics- emetics &c was necessary before giving the Quinine. But in 1841 I undertook to combat this practice in cases of soldiers & because of inconvenience instead of 1 or 2 grs, 5 gr doses & increased the amount at a dose up to 40 grs which amt seemed to affect patient & found that the paroxisms were broken up without the preparatory treatment & that 1 dose a day was sufficient if it produced cendronism as ascertained by the tinnitus aurium- Some are more easily affected than others & suggest to test tolerance of patient for the drug beginning with 5 grs doses- Is variable in its strength, Should be given before paroxism leaves patient, Some cannot tolerate it even in very small doses, some from mental objection & some from irritability- Can be given by by perdimeally 1/2 or 1/3 as much as by mouth- Returns of attack result non persistance persistance on use of quinine, if we accept the germ theory. action of quinine as a parisiticide- Arsenic- nitric acid- feebly antiperiodic- Sulphates not satisfactory &c are given to break up this fever- Paroxism arrested by opium blood letting sinapisms to spine &c have been used- General dropsy follows this fever which requires treatment for some Spleen enlarged, Pilocarpine by skin arrests paroxisms in some cases- Congestive- Pernicious fevers is generally fatal or aercoris- cannot explain why some malarial fevers are benign & malignant. A paroxism of pernicious is always preceded almost by one or more benign or mild paroxisms of fever, Coma is more or less profound when it sets in, resembling ureamic coma difference made by examining urine This coma may pass off if paroxism gives way, delirium- in some cases of some comatose state- Vomiting followed by collapse- hematuria from Kidney & bowels may come on - Diagnosis not hard- Object to prevent patient from dying stimulants- as ether- chlorogorm- ammonia to be given- Prevent if possible the reoccurrence of paroxism- by giving Quinine 20 to 30 grs before paroxism goes off or as soon as stomack will tolerate Repeat in four hours & larger dose if can be bourne Epileptic convulsions attend some cases of this fever- lar Proff Janeway Feb. 20th- Kausse an oz at a dose good to remove tape worm Shows a girl 26 yrs old totally blind preceded by general weakness- 2 years ago & ever since has had pain in head face & right side, giving way of legs in walking- cramp like pains- a year ago commenced to get blind- walks as if going to fall all the time- worse at some times than others. Has pain in left hip all the time no loss of sensation- Has several attacks of convulsions- Loss of eye sight due to choked discs- Smell- taste & hearing not much impaired- Has tumour on brain- Mengitis chronic with general effusion might produce similar condition. Pain in head is not constant in one place. Cannot locate position of tumour Prognosis- unfavorable absolutely- unless syphillitic which not likely to be because of its long continuance & resisting treatment of same- Tumour of brain may produce pain in remote part of body as knee or hip & thigh Woman- 57 years old- troubles in extremities walks as if- according to Trouses "Pursuing centre of gravity" rigidity of arms- neck- legs- has no grip cannot extend arms or legs of herself- lips tremble- cannot speak loud, difficulty in coughing- Has "paralysis agitans "- may come on from excitement burst &c not much to be done for it. Proff. Doremus Feb. 20th 1 part manganese 4 parts Salt, 2 parts sulphuric acid & water to moisture- Chlorine- Specific grav. 2.45 air = 1. 100 cc in weigh 77.04 grams- 1000 cc weigh 3.178 grams- 100 vols water absorb 270 chlorine Put piece of clean platinum cleaned with an alkali in bunsuns flame we get the yellow flame color- Chloride of sodium burned same way gives us the yellow flame- very difficult to remove the chlorides from animal tissue of body- seem to have some to do in the cell changes- Distribution of Chloride of Sodium thro the body very important. Some blood rises if moistened in water will contrast & assume concave form if moistened in salt water they assume convex form expand & burst Chloride of sodium introduce it into body in many ways- food, air & drink- is in nourishing oil, in all plants- birds- fish beasts- & insects. Thin sheet of glass will intercept heat. but chloride of Salt is diarthemorous- will transmit heat- allow heat to pass thro it. Salt mines have a basin shape- Localities of salt are elevated high above level of sea in some places- No animal life in dead Sea- Some of these mines may be covered up by seed & other deposits- Chloride of sodium found in found in rocks & earth- Adds to healthy condition of animals & is said to also add to the propagation of animals- Hindoos swear upon their salt Metallic Sodium combines very readily with oxygen has metallic lustre- is soft- To make aluminum- combine Sodium after first converting it into Salt- Sodium metallic decomposes water- setting free the Hydrogen which takes fire with an explosion Have evidence of calcium in sun & star light- This Metal Sodium- combined with Chlorine- Dephlogisticated oxi muriatic acid. To isolate this body, we must have nascent oxygen- lately released- By heating peroxide of manganese with hydrochloric acid- we get this chlorine gas given off- greenish color- is very heavy- can be poured from one vessel to another- Has an aptitude at combination with many substance- Sun light will cause chlorine & Hydrogen to explode- also with electric light- great affinity of chlorine for hydrogen by filling Us tube with hydrochloric acid saturated in chlorine & apply negative & positive poles of battery feeble light causes Urine to combine slowly- Chlorine will rob many substances of its hydrogues hence useful to us, to deprive or dihidrogenate the substance or convert into sulphates- Carburetted hydrogen- Chlorine will deprive it of hydrogen- by passing it into jar of chlorine- spread upon paper the carburetted hydrogen- [?ake] fire in process of dihidrogenation giving a thick dark smoke & coating the jar with black substance- carbon- Proff. Janeway- for Flint- Feb 20 For Obstructive Jaundice- some suggest an emetic- squeezing gall bladder- &c Warm baths good for the itching carbolic acid water may be good- when kidneys affected give diuretics & under water- Blister preceded by leaching- hot poultices- good for the pain over liver- Carlsbad water, Rochelle Salts or some mild nature laxative may be given for the bowels constipation- Fatty food often objectionable to stomack- but meat food better than vegetable because not so apt to cause flatulence Lack of bile likely to be cause or dry fats are not digestible for bile is supposed to digest in part fatty substances as well as the pancreas- give acid drinks if patient desire it. R Prevention of Disease- Public Hygiene Tis your duty to report a contagious disease regardless of your own or your patients interests. First trouble will be in difficulty to recognize one of these diseases as for example- Small Pox- Do not believe that varicelli is every time small pox- There is a kind of varicella which comes from small pox which by repitition may go into confluent small pox. is carried in clotting & if we are in any doubt about disease from the patient quarantined. Petechial Hemmorraghic- the worst type of Small pox- bleeding from mouth & nose & under skin in spots- To protect the patient from doubtful small Pox- evacuate with healthy matter- & see that it is efficacious Some people are scarred by vaccinations for life some for half their lives & I think it ought to be repeated every 7 years- or if necessary at out break of disease- We ought to pursuade persons to be vaccinated & not make it compulsory- Dont Know- a single instance in which out of rural thousand, syphillis was communicated when bovine virous is used- Eresipelas does occasionally result from vaccination- Proff Mott, Feb 21st 1883 Case of malignant pustule of lip with enlargement of submaxillary gland Free vent should be given to the pustule- let matter escape- poultice- Nitrate of silver might be used to swab out abscess- This disease has caused many deaths in this city when left alone too long Proff. Keyes- Feb. 21st- Disease of Prostrate gland- as enlargement is partly a muscle & partly a gland- rapid contraction of it expels semen in spirts during sexual excitement. In about 1/3 of all men have more or less enlargement of this glands consequently hypertrophy is often not a disease. Some being more nervous & sensitive may be effected by milder irritations of this gland Is in natural state, about size of chestnut Prostate enlarged analogous to enlargement of ovaries in female Symptoms of prostrate disease trouble with water at night, if stone, structure or urethra or bladder more apt to have trouble with water in day time- Bladder is affected in this disease- as catarrh cystitis &c Wash out bladder well often all that is necessary. Some suggest take v, shaped piece of gland to free the urethra medicine useless internally to reduce enlarged prostrate, Injections of ergot, iodine have been injected by skin in this affection- Iodide Potass & ergot have been given but they have no effect in this case. A heaping teaspoonful of Borax in pint of water good to wash out bladder with, Fountain Syringe is best to use as patient can use himself- many other substances are used to wash out bladder but I find borax best Benzoic acid internally 10 to 20 grs in capsules- Salicylic acid with salicilate of soda very good internally for ammoniacal urine- also oil of winter green good- mineral waters & alkalies also good, If not able to get these mineral waters- rain water filtered thro charcoal & seed answer a good purpose Prof Flint Feb. 21st. Rarely to see these days case of well marked Remittent fever- attack comes on by well-pronounced fever following after a few hours- remits then fever comes on again with or without a dull & if left to itself may burn to intermittent fever; Do not think that typhoid fever follows this fever as held by some- but my opinion that the two may be combined- consisting the typhus malarial fever. Typhoid fever appear often in districts where natural fevers previously existed & which had almost disappeared In some cases one of the other may predominate- A careful record of such cases would be an acquisition to medical science- Hemmoragic malarial fever - Hematuria & hemmorrage may occur from other places- We may have bloody urine from Kidney disease, but this is different indicating a change in blood corpuscles causing a destruction of [a?me] & setting free the Hematin or coloring matter. This should be distinguished from Hematurine- Hemo-globinuria periodical- is not of malarial origin & comes on at once bloody urine no fever or other abnormal condition- Exposure to cold invariably gives rise to this condition- & these paroxism occur again upon exposure to cold- no other treatment required except quiet- Hemmorragic fever- do not know that the hemmorrage is blood as this question has