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Original Communications.

Short articles on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and Treatment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Depy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest poble words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certain isunderstand them, Generally, also, a downright fact y be told in a plain way; and we want downright facts at present more than anything else.--RUSKIN.

READ. REFLECT. COMPARE. RECORD.

Notes and Comments.

EDITOR MEDICAL WORLD:-In spite of the arguments advanced by Dr. Cook (page 444), it is pretty certain that the Kansas fever is typhoid. In mild cases of typhoid we often have little or no diarrhea, especially if the diet has been well arranged, and no intestinal irritants employed. The same may be said of tympanites and other abdominal symptoms; while typhoid often subsides during the third week. The eruption is sometimes absent, often so scanty that an inspection of the entire surface of the body is necessary to detect it; an inspection not made once in 1000 cases. It is not easy for even a practised diagnostician to determine that the spleen is not enlarged; coma and extreme prostration are only present in bad cases; while as light cases generally recover, it is impossible to say in what condition Peyer's glands may have been; though the presence of blood in the stools is a fair indication of ulceration. But the time has come when such discussions should cease, since the means for settling the question are accessible. A search for the typhoid bacillus with the microscope, and the application of Ehrlich's test to the urine, are within the reach of any physician; and our Kansas brethren ought to avail themselves of these, and decide this interesting question.

Dr. Cushman (page 468) asks rather a difficult question." Have you ever known a diseased liver to produce a diseased condition of the kidneys?" Amyloid disease, syphilis, tuberculosis or cancer, may affect both organs; one not necessarily caused by the other. If the outflow of bile be stopped, and reabsorption occur, with jaundice, the bile is discharged by the kidneys, and this may cause irritation of these organs Alcohol causes hepatic cirrhosis, and desquamative nephritis later; but there is no special reason for believing that

the kidney disease is due to the hepatic. The only case now occurring to me is when cancer attacks the liver primarily, and the kidney secondarily.

In Dr. Cochran's case (page 468) the pus may have been in the frontal sinus, or some other part of the nasal tract. There are scarcely enough data given to show whether this was so, or where the pus collection was located; and trephining could not be performed without previously locating the abscess. I wish to call attention to the insufficiency of the diagnosis of hysteria. It is very nearly a meaningless word. A woman may be notoriously hysterical, but that does not preclude her having any disease of any sort. I cannot count the number of consultations to which I have been called, in which we have discovered plenty of reason for the symptoms. One case of uncontrollable "hysteria" recovered her self-control promptly when I evacuated a pelvic abscess for her. Another hysteric girl, who glared at me from under her bed (hysteromania), returned to her senses next day, when her intestines had been unloaded of a fecal collection of several weeks standing. Another, sadder still, quietly remarked to me: "Doctor, don't pester me with valerian, but persuade my

husband to let me alone for a little while." Is insomnia a disease? No; only a symptom, and not even a symptom demanding treatment. It is a danger signal, an indication for the physiologist rather than the therapeutist. I am unable to give an opinion as to the relative merits of the new hypnotics, because I never have any use for them. My hypodermic pellets of morphine I have not seen for months. Even in delirium tremens, what hypnotic can compare with capsicum and coca?

For enuresis (page 468) try salol, gr. v, at bedtime.

Nothing can be done in the way of removing the fluid of a hydrocele, except by the trocar. For injection after removal, most surgeons employ tincture of iodine. Levis advised carbolic acid.

For corns, the best remedy is the salicylic acid and cannabis plaster.

For N. H.'s psoriasis (page 468) I would use an ointment of chrysophanic acid, resorcin, aristol or oil of cade, or all in succession; applying lanoline with oil of roses to the skin after the disease has disappeared.

Well, our old friend La Grippe has reappeared in a new guise. It struck my province (beginning with myself) the latter part of November. Until to-day (December 15) it has been exclusively among the better classes of my patients; my first case among the handworkers occurring to-day. There has been little tendency to pneumonia, but head ache,

bone ache, sore throat, bronchitis, with deep cough and scanty sputa, a full, soft, compressible pulse, and moderate fever. The pulse yields at once to small doses of cardiac depressants, and reacts quickly and too strongly to stimulation. Quinine has proved valuable to a degree that has surprised me, in view of its small value two years ago. Sudden onsets have been the rule. One gentleman was talking with a friend, when he suddenly became speechless. When I saw him a few hours later, the pharyngeal mucosa looked as if it had been reduced to pulp by some powerful corrosive. Local stimulation was employed, and sloughing did not ensue. It was three days before the man could speak, or swallow without difficulty. During the last few days intestinal troubles have become manifest. While there has been some debility present in those suffering with other affections, as well as those down with influenza, this has not been very marked. This is only my individual experience. The reports of the Health Office show that the mortality in Philadelphia has increased in one week from 410 to 508, and that pneumonia caused 79 deaths last week. Thus far I can only say: Beware of over-dosing and of cardiac depressants; give quinine freely; watch the pulse carefully; do not over-do the feeding; be sparing of stimulants; drop the "antis" for the present, and use liniments for the cough. Dr. John J. Taylor speaks so highly of ammonia that I shall give it more frequently. Profuse and exhausting, but salutary, sweating followed the use of small doses of Dover's, and, for some unknown reason, the febricide pills. Finally, I cannot

recollect a time when the good influence of a cheery face and a hearty, sympathetic voice appeared to do so much good.

