Notes and Queries. We cordially invite questions for this column on all subjects of practical interest and value to physicians. Brief, pointed, practical paragraphs embodying the personal experience of any of our readers will also be acceptable as contributions to this department. The SUMMARY is thus a valuable medium for the intercommunication between the medical profession. Correspondents will give their names and addresses, but initials only will be printed when desired. Communications for this department should be written on one side of the paper only. The QUERIES in this issue await the ANSWERS which our intelligent readers may be pleased to contribute for publication in our next Diphtheria, Treatment. Reply. The article on Cause and Prevention of Disease-Diphtheria, Treatment, etc.," by Dr. George J. Monroe, deserves consideration. He says:-" The longer I live the more humbug do I see in the practice of medicine and surgery." 'What does the doctor mean by "humbug?" The origin of the word dates back to a period when war prevailed on the German continent. So many false reports and lying bulletins were fabricated at Hamburg, that at length when any one would signify his disbelief of a statement he would say :You have that from Hamburg," and thus, from Hamburg or Humbug," became a common expression of incredulity. 66 I do not think that the medical profession should be classed a lying profession, but as, "many men of many minds.” Another definition of "Humbug" is, "an imposter." I will not deny that there are not some imposters, but certainly not a great many. An imposter is a pretender. Graduates of medicine and surgery are required to be men and women of learning, of scientific attainments, of skill as well as of character. How can such men and women be pretendes, imposters or humbugs? A pretender is one who represents himself to be what he is not, a practitioner of medicine and surgery without a diploma. He says that medicine should be an exact science. In some respect it is an exact science, and in other respects, it, perhaps, never will be exact. The pathology and histology of many diseases has become exact, but symptoms and signs are at times misleading. Not all practi tioners are good diagnosticians. For the lack of this ability they should not be rated "Humbugs." The practice of medicine and surgery cannot become an exact science while its members believe differently, think differently, see differently and obtain different results in the treatment of their patients. Not all stomachs relish the same food, not all tongues receive the same pleasant impression from the same diet and not all patients are similarly benefited by the same remedies, although the microbes which produce a disease, may be the same in character. The Brown Sequard "elixir of life," produced astonishing results in several patients, but in many a failure. Hence its short duration. No Humbug," but a failure. 46 The Koch tuberculin," gave that eminent practitioner great hope in his new discovery, but it would not kill all tubercles and hence it is classed among the failures of great men's investigations, but not as a "humbug.." It may be considered safe to say, that all different diseases have their different living entities. Diphtheria has its, scarlet fever has its, typhoid fever has its, small pox has its, gonorrhea has its, and yet the same medicine will not cure the sime disease of its kind in all instances. this should be so we have not, as yet, learned to know. Why To become exact in the treatment of diseases we must have men who can point out an exact combination of drugs, or any single remedy that will cure diseases of Had Prof Koch any particular kind. proven that tuberculin would cure all cases of tuberculosis, the charlatin, the old woman and the ignoramus would purchase the same and follow the exact path. It is claimed by theologians that all diseases, and even death, are the result of sin, and that the devil is the father of sin. If this is correct, it is the duty of us all to endeavor to kill the devil, and as soon as exact science has accomplished the task we will abandon the profession of growing "humbugs," and bask in perpetual sunshine. The pathologist says that diseases are due to microbes, bacteria or living enti ties. If this theory is correct we must kill these little mischief-makers. This is the army against which medicine is battling and by which we have been so frequently repulsed, routed and forced to adopt other tactics. It is true that the medical practitioner is often led astray by following, or adopting the treatment of others. How can we avoid this misfortune? When we do not succeed with, nor have reliance in our own method of treatment, it is natural that we should seek the advice of others. Many of our brethren, in giving this advice, "explode permaturely," or go off "half cocked," and the mark is missed. They have not learned to know that "one swallow does not make a summer," but they will learn it by and by. I have feasted on such an experience and from