not been settled, but I think it is blood Relapsing Fever- was included under other fevers until about 30 years ago. In 1870 was imported into this city & has not existed here since- can be imported- occurs abruptly- with duct early perspiration- fever becomes intense quickly- pulse frequent from 5 to 7 days- may be shorter or longer- & there a profuse perspiration occurs & fever disappears in few cases- temperature lowers below normal- The pyrexia last only about a week when same symtoms recur but only lasts 4 to 5 days As a rule only 2 relapses occur- Vomiting occurs & such matter may be [cross out] taken for that of yellow fever- Spleen tender & jaundice often occurs- Delirium rare- no congestion- no tendency to serious complications. Pains in extremities- Pregnant women abort with this fever- This is a communicable disease- does not occur except from contagion- Dependent upon an organism- which is invariably present during the paroxism- and disappears with each pyrexia- In not fatal by no means- In 100 cases in this hospital only 1 or 2 died from it. Are no known anatomical changes connected with it. For the pains, give opiates- antipyretic treatment Proff Welsh- Feb. 23d 1883 Hard to distinguish between surgical Kidney acute interstitial nephritis- which is ulcerated in spots- & tuberculous kidney which presents similar condition. getting history of case & examining lungs will enable you to distinguish between the two lesions Pneumonia said to be worse when it attacks upper lobe of lung instead of lower. Anterior border of lung frequently escapes exesions of pneumonia, & you should therefore not confine your examination to anterior portion of chest. Massive Pneumonia is when fibrinous blood or exudation occupies larger bronchial tube- Large proportion of those who die with Pneumonia, die in stage of mottled hepatization. Spleen enlarges in pneumonia in many cases- hence propriety of fever applied to Pneumonia by Proff Flint- Fibro cystic tumour is thought to be rare in ovaries- mostly occur in uterus or from uterus, Ovaries have no perotoneal covering hence a tumour of this body may not be covered by perotoneum Pneumothorax- cause- Phthisis- emphysema gangreen- Traumatism- Paracenta thoracis- ulceration from Stomack & colon To diagnose- puncture one of the intercostal spaces- or by dissecting up cut of skin & putting water in & then puncture the spaces air in lung will bubble up thro water- or by blowing up lung, air will escape into plural cavity- May have air above may have air & serum.- air & pus, Pure air will not set up inflamation for some time as from a fall- or hard respiratory effort, Where serum & air found- only a mild amt of irritation- Most usual is Pneumo Pyo-thorax- bacteria found in the pus- air composed of oxagen, nitrogen carbonic acid & small amt of sulphuretted hydrogen gas. Opening into pleural may be large or partial- when large air almost natural- when partial more carbonic acid gas, Prognosis generally fatal but recoveries are possible Proff. Janeway- Feb. 23d- Venous return may cause passive hyperemia- Signs- somnolence- inaction of mind- stupor- may be due to tumour or pressure from some cause weakness of heart. If due to heart disease improve its action- if too much blood give hydragogue cathartics Anemia- signs- brought about by mental inaction- spots before eyes- ringing in ear confusion of thought & possibly by falling down- loss of motion- The anemia may be general or local. Mental depression may accompany- anemia or hyperameia For collapse or shock from loss of blood [cross out] opium is the best thing you can give Nitrite of Amyl & Nitro glycerine act quickly & are very good. Placing head low so as to go to heart & medula oblongata- the blood- same good for chronic anemia given at dinner time & a certain certain amt patient requires- Diseases of Cord- Packa meningitis- inflamation of duramater- Hamorragica very rare- Lepto meningitis rare Systemic diffused- localized & designated inflamations may affect the cord- may occur transversely & in multiple foci. may be in anterior horns or in lateral columns- Myelitis- inflamation or cord- may come on acutely or chronically acute where it destroys motion in 5 minutes or nearly so short a time- Sign radiating pains- from certain point with alternate feelings of heat & cold band like feeling around abdomen. feeling as if ants crawling upon skin Diminished tactile sensibility- Inability of walking if in a certain place- trouble with bladder & bowels. Cutaneous reflex movement & at knee unpoised if in anterior portion of cord cells of horn Pyelitis- Cystitis & bed sores rapidly follow- acute Pyelitis- Keep bladder washed out with clean catheter & water or you may have bacteria in bladder setting up decomposition of urine- Pneumonia may come on from failure to use the walls of abdomen [cross out] in process of respiration- have seen loss of arms & good use of legs & feet retained affects persons according to points affected- Causes injury to cord- concusion exposure to cold & wet. Syphilis predisposes- Severe mental emotion may cause it in adult life. Prognosis- according to part affected the higher up the more unfavorable Complete recovery may occur in some cases- Put on proper bed- not one of straw- water bed if you can- If not water bed put on smooth one with tub for passage of feces- Alcohol to harden points where bed sores likely to come- In early or congestive congestive stage- Ergot- Belladonna- counter irritation to spine- as blisters or actual cutting lightly Proff. Flint Feb 23 Myalgia muscular Rheumatism Oil of Gaultheria good for some if in back is spine taken for Kidney disease- Pain often being severe- aggravated upon motion & ease when lying down Rubbing good- quinine good- When you strike chronic disease advise patient of its duration Impaired vision one of signs of uremia general or local dropsies, ascertain quantity & specific gravity. Vomiting in morning before taking food one strong evidence of renal disease- Solution will take place of Elaterium when indicated but is objectionable to stomach often- Sulphate of magnesia may be genuine such cases. Simple pure water is one of our most valuable diuretics in uremia Case of Spermatorrhaea- Often more a disease of mind than of genital organs- Proff. Doremus Feb.23d Chlorine- Electro Negative- Obtained from peroxide of manganese & hydrochloric acid- To release chlorine from chloride of sodium- use oil of vitrioil & apply heat to act clorine free more in salt & peroxide manganese- releases quickly all the chlorine from the salt. Sulpheric acid only acts upon lead superficially & I use large [cross out] tanks of lead- in which put 1 part peroxide manganese 4 oz of salt & 2 oz sulphuric acid- put [cross out] water in first & make kind of mush of manganese & salt & then pour on sulphuric acid from a carboy. Adding water to sulphuric acid heats the vessel must have aid of several persons & all pour in acid at once & quickly leave the room if purifying a room this should be repeated at least 3 times to thoroughly disinfect a room- Do not trust a lock & key to prevent entry in to a room while being disinfected for one may suddenly die upon entering it Nail it up securely. Hypochlorites may be used to purify contents of room- The clotting. Bromine passed in jar of Sulphuretted Hydrogen the yellow color sulphur will be deposited on surface Chlorines obtained from Hydrochlorate of lime; vinegar or sulphuric acid- This Hydrochlorate of urine carried in barrels aboard ships as a disinfectant & is a deodorizer as well destroys vaccine virus. Whiteness of shirts & paper due to chlorine- acts better in dampness of atmosphere- passing cloth thro acid & then exposing to Chlorine or Hypochloride of lime- injures a little the fabric which Purifies rags out of which nitric paper is made- Hypochlorite or Bromate of soda may determine amt of area-Take washing soda & then put to it Hypochlorate of lime- & Labor raques solution of Soda will be given off. Chlorine & Hydrogen exposed to sun unite with explosive vigor- other light more slowly- Common salt & Sulphuric acid will form hydrochloric acid best to make chlorine we must add one amount oxygen- ozone- black oxide of manganese which will unite with the hydrogen- Arsenic found in all Hydrochloric acid Sulphate of Soda Glauber Salts result of making Hydrochloric acid- Uris acid is heavier than the air hence injurious to vegetation in neighborhood of its manufacture- Charcoal will do oxidizes sulphuric acid by roasting roasting in it. Pour Iodine Potassa in recently boiled starch- Bromic- a rich red collored gas- violet color grows Iodine-green from Chloric - we have blue color Iodine of starch- Pour chlorine into the starch we get green color- Use chlorine by the ton for disinfecting purposes. Proff Keyes-Feb. 23d 1883 Stone in Bladder- Bigelow of Boston in 1879 January- first introduced the present system of Lithotrity- that is rapid & complete removal of the stone- by disregarding the time that was set for the lithrotite to remain in urethra- which are at the extreme 5 minutes, Bigelows operation is now performed throout the world & can be done by almost any physician. Physician should not attempt this at his first operation unless on a small stone. Bladder should be washed out thoroughly- This operation is particularly applicable to women & children, but is not applicable to remove stone in male person under age of puberty - by this operation More than one stone or size of it does not contraindicate this operation- but a stone over 2 in. in diameter will usually resist action of instrument Oxatate of lime hardest alone & I have broken them with my instrument- Bigolows more apt to break then mine Proff Yale Feb 24th- Lateral curvature- Scoliosis- never kills of it self, but its effect may destroy life secondarily as induced learning- Potts disease- an inflamation & cases of cancellalea process of vertabra 95 percent of lateral curvatures occur in female children about 10 or 16 years of age & mostly among well to do people, but may be among poor people where children are slouchy & careless about carriage. Proff A.A. Smith Feb. 26th- Iodides 5 to 7 grs of Iodide potassa produces iodism in some- a severe cold appearances - by affecting terminal filaments of nerves or air passages- but I think its effects due aection on numerous membrane [cross out] Are more tolerated in Syphillis- disturbs & irritates gastric mucous membrane of [cross out] it in nasal catarrh but it produces same condition when taken in health but is good only in about 2 or 3 percent of nasal catarrh- Muriate of Ammonia will cure much larger number- Iodide of Potass, good in bronchitis & asthma in 7 gr doses if secreteoumos very great. Is given in Pneumonia where resolution is slow, its given in [peu?ic] exudation of Pluerisy & in serious effusion- perhaps by its tonic & diuretic effects- Is not much used in disease of circulatory system except in syphilis by arresting change going on by this