Page images


the sulpho-carbolates is due to their action on Original Communications.

pyogenic bacteria, as well as upon the typhoid Short articles on the treatment of diseases and experience

bacilli which remain in the bowels. with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treatment.

Try this theory on in your practice, and see Articles accepted must be contributed to this journal only. if you do not find it explain the why and The editors are not responsible for views expressed by con

wherefore of every step in this disease. For YUnused Manuscript cannot be returned.

instance, how else can we explain the so-called Certainly it is ercellent disciptine for an author to feel that

relapses when the fever returns; the patient is he must say all he has to say in the fewest possible words, or his reader 18 sure to skip them: and in the plainest possible worse, but there is no return of the abdominal words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way;

or other truly typhoid symptoms? The theory and we want downright facts at present more than anything of the entrance of pyogenic bacteria through else.-RUSKIN.

unhealed ulcers offers a ready explanation. In these columns, A is frequently used instead of 3.

I fancy that few of us will agree with the Notes and Replies.

alleged doctor who allows the placenta to re

main for three months (page 82). Small wonder Editor MEDICAL WORLD:

if Dr. Snyder's patient recovers slowly, after I am well aware that Villate's Solution will

three months' septic poisoning. Give her a little cause great pain, but not greater than the pa- digitalis, doctor, as well as iron, quinine and tient can bear. There is no objection to the cod liver oil," and wine. use of an anesthetic previous to making the Dr. Gentry (page 82) ought to try glycerine injection, but the resulting inflammation will enemas for constipation. They are the latest make the part painful for some time afterwards. fad, and often answer nicely.

How are the undoubted cures resulting from Why should Dr. Holt's patient have had Villate's Solution to be accounted for? I think hemiplegia twelve days after confinement? there can be little doubt but that the remedy Clots escaping from the uterine sinuses would acts as a germicide; and that any germicidal have been arrested in the lungs; or, if small solution which penetrates to every nook of the enough to pass into the arterial circulation, diseased tissue, filling every cranny in which would not have been too little to cause hemia microbe could hide, as this does, would be plegia. Women sometimes have heart-clot equally efficient. The reason other agents about this time, especially when they first comb have not proved as useful as Villate's is because out their hair ; but heart-clot means sudden they have not been used of sufficient strength death, not hemiplegia. I have often thought to destroy the germ-infected tissues.

that the severe straining at the time of confineIn the last number of my Medical Times I ment might do some damage to the delicate reported twenty-two additional cases of typhoid tissues of the brain, as I have seen the blood fever treated by the use of the sulpho-carbo appear in clots on the temples. This should lates, with no deaths. The favorable results cause hemiplegia at the birth, not twelve days reported in a previous series of cases were fully later. The cause is not clear, but may be found verified in these. I believe, however, that my by examining the heart. pathology has been somewhat faulty in my ex If there is a tumor in the case of Dr. Youngplanation of the symptoms. My theory has er's wife (page 82), there will not be much been that the fever and cerebral disturbance are likelihood of relief from medicines. Try casdue to ptomaines secreted by the typhoid ba cara for a few weeks, in small doses. It relieves cilli in the intestinal canal, and thence ab rheumatism; it may do good here. sorbed into the circulation; and that the Perhaps Dr. Kitchel's case of varicose ulcer bacilli themselves do not invade the blood (page 83) would do better if the tissues had a until late in the disease, if at all. It occurred firmer and less yielding support than the elasto me, however, that perhaps these symptoms tic stocking. Dust the ulcer with iodoform may be due to the ordinary pyogenic bacteria, and tannin, and apply adhesive plaster, with which may exist at all times in the bowels, the elastic stocking. doing no harm; but where the disease of Peyer's For nausea of pregnancy (page 83) I would patches has weakened or destroyed their tis try to find out what is the matter with the sues, the latter can no longer resist the pyoge. womb, and cure it; ulcer, displacement, fissure, nic bacteria, which penetrate the blood and caruncle, or too much husband. cause the grave symptoms of toxemia, delirium, Sometimes the affection described by Dr. stupor, fever, suppuration, etc. Since writing Humphrey (page 83) results from irritating my editorial, I find in my foreign journals that leucorrhea, which must first be cured. In other this matter has been very thoroughly worked cases there is abdominal plethora, hepatic obup, and it is probable that this view is correct. struction, etc., underlying the local condition.

