Editor MEDICAL WORLD: 29. IN Take a board 29 inches long and 12 inches wide; nail at right angles on this a piece 334 inches wide by 12 inches long, placing squarely across the board, 7 inches from one end. Take another board, 22 inches long by 12 inches wide, and nail to the upright pieces, and also to one end of the long board. Thus we have an inclined plane of about 4 inches. The boards should not be more than half inch thick. Have a tin pan made 7 inches wide, 12 inches long and 31⁄2 inches deep; place this, as a receptacle for water, close up to the upright piece and on the projecting end of the long board. The wooden part can be covered by any kind of material. This device is placed upon the floor or bed, as desired, and the patient is to lie down upon Dermal Effects of Cinchonidia. Editor MEDICAL WORLD: On page 418 of THE WORLD Dr. J. W. Groff gives an interesting article on the above subject. The doctor is correct when he says that those eruptions were caused by cinchonidia. I have treated a number of similar cases, but in no instance has the eruption been so severe as to cause me to stop the remedy. The following case is a typical one: P. B., aged twenty-five years, farmer, married, was seized with a severe form of malarial fever. He had neglected to take medicine until his condition was serious. He said he could not take quinine, because it caused a very painful eruption all over the body. I gave him a large dose of cinchonidia, and in fifteen minates I saw just such an eruption as he had described. I convinced him of the necessity of continuing the medicine, which he did. The eruption disappeared, and the fever was cured in a few days. He continued the cinchonidia for several weeks to prevent a return of the malarial fever. Three months later his it on her back, with the knees flexed and her hips drawn just over the nearest edge of the ran. She can now be covered up and the injection proceeded with in the usual manner, either by herself or an assistant. The position is not tiresome, as the woman can have a pillow under her head and rest quite comfortably. It has the advantage of being ready for use at all times, and is very cheap. Not a drop of water need be spilled, as ladies scon get quite accustomed to its use. If desired to give a long injection the pan can be removed and emptied without moving or in any way disturbing the patient. I am well pleased with THE WORLD, also the effects of jaborandi in erysipelas. THE WORLD surely has a sphere of usefulness. Coronado, Cal. DR. W. F. BAILEY. health was better than it had been for five years. Several years have passed, and at no time since the above described attack has quinine or cinchonidia caused any kind of eruption. It is by no means certain, however, that a continuation of the quinine or cinchonidia in such cases will always act so kindly. THE WORLD must continue to come to me so long as I practice medicine. Corinth, Miss. C. KENDRICK, M.D. [Had our beloved friend, Dr. Kendrick, used picrate of ammonia, or the hyposulphite of sodium, or sulphite of magnesium, we are ineffective in much smaller doses, and in many clined to think that the quinine would have been cases it may be dispensed with altogether.-ED.] On account of the elaborate completeness of the index prepared by Dr. W. B. House for our volume for 1888, we find that we cannot issue it until too late for it to go out with the January number. As we do not wish to hold The World back in its monthly visits we will send it out with the February issue. Conservative Surgery. Editor MEDICAL WORLD: On the night of February 11, 1880, I visited a young man who had cut his foot by accident with an axe. I found the next larger toe severed at the middle joint, and hanging by a mere strip. I sewed it on, applied adhesive plasters, and it grew together without any trouble, and to-day the young man has fine, good toes. Conservative Surgery, on this side of the Big Waters," claims priority of date in this case. Lynchburg, Tenn. J. N. TAYLOR, M. D. As to Prescription Writing. Editor MEDICAL WORLD: The Manual of Treatment arrived all right, and I am well pleased with it. In the next edition I hope you will simplify matters still further by writing drachms and grains just as Take the preyou write dollars and cents. scription on page 4 for example. It should stand thus: 40 Strychnia... Acid. nit. mur. .q. s. .01 .3.00 I was led to hope from the last paragraph in the preface you had discarded the diphthongs, but I see you use them even in aqua. And tell me, what is the use of the f before the drachm sign? What is the use of saying fluid ounces of water-is there any other kind of ounce for water or other fluids? I know water can be weighed, but what druggist with common sense would weigh it if the f was omitted? One more question: What is the use of the M. S.? Does not the druggist know enough to mix and write without special orders every time? C. H. MERRICK. Dwamish, Wash. Ter. [In regard to the use of the f to designate fluid drachms, there is no question but that pharmacists would generally comprehend which But there is intended, fluid or solid drachms. are some substances which are sold by both : such as castor oil, glycerine, and the mineral acids. Then, without wishing to cast any reflection on my good friend and ally, the pharmacist, there are some of him who are not very ready in interpreting the physician's meaning, and others who take refuge from responsibility by a rigidly literal obedience to instructions, giving fluid or solid measure as called for. We do not believe that orders for drugs can possibly be too explicit; and we think that the physician should cultivate exactness, and that this should be so well known to his druggist that a mistake