poisoning- given in aneurism, but will not cure it. May diminish size by arresting degeneration of walls of some- Injecting into neck of not much importance, Do not think it ought to be given in 1st or 1st of secondry, stage of syphilis- give after meals begining with 10 grs doses & increased, Do not believe that patients stomach will absorb much over 300 grs a day- but has been given in as much as 9 & 1400 grs a day- Will pass off with foeces in large doses- 1 drop of water will dissolve 1 gr Infusion of hops good vehicle to give in. Iodide of soda- calcium &c may be given when that of potassa disagres with stomach, Iodides of Potassa, & others diuretic- that of Potassa irritating Iodide of Potassa will produce Iodide of Lead when given in lead poisoning which is eliminated by Kidneys hence not in my opinion not of any service in this affection, Acetate of Potash will give acetate of lead in lead poisoning- Glandular Enlargements as in struma or scrofula benefited by internal & external applications of Iodine & its compound with cod fever- good to inject iodine in hydrocele sack, but doubtful in other cases of glandular enlargunar- injecting of 3 drop in enlarged tonsils by long syringe- will often relieve the enlargement Galvanic current is constant or continuous- Farrady is the interrupted current or induced current, Farradaic mostly used- has in it zinc & carbon plates- Sulphuric acid dichromate potash & with only 2 cells is very strong, This used mostly on muscles, Makes but little difference about which pole the negative or positive where each is applied to the muscle- wood- glass, more conditions but all metals are moistened surface assists action of batterey. In treatment of disturbances of nervous system use the galvanic current. In that of muscular system use the farradic current, but both may be used in either disturbance, In headach of different kinds, galvanic current to mastoid processes not longer than 3 or 4 minutes may in some cases be used 10 minutes the above good in post occipital neuralgia but is of not much service in facial neuralgia, but may occasionally cure it when other remedies fail. Proff Noyes- Feb 26th Consequences of inflamation of [middle] ear- chronic otorrhoea- discharge from ear when tympanum is destroyed or the bones or bone of ear removed- loss of hearing to a great extent. An artificial drum can be of service in some cases where there is no granulation tissue growth- a lock of cotton wet in glycerine often makes a very good one worn for a day or two. The chronic discharge leads in some cases to cerebral & meningeal trouble. Solutions of boracic & carbolic acid good to keep ear washed well which is very important in the treatment- Boracic acid powder blown in ear of considerable quantity the least thing I've found. Much depends upon health & constitution of patient, as to affect of med. Pathological changes as thickening atrophy &c take place in drum head & ossicles giving rise to hardness of hearing especially in old persons. Then Eustachaian tube may become occluded & cause it, Hard to restore after exposure of mouths of ears- Chronic mass Pharnigitis Rhuematism gout & hereditary disorders may effect ears & hearing. Tinitus Aurium most distressing buzzing noises in ear- is effect of distorted condition of parts external to internal ear & disorder of nerves of same Parus catheter into Eustachian tube when loss of hearing due to noso Pharengeal catarrh- treat the catarrh by astringent & stimulating applications with cotton & uterine sound with proper curve, If serum or other liquid middle ear will hear most loudly the tuning fork when put to the teeth on diseased side If trouble in internal ear the same sound will not be heard so well if at all Proff J.L. Smith Feb. 26 Rachitis more rare in this country than in Europe Lactic acid & Phosphores will cause this disease in animals- trouble in epiphiseal cartilages- an arrest of deposit of certain bone making material by a slowness inflammitory process Comes with rachitis cross & fretful in earlier stage. Remedy- give best Hygienic treatment- with codliver oil ℥xi lime water & Lactophosphate of lime aa ℥iv dose one teaspoonful [cross out] This disease makes its appearance about age of dentition Case of Hydrocephalus- downward look of eyes due to pressure of liquid upon orbital plate- About a year old cant hold its head up- Fluid in lateral ventricles- about foramen of Monroe forming a cavity filled with this cerebro spinal fluid- Occasionally may be in arachnoid- Do not Know that I have ever seen one get well- but use of Iodide potassa may control accumulation & child arrive at maturity a skull cap may be used to prevent expansion of bones - & remove if cerebral symtoms intervened, Aspirating not attended attended with favorable results- Proff. Flint. Feb. 26th 1883. Small Pox- Varoila- an eruptive fever Stage of invasion of eruption of desquamation & convalescence, Period of incubation from 5 to 20 days- average 14 days duration of invasion 2 days, in Rubella 4 days & 1 day is scarlet fever- Symtoms in small Pox- pain in back- chill more or less fever- delirium & coma in some case- purpuric spots with hammorage- in children convulsions not very infrequent- laringitis, coriga- Pharengitis Opthalmia rash ominous membrane- Vomiting sometimes present, rash may appear on mucous membrane before on skin- Eruption first appears about lips skin & forearm spreading this over body in small spots or maculae- which in a few hours are elevated, are harder than those of measles- Strange then into vesicles See 42 hours become distinct & in 72 hours Are full sized- have a depression in loss umbilicated- only occur in some cases with aid of microscope. There is viscous fluid becomes purulent in 2 to 4 days- Some of the pox or measles harden & are absorbed- some burst & fluid escapes. Vesicles may coalesce- & then is called confluent. When they remain alone is discreet small pox- Odour disagreable & characteristic- Eruption apt to occur in any of the mucous membrane- that of other eruptive fevers being confined to certain mucous membrane- When eruption appears the fever disappears- which is a characteristic of this disease- In rubeola- fever is increased also in scarlet fever- The fever which occurs at time pustules undergo change called fever of maturation & is seconary- Diarrhoea sometimes present saturation from irritation of mouth, In last stage or desquamative- vesicles harden or are absorbed or scabs form leaving the pits & now secondary fever subsides, Bronchitis Oedema of glottis Erisipelas- inflamation of fauces &c may exist with this disease as result of the inflamation- Kidney may be arrested in its action, urea accumulate in blood & patient have convulsions- as do carditis & Pleuritis as result of Renal affection, Flactus may contract it & labour with it without mother having had it. Mortality about 1/4 in confluent in suppurative stage by exhaustion about 1/10 in discreet Small Pox- Varioloid is variola or small Pox modified is communicable. May be produced by inoculation- introduction of the virus intentionally into healthy patient which is intended to and does prevent the invasion of small Pox (Women pregnant as a rule miscary with this or small Pox) Vaccination does not afford complete protection from the disease but renders it much more mild- In Varacella the depression is absent in the vesicles- Chicken Pox of no consequence but is confounded with varicella sometimes- Varicella has no period of invasion marked- Papules never become pustules are smaller fever & other disturbance slight Treatment- dont know of anything than will abort it (Curry held that cold nights cut is short) Must be palliative- There is extensive local inflamation (hence stimulating contraindicated (?) good hygine- air & food & alcoholics. Mineral acids Sulphates are good, Eccrotic measures to prevent pustules pitting- I suggest opening them & squeezing out matter. Iodine suggest- exclusion of air & light- collodion have been suggested for the eruption to prevent pitting. Proff Lusk- Feb. 27th 1883 Lochia 1st 3 days of blood & serum- after 4th day serum greater than blood- about & after 8th day lochia assumes a pus like form- I believe tis best to wash out wound after 1st day with boracic acid solution & infusion of camomile flowers as a deodorizer- Have been told that collapse follows above course but dont believe it- After 3d day add carbolic acid used- Use washes 2 or 3 times a day. Stroking breast & drawing out milk relives the trouble in breast. Oiling it well & then stroking towards nipple will often start milk freely. Better have child to nurse its own mother as a rule all the time- but under any circumstance should nurse it for 4 or 6 weeks both for her own good & the childs. Mothers who are diseased should not nurse her children- Once in two hours often enough to nurse child- Should not be allowed to hang onto breast all night & should not be nursed more than once or twice at night. Saturated Sal. of Boracic should be used to wash off nipple after each nursing.- Goulards sac. of Lead good to use to nipples at first to prevent soreness- Must be washed off before nursing child- About 10th day soon enough for woman to get up & then be very careful- If stout woman she may get up on 8th day. All need an abdominal bandage for two or three months- The pain about hips & slow getting up after delivery, due to relaxation of symphysis pubis & a bandage of much service. Oil or lard will [cross out] if rubbed on before putting on water loosen up scurf which is on some children- For a wet nurse select healthy woman between 20 & 35 years of age long nipples- pyriform shaped breasts with good teeth or good healthy looking gums Examine throat & legs & if necessary the vagina so as to be sure there is no syphilis existing. And after you get one do not allow her to be tainted or abused in any manner for it may arrest secretion of milk- Bottle feeding will not as a rule raise healthy children- They may be raised very well but when half grown will often be diseased some may. Thick goats milk indijestable unless it gets it directly from teets of goat. Should get one cows milk- & if you find it does not agree with it- try another cow. The cows milk forms lumps in stomacks- curd- while mothers milk curdles in shreads- One part of cream to 2 oz of water has been given But I prefer the milk & to prevent curdling add little isinglass for it four or 5 weeks- Then you may give oat or barley meal or water with the milk- Should be given warm, sweetened with milk sugar- with little salt, give them teaspoonful of water every now & then Proff Janeway- Feb 27th Boy about 12 years old has been taking 20 drop doses of Fowlers solution 3 times a day for 2 weeks without any bad perceptable effect Case- of Gastroduodenitis- skin yellow pain & tenderness in pit of stomack- has some fever- Liver rather enlarged. conjunctiva yellow. Liver tender to touch. Foeces light colored. Vomiting at first. Suggest a blister over liver & repeated if necessary Has itching of skin inside of thighs & back- Pulse 60- lower than normal- Suggest laxatives to keep bowels loose- For the itching suggest sponging with vinegar or alcohol & borax solution. Child 4 years old- who has convulsions every day- had 7 last night- but is up & playing about today & is always so after having them- Gave him first heavy doses of Bromides with no effect. Am now giving him atropine which is improving his general health but has not so far affected the convulsions Case of chronic gout with much deformity of fingers- Look at ear to see if any deposit of urate of soda in little specks or Prima This may effect big toes or other joints first Some of the attacks may be from living in damp places & depraved living- Case of neuralgia of 5th nerve of face- girl- pale- tenderness over point of emergence of nerves- Oil of peppermint peppermint as best with large doses of quinine lately good for this disease Faradism & galvanism- will cure some cases one or the other. This girls neuralgia due to anemia- give her iron & good nourishment. Teeth pulling should not be allowed unless teeth be visibly affected Proff Doremus- Feb 27th 1883 Metals of Urine- Iron- outranks every metal in the world as exhibited in machinery from that of the watch to that of the largest steamship. Exists in the sun as well as earth & other burning spheres as seen by urethritis & by spectroscope do not get it pure on account of its affinity for oxygen- Formed in earth- plants flowers which gives them their color- Seen in our cheeks.