Page images

the chances of a cure are considerably in:

Original Communications. creased. I will say even more. Taking into consider

Short articles on the treatment of diseases and experience

rith new remedies are solicited from the profession for this ation the antiseptic and harmless properties of tepartment; also difficult cases for diagnosis and treatment

Articles accepted must be contributed to this Journal only. peroxide of hydrogen, the physician who uses the editors are not responsible for views expressed by onit need not fear danger of poisoning by absorp

cributors. tion, nor need he trouble himself about the

* Unused Manuscript cannot be returned.

Certainly, it is excellent disctpline for an author to feel that As quantity, be it great or small, of the liquid must say all he has to say in the Serbest possible words, or hu

sader is sure to skip them: and in the plainest possible words, which might accidentally find its way into the or me reader rotll certainly misunderstand them. Generally, stomach. This consideration, then, permits

th, a doronright fact may be told in a plain way; and we want

Loronright facts at present more than anything else. -RUBKIX. him the use, or even the abuse, of irrigation In these columns, A is frequently used instead of 3. or gargles which would insure the complete and immediate destruction of the diphtheritic

A Medical Autobiography. membranes. Consequently, peroxide of hydrogen will

CHAPTER 1. prevent at all times the development and reproduction of these infectious membranes; and

INTRODUCTORY. it is obvious that all that will be necessary to obtain a prompt cure is a vigilant surveillance.

Editor MEDICAL WORLD: 10 W. 4th st., New York City.

This autobiography will contain an accurate portrayal of actual personal experiences from

the first day I settled in the practice of mediWe desire our correspondents to notice some of the principles which we endeavor to observe in preparing tions in the actual practice of others as are

cine to the present moment, and such observamatter for our columns. Avoid all diphthongs, as entirely unnecessary and

known to be true, and have a bearing upon cumbersome in language, except in ihe Latin genitive the subject matter contained in the story. case ending (æ) in nouns of the first declension, in If every young man contemplating the study prescriptions. Avoid using abbreviations, except in formal prescrip- chapters of this autobiography, as they appear

of medicine, could and would read the various Haste may be a possible excuse when you are willing from month to month in THE MEDICAL to let some poor druggist puzzle over what you mean WORLD, I venture the prediction that next by Hy, chi.,” but it is gross injustice to submit twenty year's medical classes in the colleges would thousand professional brothers to the same uncertainty, not be as large as they otherwise would be. and perhaps it may make your entire contribution worthless on account of a lack of accuracy.

Yet I would not have you think that I have The same reasons make it essential that you should made a total failure of the practice of mediwrite all technical terms very plainly. The context, cine. With becoming modesty I will state or the "sense of the sentence,” will often enable the that I enjoy the reputation among my fellow printer to make out the indistinctly written words of practitioners, as well as the laity, of being a cannot guide him in professional technical terms. If hard-worked man. I am quite sure my wife your contribution contains valuable medical informa- would confirm the diagnosis. tion we do not want to throw it away, nor to perform the When I entered the profession I located in laborious task of re-writing it, nor to occasion delay by the city in which I now live, renting a respectreturning it to you for explanation.

Do not sprinkle Latin words in English composition. able looking house in what I considered a fair Plain writers seldom resort to this. "Aged 40" is a

locality. Everything of a material value, exgreat deal better than “æt. 40." Those with a thor- cept one small box containing my medical ough classical education are seldom guilty of this inter library, and a larger one, about the size of an polation, nor are those who have a sound English ordinary trunk, together with my good wife, training with good medical judgment. It is mostly myself, and a driver, came on a light two-horse those whose knowledge of strange tongues is fragmentary platform spring wagon. The load was not a and limited. Stick to your mother tongue. It is now the best language on earth.

heavy one, either. Having arrived, I purWe much prefer the use of gr., dr. and oz., rather chased a ton of coal, a small kitchen stove, two than gr., 3 and 3. Still

, use your choice in regard to small, cheap ingrain carpets, a very little that. After all, it you have a valuable medical fact to con

second-hand furniture, and paid one month's tribute to the profession, and feel your inability to write

rent in advance. In a couple of days I put out it correctly, do not hesitate to give it your own expres- my sign and announced myself ready for busision, and we will give it any finishing touches it may ness. I was then practically penniless, and did aeed, if you will give us room enough between the

not know a single individual in the city. I lines and on the margins to do it, and write on one side

didn't have anything. only of the paper. Many excellent medical facts are first communicated to the profession by men who are