as to what is wanted is impos 25 sible. For the same reason I prefer to stick to Diphtheria. Editor MEDICAL WORLD: In the March number of your excellent As my treatment journal you call on the physicians for their treatment of diphtheria. is a little unique and my experience in the disease so different from the most of writers that I have read, I wish to give it to the readers of THE WORLD. My success with the disease has been satisfactory of course, though I have not cured every case; but, with the exception of perhaps a half dozen cases of laryngeal or croupous diphtheritis, I have cured every case, and I have an experience of over sixteen years and have passed through some pretty serious epidemics of the disease. I will begin by saying that I invariably keep the diphtheritic membrane cleaned off the af fected parts. Most writers say, do not use any rough measures to keep the deposit cleared away, but I say, leaving out nitrate of silver and other strong caustics, that are apt to injure sound parts, it is best to keep the dewill reach the diseased parts, and also to keep posit cleaned off so that your local applications the poison from being absorbed into the general circulation. To do this I use the following: No. 1. R Cupri sulphatis. Ext. eucalypti fluidi.. Aquæ destillat. q. s. ad.. .grs. v 3j .git. xx ..fzj M. Sig-Wet a sponge with this, and use sufficient force to wipe off all the white from the tonsils, palate, etc., and be sure you get it all, even if the mopping causes a little blood to come. I sometimes use the following instead, and especially if I find the membrane very tenaceous. No. 2. B Feri perchloridi, M. et. Sig.-Use as with the first. .āā. ....3 iv Sometimes I use glycerine instead of water in this last prescription. After I have well cleansed off the affected parts I apply with a fresh sponge or rag mop the following: B Glycerin. Cupri sulphl. Tr. hydrastis.. Tr. myrrhæ. Aquæ destillat. q. s. ad. .34 gr. iv .gits. x 13j M. et. Sig.-Apply with sponge or mop. Then I take a powder blower and blow upon the parts lac sulphur. The cleansing process M. et. Sig. Apply the liniment with a piece of flannel and allow flannel to remain around throat till the throat is quite sore outside. I give plenty of brandy, milk punches, beef tea (or essence of beef as I call it). When there is much prostration the alcoholic stimulants must be given regularly. Keep the bedding clean and rooms ventilated well. Keep the With bowels open with castor oil and enema. this treatment, sometimes a little varied, according to symptoms, I have pulled many a bad case through, and, though I know others have equal good luck with a different course, still this treatment has been very satisfactory to me. Those cases where the disease is in the trachea, or where the deposit begins in the windpipe below the larynx, I find very difficult to cure owing to the reason that the local remedies do not reach the disease. In such cases I use the constitutional treatment, and give them inhalations of vinegar and water vapor, and of the vapor of carbolic acid, eucalyptus and camphor. When the nasal cavity is affected I inject with a nasal syringe or douche the third mixture in this article. I hope other readers of THE MEDICAL WORLD will give their experience in the treatment of this formidable Pneumonia. Editor MEDICAL WORLD: I see in Dec. WORLD an article by Dr. Wm. B. Bigler, on the treatment of pneumonia by judicious blood-letting, his motto being "Keep blood from your skirts by judicious blood-letting." His treatment is certainly a bold one: bleeding to syncope, a prompt mercurial cathartic, and a large blister; also veratrum viride, tartar emetic and morphine. "If on his second visit he found the inflammation unsubdued, he would bleed again." Now, if pneumonia be due to an excess of blood in the lung, and if by abstracting a sufficient quantity from the patient's arm to produce syncope, regarding syncope as our guide-mark of sufficiency, we thereby remove the cause of pneumonia, then I am in strong and solid favor of blood-letting. But pneumonia is not due to an excess of blood to the lung. The lung is not inflamed because it receives more blood; but it receives more blood because it is inflamed. This excess of blood is caused by pneumonia. Then, if we remove this blood (which I am much inclined to think we do not), we remove only the effect, and not the cause. Does the removal of the effect remove the cause? Not by any means. He says: "He feels himself a very sick man indeed;" and no wonder ! I would rather have pneumonia than to be in the condition the doctor places his patients before he allows them even to start towards convalescence. The mercurial purge is all right if used in the first stage -that of engorgement. It rouses the secre tions, and to some extent relieves the engorged condition of the lung. Now I have seen patients in whom bleeding would at least be harmless, and may have done good. We bleed in convulsions sometimes to quiet the nervous system by the shock produced; but in pneumonia there is sufficient shock to the nervous system without bleeding. Pneumonia is a self-limited disease; and no treatment with which the medical profession is acquainted has ever been known to shorten or cure the disease. All we can do is to watch the symptoms and attend to them as best we can. Vast numbers of pneumonic patients will get well with no other treatment than plenty of cold water and milk. Stimulants are to be given when needed, and they are surely needed the day after Dr. Bigler sees them. I have no special medicines to use. I never give any antipyretic unless the temperature is above 103°. The best I have used has been antifebrin, and I have had a bad result only in one