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Hydrocephalus Complicating Labor. easily slip it off. The nurse, or midwife, said EDITOR MEDICAL WORLD:-I notice in your
that she was sure she had tied it tight. December number, page 463, that Dr. J. G.
This, of course, furnished a good text for Knox, of Toomsuba, Miss., describes. three
me to talk to the parents about having an cases of “Hydrocephalus complicating labor,"
ignorant midwife in such cases. (They have and desires to hear from other physicians
never had one since.) who have had such cases, and how they
Now, at the very next case of confinement
which I attended there was no one to wash manage them." I have only had one such case, and the
and dress the baby, and no neighbors near, so
I proceeded to fix the little fellow myself, and patient was a white woman. It was a head
I might say here that I used an extra amount presentation. The case was a complete puzzle to me for
of caution in tying the cord, which was very
thick. several hours. In vain I searched for sutures and fontanelles and other obstetrical landmarks
Having occasion to go on beyond to visit a of the fetus. I had carefully watched all
patient, I stopped on my return to see how the
? through the first stage of labor, and could get
woman and child were getting along. What
was my chagrin to find this child in the same even no tidings of a head, arm, leg, body, hand or foot; but there was something present
condition as the other one-bleeding freely ing which at every pain grew tense and relaxed
from a flabby cord, with the ligature large in the interval. Finally it came within easy
enough to tie three such cords. Ever since reach, and there it remained hour after hour.
that time I have made it my rule to roll the I applied the forceps once, twice, three times,
cord between thumb and finger for a few sec.
onds before giving it to the nurse, and if the and they slipped off each time. I was perplexed. Passing in the thumb and forefinger
cord is large I find it dwindle in my fingers to I found that I was able to pull hair, and to
half its former size; then I tie it again and, discover that if it were a child this was surely
whether tied with wrapping twine, twisted the head. Then for the first time in my life
thread, linen, or silk, I know that cord is not I realized the value of hints I had seen in books
going to bleed any more where cut.
& and heard in lectures concerning"Hydroceph
In regard to “painless parturition” I have alus as an obstacle to labor." I punctured the
tried various methods of dieting, etc., with no head with a large trocar and it collapsed; then,
success, as far as entirely doing away with
pain is concerned. But I have attended two seizing hold of the long empty hair.like sack, I made traction and, with great difficulty,
ladies living under the same conditions, eating delivered the body of a very large male child.
the same food, both living in good hygienic All the bones of the head, above a line
surroundings, both in the same week. One drawn around the head just above the ears
suffered intensely for a number of hours from and eyes, were absent, exeept a piece the size
the time the os was dilated enough to admit of of a silver dollar attached to the inside of the
one finger; the other had no pain scarcely. skin near the top of the head. There was very
Although a primipara, yet with the expulsive little substance present. The mother made a
efforts she said she had no more pain than she good recovery.
would have in having a passage of the bowels J. G ATKINSON, M. D.
if constipated. In fact she had absolutely no Oak Hill, N. B., Čanada.
pain until the os was dilated almost sufficiently
to slip over the head. Tying the Cord.—Painless Parturition.
From my experience I would say that I
know that living a temperate, orderly life, Effects on the Unborn Child of Drugs
with enough exercise-in fact living as a woGiven to the Mother.
man should, be she pregnant or not, will aid EDITOR MEDICAL WORLD:-"Doctor," on materially in giving the woman an easy, safe page 422, of November WORLD, invites dis- and quick labor. cussion on the manner of tying the cord. When But some women will suffer greatly in spite I had been practicing medicine for perhaps of everything, and others will suffer very little five years, I arrived in answer to a call at the whether they diet, etc., or not. house of Mr. M., one hour after the birth of a I would never advise a woman to go without child.
any food she craves for, if consistent with I found the mother doing well, but the baby ordinary common sense. was blue, with cold hands and feet (dressed); I would like to see an expression of opinion nurse saying that she could not get them as to the effect on the unborn child in giving warm. On examination I found the baby's such drugs as chloral, morphire, etc., to the clothes round the navel saturated with blood; mother during confinement. In my practice, ligature round the cord so loose that I could in attending over three hundred cases of con
finement, I have had only two still births at term. One was my first breech presentation, the other was a case where the woman had been suffering for three days. When I arrived I found the attendant urging her to bear down, etc. I gave her a dose of chloral and morphine to relax the constricted womb, and give her rest. She never felt any motion of the child afterwards, and, although the child cried once, it died in spite of artificial respiration, etc., and I could never hear or feel any heart beat.