Perhaps a brief account of my library, instrubetter scientists than linguists.

ments, office fixtures, etc., may not prove en

that way

tirely uninteresting. By actual count I had marks as critical. They are not so intended. nineteen volumes in my medical library. Four I know very well that in dealing with patients of these were not of much account in practice; who are not overly intelligent, there is fre. the remaining fifteen volumes were standard quently very great difficulty in persuading them authorities, however. My instruments con to submit to operations at the proper time. sisted of the necessary articles for urinary analy I am getting a little bolder in the use of the sis, a pair of pocket scales, and a small pocket sulpho carbolates, giving from two grains every instrument case. My office, only one room, two hours to ten grains. In this case I use the did not have a carpet or mat upon the floor, soda salt, fearing that so large an amount of yet was pleasant and cheersul nevertheless.

zinc may have some undesirable effect, whereas During the first two months my office desk con

the soda has none but what we are familiar with. sisted of a dry-goods box, covered with some In a case of tubercular diarrhea I am now give material my wife happened to have. My ing ten grains of the zinc sulpho-carbolate every “library” stood in one corner of the room, the four hours, and there has been no evidence of case being an improvised one. Three or four irritation or any unpleasant effects whatever. second hand chairs were distributed about the

Dr. Layton's suggestion is a valuable one. room. Do you ask why I didn't have better furniture and more of it? Simply because I

There are many medicinal springs in this counhad nothing with which to purchase it. My try equal to any in Europe; bit of little value

because their virtues are not known. In Europe medical dip ona, an academical diploma, and three certificates of special training from the

the various waters are prescribed by physicians University from which I graduated, hung upon rug-store. That the same is not done here is

with as much certainty as the contents of a the walls. I might add, by way of parenthesis, that our dining-room table, for a short time,

our own fault. We might just as well have the was a twin sister to my office desk, and for a

golden stream diverted from Carlsbad and Ems

to our own fountains, if we took the trouble to long time our kitchen table was first cousin to

ascertain the real value of our waters and preboth. I did not keep a horse, yet was not weary

sent them properly to the profession. But as

long as we leave it to the owners of the springs, from walking, although doing all my visiting in

who claim that they will cure everything from Thus located, without one solitary friend, or

corns to leprosy, we need not look for a change. even acquaintance; without the kindly assist

If I were “Delta," I would be very well satance of an older physician to send me stray

isfied that my case of progressive muscular patients or even poor business, and withont atrophy was improving at all, and would not anything in the world, and my wife and myself be in a hurry to alter my treatment. being obliged to eat three times a day, and sit Dr. Foster will not obtain a very efficient ting whole days in my office with nothing to do, remedy for granulated lids until he has removed I commenced the battle of life.

the lashes which cause the irritation of the corIn the next chapter I will tell you about my first call, and the amount of business and col Dr. Davis (page 475) has a patient who de. lections the first two months.

sires a good deal. If his blue veins show [TO BE CONTINUED.)

through the lids, he must be very anemic, and should take iron. He might try the local use

of lanoline, rubbed into the skin every night Answers to Inquiries.

to improve its nutrition. Editor MEDICAL WORLD:

Dr. Luff should look over a few back numOn page 458 Dr. Kendrick describes a case bers of The World, and he will find some exwhich looks to me like one of tuberculous dis cellent methods of treating gonorrhea Fol. ease of the bones forming the ankle joint. If lowing the advice given in Milton's valuable this surmise be correct, an earlier operation little book, I have used nitrate of silver recently, might have prevented systemic infection. But and like it. Copaiba is a relic of the dark is Dr. Kendrick certain that there was no de. ages. Acetate of potassa is one of the best inposit of tubercle in the lungs previous to the ternal remedies. Injections should be made appearance of the disease at the ankle? Doubt with the soft rubber tube opening towards the less, at the time the operation was performed, meatus, and the fluid injected should be hot. nothing else would have arswered; but less In A. M. D.'s case of heart failure (page radical measures might have done well if used 475) I would use strychnine in doses of i'd grain earlier. In one case of caries of the tarsus, I every four hours, gradually increased unul good used Villate's solution with perfect success. I effects are obtained. hope Dr. Kendrick will not look on these re Dr. Stuart's case has a feeble heart, and the


