PRACTICAL

PREPARATIONS, ETC.

VOL. XXXI

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No. 4

ceaseless daily grind that they often forget to live. It is a good time to take a short vacation. If you will maintain the entente cordiale between the doctor across the way and yourself he will perhaps look after your patients and treat you right. Even though you do not take a vacation and remain at home during these long quiet days, endeavor to do something out of the ordinary. If you do nothing more than read and digest a volume of poems or delve into some new scientific subject for a little while, you will be a broader and more versatile man for so doing. June is the ideal month for the doctor who desires recreation and mental embellishment.

mer.

JUNE.

May and June are the healthy months. of the year. The balmy air and pleasant sunshine are a compromise between bleak winter and the enervating heat of midsumSuch days help to eradicate gloom and pessimism from our lives. This may smack of a little preachment, doctor, but you will pardon the suggestion. We want you to enjoy these long, beauteous days while time hangs rather heavily on your hands. Go to work enjoying yourself and having a good time. So many doctors are so continually wrapped in their routine of work and become so accustomed to the

DIRECT TRANSFUSION.

The idea of direct transfusion is rather old, but it is only in times quite recent that the procedure has gained anything like general recognition. The technique of the operation is effected by causing an anastomosis of the arteries of one individual with the venous system of another, the former being the donor and the other the recipient. In exhausted, depleted, and exsanguinated conditions life may be saved by the sufferer being permitted to have the healthy blood of another person pumped into his veins.

But here we wish to sound a word of caution. Transfusion cannot be performed

indiscriminately. Persons suffering from blood dyscrasias and with a very small quantity of this life fluid have blood-vessels and hearts whose strength is in keeping with the state of the blood. To run a considerable quantity of blood into such an individual may mean to waterlog the heart or rupture blood-vessels, and cause sudden death. Such a case came under our notice. A man suffering from a constitutional disease in which anemia was a factor, was pumped full of blood from his healthy brother. Death ensued in a very few hours. Transfusion, like everything else, has its limitations. Its special field is in normal states of health in which there is sudden loss of blood.

CONVULSIONS.

First get excited relatives and attendants busy heating water and doing other things while you can give your attention

to the sick child. Take with you a syringe to which you can attach a small soft rubber catheter. Irrigate the bowels as high as possible with soap suds. A few ounces of glycerin or castor oil added to the water increases its efficacy. If the stomach is loaded administer ipecac if the child can swallow; otherwise inject, hypodermically, 1-12 to 1-20 grain of apomorphine. This will produce emesis in less than five minutes. Meanwhile the spasms may be broken or mitigated by inhalation of ether or chloroform administered cautiously. The mustard bath is very classic treatment with the laity, and is probably beneficial. The after treatment is to administer calomel or rhubarb, followed by castor oil. If there is a strong nervous element bromide of sodium or potassium should be given to prevent recurrence by sedating the nervous system. Belladonna is also sometimes given. This little dissertation seems absurdly simple, but it does the work.

TYPHOID FEVER.

Young physicians are inclined to attach too much significance to intestinal antisepsis, or rather the attempt to bring about such a desideratum. Without good and sufficient elimination there can be accomplished no semblance of intestinal asepsis. This should be done early and effectively before putrescent matter has made inroads upon bowel tissue, and the toxins have exerted enervating effects upon nerve and ganglionic centers. Calomel, salines, and castor oil are our most effective remedies. Colonic flushings are at times of the greatest service. In one case treated by the writer the hyperpyrexia resisted all remedial measures until the colon was thoroughly lavaged, when the high fever dropped. There was washed out offending scybala which had not been affected by cathartics, but remained in quiet nooks of the large bowels, a menace to the life of the patient. Few typhoid patients will become dangerously ill, and in that low state of inanition so suggestive of death if the alimentary canal is kept reasonably clean from start to finish.

THE BABY DOCTOR.

It is sometimes amusing to note the reputation and prestige a medical practitioner unconsciously wins in the minds of his clientele and the public generally. If his acute cases usually terminate favorably he may earn the credit of being a good "fever doctor," while if he chances to have bad luck, either avoidable or unavoidable, with a woman or two in confinement, he sees his reputation as an obstetrician go glimmering. While this may be the case with Jones, perhaps with Smith it is a vice versa case. The inexorable law of compensation usually wins out, and every physician, however humble, will eventually get to a plane where he is appreciated by a certain number of people.

It pays any doctor to win the reputation of being a good doctor for babies, provided he ever puts forth zealous efforts to make good. There are not a great many medical men who care to be known as good "baby doctors." When we contemplate upon the fact that about nine-tenths of general medical practice concerns women and children, it is surprising that more physicians do not pay more attention to the ailments of infancy and childhood.

