SEPTEMBER, 1903] Phosphates and Hypophosphites-Coal Oil Poisoning Phosphates and Hypophosphites. Editor MEDICAL WORLD:-As one of the suggested subjects of discussion for WORLD readers was phosphorus, I would be pleased to contribute my mite of experience: In my practise I use about fifty pounds of phosphate of soda per month, usually buying it in 100 pound lots, thereby getting it for half the usual retail price. I find the ordinary country drug store rarely has ten pounds of sodium phosphate on hand, which goes to show that I have gone somewhat to an extreme in its use. Sodium phosphate is my preferred saline laxativ. While it is "laxing" it is also rendering very useful service in the liver. and blood. It is indispensable to me in malaria and biliousness, where I use it. in doses varying from 3ss to 3ij, at intervals of from one to twenty-four hours, as the case may be. Too much sodium phosphate rarely does harm; in fact, "too much" is sometimes just enuf. It is a "pius notion" in the first stage of typhoid to give from five to ten grains of calomel, and then give 3ss of sodium phosphate in hot water every half hour or oftener until vomiting results, good and plenty, and even then keep it up, for by so doing you may abort the typhoid, and this is a very desirable result to obtain when the folks are poor pay. Whiskey-soakt stomachs usually revolt against phosphate of soda; and it is a splendid idea to let people with such stomachs get almighty sick. Now phosphate of soda does not require any of the effervescent attributes excepting when the patient is an epicure or a crank, or has one of those sensitiv whiskey stomachs. If the taste must be disguised, sweet milk or cream, or condenst milk, may be used. The writer finds that when it is desirable (and so it often is) to make the medicin bulky, that the patient may feel that he is getting his money's worth, a box of phosphate of soda colored brown with licorice to disguise its character is just the thing. The writer uses Abbott's granules extensivly, and deeply feels the necessity of a bulky prescription, not only to satisfy the faith of the patient, but also to make him feel that the doctor has given him a good bargain. Now, as to the hypophosphites: There is a notion that they should be prescribed as syrups. This is an advertising fad. The hypophosphite of calcum straight, in a capsule, or in a powder to be taken dry upon the tongue, or even in solution with plenty of water, does all the high-priced, fancy syrups can do. course, a case sometimes also demands iron, quinin, and manganese, but as long as plenty of the calcium hypophosphite is used it is not essential that the others be hypophosphites Of 411 also. However, the ideas upon these matters that mean profit to the syrup seller are the fad theory of the hour. The writer has furnisht his patients with medicin for years, and therefore has found that ten cents worth of calcium phosphate and some plain, old-fashioned quinin and citrate of iron will do every bit as much good as a dollar bottle of the hypophosphites, label and all. And in very fact, the common phosphate of soda, manufactured by Merck and others, is superior to the effervescing article. C. E. BOYNTON, Los Banos, Cal. Religious Press Advertising. Editor MEDICAL WORLD:-Noticing in the August WORLD the article "Medical Advertisements at Last Excluded from the Methodist Press" (page 344), I send you by this mail a copy of the Nashville, Tenn., Christian Advocate (Methodist paper) which has always, since I have taken it, over twenty years, been a clean exception instead of the rule with it. paper, patent medicin advertisements being the Saulsbury, Tenn. W. L. GODDARD, M.D. [We received the paper and find its advertising pages exceptionally clean-free from nostrum advertisements, and carrying an exceptionally high class of advertisements. Doctors and other intelligent classes should notice this feature of religious papers, and protest against objectionable advertisements therein.-ED.] Rag Weed for Poisoning by Poison Vine. Editor MEDICAL WORLD:-I notice that several members of the " family" want a remedy for poison by poison vine. Ambrosia trifida, commonly called "rag weed"—a strong decoction of this weed, and compresses wet with it placed upon the abrasions frequently repeated, will relieve very promptly. I have been using it for seven years, and in my hands it has been a specific. There has been no tincture or fluid extract prepared of it until within the last year. P. D. & Co., of Detroit, Michigan, have been preparing one recently. Topeka, Kansas. J. A. G. SAMPLE. Coal Oil Poisoning. Editor MEDICAL WORLD:-I beg to report a case of poisoning by "coal oil." Patient, male, 16 months old, drank about eight ounces of the refined oil at 9 a. m. Parents immediately gave several doses of salt water and mustard water, without causing vomiting, and then. gave a tablespoonful dose of castor oil. Within an hour of drinking the coal oil the patient fell into a deep sleep from which they were unable to awaken him; his skin was cold and bluish in color, pupils dilated, pulse weak and fast but could not be counted by parents; breathing was short and described as panting. After a sleep of four hours patient awoke but was nervous and had a high fever. I was called at 10.30 p. m. and was at the bedside at 12.45 a. m. and found the patient in the following condition: Pupils dilated, muscles twitching as if convulsions would occur, skin hot and dry, tongue had a heavy coat like white flannel, pulse thready and fast, was