Reputation and the Family Saved, as Well as

the Patient. Not Perplext.

Editor MEDICAL WORLD:-I practise in a small town where every one knows the number of cows in his neighbor's back yard, and more about my affairs than I do.

The pastor of one of our denominational institutions moved into our community last November, having a large family. I was called to attend them shortly after his arrival. In December the father came to my office, stating that his oldest daughter, a mature and accomplisht young lady, was having some trouble with her periods, giving the following history: Three years ago missed periods for two months, with bloating; pains, intense tenderness over left ovarian region. Pain increast under treatment of three physicians, until nervous tension developt. On consultation, examination was made under anesthesia, and agreement on organic trouble in left ovary, and operation counseled. This the patient refused, and on expectant treatment and change of climate, full recovery resulted, with good health for two years previous to time she came under my care in December.

With this history, called on patient, found apparent good health, slightly nervous, supprest menstruation, slight coryza. Last period reported, slight stains, November 22. Gave mild laxativs, and put her on tonics, aletris and viburnum, and instructed them to call at office on January 17 for medicin, which they did, and I gave some capsules of apiol and savin, of each gtt. 3, every four hours during daytime, with instructions to use hot sitz bath at bedtime, and keep bed for three days. By 21st she was very nervous, and was showing slight choreic twitchings, but no evidence of period showing. Discontinued apiol and savin and put her on ascending doses of arsenic,

and used Rochelle salts to three copious stools daily. She showed markt improvement, and was apparently well in three or four days. Kept her on tonic doses of arsenate of strychnin for ten days, with laxativ dose of salts every morning, and as she seemed perfectly well, told family to let her have plenty of outdoor exercise, and if period did not show in couple of months, report. She interested herself in our young people's society, was cheerful, and apparently well.

In two months or a little more, father reported still no show, and said they were afraid of organic trouble, and askt me to examin her carefully; and as case reported a previous examination, I suggested that at next time for period to return I would make an examination, which I did. Found no evidence of any ovarian trouble; uterus slightly enlarged, cervix soft, no erosions or local trouble, but uterus still in normal position with a little raising of the fundus toward abdominal cavity. On examination of breast, found pronounced areola around nipples, and nipples erect and protruding. Askt that they save me a twenty-four hour sample of urin, and bring to office next day, which they did, and I demanded thirtysix hours for examination of urin; that in view of the previous history-grave organic, ovarian trouble-I could not afford to make a snap diagnosis. Well, brothers, I suppose all of you have added a few grams of yeast to the urin of a pregnant woman and noticed the odor of it twelve to twenty-four hours later. Well, you know what it is. It has an odor that nothing else has. Once inhaled, you never forget it. It is like the young physician after his first labor case; he will wash his hands every opportunity the next day, but that smell haunts him still. Well, this put me in a position that either makes or breaks a young physician.

The parties were, like Caesar's wife, above reproach. I told the father frankly that there was no organic trouble with the ovaries; that, sexually, she was all right. There was no evidence of any organic trouble with uterus or its appendages. I thought that time would bring her around all right. That sometimes a membranous, dysmenorrhea, or a hydatid mole or cyst, caused such manifestations; that if that was the trouble and she did not come around in time, we would curet the uterus, after counsel; but as present health was good, it would be best to wait until there was need of interference.

Well, matters went on until about five months had passed from her last period. She was showing some bloating, ankles swelling some towards evening; shortness of breath on exertion; in fact, every evidence of a five and onehalf or six months' pregnancy. I dropt in one

DECEMBER, 1903]

evening, and made examination of abdomen by palpation; found quickening-a good, lusty kick when disturbed. This brought us, in time, to June 7. The father came to me and said: "Doctor, what is the matter with daughter?" Putting the question from the standpoint of family physician and friend, this admitted of no equivocation; and, as kindly and feelingly as I could for his great calamity, I told him his daughter was enceinte. Then, as friend, physician and brother mason, he askt for help. I had him send her with her brother to visit for the summer with her relativs in a distant part of the state. After two weeks' stay with relativs, had her meet me in a city that was near enuf to be in easy reach, where I placed her as my patient in a hospital, to wait for her labor, which I located at about September 6. This was June 28. I arranged for mail thru me and her brother, who was to remain with relativs.