Vernonia, Oregon, C. H. NEWTH, M. D.
Umbilical Hemorrhage. EDITOR MEDICAL WORLD:-The discussion of the subject of umbilical hemorrhage in the Jan. WORLD calls to my mind the following case. Nov. 9th, 1891, I was called to attend Mrs. N. in her third confinement. The child's head was born just as I entered the room, and before I could disengage myself from my overcoat and wraps to render assistance the cord, which was short and wrapped around the neck, pulled in two close to the navel. So soon as the body was sufficiently expelled to reach it, but not before a strong gush of blood had occurred, I seized the navel with the surrounding skin and held it firmly for several minutes between my thumb and fingers. The child lay as if dead at first, but soon rallied and cried lustily. The remaining portion of the cord was so short that it could not be tied, so I dressed it with oiled muslin and a small compress. No further hemorrhage ensued and it did well thereafter.
In THE MEDICAL WORLD, Feb. 1890, page 73, I reported a case of severe umbilical hemorrhage (for some reason Dr. Anderson failed to index it') which occured on the eighth day, and which, after other means had failed, ceased immediately on the application on and around the umbilicus of a paste made of plaster of paris, secured by a compress and bandage.
Decatur, Ohio. L. C. LAYCOCK, M. D.
Indolent Ulcer of Leg. EDITOR MEDICAL WORLD:-In answer to N. H., in December number of THE MEDICAL WORLD, in regard to sore on leg, allow me to say that the name is very indefinite. Taking for granted that the inquirer means ulcer of an indolent nature, the following treatment will bring the ulcer to a happy termination sooner than any other treatment I have tried :
Apply adhesive plasters about the edge of the ulcer to hold the integument and deeper tissues as nearly at perfect rest as possible. Then dust on the following powder : R Zinci oxidi
Bismuthi subnit.......... aa equal parts M. Let this be dusted on once or twice each day, but do not wash away any of the powder or allow water to touch the sore.
This treatment brings two important factors of nature to assist in the healing process, viz: rest and stimulation. The powder forms a layer, underneath which the healing process goes on uninterruptedly. Unhealthy granulations are kept down by the zinc, and every requirement for cure is present, except, probably, in cases where the patient needs toning up-or where some function is being improperly performed because of the condition of life of the patient.
Every ulcer of the leg needs some particular course of treatment, which can be given only after a close inspection of the ulcer.
As a rule the treatment mentioned above will answer, and will always prove successful if the bodily functions are properly performed, and the ulcer is an indolent one. Huntsville, N. J., SIDNEY B. STRALEY, M.D.
Intuitional Prognosis. EDITOR MEDICAL WORLD :-I am not superstitious and do not believe in modern spiritism, visions or dreams; neither do I profess to see farther into the future than any fellow practi. tioner : but a certain phenomenon has occured in my professional life which may be of interest to the readers of THE MEDICAL WORLD, that care anything about the anomalies that occur in the healing art.
To prognosticate the determination of a disease, either in health or death, without drawing somewhat upon our past experience, medical knowledge, or even common sense, would look like foolishness in the extreme; and so it would be were we to advocate such a proced. ure in all cases. Nevertheless, I can recall, during a practice of nearly thirty years, from fifty to one hundred cases, where my prognosis has been determined in this manner.
