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On returning next day I found him where I I use a steam atomizer ten minutes night and left him and in much the same condition, ex- morning with the following: cept that the numbness had disappeared, but
R. Acidi carbolici crystal ........grains xv the pains were still severe and aggravated on
................ grains xxiv slighest movement of head or attempt to move Pot.. iodidi,,
............. grains lxxx the jaws. His temperature was 99.50. The Glycerini.
••••••.ounce vị swelling on the back of the neck had subsided Aquæ destil. .....9. s. ad.....ounce xvi a little, but I now saw that the injury was of a At the same time internally : very serious nature and did not give a very
R. Pot. iodidi... ..........drachm ij flattering prognosis of the case to the family.
Liq. pot, ars................. drachm j But now some six months have elapsed and
Syr. sarsaparillæ comp..........ounce iv the old gentleman is still living under sympto M. Sig.–Teaspoonful in water after meals, matic treatment and the important element, Or in mild and receni cases : time. He has regained to some extent the use
R. Menthol..................grains X-XX of his head and jaws, can be in bed with his
....ounce j head well raised on pillows, can move his head Spray in atomizer three times daily. to a fair degree back and forth and rotate it The use of the steamer should be continued somewhat. His appetite and general health from one to four months, according to the are fairly good, but the prominence on the severity of the case, and gives best results in back of the neck still remains clear and dis- summer seasons, on account of freedom from tinct, and will remain, for it is a long one and, fresh chills. in my opinion, is caused by a dislocation for- Try it and keep your patients from falling wards of perhaps the third cervicial vertebra. into the hands of the quack. What say you, brother M. D's?
To the doctor who had trouble in comI was somewhat surprised at the number of pounding his lumbago liniment, if he will cures of abdominal aneurism lately appearing, have the druggist put it up in the following and what I would say in regard to the same
order: Tincture of iodine, ammonia water, has been said by Dr. Waugh. I had a case
collodion; it will not solidify afterwards, some time ago in a woman of thirty of a pulsa though it will become colorless in a few hours. ting tumor about two inches above and to the which does not affect its virtue. Success to left of the umbilicus, with pulsations synchron
THE WORLD, with its regular monthly clinic. ous with the heart beat, shortness of breath
Prospect, Pa. J. B. THOMPSON, M. D. and other aneurismal symptoms that disappeared very promptly under treatment for in
Ulcer on the Leg. digestion. Since then patients troubled this way have complained to me frequently of what
EDITOR MEDICAL WORLD:--In December they call a beating in the stomach. But don't World, page 468, N. H. desires a “ first-class be alarmed; cases of abdominal aneurism must
treatment” for a sore leg. of necessity be a rather rare occurrence, and
I will simply say that I once had a sore leg in diagnosis here it is well often to apply a line
on a man sixty five or seventy-five years of age. of Longfellow that “Things are not what they
My treatment was as follows:
I ordered six leeches every other day to the seem.”
How many of the brethren give quinine in affected part, and in the mean time, cleansed sugar coated pills, so convenient, you know,
the parts well with castile soap and warm water. or gelatine capsules? I have done it, but don't I gave as an alterative, podophylin, sufficient do it now in fevers. True, a gelatine capsule to insure a free discharge from the bowels each will dissolve very readily in the mouth or in
day; also iodide of potassium, five grains three the secretion of a stomach free from fever; but
times a day; and in three months the sore
healed and troubled no more. solvent power of the stomach is not equal to
Freedom, N. H. A. W. Hobbs, M. D. the task, and three times out of five you will find them in the stoois as they were taken. If
Labor Complicated with Hydrocephalus. you don't believe it try yourself and see.