it have learned that every man must read, think, observe, depend on himself and be disappointed. During the second year of my practice I landed in an epidemic of diphtheria. I pursued a certain course of treatment with universal success. Older practitioners than I, lost their patients, I treated sixty cases without a single death. I felt strongly impressed with the current idea that the young doctor knows much more than the older ones, I established a reputation. At once matters changed. My certain course of treatment failed and my patients died. My lofty ideas dropped to the very bottom. I read and tried other men's successful treatment, and it frequently failed. It took me years of study and practice until I could adopt one method of treatment better than any other that I had ever tried; to that I have adhered and with very fair success. No matter how different the opinions and experience of medical practitioners may be, every man is entitled to his opinion, and because it does not always seem logical, reasonable or scientific, that man, if a graduate, is not entitled to the name "humbug." leakages and the out-of-heaven plumber. Who would think that sewer-pipes would not, once in a while, spring a leak as well as the human brain? In both instances there should be prompt repairing and no exclusion from heaven for the leak. After dealing with medical "humbugs," the doctor next meets paradoxes in the cause of diseases. Diphtheria and typhoid fever, where the best sanitary surroundings prevail, and no diphtheria where dirt and filth abound. His next step is to burn all decaying animal and vegetable matter. I suppose even the manure heaps on the farm, yet he does not give the mortality rate of the scavanger, the phosphate manufacturer, nor the sower or driller of phosphates. God knows the smell of those different fertilizers is bad enough. Fire is undoubtedly a great disenfectant and destroyer of living entities. That is just what the dutchman said when he set his house on fire to destroy bed-bugs, and happily sang: "Won des net gute fer Wonsa is, "If this no cure for bed-bugs is, Dr. Monroe wonders whether boy No. I. could have been killed by too many medical attendants instead of diphtheria. If by the former, and he should know, then the doctors in attendance, and not the plumber, must meet the charges of the boy at heaven's gate. Boy No. 2. Dr Monroe alone in attendance, his visits few, and the sanitary surrounding very bad, recovered. This is really a paradox and "something greatly amiss in our calculations," and unjust to consultations. Truly, this seems to be the trouble with many practitioners, "something greatly amiss in their calculations." We must study temperaments, stability and courage of the patient and the different forces of different diseases. Winds and rain floods, owing to their force or volume, become destructive. So do diseases and no man, theory, science or exactness can check them in their progress and many of those caught in their onward march become victims. There are many deficiencies in the medical profession which need, and towards which an effort is made for further improvement, many things to be rooted out, some practitioners called to heaven or engaged in another avocation more suitable to their intelligence and calling, and when all this has been accomplished, then medicine and surgery will become more exact and the mortality of small pox, scarlet fever, diphtheria, tuberculosis, and typhoid will be on the decline and the intelligent practitioner need not cogitate whether the force of the disease or the force of medicine forever closed the eyes of his patients. FRANK R. BRUNNER, M. D., Eshbach, Pa. Diphtheria-Note. Editor Medical Summary: I should have stated in my article which recently appeared in the SUMMARY, that the ingredients entering into the powder I recommended to be blown into the throat and nose in diphtheria, should be pulverized separately, and only combined at the time of using. Druggists would know, but physicians might not, that pulverizing chlorate of potash and sulphur in a morar together, will produce an explosion. So they cannot be pulverized together. Many diphtheria patients die from heart failure. When we find the circulation. feeble, and soft, as though there was no vis a tergo, force behind, we must be on our guard, and try to increase the action of the heart. We can do this with tinct. digitalis, nitroglycerine, some of the cactus preparations and strychnine. What I believe is better than any of these is sulph. morphine, in minute doses. We must remember children bear any opium preparation badly. Therefore the dose must be very small. B. Sulph. morphine............g. ss M Sig. From one-half to a teaspoonful every two hours. This seems to stimulate the action of the heart. It also quiets nervous excitement. GEORGE J. MONROE, M. D., Louisville, Ky. Treatment of Lupus.