There is no medical matter of more vital interest than that of the scientific feeding of infants. It is a subject with which all doctors have a speaking acquaintance, but of which few, indeed, are masters. Infant mortality has been prodigiously reduced since better sanitary and hygienic measures have been adopted in our large cities. It should and will in time be reduced still lower. The education of mothers along the line of correct infant feeding and hygienic management, depends largely upon the family physician. The doctor who would successfully tide these little ones along until their growth and nutrition are well established, must be both vigilant and versatile. He may not be able to change a bad environment into one that is altogether sweet and wholesome, but he should work to that end.

The diagnosis of infantile conditions is not usually so difficult, notwithstanding the oft-repeated lay platitude about the little fellow not being able to tell where it hurts. To those who will carefully study the young child when ill there are symptoms spoken in "a various language." The objective and subjective symptoms of disease and ill health are both manifest. It is much easier to make an accurate diagnosis of a young child's case by making friends with him and thus lessening his antipathy for the doctor. The examination of the throat should usually be the last procedure, for this too often puts the little one in a belligerent mood and severs the entente cor

diale between him and the doctor. The examination of the child should always be thorough and satisfying to the physician; too often it amounts to little more than a momentary inspection. Often the doctor feels it his bounden duty to "give something" for the psychic effects upon the parents when, in reality, no indicated line of medication has yet presented itself to him.

It will pay any doctor in general practice to give more attention to the troubles of babies. He should be especially painstaking in his diagnosis and cautious in his therapeutics, always working along the line of least resistance.

INDEPENDENT JOURNALISM.

This subject may seem to you, dear reader, as being trite and commonplace. It is a matter that concerns you as well as the publisher. There seems to be a concerted action on the part of a few to freeze out the independent medical press. Will you, reader, stand for this? The independent journal is the only kind that is untrammeled and without bias. It stands for the rank and file, "the hewers of wood and drawers of water," as it were. It is opposed to cliques, clans, and trusts. It is the representative of the independent doctor. It is his mouthpiece. And after all many of the best ideas and inspirations come from men who are toilers in this humble class. To be independent does not mean to be iconoclastic or non-progressive. An independent man or organ is one who vehemently opposes second-hand thinking and cut-and-dried rules, and regulations. which others seek to foist upon him. Independent journals have a mission to perform that cannot be subserved by those under the dominion and guidance of organizations, no matter what virtue and ideals the latter may claim as all their very own.

AS OTHERS SEE US.

"With its March number THE MEDICAL SUMMARY begins its thirty-first year. The SUMMARY is not as pretentious as some of our exchanges, but Dr. Andrews, during the period of its existence, has given to his readers a really useful journal, indeed; a journal well suited to the class of physicians for whom it was intended, namely, the average practician. The SUMMARY has been clean, kindly, and uplifting in its field during all the years in which we have known it. Andrews is a good man personally, a man who, throughout his journalistic career, has tried to do right according to the light that was in him. There are other journals which could be much better spared than the SUMMARY. Take any copy and go through it, asking this question: What is there in this which would be likely to give real help in his daily work to the average practicing physician? You would not find a great many publications that would count up as many useful suggestions as would the SUMMARY. We hope that Dr. Andrews finds his work fully appreciated, and that the SUMMARY is as prosperous as it looks." -The American Journal of Clinical Medicine for May, 1909. In reply to the above we have nothing to say but Thank You, Gentlemen; Thank You.

THEY DO NOT AGREE.

The recent adverse report of the Council of Pharmacy on what is claimed to be a preparation of strictly chemical composition by the manufacturers, The Organic Chemical Manufacturing Co., has elicited considerable controversy as to test given it by that august body, which, it is claimed, did not include one prescribed by the United States Pharmacopeia. The council's report does not agree with the chemical and therapeutic tests before made of same preparation by a well-known chemist

and a prominent member of a State Board of Medical Examiners: one a chemist of reputation, and the other a practitioner of known ability.

DID YOU SEE IT?

In the April number of THE MEDICAL SUMMARY there is a very good editorial, entitled "A Business Talk."-The Philadel phia Physicians' Business Journal. By the way, this is a new monthly publication devoted to the business interests of physicians.

The reader will notice that "A Business Talk," mentioned above, was continued in the May issue of the SUMMARY, and we expect to have more to say on the same subject from time to time in future issues.

"THE GUN."

This is the term employed by the dope world to signify the hypodermic syringe. Its use is becoming more and more common by denizens of the underworld, as well as many who lay claim to education and respectability. Doctors are largely responsible for the quite general use of narcotic drugs hypodermically employed.

LITTLE SUMMARIES.

The young doctor knows more than the old doctor, but the latter gets more busi

ness.

How many SUMMARY subscribers employ automobiles in their professional work? We would like to have a symposium on this subject.

Calomel usually helps to mend the broken heart of a sixteen-year-old girl if her cardiac wreck has been caused by unrequited love.

Every old drunken doctor has his remaining vestige of pride tickled every day by his foolish friends, who say: "Doc. is a splendid doctor if he would only let whiskey alone."