If this be the case, the benefit derived from After rendering the whole genito-urinary tract

aseptic, with lotions of sulpho-carbolate of in the opposite direction from time to time and zinc, the spots may be touched with the gal- wearing a pessary in the interval, I have sucvano-cautery, or with nitric acid and cocaine, ceeded in curing many cases. equal parts.

The principle on which the instrument of the Dr. Collins' case (page 84) might take a

te Professor Hodge constructed seems most good tonic, like hydroleine, with advantage, as to recommend itself, and, in its various modishe is of the scrofulous type. For the heats, fications, this pessary can be made to meet the salol or digitalis.

indications of almost any case. The exact raDr. Bateson asks an opinion (page 84) on tionale is not, I fear, sufficiently understood by the utility of a knowledge of temperaments and general practitioners in whose hands such cases of phrenology. No knowledge comes amiss to may drift, and, for the benefit of my younger the physician, and the advantage of “knowing brethren, I will lay down some of its most the constitution” is very great. But as to important principles necessary to be successful. phrenology, it is hardly worth while for a busy In retroversion and retroflexion, the point doctor to waste much time over it.

d'appui is beyond the symphysis pubis, the To Dr. Gardner (page 85) I would reiterate other curve of the instrument occupying the my axiom, that there is one anti-syphilitic, and posterior vaginal cul-de-sac. his name is mercury. Why should we give In anteversion and anteflexion, the perineum iodides in leg-ulcers? The object is to build is the point d'appui, the opposite bar occupyup, not to destroy. Give the astringent mer- ing the anterior vaginal cul-de-sac. curials, internally as well as locally.

The great desideratum in all these cases is WILLIAM F. WAUGH. that conception may take place, as it frequently

does, while the uterus is artificially maintained Uterine Displacements and Flexions; their Me. in its normal position. A patient of mine, chanical and Clinical Treatment.

who was confined a year ago has, after a long (Continued from February No.) childless interval, been twice impregnated while

wearing a modified Hodge pessary, without IV. MECHANICAL TREATMENT.

which she is incapable of rising from her bed. Editor MEDICAL WORLD:

Since her last confinement, the gradual imThe first step in the mechanical treatment is provement in the condition of the uterus, the restoration of the organ to its normal form which has been going on so long, has culmiand position by means of the uterine sound. nated in her being able to dispense at last enThe real difficulties of treatment, unfortunately, tirely with this mechanical support. only begin at this point. In cases which have Cases, however, of retroversion and anteveroccurred suddenly, as the result of some direct sion, and many more of flexed conditions, are violence, such as a fall from a height or on a met in which local medication and vaginal hard substance, or the listing of too heavy supports alone entirely fail to relieve even the weights, if they be seen at once, simple repo- most urgent symptoms that have called attensition by the sound, or even by judicious manip- tion to the lesion. The question then arises : ulation, will often suffice. But nearly all the Do these cases warrant or demand such applicases which come under our observation have ances as the intra-uterine stem pessary? existed for some time, and have been gradual To this question I unhesitatingly reply, Yes. in their approach and development. In all of I am, however, prepared to admit-indeed, it these it is necessary, after reposition of the is within my own knowledge—that this treatuterus, to devise means for its retention in situ; ment has been too often indiscriminately and otherwise the relief, which is invariably thus unnecessarily employed, and often detrimenobtained, will only be temporary. In a few tally in inappropriate cases, or under unfavorcases, occasional reposition or straightening able conditions. Nevertheless, I maintain that with the sound, combined with rest and astrin- the intra-uterine instrument can be used with gent medicated pessaries, and attention to the perfect immunity and with the best effects in general health, may attain the desired result. appropriate cases; the uterine tissues, particuIn flexions, the occasional dilatation of the larly the mucous lining, being in their normal uterine canal with sponge or tangle tents may state of low sensibility and singularly tolerant overcome the difficulty by restoring the ana- of manipulation. It would, indeed, be strange tomical equality and increasing the tone of the if they were not, considering how much they uterine walls. But in most cases vaginal sup- are called upon to undergo in connection with ports or pessaries have to be employed in some the ordinary discharge of their functions. I form or other. They are of course, per se, have found the uterine cavity, under ordinary more effective in versions than in flexions. By conditions, as tolerant of metallic substances exaggerating, by means of the sound, the flexion as the mouth similarly is of the appliances of

the dentist, or as the conjunctiva of the pres

The Treatment of Children. ence of an artificial eye.

