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Labor Badly Managed by a Midwife.
in these fevers except in tonic doses, though EDITOR MEDICAL WORLD:-) was called on
he agreed with me as to the use of the other
antipyretics Nov. 15. 1891 to see Mrs. S., aged twenty-four,
It not my purpose to give details of treatin her first labor, at term, she having aborted
ment of these cases, but in view of this exonce. She had been in labor four days, at.
perience as well as two year's experience since tended in her sufferings by a female midwife.
in a great variety of febrile affections, to take Women of this class are a great detriment to
strong ground in favor of these remedies. I parturient women, their practice being entirely
will relate a typical case, which I select because empirical. The attendant midwise to'd me that the liquor
it is nearly the same age as Dr. Corcoran's
case. amnii escaped on the first day of labor. Being
Johnnie W., aged eight years, had been ill young in the practice I feared trouble. On
four days when first seen. Temperature 104, making vaginal examination I found that labor
face flushed, skin dry, headache, general achhad fully passed the first stage, and that the
ing and restlessness, abdomen enlarged and head of the child was advancing into the vag
somewhat tender, tongue furred and no appeina. The vagina was hot and dry and the wo
tite. I gave a pill representing one quarter of man was becoming exhausted, and having but
the compound cathartic pill in common use, few and feeble pains. She had not been al
which was repeated in the evening and a good lowed to get off the bed, lie on her sides, or
action of the bowels secured. At the same put her hands above her head.
time I gave two and one-half grains of phenacI annointed the vagina well with lard and gave
etine to be repeated hourly till the temperature her every hour twenty drops of fluid extract of
was lowered. I called in the evening and ergot and two grains of quinine in a little black coffee ; also allowing her to lie on either side,
found temperature 10172, skin moist, no head
ache or other pain and the child comfortable. get off the bed, walk the floor and sit in a chair.
Two powders had been taken. The father, After giving the third dose as described
who was very intelligent, was provided with a above, I put her in the squatting position, when
thermometer and instructed to give a powder labor pains soon began, and she had speedy
when the temperature reached 10272 or at any labor, giving birth to a healthy male child.
time when it appeared to be rising. At no There was no injury to mother or child. Did
time subsequently was more than one necessary I conduct the case properly? Let me hear by
to reduce the temperature, nor more than two letter from members of The WORLD family.
each day. Temperature ranged from 1oo to J. W. SHEMWELL, M. D.
102 during the rest of the illness, which lasted Bumpas Mills, Tenn.
about ten days. From five to ten grains of
quinine were given at a single dose each mornA Plea for the Antipyretics.
ing, the amount varying according to the tenEditor MEDICAL WORLD :— Dr. John P. dency of the temperature the preceding day. Corcoran, in the November WORLD, expresses One or two calomel purges were given to cor. his satisfaction with his treatment of a case of rect the appearance of the stools. A half typhoid fever without the use of the new anti- dozen sponge baths were given each day, the pyretics. He does not say that his condemna- temperature of the water to suit the patient. tion of these drugs is due to experience with in the words of the father, this was the most them.
comfortable sickness he had ever seen. During an epidemic of so-called mountain Phenacetine, which I prefer to the other new fever, the same as described in the article of antipyretics, by lowering the temperature, preDr. Harrington in the same issue of The vents delirium, relieves pain and restlessness, World, I had charge of about fifty cases. keeps the skin moist and the patient comfortMany of these were undoubtedly typhoid, all able. Does phenacetine lower th temperature running a course of from ten days to six weeks, by depresssing the system ? So does aconitine, and two were ill three months. In all of these aconite, veratrum and gelsemium if you give cases except one I used, from beginning to end, enough to bring the temperature down, and some of the new antipyretics, antifebrine and these drugs are just as dangerous. It is necesphenacetine being the principal ones. All of sary to depress the system in sthenic conditions. my cases pulled through except two, one of By keeping the temperature below the danger which was the one who did not get the anti- mark the prognosis is improved and conval. pyretic. I will add that the two who died did escence shortened. not get nearly the amount of quinine as did Why not use baths ? In the first place sponge all the others, who received it in heroic doses. baths, though very useful for other reasons, do This latter statement conflicts with Dr. Har not, as a rule, reduce the temperature in any rington's view that quinine should not be used perceptible degree; and immersion baths or kind.