unable to count it because of the restlessness of the patient. Bowels tympanitic, tender to touch and had not moved since drinking the oil. Urin was voided once during the day. Treatment: As the patient had drank during the day about a pint of milk and was not sick at stomach, I decided that the oil had passed on thru the stomach, and elimination per rectum was indicated. I prepared a gallon of water as hot as I thought the patient could stand it, and used a colon tube with fountain syringe, using the full gallon. The bowels moved immediately, a large number of lumps. about the shape and size of marbles coming away with the straining following the flushing. Gas escaped quite freely, and the bowels lost their tenderness. Patient became quieter. Pulse gained in volume, now beating at 130 per minute full and strong. Temperature in axilla 102° F. The muscular twitching still kept up. I now gave calomel 4 grain and bismuth subnit. Two grains every two hours when awake, and two grains acetanilid every two hours. This treatment I kept up until 7 a. m. Temperature then 1032° F., when I gave aconite and passiflora (Lloyd's specific tinctures) alternately every hour when feverish. Next day the temperature was 100%; kept up same treatment and next day temperature normal, and all indications pointing to the child having fully recovered, the case was dismist. As soon as the bowels moved from the effects of the calomel the muscular twitching ceast. о After the fluid, consisting of oil, water, and fecal matter was allowed to stand for a time it would burn with the characteristic flame of coal oil. Urin was voided as soon as patient commenced to strain from the effect of the injection. Guilford, Mo. A. D. BARNET. The Doctor's Telephone Bell. 1 With apologies to Mr. E. Poe.) Hear the ringing of the bell Telephone bell! What a world of joy or sorrow, When I'm very tired or lazy Hark! the ringing of the bells Of the bell-the telephone bell! All day long I keep a'going, Then my precious wife complains All day long they've kept aringing And she swears she long would tarry She has found it lots of trouble Do I sit down with a book Hark! the bells! telephone bells! Up and up again I jump, Oh! the bells, the bells, When the household's wrapt in sleep, I my weary spirit keep Far from earth Cure for Head Lice.-Case of Tuberculosis. Editor MEDICAL WORLD:-Here is a cure, and it is a cure, for head lice. Fill a bottle, say one-third, with fiishberries, then fill full with whiskey or brandy. After macerating apply the liquid two or three times. Before taking up medicin I was connected with a children's home where this remedy was used, and I know it to be very effectiv and nonirritating. I have a tuberculous patient who some months ago was in Mexico for his health, and while there was taking hypodermic injections of eucalyptin Lebrun, and with markt improvement. Since returning to Canton he has had me continue this treatment; and he is improving. Eucalyptin Lebrun is a French preparation; and so far we are unable to obtain it in this country. I can find nothing about it in any of my books. Can you or any one give me information regarding it? This patient has been tuberculous for seven years, but has wonderful strength and vitality. He is on restricted diet, and is living in the open air. Sleeps on a porch on the south side of the house. I am hoping for great things, but realize that a case of tuberculosis of seven years' standing is mighty serious. Canton, O. E. W. GRUbb. [It is likely that the open-air treatment is doing more for your patient than the French preparation.-ED.] In fermentativ conditions after eating try half-dram doses of aromatic spirits of ammonia in water before meals. Painless Circumcision. Editor MEDICAL WORLD:-In reading the July WORLD I observe that Dr. W. J. Brown's method of doing a painless circumcision (page 300) is almost identical with my own; but I must take exception to his statement that: "One should not do like the Jews and trim off all the loose skin, etc.," because in a practise of twelve years I have made twenty odd circumcisions on adults, and in each case removed all the skin just to the border of the corona. I then place six to eight silk sutures, coapting the skin and mucous membrane. I then apply a moist dressing of borated calendula for twenty-four hours and afterward a dry boracic acid dressing. Do not remove the stitches before the tenth day; otherwise an erection may tear the new seam. The hood is not needed. Protect the glans for a month with a light gauze dressing, when the glans membrane will have toughened and no tenderness or discomfort remains. True, the sensitivness is lessend, but not to the extent of destroying copulativ pleasure; but on the contrary, prevents premature emissions. Moreover, the secretiv function of the glans is destroyed, and the organ is always dry, clean, and free from odor, and the results are most highly satisfactory to the patients. On children the slit operation only is necessary, unless the prepuce is very long. W. H. HAIFLEY, M.D. Amboy, Ind. Withdraw from the Case. Editor MEDICAL WORLD:-In the August WORLD Dr. Shirk asks, "What should I have done when he (the patient) refused to allow what I knew should be done?" Withdraw from the case, to be sure. In no other way can you avoid responsibility. In a damage suit tried in Cleveland in 1869, in which Dr. Beckwith, of that city, was defendant, it was held by the trial court that the patient could not carry responsibilities. Dr. Beckwith's case was that of a man whose