This intuitive knowledge does not come at my bidding, but in an instant and when least expected, and is usually contrary to my betier judgment, if I may so speak. That you may the better understand me I will give a few typi. cal cases, without saying anything about diagnosis or treatment, which, you will readily un
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derstand, do not have any bearing upon the Did not improve at all, and I was sent for. Sat subject.
by his side laughing and talking when I looked About twenty-five years ago I had a partner upon the bed and saw him apparently cold in much older and more experienced than myself. death. I then examined him and told him that He was away on a visit, when a young man I did not understand his case and would not belonging to one of his families was taken ill, attend him unless he got the best counsel he and I was sent for to attend him. He went could find in Chicago, as I considered his case from bad to worse and at the end of the week serious. Told the wife and children that he did not think that he could live another would die. The counsel came and gave the day. The old doctor returned, and we were family hopes of his recovery. He died in about both summoned to the patient's bed-side. As a week. I opened the door to his room, I saw the patient was called about one o'cloek a. m. into the (in a vision) sitting up by the side of the bed, country to another doctor's patient, to see a looking quite well. This vision brought a per- lady that was dying. Arrived and as I entered fect confidence to my mind, as it has in all the room saw several grown up children cry. such cases, that the disease would terminate as ing, at the foot of the bed. As I adjusted the indicated in the vision; and I immediately optics of my second eye sight upon the dying told the mother that her son would recover. woman she appeared in tolerably good health, The old doctor, not being a religious man, car and the whole scene seemed so ridiculous, that ried with him a vocabulary of words usually I laughed aloud. Now those who know me the associated with pirates, and as we reached the best have realized that I have not lived a life next room, he rehearsed them to me quite of hilarity, and do not give such utterances of freely, winding up with the statement that any pleasure very often; and particularly when I fool would know that the young man was dy- am called in the presence of the dying. This ing." He made a rapid recovery and I saw came near being a dear laugh, for the husband, him in a few days, sitting by his bed-side, quite who was a large strong man, said he came near well.
kicking me out of doors. She made a rapid Was called to attend a boy eight years old, recovery. stranger, living in a distant part of Chicago. An old friend of mine had been running As I entered his room, I saw him a corpse. Ex- down for a year, I could do him no good. Had amined him and did not consider him much counsel, but he gradually grew worse. Became out of health. Told the mother that her son unconscious and apparently moribund. As I was dangerously ill and that she had better watched over him and tried to count his flick send for her family physician. He was sentering pulse, saw him sitting up in another part for and came. After this very polite doctor of the room in his sick chair looking quite had informed the parents that Dr. Dodge did well. Got up and went out in the next room not understand his business, and said the boy where his grown up daughters were and told would be all right in a few days, I had nothing them their father would get up again. He did more to do with the case until the seventh day, get up and lived for several years in comparawhen I was called in to see him die.
tive health. Was called to see an old man seventy-three The next and last case I will record is someyears of age (if my memory serves me correct. what different from all the rest and unique in ly). After giving him a thorough examination, itself. . looked upon his case as desperate. Told his Stranger came into my office to see, as he son to send for counsel; two physicians came expressed it, if I could tell him what ailed him, about ten a. m. Prognosis,-death within a whether I could cure him. Diagnosis obscure. week, or, as they expressed it, “there will be a Told him if he would follow my prescription funeral in this house within a week." Went for two weeks could tell him whether I could back to my patient about four o'clock in the do him any good. Sent for me to come to his afternoon and found him worse. As I sat by house in two weeks, and demanded that I his side I looked up to the door leading to his should tell him whether or not I could cure him, sitting-room, and in he walked, smiling and and if not how long he was to live. Somein good health. Three or four weeks after this times our patients are so exacting about such I was called to see my patient's wife who was things that we have to refer them, after we have sick in the same room. In a few minutes I exhausted our own skill above for further inforlooked up to the door and in the old man mation. But not so in this case. I was in a walked, not in a vision this time but in reality. deep study trying to conjure up something to
Had an old friend in Chicago who had been say, when I dimly saw the man in a coffin. Ir. ailing, as he expressed it, for several days, as some respects the man had improved during there was a Homo. man called in to see him. the two weeks of my treatment; but my progThis doctor said he would be well in a few days. nosis had been foreshadowed, and I no longer wanted the case. I said "I can do nothing for ing which time I treated twenty typhoid cases, you, and it is my opinion no one else can. I I have been using sulpho-carbolate of zinc, do not think you will live four months.” He with much happier results. This is the general sent for another physician, and I lost track of outline of my treatment. I have had all my him for between one and two months. At the cases to go through the full term, and have had expiration of this time I went into a grocery the honor of seeing all my patients recover but store to do some trading, where I found him one, and in that one the parents injudiciously apparently improved in health. As I went in administered a course of calomel and santonine he pointed me out to a half-dozen standing without my authority or knowledge, and the around as the doctor who did not know every little fellow died in about twenty-four hours thing. He went on with his tirade about thereafter. doctors in general and me in particular, until Dr. Etter says that they take it for granted I could stand it no longer. I said_“Gentlemen, that they are going to have a case of typhoid I did say that Mr. D. would not live four fever, &c., which we do, and I follow his line months, and I want you to write down what I of treatment for three or four days, and it connow say. Mr. D. will not be alive six weeks tinues all the same. I attribute my success from today." About a month after this he sent greatly to the calomel, followed by the antifor me and apologized for what he had said in septics, iodine and carbolic acid. They the store, and in a few days died.