Editor MEDICAL WORLD: But, under conditions of irritation and innammation, it is very different; and, like corres

The primary idea suggested to the minds of ponding structures elsewhere, the uterus be

not a few children by the word medicine is comes highly sensitive, and strongly resents all

that of some nauseous and disgusting cominterference until the morbid state is reduced. pound to be administered to them, nolens One should hesitate to introduce, even tempo

volens. To them the “doctor" and the devil rarily, the uterine sound, much less to leave a are nearly synonymous terms, with this differ

ence: that the former seems a little nearer to foreign body, like the stem of the pessary, within the cavity of the uterus, were that organ

them than does the latter. Every physician

with any considerable experience among chiland its associated structures in an irritable or inflammatory state. Such conditions must first

dren has met with frequent instances confirmbe reduced by appropriate means, of which

ing this statement. rest, local sedatives and depletion are the most

The evils arising from this state of thnigs efficient.

are many and obvious. The doctor is called In any case where it is posible to anticipate

to treat a child rendered cross and peevish by difficulty, it is wise to insist upon a probation

illness. At sight of the dreaded monster, the of rest after introduction, in order to test tol.

child sets up a fearsul howl, clings to the erance. This, however, is not often necessary.

mother, and persistently refuses to submit to Indeed, I have very seldom seen the presence

the necessary examination by the medical man. of the instrument resented when used with the

All the doctor's seductive arts, including the ordinary precautions just indicated and in

proffer of his Waterbury watch for inspection, intelligent hands. In order that the stem pes

fail to ingratiate his favor or to pacify the

alarmed youngster. sary may be retained and the full benefit of its

As a consequence the presence be derived, it is absolutely necessary

doctor is unable to get at the true condition of that it be exactly of the length of the uterine the child—fails to see him as he was ten mincavity and of the calibre of the os uteri. If it

utes before his arrival, and probably will be be too long, the bulb of the instrument will

half an hour after he takes his leave. Such not be in contact with the cervix, and the point inspection and examination as are made, despite will irritate the fundus and cause its expulsion.

the struggles and resistance of the little one, So also, if too short, it will not be retained.

are, as a matter of course, unsatisfactory and I am here speaking of simple stem pessaries misleading. To understand anything of the of metal or vulcanite; but in cases where there

state of the child he should be passive, or at

least consenting. is uterine atony, especially with defective men

To pretend to treat sick struation, I have found great advantage from

children without such knowledge as comes the introduction of the copper and zinc gal

alone from proper examination is arrant emvanic pessary. Many patients are perfectly piricism, not far removed from the veriest conscious of a throbbing feeling of the stimu

quackery. lating effect of this instrument; whereas they

One cause of this difficulty is that most are quite unaware of the presence of the sima physicians are too hurried in their calls, espeple stem when properly adjusted.

cially where children are concerned. The There are here two indications of treatment

hurried entrance of a stranger into the family met with the same instrument: first, the neces

circle occasions more or less disturbance at any

time. To have the attention directed at once sary mechanical support; and, secondly, the direct stimulus to the debilitated uterine tissue

to a rigid scrutiny of the young patient is to from the galvanic current developed. There

disturb the harmony and natural progress of

domestic affairs. Time is required to study are, however, occasionally cases met with where even still more elaborate appliances are neces

the child, and this while he is not conscious of sary. In extreme cases of version, and espe

being specially observed. If the doctor has cially where flexion and version coexist, and

not time to do this, he had best leave this sort where the organ is low in the pelvis, it may be

of practice to someone who has time and requisite to combine the intra-uterine stem with patience. a vaginal support. WM. H. OLSTEN, M.D.

