What I do in Pneumonia. Editor MEDICAL WORLD:-You ask, "What will I do in pneumonia ? In mild cases I will make my patient as comfortable as his means will justify, and see that no complications arise without being met on the threshold. In malignant cases, seen late, will meet indications without overloading my patient with drugs that will tax his powers of elimination. Will give you an illustrativ case: H. P., male, 45 years of age, a hunchback, tenth day of illness. Delirious, and had been for eight days; temperature 105°; respiration gasping and 60; teeth covered with sordes, tongue pointed, red edge, brown top, point turned up to roof of mouth; pulse not countable, irregular; eyes turned up till only about half of iris visible. On account malformation of chest, could not map out area of dulness satisfactorily. No expectoration for thirty-six hours; before that, a bloody mucous expectoration. Tympanitic abdomen, and no action from bowels for thirty-six hours. Patient apparently moribund. At the solicitation of his aged mother, I began work with him. Treatment: (1) hypodermic of strychnin, grain, morphin 4 grain. Then high colon flush of two quarts of saline solution. Tablespoonful of whiskey with same quantity of liq. peptonoids, and white of egg with 3 ounces saline solution introduced into stomach with tube. Rubbed 45 grains of Creed's ointment into abdomen, and waited 2 hours. Then, to stimulate secretion, gave grain pilocarpin mur., hypodermically. This produced reaction, and I gave two quarts saline solution into bowel. System began to appreciate the spur and arouse itself; perspiration began, temperature began falling, secretions started, and by close personal work, meeting indications as they came up, he had passed crisis in forty-eight hours, and temperature was normal. This will show you something I do for my pneumonia patients, but with all my doing I try not to do too much. In mild cases of pneumonia I have been satisfied with 5 grain doses of thiocol every four hours, with nux vomica after fifth day, as indicated, always keeping bowel and kidneys activ, and skin in best condition possible. JNO. W. HYATT. Bellevue, Clay Co., Tex. Tenderly she laid the silent, white form beside those that had gone before. She made no outcry, she did not weep. Such a moment was too precious to be spent in idle tears. But soon there came a time when it seemed as if nature must give way. She lifted her voice, and cried long and loud. Her cry was taken up by others who were near, and it echoed and echoed over the grounds. Then suddenly all was still. What was the use of it all? She would lay another egg tomorrow. Boston Herald. The Treatment of Lobar Pneumonia. Editor MEDICAL WORLD:-In reading "A Few Suggestions on the Treatment of Lobar Pneumonia," in the October issue of THE WORLD, page 445, some thoughts occurred to me that I thought should be printed in response. The article mentioned closes with "Let us always bear in mind that nature saves Our patient, and not our drugs; therefore don't drug your patients too much." This statement is often true, and we believe in many cases it would be more proper to state, "Nature saves our patient in spite of our drugs." But the way that we see it-after having drank of the cup of the sorrows of death caused by this very disease-it would be better to word it, "Nature generally tends to right herself, and it is the duty of the physician to assist her in that effort." If the statement in question, "Let us always bear in mind that nature saves our patient and not our drugs," were true, then why not send for the clergyman instead of the physician? The preceding sentence to the one just referred to contains the keystone of the whole structure of treatment of this infectious disease. As progressiv physicians we should be everlastingly in search of the cause of the disease and the removal of said cause. Lobar pneumonia is an acute infectious disease caused by a certain variety of bacteria. Now, if we can make full and free use of an internal antiseptic medicin with which to combat the multiplication of the cause of the disease in the form of the specific bacteria, then we will assist in nullifying the use of the blood as a culture medium for the propagation of the germs of the disease. We should endeavor to arrest or inhibit the germ culture. As the culture medium from which the diplococcus obtains its nourishment is derived from the blood, any substance added to the latter will also be found in the former, and if that substance is inimical to the growth of the coccus, it will thus act in inhibiting the growth of the germ. Heart-failure is the most frequent cause of death in pneumonia. This is caused by the poisonous effects of the toxins of the disease and the action of the prolonged fever. This condition can be successfully combated by obstructing the growth of the cause of the disease, washing out the toxins by free elimination and supporting the system by the liberal use of milk and whiskey. S. LEWIS