- Here of exertion jaundice &c due to iron. Color of urine due to the iron its different colors- If blood corpuscle corpuscle burnt up gives iron in the urine which is natural constituent of normal urine- Administration of arsenic- shown by examining urine. This was not known until recently discovered by Harley- To discover it in urine, you must break up the organic compound by some acid as hydrochloric acid- a very small quantity only of urine will do to exhibit test. First evaporate urine down & add chlorate of Potass nitric, hidrchloric or sulphuric acid over water bath- Evaporating natural urine without the acid will give us different dark colors- the darker the urine the darker the color- Use hematin coloring matter of urine- Take iron a few days & use sulphuric acid test & gives a very black color- Iron has power of disguising itself, as sun light or electric light necessary to show it in blood-& [cross out] hold little blood between glass plate the rays of sun are absorbed in bands called absorbent bands- The glass of itself giving the different colors of the rainbow by intercepting sun rays with their stratum of blood, we get marring of the colors of the rainbow by the rain- by using the spectroscope. - called spectroscopic analysis. Take telascope & look at sun we have dark lines in number according to prism used instead of bands as seen with spectroscope. In disease after subcutaneous inj of Indol One of the Products of Pancreatic digestion in alimentary canal- Gives odour to foeces. Vomiting with a saccharine substance eliminated in urine as In disease This mother substance of Indigo decomposes with sulphuric acid or hydrochloric acid into Indigo Blue Uroglaucin " Red Urrhodin Proff Flint Feb. 27th 1883 Yellow Fever- has no distinct known anatomical characteristics- only change is fatty change of liver found after death which is constantly found- What this significance is we dont know. Begins abruptly usually with slight chill & rapid rise of fever. tenderness in stomack pain in lumbar region & lower limbs- red & watery condition of eyes- lasts from a few hours to 3 days, when remission or apenexia complete may take place- Sequels of this fever which developes in 24 or 48 hours most serious as black vomit of blood as proven by snycroscope hemmorrage from bowels occur & death almost always follows- Albumen exist in urine & urine may be suppressed & uremia give rise to convulsions & death. Hemmorrage may take place from nostrils. Kidney or at wound. Petechial spots may appear & fill with blood. Some cases may be so mild as not to put patient to bed Death takes place in state of collapse & by asthenia- Is confined to single paroxysm- The icterus not so grave a condition as uremia & convulsions. Black vomit may occur after fever leaves patient. Mortality ranges from 10 to 75 percent. average duration 3 days- Evidence that disease is communicable is by inoculation- but have no evidence that this disease is inocculable- Is not liable to occur in all places, as is the case with a communicable disease This fever is confined to certain zone require certain temperature breaks out simultaneously- disappears at frost. Do not find that disease spred from locality where its breaks out. Is not communicable in hospitals- Therefore this is not a communicable disease- Ceases of its own accord without frost. another evidence of its non contagious- But it is a portable disease & can be carried in vessels &c. hence the importance of quarantine regulations & disinfecting merchandise. Persons should not be restricted- its not settled that this disease is due to a germ or organism unacclimated persons more subjects to it. negroes not so susceptible & is generally milder with them- cant account for this. One attack as a rule exempts one from second attacks Yellow-fever epidimics may be arrested by disinfectant- affects all ages alike. Have no specific remedies for it Tends to recovery in some cases, & in others death will take place whatever is done. Meet symtoms by expectant plan Perfect quiet & rest important moving mostly proves fatal. Proff Stone of New Orleans held this view. Preservatory measures to be used- Nitro muriatic acid suggested- mild diaphorisis by orange leaf tea- Have no doubt about this good effect of alcoholics as champaigne wine in this disease as Proff Mott. Feb. 28th- Mur. tinct of iron almost a specific for erisepelas in 10 drop doses every 2 hours or more if necessary- or 20 drops or more every 4 hours- Lead & opium wash good application to the inflammation- Depletive measures in treatment of this disease about out of date- Proff. Janeway- Feb 28th Burn all scabs from sores of small Pox as they fall off. cleanse the person thouroughly & shave his hair- put on new clothes before allowing them to leave room. Here disinfect room by generating chlorine use it or by burning sulphur in it & shutting up for several days- Close room thoroughly by pasting paper over the openings. Small Pox will not go far in open air- not more than 5 to 10 feet. Small Pox least to be dreaded of all mentions disease because of the exemption by vaccination- Keep vaccine matter in a cool place & not in your vest pocket as many do. Deposits of privies & cess pools &c may be carried to wells or springs 50 or more feet away- if there is any descent may be carried much farther than 50 feet. Therefore be very careful about these things or you may have typhoid fevers - Water may become contaminated by milk- Excrement from typhoid fever patient if thrown into privy may give one typhoid thro the air from this matter Chloride of zinc 3 oz. 5 oz Salt & 5 gallons of water- better than sulphate of iron to disinfect typhoid fever stools The sulp of iron very good if you do not want to disinfect clothes- to disinfect stools & privy vaults. Difficult to acertain origin of typhoid fever in a large city- but in country we can trace the origin to a privy, water, or cesspool &c. Typhoid fever slightly contagious- Typhus fever very contagious- Physicians may carry measles Scarlet fever & dyptheria- as well as small pox &c. several miles & communicate these diseases to other persons. Have known dyptheria to have been carried from this city- Brooklin to Florida in clothing- Proff A.A. Smith- Mch 1st Woman- Took cough 2 months ago. Pain in left shoulder- loss of appetite & pain in left shoulder- On inspection find retraction on right side of chest Vocal fremitus- has not lost much flesh Has Phthisis- Heart disease in some cases does same to retard progress of this disease- Phthisis As a rule if hemmorage occurs in early stages of Phthisis it arrest progress of disease according to some this is not a generally accepted theory- Case of anemia- Aortic regurgitation come of most rapid anemia & Hemmorrhages - Took cold in side of head & face & had pain- waked up in morning all swelled up- Pain in loins- Symtoms of acute Brights disease- said disease due to disease of lungs of convoluted tubes straight tubes- Parenchimatous portion of Kidney- Large carts in urine due to destruction of epitheloium- & more grave the disease degeneration of casts indicate pretty rapid progress of disease- Iron & Bitter tonics good to give- Complications as heart disease, oedema, serous inflammations. In waxy degeneration in blood vessels & tubes In contrast in kidney in intestine tissue In cirrhosed kidney increase of interstitial tissue & in Parenchima Best form of Heart disease to have is that between aortic obstruction & mitral reg Proff Lusk- Mch 1st 1883 To induce premature labor introduce catheter up about placenta & let remain a while - if bleeding sets in take out & pass in at another point, be careful not to rupture membranes- but if you do not of much consequence. To excite contractions you may use vaginal douche before using catheter. The oldest method of inducing premature labor is to rupture membrane by pin through a quick & then passing in sound arouse foetus, but I object to it, because danger of septic poisoning especially in hospitals- Injections of hot water a gallon to os uteri used by Hedisk- Two or three times a day, but this apt to set up pelvic inflamation, unless delivery takes place at once- Prefer the douche to introduction of sponge lint- when cervix becomes soft we can introduce the Barnes dilator to dilate cervix- My way is to first in the evening give two or three vaginal douches and then when os is soft, introduce solid bougie & leave until morning then labor is apt to have set in & I put in the dilator & hasten delivery as soon as possible- 12 or 14 hours usually sufficient in this way to induce premature delivery- You may perform incision necessary If cord gets in the way in delivery put woman on knees & try to get it out of way & when pains come on try to get head in cervix while cord is out of way- If this does not succeed & the rupture of membranes has taken place, put in hand & [cross out] very staid. With a loop in string passed thro catheter you may loop the cord & with catheter push it up out of the way & leaving catheter there- If child still born- clean out air passages & introduce catheter into trachea through mouth, & inflate lungs with breath, & by it get up respiration by holding at shoulders & throw it up allowing its feet to come over its body- 4 or 5 times- Putting small pillow under shoulder & extending rapidly the arms over the head back & forth with the hands of child upwards- Pouring of fluid from a height good in some cases- Putting in warm water & sprinking face within cold water good. Pere metritis inflamatritis of covering of womb. May have inflamtion of mucous membrane of cellular membrane- called endometritis vagina swollen & oedematous with patches of ulcers on surface Dyptheritic like patches may form on surface of vagina & vulva Proff Doremus Mch 1st. 1883 Hellers, Test 3 or 4 ce hydrochloric acid- 10 or 20 drops- urine- normal pale yellowish red & violet or blue- Hydrochloric acid & hypochlorite of lime - Red-violet green & blue- 2 parts urine & 2 parts nitric acid - warm to 60 C.