EDITOR MEDICAL WORLD:-In the DecemHow many of the brethren are satisfied with ber number I see a communication from Dr. J. their results in the treatment of chronic nasal G. Knox, (page 463) which calls to mind two catarrh? Few, no doubt. But I think that cases of hydrocephalus of the fetus which octhe greater part of cases under forty years of curred in my practice some time ago. In the age ought to be cured and that without de- first, a woman of some forty two or forty-three stroying a good stomach while doing it. True, years of age, who had given birth to eleven it takes perseverance on the part of the patient, children, all of them fully developed and but if he don't follow it up, don't take his case. sound, called me to attend her in the early
morning. I found the breech presenting and large compresses, pressure with the fingers, &c., I proceeded to deliver. All went well until &c. Sometimes thinking I had the bleeding the body was out. Then I labored. Finding stopped, but never getting it entirely controlled. a head enormously large, I sent for assistance, After some hours I sent for a neighboring but none being at hand before evening I gave physician, who gathered up the abdominal skin ether and, wrapping a cloth about the feet of surrounding the navel and put a ligature around the child, requested one of the women to pull it. This apparently stopped the hemorrhage while I was trying to find the most available and satisfied the parents, making them think point for a puncture, as I had decided to use that I was very stupid for not doing so sooner. my pocket knife and empty the encephelon, The child died about two hours later. then apply the forceps (I did not then recog. I wish some one would say in THE MEDICAL nize the exact condition of the fetus) and WORLD just what should be done in such a case. compress the heart and deliver. I had told · Carnot, Pa. Wm. H. McGEEHON, M.D. the woman to pull, and she did pull and, as I found a weak spot in the scalp, to my surprise
Hemorrhage from the Cord.—Hematuria. and delight there was a great gush of water and the child was born, my assistant taking an
EDITOR MEDICAL WORLD:- Let me ask involuntary movement backward against the
“Doctor" (page 422) if he is sure of the wall of the room.
source of the hemorrhage in his case? In the The mother, after suffering from a little sep
evening of January 26th, I was sumnioned tic trouble, made a good recovery and, after
across the street, in haste, to attend Mrs. C., about two years, I attended her in another con
who was delivered, within thirty minutes, of a finement, when she was delivered of a good,
nine-pound boy. The loss of blood during the
third stage was so great that symptoms of colsound boy baby. The next one was the mother of two fine
lapse followed, from which she recovered healthy children. When I was called to attend
slowly by usual treatment and constant care her I found a breech presentation. As she
during the night. My attention was called the seemed in good condition and, not finding any
next morning to a severe hemorrhage from the reason for the delay of affairs, I suspected hy
cord. Upon examination I found the child's drocephalus and, as soon as possible after body
bandage, dressing of the cord, and the upper was born, ruptured the coverings of the head,
part of the diaper wet through with bright blood. which, fortunately, were very thin. The
Knowing that, on account of the condition of woman got up well and in due time I attended
the mother, I had tied the cord in haste, and her again, when she was delivered of a fully
thought that the knot had slipped, I tied it developed healthy child. Two cases, both
again. After securing the cord the hemormothers healthy, both breech presentation, both
rhage continued wifh increasing amount, when had previously and have subsequently had
I made a close examination of the cord, penis
and anus, and was still at a loss to know its healthy children. I have classed them in the
source. At first the color of the stain was same category as dropsy of the funis and spine, but the cause of the dropsy I can not give any
bright, but as the case continued the amount more than can Dr. Knox.
of urine became excessive, and the color less Pascoag, R. I. H. J. BRUCE, M. D.
bright. January 31 the child was too weak to nurse; had emaciated very much, pulse 39
and feeble, extremities cold. I had given Umbilical Hemorrhage.
large doses of ergotine, tincture of the chloride EDITOR MEDICAL WORLD:--Articles in Dec. of iron and tincture of opium without benefit. WORLD prompt me to write the following: The last hemorrhage had gone through its
On March 18th, 1887, I attended Mrs. S., diaper, clothing and thirteen thicknesses of a in her sixth confinement, which was quite an folded sheet. I then gave three drops of oil ordinary one. The child was a vigorous boy, of erigeron every three hours. Marked imweighing 8 or 9 pounds. There was no hemor- provement followed during the night, with rhage from the cord at any time, and before I very little stain to the urine the next day, and discontinued my visits, I was informed that much less in quantity. February ist I col. the cord had come off, and it was all right. lected a few drops of urine by placing a small On March 30th, just twelve days after the vial over the penis and doing it up in the woma!'s confinement, a messenger came for diaper. Examination showed it to be nearly me, saying the child was bleeding. I went out limpid and acid; by microscope numerous in haste and found profuse hemorrhage from blood corpuscles and a variety of epithelium the umbilicus. Saturating a bunch of cotton and some water. In a few days the oil was in Monsel's solution, I pressed it down on the discontinued, when the amount of urine insource of the hemorrhage. Afterwards I tried creased to normal. A rapid improvement fol.
lowed and the baby was entered at the fair for around my hands, that I may have an un•
doubted purchase. I want my hands and directed upwards, and the urine and hemor- ligature dry that there be no slipping. In case rhage had reached the dressings of the cord,
the ligature is not the best, and well tied, two so no one could tell its source.
ligatures are safer than one. Edinboro, Pa. F. G. GREENFIELD, M.D.