SUMMERS, M.D. 309 Susquehanna avenue, Philadelphia. Always search for the cause when confronted by a case of sciatica; it may be found in auto-intoxication, pelvic disease or disorder, rheumatism, gout, syphilis, or metallic poisoning. Pneumonia. Editor MEDICAL WORLD:-In reply to your query, what shall we do for pneumonia: I speak from an experience of twenty-five years, during which time I have not lost to exceed five cases, and those were complicated with other diseases, such as pertussis, etc. If called during the prolonged chill, or immediately following it, I have invariably administered aconite, giving ten to twenty drops of the first decimal dilution in 1⁄2 glass of water, according to the age of the patient, teaspoonful every 1⁄2 hour. If complicated with pleuritic pains I alternate with bryonia, doses same as the aconite. After the congestiv stage, I substitute veratrum viride in doses the same as aconite, but I never desert bryonia as long as the stitching pain of pleurisy is present. I rely on phosphorus, second decimal dilution, ten to twenty drops in 1⁄2 glass of water, teaspoonful every two hours or as the case may require, to help out the third stage. Erie, Pa. R. T. MARKS, M.D. Four Deaths in Five Cases of Pneumonia. Editor MEDICAL WORLD:-You ask for items of interest on the subject of pneumonia. Now I am aware of the fact that a good many of the reports sent in will be something like this: "500 cases in ten years; never lost a case; my treatment never fails." So far they will be all alike; but the plan of treatment will vary. One will have his success by stimulation, one by sedativs, and others by letting drugs alone, but giving good nourishment and nursing. These reports will make one wonder "where we are at.' Again, I prophesy that a considerable number of your correspondents will give it as their opinion that pneumonia is more prevalent and more fatal than formerly. I had several fatal cases during an epidemic of la grippe in a valley in the Coast Range in June, 1902. Previous to this experience I had very few deaths from this disease, and they were nearly all too far off to see often, or too near death when first seen. The first of this series of cases in the valley spoken of was a lady in previous good health, aged forty-two, and after one of the hardest fights I have ever experienced with the disease, several times seeming almost hopeless, in fact the family did entirely give up hope, she finally recovered. This was in May. Early in June I was again called to the valley (twentytwo miles) to see Mr. T. Found him in the throes of death-in collapse. He had been under treatment from another physician, of which fact I was ignorant until I arrived at his home. He died in one hour. He was about forty, but had previous bad health. A few days afterwards I was called in company with another physician to a neighbor of the former two cases, a man seventy years old but vigorous and well preserved. From the first there seemed but little hope. I stayed with him. continually on account of the distance, but after two days struggle he died. The next case was twenty-five miles farther down the valley, and I found a lady 45 years old with, as I called it, a mild attack of pneumonia. Temperature 103°, pulse 115. But on account of the distance and the importunities of friends, I promist to stay a day. She had already been sick four days. Next day temperature was 102° (without antipyretics), pulse 125; next day temperature 102°, pulse 135; next day 145, and the next day she died, temperature having steadily declined. A few days afterwards another man was taken with the disease. Another physician was called, but the man died. Here were five cases in one month, partly under the care of four different physicians, and four out of the five died. I have not detailed the treatment. Strychnin was given in all my cases; veratrum and aconite was given for twenty-four hours in the fourth case. The ordinary treatment was given in all of my cases, both local and general. The point is, that the same treatment that had formerly proved successful in over twenty years of practise here gave no results. Nuclein was given in three cases, the one that ended favorably being one. The one point of resemblance was the steady decline of vital powers to a fatal ending. It might prove interesting if I could give the treatment in detail and have the WORLD readers criticize and give their views of the cause of the fatal ending. If these had happened separately I would have lookt for different causes; but as it was, and studying carefully over the outcome with a retrospectiv view, I conclude that it was on account of the virulent type of the disease, or the virulent quality of the toxins generated; and altho I used elimination as usual, yet if I had the cases over again I would be if possible more thoro in that respect. It is a curious fact that the one who recovered drank seventeen full glasses of pure spring water in less than two hours, then broke out in a big sweat, and