leg was crusht, and in which amputation was clearly indicated. This was the opinion exprest by Dr. Beckwith, but the patient refused to acquiesce and told the doctor to go ahead and treat him without amputation, and that he would hold him guiltless of neglect, whatever the outcome. The patient died and surviving relativs brought suit against the doctor, who was mulcted in the sum of $4.500, A. C. Kellogg, M.D. Portage, Wis. In cauterizing mucous patches and other syphilitic ulcerations of the various mucous membranes, the time honored nitrate of silver may be advantageously replaced by pure carbolic acid, which is not nearly so painful, and the primary burning soon gives place to anesthesia. Simple Method of Removing a Ring from a Swollen Finger. Editor MEDICAL WORLD:-The following plan for removing a ring from a swollen finger is so simple a child can understand and do it. First, have the patient hold the hand up, for a few minutes, and while holding it so, rub gently from tip of finger toward hand. Then wet a piece of soap and rub it all over the finger. Then take a piece of coarse sewing thread, push one end under the ring, drawing the end thru and below the ring. Hold this firmly. Now commence winding the other end (which ought to be about ten inches long) around the finger, commencing as near to the ring, above it, as possible, and wrap very closely, holding the thread taut, so as to make as tight a bandage as possible. Wrap the finger till you reach above the knuckle, or to the end of the finger if necessary. Now, holding tight the end that is left, begin with. the end of thread below the ring and begin to unwind. This will bring the ring up the finger as far as the thread is wound, and thus the ring can be easily removed. This plan, if adopted in time, will save much pain, trouble and the necessity for filing the ring from the finger, and possibly a surgical operation. Tenn. H. C. S. Poisoning by Acetanilid Used Externally. Editor MEDICAL WORLD-I wish to ask if any of the brethren have met with acetanilid poisoning by absorption thru the skin, no other drug having been given inwardly? My case was an infant, 6 months old, very fleshy, and broken out from heat, especially in folds of skin, at joints. I gave a drying powder of acetanilid and boracic acid. The mother used one application, and sent for me, thinking the child was dying. I found it livid in face, body mottled all over, and nails purple, heart action very weak; but after using stimulants, and ordering the powder discontinued, child recovered. Hope this may be of some use to other young physicians. Gauley Bridge, W. Va. T. H. ELLIOTT. Aggressivness in Consultation. Editor MEDICAL WORLD-I am located in a small town four and a half miles from the county seat, and occasionally I find my ability measured in direct proportion to the population of my town, which, I must confess, is small. On this occasion, I was called on Saturday evening to the home of one of our most influential families to see a beautiful boy of two years. I made a careful examination of the child and found a high temperature, rapid pulse, and abdomen slightly tympanitic; how ever, no tenderness, and tongue clear. The grandmother informed me that during the day the child's flatus was very offensiv. Hence I rightly concluded that the alimentary canal contained some offensiv material, and prescribed calomel, one-fourth grain every hour, until five doses were given, to be followed with castor oil. I also left several powders of salol to be given every two hours. Three o'clock the next morning the father, in an excited manner, informed me that they believed the child was dying. I hastened to the bedside and found the child in a severe convulsion. In the meantime a physician from the county seat had been dispatcht for, and arrived in about three-quarters of an hour. By this time I had succeeded in restoring the child by means of hot baths, alcohol baths, and friction, mustard not being at hand. I gave my colleag a brief history of the case. He immediately prepared five grains of chloral hydrate in a little water, and attempted to inject it thru the anal sphincter with a shortnozzled, ureteral syringe, but every drop of it ran down on the bedding and not a drop of the solution entered the rectum. I held the child while he did the injecting, hence I know what I say. I then examined the feces, the calomel and oil given the evening before having already operated. There was a half-gallon or more of the most putrescent, green, slimy, and lumpy mass I ever saw pass from a child; among it was whole halves of dried apricots, with innumerable other undigested articles. The stench was unbearable. I diagnosed the case that of ptomain poisoning, following a neglected bowel, and that the convulsion was caused by the undigested mass passing down thru the small intestin and irritating its delicate nervous mechanism. Dr. Blank left a solution of chloral, to be given as necessary, and ordered oil every two hours. Thus far I had no objection to his treatment other than I would have added one of the intestinal antiseptics and irrigated the colon with a normal salt solution. Remember, I was not consulted as to the above treatment, and was not treated as tho I was supposed to know anything. His aggressivness disgusted me. By this time he departed, assuring the family that in a day or two all would be well, and all were lighthearted and satisfied except me. I called again later in the morning and found the temperature 1042°. I had the nurse reduce the temperature