the wet pack are four times out of five wholly emeral fever will jugulate itself if you will wait
Practic die. Indeed, many times the facil. a few hours. At most a mild cathartic or a ities and attendance are so poor that I cannot bath is all that is needed. If the cathartic does get my patients sponged off once a day. It is
not seem to be indicated and the bath is imprachere that the antipyretics are worth their weight ticable, one or two small doses of phenacetine in gold. Do not understand that I use them will lower the temperature until nature reasserts indiscriminately. They may be abused and herself. I speak of ephemeral fevers because are abused. That is true of any valuable drug. many of the cases described in the journal
In all my fever cases all the water was used mentioned in which dosimetry has achieved that I could coax or drive the atttendants to brilliant results seem to me to be cases of that apply-externally and internally, by mouth or enema. I did not use water for its antipyretic Ontario, California, O. S. Ensign, M.D. effect, for unless the facilities are good it costs more in appliances and the patient's strength
[Doctor, acetanilid has repeatedly been than it comes to, if you use water enough to
demonstrated to be identical with “antifeblower the temperature. Its effect on the skin
rine," and is very much cheaper. Why not
use it ? and in Aushing the bowels, with or without an antiseptic, as well as its absorption into the
In our opinion the method called dosimetry circulation, are very beneficial.
It is not, is not yet completely elabor ited.
I have no rule for the temperature of the water. The
properly speaking, a new system of medicine, patients' feeling are a sufficient guide.
but rather a little more light upon the common So much is said in The World on dosimetry
remedies with which we are already acquainted. that I feel privileged to contribute something
Viewed in that light we think that our physion the subject. I have read a journal devoted
cians can not give it too close attention. to that subject during the last year. I have
Adopt at first a small vest pocket case, conreached the conclusion that I have no use for
taining a few remedies, and revise and enlarge the system. It is asked if I have tried it. No,
the list as experience suggests.-ED). for I can accomplish all that is claimed for the system in a simple way, using fewer remedies Typhoid Fever Treated Without Cathartics. for the same indication and less in quantity. EDITOR MEDICAL WORLD :--Since publish Did time and space permit I would like to ing the collective investigation in the Augus consider in detail a number of cases treated WORLD I have received about twenty more re by this method detailed in THE WORLD. A plies from all parts of this country, and one brief notice of one will suffice, a case of scar from Constantinople. But as they ran about latina. For initial fever, aconitine in proper as those already published, I thought it not doses, and before the eruptive stage 1.6 grain best to ask for more of your valuable space. of sulphide of calcium added to each dose of I have, however, treated nine cases of the the aconitine, both to be given every fifteen or fever and have had nine excellent recoveries, twenty minutes till the climax of the eruptive and not a drop or grain of any cathartic went stage is passed. I have no objection to aconi. down one of their throats, either. tine provided the temperature is high and the I have just been looking over a medical pulse strong. Phenacetine or a wet pack would work written by Dr. William Buchanan, dated do as well and is just as safe. But 1.6 grain of Edinburgh, 4th June, 1772. In reading his calcium sulphide every fifteen or twenty min introductory remarks, the following paragraph utes to a child for possibly one or two days is appears, showing that at that time there existed away beyond me in dosage. Later he adds the more prejudice and less enterprise in medical arseniates of iron and strychnine and, if urine circles than to day: Dr. Buchanan says, is scanty, digitaline. It is a little singular that "Very few of the valuable discoveries in medito this treatment is added about all the usual cine have been made by physicians. They treatment, viz.: cathartics, gargles and baths, have either been the effect of chance or of newhich leaves us in doubt as to the influence of cessity, and have been usually opposed by the dosimetry. I should have added biniodide of faculty, till every body else was convinced of mercury, which the writer recommends if there their importance. is glandular swelling. Most physicians could " An implicit faith in the opinions of give that or the bichloride. Later in the same teachers, an attachment to systems and estabarticle he soften gives a few teaspoonfuls of lished forms, and the dread of reflection, will turpentine in diphtheria." This again is an always operate upon those who follow medicine addition to dosimetry and beats me on dosage. as a trade. Few improvements are to be exWriters on dosimetry often speak of jugulating a pected from a man who might ruin his characfever. You cannot jugulate a continued fever ter and family by even the smallest deviation with dosimetry or anything else, and an eph- from an established role.”'