Well, on the morning of September 7, I received a message that I was needed at the hospital, and on arrival found a ten-pound boy. I arranged with a party that made it his business, to take the child in ten days and keep it until he could have it adopted by a Christian family. In eighteen days the girl came home from her summer visit, and that is all there is to it, thus saving a prominent family, possibly two lives, and nobody hurt. I think a man in the practise of medicin should always be ready to act in such an emergency, and avoid such crime and calamity as were involved in the case of Perplext." PROBLEM SOLVED.

"

High Temperature.-Epilepsy.-Chronic Diarrhea.

Editor MEDICAL WORLD:-In the November WORLD, page 520, a report is given of a case with high temperature. I have attended four cases in which the thermometer registered 107° F. or more. All died except one case, a boy eight years old, who had a severe attack of pneumonia. The thermometer registered 107° F. at 8 a.m., and 108° F. at 6 p.m. The patient was very ill for five or six days, but made a rapid recovery in about ten days. I do not think that the atropia produced all the symptoms in J. E. P.'s case, altho belladonna has been credited with the property of increasing the temperature in the human body; how the drug acts to produce such an increase I am unable to say.

W. G., on page 521, requests assistance in some cases of epilepsy. I have had several cases under treatment for some years (some of which do not have a fit during a whole year). Hydrocyanate of iron has given me the best results; next in order come the bromids, belladonna, arg. nit., etc. The editor says that

543

nitrite of amyl will often abort a convulsion; so it will; but I have found that most patients cannot, or do not for some reason or another, use it or get the remedy quickly enuf. Most of these cases are hearty eaters and have some derangement of a part of the digestiv system.

On page 525 is an obstinate case of chronic diarrhea; and if the treatment outlined by the Editor does not benefit G. W. C.'s patient, he might try dil. nitro-muriatic acid, 15 to 20 drop doses in water fifteen minutes before meals, and 10 to 15 grains of subgallate of bismuth after meals or oftener, and continue the general advice given by the Editor. Roxbury, Conn.

L. J. PONS.

A

Editor MEDICAL WORLD.-In November WORLD, page 520, J. E. P. records a case of high temperature following uterin douching. This brings to mind a case somewhat similar occurring in my neighborhood a few years ago. The confinement was attended by a brother of the husband, living several miles away. few days later I was summoned hastily to see the case; found temperature 104° F., patient nervous and excitable. Ordered quiet, warmth, and moderate doses of acetanilid and sodium comp. Rallied nicely. Two days later was called again under like circumstances, found like conditions, gave same treatment as before, with same results. Found that in both instances the high temperature had followed the use of the vaginal douche. I askt that the doctor in attendance call at my office on his next trip, which he did, and I advised him to discontinue the douche, which he did, and patient made a good recovery with no further trouble. I believe that in some cases the high temperature is not due so much to absorption of septic material as to an unaccountable excitation of the nerve centers. I have seen this condition, in lesser degree, follow the use of the rectal syringe, where of course the idea of septic absorption was wholly eliminated. I think the routine use of the douche following parturition utterly unjustifiable, and should be adopted only when it is demanded by unusual conditions. What say the Editor and family to this proposition?

Cortland, N. Y. E. W. BOGARDUS. [We are inclined to agree with the Doctor. -Ed.]

Schamberg, of the University of Pennsylvania, treats impetigo contagiosa by washing with soap and water, and applies during the day a perchlorid lotion I to 500, and at night a paste is used containing 10 or 15 grains of ammoniated mercury to the ounce. An occasional case yields more rapidly to resorcin, 15 grains to the ounce.