sweat and slept nearly all of the time until temperature returned to normal. The first five glasses were given while I was sleeping, then the attendant would give no more until consulting me; but I found such favorable symptoms that I let her have her way. She had been delirious for twelve hours, but whether the water caused amelioration of symptoms or whether the critical period had passed and with it came thirst, I am unable to say. Her breathing was 45 until the sweat, then gradually slowed down. I believe every death was caused by the poisonous action of the toxins on the heart. There are fulminant or malignant types of all infectious diseases. While on the subject of pneumonia, will say that the only time I have had any proof of the infectious nature of pneumonia was two years ago. One boy in the family had measles, followed by pneumonia. The rest of the family had no measles then, but all took pneumonia of a severe type-mother, father and sisters. Those cases of grippal pneumonia were of course catarrhal pneumonia. Now these remarks are very rambling, and if the "wise man" thinks they are not instructiv, why, there is the basket-never full. Philomath, Oregon. C. H. NEWTH, M.D. [We want variety; and particularly we want deaths-that is, reports of deaths. We have plenty of marvelous recoveries, and remarkable records. We want the truth, even when bad. -ED.] Questions. 1. Have we any proof whether a human ovum is vitalized with one or more than one spermatozoon? 2. Can ovarian tissue be transplanted from one species of animal to another and made to grow? 3. What animal tissues have up to the present been successfully grafted upon human tissues? 4. Has an ovum ever been fertilized artificially and the phenomena viewed microscopically? If so, with what result? 5. Has any effort ever been made to obtain an artificial culture medium for the growth of an embryo? 6. When a tissue is frozen, does it undergo any changes during long periods of time? C. E. BOYNTON, M.D. W. R. Pryor, of New York, the second written as a commentary on Dr. Pryor's article by Dr. Chas. E. de M. Sajous, of Philadelphia, in the September number of The Monthly Cyclopedia of Practical Medicin. These two articles contain in my estimation the most rational and specific treatment yet proposed for puerperal sepsis. The next most important line of treatment is that of formaldehyd as initiated by Dr. Barrows, and which has been reported in nearly every medical journal since January last, and so clearly commented upon by Dr. Sajous in the February issue of the Monthly Cyclopedia. The excellent results following the formaldehyd treatment must be ascribed to the normal or rather decinormal salt solution used, especially. in the face of scientific evidence furnisht by experiments and investigations made since Dr. Barrows' report of case. In the belief that many of the MEDICAL WORLD readers have not had access to the journals mentioned, I will perhaps be pardoned if I abstract and necessarily give much that is verbatim. Dr. Pryor says that puerperal sepsis, while originating in uterus, is a lymphangitis extending to remote parts, and the mortality resulting is dependent upon the implication of other organs, the peritoneum, lungs, heart, and particularly the kidneys, from septic involvement. It is not a local disease, hence local treatment alone is valueless, tho the point of entry or organ of inception must, thru common sense, be the object of such attention as to require removal of causativ material. Dr. Pryor outlines the treatment as follows: In condensation, his method is a sufficient curetment, then opening freely the posterior cul de sac; he generously packs both uterin cavity and posterior cul de sac with iodoform gauze. The drainage matter is found to be serum alone, which carries away the streptococci invariably present. In all cases reported but one, the second dressing disclosed not a coccus, which proves that the procedure is certainly a most efficient inhibitant of germ growth. The iodoform in contact with the raw tissues is, thru the serum, converted into methenyl and free iodin, which destroys the cocci. The change is slow, but more slow if pus be present. Iodoform in contact with serous tissues at once releases iodin, producing a local iodism. The iodin is rapidly absorbed and is found in the urin in five hours on an average, but frequently sooner, dependent upon the amount of pus and serum present at field of liberation. In addition, normal salt solution, intravenously or per rectum, was used by Dr. Pryor in all cases, with the object to stimulate vitality and promote elimination. Dr. Sajous, in his masterful style, then forges another link in his chain of proof of the stability of his marvelous adrenal system and ductless gland secretion discovery, showing conclusivly that the method described as used is but nature's own method of restoration. The iodin supplied stimulates the adrenal system, which in turn causes organs to assume natural functional activity, to