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FIRST OF ALL

Insist on rest and freedom

from care; then always prescribe

Glycerine

GRAY'S certe TONIC

This, authorities state, will,
if persistently followed, overcome
any case of general debility, nervous
exhaustion or neurasthenia.

THE PURDUE FREDERICK CO.

Comp.

No. 15 Murray Street, New York

"Hill's Reference Chart"

DOCTOR: You are entitled to a copy of "Hill's
Chart," and if you have not received it, (delivered
free of charge), send your name and address to
The ANTIKAMNIA CHEMICAL COMPANY
ST. LOUIS, MO., U. S. A.

And you will get one by return mail!

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A MONTHLY JOURNAL OF

PRACTICAL MEDICINE,

NEW

PREPARATIONS, ETC.

R. H. ANDREWS, M. D., Editor, 2321 Park Avenue, Philadelphia, Pa. ONE DOLLAR PER ANNUM, IN ADVANCE. SINGLE COPIES, TEN CENTS.

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PHILADELPHIA, JUNE, 1903.

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No. 4

scure diagnosis, he fails to do his full duty. Typhoid may occur in the fetus, and from birth to the age at which it assumes the adult type; but the Widal test and the Diazo reaction will settle the diagnosis in practically every case.

Out of 84 cases of typhoid in children treated by Koplik, 16 per cent. occurred before the fifth year and over 50 per cent. between the fifth and the tenth year; one case occurred at eighteen months; four at three years; and nine at four years.

Dr. J. P. Crozier Griffith says we should think of the possibility of typhoid in every case of continued remittent fever not explainable on other hypothesis, even if occurring in a nursing infant. To be sure, the opportunities for infection of an infant at the breast are not so numerous as for older children, but a little thought will reveal many possible avenues. The possibility of congenital typhoid, or of typhoid occurring soon after birth are no longer denied by competent authority.

In the child, the onset may be accompanied by malaise, aching of the head, back and limbs, vertigo, vomiting or chilly sensations; but seldom with a pronounced chill. There is a marked tendency to cerebral symptoms, and consequent erroneous diagnosis of meningitis is common. In very young children the invasion is ushered in, in many cases, by a convulsion, which may

or may not be followed by more or less typical symptoms such as epistaxis, splenic enlargement, rose spots on the abdomen, etc. Diarrhea is a pretty certain symptom in all cases. In many cases it is not possible to clearly make out ileocecal tenderness. Hemorrhage rarely occurs. A complicating pneumonia is not rare, indeed, it often presents the primary symptoms and the typhoidal symptoms appear later. The tongue and lips approximate the appearance noted in the adult more closely than any other symptom. The tongue is at first coated and protruded tremulously, later losing its epithelium and the papilla becoming prominent; at the height of the disease the tongue may be dry and fissured, and sordes collect on the teeth and lips. Enlargement of the spleen is not of so great diagnostic significance as in the adult, because so many conditions will cause enlargement of a child's spleen.

The diagnosis is difficult; yet it is exceedingly important. Meningitis, enteritis, appendicitis and pneumonia may simulate typhoid fever at the onset, and vice versa. The history is important, and the existence of an epidemic or of other cases in the same household should place us on our guard. The gradual onset; the progressive intensity of the cerebral symptoms; the rose spots and the enlarged spleen should all be considered, but the final and conclusive evidence is to be sought by the Widal and Diazo tests, making them daily, if necessary, till an absolute diagnosis is established.

The prognosis is good in the milder cases; grave in the severer types. Milk and raw eggs are the most suitable diet. Little medication is called for, but alcohol is important in those cases with weak pulse and high temperature; in such cases delirium is no contra-indication to its employment. Digitalis, strychnine and camphor are the best heart stimulants. The temperature is best controlled by hydro-therapy.

BICHROMATE OF POTASSIUM,

This drug is available in cases of Winter cough when naso-pharynx and bronchial tube are coincidentally involved..