case, in which it produced such profuse sweating that I withdrew it and gave antipyrine. I use plenty of milk and water from the beginning, and rely on good whiskey for my stimulant when stimulants are called for. I almost invariably give small doses of calomel and sodii bicarb. every two hours till I get a pretty free action of the bowels; then I do not give any mor physic till after convalescence is established," unless I think it necessary. I give no quinine unless I have reason to believe there is some malaria in the case. If the cough is dry and painful and harasses the patient a great deal, I give Dover's powders and ext. glycyrrhiza rad., aa gr. v every three or four hours. This combination is pleasant to take, does the patient good, and makes him feel thankful to me, which you know is quite a good thing. Do not forget to give plenty of cold water to drink. As for cough syrups, I generally use this prescription, although there are others as good or better. R Potass. iodidi. Syrp. prun. Virg., 3 iss ...aa..q. s. ad 3 ij M. Sig.-Teaspoonful every four hours. Cold water is the best expectorant. I seldom blister in the young or old, but generally do in the adult. If I blister, I do not use any poultice, and vice versa. This is an outline of my treatment of pneumonia. Of course, I vary from it as the case or cases demand. I presume it will be criticised; but I can bear any criticism for my own good. Still I have had good success in the treatment of pneumonia. Brethren, take hold of the subject and work it well. I am anxious to have this "bloody skirt " shaken till not a drop, not a red corpuscle, remains. W. B. MIDDLETON, M D. Newark, O. Foreign Body in the Trachea. Editor MEDICAL WORLD: Accept my congratulations for the admirable journal for 1888. I can truly say it has been a great help to me in my practice. I send you a segment of a button which remained in the trachea of a child six months. I was several times during that period sent for to operate; but each visit finding the patient better, concluded to try conservative surgery. One day, to the great joy of her parents, in a violent fit of coughing the button was expelled. Bowling Green, Va. C. C. BROADDUS. [The segment is one-half of a colored glass button, three-fourths of an inch in diameter, and one-sixth of an inch thick.-ED.] Treatment of Typhoid Fever. [Dr. Waugh has kindly handed us the following letter as interesting for publication.] Prof. WM. F. Waugh, M.D., tinctoria, gtt. j, hourly will do it just as soon, hydrastis, arsenic, phosphorus, etc., This as I F. A. REW, M.D. P. S. It will be noticed that I have made no mention of the cinchona preparations. Several of my most severe and unfavorable cases have recovered without their use. In other cases I could plainly see that quinine really did harm. Dear Doctor:-I notice in THE MEDICAL WORLD for November your mention of cases of continued fever in which you find, as prominent symptoms, "Fetid stools and breath, debility, anorexia, anomalous pains, etc." II beg pardon for expressing my belief in the have had quite an extensive experience with such cases this past summer and fall, and have often thought of writing you an article on the subject; but have hesitated to do so, as my therapeutics have differed so much from yours. Your assurance that you are not a bit "stuck on the zinc salt (and I hope not on jaborandi) gives me confidence to write the following: I have the careful history of twenty cases tabulated for reference. In all of them, the symptoms have appeared in about this order: First, high temperature, then the muscular pains, then the fetid stools, anorexia and debility. If the first symptoms are kept under control, the succeeding ones are much modified. There may be diarrhea or constipation. My treatment has been to control the temperature, stop the muscular pains (stagnation of the lymphatic circulation), disinfect the stools, and nourish the patient. As my success in these cases has been unusually good, I will mention the remedies used. I control the temperature with antifebrin, or the "febricide" of Thurber, Whyland & Co., and the plainly indicated arterial sedative (this last I insist upon). I have never found anything to relieve the anomalous pains so certainly as macrotys. I use Lloyd's specific tincture or the fluid extract of P. D. & Co., gtt. ij, quaque hora till the pains subside. The sulpho carbolate of zinc will soon stop the fetid stools, but the fluid extract of baptisia "heresy" that all drugs have a peculiar, specific action (Vide. Zinci Sulpho-Carb. jaborandi, et id omne), and when indicated and properly used do good; otherwise they may do harm. I think that quinine is no exception to this rule. F. A. R. A Case of Acute Diffuse Peritonitis of Idiopathic Editor MEDICAL WORLD: The writer was called a few days since to relieve the suffering of Mrs. W., a lady of some forty summers, who, upon interrogation, gave a history of having contracted a severe cold, which had retarded her menstrual flux and given rise to anomalous pains. Those causing her most inconvenience being restricted to the sacral and lumber region, which were very much intensified upon assuming the erect posture. Within a few hours of my summons she had suffered but little inconvenience from the condition mentioned. There ensued, however, an eruption of symptoms of the most agonizing nature, suggesting to those present the possibility of congestion, a term associated with all that is dread and appalling to the credulous layman. Broad in its significance, it is very much used by some physicians of to-day as a subterfuge with which they cover their ignorance of existing morbid conditions. Hence its application by those to whom it is so often reiterated. |
