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spoonful of each dissolved in a little water and given to the patient one after the other on an empty stomach. The gas generated hereby distends the stomach and indicates how far the organ has descended.
The splashing sound, auscultatory percussion and gastro-diaphany can also be resorted to. I consider the gas test quite satisfactory. The position of the other visceral organs can be made out by palpation.
Glenard advises that the physician stand behind the patient, and lifting the abdomen with the palms of both hands, if enteroptosis is present, the patient will feel a sense of comfort and relief.
The prognosis of enteroptosis as to relief is very good, not so as to a cure. But inasmuch as we are not called upon to cure conditions, which do not disturb the physical well-being, and inasmuch as we can give these patients relief from their symptoms, we may consider the prognosis altogether as favorable.
To mention all the symptoms of enteroptosis would be to enumerate the infinite variety of symptoms comprised in nervous dyspepsia-atony of the stomach and intestine, neurasthenia, malnutrition, anemia, constipation, mucus colitis, etc.
Prophylaxis: The physician should caution patients with hereditary enteroptotic tendency against tight-lacing and garments that contract the waist. As it is useless to decry the fashionable corset altogether, we must compromise on a corset built on rational principles. After confinement, a well-applied abdominal bandage should be worn. Proper diet, with plenty of fresh air and sunshine, can not be too strongly insisted on.
The indications for the treatment of enteroptosis are:
To support the prolapsed visceral organs by mechanical devices and by such diet and medicines as tend to toneand build up the body.
Experience teaches that many of these patients are best treated at institutions, removed from their families and household responsibilities.
In some advanced cases showing emaciation, anemia and nervous exhaustion, it is necessary to put them to bed for a time and treat them on the principles of the Weir-Mitchell rest cure.
A few weeks of treatment in an institution accomplishes. more than prolonged treatment at home.
Rest in bed relieves the ptosis and traction on the visceral organs and facilitates the rest of the treatment.
The mechanical treatment consists in the application of a well-fitting abdominal bandage. One made to order after measuring is preferable to a ready-made one, which is rarely satisfactory. The moleskin adhesive plaster bandage (Rose) has given many of my patients great relief, affording them at once a sense of comfort.
(As the application of the bandage is better demonstrated than described, I will demonstrate it at the close of the reading of this paper.)
The only objection to the support is that it sometimes. irritates the skin. I have had patients, however, wear it. for months without producing any dermatitis. The moleskin plaster is impervious to water and there is no objection to the patient taking his regular baths.
Massage of the abdomen from five to ten minutes daily. is of great utility. The different manipulations are simple and can be easily acquired by the physician. I never leave my patient to masseurs. Personal interest and attention on the part of the physician has a beneficial psychic effect on the patient.
The relaxation of the abdominal wall can also be counteracted by electricity. The static current has given me satisfactory results—the plate electrode with positive polarity to the abdomen. Some prefer the faradic current— external or intragastric. The static current is pleasant and the patient does not have to swallow electrodes, a procedure often very objectionable to the patient.
Abdominal gymnastics also strengthens the muscular wall. A simple way to execute it is to instruct the patient to lie down flat on a couch or the floor, then gradually and slowly raise his trunk into a vertical position, without moving his extremities, the exercise to be repeated ten to twenty times daily.
Another valuable aid to the treatment is hydrotherapeutic measures. The cold douche over the abdomen, Priesnitz or alcohol applications over the abdomen are simple and effective.
The diet should be nutritious and fattening. I find many of these patients underfed amounting to emaciation. They claim that they diet themselves, when in fact they starve themselves, they are afraid to eat. I insist on their taking plenty of food, and even if they are uncomfortable at first, the stomach soon tolerates more liberal rations. Of course the selection of food and the mode of preparation has to be in accordance whether we have to deal with atony, hyperchlorhydria or anacidity. Never give vague directions as to diet nor stereotyped printed diet-lists, but write out the patient's diet-list, enumerating every article of food you wish them to have.
Experience teaches that a gastro-entero or nephroptosis is materially helped by the accumulation of fat. Liberal quantities of butter and cream should be prescribed.
Tonics, stomachics as iron, arsenic and hydrochloric acid, tincture nuxvomica and the fluid extract of Condurango in liberal doses.
Bismutose or the subcarbonate of bismuth in teaspoonful doses, t. i. d., sometimes combined with the salicylate of magnesia to counteract irritability and fermentation.
For the constipation there is nothing as efficacious as massage and rectal injections of one-half tumblerful of warm oil administered through a colon tube at bedtime, and to be retained overnight, as advised by Fleiner.
Gastro-intestinal surgery has made such remarkable strides that there seems to be a field for this art in cases that can not be relieved by approved medical measures.
THE TREATMENT OF NEURITIS AND OTHER CONGESTIVE CONDITIONS WITH THE STATIC MODALITIES.
BY R. P. IZLAR, M.D., WAYCROSS.
Pathological conditions are characterized to a greater or less degree by congestive hyperemia which arises from circulatory disturbances, due to pressure, trauma, obstruction, paralysis, etc., of the muscular coats of the blood-vessels. This hyperemia may be active or passive, and if the stasis is allowed to persist, tissue death results and repair is deferred. The process of regeneration may be delayed by many causes. In both types of hyperemia the indications are apparent-that the static modalities being of great potential, high frequency and small quantity removes obstacles to regeneration and promotes normal tissue proliferation, can be demonstrated by experience. The properties which effect the results to which I will refer are due to the penetrating vibrations and consequent induction of contraction of the muscles and structures surrounding the congested area, and coats of blood vessels, which actions are peculiar to electricity. The contractions give the impetus which starts on the blood stream and overcomes local stasis, and I am certain that no other agent can produce the degree of intensity, frequency or penetration which is obtained from the static modalities, which has its frequency and amplitude controlled by the spark-gap, associated with a current output which can be