WILLIAM F. WAUGH, M. D.

1725 Arch St., Phila.

Quadrupulets.

EDITOR MEDICAL WORLD:—On the night of November 11th, I was called to visit Mrs. Edgar George, living three miles south west of this place, in her fifth confinement. On arriving, at about 9.30, I was informed by Dr. O. C. Irvin, of El Paso, Texas, who was visiting the family, and who is a brother-in-law of Mrs. George, that the labor was over and that FOUR LIVING GIRL BABIES were born, remarking also that he didn't think he let any get away. attention to the mother and four little strangers. They were all perfectly well-formed, though small, not averaging over three pound each. One of them, however, only lived about five hours. The remaining three and mother at pres

For a time we had business giving

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An Anomalous Fever.

(Continued from December.)

EDITOR MEDICAL WORLD:-Referring the readers to December WORLD for a typical case, I will refer here to a few of the many variations. A certain percentage of cases run the entire course without any other marked symp. toms of disease than a fever. They eat well, sleep well, and do not complain of anything but weakness. Another class of cases have a persistent diarrhea from first to last. Others are constipated throughout. In some the diarrhea begins after the fever has left.

The alvine discharges in some cases are thin and watery; in others they consist of mucus and blood. Sometimes there is tenderness in the region of the ileo-cecal valve, sometimes not. The onset of the disease is sometimes abrupt, but generally slow. I have seen cases begin as an intermittent and repeat the chill and fever as many as four times in successive days, presenting all the symptoms of an ordin ary ague, and have given quinine, but the fever continued. The duration is as uncertain as the mode of beginning. Some cases run seven, some fourteen, some twenty-one days, and perhaps longer, but I think there is usually some complication in cases lasting more than twentyone days. Relapse is not uncommon and usually lasts as long and presents the same symptoms as the first attack. I saw one patient relapse the second time, and with the same course of fever each time. I believe cases that are reported to last six weeks or longer are simply relapses. Typhoid fever has been known to behave in like manner.

The termination is usually by lysis, but not always. I have seen an intermittent follow as well as precede the continued fever. In fact the disease at times presents such a variety of symptoms and conditions as to almost lose its identity. For a time, after my introduc tion to the malady, I was by no means certain whether I had to deal with one or several dis

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or very young. My youngest patient was three and my oldest fifty-five years old.

Sex. It attacks either sex equally, but is more fatal to girls from sixteen to twenty years

of age.

Physical condition -It seems to specially attack persons of previous good health. All my fatal cases were of this class. Young, strong, robust, the very picture of health, yet they fall soonest. Pregnancy offers no obstacle to the disease, as I have seen often. I treated one case where the woman was confined during the progress of the disease; but the puerperal condition did not seem to affect the course of

the disease in any way, The patient made a good recovery in the usual time. The babe did not contract the disease. I have never noticed any tendency to abortion from the

disease.

Climatic conditions. --The only particular point that I have noticed is, that the disease is much more prevalent and also severer in very hot, dry years. In 1879, at Ellinwood, Kansas, the disease was extremely fatal, some cases proving fatal in the first week. In 1887 a very extensive epidemic prevailed in western Kan. sas. In both these years the vegetation was killed in July by the hot winds, and the weather was extremely hot and dry until late in the fall. Neither moisture nor drouth seems to have any effect except when accompanied by heat. But the disease is by no means always epidemic. I have frequently seen isolated cases, as well as epidemics confined to certain small neighborhoods or villages.

Season. The disease almost always occurs in the last six months of the year, and it seems fair to presume that the conditions prevailing during that part of the season have some influence in its production, although we see the disease under widely different climatic condi

tions.

Sanitary conditions.-The disease has decreased in frequency and severity in exact ratio to the improved sanitary conditions. In the newer parts of the State, where people live in sod houses, small and badly ventilated, the disease is much oftener seen than in the older parts, where the people are better housed. For the benefit of those living in the East that are not acquainted with the sod house, I will describe one. It is built of sod cut into squares of convenient size, and about two inches thick, and laid up into walls from two to three feet thick and five to six feet high, and is covered by the same material supported on posts or poles, or sometimes boards or brush. The whole structure is composed of vegetable matter and dirt, and usually rots down in a few years. The inhabitants thus live in an atmosphere laden with the products of vegetable de

composition, besides the ill effects of bad ventilation. I have seen large families live in a house of this kind that only contained two small rooms. I am sure the disease has decreased in frequency seventy-five per cent since the sod house has disappeared.