I prefer absorbent cotton for dressing the cord, as it hastens dessication by absorption,
and prevents the introduction of bacteria, and Umbilical Hemorrhage.
thereby serves to avert certain diseases of the Editor MEDICAL WORLD:-I have had three umbilicus. cases of hemorrhage from the cord, after ligat- As to the time of ligating after delivery, ing in the usual way. One proved fatal, the some recommend to wait till pulsation ceases other two recovered. These cases led me to in the cord, that the child may receive an a study of its causes, and a series of experi- abundant supply of blood. I believe this ments to determine a safe method of ligating recommendation to be based on a false hypothand dressing the cord to preyent the possibil esis, and to be misleading. This brings up ity of leakage.
another point in the “Doctor's” case. He An established rule of surgery is, that in states that “The placenta was pumping blood ligating an a:tery, the ligature should be drawn into the child's circulation for some time.” sufficiently tight to divide the internal and mid. Let us see-during the last throes of labor, dle coats of the vessel, leaving only the tough, when the child is being expelled from the womb elastic outer coat in its grasp. There is then and through the pelvis, the anatomical relation imme-liate retraction, and contraction of the between the uterus and placenta is broken up internal tunics, w'ich favors the formation by forcible contractions. Immediately after of a clot. In ligating veins, the walls or coats delivery of the child, the placenta will be are not divided, but corrugated. The umbili. found resting over the os, protruding, or cal cord consists of two small arteries and one wholly expelled into the vagina-except in large vein, imbedded in a dense elastic gela. cases of morbid adhesion. tinous substance, surrounded by a tough mem- If this beso, there can be no further relation branous sheath-a reflection of the amnion between the circulation of the mother and and chorion. Tying all these tissues is a some child. The pumping process goes the other what different operation from tying a single, way. To convince yourself of this fact, cut isolated vessel, and requires a greater degree the cord while it is yet pulsating and observe of force to divide the internal coats of the the venous blood flow in jets from the umbilarteries.
ical arteries at each pulsation of the fetal heart. I am satisfied that the cause of hemorrhage Notice the placental end of the cord, and see in "Doctor's" case, (page 422, Nov. WORLD) the blood flow without pressure till the small was not contraction of the cord where ligated, quantity contained in the blood vessels is as he reported, but that the ligature was not drained away. sufficiently strong and tightly drawn to divide The child should evidently receive our atthe internal tunics of the arteries, leaving tention till breathing is well established. First, them patulous in the presence of all these it should be placed on its right side for obvious tissues. This I judge to be the cause of hem- reasons, have its whole body exposed to the air, orrhage in two of my cases. In the other case mouth and nose well cleaned and free from the hemorrhage occurred after separation of obstructions, when a momeni's attention should the cord, and was due to antecedent blood be given to the mother, to ascertain the possichanges, evidenced by the development of bilities of hemorrhage, twins, &c., and if purpura hemorrhagica.
nothing contravenes we may safely proceed to Authors classify hemorrhage occurring under tie the cord without regard to pulsation. the above conditions as being due to careless As to what the result might be if the cord ligation, but fail to point out the peculiar en be not tied at all, those who practice that vironments of the vessels to be ligated, and the method can best answer. I am satisfied that necessity of an extra strong ligature tightly hemorrhage will not occur in the majority of drawn, From the moment the cord is cut till cases; but to appreciate the possibility of its complete dessication there is loss of substance occasional occurrence, and the necessity of a by exosmosis, which favors loosening of the safeguard in all cases, is but to refer to its ligature; hence the importance that it should primal causes, viz.: the hemorrhagic diathesis, include only the denser tissues of the cord and enlargement and imperfect closure of the accesblood vessels in its grasp.
sory blood vessels, inhibition of the function I now use a linen cord the size of ordinary of that part of the nervous system that influwraping twine. I want it long enough to wrap ences collapse and maintains closure of the placento-setal vessels after birth, and certain “How long after birth do you tie the cord ?" morbid blood states.