paroxysms, as he describes them, bear some re depends for its origin upon an obstructed cir. semblance to asthma. Dyspnea is very com culation in the superior hemorrhoidal veins; mon in feeble heart from any cause, in Bright's but what the cause of such obstruction may be disease, and in chronic bronchitis and emphy is a matter for discussion. sema. In any case I should give the tincture M. Verneuil claims to have discovered that of digitalis and quebracho until the patient is where these veins perforate the wall of the recbetter, and would then substitute strophanthus tum they pass through a sort of muscular for the foxglove. But an examination of the button-hole, which are not surrounded by any heart and lungs would make prescribing an protective fibrous tissue, and therefore have the easier task.

power of contracting and causing a condition Dr. Vaughn ought to give us some more data of stasis and congestion in these veins which before we can intelligently advise him. Insom

constitutes the starting point in the formation nia is not a disease, but a symptom of very of internal piles. many diseases. As a rule, it depends on cere

Whether this state of stasis and congestion is bral anemia or hyperemia; in one case de

really caused by the contraction of such muscumanding a cup of hot beef-tea at bed-time, at

lar button-holes, or whether it arises from an another a dose of hydrobromic acid at bedtime or a cathartic after dinner. The symp- factor, we shall not attempt to decide; in fact

engorgement of the portal system as a primary toms given may coincide with plethora, when low, dry diet, exercise and nitrate of potassium affection, and more to find a method of treat

we care less for the etiology of this troublesome will do more good than the bromides. If there

ment which shall give prompt and efficient is anemia, however, the best remedy is a com

relief. pound of iron, quinine, strychnine and the

For the past two or three years the advertisphosphates. But there may be local disease of the uterus, heart or kidneys to modify or nullify crowded with matter devoted to the advocacy

ing space in our medical journals has been the above general rules.

of the Brinkerhoff, Rorick, or other alleged When a pin has been swallowed, give plenty systems for treating hemorrhoids. of bread and a little opium to cause constipation, and examine the stools until the pin

Like an innumerable number of other mush

room productions of the day, whose chief merit passes. Locomotor ataxy curable? Yes; I had a re

has been the cash paid the printer for honest covery under the use of strychnine. Carter

labor, they are falling into disrepute; physicians had two recoveries under oxide of silver. One

have squandered money upon these so-called of these cases had been pronounced incurable systems to be met with disappointments in by Prof. Samuel D. Gross.

therapeutic results. I will conclude this letter by wishing the

It has been insisted so strenuously by the great WORLD family a very happy New Year! fathers of the profession that topical treatment hoping that the coming year will see them all was of no avail, or at the best only palliative, enjoying health and prosperity, and obeying that I hesitated for months to acknowledge that the injunction to increase and multiply, for perhaps these wise ones might have been misFriend Taylor's benefit, and their own as well. taken, and that it was really within the bounds

W. F. WAUGH. of possibility to relieve and radically cure hem

orrhoids without the use of the knife, ligature,

or other surgical procedure. Successful Treatment of Hemorrhoids.

There is in this city a gentleman, F. W. Editor MEDICAL WORLD:

Stuart, who is preparing for professional use an We recognize two forms of hemorrhoids, viz., ointment, which, for the cure of this trouble. the external and the internal, although these some affliction, has no equal, as far as my extwo forms of the painful and troublesome affec perience reaches; one of the principal ingredtion are often so blended that each partakes of ients of this ointment is a semi-solid extract of the nature of the other.

petroselinum sativum, which is made by Mr. Of the external typical hemorrhoid we shall Stuart himself by a peculiar process. Any say but little; they are usually hardened, con physician who will take the trouble of writing gested, mucous, or muco-cutaneous excrescences, to Mr. Stiart will be furnished with a sample easily reached, and readily remedied; and as box of this ointment, and the exact formula and the same line of treatment suffices for their re method for compounding the same. moval, as for the internal form, a mere It is doubtleis due to the petroselinum that knowledgement of the usual classification is this ointment posse ses such soothing, altersufficient.

