Vol. XXIII. No. ii.] 



'OPULAE SCIET^OE I^EWS. 



173 



of the desire for certain kinds of food, is but a 

 tedious disease. To be led, then, bj the law of nat- 

 ural inclination in the choice of food is a law of 

 instinct, which should prevail in the dietetic code. 

 There should be an interval of an appreciable length 

 of time in the taking of food, that the assimilation 

 of food into blood, which goes on alternately with 

 digestion, should have an opportunity for the pro- 

 cess. To digest food well, it should be eaten under 

 the best method to secure digestion — social enjoy- 

 ment. Around the table there should be friends, 

 and the instinct of social life enjoyed. The old 

 proverb about chatted food is already half digested, 

 is an admitted physiological law. 



The problem to be solved is to take the rough, 

 natural material from the storehouse of nature, and 

 proceed to build the human frame, transforming the 

 materials that are used into life, and to supply the 

 force needed to secure its mechanical apparatus. 

 There are quite a number of organs of the most 

 delicate and elaborate construction provided and 

 made to co-operate to achieve this end. If the body 

 was a wondertul machine, regulated by well-known 

 mechanical laws, science could dictate the exact 

 amount of material, the exact time for feeding the 

 machine, and predict the exact result in action, 

 force, and mental surplus, and the physician could 

 be perfectly exact in his methods of dealing with 

 "the ills which flesh is heir to." But the term 

 assimilation, used as a term expressing the work of 

 the digestive apparatus, isof wonderful significance. 

 Assimilation is a modification of the food supplied, 

 taking such portion of the material as is like the 

 kind which is to be added to, and adopting it, and 

 rejecting such portions as are unlike. To accom- 

 plish this, the material is raised — vitalized — bv suc- 

 cessive steps, to be able to add to the new organism. 

 Much depends on the mode of expenditure of this 

 material, what kind and quality is necessary for the 

 building. If the athlete thrives best on the strong- 

 est food, brain work requires a different regimen, 

 and the nursing mother still a quite diflFerent course, 

 — although all demand the material which will most 

 easily each of his kind supply in the work of recon- 

 struction. 



So far as these obscure laws are known, it seems 

 to be a fact that in mental toil there is no less waste 

 of force and material, but there is not the same ease 

 in taking of the new or raw products supplied and 

 reconstructing the waste. For the law of existence 

 seems to be to secure a balance-sheet, between the 

 growth and development, and the loss or decomposi- 

 tion of the human frame, and in the vigorous result 

 of this law consists the health of mankind. 



Another concomitant which plays an important 

 part in securing a good digestion is a serene mental 

 life. The brain is the seat of more trouble in the 

 disturbance of the digestive action than the larder. 

 Monotonous and despondent people, with restless- 

 ness of spirit, oppressed by care, full of worry and 

 agitation, are ever the prey to poor appetites and 

 indigestion. The food supply is criticised, when a 

 change of scene and occupation afford immediate 

 relief. 



Perhaps one of the most antagonistic symptoms 

 to combat is that over and excessive carefulness 

 which is ever occupied with the questions : What 

 shall I eat.' When shall I eat? How often shall I 

 eat.' When, where, how shall I drink? Let instinct 

 settle the questions. Science may manipulate a 

 perfect machine, and the automaton will respond 

 perfectly, but there is a veiled spirituality, an added 

 moral language, which instinct whispers ever to the 

 human being, and her laws are Nature's laws and 

 may not be broken with impunity. 



See Club List on the third page. 



I Specially Compiled for The Popular Science News-i 



MONTHLY SUMMARY OF MEDICAL 



PROGRESS. 



BY W. S. WELLS, M. D. 



T. Pridgin Teale, F. R. S., etc., delivered the 

 address in surgery at the late meeting of the British 

 Medical Association, choosing as his subject, "De- 

 tail in Surgery." Speaking of ligature of arteries, 

 he said : 



"It happened not long ago that I had to deal with 

 a wound of the brachial, at the bend of the elbow. 

 Esmarch's tourniquet enabled me to easily expose to 

 the eye a longitudinal slit in the artery. I applied 

 a ligature on both sides of the puncture. There 

 were then clearly exposed to view the two ligatures 

 and about half an inch of the artery containing the 

 "slit. It occurred to me to divide the artery between 

 the ligatures, and so to relieve the obvious tension. 

 I then appreciated what I had nevt r before realized 

 in connection with ligature of an artery, — the 

 immense elasticity of the arterial coats. The sepa- 

 rated ends receded fully half an inch from one 

 another. The question at once occurred to me : 

 Can it be right ever to tie an artery by a single 

 ligature, and to leave this powerful force of elasticity 

 to act upon ulceration of the coats and gaping of 

 the ulcer, with the risk of final disturbance by 

 retraction of the divided ends when ulceration has 

 completed its work? May we not find here an 

 explanation of the numerous failures of ligatures of 

 the great arteries, twenty or thirty years ago, and of 

 the fatal secondary hemorrhages, chiefly from the 

 distal end? Secondary hemorrhage and fatal re- 

 sults will, by this plan of dividing the artery between 

 the ligatures, be thereby rendered extremely im- 

 probable. Recently I assisted my friend, Mr. R. 