- Shaken with chloroform & ether Both solutions violet blues- Absorption bands between C & D. Test for metals of all kinds- sulphuretted Hydrogen- Protosulphide of iron black & bisulphide- yellow color- Take Sulphide of ammonium vapor (dilute & add iron a black liquid is given) important to restore writing, Laboraques solution with drop or two of sulphuric acid will remove cording To test for iron in blood, heat little & add little nitric acid a black color will be given by exposing to vapor of this Sulphur or ammonia.- giving. Yellow prussiate of Potash swollen test. Sulpho cyanide of Potash another test which is also in the saliva, Prussic acid found in saliva by testing with sulphuric acid To test for blood stains or cloth &c must if dry, moisten it with glycerin or any thing of Spt guai can not distinguish with 2 or 3 blood cells- Requires much practice to become expert in testing blood with microscope- Urine sure to have evidence of arsenic but to test for poison in stomach tie stomack & intestine &c so as to allow the contents not to escape until you get to your laboratory- where your are sure to get a clean vessels to put it in - In analyzing urine for arsenic evaporate urine down add acid to break up the organic compound & add test for the metal. If piece of liver bone or flesh or any part of body decompose with hydrochloric acid and chlorate of Potash & test as above- Again add to residue nitric acid to further oxidize it, & we have arsenious acid- Put into horse shoe tube [cross out] each end strip of Platinum & free with water- there apply electricity by means of two tubes inserted into each end of tube oxygen will be given of at one end & hydrogen at the other- Proff. A. A. Smith- Quiz- Arsenic given in diarrhoea following measles in small doses before meals Magendis solution contains 15 grs morphia & 2 or 3. 1 gr to oz- 1 gr of atropine too large a dose 1/2 4 grain a dose- Aqueous ext of Opium in double strength of pound opium- Calomel diuretic Dose of Corrosive Sublimate 1/30 to 1/10 gr- Bichloride of mercury same dose- Nothing with which calomel will combine in stomack to form bichloride of mercury- digitalis indicated in aortic obstruction Belladonna- as atropine gravel respiratory stimulants- Atropine & convaleria are now very popular in Pulmonary Oedema Proff Welsh. Mch. 2d- Death from operations for lacerated cervix uteri very rare- Persons stomack may fill with blood or yet vomiting not take place but such cases are very rare- Blood may pass from rectum in such cases & from varicose veins of Stomack Shows us Stomack from a Wealthy scotchman who died from small milliary anuerism on one of the gastric arteries of stomack by hammorrage gangrene or putrid Pleurisy may occur from gangrene of lung pretty often. But for it to exist independent of gangrene of lung is very- in fact one of those rare occurrences- Prolipherated thicking of Plura is rare & may form fibrous bands treading into lungs- is a malignant affection- is a kind of fibrosis. Peri Pleuritis- a suppuration inflamation between ribs & Pleura outside of pleural cavity- causing bulging between ribs- is very rare Hydro thorax collection of nervous effusion without fibrin blood or Pus- P Proff. Janeway Mch 2d Ascending & descending Paralysis occurs in adult life- more often in male than female, muscular paralysis- different from myelitis in child & adult affects - muscles of thigh, arms, jaws- &c. Absence of bowel & bladder trouble- Cause some stimulant entering system & bowing effect like strichnia does- or to an inflamitory process- may be mild, or similar menigitis- Not so apt to have much trouble in bladder in chronic meningitis, as in myelitis. Pain in bone above kind of Paralysis Iodide Potassa- Opium for the pain- Strong counterirritation & galvanism to spare- Spinal Hemmorrage may occur between dura mater & bone [cestre???] dura mater & arachnoid & may be in gray matter- is rare- may be result of inflamitory process- or result of injury taring of some of the sinuses- may have their structure poisoning or tetanus- Do not allow the moving of a person with injury of spine, for there is no condition under which more trouble may arise by moving patient- If moving has to be done- give the best support possible- apply cold- & after a few days apply counteration, for pain give opium with bromides if reflex action great. Then give iodide potassa & perhaps bichloride of mercury-. Any injury above 4th cervical vertebra destroys sensation- below may be only be Pyramidal tract of spinal cord affected in lateral Sclerosis- Cerebellar tract overlies above tract Ross's best book on cord disease Myelitis in anterior gray matter produces muscular atrophy slowly with paralysis taking place in proportion-. Bulbar paralysis affect tongue face & throat. Progressive muscular atropy usually affects adults in early life & males mostly Cold- great muscular action or hereditary influence & injury may cause it. Treat by cord muscle or cord nerve farradic current. Galvanic counterirritation- Infantile Paralysis- occurs in anterior gray matter of cord comes on after fever- Sensation preserved rapid atrophy of muscles Prognosis as regards life good & so regard to recovery of paralysis not good; Bromides- Strichnia anterior bone cells of anterior bones of gray matter destroyed, Treat the paralysis if great the galvanic current of slight, Farradic current In meningitis we have Hyperearth of skin- In myelitis not so much so - Some anesthesia- In myelitis bladder paralysed- bowels even controled- urine decomposed- & cystitis may occur- Draw off water- Person may die of cystitis Pyelitis or acute interstital nepritis- Wash out bladder- prevent bed sores on heel maleoli as well as elsewhere Proff Flint- Class Mch 2 Case of Pneumonia- Pain occasionally precedes disease of Pneumonia as in this case- We have most moist baling rales in resolution of Pneumonia both on inspiration & expiration- Phthisis may exist without any pulmonary manifestations- as cough or hemmorrage- Diarrhea may exist in earlier stages of Phthisis & not be a Phthisiscal diarrhoea In which case tis controlled by usual remedies Proff Doremus- Mch 2d-1883- Test of Marsh for Arsenic- Hard to make Hydrogen except by galvanic battery & distilled water- because of the impurities of water, acids &c use To make arsenic- Take distilled zinc pour acid upon it- sulphuric acid & hydrogen will be given off- leaving the oxide of sulphate of zinc, To dry the hydrogen heat & pass thro red hot tube or fill tube of caustic potash horse shoe shape- & a horizontal tube with chloride of calcium & pass the glass thro them &c * arsenic poisoning- besides vomiting & Stomack disorder- it may also produce Sedative effect. May also have effects of strichnia- also arrest discharge of urine antidote- Perchloride of iron diluted & add ammonia then filter. & give several tablespoonsful- arsenic is converted into more poisonous substance- Bicarbonate of Soda in water is also good. * and a coil of glass tubing heated red hot. in When the case is heated until each end of this glass tube will not color piece of paper- pour solution of arsenious acid with the zinc jar, & metallic arsenic will be given off. The heat decomposing sulpheretted hydrogen [illustration] Liquid test for arsenic- Take let sulphate of copper & dissolve in ammonia- Sal of arsenic added a beautiful blue color; which will be returned to water color on addition of nitric acid Proff Larsk- Mch 3d 1883 Puerpural fever generally occurs between 2d & 5th day- The severity of chill not an evidence that the fever will be great- Often suspension of lochia- involution of uterus is arrested, Colon dilated to moderate extent 102 degrees average temperature. Catarrhal endomitritis least grave- In this fever uterus & perotoneum are inflamed Inflamation of cellular tissue in sinuses may occur- giving rise to albuminous gelatin like fluid which may extend of broad & round ligaments, Trouble may extend to vagina vulva uterus bladder & broad ligaments Remissions take place after 3 or 4th day & fever may entirely cease in the mornings - said fever may last from 5 to 10 days. Pulse rises to 120 per minute is usually slower than normal after delivery- Pain sharp & lancinating from the inflamed perotoneum until after exudation takes place when it disappears pretty well- Profuse perspiration occurs- bowels usually constipated rarely vomiting- diarrhoea may exist tho. Sudden lowering of temperature like collapse not often lead sign. In source cases a tumour may form of the exudation in illiac fossae- symtoms- pain- difficulty in urinating defication & may cause constipation They seldom suppurate if patient keeps quiet but may give you trouble for a year or more; When abscesses form pus arises & discharged thro vagina region region &c but you need not have this to occur if you recognize in time. Exudation of this fever rarely goes above brim. Abscess may form under Psoas or illiac muscles but are not so serious as the books tell us. The inflamation may spread from dyptheritic ulcer & lymphatics enlarge- from the presence of enterococci & extending to lungs heart & brain & every where there is any serous membrane, setting up peritonitis which is a bad condition & the exudation may be slight- woman may feel like all is well & after death temperature may rise to 109 or 10. We may have phlebitis as one kind of Puerpural fever which as a rule is not dangerous- unless it gives rise to metestatic abscesses- may be unnoticed until chill comes on & there you may think you have a case of malarial fever- as it will return after an exacerbation or two. are not affected by quinine- Treatment- be conscientious & careful you do not carry the disease- to dytheria- scarlet fever or measles- Look after surrounding of place Wash out vagina with carbolized water regular for the person enters that way- Do not do this if temperature above 102 or 3 degrees & I have my doubts if this washing does any good & I do not advise you to do it, unless satisfied there is clot. Proff A. A. Smith- Mch 3d- Rusell & Reynolds best book on Electricity [cross out]. Electro diagnosis of nervous diseases of by Bennett of London- best on this disease. Gaff of Paris- pocket battery very good & only costs 7 or 8 dollars. Trifacial neuralgia not apt to be affected by galvanism but is in some cases use the galvanism- Rheumatic headache as a rule due to some