New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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intestinal tract or due to a reflex spasm originating in a disease elsewhere, were present. Benzedrine sulphate is a sympathicomimetic drug which diminishes or 'abolishes gastro-intestinal spasms without interfering with normal peristalsis. If the barium meal Cor a barium enema? is not progress- ing as it should, due to a spasm, mild massage of the abdomen should be at- tempted. lf this does not give the desired result 30 mgms of the drug, taken orally, will alleviate the spasm within five to ten minutes. This effect is also useful in that it aids in the differentiation of a functional spasm from an organic one. As yet, only one objection has been forwarded against its' use, and that is the temporary elevation of blood pressure. This elevation varies from 20 to 50 mgmsfl-lg and is a definite contra-indication to the use of the drug in severe cardiac cases. Benzedrine sulphate has also proven of definite value as a therapeutic aid in spastic colitis and pyloric spasm. ' In the field of therapy, one of the most important contributions was intro- duced in the treatment of diabetes. Previously, the use of insulin was not without its faults, since either an overdosage or an underdose would disturb the metabolic equilibrium intensely, with a resultant fluctuation of the blood sugar. A new form of insulin was introduced which more closely approximated the normal continuous secretion of this hormone. Protamine insulinate was pro- claimed as the desired substitute since it is absorbed slowly, maintains the blood sugar at the desired level for twice the length of time that insulin alone does: thus decreasing the possibility of insulin shock. It is stable for a few weeks only, and should not be used after being kept over the specified time. Protamine insulinate does not really supplement insulin but serves as an adjunct to insulin. Both may be used together at different times of the day. Protamine insulinate is especially useful in cases which can not be controlled by insulin alone. ' . Pneumonia has presented numerous problems which have been solved by medical science. But until now, it has proven rather difficult to supply a pati- ent with a consolidated lung with sufficient oxygen. The use of nasal tubes and oxygen tents have been objected to because the alveoli are incapable of absorbing oxygen. Other channels are therefore necessary for the introduc- tion of oxygen. Recently the use of subcutaneous oxygen therapy has been utilized in pneumonia with favorable results. Oxygen introduced in this man- ner is readily absorbed with a relief of dyspnea and cyanosis. The patient's blood pressure soon rises While the viscosity of the blood decreases. Children are given fifty c. c. to 200 c. c. while adults can withstand 200 c. c. to 800 c. c. Recently several favorable reports have been made on the use of a high carbohydrate diet, in combination with insulin, in the treatment of cirrhosis of the liver. Since this condition has been generally recognized as being hope- less, from the medical aspect, these favorable results should be only the spark to stimulate further investigations into the problem. Another condition which has defied medical treatment is migraine which has been justly called the enigma of medicine. The successful treatment of any condition is predicated upon a sound knowledge of its abnormal physio- logy and since practically nothing is known about migraine it is not surprising that its treatment is so devoid of success. Complete relief of a series of cases was recently reported through the utilization of ergotine tartrate. In recent years extensive research has been undertaken in an attempt to limit the occurrence of epidemics of poliomyelitis. The use of convalescent One hundred ninety

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RECENT ADVANC ES IN MEDICINE By Ioseph F. Tedescop Nicholas A. Knox, Ir. DURING the past few years extensive and remarkable progress has been made in the diagnosis and treatment of various conditions which have hitherto presented obstacles to the medical profession. Since the majority of overworked medical students have neither time nor facilities to keep pace with these incessant changes, this article aims to merely acquaint the reader with a few of these innumerable contributions. ln the field of diagnosis the Frei test has been brought to the fore as a positive sign of lymphogranuloma inguinale. When an antigen made from sterile pus, or aspirated from previously unruptured abscesses, was injected intradermally a positive skin reaction was produced in patients who have had the disease in the past or are actively infected at the time. Satisfactory anti- gens are made at the present time by grinding infected glands and periglandu- lar tissue. Another condition which has presented diagnostic difficulties is Kala-Azar. It was previously thought that splenic puncture, with the demonstration of Leishman donavon bodies, was the only possible method of diagnosis. In the last few years various investigators have advanced the