-Reply, Etc. Editor Medical Summary: I am greatly interested in Dr. Livezey's case, for it was indeed strikingly strange. One would think among the many remedies he has tried, that at least some would have been found to favorably affect it. I don't remember to have seen in his recent article the character and nature of his ulcer stated. Is it malignant, if so, what variety? May it not be tubercular? From his description I would judge it to be a lupus exedens. Has he examined his urine for Bright's disease or diabetes? Are there any tubercular deposits in his lungs? Does the ulcer suppurate freely, and what is its character? This examined microscopically might give a clew to treatment. My treatment would be as follows. Externally:-Cleanse the ulcer with bichloride of mercury, 1.5000, then irrigate with mild boric acid or Thiersch's solution. Dry with cotton and dust with iodoform and wood charcoal, ss of former to 3 iij of latter, or simply with europhen and phenacetine, the latter for its slightly anesthetic, and analgesic effect. This, in my opinion, should start the healing process. If not, it should be brushed lightly with stick of nitrate of silver. Internally:-I would advise the administration of creosote. My favorite combination is: 3 j Tr. gentian comp........... Sig. For one dose, and gradually increase creosote to m x. To the above a little tokay might be advantageously added. If the doctor prefers he can take liquid peptonoids, cum creosote et guaiacol. I have often prescribed this preparation and have only praise for it. In either case the creosote must be taken in large doses and pushed to tolerance and gradually reduced, again returning to the maximum dose. All the good things of the materia medica no doubt have been thought of and suggested to Dr. L, and I believe yet there is a combination that will rapidly heal his ulcer. I should like to hear through the SUMMARY if the coctor will try the above and with what success, provided of course it has not already been done. The only other suggestion I make is skin grafting, done antiseptically, and would advise the grafts to be taken from a young persons thigh. The ulcer must be gotten in a healthy appearance and condition by repeated washings, and I also recommend irrigation with mild boric acid solution in preference to mercuric bichloride, as that has been shown to paralyze the regenerative process. One or the other of these should meet with success, B. RAY BROWNING, M. D., Littleton, N. C. Dosimetric Treatment of Pneumonia. I well remember my first case of pneumonia, as my patient, an old lady, who had a weak consitution and little vitality. That was in '92. This season, about one month ago, I treated a case with the dosimetric granules, which I will give in detail for the benefit of the Summary. On January 3d I was called to see H. F., aged about 32, a strong, robust male. Found the patient with temperature of 103° strong, quick pulse of 96, some headache and a cough, with pains across the chest. On percussion found the lobe of lower right lung congested, The patient was expectorating tough, blood-streaked sputa. I gave him aconitine, four granules, gr. 1-500, dissolved in twenty-four teaspoonfuls of water, one teaspoonful every three hours, to dilate the capillaries, and reduce the fever. To assist the aconitine and slow the heart, I gave veratrine, gr. 1-134, and digitalin, gr. 1.67, to add force to the circulation. These last two remedies were ordered to be given every fifteen minutes until the pulse went down to eighty, and then to be administered every half hour, with the special charge to watch the pulse, and if it increased any, to give them as at first. Bottles of hot water were put under the armpits, close against the side, and to the feet and legs. For the headache gave gelseminine muriate, gr. 1-134, one every half hour, On my call next day found the patient much improved, pulse down to eighty, lower temperature and a general feeling of comfort. Ordered the remedies given Now that we are advised by both our class journals and the secular press, that another epidemic of la grippe has broken out with greater fatality than at any former visit, a short article on that dreaded disease may not be wholly without interest to your readers. While this scourge we call la grippe, which, by the way, may not be so meaningless a name, as some writers would make us think, any more than Bright's disease, Addison's disease, etc., are meaningless, swept in upon us as the profession possessed little or no literature upon it. It has been classed as a disease of the respiratory organs; bacteriologists claiming it to be caused by a "bacillus or micro-organism acting specifically upon the mucous membrane of the respiratory tract." But as most bacteriologists are uncompromisingly prejudiced, looking upon things through their own colored spectacles, which makes it impossible to see things as they are; and since there seems to be a kind of octagonal dispute going on as to the name of bacillus of la grippe, between such distinguished bacteriologists as Prudden, Marmorck, Kowalski, Koch and others of awful" hard names; and since we have no affinity for the bacillus theory we will leave them to fight it out, and if it aids in quieting the "bugs" the world will be the better. 