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

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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

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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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The extensive use of roentgen rays may produce nausea or vomiting but this untoward effect can be easily controlled by the use of Zcc of liver extract intravenously or intramuscularly. Other studies, just as valuable as these have been made in physiotherapy but space does not permit the discussion of even of ,small amount of them. Acetyl-Beta-Methyl Choline has also been recommended in paroxysmal tachycardia which has not responded to other measures, in spastic types of peripheral vascular disease, and in post-operative abdominal pains. Its use is based on its muscarine effect and it has the added advantage of being ef- fective by mouth. The so-called muscarine effect consists of three actions: an inhibitory effect on the heart, a peripheral vaso-dilatation with accompanying' fall in blood pressue, and a stimulation of gastric and intestinal paralysis. Remarkable results have been obtained in the treatment of post-encephali- tic Parkinsonism by Italian workers. They have devised the Bulgarian Treatment which is based on the use of a SW decoction of atropa belladonna in white wine. Patients under fifteen years of age are given 5cc three times a day while those over fifteen are given l5cc doses. The patients are also en- couraged to utilize a hypo-toxic diet, a minimum of stimulants, and various orthopedic and gymnastic exercises. . Another important contribution has been made by foreign workers who have introduced a dye which is useful in the treatment of streptococcus in- fections. German investigators first studied the effects of prontosil, which is a bright red solution used hypodermically, and prontylin which is a tasteless white powder used orally. These chemicals do not kill streptococci, but merely check their growth and damage them, so that they become easily susceptible to the action of the white blood corpuscles. These chemicals are useless in patients very near death from the infection, since they must be allow- ed thirty-six hours to exert their influence, and the patients must have enough vitality to destroy the germs after the chemicals have checked the growth of the streptococci. The favorable results obtained to date warrants the careful use of prontosil in infections due to beta hemolytic streptococcus. Cobra toxin has been advanced as a possible substitute for morphine in the relief of pain due to an inoperable or relapsing carcinoma. This extract does not reduce the appetite or diminish normal defensive powers of the body. Cobra toxin is also useful in neuritis and neuritides. The proper dose must be determined for each case starting with O.5cc doses in the gluteal muscles every 3 days. ' The introduction of varostadin Clistidene monohydrochloridei was widely acclaimed by the medical profession as a cure for all gastric ulcers, but inten- sive investigations have shown that its benefits last only for six months. It may be helpful in chronic ulcer cases which do not respond to diet, alkalies and other medical treatments. Any discussion of the recent advances made by medical science could not be considered complete without any mention of the enormous amount of re- search being conducted in two very important fields of medicine, one the en- docrines and the other cancer. The amount of experimentation that has been done in these subjects in recent years has been so great that any attempt to valuate the results obtained would be foolhardy. Therefore, in closing this article reference to the proper literature is recommended since it would give more information than could possibly be derived from this resume. - l- One hundred ninety-two