It can be used with equal advantage in acute or chronic bronchial catarrh. Loud bronchial rales and strong vibration of chest walls seem to call for it. Children or adults may have it all through the course of an attack.

Absence or lack of secretion, dryness of throat, toughness of sputa, difficult expectoration, are some of the conditions that as a rule are speedily relieved.

The "rattling" coarse, bronchial rales, that are observed in attacks affecting infants and young children, which causes so much uneasiness to the parent,is speedily dispelled by small doses frequently repeated. The bichromate is marketed in two forms of small tablets and granules.

These forms are convenient for administration to adult patients, but for children they must be subdivided. The required number of tablets can be dissolved in a goblet of water, forming a solution which is not unpleasant, and will be taken by the youngest and most delicate.

We believe the importance of this drug as a medicine is not sufficiently recognized, and feel confident that a better knowledge of its properties will add substantially to our equipment for the treatment of throat and bronchial affections.

Note.

Dear Doctor.-Please read the standing notices at the head of the departments in the SUMMARY, and act accordingly. We have frequently called attention to this matter before, but, it appears, some doctors never read those standing notices; they present an idea of just what we wish you to do, all in a nutshell, as it were. Now come along with pointers of your past experience in practice, and we are sure the effort made and time consumed will be compensated for, if not direct, in an indirect way that will gladden your heart.

Original Communications.

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.

Write only on ONE SIDE of the paper.

IN

APPENDICITIS.

BY G. O. SMITH, M. D.

N a former article for your valuable medical journal I promised you my experience in recent cases of appendicitis. A fresh case of this disease admonishes me of my pledge. Appendicitis of late appears to be one of our most frequent and formidable diseases. That death frequently claims its victim in these cases is too well established to be passed over lightly. My observation is that few diseases cause such terror to a patient as when he is informed that he has appendicitis. Medical treatment is quite an uncertainty, and if continued too long, surgical treatment becomes also uncertain. This want of confidence in the successful treatment, either medically or surgically, is what appalls the patient, the friends and the physician. The cause of appendicitis is also an obscurity. If it be a foreign substance in the appendix, there is no way of finding it out accurately but to perform the formidable operation of laparotomy. Only temporary relief can be had as long as the foreign substance remains. whatever it may be. Usually this is something eaten that is indigestible. In one case recently, within a neighboring physician's practice, a case operated on after recurrent attacks, disclosed a date seed in the appendix. The patient distinctly remembered of having accidentally swallowed it at a party given a year before.

In a case within my practice a young lady had had several attacks and recoveries from appendicitis, when a new attack took place, so formidable as to indicate no other course but an operation. This was made and a knurly bean was found in the appendix. It thus appears that no medical treat

ment can be depended upon where any foreign matter is in the appendix.

There is another class of cases where no foreign substance is in the appendix, but the specific inflammation appears to be caused by exposure to wet and cold combined. A recent case in practice was that of a strong, healthy man,who, while trimming apple trees was caught in a shower that wet his clothes. He kept right on to work with wet clothes on in a cold wind. That night he was taken with appendicitis. This case being purely catarrhal, yielded to external applications of hot spirits of turpentine diluted one-half with melted lard, together with unloading the bowels with castor oil. Morphine was given to ease the pain and as an antiphlogistic. Absolute rest in bed was enjoined. Dr. Bartholow advocated this same plan of treatment, except substituting sulphate of magnesia every three hours until the bowels were moved. I think that no better treatment is extant than this in catarrhal cases which the history will disclose to the practitioner. Take for example a case taken with chills, mild fever and pain with soreness over McBurney's point, and especially after having been exposed to wet and cold, and most probably you have a case of appendicitis of a catarrhal type. I notice in the case of something foreign in the appendix we are warned by a continual soreness about McBurney's triangle, at first not as severe pain as in the catarrhal variety and with less fever. It will get better on rest, local applications of turpentine and lard with morphine to allay pain, but is certain to keep returning. Here no treatment will effectually cure, and the appendix should be removed between attacks. I notice an unusual buoyancy in those who have been successfully operated upon, and well they might be for they have no further fear of this dreaded disease. The operation before suppuration appears to be very successful, and yet a very large majority of people are appalled at the idea of submitting to it. An early and correct diagnosis is a very important factor in the management of this disease. The masses of the people are not aware of the disease from the symptoms,and are apt to neglect a case too long. It is the