Whether the disease is malarial or typhoid, or a mixture of both, or whether it is caused by a poison different from either, I can not say. I will say, however, that the most common manifestation of malarial poisoning, ague, is not seen here at all. I have never seen, either, a well marked case of remittent fever. If it is typhoid it must arise in many cases denovo, for I have seen many cases, isolated, far from public thoroughfares and miles from any other cases, where there is not the slightest suspicion of a contagious origin.

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EDITOR MEDICAL WORLD:--Je sie W. H., a full-blood Sioux female, aged 17, presented herself at the dispensary July 29, 1891, with a swelling on the right side of her neck muscle and about midway of its length. It was immediately over the sterno-cleido-mastoid about as large as a lemon, and on palpation revealed fluid contents. I diagnosed cold abscess of tuberculous origin, and made a small puncture with a bistoury. On the escape of the pus the tumor had completely disappeared, leaving at its site only a bunch of shriveled integument. I then washed out the

sac with a solution of chlorinated soda and

carbolic acid, and applied a compress, sustained by a roller bandage about the neck.

This was repeated three times a day for a week, when it was observed that the sac had closed entirely, and the wound of puncture healed. There has been no return of the abscess. Now had she not applied for treatment, but allowed the abscess to take its own course, it would have have finally opened itself, and degenerated into a large ulcer, which would have lasted her for years, prob· ably, and by constitutional infection possibly destroyed her. These cold abscesses are very common among the Sioux, and this seems to be the best treatment of them.

2. T. DANIEL, M. D. Cheyenne River, U. S. Indian Agency, South Dak.

THE Physician should be a good business man. Get our new book and resolve to be guided by its rules and suggestions during the coming year.

A Case of the Keeley Treatment. EDITOR MEDICAL WORLD:-I have a case which I think will interest the many readers of THE MEDICAL WORID, both on account of its rarity and as relating to the latest craze-the Keeley morphine treatment.

Miss G., aged 30, a morphine habitue, began the home treatment by Leslie E. Keeley, with the "bichloride of gold," about two months ago. She was using about to grains of morphine a day at the time. From the first of the treatment she began to complain of her failing health and came to me for remedies, which I refused to give while she was taking the treatment. She took two bottles, about 20 ounces, of the remedy in the time, losing about 20 pounds in weight. During the last two weeks she was taking the remedy I was away from home. On the evening of my return, Nov. 20th, I was again called to see her. I found her very weak-much emaciated and her skin a perfect yellow. The conjunctive were very yellow-so much so that I could plainly notice it 20 feet away. She was much constipated and was passing immense quantities of urine, perfectly black and very bad smelling, but which caused no pain on passing. She had no appetite and was generally in a very weak and bad condition. I at once credited the condition to the "bichloride of gold" and at once vetoed that remedy. The patient was put on the following prescription:

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I also gave tablespoonful doses of syr trifolium comp., three times a day and wine glass doses of infusion of buchu twice a day.

At this date (Dec. 3rd) the patient is doing finely, the jaundice has almost entirely disappeared, the urine is clear and natural and the patient is on the high road to recovery, but is still using the morphine in slightly reduced doses. I am satisfied that two weeks treatment more of the Keeley business would have called for an undertaker. THE WORLD is the best medical journal in the universe.

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EDITOR MEDICAL WORLD:-The effects of coffee or the influence of coffee on the growth of organism in the human system is very great.

Prof. Carl Luderitz made a careful series of

This

experiments in which he determined the influ ence of coffee infusions of different strength, (varying from 10 to 20 per cent) upon the growth of various forms of pathogenic and non-pathogenic micro-organisms. The coffee was freshly roasted and ground, this was covered with boiling water, the infusion thus prepared was placed in a closed flask in a water bath for about ten minutes, it was then filtered. infusion was used in part for making gelatine, and in part directly. He found that the destructive power of coffee upon various microbes was very great. He found that the organisms all died in a longer or shorter period. In one series of experiment anthrax bacilli were destroyed in three hours, cholera bacilli in four hours, erysipelas streptococci in one day. &c.. &c. The antiseptic effects of coffee do not depend on the caffeine, as some suppose, but on the empyreumatic oils developed by roasting. Prof. Luderitz's observations have been con firmed by Profs. Wees, Oppler, Rabateau and others. Hence these observations may be considered reliable. If infusions of coffee have such marked deleterious action upon pathogenic organisms, and especially upon some forms which are the cause of epidemic types of diseases, it is certainly a valuable agent for the restriction of these, and may be used as a drink instead of water, when there is any sus picion as to the contamination of water; especially is this true in cases of epidemics of typhoid fever, cholera, erysipelas, scarlet fever, and the various types of malarial fevers, which are transmitted almost entirely through the medium of food and drink. Numerous exper iments have also been made with infusions of coffee upon living animals, such as dogs, &c., in order to ascertain the effects of coffee on the organs of digestion, circulation, respiration, &c. These experiments demonstrated that coffee was a very valuable agent in assisting the digestion of food; it quickened the digestion and in a way increased the demand for

food.