66 Periodically, we may say, a fad or notion comes to us "from over the sea" from a land that is itself greedy for American medical lore, and there are always those who are ready to shout, "Great is Diana of the Ephesians, and it shines and bangs about in vacant heads for a time until some other foreign fad crowds it out, and you must keep out of the way or be ground under their "juggernaut." One more thought here: to my mind the realm of medicine is no fit place for a man whose cranium is crammed full of notions, hedged -walled in-with unbending prejudices. I believe in a man maintaining his convictions of right, but not to the closing his ears against reason. to My investigations, which have been extensive and systematic, aided by other and able neurologists, have convinced me that la grippe is not primarily a disease of the respiratory organs, any further than any derangement of the nervous system characterized by waste of nerve tissue effects the organs of respiration: and right here we will say that the statement recently made by one or two writers that "la grippe attacks all persons indedendent of age or condition of health" does not accord with the results of our investigations and carefully collated statististics, which lead to the conclusion that the brain and cord, especially, must be more or less anemic, and shriveled make an attack of la grippe probable not to say possible; and we repeat what we have before said, that we doubt if a single case of la grippe has developed where the nervous system was in a perfectly healthy state. Touching the contagious or infectious character of this disease a surprising fact is it rarely attacks two or more members of the same family within a period of infection. On the last two peculiarities of la grippe we would be pleased to hear from any physician who has given much thought and carefully observed the workings of the epidemic which in 1890 passed into history as the "Great Epidemic," carrying away in the British Isles in part of that year 4.523 persons, and according to the New York State Board of Health's mortality report that of 123,878 deaths, not less than ten thousand were due to the la grippe directly; to say nothing of the number and variety of cases of neuritis, meningitis, cerebritis, otitis, convulsions, paralysis, hystero-epilepsy, and even insanity. But we are digressing. A few more thoughts on the evident cause of la grippe. True, there exists during the acute attack all the symptoms of an acute catarrh, but this we regard as more proof of the correctness of our position-that it is a nervous disease, as catarrh is the result of perverted nerve force, and often in epi lepsy, an acknowledged nervous disease of the most serious type, a seizure is excited by some invitation of the mucous lining. There is in the beginning of an attack evident degeneration of nerve tissue. Post mortem examinations reveal great degeneration of spinal nerve cells; the red globules of blood are deficient in number, broken down and oviform in shape. Death results from cerebral and spinal disorganization. In the treatment of la grippe, the physician's responsibility does not begin with his call to the bedside of an acute case, nor does it end when he can cease his daily calls, especially if the physician has been long in his field of practice. He knows the history, the idiosyncracies and physical peculiarities of the tamilies in which he practices to a large extent, and no where perhaps, is the old hackneyed saying that "An ounce of prevention is better than a pound of cure" fuller of meaning and significance than in la grippe, Instruct your patients in all that will fortify the nerves, habits, food, and as well, preventive medicines. Let the reader think of this. There are many things that are efficient, used simply as foods that serve us well in building the weak wasted nerves, among which we mention as prominent and meriting your attention now Kolafra. This does not assume the role of a medicine so much as a beverage (or I would rather say food), in place of tea or coffee without producing any of the ill effects often attributed to them; and it not only retards but repairs tissue waste. I believe in Kola and Kolafra, as other valuable preparations of that drug, as most valuable in nervous diseases. The great trouble will be from attempts by unprincipled venders of worthless substitutes; but there are several reliable houses interested in Kola and prudence and care will be only necessary on the part of the profession. The direct treatment upon which we depend, and that has served all others who have adopted it, is directed to the positive renewal of wasted nerve tissue. Stimulation increases nerve waste and must be avoided. Sedatives decrease the blood vessels of the brain and are equally dangerous. I shall be pleased to answer any inquiries I can, coming from any regular physician. J. P. KOONSE, M. D., Lafayette, Ind. |