vitalize tissues, produce antitoxin, eliminate and repair. The ductless glands produce the antitoxin necessary during life to combat disease and death, and in the inhibition of ductless gland functional activity, as in the presence of a virulent toxin, nature only responds when restorativ measures are prescribed. In this case we may roughly interpret the iodoform as acting as the pressure to the push button, which thru wires and batteries sets machinery in motion. Personally, I would additionally recommend a thoro cleansing of the intestinal tract with mild chlorid and salts, to be followed by the arsenate of quinin, iron and strychnin with nuclein to effect, with an internal antisep ic, as echthol and sodium sulfocarbolate. The temperature should become reduced soon under the controling influence of iodin, but if not, I would use repeated normal salt enemas with bovinine added, and guarded antipyretics. Sufficient Sufficient nourishment of a condenst nature as presented in many of the preparations on the market, will prove serviceable. M. H. SMITH, M.D. Colorado Springs, Colo. Acute Gastro-Enteric Intoxication in Chil dren. Editor MEDICAL WORLD:-Diseases of children are of such importance that the laity are quick to label a physician as being successful or unsuccessful in his treatment of children. He is soon known as a good doctor for children or a failure in treating children. It is the anxious, loving mother who makes the appeal for good children doctors. She looks to them for help to save her darling child. Why should she not look to us for help? In my battles with disease most of my failures have been with children. Whether this is the experience of other physicians I can not say; but I feel that the title of this paper will label a great many of your cases, in which you have failed to prescribe successful treatment. We must not go to battle unprepared. The medical treatment of diseases of children is a success, and he who fails must consider the failure his own and not that of medical science. Acute gastro-enteric intoxication has given me more concern and anxiety than most all other diseases put together. It has been the paramount affliction of children whom I have been called upon to treat. My failures have been far too many for my own satisfaction; however I have more cures or favorable terminations to my credit in this neighborhood than either of my co-worker M.D's., but this does not satisfy my longing to save more children. In this paper I am not to deal with the etiology, pathology, lesion of tissue, prophylaxis, diagnosis or symptomatology, all of which are important, but far more especially I am to deal with the treatment. Symptoms help us in selecting remedies, so it might be helpful to refer to a few symptoms in pointing out the treatment. In selecting remedies, never discard a medicin because it is old, but let merit be your guide. It is well to give the newer remedies a test before depending upon them in a serious case. If you should lose a precious child in trying a new remedy, your conscience will never be clear. If a remedy is good, does the work, don't discard it for a newer and less tried medicin, as it may be the means of helping to label you as a failure in treating children. If the child must die, it is a satisfaction to you for it to be said that you did all that could have been done for the child. It is not just to patient, parents, or yourself, to go to extremes for or against any special remedy. I use antitoxin in diphtheria, and vaccinate every child that comes to me for that purpose; and when the people ask for my opinion in such matters, I always answer that I give my patients the advantage of doubt in every case. You will find that this broader view will add to your reputation and win the confidence of the great mass of the people. In selecting remedies for acute gastroenteric intoxication, we should bear in mind that we are not treating an inflammation of the stomach and bowels, but a condition which has arisen as a result of the cessation of the process of digestion; a process of decay immediately begins, which process is the cause of the entire disturbance. The first symptom in these cases will be vomiting, followed by diarrhea, which is the appropriate effort of Nature to get rid of the poison in the stomach and bowels. Don't try to stop this process, but, on the contrary, help Nature in the cleaning process. Give a thoro emetic, having the child to drink all the water it will, thus more completely washing out the stomach. The stomach pump is better, but can't always be used. As soon as the stomach is clean and vomiting ceases-usually the second day, but may be sooner-begin the cleansing process on the upper bowels. The lower bowel should be cleaned out by a high enema of saline solution on first visit, and repeated at least once, and better twice, a day during the entire sickness. For cleansing the upper bowels, nothing is so thoro as pure castor oil in large doses, often repeated, until