condition of muscles causing soreness of scalp very often relieved by metallic brush- their neck may be relived by passing faradic current over muscles- & if chronic by being careful you may use both poles of battery alternately and apply to muscles which are not affected as a rule- Reddening of surface adds to conductivity of current. Application of electrode may relieve some eye pain & head ache. Paralysis of tongue may be relieved by galvanism- also relaxation of urocela & tonsils Current good for lumbago & one application sometimes relieves " may be taken for sciatica & then you will fail with farradic air rest, but may be relieved by galvanic current & by using plates of metal you may get up a sufficient irritation to cure the sciatica by lst looking after cause. In intercostal neuralgia very often relieved by electricity & one of the plates. Apply one pole to seat affected & the other over course of nerve. Is good in uterine or ovarian neuralgia- Neuralgia dysmenorrhoea often relieved by passing current into cervix twice a week. In disease from general nervous disturbance or relaxation of muscles electricity may do good- by one pole to spine & the other to the whole body, & to epigastrium & to Pneumocogastric nerve- Danger of producing heart paralysis in some cases. Have much confidence in electric baths by putting both poles in water & interrupting current by slipping in & out of one pole. Good appears to stomach by a plate of metal to stomack negative pole & proactive to assume opposite. good to relieve insomnia in some cases when all other remedies fail but may have opposite effect in others apply to spine & around head. Good in inflamtion paralysis- In paralysis from apoplexia six weeks as early as it right [cross out] to be used or earlier- Not good much much in hemiplegia- or Pareplegia- rarely does good - nourish well & relieve pain by opium chloric & bromides Hydrophobia- occurs any time of year- All do not have this disease who are bitten by rabid dog- Have a tendency to bite at most exposed part as a wolf. If dog bites in incubative stage of rabid which is 2 or 3 weeks apt to be poisonous- occurs in cats dogs & wolves- Remedy- immediate excision of bile & cauterizing- apply cupping glass over bitte, & tuing cord around above bite good- Oxygen gas good to give patient. Tetanus- 3 varieties- Toxic as of strichnia- Traumatic- & from cold apt to occur from very trifling warms after extreme changes of weather apt to induce it- occurs after 5th day & is not likely to occur after 21 st day- Signs- acute intellect &c- Apt to die of apnae or asthenia- Amputation tumour & 4 schirrous- is hard for alveoli cells- 5 Colloid- has gelatinous metamorphus alveoli cells Cancer very rare in early life Signs- Pain- may be at openings of mucous membrane or at anus- Of in female breast is not movable nipple retracts occurs after 50 years of age- remedy- remove early- lymphatics enlarge, If in cancer of penis look for enlargement of lumbar lymphatic glands Granuloma- 3d of cellular tissue of neck granulating tissue may be lupus, Lepra tubercle or glanders, Can distinguish by examining there getting clinical history important- Which will help you in diagnosing- . Always remove a tumour if possible early Rounded or giant cells- Sarcom has a little fibrous tissue- called fibro sarcoma- Mixosarcoma- Lymphosarcoma osteo Sarcoma- Same Sarcoma containing sand &c- As a rule these are malignant- is malignant if very vascular- Symtoms- common to all tumours- grows slowly- except when extremly malignant Metastacis in sarcoma is in vessels & not thro lymphatics as in carcinoma- Remedy- excision Carcinoma 2d cellular tumour of alveolar cells [cross out] may be general or constitutional- May be flat cillindrical cells as chancroid may be cillindrical from mucous membrane- the above from skin- & 3 may be meddling or soft cancer of alveoli cells with little stroma in make up of moved. Papilloma- hypertrophy of papilla as warts & horny excresences- cauterizing & excision remedy 3 Cystoma- walls of cavity- encystic by connective tissue lured with epithelium- cavity containing- blood gelatinous- used albuminous or atheromatous as cholesteric cells- Should be removed entire or if any left it may come again, withdraw fluid inject irritating fluid if you can excise 4 Dermoid- of teeth- hair muscle bone Teratoma- monstrosity- often one foetus in another Cellular Tumours characterized by redness of cells- 3 Kinds Sarcoma 3 Kinds spindle shaped within wall or within cavity of uterus - occasionally grows from deltoid muscle- Centroid of vessels- 3 Kinds cavernous, as in Penis- Morten Mark- Neuroma- Painful should removed Proff. Dennis- Mch 2d Organoid Tumours- 5 varieties 1st Adenonid of gland tissue as parotid gland- female breast- Prostate mostly between ages of 20 & 30 years may occur in thyroid gland & in some places is endemic particularly in females in some places- is usually a benign tumour but may become sarcomatous Signs- Symetrical enlargement of gland affected- lymphatic gland are not affected by this tumour. Seldom painful- is smooth- Should here later tissue on back of shoulder- or abdomen is not painful unless at nerve is benign- grows slowly- has a tendency to become inflamed & liquify has a lobular feel- has no tendency to go into sarcoma is moveable under skin Best to Excise them to prevent growth & Suppuration by cutting down & turning on Enchondroma- affects ends of toes & fingers- cartilaginous in young people from traumatism, are sharply defined very slow in growing- Treatment- amputate if on extremities- Exchondroma of not much consequence Osteoma found in young people best not to interfere unless positive or special indication- is a benign tumour & painless- Myoma- 2 kinds generally affect uterus are multiple, may be inside are in same relation as the organ itself from middle internal & external blastodermic membrane to 1 Adenoma 2 Pappilloma 3 Cystoma 4 Dermoid 5 Teratoma or monstrosity. Celluar Tunicas- Composed of tissue differ from normal tissue in their extreme richness of cells & may come from any of the blasterdemic membrane- Sarcoma- Carcinoma & granuloma Fibroma of connective tissue found mostly in uterus- Treatment excision Myxoma- found in vitreous humour of eye- in foetus- grows slow- is soft because little vascular. May like fibroma degenerate into sarcoma- Treatment excision- no Pain Lycoma- is circumscribed of fatty cells- is generally in subcutaneous cel - In bites of insects or snakes- excision often best & cauterizing wound. bending the limb to prevent spread of poison good - give whiskey Quinine & use carbolic acid. Excision if immediately after bile better than a while afterwards. Tumour is a circumscribed new formation of tissue. 1st Hysteoid 2 Organoid & 3 Cellular- Hysteoid, composed of some of the many forms of connective tissue from middle blastodermic membrane of foetus. 8 in number 2 Mixoma of abuminoid- 1 Fibroma 5 Osteoma of bone tissue 6 Myoma of muscular tissue 7 Vasteoma of blood vessels. 8 Neuroma of nervous tissue 3 Lycoma 4 Chondroma exchondroma & encondroma- from cartilage Organoid- composed of one of the several normal tissues of body & Proff Dennis Mch 1st. 1883 Shows us amputated limb- arm where no stiches were used to bring the flaps together- doing well. Maliginant pustule- is constitutional disease- comes from diseased animal tissue as glanders in horse or mesocranic in cow. Epidemic some times- begins by a little red point in skin then a vessel & then the pustule spreading rapidly & killing patient soon.- is most infectious contagious & deadly disease we are subject to. Flies- spiders &c may carry it may come from hectic- Occurs mostly in hands & face- & neck- Best thing to do is cut out entire part, whereever it is- & then scrap tissues thouroughly Give large doses of Quinine- Salines & use carbolic acid freely. Will prove fatal or recover in 24 hours- Treatment of Pyemia- Constitutional & local- give plenty of pure oxygen- plenty of milk eggs & stimulants if tolerated for restlessness opium or digitalis if pulse full & tense- Quinine in large doses 20 to 60 grs- Sponge body off with alcohol or brandy- Let diarrhoea alone if not too great. Carb Ammonia a good stimulant, encourage patient- Iodo- Phenic acid injections by skin has of late been used in the disease Use carbolic acid about wound & in room freely- Metastatic abscesses should be opened early & washed out, if in joint lay it open, but is a serious thing to do- For the Pericardice, Pleuretic or Peritoneal pain, warm applications good Do not recommend lining resins above abscess- but it has been done the same- cyanotic dusky green color & crackling feet- vesicles about part The emphysematics crackling due to rapid decomposition of the gases about the part Symptoms of Pyemia- Chill always present followed by irregular intercurrant chills. Followed by great heat & then profuse perspiration- Temperature not so high especially at night but rarely as high as in septicemia. Pulse full tense & frequent. Skin moist & often skin jaundiced- urine same as in septicemia tongue coated Breath like that of new mown hay Sweet aroma- due to decomposition Intellect as a rule- Acute- restessness & jactitation- Wound becomes dry & parts about oedematous, Respirations rapid- Diarrhoea by the micrococci depositing themselves along the course of an artery Ulcerative Endocarditis- small & large ulcer an endocardium usually in left ventricle where valves touch each other because of roughness- covered by coagulated blood- metamorphorised tissue- Purilent inflamation of joints due to smallness & fever number of capillaries preventing passage of emboli In all blood poisoning a tendency to abscess about joint due to above causes- 4 Purulent inflamation of serous membrane where the micrococci form 5 Purulent inflamation of Lymphatics appear early in pyemia- are sensitive tho in their course- Painful Infective Gangrene- not same as senile or that of old people- Swelling is on account of their smallness or by the emboli passing thro some anastomoses. Puemia forms Uictestatie abscess as ulcerative endocarditis- Purulent inflamation of serous membrane of joints of Lymphatics & infective gangrene Milliary - first metestatic abscess formed by Zooglea or presence of colony of micrococci in capillary of Kidney- gives vessel beaded appearance first then a change in surrounding tissue takes place around these masses or beads of granular cells- fatty granules & albumen covering a zone- Then the Zooglea begin to multiply & emigrate causing faus cells in the tissue which causes a liquifaction or breaking down of the tissue forming the abscess Large Metestatic Abscess forms from multiplication of these in some cases- But as a rule they are formed Proff Dennis- Feb. 28th Septicemia- Signs- chills rare & also intercurrent chills- Temperature higher than in pyemia- 104 to 106- Pulse rapid & feeble- Skin dry at first- urine scanty highly concentrated & contains album tounge dry & hard- diarrhoea- expression dull & pinched- also intellect- Pyemia- Pus in the blood- a misnomer- is a septicemia added to metistatic abscesses- spleen elarges- anatomical changes same as in septicemia. In Pyemia we have thrombic in veins which come from wound, & from independent of Phlebitis- Thrombi are infective emboli are detached from them which form the abscess & if in rootlets of Portal vein from abscess in liver- if in systemic rootlets form [cross out] embolies in right side of heart & form abscesses in lungs. The reason they form abscess in Kidney or liv Goulards ext. Lead & opium wash better than any of above used warm Some suggest putting parts in hot water & woolen rags dipped in hot water to parts This a great scourge to every surgeon- Do not perform operation in neigborhood of it &c. Lower extremity most subject to erisipelas from transition- Next most frequent place attacked is face which may go into brain. Often albumen found in urine in stage of desquamation- from effort of kidneys to get rid of poison- If pus forms about eye lids open them but do not squeeze out matter- Hypophosphites are highly recommended in blood poisoning as that of Soda- Delirium may exist early for which give chloral Bromides or opium if others do not succeed. Collodion is used locally also. If in Phlegmonous erisipelas abscess forms open them - tion so as to get up formation of connective tissue which will cover over the opening - Eresipelas- is a blood poisoning- produced by certain germs- is contagious- it occurs from or without a wound- 3 Kinds simple oedematous or Phlegmonous or cellulo cutaneous- If in skin in retae malpigii of skin- Phlegmonous- swelling- pain & redness & may involve cellular tissue- As a rule eresipelas does well- tendency to recovery- Treatment- occurs in alcohol in badly housed & nourished- give saline cathartic first - for fever give quinin & iron in large doses to control fever- give plenty of milk eggs & good nourishment- if in alcholic continue stimulant- Painting part with Perchloride of iron Tinct or Sal subrate of silver- Stardiausted over parts injection of carbolic acid- Phenic acid have well been recommended but are infective & which are non infective, but this we know that surgeon can convey these germs, Water as oedema or anasarca favors the development of these germs, as also carditis or synovitis- Must have water- nitrogen oxygen & certain salts. Any fluid of acid reaction prevents formation of ammonia & consequently the nitrogen not formed as carbolic acid should be used as a dressing to wound This acid is product of many decompositions which hinders development of these germs- Signs of Septicemia- initial chills rare as are also intercurrent chills- Proff Dennis Feb. 27th 1883 Shivers in a child with Spina bifidae- Suggest [illegible] off of some of fluid & inject with [illegible] some iodine & glycerine Iodide [illegible] or something to get up degree of mild [illegible] from without, Changes of blood take place in this disease also changes in vascular system glandular & secreting organs In first blood is darker due to solution of hemoglobin [cross out] & 2 becomes thick & tarlike due to elimination of water of blood- When vascular system affected the heart undergoes fatty degeneration- & enlargement of spleen- Presence of microorganisms found in diseases and 1st Bacteria 1 Bacilli in carbuncle 2 Phthisis micrococci 3d Spirella Relapsing Spirochaeteae 4th Chaetacocci Chaeto bacteria- 5th Zooglea in Pyemia & Septicemia number in a membrane - as in metastatic abscess- Bacillus occurs in carbuncle anthrax &c Pasteur has demonstrated that 212° heat destroys germ life in urine &c which prevent its decomposition, & has also proved that fever result of their introduction into system. All discharges contain germs but we are not able to tell which Is result of absorption of blood lymph or serum into the blood & general nervous disturbance & this is generated from within. Traumatic fever is not dangerous in itself- but Septicemia or Pyemia may come on and be aggravated by existence this fever- Treatment should be directed to diminution of fever & support power by bathing in alcohol. Small pieces of ice in mouth for thirst- Give Quinine in 20 or 30 grs. Fresh air- cleanse wound opium for the pain, or chloral or Bromides Give good nourishment especially milk eggs & beef extract & feed by rectum if necessary- If diarrhoea not excessive. let alone for one of natures ways of eliminating poison from system. Cleanse worms with disinfected & stimulating as balsam of Peru or iodoform Septicemia & Pyemia- Poison generated Stones may be removed by an operation first by our Dr Sims- Wounds of Spleen- Hard to diagnose has been removed- so dangerous because of its vascularity- should not be removed except from malignant disease Proff Dennis- Feb. 26th Blood poisoning- Traumatic or surgical fever- 2 Septicemia 3 Pyemia- Traumatic fever does not always follow- in injury follows surgical operation- tendency to recovery. Constitution age & situation & character of injury influences recovery 14 to 48 hours time for symtoms to appear- 1st dry skin- thirst- elevation of temperature slight reslessness quick pulse- urine less than normal- Headache flushed face- bowels constipated- & loss of appetite, Fever not result of absorption of putrid or septic material of Hidleburg in 1869 Incision made above 11th rib vertically to near crest of illium downwards. Look out for 12th intercostal & lumbar arterys to then if cut. also a nerve- Til the renal artery & vein & look out for anomalous renal arteries from lower or any part of kidney- Out of 20 cases 11 recovered - & in some of those which were fatal- it was removed by mistake- Rupture of Liver- may result from falls blows &c- if on surface not much trouble but if deep, apt to be great amt of hemmorrage- Keep patient perfectly quiet for 2 weeks & narcotized- to prevent rupture of new adhesions from the original rupture Abscesses should be aspirated- We may have rupture of gall bladder which is fatal- turpentine &c pregnancy. by pressure- wounds & contusions Brights disease- zeniotic disease as scarlet fever- Pareplegia with paralysis of bladder by backing urine injury of spine & bacteria introduced by catheter- Pyemia & septicemia- Chances of recovery small- Signs- Pain unilateral- Constant tender upon pressure- breaking down of blood clots frequent micturition- chills mostly at night diarrhoea from adhesion of kidney to colon- or constipation when tumour is large by pressure upon colon- To satisfy ourselves if we find a tumour use operator needle- but should not be done unless actually necessary. If Acute Brights disease - cupping & hot applications good to relieve- Nephrotomy- operation for removing Kidney- done first by muscular disease, may be organic or incidental from disease in other organs- Is most common when urine is very acid as in rehumatism gout or old age. Renal calculis often cause of nephralgia- in pelvis of kidney- impacted- Diagnosis- must exclude all disease of bladder or prostrate gland & pyelitis by pus in urine- Wine or malt liquors may give rise to this affection by give tendency waters & citrate of Potash build up general health- rely upon skin to act for Kidney- by Turkish bath- Suppression of Urine- is lack of secretion of urine by Kidney- Retention of urine is failure of bladder to act Treatment of supression- give Jalap elaterium or croton oil- attend to skin Pyelitis inflamation of calices & pelvis of Kidney- cause renal calculus in ureter- cystitis or ureteritis, cancer of Kidney. Cantharides or terpentine blood in urine not a positive sign of wound of Kidney- Stab or Gun Shot wounds may reach Kidney- pain- epithelial cells in urine &c signs- , The Kidney has been removed Leaving wound open to allow drainage good practice- Hydatids in Kidney- there should be adhesions of the cysts before opening & is required in cyst of liver opening- Proff. Dennis- Feb 12th Two urethras may go into one Kidney- & one Kidney may exist in a person, Therefore in operations for removing Kidney we should bear this in mind- Nephralgia- pain in kidney- is most severe when patient weried. may be sharp or dull similate renal colic- must not be confounded with lumbago- systitis or prostatitis, Lumbago is a muscular Before opening intestine stich to edge of wounds & be sure to bring edges of perotoneum together- at the wound- Stab wounds of Abdomen- Sew if intestine not wounded by stickes thro small of abdomen- but never close external until sure that there is no wound to the intestine, If intestine wounded sew up or reset, wash off with warm carbolized water before returning intestine Gun shot Wounds of Abdomen- May or may not penetrate- if intestine wounded always fatal. Shock to semilunar Ganglia nearly always kills patient- Vomiting & passing blood by rectum- signs Six or eight inches of intestine have been successfully removed. Surgery of Kidney- Malformations usually congenital. Sound has been passed thro female urethra bladder & ureter to pelvis of Kidney- Passage of have been lately removed- Gastrotomy is opening stomach for purpose of removing foreign body- the nature of which body you know. Be careful & not open the colon as it lies under stomach- Make incision vertically- less apt to wound arteries, running between the Arteries running are lesser & greater curvature- Colotomy down in imperforate anus is done for foreign bodies in colon, generally best on left side midway - anterior & posterior superior spinous processes- make incision parallel with ribs, 1st stich gut to side of wound before opening so as to prevent feoces from entering cavity, Is performed where infants have no anus - also, Enterotomy performed to remove foreign body, but never do it unless positive of your diagnosis- is a serious operation. but has been performed successfully mouth, but by rectum & skin- Stich edges of wound in stomack to external wall of opening- Perotonitis will follow- but tis best you can do- Then put patient under influence of opium to paralyze stomack- Nourish thro rectum & give brandy by skin, & abscesses may form from use of needle Foreign Bodies- Substances- not acted upon by gastric juice- Round & flat as money- Sharp as a tack- & those around which nuclei form as hair balls- Epileptics eat such things as hair- False teeth- case Knaus- nails- have also been swallowed. Do not give a cathartic when a sharp or pointed body has been swallowed- Section of Stomach for carcinoma is now perform with success but must be sure that it exists & that it is not a secondary- Spleen & uterus have been removed condition to operate in & sugar always exist in urine when gangrene is present to a greater or less extent- Proff Dennis Feb 14th 1883 Regional Surgery- Of Stomack & intestine- Stab wounds of stomack- generally fatal by extraction of blood & contents of stomack into peritoneal cavity the fuller the stomack the more grave the wound. Signs- vomiting of blood & contents of stomack- fixed pain