Vomiting of Pregnancy.

Editor MEDICAL WORLD:-In October number Dr. Baird asks for the best remedies for vomiting of pregnancy. Study well the case, Doctor, is a large crumb of wisdom, as upon the physical condition depends the effect of the remedy. Constantly bear in mind that loaded bowels is a principal factor in that very unfortunate result of pregnancy. There have been remedies, almost without number, and in my long experience I have tried the most of them; but that which has proven the most satisfactory is nuclein. Having the system properly unloaded, by gentle laxativs, I think you will seldom meet with failure with this remedy. In anemic, feeble women, it seems to me this remedy is specially indicated. It is to me something comparativly new, being the fruit of the last decade, and termed "the activ principle of life." L. B. MORROW. Greencastle, Ind.

Extracti glycyrrhiza glabrae fluidi neutral 60 grams.
Shake label.

In reading the September and October WORLDS I saw formulas for head lice where it is recommended to fill a bottle one-third full of fish berries and fill the bottle up with whiskey. Don't you think this is a dangerous application?

There are cases recorded where even the tincture has produced death, used on a scalp that was more or less excoriated from scratching. Cocculus Indicus, staphisagria and sabadilla have all been used to kill pediculi, and are powerful poisons; the latter is the least so. There are many harmless and efficient applications that do as well; as, petroleum or kerosene; moisten the hair at night; next morning rub sweet oil in scalp and wash out with tr. green soap. If the petroleum is objectionable, a three percent solution of thymol in sweet oil may be used in its stead.

Í still think THE WORLD is the most practical medical journal publisht.

San Francisco, Cal.

Some Replies.

E. T. KREBS.

Editor MEDICAL WORLD:-There are some things in the November WORLD which certainly require an answer before they are passed by, as some one might gain a wrong impression by reading them. My first thought was that the Editor should not print such utterly incredible stuff, but on reflection it seems the best thing to do, as these articles give the profession a chance to repudiate such worthless opinions and give the truth in its stead.

The article which prompted me to write was "Homeopathic Substitute for Circumcision." Of all the fake notions this certainly takes the cake. This surely comes up to the standard of anything I ever heard of in the osteopathic line, which so many good authorities are rightfully calling down. While I am a regular, I believe there is good in all schools, but still I cannot be made to swallow all their stuff. The writer of this (to me) novel article, says he does not give his remedies according to "Taylor, Jones or Edgar," but because it is so from the foundation of the world. How does he know these remedies will have this effect without someone has tried them? Would

he stand up and affirm that a remedy is a specific when no one ever used it to know what the effect upon the human organism would be? How does he know these "indications so well if no one ever tested them before?

There are some things that logic will prove to us without experience, and one of these is that the foreskin cannot be absorbed by an infinitesimal or other dose of any drug. Our worthy brother certainly has to be very careful and stop just in time, or he would absorb the whole foreskin with his medication; or if given too long, it looks reasonable that the whole penis might be absorbed. Or do these sagacious medicins know just how much of nature's covering is needed, and remove only to a certain imaginary line?

Again, these drugs might be given for some disease in another part of the body, when the prepuce would be absorbed unwittingly unless they are so well under the control of the mind that they act only when wanted.

I am glad to know that one doctor in this world can know just exactly what his remedy is going to do and always knows that he is certain to effect a cure. We may be reasonably sure that our treatment is going to have the desired effect, but there are very few of us that would care to make a guarantee on any particular case, as there are so many modifying circumstances to be taken into considera

tion over which we have no control.

Brother physicians, it is our duty to nip such wild claims close up in the bud; and while we wish to encourage research and progress, there must be a limit to what we shall give ear.