to 102° by a cool alcoholic bath, and left instructions to repeat it whenever the temperature went above 102°. I did not make any change in medicin as I felt that the confidence of the family was not with me, and that danger was lurking, as I could already see the effect of toxic absorption. feared to do my duty, lest I would be censured if a fatal end should come. I called again in the evening. The temperature was now 1032° and bowels moving every hour all day, a bloody offensiv mucus. I reduced the oil, ordered the child bathed thoroly, and prescribed a powder of zinc sulforcarbolate, salol, and bismuth, with one-thirtieth of calomel, to be given every hour, and ordered brandy given freely. Believing that a successful issue depended on thoroly rendering the alimentary tract aseptic by the administration of internal antiseptics, and irrigation of the colon with a normal salt solution, holding up the vital centers with strychnin and alcohol, keeping up nutrition with liquid peptonoids, barley and rice water, keeping up sufficient elimination, and lastly amelioration of pain, tenesmus, and restlessness with starch water and tincture opium injected into the rectum. Hence my line of treatment would have been stimulation, elimination, antiseptics, nutrition, and ameli oration. I After I had mapt out the treatment for the night the family and friends questioned me very closely as to my opinion of the case. made my prognosis very guarded, and stated that if the poisonous mass was entirely eliminated and ileo-colitis did not follow, the chances were good; otherwise I could not say. My words fell like lead on a bed of down, and all was gloom! Ah, they were only too true! Again they sent for Dr. C., who, when he arrived, with his ponderous brain and a gesture awed into silence all the clamorous crowd, and left assurance in abundance that all the child needed was a few days rest and all would be well. He immediately gave a powder of phenacetin. Its effect was so profound that it enabled him to irrigate the colon without arousing the child. It was completely prostrated, and he called the attention of the family to the beautiful effect of his medicin; how beautifully it rests! I directed his attention to the powders I had prescribed, and he said in the presence of the family that they would not do at all, and brandy must not be given. I did not resist. I felt that I had no prestige. He still maintained the same aggressiv manner. He told me that I was tired and could go home, as he was going to stay all night. During the night he repeated the phenacetin whenever the child aroused. In the morning he told me that the child passed a fine night, and the mother patted him on the shoulder and said, "You are a good doctor; you saved my child." He told me he would send up a colorless solution of bismuth that he wanted given every two hours, and had left a solution of specific tincture of passiflora to be given every hour or two as required to keep the child asleep. The father informed me that morning that he had spoken to Dr. C. about taking the case, and he said that we would treat the case together. Another evidence of lacking confidence. The following morning Dr. C. called again and stopt the bismuth solution and added specific tr. ipecac and tr. aconite in solution and continued the passiflora. On this treatment the child remained two days and nights. Each day the stupor was more evident. The blood had almost left the stools, but they were quite frequent and full of mucus and not very offensiv, being entirely the product of the colon, nothing passing from the small intestin where poisonous absorption was taking place. That day I advised the father to place the case entirely in the hands of Dr. C., explaining to him that we did not agree as to the manner of treatment, and that his child would be better in the hands of one physician. That evening when Dr. C. returned he was askt to take absolute control of the case and reasons given therefor, but he declined, saying if Dr. Robertson abandoned the case he would also. He saw the position he was in, and feared that I would not use him in the future as a consulting physician. But yet he saw no approaching danger, and wisht to usurp the glory of a speedy recovery. After much persuasion from doctor and father, I consented to leave my name connected with the case and acted as an intelligent nurse to report symptoms over the telephone and make such changes as he might advise. The colon was irrigated four or five times with a boracic acid solution, after which was injected a solution of bismuth subnitrate and a few drops of tincture of opium. The diet consisted of liquid peptonoids, barley and rice water. Each day brought more lethargy, and no important changes were made in medication except the addition of bromid of potassium, chlorid of ammonia, codein, Dover's powder, and finally morphin and digitalis hypodermically-rest at any cost! The child's temperature ranged from 99° to 103°. The evening before death supervened I prevailed to have calomel given, believing that the small intestins were loaded with ptomains. The calomel brought down a load of the most offensiv material, composed of pus, mucus, and fecal matter, enuf to poison a healthy man. On the following morning he telephoned me to give the dying child a mixture of tincture of aconite and digitalis, notwithstanding they are physiologically antagonistic. On the evening of the ninth day the inevitable came. Death was due to profound septicemia. My idea of treatment was to hold up |