Ought not we of the present day to be beginning to be established, when up went her thankful that we live in a free country, where temperature to 102°, and the next day to we are allowed to think and speak each for 103720 at 6 p. m., but soon dropped and himself! Now, knowing, as we do, that the oscillated between 98 and 102° until the 42nd local lesion in typhoid fever is in Peyer's day was reached, when, in the space of two patches of the small inte:tines, how can cath- hours, her temperature dropped from 102° to artics do anything but harm ? Is it not a fact 9372° with the thermometer well under her that the action of any cathartic is to deter- tongue for three minutes, pulse imperceptible mine more blood to the mucous membranes of at the wrist. But by the use of hot water the small intestines and to increase their per- bottles and hot flannels and, internally, arseniistaltic action, while in typhoid fever our ate of strychnine and digitaline granules reaim should be just the reverse of this, that is peated every fifteen minutes for a time, her to relieve congestion of the mucous surfaces of temperature gradually began to rise, and from the small intestines and keep the peristaltic that time improvement has been steady. Her action quiet! Then, too, in a disease produc- bowels were moved every day by the use of an ing diarrrhea, why help the disease to run the injection of warm water, containing five grains patient down by keeping up the very trouble of chloral hydrate to the pint and, when that ought to be quieted, by giving calomel, tympanitis was present, injections were used rheubarb and sedlitz salt ?
two and three times a day, which always had To again refer to Buchanan's work of 1772, the effect not only to clear the colon of its conhis directions for the treatment of typhoid tents, but to relieve the bowels of gas, which fever, which he calls "slow or nervous fever," was very grateful to the patient. are, in the main a supporting plan. He says, Now, some one, and many, I presume, will "Where the force of circulation is too great or say, had you given this patient calomel or the blood too dense, bleeding and other evacu- sedlitz, she would not have suffered those two ants are necessary; but when nature flags, relapses, and I think that is a fact, as, without when the blood is too vapid and poor, the doubt, the undertaker would have had charge lancet is to be avoided.
of her remains long before the 42nd day. He directs, in case the bowels are consti- James H. Hutchinson, M. D., in “Pepper's pated, that a "clyster” be given every other System of Medicine," says, that Maclagan almorning, consisting of warm water and milk, leges that relapses are more frequently met to which he adds sugar and salt. In case the with in cases in which constipation is present patient is delirious he says, apply a blister to in the primary attack, a condition which he the nape of the neck.
regards as favorable for absorption of the But above all, he cautions that the strength poison. But Hutchinson says that this is opbe kept up by good liquid nourishment and posd to the experience of almost every one who stimulants, often repeated, with tincture of has paid close attention to this subject, as, “in "bark" when necessary.
the cases that have come under my own obserOf my nine cases referred to above, in seven vation," says Hutchinson, "it certainly was deservescence took place in from ten to twen- not the case, diarrhea having been present in ty-two days. One case ran a mild course up all of them” (that is in all the relapsing cases to fifteen days, when the temperature was that came under his observation). nearly normal for three days and, to all ap- My opinion is, that had diarrhea existed in pearance, convalesence was getting well estab- this gth case it would have been impossible to lished, when, without any apparent cause, a have •nourished her sufficiently to have kept relapse occurred, the fever ran on for twelve soul and body together during this long run, days more, when defervescence took place and and she would have gone where the “5 per the patient made a good recovery.
cent” and “8 per cent” and “15 per cent" of But the ninth and last case was the bad one. typhoid cases do go. This patient was the mother of the one referred My treatment this season has been about to above. She had a very light run up to fif- as follows: When first called, if the fever was teen days, when a collapse occurred, tempera. well established I gave aconitine, veratrine and ture dropped to 96° and for two days she digitaline, frequent sponge baths and “flushed" seemed to improve, temperature being nearly the colon with from 1 to 4 quarts of warm normal. But on 3d day, or the 18th day of water with 5 grains of chloral to the pint. I the fever, her temperature again rose to 10372, instructed the nurse how to use a clinical thershowing that a relapse had set in, which ran mometer and left one with instructions to use on to the 28th day, when a second collapse it every hour or two, keep a record of the same occurred and her temperature dropped 950. and use the defervescent granules and the Again, for two days, her temperature remained sponge baths as indicated by it. To quiet the normal, and I was sure that convalescence was neuralgic pain in the head, back and limbs, I gave granules of codeine, and, if necessary, Dr. Cline's treatment of dropsy (page 417) morphine. If delirious, I gave granules of may be as successful as it is unique. I treated hyosciamine. Every two hours one granule of two cases six months ago, one of anasarca and arseniate of strychnine and the salicylate of ascites, the other of anasarca. The former as ammonia mixture, so often referred to in The follows: WORLD this season (should now use the sulpho. R Acet potass........