A few days since I was called to see a strange Ephraim, Utah.

child, three years of age, suffering with a seri

ous attack of broncho-pneumonia. On my en[TO BE CONTINUED.]

trance into the room the mother announced, You can begin using THE MEDICAL World Visiting

“Charley, here comes the doctor to see you.' List during any month in the year. It never goes out

The little fellow set up a feirsul howl, and continued to cry during my entire stay, despite

of date.

the mother's soothing assurance that “the hour's uninterrupted sleep. The ordinary doctor is not going to cut you.” This fear, I treatment would seriously endanger the health, was told, was the outcome of a vaccination ex if not the life, of a well child. perience, and was aggravated (evidently) by When we consider that in a large proportion parental unwisdom. Since the complete re of cases to which we are called there is no covery of the child my entrance into that

actual need of drugs, and that the assumed house is still the signal for wailing and tears.

action of so many drugs administered is by no In another instance it required two or three means certain, and in how many cases they are years' intimacy with the family to gain the given solely to satisfy the demands of the confidence of a little girl, six years of age, friends, we may lay it down as a general rule, whose most vivid impression of a doctor is as to which there should be few if any exceptions, sociated with having a spoon-handle violently that no unpleasant medicines or objectionable thrust down her throat. It is bad enough at forms of medicine should be administered to any time to have to examine the throat of a children. child, but even that may be done in a manner both considerate and humane.

If any one deems this too sweeping, let him To secure the confidence of the sick child

run over the list of unpleasant things which is one of the first and most desirable steps then ask himself whether there is not some

he may have deemed it important to use, and towards its intelligent treatment. A glance at the list of drugs commonly pre probably have been equally effective.

thing less repulsive, more palatable, that would scribed for children ought to convince the most skeptical that too little attention is paid

Custom may compel us to appear to be doing to what is often sneeringly referred to as “ele

something. The average mother is not pre. gant pharmacy." Elegant pharmacy is some

pared to accept the dictum of the doctor, that thing to be proud of. The palatableness and her child, apparently so sick, does not need attractiveness of the homeopathic pharmacy any medicine; nor is the father so willing to has lured many from the regular school of

pay for advice as he is for something to practice, whose chief idea of the difference in take." I do not recommend placebos. Even the schools of medicine is that one gives nasty

in cases where the diagnosis is not clear, there drugs, while the other gives nice sugar pellets.

is usually some symptom that is prominent or From a well known work on the “ Diseases portentous, as high fever, nervousness, nausea, of Children," now before me, I select almost

etc. Here tentative treatment, as a febrifuge at random some of the drugs prescribed :

or a nervine, finds a proper place. Quinine, castor oil, calumba, buchu, senega, Finally, in the treatment of children is a iodide and bromide of potassium, lobelia, nux fine field for the exercise of that trait, without vomica, assafetida, turpentine, cimicifuga, which exalted skill and profound erudition are ipecac, jalap, scammony, gamboge, copaiba, of little avail_I mean good common sense. fluid extracts, that are usually far from pala Brooklyn, N. Y. BENJ. EDSON, M. D. table, and many others that are no more attractive, and many of these with bitter infusions as a vehicle, and no attempt to cover the Parturition Among Inferior Races. repulsive taste of the nauseous dose.

Editor MEDICAL WORLD: Some of us are old enough to remember the old-fashioned “picra” bottle, that was once Dr. Waugh is desirous to know if the females an essential of the domestic armamentarium, of the Negro and Indian races suffer the pains and whose effectiveness none who partook of parturition to the same extent that those of thereof ever had the temerity to question. It the white do; I delivered my first negro cannot be truly said that children ever cried case in Oct., 1837, and have been doing so for it.

ever since; have delivered hundreds of them As a general rule, more harm is done in the and can say that I find no difference between exciting struggle of compelling children to them, only that they all seem to suffer alike. swallow repulsive medicines than all the bene- I once had the pleasure of performing this fits that result from their remedial action. operation for an Indian girl, primipara, and

Nowhere, perhaps, is this more marked than although she appeared from the contortions of in the treatment of diphtheria. The disease is her face, to suffer as much as any woman I ever too frequently attacked as though it were to be saw, still she never uttered even a grunt; and I vanquished vi et armis. In addition to the can also state, that like the Chinese women, heroic remedies, the patient is steamed and she had no more hair on the pubis than can be stewed, and swabbed, and probanged and found on the palm of my hand. dosed so frequently, that it can never have an Camden, Ala. E. GAILLARD, M.D.