opinion of the writer of this article that the surgeon when operating for appendicitis in a woman should remove the right Ovary at the same time. In a case in my practice a second suppuration took place in

DILATION OF THE RECTUM.

BY J. A. BURNETT, M. D.

the ovary after the appendix was removed, HE value of dilation of the rectum is

and resulted fatally.

A great responsibility rests upon the medical practitioner. If he err in diagnosis, it may be too late for surgical help. If he operate too soon, he may open the abdomen of a typhoid fever patient. The writer had a case where he had diagnosed typhoid fever in a family who had lost a member from appendicitis. There was besides the nose bleed and mild diarrhea a great tenderness in the right iliac space and it included McBurney's triangle. The family having had sad experience concluded to call counsel. Two good surgeons experienced in appendititis, were called, one two days in advance of the other. The first decided, on the account of the great tenderness over the iliac region on the right side, that it was a case of appendicitis and urged an operation. This surgeon, although mistaken, was excusable, for no positive signs of typhoid were present. There had been the prodromic period moderately but as yet none of the rose colored eruption. I asked for a delay of the operation for two days, at the end of which a second surgeon was called, but he knew of the opinion of the first one and conarmed the diagnosis of surgeon No. I in spite of my pointing out about twenty rose colored pimples that had appeared within the two days. Surgeon N. 2 denied the genuineness of the rose eruption as typhoid. I then produced before the family Bartholow's Practice of Medicine and compared the eruption with his description, pointing out each rose spot and pressing on it to see the color recede and return again when the pressure was removed. "Who shall decide when doctors disagree?" The parents of the sick girl decided to dismiss the surgeons and retained the writer of this article four weeks, during the course and convalescence of typhoid fever. It is needless to add an opinion that the life of the patient was saved, as recovery would have been very doubtful if laparotomy had been performed at that stage of typhoid fever.

Odessa, N. Y.

very great in many diseases, both chronic and acute, and often in many conditions where cathartics are now prescribed, far better results could be obtained by dilation of the rectum as cathartics are weakening to the general system and are constipating in their secondary action.

The external sphincter ani which is just beneath the skin at the opening of the rectum is supplied and operated by the cerebrospinal system of nerves and is under control of the will power of the individual. It prevents the passage of stools without the mental co-operation of the person.

The internal sphincter ani lies within the muscular walls of the rectum itself at a point from one inch to one inch and a quarter from the opening of the anus, and cannot be governed by the will power as it is under control of the great sympathetic nerve.

The sympathetic nervous system, the principal factor in health and disease, controls all functions that are performed without the exercise of will power, extends to the rectal muscle and if we were to cut into the rectal muscle to these nerves and compress them, the patient so operated upon would gasp for breath, and if the pressure were continued breathing would cease and life would soon become extinct. Dr. E. H. Pratt, of the Chicago Homeopathic Medical College, said: "Disturbance of the sympathetic nerves, although they do not make themselves known in the language of pain, greatly disturb the various functions of the body, interfering seriously with its nutrition but very readily escaping the notice of the careless observer." Dr. C. E. Lanning, of the Hahnemann Medical College, of Chicago, said: "No matter from which standpoint we start, the nervous system is the all important structure in curing or preventing disease."

This is plain enough for any ordinary person to realize the great force that can be utilized in the treatment of diseases by dilation of the rectum and the great force for

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