feasibility of precipita- tion of a pathological serum by iron peptonate. It has been definitely shown recently that the Takata test is not infallible in the diagnosis of liver pathology. The Ucko modification of the Takota test has recently gained favor since it has given more accurate results than the original method. I-Iodgkin's disease has presented diagnostic difficulties which may or may not be solved by the Gordon test. This test has not, as yet, been definitely proven to be correct in all cases. The procedure involves the injection of an extract of enlarged nodes twhich microscopically do not show the typical pic- ture of Hodgkins'l intracerebrally into rabbits. An encephalitic syndrome is produced when the nodes are involved by lymphogranulomatous changes. Various dyes have been used to demonstrate definite pathology in the kidneys. A new contribution has been made in the intravenous injection of Trypan Red. If any of the dye appears in the urine within 10 minutes there is an impairment of renal function. After using Trypan Pied, inject indigo car- rnine. Therefore, if the urine shows either an absence of indigo carmine or the presence of Trypan Pied, there is a definite lesion in the kidney. ln roentgenological diagnosis a new preparation, benzedrine sulphate, has been introduced which has been a great aid in facilitating the visualization of the gastro-intestinal tract when a barium meal has been taken. Previously it was practically impossible to obtain a clear picture of the entire tract when spasms, whether due to unpleasant emotion or organic disease of the gastro- One hundred eighty nine

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serum for protection is still in a controversial state. Some investigators claim that no protection is given while others claim that very good results were ob- tained with whole blood. The use of serum in the pre-paralytic stage of the disease is also questioned by some observers. Brodie and Park have pre- pared an inactivated vaccine from a suspension of the spinal cords of monkeys injected with poliomyelitis. As yet, nothing definite can be said concerning the protection given to children until observations are made during an epide- mic. Kolrner has prepared an attenuated virus which may be too dangerous for use. A chemical method of applying protection to poliomyelitis was recom- mended by Olitsky and Cox. They have demonstrated in experiments, with monkeys and human volunteers, that sodium alum or tannic acid when drop- ped or sprayed into the nose acts as a shield against the disease by prevent- ing the causative virus from entering the body and reaching the nerve cells in the brain and spinal cord. Another contribution in this field was the demonstration of the value of vitamin C in the treatment of poliomyelitis. Two recent contributions have been made in the treatment of hyper-ten- sion. One form of treatment involves the use of roentgen irradiation of the carotid sinus. A dose of fifty roentgen units is used, alternating sides with each treatment until three doses are applied on each side. All treatments should be given at intervals of three days. The use of sodium or potassium thiocyanate has been shown to relieve symptoms and reduce blood pressure. Some danger is attached to this form of treatment since the concentration of cyanates in the blood may reach a dangerous level. Of the two methods it appears that the use of irradiation offers a better form of treatment, with a minimum amount of discomfort to the patient. The use of various physical agents in therapeutics has been another fertile field for research. Only three of the innumerable contributions which have been made recently will be presented in this article. The first is the use of artificial fever in the treatment of gonorrheal ophthalmia. The patient is placed in a cellotex lined cabinet and exposed to ra-diant energy which is derived from carbon filament lamps placed over the eye to maintain a high temperature. During the treatment, which lasts twelve hours, at a tempera- ture of 41.50 C, the patient is given large amounts of fluid and mild sedatives. Favorable results have been abtained in all cases treated by the originator of the treatment. This treatment should not be instituted in patients, with cardio- vascular, renal or liver disease. Chronic varicose ulcers have been treated satisfactorily by acetyl-beta- methyl-choline chloride iontophoresis. Reinforced asbestos paper is satur- ated with a 0.5W solution and wrapped around the foot and leg as high as the knee, not touching the ulcerated area until a firm scab forms over it. A rnal- leable metal plate is then placed over the wet asbestos and connected to the positive pole of a galvanic machine. An inactive electrode is placed under the back. The current is turned on and off slowly, using 20-30 ma. The treatments last 20-30 minutes and are given two or three times weekly. This treatment does not require hospitalization and is rather safe. The intra-nasal ionization of zinc sulphate has given favorable results in the treatment of hay fever and vaso-motor rhinorrhea. One hundred nintey one