almost all recover in from twenty to twenty six I have simply stated facts and shall defer days. giving any explanation of the whys and where Gann, Tenn. T. N. Cochran, M. D. fores until scientists tell us what life and matter are, and their proper relationship with
Mercury in Typhoid fever. each other, which will be in the far distant
EDITOR MEDICAL WORLD.-I must say that sweet bye and bye.
I am very much interested in some of the W. C. DODGE. M. D. articles in the December number of THE Mount Dora, Florida
WORLD, more especially the articles on typhoid [Dr. Dodge is a graduate of Jefferson
fever. I cannot agree with Dr. J. R. Etter Medical College, Philadelphia, of the class of
as to his theory of typhoid fever, as he im1864.-Ed.]
plies in his article that typhoid fever is not a
germ disease, or, in other words, a disease of Treatment of Typhoid Fever.
itself, but rather a neglected case of remittent EDITOR MEDICAL WORLD :-In your Decem- fever-a theory which has long since been exber issue is an article written by Dr. J. R. ploded in the progress that pathology has Etter on the abortive treatment of typhoid made of late years. I cannot agree with him fever, saying that in sixteen years practice he as to his ability to abort typhoid fever either, had not one case of developed typhoid fever in but am prepared to admit that his mercurial his own families. He also states that typhoid treatment may lessen the gravity of the disease is very prevalent in his community, and seems and, perhaps, in 14 to 21 days the fever may to place the entire credit of his own success to subside without having attained any very great calomel. How different his experience is to degree of severity. While giving the doctor mine. I have in the last seven years treated credit for his article and his desire to benefit about one hundred cases of typhoid and his brother practitioners by his experience, I typhoid malarial fever. My plan of treatment am compelled to say that he has been exceedhas been about as follows :
ingly fortunate in the class of cases he has been I invariably begin with about six grains of called on to treat. I am very much pleased calomel in three doses of two grains each, to with Dr. O'Neal Menden hall's article on merbe given two hours apart, this to be followed cury in typhoid fever, and see that his experi. in from six to eight hours by a full dose of oil ence in his cases has been very much like my and turpentine. I often repeat this as often as own. twice; then I leave calomel off for good, for I have come to the conclusion that mercury by this time I have aroused the secretions is one of the principal remedies in this disease. pretty well and have my case pretty well My rule is that as soon as I am able to make shaped up. I almost invariably administer my diagnosis of typhoid, I give for an adult from ten to fifteen grains of quinine during about fifteen grains of mercury in the form the morning remission, relying on bismuth sub- of calomel, and give all through the course of nitrate five grains every four hours, alternated the disease about one or two grains during the with tincture of iodine, drops two, and carbolic twenty-four hours, with salol in five grain acid, drop one. With antifebrinę and bathing doses four or five times a day, using no antipy. I hold the temperature as rear normal as retics except warm water with soda, with possible. However, for the past summer, dur- which I have my patients sponged frequently.
