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Child Crying in Utero.

day to day. Along with the flexion, abduction, Editor MEDICAL WORLD:-I had an experi. Then placing the patient upon his belly, mas

adduction and careful rotation are performed. ence analogous to that of Dr. McLean, page

sage is applied to the affected parts and along 396, MEDICAL WORLD for November.

the thigh as far down as the knee joint, conOn June 30th, 1891, I was called in consultation by Dr. Russell, 'of this city, and found sisting of strong frictions, tapotement, petrisMrs. H., aged 19, in labor at term with her

sage and effleurage. (The French terms for first child. The brow was presenting, and in

these different kinds of massage being still in trying to correct the position through the im

common use and none more appropriate in the perfectly dilated os, we were astounded by the

English language having been proposed, I may

be pardoned for using the n. stifled cry of the baby. After waiting a few

To apply friction, insert the tips of the finmoments, the crying ceased, only to be renewed each time we made an examination,

gers of one hand deeply down into the tissues and when the doctor applied the forceps.

or upon the nerves and perform energetic cir.

cular motion, while the finger tips of the other The grandmother of the child and two

hand apply gentle strokes in an upward direcneighbor women were present and heard the

tion. The aim of these frictions is to break up repeated crying of the child.

and remove pathological products from the F. W. WINGER, M. D.

tissues and to stimulate the nerves. 30 Main St., Bradford, Penna.

Tapotement in sciatica i masle either with

the radial borders of the extended hands, The Massage Treatment of Sciatica.

which are brought down upon the muscles in a EDITOR MEDICAL WORLD:--The numerous kind of forcible percussion, or with the fists, drugs placed in the field against this linger- where a stronger application is desired (gluteal ing disease are a true indication that no spe muscles). The arm is not used in tapotement, cific as yet has been found, to effect a posi. all movement being made from the wrist alone. tive cure. Electricity, both faradization and Petrissage is a manipulation by which the galvanism, have proved to be effi cacious where muscle is seized between the fingers, and firm internal medication failed. (Compare article pressure, rolling and squeezing exerted. This of Dr. Curries, page 305, and Dr. Bennet, squeezing is begun below and slowly advanced page 425 of THE WORLD, 1891.) Another towards the centre of the body. mode of treatment, unfortunately but very Petrissage and tapotement have a powerful little practiced among physicians in this coun- effect upon the circulation and cause a strong try, is the application of massage, which, as general reaction in the parts to which they are extensive hospital experience in Germany has applied. taught me, will prove a reliable agent in most Effleurage is done by moving the palm of cases with or without the aid of electricity. the hand under more or less pressure along the Most certainly diagnosis must be beyond a surface in a centripetal direction. One or both doubt aj to the cause of the neuralgia, to ex- hands may be applied, and while the second clude ovarian cysts, caries and tumors of the hand has nearly finished the movement, the vertebræ, inflammation of the spinal cord and first is brought back near the starting point, its membranes, tumors and abscesses of the thus changing constantly and advancing slowly pelvis, para-and perimetritic exudations, psoas from the extremity of a limb towards the trunk. abscess, pregnancy, etc. Sciatica, however, as Effeurage enforces venous and lymphatic circaused by an inflammatory process of the nerve culation. or its sheath, or by a myositis of the surround- The above treatment is applied once daily, ing muscles,--be the exciting cause syphilis, perhaps with the exception of one day of rest malaria, lead intoxication, cold or ove: exer- (each week), the length of each seance varying tion--is amenable to massage treatment. Sy. from fifteen to thirty minutes (or more) accordphilis and other dyscrasies of course require ing to the reaction in each case. Pain may constitutional along with the mechanical treat- increase at first, but that must not worry us; ment.

the patient will soon experience marked reThe most essential point in the massage lief. It is wise to practice all movements and treatment of ischias seems to be the stretching to apply massage to all those parts that are of the nerve, which is accomplished by plac- especially painful; they are certain to be in ing the patient upon his back and slowly enforc- volved most in the rheumatic process (Schrei ing flexion of the hip joint, the leg meanwhile ber). The patient is advised to exercise his resting upon the masseur's shoulder to lessen limbs as much as possible in the intervals of or prevent flexion of the knee joint. The force massage sittings. The cure may perfect in one of the flexion is to be regulated according to the to two weeks, while cases of long standing repain of the patient, and gradually increased from quire from three to six weeks. If the treatment

is reinforced by electricity, it is advisable to or diminish the total amount of the mixture try faradism first, because it has a quicker given, but he does not, and cannot know how effect, if any, than galvanism. It is best to use much or how little, if any, real medicine such a wire brush electrode at the positive pole and as he desires, is being administered, Even apply it at the most painful points (points dou- the assayed Auid extracts, valuable as they are, loureux) while the other electrode is moved present many difficulties that cannot, in the along the course of the nerve. It is neither very nature of things, be overcome. They useful nor desirable to apply electricity for are liable to change from various causes, such longer than ten to fifteen minutes each time. as evaporation, exposure to sunlight, heat or

F. DETLEFSEN, M. D. cold, a dry or a moist atmosphere, to precipi1027 Lincoln ave., Chicago, Ill.

tation of the active principle, to chemical

changes in the compound (for all such preAccurate Medication.

parations are very complex in composition.)