-I wait till the “child squalls'' usually, but if That hemorrhage does occasionally occur it is slow about it, I shake it about, turn it from under the above conditions, all authors, and I side to side, clear its mouth, get it to breathing presume most of the World readers will agree; well, then placing the hand in the uterus, I therefore we should ligate in the most careful notice if the placenta is detached and tie immanner in all cases, since there is no physical mediately; usually the time occupied is one sign or condition by which we may safely minute. judge of the possibility or probability of its "The result if the cord were not tied ?" occurrence in a given case.
- I was called to see a case where the child Crittenden, Ind. L. A. SIMMONS, M.D. was born three hours before I arrived (and an
other of the same kind two hours). I found Dressing the Cord.
the child, cord and placenta wrapped up Editor MedicaL WORLD:-On page 422,
together at the foot of the bed. Curious to the question is asked by “Doctor" "How
note what was the effect of the long waiting, other doctors tie the cord ?" Whether "ex
I cut the cord four inches from the navel-no ceptionally good” or not this is my method.
blood flowed. I use shoemaker's ball flax (flax shoe thread)
In another case, when the cord was only take one strand three yards long, fold it three
about seven inches long, the negro midwise times, making a triple strand one yard long,
broke it off about one-and-a half inches from wax it heavily with yellow bees wax (not par- the child's body--only a few drops oozed from affine) cut it into three p eces each a foot long, it and when I got there two hours after, I did tie a knot in each end (after the manner of a
not, after examining it, tie it. At the same woman's knot in her sewing thread). This
time I have seen free bleeding from cord that knot, being large, gives a better chance to find
had been apparently securely tied (and had to the end. I do not twist it, but wax it flat. I
be re-tied) two or three hours after the child usually make a dozen or more, twist each one
was dressed and put away to sleep. lightly, fold it, twist again and let it roll to- * gether in a loose roll three inches long, fold a
Another case, a woman 30 years old, while
in labor with her second child, got up to cham. piece of stiff paper lay them together and put
ber, and while straightening up to get back to them into the cover of my pocket surgical bed, the child slipped oui, cord broke four case.
inches from navel; only a very few drops of blood "How to tie?'' _Take one end by the knot
came from the broken end of the cord, then pass it around the cord, slip it to within an
stopped entirely. inch or so of the navel, make one tie, pass the
I am of the opinion in such cases, that, the knot around the thread so as to make a "sailor's blood vessels
blood vessels are stretched, break and are redraw-knot” that wont slip-slip the fingers tracted into the sheath, which collapses and along the thread, catch the other knot, pass it
thereby closes them.
Cutting leaves them around the cord and tie about 34 of an inch
patulous, and they bleed from necessity. from the other lie and cut between the two
N. L. Backwoods. then cut all four ends off so as to leave all half an inch long. I have never had a ligature to slip off the
Dressing the Cord. cord. I have seen woollen yarn, common cot. Editor Medical WORLD:-Since the subton ball twine, sewing thread--and the fibre ject of management of the cord is open for of manilla rope wet-used for the same by the discussion, I will give my method, trusting negro midwives in this section, but they sel- that it may prove as satisfactory to other memdom wax them.
bers of The World's family as it has to the In fact, so careless (and successful) are they author. After having thoroughly considered in many things, which we consider "essential causes of hemorrhage from the cord, I have to safety,” that I have become skeptical in a been led to the following conclusions: ist. great many other matters. Many of the ultra A great thickness of the gelatinous substance, "antiseptic treatment" members of the profes- which shrinks awhile after the cord is divided, sion would go into spasms if they were com- loosening the ligature. 2nd. The obstetrist's pelled to practice one year among the negro fingers being lubricated by the vernix caseosa population of our plantations. Dozens of severe or secretions from the vagina, the first knot is cases of ovarian, fallopian, uterine and vaginal but partially drawn, or slips before the second inflammation get well and able to do field can be secured, leaving the vessel but poorly work where the knife or ovariotomy is never compressed, when a very slight shrinkage of the thought of by the “North Louisiana Back- cord is followed by hemorrhage. woods Doctor."