ative, and healing properties; and that these We understand that the internal hemorrhoid ' properties are resident in the drug is, I think,


evinced by the fact that the semi-solid extract upon this much vexed question; but there are of which I have spoken, properly diluted with indications that it has undergone a great water, forms one of the best applications for change. Gynecologists are still far from being post-nasal catarrh, pharyngitis, etc., etc. I agreed, even as to the exact nature of the me. use about one part of the extract to fifteen of chanical treatment to be employed in this water and direct it to be inhaled through a bent large, important and interesting class of cases. glass inhaling tube two or three times a day, or I think there are two extremes of opinion as used as a gargle, as the case may be. I have, to the clinical importance of uterine displacefor something over three years, used the oint ments and distortions. According to the one, ment extensively, and have yet to know of the these conditions are always the active or po. first case where it has not afforded prompt and tential source of grave local and general efficient relief. For internal piles I prescribed troubles, and should therefore be at once it in P. D. & Co.'s rectal capsule suppositories. brought under treatment, mainly of a local One of these capsules filled with the ointment and mechanical character. According to the and introduced into the rectum allows the other extreme the conditions in question are to medicament to come in direct and prolonged be regarded simply as the passive local expres. contact with the affected part. Morphia, co sion of troubles to be looked for and treated caine, tannic acid, etc., etc., can be added if elsewhere, either in ovarian irritation or in circumstances seem to demand ; but this will disordered states of the general health. It is seldom be found necessary.

greatly to be regretted that not only have opinWhen the hemorrhoids protrude extensively ions in regard to these questions been too exand are of an intensely congested appearance, treme, but sentiment, if not personal feeling, I exhaust them of their blood as far as possible has too evidently prevailed in their expression. by a double-acting hemorrhoidal syringe, and Displacements and flexions of the uterus are then inject them with Stuart's extract diluted

in no sense obscure, much less speculative in with warm water, without withdrawing the character; they are purely physical conditions, needle, using the ointment as a subsequent

even more capable of recognition than the dressing.

fractures and dislocations of surgical experiIt is surprising how rapidly even aggravated ence; and their relief and cure by the judicases will improve under this treatment, forty- cious use of appropriate mechanical appliances eight hours often sufficing for complete relief, are as capable of demonstration as any in the as I have experienced in my own case.

whole domain of medicine. I have had a May it not be a fact that the direct action of continuous experience of the mechanical treatthis ointment is upon the muscular fibres of the ment of this class of ailments, and I am more button-holes described by M Verneuil, relaxing and more convinced that it is the only efficient them, and permitting the circulation in the

means, when confirmed, for their relief and hemorrhoidal veins to be restored to its normal

cure. I readily will admit that in incompecondition?

tent, perhaps in unscrupulous hands, their emIn conclusion, I would say to my professional ployment has often been unnecessary, dangerbrethren, do not invest from $35 to $150 in the

ous, mischievous and sometimes fatal; but I purchase of any so called system for treating yet maintain that these are accidental and prehemorrhoids (the majority of which are simply ventable abuses, and do not in the slightest a renewal of the old and exploded idea of in

degree affect a sound principle of the treatjecting the pile tumor with a solution of car

ment. bolic acid), but write to Fred W. Stuart, Oswego, I will now proceed to state that my thesis N. Y., and get a sample box of this ointment, resolves itself naturally into a question of pathtogether with the formula from which it is ology and a question of therapeutics. made, try it thoroughly and become convinced,

Therefore I shall establish my subject in two as I have done, that it is the remedy par excel. lence for the alleviation and cure of hemor

propositions: rhoids.

I. In some women certain well-defined Oswego, N. Y. H. L. WILDER, M. D. groups of local symptoms, and evidently rela

ted constitutional disturbances, are found asUterine Displacements and Flexions--Their sociated with certain flexions and displace

Mechanical and Clinical Treatment. ments of the womb as the only recognizable Editor MEDICAL WORLD:

organic exciting cause. PRELIMINARY REMARKS.