Another visionary article occurs on page 492 under the heading, "A Galactagog.' Does the brother mean to say that he causes a full flow of milk for any length of time by the use of fld. ext. of jaborandi? There is no source for the production of milk except from food, and in deficient lactation if good nourishing food is given, after seeing that the general functions are all right, there is nothing further that can be done. Would a dairyman give his cows jaborandi if they failed in their flow of milk? or would he give the matter careful study to find out what food was necessary, and give accordingly? Besides a fld. dram ext. jaborandi is a dangerous dose of a dangerous medicin, and would in a short time cause salivation, excessiv diaphoresis, vomiting and other untoward symptoms. To be sure the flow might be increast for a short time, but that would be of no benefit. There are some things that drugs will not do, and among them are absorbing a superfluous foreskin and starting a dried up mammary gland to action.

Editor MEDICAL WORLD:--In answer to "Indiana" (November number, page 517) will say that I tried cineraria maritima, sold at $1.00 by some St. Louis firm, in six cases of cataract without any apparent benefit.

To "Jamaica," page 526, will say that if paper for sphygmographic traces is smoked with burning camphor and immerst in tincture benzoin after trace is taken, the same will be permanent.

What is your experience with thiosinamin in urethral strictures? J. M. DIAZ. Santa Fe, N. M.

[Have had no experience with the latter. Who has?-ED.]

I

regard to the action of quinin on uterus. I was glad to see an expression from you in agree with you exactly.

In answer to Dr. Rupert's question, opium and consumption, yes; I have known many who have died of tuberculosis while "eating opium or some of its salts. I treat these cases oftentimes (I mean the habitue), and never fail to cure unless it be one with bronchitis or consumption. These poor victims got into the habit trying to "cure" the harassing coughs attendant upon them.

W. G. (Minn.) asks about epilepsy. Fl. ext. black cohosh in sensible doses, alternated with nux vom. and pepsin tablets (ext. nux meal, black cohosh between meals and at bedone-fourth grain, pepsin one grain) before each time, with an occasional, thoro emetic (lobelia), is the most universal positiv cure ever used. I know whereof I speak. Doyline, La.

T. J. TABOR, M.D.

Dear DR. TAYLOR:-Why don't the men who ask questions in Quiz department write their name and address so that one could answer them directly? This way you must act as "Central." Well, give me A. H. B., New York (pages 516 and 517). Hello! Doctor, about your migraine case. Here it is

-I got it at the medical society a few years ago, and tried it with happiest results. I. Give a teaspoonful of castor oil (aromatic, if you wish), t. i. d. p.-c. continuously, for 4 to 8 weeks. I. Then, at the very first intimation of the oncoming attack, have your patient go into a darkened room with a gallon or two (sic), of almost boiling water. This she is to to drink as fast as she can, say in 30 minutes. Result: diuresis, diaphoresis, and cessation of attack. She may have to remain in dark room 6 hours. You are likely to find that the intervals lengthen, and, we hope, that the attacks will soon cease altogether

Next: "Indiana." Hello! Yes, hot air is very good. Must be used for quite a long time in some cases.

In April, 1902, myself and Dr. M. J. Scott of here, removed, under cocain, a lipoma (?) from the forehead of a woman age 37; very fleshy. Growth was shape and size of half dollar, under skin. In six weeks it was back bigger than before. Then I gave a general anesthetic, while an older surgeon did what he was sure was a thoro job. In six weeks it was back, bigger than before. Then I used ergot and tr. iodin over growth, driving same in by static cataphoresis. In six treatments growth was gone, but there were 3 others around the site of the first. I now added oil thuja (prepared by the Porter Ryerson Hoobler Co., Omaha), and in 16 treatments all were gone, and have not returned to date. Omaha, Neb.

A. F. BURKARD.

Do not allow a patient to die from typhoidal perforation of the bowels without his having the chance offered by operation; immediately after diagnosis, if possible; if not then possible, just as soon as it can be done. The mortality increases in proportion to the hours elapsing between the perforation and the operation.

gtt. ij

gtt. viij

3IV

After 2 to 4 days' use, substitute the follow