 N. Hartley, in a case in which he first ligatured the 

 femoral, and, a week later, the external iliac on the 

 same side in the same patient. On both occasions 

 he doubly tied and divided the artery, with admira- 

 ble results. This principle, proposed by Abernethy 

 and afterwards forgotten, has recently been restored 

 to practice at St. Bartholomew's Hospital by Mr. 

 Walsham, and is, I believe, practiced elsewhere. 

 May we not call this 'a detail' in the operation of 

 tying an artery? Does it not embody a principle — 

 the principle of physiological rest? Are we to 

 recognize and act upon the fact of the elasticity of 

 an artery? or are we to ignore it, and thus place our 

 patient at the mercy of elastic drag, tension, ulcera- 

 tion, retraction when liberated, and secondary 

 hemorrhage?" 



Mr. Teale regards this principle of rest as an 

 important factor in the healing of any tissue. 



In another portion of this address, speaking of the 

 sphincter ani in the surgery of the rectum, Mr. 

 Teale said : 



"There is a detail in operations on the rectum or 

 anus, which, rightly carried out, contributes very 

 greatly to ease in operating, to the comfort of the 

 patient after the operation, and to the permanency 

 and perfection of the result. As a preliminary step, 

 in every operation on the rectum or anus, there 

 should be dilatation of the sphincter ani by the 

 fingers. First and most conspicuous in this relation 

 are bleeding piles. Some twenty-five years ago I 

 was asked to operate for bleeding piles on a gentle- 

 man about thirty years of age. On mentioning the 

 case to my father, he said : 'Dilate the sphincter, 

 and most likely you will never have to operate on 

 the piles; — they will be cured.' His anticipation 

 proved to be correct. His advice was acted upon, 

 and the gentleman has remained well to the present 

 time. So late as in 1887 did M- Verneuil bring this 

 subject as a novelty before a meeting of surgeons in 

 Paris, nearly all of whom were entirely ignorant of 



the question. I now rarely operate on internal 

 haemorrhoids without having previously tested the 

 effect of simple stretching of the sphincter. The 

 stretching at once displays the piles to view, and 

 places them in a ready position for being seized and 

 dealt with. Another advantage is that, after the 

 operation, the parts remain at rest, and the wounded 

 tissues are not liable to protrude and be strangled 

 by a resentful sphincter. Also, if there be bleeding, 

 there is great facility for escape and discovery of the 

 blood, and therefore less danger of concealed hem- 

 orrhage, which may fill the rectum with a large 

 clot, perhaps only to be suspected from the pallor 

 and feeble pulse of the patient. A further advantage 

 is that wounded and granulating surfaces within 

 the rectum are not interfered with or kept in a pain- 

 ful or irritable state, after the fashion of fissure, by 

 an over-active, excitable sphincter. Two cases 

 have recently been under my care in which long- 

 continued suffering, after removal of piles without 

 stretching of the sphincter, was at once cured by 

 simple dilatation. This dilatation is an equally 

 important preliminary in treating fistula in ano." 



HiLDEBRAND (ZtscJir. fiir Chir.) reports three 

 cases of operative interference, in Koenig's Clinic, 

 in which congenital defects existed in the cranial 

 vault, with protrusion of its contents. He recom- 

 mends the following rules in operating: In all 

 cases of cerebral and spinal herniae, when the con- 

 tents of the sac are fluid, incise, evacuate its contents, 

 and remove it. If the contents be brain substance, 

 it should be reduced, if possible, and held so with a 

 truss. If irreducible, the contents should be excised. 

 Ligation of the sac base, without opening it, is only 

 to be done with meningoceles containing only small 

 amounts of cerebrum. Escape of cerebro-spinal 

 fluid is avoided by immediate introduction of the 

 finger through the incision in the sac, and occlusion 

 with its tip of the communication between it and 

 the interior of the skull. An elevated position of 

 the seat of operation, and narcosis, are considered 

 advantageous. 



Benzoated chloroform is suggested by Dr. B. 

 W. Richardson, in the Asclepiad, as an antiseptic of 

 considerable service in the treatment of fetid 

 wounds. It is made by dissolving three drachms 

 of pure benzoic acid in twelve ounces of chloroform. 

 After the bandage has been applied, he directs a 

 fluid drachm of the solution to be poured over the 

 ulcer, the deodorizing effect being of the best char- 

 acter. It is equally efficient in removing fetid 

 exhalations of the feet. Used like eau de cologne, 

 he finds it advantageous to rub over the hands at a 

 post-mortem examination, and for similar purposes 

 where a disinfectant is required. 



Prof. Billroth, of Vienna, (London Lancet), has 

 written an article on the dangers of carbolic acid. 

 He says : 



"I have lately seen four cases in which flngers 

 which had suffered insignificant injury, became 

 gangrenous, through the uncalled for application of 

 carbolic acid. The acid may not only cause inflam- 

 mation and gangrene, but also blood poisoning, 

 and so may prove fatal. It ought never to be used 

 without the advice of a surgeon. The best antidote 

 in carbolic acid poisoning is soap, which should be 

 taken immediately — dissolved in warm water — and 

 repeatedly, until all symptoms of poisoning have 

 disappeared." 



In fractures of the radius above the insertion of 

 the pronator radii teres. Prof Brinton (Col. and 

 Clin. Record) directs the hand to be in extreme 

 supination, and the application of an anterior angu- 

 lar splint. 