Some of these changes take place in dry or EDITOR MEDICAL WORLD :-How much or how little of a given medicinal preparation much inert material to be eliminated, and a

solid extracts as well. Then, too, there is shall be administered in order to produce the desired effect? This question confronts the

host of complex bodies which modify to a practitioner every time he writes a prescription greater or less extent, the active principle. or orders a dose of medicine as ordinarily pre

Why not eliminate all these in the laboratory pared.

of the pharmacist or the chemist, and not atMuch has been written and said upon the tempt it in the stomach of the patient? unreliability of the galenical preparations, and

Active principle, or alkaloidal medication, there is a strong demand upon the part of the presents no new system of medicine. The profession for some standard of strength, the practitioner knows, or ought to know, the one most generally favored being that based therapeutic or physiological effect of his remupon the contained alkaloid or other active

edies. Then, with pure isolated drug of principle in the crude drug.

known strength, in soluble, convenient form, In an article published by the writer in The he may intelligently cope with the disease. New England Medical Monthly, for October, From a long experience, both pharmaceutic1891, the question of standardization was fully ally and clinically, I am fully convinced of discussed. I therein showed the extreme un- the superiority of active principle medication reliability of the gale nical preparations of the over that by crude drugs, or unstable galenical U. S. P., and advocated a much greater ad- preparations. vance in this direction than the revisors of the

WM H. WALLING, M. D. U.S. P. had conceded. In quite an extended

2009 Arch street, Philadelphia. correspondence with representative pharmacists, both manufacturing and retail, as well as

[The above impresses us as the best arguwith our leading physicians, the same thought

ment we have yet seen for the use of isolated was expressed by all, almost without exception; active principles in medication—the dosimet. a desire for some accurate method of arriving ric form of medication. With these drugs the at an accurate dosage.

doctor practices his own well-known system of In fact, we must dispense with the crude therapeutics with a new and vastly impruved material in medication, and use only that

materia medica—truly rational therapeutics which is of undisputed value, namely, the

with strictly scientific remedies. active principles, the alkaloids, resinoids, glu- The above article, coming from a man of cosides, etc. The physiological and thera- wide experience and liberal ideas, who spent peutic effects of these substances are known, years in the scientific practice of pharmacy beand if we can have them presented in proper

fore advancing to the study of medicine, is a form, accurate and reliable, it would seem that strong testimonial to the rapidly growing favor there was little left to be desired in that direc- of accurate medication. Now the physician tion.

must be especially careful that he purchases Active principle medication has most de- such drugs only where they are made with accided advantages over any other form of ad- curate scientific skill and scrupulous profesministering drugs. The proper form being sional honesty. The time is rapidly approachpresented, as above referred to, we find that ing when every physician must pay some at. the dosage is accurate aud constant. It is tention to this phase of medical progress.-ED.) known to the prescriber, and he may increase and diminish it at will, and with little trouble, SUBSCRIBE now and get full benefit of interesting still preserving his accuracy.

subjects for discussion now going on and about to le With the ordinary galenicals he may increase started.

Labor Badly Managed by a Midwife.

in these fevers except in tonic doses, though EDITOR MEDICAL WORLD:-I 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, in her first labor, at term, she having aborted

It not my purpose to give details of treat

ment of these cases, but in view of this exonce. She had been in labor four days, at. tended in her sufferings by a female midwife. perience as well as two year's experience since Women of this class are a great detriment to

in a great variety of febrile affections, to take parturient women, their practice being entirely will relate a typical case, which I select because

strong ground in favor of these remedies. I 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

On young in the practice I feared trouble.

Johnnie W., aged eight years, had been ill

Temperature 104, making vaginal examination I found that labor four days when first seen.

face flushed, skin dry, headache, general achhad fully passed the first stage, and that the head of the child was advancing into the vag- somewhat tender, tongue furred and no appe

ing and restlessness, abdomen enlarged and ina. 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 few and feeble pains. She had not been al

the compound cathartic pill in common use,

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. I annointed the vagina well with lard and gave

time I gave two and one-half grains of phenacher every hour twenty drops of fluid extract of etine to be repeated hourly till the temperature ergot and two grains of quinine in a little black found temperature 10142, skin moist, no head

I called in the evening and coffee ; also allowing her to lie on either side, 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 labor pains soon began, and she had speedy when the temperature reached 1024 or at any

thermometer and instructed to give a powder 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 100 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.

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 convalpyretic. 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

the wet pack are four times out of five wholly emeral fever will jugulate itself if you will wait impractic ble. 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 interwally, by mouth or kind. 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 and in Aushing the bowels, with or without

use it ? an antiseptic, as well as its absorption into the

In our opinion the method called dosimetry circulation, are very beneficial. I have no

is not yet completely elabor ited.

It is not, 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. Aplies 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 minuies 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 wercury, 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 "often 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 10372° 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 oth 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 abcut 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

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