deep in epigastrium- Prostration of nervous system Protrusion of stomack if wound large enough- also discharge of contents of stomack as well as blood- more serious in each end. Treatment- arrest hemmorrage if possible- pull out part of stomack & sew it if can be done- give ergotine by skin & about wound- Be careful not to over stimulate, & give more by incarcerate hernia- case of incarcerated hernia is often foeces- One person out of every 10 have varicocele- signs [cross out] a tumour behind testicle feels as if twas earth worms- Treatment put on ring on scrotum with testicle above said ring of lead covered with chamois around it- cut off scrotum has been done- never operate for varicocele under 15 years of age. In ordinary Synovitis- compression by wet sponge good- Putting sponge on dry & then wetting- Blisters or actual cautery may be used to produce absorption Case of 2 year old child with particular abscess at ankle joint- Do not bring patient with frozen extremities about a fire- but rub them with ice or ice water, give him a stimulant & after sensation is restored warm applications good- Dialectes is an unfavorable consure consure to air- as in tents. Cleanliness- remove sordes from mouth & cleaning tounge- Perceptions of patients with these fevers are blunted & do not feel uneasiness of position- should be turned about to prevent hypostatic congestion- attend to bladder- Disinfect discetions by sulphate of Iron- Supportive Treatment- Proff Dennis- Feb 13th- Clinic Case of pus in tunica vaginalis which was opened a week ago- Thin watery discharge now. Put him on Iodid Potass & necessary to produce absorption & apply a plaster to testicle as follows- Hydrargini cina ammoniacum- [cross out] For incarcerated Hernia without inflamation- give brisk cathartic first & then warm enemata injected into rectum. Diarrhea often follows & relief of Quinia good- digitalis veratrum not much importance- Headache which is prominent symtom- relieved by cold & hair may be cut off- Insomnia- with subsultus tendinum & nervous trouble- Codeia good form of opuim good to relieve it. Digitalis & Bromides have been given- Tartrate of antimony in small doses may be given- or has been given- For the diarrhea- opium with astringent good turpentine good- For Hammorrage from bowels- digestion of Opium to arrest peristaltic movements- & cold good. In anterior of Abdomen- sauna- Turpentine over bowels charcoal &c good, bile introduced may relieve, puncture has been suggested For the Perontonitis treat as other cases of perotonitis The Sanetary treatment Free expo The great object in treatment of typhoid fever is to control the temperature- using the antipyretic treatment systematically employed- reducing temperature to a certain point & when there try to keep it there- Cold water applyed is the 1st way- strip patient, place over tub & pouring on water- Stripping & putting in bath tubs but these ways are tiresome & troublesome- The simplest & easiest way is sponging with cold water (temperature should not be allowed to get to or beyond 133 degrees) continue sponging for sometime. Should use it your self or by an inteligent nurse & repeated every 6, 8 or 10 hours- If this does not do, the wet shirt may be employed & if no bad symtom can reduce it to normal temperature- Exposing body to cold air very good tho unpopular Mortality rate 25 or 30 percent. Same range of gravity or not in typhus fever its a graver fever- Mortality greater- more fatal in old age- Treatment of Typhoid & Typhus fever- Remedies said to posess abortive properties have failed in my hands- & in those cases in which opium has been said to abort it. the cases were likely not to have been typhoid fever Quinine emetics & calomel & Iodide of potassium have failed in my hands as abortives, but there may be such remedies found as will arrest disease- Sulphide have been used by an Italian with good results. Curry claimed has cold water may arrest or modify the disease- about a century ago, Was a pioneer in use of axillary thermometer. But I do not doubt but mineral acids have a good effect in treatment of this fever- as phosphoric uric acid or urea &c the recurrent laryngeal & descendens noni nerve which is often in sheath of carotid- Oesophagus is 9 inches long & operation should be performed on left side- Proff. Flint Feb. 12th 1883 Can germs of Typhoid fever be produced outside of body under any circumstances It has been proven that it is produced in almost all cases by contagion- Enteritis in children in sometimes taken for typhoid fever also acute tuberculosis- a fever of acute syphilis may simulate thro fever- the eruption of both may be essential Essential fever to the fever itself- the disease Symtomatic- when another- disease is the cause; Prognosis of Typhoid- Mortality differs in different times & places- Rarely fatal of itself- but complications may be as oedema of glotis Coma from uremia &c in locked jaw, but you should give chloroform first- & places where bodies may lodge in oesopagus- may exist in upper part oftener- needles & pins may be swallowed & lodge in epiglotidian folds & in walls of oesophagus at cardiac portion where it is smaller Signs- choking- Pain & erosion- & pain may be referred to stomack- & on left side generally erosion occurs & the hemmorrage apt to be from left subclavian & carotid arteries- Mortality about 1/3 - 3/4- cases 109 died- Oesophagotomy has been considered very serious- but of late tis a very satisfactory operation but of 28 cases- only 5 died the 5th doubtful - Incise as for common carotid artery- pass round into oesophagus thro mouth- & cut on to it but be careful & seal wound the inferior & superior thyroid artery & but if nail or metal - better try to extract it. Should be careful in using a probang or you may pass it thro ulcerated surface. When foreign body goes into stomack- some give castor oil - If not sharp & can pass into instestine- but if it has sharp points or angles give such food as will collect around body parts & thereby facilitate its motion thro intestines- Simple Structure of Oespohagus- spasmadic occurs in hysteria &c- 2 Organ Stricture- from inflammation- Relieved by introducing a well oiled probang every day 3 Malignant Stricture- carcinoma generally in old people- behind cricoid cartilage opposite 5th cervical vertebra or may exist at cardiac portion of Oesophagus Catheterism may be employed Should give nothing for the collapse by the mouth- may give by skin rectum or by inhalation- brandy- ammonia- nitrite of Amyl- Look out for Oedema glotodis & be ready to perform tracheotomy give morphia by skin for the pain. Wounds of Oesophagus as in attempted suicide- & is apt to be associated with wounds of trachea - Not good idea to use suture in to oesephagus because wounds of same heal very rapidly- Difficult to pass tube into stomack thro mouth or nostril to stomack & in doing so break up granulations & set up coughing- Catheterizing Oesophagus- for foreign body tumour- insanity or stricture- Should be passed over by side of finger- At 9th cervical vertabra come to a state & by having patient to bend head forwards instrument will pass in- Should try to know the seature of foreign body. & if can be assisted push it down Proff Dennis- Feb 12th 1883 Regional Surgery- of Pharynx- about 4 inches long- has seven different openings widest opposite hyoid bone- wide antero posteriorly,- Pharenegitis- inflamation of mucous membrane- as from poisonous substances, abscesses in pharnix- associated with caries of cervical vertebra- Dense facia or aponeurosis surrounding pharnix- presents fluctuations, open abscess with trocar and canula - for pus is apt to run down & cause shortening - Paralysis of Pharynx occurs sometimes & also spasm of same- we may have stricture of same- from tumour Operation of Pharingotomy- for tumours fibroid &c- Do not open in median line- open on one self,- Inflamation of Oesopagus by caustics or mineral acids- of alkalies give something to act mechanically upon inflamed mucous surface - as oil egg or or backward- vessels lacerated nerves injured & often suppuration- Of Ankle- out in forward & backwards- in but foot is turned to fibula may simulate Potts fracture laceration of internal lateral ligament Fibula not broken in inward dislocation but astragulous is fractured- may be necessary to divide tends achillis to reduce- In backward dislocation we have the lig. torn & foot turned backward- To reduce flex leg on thigh- [cross out] Compound Dislocations- very rare only 10 out of 250 cases more often in Knee- when amputation or resection is thought of & we should be careful that we are justified in resorting to this - will hardly be necessary unless great laceration. if on dosum illii - if in thyroid foramen adduct & rotate inwards- Comp. Pullys an old method, towel on leg & band in perineum- Some suggest a pad put between thigh & using as a fulcrum- Vertical extension has been used- Jarvis- adjuster has been used- rachet & lever- is out of date- also the comp Pullys- Are only applicable in old dislocation of 2 or more months- Sciatic nerve is often injured Dislocation of Patella- by mechanical violence or quadriceps extensor muscles- out, in, up or down- out most common- patella on external condyle- Knee flattened above muscle tense, If in Patella on internal condyle Can have it up only in rupture of ligament below. Dislocations of Knee- Cause- sudden mechanical violence- out in forward In fracture we have crepitus- mobility of limb- foot everted- patient apt to be old- limb little shortened- In contuse no shortening of the limb- 2 cuts Ischiatic notch- occasionally slight eversion of foot & Limb shortened about 1 inch 3d Into Obturater or thyroid foramen head lies on obturator muscle Limb lengthened 2 inches about- is everted foot points forwards & outwards- Knee slightly flexed- hip flattened- trochanter major towards mesial line- is the only dislocation with 1/2 in shortening - Onto Thyroid or Obturater foramen is the only one in which we have 2 inches lengthening Capsular lig. obstacle in reducing this dislocation- Flex leg on thigh- thigh on abdomen & by seizing foot in one hand & knee in the other- abduct & rotate outwards & raise up suddenly the limb Proff Dennis Feb 8th Dislocations at hip joint- next in point of frequency to that of humerus causes external violence to knee thigh or foot. abducted or adducted more by 10 times in male than female is seldom in young person- most common between 25 to 50 years of age- are rare under 25 years age is very seldom compound- except in gun shot wound is simple- 1st with head of bone on dorsum illia with leg torn above - 2 into ischiatic notch- 3 into obturater foramen & [illegible] in os pubis near symphisis most frequent tonic is in dorsem of illium Symtoms of head or dorsum iliac - leg shortened about 2 inches toes towards opposite in step- foot inverted Knee slightly flex & in advance of opposite Knee- thigh rotate in & adducted trochanter major is more promulgation