....ounce i carbolate of zinc in alternation continually
Tincture of digitalis ..........drams iiss throughout the fever). After defervescence I
Fluid extract of Queen of the Meadow
(P, D. & Co.,) ........ continue the arseniate of strychnine, alternated
Fluid extract of corn silk (P. D. & Co ) with hydroferocyonide of quinine and quassine.
Equal parts enough to make .. ounces iv The diet is highly important; an exclusive M. Sig --Shake. Dose one teaspoonful, well diluted, milk diet is the best. Regularly every two every four hours. hours, I gave a glass of milk, or its equivalent. After I had run all the water out of him, To those to whom it was impossible to admin- (which took about one week), I put him on ister milk I gave broths thickened with arrow cactina pillets, one every one, two, or four root. Stimulants were resorted to in but two hours, as required to control the heart pain, casez. (Plenty of cold water first, last and all dyspnea and palpitation, conjoined with the the time.
following: One hundred and nineteen years ago, when B Fluid extract of sour wood ...... Dr. Buchanan wrote his then excellent work,
Fluid extract of Solidago virgaurea aa blood-letting was in vogue in the treatment of
......... dram ss almost all diseases, but to-day the use of the
M. S.-One dose repeat t. i.d. lancet and tape is almost a lost art, and my
He told me yesterday that he considered opinion is that in less than that number of himself permanently cured, which I much years more the use of cathartics amongst the doubt, though he has been free from dropsy careful observers and thinking men in the some five months. When I commenced treatmedical profession in the treatment of typhoid ment he was water-logged from his toes to his fever will have been banished, and thereby nipples, and had to be propped up in bed to many valuable lives will be saved.
sleep. I think my friend, Dr. W. C. Abbott, does For an experiment I put the other case on not correctly interpret nature's anguish; sour wood and solidago, with tincture of instead of the small intestines crying because
strophanthus until the cellular tissue was emptheir contents are so nasty, they are crying
tied; then on cactina pellets. This case did because their mucous membranes are inflamed, as well as the other and their tears are what produces the diarrhea.
One thing which I do not understand about Now, instead of increasing the inflammation
the first case was that the diuresis was all diurwith cathartics, soothe with the sulpho carbol- nal no rising at night to evacuate the bladder. ate of zinc, and “flush" the colon with the Dr. Harrington (page 407) voices my opinion chloral solution and relieve their grief.
of Dr. Hurd's cases of anamalous fever both as Albany, Vt. J C. CAMPBELL, M. D.
to name and treatment. In the settlement of
new territory, here in the West, fevers are uf Comments on Morphinism.-Cyanosis. the intermittent and remittent bilious type. As Dropsy.-Continued Fevers of
population becomes more dense, we find a a New Country
transition to enteric complications, and WoodEDITOR MEDICAL WORLD:-) would suggest ward's misnomer a "typho-malarial,” which in Dr. Emory's case of morphomania (page 427), is typhoid, and should be recognized and
Opium habitue, like one afflicted with syphilis, is always a liar. To tide him over the "pitiable condition,” which I presume is caused by being deprived of the drug, I would give him Keith's avena sativa con. tinc. for the attacks of angina, inhalations of amyl nitrite, and do not spare it ; his head will not burst ! In the intervals give cactus grandiflora, or cactina pellets.
