PRACTICAL

MEDICINE,

PREPARATIONS, ETC.

VOL. XXV.

TERMS.

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A NOTABLE WIDENING OF THE FIELD OF DIAGNOSIS.

Hitherto an absolute diagnosis of calculi in the kidneys and ureter was impossible, and frequently both doubt and difficulty hung over the diagnosis in many cases of suspected stone in the bladder. The X-ray

No. 8

has cleared away this vexing problem. It is now possible to affirm the existance of calculi in ureter, kidney, or bladder; or to make a negative diagnosis which will preclude the necessity of an exploratory operation and prove of great aid to the patient and surgeon.

Any one can do this work who has sufficient experience with the X-ray, but it is not advisable for the beginner to attemp it. Experience is necessary in exposing and developing plates as well as in handling the X-ray itself, since such work can not be satisfactorily performed with the fluroscope alone, reports to the contrary notwithstanding. Even the expert deems it advisable to use two plates so as to prevent the possibility of error through imperfection in a single plate. In the first work of this kind attempted, apparently stones were found, which later investigation proved to be air bubbles in the plate. The plate used is preferably large enough to reach from the upper portion of the kidney to the lowest portion of the pelvis; thus all parts of the kidney, ureters, and bladder are exposed to the rays, and a calculus in any locality is readily detected.

Thus the patient who formerly complained of "dull lumbar pain, some slight alteration in the urine, and other obscure symptoms which might indicate floating

kidney, chronic nephritis, lumbago, or other diseases" is at once tendered a positive diagnosis excluding or confirming the presence of stone. Gall-stones too, are now being radiographed, but they present greater difficulties owing to their often being partly covered by the liver, partly because of motion during respiration, and partly because of the composition of the stones themselves. Those containing cholesterin do not show as readily as those containing phosphates and other salts.

No up-to-date physician will allow an operation for suspected stone till after it has been located by the X-ray, nor will he worry himself over a doubtful diagnosis until after the operation has confirmed his suspicions or left him to his chagrin from an unwarranted and dangerous procedure.

TYPHOID FEVER OF THE COUNTRY.

This is probably the so-called typho-malarial fever of the older writers of the period of the Civil war. Cases of this description require the closest scrutiny to differentiate them from typhoid per se, but usually the problem is solved by absence of rose-colored eruption, reference to the history of attack and less tendency to intestinal over-activity.

It will also be observed that the malady refuses to yield to the influence of quinine sulphate, which, by most writers,is believed to be specific for pure remittents. On the other hand cases of this kind tend to prolong their existence into the fourth and even fifth and sixth week. This chronicity with irresponsiveness to quinine and the more or less frequent occurrence of mild diarrhea and delirium, seem to justify the title. Treatment that succeeds the best is that best suited to typhoid fever. Therefore, the one thing and the first thing of importance to do is to render the intestinal

canal aseptic by pushing the sulphocarbolates to point of saturation. A combination of the various salts may be employed, or if no diarrhea be present, the sodium salt alone will answer, given in daily dosage of 40 to 60 grains. Cases bear acetanilid well when safe-guarded by caffeine and an alkali, preferably sodium bicarbonate or aromatic spirits of ammonia. The drug thus used must be given in dose and frequently enough to bring temperature to about 100 degrees Fahrenheit, and maintain it there. General comfort, freedom from headache, more sleep and less anxiety of mind, may be enumerated among the results. The proper application of hydrotherapy is, however, preferable to the administration of any drug for the reduction of the temperature in these cases, no doubt, as instead of a depressing, it appears to have a tonic effect.

Quinine may be first thought of, particularly in malarial situations, i ut after a trial must be dropped as 't can only contribute to the patient's discomfort without compensating advantage.

As in typhoid fever, attention must be on the all-important subject of alimentation and how best to conserve vital energies by early and duly supporting the heart.

Cactus, strychnine and perhaps glonoin are grand props to the overtaxed heart.

PHYSICIANS as a rule do not write enough about their experiences. They have valuable practical knowledge which it would benefit themselves and the profession to publish. But they wait, because they think it necessary to write a long, big-worded article when really a short letter or description would be of more interest. Doctors should write more about their practical results.

Brief and practical articles, short and pithy reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the Summary must be contributed to it exclusively. The editor is not responsible for the views of contributors.

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PRIMULA SINENSIS (DAISY PRIMROSE) POISONING MISTAKEN FOR ECZEMA.

WA

BY J. C. DENSTEN, PH. D., M. D.

AS called to see a lady 69 years of age. On entering her room found her excited, nervous and suffering mental anguish from itching, burning and stinging sensation of hands and face, which were inflamed, red and swollen.

The history of the case was meagre, and the first warning she had of its appearance was about one year previous a red spot, with burning, stinging and itching had appeared on the attenuated part of little finger of right hand. Then on other hand and fingers and had spread to wrist of each and also to face, particularly to right eye, nose and chin, which when I saw her were "erysipelatous" in appearance. Said "she was nearly crazy," could not sleep at night and could not rest in daytime, and the only relief she could get was to allow hot water to run over her hands which seemed to carry all the burning and stinging out at the ends of her fingers and gave her immediate relief.

She had called in five or more physicians within the year and had given them a fair trial. Each had diagnosed her ailment as "eczema" and had treated her accordingly.

I saw at once that this was not "eczema❞ but the result of a "vegetable" poison, which variety I could not then determine as she could give no information to assist me, declaring she had not been among ivy or sumac, etc.

Being confident of my diagnosis I at on‹ : prescribed for her. Had her stop all

R. Rhus radicans fld. ext. gtts. v at dose to begin on, four times a day, increased one drop per day until gtts xv are reached per dose. Then decrease until gtts. v per dose is reached and discontinue. Also

R. Fld. ext. echinacea 3 iij t. i. d. and strychnine gr. 1-20 before each meal. Also R. Epsom salts, two teaspoonfuls in glass of water each morning before breakfast. On this treatment she at once, after twenty-four hours, began to improve and was discharged entirely cured in a little less than six weeks.

The reason why grease and ointments are not applicable in vegetable poisoning such as rhus radicans, (poison ivy) rhus veriux (poison sumac) and permula (daisy primrose) etc. is because the poison is volatile, and grease, alcohol, etc., dissolves it and the poison follows the application along the surface of the cuticle and spreads it. Hence the spreading of this "vegetable" poison to the face, she having a habit which I observed of rubbing her eye and right side of face with fingers after applying the ointment.

I was continually on the alert for the cause of the poisoning and noticing a "permula” plant in her window I remarked that it was poisonous to some persons. She then remembered that she had repotted the plant and trimmed it up about the time this ailment first appeared, which on investigation proved true and was undoubtedly the real cause of her ailment.

311 Spruce St., Scranton, Pa.