the oil alone passes. I usually prescribe one-half ounce of the oil every three hours until the oil passes thru. It takes about four doses, two ounces, in most cases to thoroly cleanse the upper bowels; however, I keep giving the oil until the pure oil passes if it takes four ounces. This oil cleansing should be kept up during the entire sickness. I find it is necessary in most cases to repeat these large doses of oil every second day. Especially is the oil cleansing indicated when fever runs high, which shows that the poison is being absorbed, and elimination should be hastened with all dispatch. Feeding these children properly is as necessary as proper medication, as improper feeding will add fuel to the decaying process, and more than over-balance the remedies you are prescribing. Withdraw all food for twentyfour hours; boil all the water, boil and salt the milk, boiled oatmeal water, browned flour, egg albumin diluted with boiled water, boiled fruit juices, bovinine, trophonine-this is my line of feeding, and I find that it is a success. You must not allow anything given to the child that will add to the decomposing process already going on in the stomach and bowels. Especially is such feeding necessary when the cholera infantum type develops. This form of the disease calls for prompt and efficient work, both in the cleansing process with oil for upper bowels, and the saline enemas for the lower bowel, and antiseptic medication. Bacteria, ptomains, and high fever give a fierce battle for life. Medical treatment of children is indeed a very difficult subject, and for that reason demands our careful study and attention. Let us reason a little and see if treatment will not be more easy. Now, what is the condition we have to deal with? (1) The digestiv process has ceast; (2) contents of stomach and bowels become foreign material-poison-which is ejected by vomiting and purging-Nature's work; (3) secreting glands of stomach and bowels cease to perform their function. The antiseptic bile from the liver ceases So we find the alimentary canal converted into a place of inactivity where food, if taken, will simply and surely decay. With these facts before us, the first thing to do is not to keep feeding the child, as that would add to the trouble, but withhold all food until you have cleaned and rendered aseptic, as far as possible, the entire alimentary canal-usually the second day. The first medicin needed after the cleaning process is syr. rhei et pot. comp., seven parts, fl. ex. prunus virg. one part; a teaspoonful every two or three hours. Follow this with (or give at the same time) sulfo-carbolate of lime, zinc and soda ää equal parts, one-half to one grain dose every hour. I use Abbott's preparation known as the W.-A. intestinal antiseptic. Persist in this treatment and you will save your patient. The frequent copious watery discharges which indicate dissolution are to be regarded as extremely grave, and they call for immediate treatment. For this condition use atropin sulfate, so grain, every thirty minutes until physiological effect of the drug; or until the condition is corrected. Don't neglect the liver in these cases, as the antiseptic bile is needed in the intestinal canal to help correct the abnormal condition. I use juglans night and morning in tonic doses. stomach rebels, use juglandin, the resinoid. If There is a tendency to internal congestion, both of the abdominal viscera and the brain, and it is important to keep up an outward circulation. Keep the extremities warm with dry heat. I use a capsicum plaster on the abdomen and capsicum liniment on the extremities, with dry heat. Complications may arise, and they should be treated according to indications. Pepsin compound should be used with the food. Glyco-thymoline is useful in these cases; by its soothing and alterativ effect on the mucous membranes, it restores the glandular activity of the entire alimentary canal. I use it in ten-drop doses every two hours. In treating children, the fault is in using too much medicin. Let your greatest effort be in selecting and using only such remedies as are positivly indicated. Whatever else you may do, don't be guilty of drugging innocent little children into eternity. M. D. HENDERSON, M.D. Pleasant Plains, Ills. Treatment of Arthritic Inflammations by Super-heated Air. Editor MEDICAL WORLD:-It is not generally known or appreciated by the general practician that one of the most, if indeed it is not the most valuable method or procedure in the treatment of arthritic diseases, be they traumatic, rheumatic, or whatever the character, is by super-heated air, or dry hot air as it is commonly termed. There is no treatment that I have ever used that has proved so exceedingly satisfactory to me in the treatment of both acute and chronic arthritis, and my results have been very pleasing indeed, especially in chronic cases. Acute and chronic rheumatism respond very readily to the treatment by hot air, and arthritis deformans, the most terrible |