Dr. Meigs' plan of treatment of cyanosis neonatorum, as mentioned by Dr. Dix, (page 420), will not avail in all cases, as I know by experience, but I will confess that I do not know of anything better.
sixteen years ago, it was the exception to have a fever patient in bed longer than from five to seven days. If intermittent, calomel and quinine sufficed ; if remittent, when called to a case, you would load your patient up at night with calomel tamped down with Dover's powder, touch him off with salts in the morning, feed him on quinine for a week, and discharge him convalescent. Another fact as to the change in fevers here; our river bottoms are from one to four miles wide, with a sandy subsoil, and the people use drive-wells; that is, they bore a hole in the ground with a threeinch anger down to the sand or gravel, drive down a hollow iron tube, put on a pump-stock, him to strip back the prepuce every evening and and go to pumping. One half day's work wash thoroughly with warm water and soap, gives a well from twelve to thirty feet in depth. and to cease all internal medication, as well as No dirt or trash can get into such a well. Out dilatation with bougies. on the uplands they use open dug wells about As the patient lived at a distance I told him four feet in diameter, walled with stone-a to come in again in a month. A month later veritable catch all for crickets, toads, snakes, I received a letter from him, stating that he and rabbits. Now, as to the origin of typhoid, had had but one seminal emission since seeing in my medical career, dating from 1874, I me, that he could retain his urine five or six have never seen or treated a case of typhoid in hours during the day, and all of the night. the valley. They have always been on the up- He also stated that the dribbling after urinaland, where open wells are used ; and in every tion had ceased, that he had no trouble in instance where I have prevailed upon them to starting the stream, and that he felt entirely clear out their wells, the debris has been crick
n crick- well. ets, toads, snakes and rabbits, some or all of I send you above for publication in The these. I have come to the conclusion that ty- WORLD, thinking it may interest some of its phoid does not originate spontaneously, but many readers. I would like to hear through that it is the digestion and maceration of septic The World from some of the other members animal matter carried into the digestive tract of the medical profession if they know of any by polluted drinking water, that causes it. I instance where retained smegma has caused also believe that once started in this way, the such a train of symptoms. dejections of a typhoid patient, by being care- Cincinnati, Ohio. R. P. KING, M. D. lessly thrown out on the ground, can be carried to well-water and thus perpetuate the poison. Iniury to Cervical Region of the Spine. Our typhoid fevers occur in dry years, when
-Pulsating Abdominal Tumors.-Quinine wells are low, and the sources of infection con
Pills.-Treating Nasal Catarrh. centrated.
-Formula for Lumbago. Mulvane, Kan. W. K. HARRIS, M, D.
EDITOR MEDICAL WORLD: — About six
months ago I was summoned in haste to the Reflex Genital Irritation.
country to attend a Mr. L., some 68 years of EDITOR MEDIGAL WORLD: - About two age, who, in descending a flight of stairs leadmonths ago I was consulted by Mr. J., aged ing from his barn floor to the fteding room, twenty.one, who had, for the last two years, had suddenly lost his balance and fallen, strikbeen troubled with frequent seminal emissions, ing his head on the floor some 8 or 10 feet two or three per week, also troubled with too below. In falling, about half-way down, his frequent micturition, sometimes every two or head struck the side of a manger and glanced three hours during the day and once at night; therefrom to the floor below, where he was at other times only three or four times during found by his son a few minutes after, crowded the day and not at all during the night. There in between stairs and manger, head flexed on was a dribbling after urination, especially if chest and for the time insensible. He soon he coughed violentiy or bent over suddenly. regained consciousness, however, and was The stream of urine was somewhat twisted and carried to his home, where, on arriving, I the water did not start readily. He has never found him sitting up in a chair, head flexed on had gonorrhea or practiced self abuse. He has chest, totally unable to move it in any direcbeen treated by several different physicians tion or to assume the recumbent position. He but without success.
complained of numbness in the left arm and One physician suspecting stricture, tried side, and of so much pain in the top of his gradual dilatation by means of soft bougies. head that I feared injury to the skull, but, on He claimed that there was an obstruction about examination, I found nothing more than a five inches from the meatus. Upon examination severe bruise of the scalp. I now found, howI found a rather diminutive penis. The prepuce ever, his most serious injury to be in the cervi. adhered to the glands slightly, but I pushed it cal region opposite the third or fourth cervical back without much difficulty, and found the vertebra, where a distinct swelling or prominsulcus completely filled with smegma, which ence appeared, hard and unyielding on preswas with difficulty removed. I told him that sure, and from which the patient complained the filthy condition of the prepuce was probably of sharp shooting pains, radiating to the side the reflex cause of all his trouble ; but to quiet and top of the head. I gave him an anodyne, his fears of stricture I passed a full sized steel ordered him kept quiet and hot application of sound easily into the bladder, showing that leal water applied to the back of the neck and the deep obstruction was spasmodic. I told left.