I keep everything about the room as aseptic as possible, changing the sheets and clothing at least every other day, using liquid food. I prefer Carnrick's or Mellin's with milk, etc.
With the above plan as thus briefly stated I have been very fortunate, and have noticed in several cases in which the patients complained of their gums being a little sore, and gave a slight metallic smell, that the fever never ran very high, and that I had no unpleasant effects from the mercury. As a
a matter of course I use a mouth wash, and generally in from fourteen to twenty-one days my patients are clear of fever and have made a good recovery. I should like to hear more upon this subject.
I have now a case, Mrs. J., who was feel. ing quite badly for a couple of weeks before I saw her. She stated that every morning she had a slight chill, headache all the time, and disturbed sleep. When I first saw her her temperature registered 103.5 degrees, pulse 110. She was restless and uneasy. I gave twelve grains of calomel in eight capsules with five grains of salol. The next morning she said she had rested well, temperature 10112, pulse 96. Continued the calomel, using a mouth wash, and from that time to this her fever has never been above 100 degrees. She says that she feels able to get up and go about her work, but I find that she has a little fever (99.5 degrees, pulse, 84,) and this is about as low as I am able to keep it: I expect in the course of a few days to report her convalescent. I forgot to state that upon the third day she was slightly ptyalized.
Now, my reasons for giving mercury are, that ist, it cleans out the “ Augean stable" better than anything else, without much danger from prostration; and, it is our best antiseptic and 3d, when its physiological effects are obtained the bowels are so thoroughly aseptic
ghly aseptic that it is impossible for reinfection to take place and the disease runs a short course without high fever; generally it does not last over fourteen to twenty-one days and the patient is not much reduced in flesh and strength. I will add that I give my patients their food as regularly as their medicine, and believe that much of the success in the treat
treatment of this disease will be found due to a properly regulated diet and proper hygienic surroundings.
J. M. APPLEWHITE, M. D. Corvallis, Oregon.
Typhoid vs. Bilious Fever.-Cupric Arsenite.
EDITOR MEDICAL WORLD:_Dr. J. R. Etter has an article in December World on the prevention of typhoid fever, in which he very graphically describes the method of aborting the disease by calomel. As I have had no ex. perience with the method I may not be in a position to criticise, but his views on the cause, symptoms, etc., of the disease, are at total variance with the accepted and recognized opinions of all the authorities I have read. Be it remembered that I am actuated by the kindliest of feelings in my remark kindliest of feelings in my remarks, recognizing that magnanimity ever invites and holds sway over the true physician, no matter how different our opinions may be. He says that, "All cases have symptoms in common with bilious or malarial fever," implying, I infer, that cases may commence as bilious fever and develop into typhoid, which they will never do unless the specific microbes of typhoid enter the system. We can, with just as much reasoning, say that every case of measles commences as scarlatina and vice versa.
Another cause advanced by the doctor would give the disease an auto-infectious origin (which I think is extremely doubtful) for he says that " it is only after the system be. comes poisoned by reabsorption of the material that shonld be thrown off by the bowels, kidneys and skin that the symptoms peculiar to typhoid fever are developed."
Now, I suppose that all physicians who have had any experience with typhoid fever cases, especially where malaria is prevalent, has recognized a mixed type of the disease, one or the other predominating according to the potency of their specific elements : hence the disease has been denominated typho-malarial fever, and the admixture of symptoms belong. ing to both diseases in the same case are frequently met, at least such has been my experience in malarial regions. But the slow, insidi. ous development of typhoid, the gradual rise of temperature, the abdominal and other symptoms, are sufficiently striking (in uncomplicated cases) to prevent confounding with bilious fever. Bnt I do not wish to undervalue the doctor's treatment, for I think any man may justly feel proud, and certainly deserves the highest encomiums of this age, both lay the highe and professional, who has " practiced medi. cine sixteen years in a community where typhoid fever is the rage every year, and has never had a developed case.”
I have read several articles in the journals of late on cupric arsenite in diarrhea, both P pro and con, but my experience with the remedy will not allow me to condemn it as entirely useless. On the contrary, I have employed it
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