Knots in the Umbilical Cord.

and heard of many others, who have been Editor MEDICAL WORLD:

greatly improved by the use of this water in On page 391, October WORLD, Dr. J. A.

nephritic diseases. Robinson asks for information on the above

Black Rock spring, situated in the Blue subject. As no one has volunteered anything Ridge mountains, six miles from Patterson staon the subject I will extend a helping hand.

tion on the S. V. R. R., has been visited for Hecker, who has made the most extensive

the last fifty years by citizens of Augusta, researches on the subject, found that knots of Rockingham and adjacent counties, and, since the funis occurred once in every 247 labors (83

it has become more accessible, is annually betimes in 20,515 labors). They are brought coming more popular as a pleasant as well as a about by the passage of the child through a

healthful resort. Both observation and clinical loop of the cord so placed that its fetal end

experience confirm me in the opinion that no lies under the placental; otherwise the passage

water excels this in promoting an unusual apof the child through the cord would cause the

petite, while at the same time digestion and knot to disappear. Knots may occur during assimilation are so improved that no evil results pregnancy or labor ; in the majority of cases

from excessive indulgence of the appetite, unthe latter. These, when undone, leave no

less some gross imprudence is manifest; hence marks on the cord.

I have no hesitancy in recommending Black Those found during pregnancy give rise to

Rock to all those suffering from dyspepsia. atrophy at their seat. Ā capacious uterus has In addition to the above curative qualities I no relation to the formation of knots, since

will add that the spring is 2500 feet above the the condition necessary to this are not such as

sea level and 12co above the valley, which favor mobility of the child, but depend on the gives a light and dry atmosphere, the purity of position of the loops of the cord during labor.

which is a sure relief to those suffering with Of Hecker's 83 cases, 69 children were born

asthma or hay fever, several of whom are analive; 5 were asphyxiated, but restored; 4 were

nual visitors to this place. still-born; 3 died during labor; 2 were asphyx

This water has not been analyzed, though it iated and not restored. All but two of the is thought to contain, beside iron, a trace of deaths were due to other causes than the knot.

arsenic and sulphur, these metals being found In all but four cases the cord was longer than

in the vicinity of the spring. There is this the

average; on an average it was three inches peculiarity of the water, which I would like to longer. The placenta was attached to the

see explained. A fish, placed in the spring lower part of the uterus in thirty-nine cases.

from a creek near by, will die in five or six Of the fifty cases in which the knot was ob

minutes, though, if taken out in three minutes served, it was in forty-one near the navel, and

after turning on its back, as evidence of apin nine near the placenta. In one, case two

proaching dissolution, and returned to its natuknots were present, and in one case the knot

ral habitat, it will soon recover its usual health was double. S. J. SMITH, M. D.

and vigor. Dr. Layton is too remote to enjoy Charlotte, N. Y.

the benefits of this resort, though others to whom it is more accessible may receive benefit therefrom.

Mineral Springs of Virginia.

Port Republic, Va.
In reply to the suggestion of Dr. Layton in

Pneumonia. the Dec. number of THE WORLD in regard to

Editor MEDICAL WORLD: mineral waters, I will offer a few remarks (not going into details) in commendation of several I did not write the article on pneumonia for springs in my neighborhood.

the December World for the purpose of proRawley springs, twelve miles from Harrison- voking discussion; but I see by the January burg, is justly celebrated as one of the best number that Dr. W. B. Middleton feels like chalybeate waters in the country, having a rep- “pitching in,” and flaunting the bloody utation for curative properties in female dis- shirt" over my brief defense of the lancet in eases equal to any other of which I have any the treatment of this formidable disease. I do

not wish to occupy much space for the mere The Bear Lithia spring, at Elkton, on the purpose of defending a line of treatment much S. V. R. R., has lately come into favorable older than Dr. Middleton himself-one that in Dotice as a remedy for kidney troubles, and my hands has proven itself time and again a upon analysis is said to be purer water of this thousand fold better than “milk and water." character than the celebrated Buffalo spring of What does he mean when he says: “Pneumonational reputation. I have seen several cases, nia is not due to an excess of blood to the


« PreviousContinue »