II. In appropriate cases, local suffering and A few preliminary remarks are necessary be constitutional disturbance subside on reduction fore entering upon this subject properly, inas- of the displacement or flexion, and the retenmuch as professional opinion is still divided tion, for a longer or shorter period, of the


womb in its normal attitude and axis by me ments of the uterus, the supporting power, or chanical appliances is followed by permanent rather function of the vagina and its attachrelief and cure.

ments has been more or less reduced, so that 2. PATHOLOGY (UTERINE).

there is always at the same time a certain

amount of uterine procidence or displacement Nothing in uterine pathology is more re downwards. The importance of this pathogenarkable, and often inexplicable than the netic relation has as yet not been sufficiently varying amount of pain and distress which recognized. In fact, there can be no shortensuch conditions involve in different patients. ing of the vaginal tube from whatever cause, A slight disturbance of uterine equilibrium and consequent subsidence of the uterus within will produce continuous suffering in one the pelvis, without a disturbance of uterine woman, while extreme forms in another will be equilibrium to a certain and usually corresborne with comparative impunity. This patho- ponding degree. There is, then, an essential logical anomaly is often adduced in triumph relation between procidentia and version of by the opponents of mechanical treatment. uterus, and this relation at once and satisfacto. But it is equally well known that in other rily explains the beneficial action of purely morbid states phenomenal parallels are ob- vaginal supports to some extent in all such served. In every disease different patients cases, and, it may be, completely in slighter react differently to the same exciting cause, forms.

WM. H. OLSTEN, M. D. and this is more evident when the latter is

Ephraim, Utah. physical in nature and local in action. Some

(To be continued.) woman will have constitutional disturbances to an extreme degree without suffering; in others Case of Extra Uterine Pregnancy. a slight lesion will give rise to intense local

Editor MEDICAL WORLD: suffering and great general sympathy.

I was called to Mrs. H., age 22 years, pregothers, again, the symptoms are either entirely local or altogether general in character. There

nant two months, having had wo abortions

before and one natural labor. can be no disturbance of uterine equilibrium

On the 19th of November (Sunday morning) without more or less interference with the vascular and nervous supplies of the organ, and

she arose well, ate a very hearty breakfast, and

was about and in good spirits until 10 A. M., through them with its secretory apparatus. Hence arise congestion, leading to inflamma- when, like a flash, she was suddenly seized with tion, morbid sensibility and pain from pressure

an excruciating pain in her pubic region, and

soon fainted. I arrived there at 12 A. M., on the nerve filaments, and excessive and per: having

had five miles to go, when I found her verted glandular secretion, as the direct physi, condition as follows: Death-like pallor of the cal results of this disturbance. The clinical

face, lips cyanosed, pulse nearly imperceptible, importance of these conditions cannot be overlooked as immediate factors in the causation of her husband how the attack came on, he said

extremities cold, extreme thirst. On asking a variety of functional derangements; and if with chills, and vomiting and pain. Having not corrected, ultimately, sooner or later they made an examination per vaginam I found the induce changes of structure of a grave character. Women who are the subjects of uterine

os firmly contracted. I then came to the con

clusion that I had a case of extra uterine pregdistortions and dislocation suffer more or less from disturbance or interruption of the two

nancy (possibly tubal) with rupture, and the great distinguishing functions of their sex.

fetus escaping into the peritoneal cavity with a

concealed hemorı hage. The patient lingered “Menstrual irregularities and sterility are

until 4 P. M. usually present, and are in most instances the subjective conditions which attract the atten

The only thing I regret to mention is that I tion of the patient and lead her to seek pro

was refused a post-mortem examination, the fessional advice, which results in the recogni- husband saying it was always against her wish tion of the disability.


John P. HILLEGASS, M. D. Paulus Ægineta recognized distortions of the uterus first and their effect in producing

Pennsburg, Pa. sterility, and suggested coitus a posteriore as a The companion to the visiting list is a handsome, inpossible means of overcoming the difficulty as dexed book, arranged as a ledger of monthly halances regards conception.

and index of accounts. The two sets of books form a With respect to the immediate causation of very complete and handy system of bookkeeping. The all forms of flexion and version of the uterus,

price of the entire set is $2.00, aud if not found satis

factory after three months' use, the money will be reit must be borne in mind that, in addition to

funded on the return of the books.--American Medical stretching or relaxation of the proper liga. 'Fournal.

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