This should be well born in mind by those who live in a hot and malarial climate. The experiments also demonstrated that coffee aided the blood to take up more nourishment than it would without it. It also quickened the circulation of the blood and of respiration, and a rise in the temperature of the body was perceptible.

Apart from the above experiments, it is well to mention that coffee is also stimulating and refreshing, and that this quality is due to the caffeine it contains. Coffee contains also besides caffeine, sugar, fat, acids, casein, &c. It is also a neutral stimulant of the highest order. But if carried to excess it will produce wakeful. ness, debility, irregular pulse, injury to the heart and spinal functions, &c. But coffee is a sovereign remedy in tiding over nervousness in emergencies. In order to derive the good effects from infusions of coffee, it is of the utmost importance to know how to prepare a good infusion. The first step towards it, is the roasting of the coffee bean. This should be done at home within twenty four hours of being used. The roasting is a too delicate an operation to be left to the grocer or merchant, who invariably subjects it to a too severe fire. They burn it either dark brown or black, charring it to the core, and thereby deprive it of its aroma, and render it intensely bitter. The coffee bean, in its natural state is sweet and contains, as above stated, sugar, &c. tain this quality it should only be roasted to

To re

an amber brown. Coffee infusion made from beans thus roasted possesses an exquisite flavor and should be drank without sugar and cream. The following is a good way to prepare a good fresh cup of coffee:

Take two or three ounces of fine ground coffee, pour upon this one pint of boiling water. This makes a first class beverage or drink. To avoid bitterness, don't boil the coffee. The following is also a good way. Put two or three ounces of fine ground coffee in a granitized kettle and pour a pint of cold water on it and let rest over night. Heat it next morning to just the boiling point, set it back to prevent further ebulition. The strength is extracted, its aroma is preserved.

Whoever drinks this coffee during the day, will render his system proof in a great measure against typhoid fever, cholera, erysipelas, malarial and other fevers.

A cup of hot coffee should be drunk before venturing into the morning air. Fine ground coffee burnt on hot coals will disinfect the sick room. Coffee infusion is also a healthful substitute for tooth powders, and a most excellent mouth and tooth wash. The mouth and teeth should be rinsed with it after each meal. Its

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Fatal Pulmonary Emboli.

EDITOR MEDICAL WORLD:-Mrs. R. expected to be confined about November 1st. She was the mother of two children. Both confinements had been normal and easy. Youngest child one year old, girl; oldest three years, boy. October 2nd I was called to attend the boy in what proved to be a severe case of typhoid fever. His life lay as in a balance for nearly two weeks. His mother was his constant watcher and the mental strain told severely on her. October 29 I made my last visit to the boy, he being convalescent.

November 6th I was called to see the mother and found her with a temperature of 103°. I diagnosed the case as one of typhoid fever. The temperature stood 102° morning; 103° evening from that time on. November 10th, about 6 a. m., labor began. I found her temperature 102°; pain, slight; vertex presentation; os soft and dilating. About noon the membranes ruptured. Expulsive pains came The head de

on at once and continued. scended, entered the pelvis and the occiput presented at the vulva, slightly distending the perineum, when suddenly she turned purple in the face and was in a state of collapse. I instantly applied the forceps, which were in readiness, and quickly and easily delivered her of a still born child. I gave the lady several hypodermic injections of whiskey and by shaking and dashing cold water in her face, general friction and other approprlate measures we established respiration again. I then gave a hypodermic of strychnine sulph. 1-25 gr., morphine 4 gr., atropine sulph. 1.75 gr. She improved shortly and swallowed at intervals whiskey and strong coffee, taking in all about four ounces of whiskey and one cup of coffee. The radial pulse could not be felt for a time, but gradually returned; it was small, threadlike, very rapid and difficult to count. Respira tion was also rapid and difficult and her lips still remained purple. still remained purple. The placenta was expelled, the patient losing scarcely any blood,and the uterus could be felt firmly contracted. about thirty minutes from the first attack she had another exactly like the first, which refused to yield to the same methods and in a few minutes she had a tonic spasm with slight opisthotonos and died.

In

She had no symptoms at any time of kidney trouble. There was no rupture of the uterus; neither did she take any ergot.

I would invite comment on this case from the brethren of THE WOrld. W. B.

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