Now, to obviate the first cause I am careful to ligate at a point within two inches of the After taking for a few days, if the physioabdomen, where the gelatinous substance is logical effect of the drug is not manifest, I least predominant; and to combat the second usually increase cne drop each day until dryI use well waxed ligatures, drying the hands ness of the throat with dilatation of pupil is well before tying the knot. Since resorting observed, after which the dose is decreased to to these precautionary measures I have had no the amount commenced with. I have relieved bleeding cords. I tie the cord from three to quite a number of cases with this prescription five minutes after the birth of the child.
the past four or five years. I find that some Hunter's Lodge, Va. E. M. SNEED, M. D. cases yield very promptly, while with others it
is necessary to continue with the medicine for Treatment of Enuresis, Hydrocele and Corns. one or two months. -Cerebral Abscess.
E. A. FARQUHAR, Jr. EDITOR MEDICAL WORLD: - Dr. J R. 117 Putnam Ave., Zanesville, Ohio. Thompson, in Dec. number, asks as follows: ist. Treatment for enuresis in boy of 5 years.
Enuresis-Hydrocele-Corns. 2d. Treatment for hydrocele.
Editor MEDICAL WORLD:-In reply to Dr. 3d. How to remove corns.
J. R. Thompson, page 468, Dec. World, for Let me suggest the following, since they enuresis, I would advise him to give the patient have given satisfaction to me in a number of the following: instances:
B Tincture belladonna............ dram j ist. Exclude adherent prepuce or phymosis.
Fluid extract of rhus aromatica....ounce Then give fluid extract of ergot, or what is
Glycerin...... ...........ounce ij better, the normal liquid ergot of P. D. & Co.,
Water q. s. ad................ounce iv in twenty-five drop doses, combined with one
M. Sig.-One. half to one teaspoonsul ihree times third part of tincture of belladonna, to be
a day; last do:e at bedtime. taken four times a day, the last dose at bed Test the urine, whether acid or alkaline, and time, after having the bladder emptied. act as you think best in regard to the condi
2d. Don't bother with absorption in hydro. tion. cele. Evacuate the fluid and inject five min- The best treatment for hydrocele is to drain ims of carbolic acid with one drachm of pure t. e fluid and inject carbolic acid full strength. tincture of iodine. In the majority of cases It will cause but little pain and, if the first with me this has proven successful. But when
this has proven successful. But when treatment does not cure, repeat. after two or three trials it fails, do Valkman's For the corns use the following, which is radical operation at once.
the best thing I have ever tried. 3d. For corns, remove the cause. Don't
☆ Fluid extract of Cannabis Ind. ... dramj wear shoes or boots that are too small or too
Morphine sulph.............. grains xx large and corns will not appear. However,
Salicy'ic acid................ grains xv when present, touch the center of the corn
Collodion q. s, ad............ounce ss
Mix thoroughly. Sig.-Pare the corn closely and with a stick dipped in fuming nitric acid ;
apply till a film forms, once or twice a day and the corn repeat in two days and shortly the hardened parts can be removed. Then advise well ad Irving, Ills.
M. MCMAHON, M.D. justed shoes In Dr. S. N. Cochran's case (page 468) an
Enuresis-Hydrocele, Corns. operation would no doubt have been justifiable REPLY TO DR. J. R. THOMPSON'S QUERIES. if there were any symptoms of an abscess in
Editor MEDICAL WORLD:- For enuresis: the early part of the sickness. While the
Fluid extract of rhus aromatica m. v, three patient had strength to bear it, trephining with drainage would have given some hope for
times a day. Avoid "sweets;" no fluids for success.
supper, and empty bladder before retiring. 0. W. BRAYMER, A, M., M. D.
This remedy rarely fails, but I sometimes have Camden, N. J.
to use some other remedy. In weak, anemic
children, syr. iod. iron cures more surely. For Enuresis.
Where I find excessive acidity of urine I give EDITOR MEDICAL WORLD:-If J. R. Thomp
alkalies to render the urine neutral, and give
tincture of belladonna or atropine in solution. son will use the following for his case of enuresis (page 468), and will persevere with it, I
I always examine every case before treating, if think he will relieve the patient :
convenient. Sometimes the trouble is caused
from irritation produced by ascarides; and ocR. Atropinæ sulph.................. grain ;
casionally from some irritation in genital orAquæ dest.....................Ounce j M. Sig.–Give one drop for each year of age of the gans; as adherent prepuse, &c. patient at 4 and at 7 o'clock each evening.
Hydrocele :--When in children, you can in