We often: bear the remark that it is diffcult to diagnose the: diseases: of infants because they have no language to express their feelings, but they are as devoid of language to deceive us. But take the various diseases of the skin where we can look directly at the symptoms. I can say, after thirty years of practise, that they bother and defy the general practitioner more than any other class. He is a happy man that can diagnose them all. Everything that is red is scarlet fever or erysipelas; and all red blotches, measles; salt rheum takes the balance. I have seen and made more mistakes in diagnosing skin diseases than in any other department of practise. The skin has many and varied expressions in diseases of internal organs, depending to some extent upon the individual peculiarities. And it has many diseases of its own with strange and sudden manifestations. Some of its diseases will effect or produce diseases in the internal organs if it continues long enuf. For example, all inflammatory disease of the skin over extensiv areas, if it continued for a few days or weeks, will produce disturbance of the kidneys, which may be temporary or become permanent. If this "Cuban itch" is small pox, then it has changed from a very fatal and bad marking disease, to a very mild and inoffensiv one. If an itch from Cuba or the Philippines, then we are getting more than new territory; and if we are making their conditions better, they are making ours worse. We may be thankful it is not more fatal. I had no idea of writing when I began, more than sending subscription. Poynette, Wis. JOHN BINNIE. Editor MEDICAL WORLD:-I want your valuable magazine another year. It is run on broad, liberal lines that I much admire. I have been looking for a Vermont article on Cuban itch. We have had it here, and I will give you our experience briefly. About April, 1900, a man returned from a western camp, in Arizona perhaps, to his former home in Hardwich. He was taken sick and his physician called it small pox. All others laughed; finally the State Board of Health made Hardwich a visit and they decided it was not small pox. It was classed "Cuban itch." Matters continued the same up to August. Some discussion occurred, and some ill will was displayed from time to time, and a few sporadic cases were in evidence all the time; but as I understand, no quarantine. None of the most experienced physicians called the cases small pox. Finally an expert was called from New York City, and he declared the cases small pox. So our "Cuban itch" left us. With isolation and hygienic precautions all the cases terminated favorably, and to the best of my knowledge none were even pitted. Montpelier, Vt. P. L. TEMPLETON. We have Cuban itch here. No small pox in my estimation. Seems nearer to impetigo contagiosa than anything else. Treatment, ointment of ammoniated mercury, Dov. powd., Fowler's solution, and Abbott's saline laxative. All get well in from ten days to two weeks. No pits. JOHN M. BACHTEL, M.D. Fair Plain, W. Va. Rattlesnake Bites; Cure Whisky.-"Cuban Itch."-A Case Vaccinated and Followed by two Attacks of the Disease. Editor MEDICAL WORLD:-In early times Kansas was infested with rattlesnakes. I know of over sixty cases of bites in persons. Remedy, whisky till intoxicated. Results, cures in every case. Two other cases refused to take whisky; both died. Some of the cases had to travel as far as five miles to get the remedy, but it never failed. It takes lots of whisky. I have given a pint to a boy twelve years old before he got drunk. Clothing does not prevent the bite poisoning, as in a mad dog bite, for the reason that a "rattler's " tooth is a natural hypodermic needle. If there ever was a specific for anything, whisky is a specific for rattlesnake poison. It must be pusht fearlessly to the point of intoxication. In regard to the "Cuban itch" discussion, I agree with Dr. Moore that it is contagious impetigo. Also with Dr. Hall's description and statement that vaccination "does not protect from the disease." Some of the worst cases in Seneca had been vaccinated, and only a short time before. I had one case that was unusual. It was my office boy. I had vaccinated him, and it was a typical case of successful "take." About the day the scab came off he complained of chilly sensations, a violent headache, high fever, and in twenty-four hours he was broken out nicely with" Cuban itch." He went thru it in about nine days, and his brother, whom I had tried to vaccinate three times, took it. He was what our experts call a sure case of" small pox." In ten days he was all right again. In two weeks' time from that my office boy took sick again, and in thirty-six hours was, if anything, a nicer specimen of "Cuban itch" than he was the first time. These cases were watcht by Dr. W. F. Troughton, who is familiar with small pox, having been in three epidemics of the "real thing." He agreed with me that none of the cases we saw were genuin small pox, and my office boy settled it with us. We decided it to be impetigo contagiosa, and stuck to it, altho much sport was made of it. The disease left no pits, and as a usual thing they were up and "all right" the next day after the eruption came out. There There were no fatalities from the disease itself. No fetor like small pox, and we punctured the vesicles until they became scabs, but never found true pus. Their contents was a straw colored serum that became thick, but not pus. JOSEPH HAIGH. Seneca, Kansas. Suffocativ Catarrh of Children. Editor MEDICAL WORLD:-Your editorial on the above subject, with request for WORLD readers to take it up, has prompted me to introduce myself to the WORLD family by describing a case I attended several years ago, which I had always supposed to be one of capillary bronchitis. In January, 1893, I was called to see a girl baby about one year old, who had been suffering from a cold for some time, but suddenly became very much worse and I was sent for, and saw the child within two or three hours after the beginning of the attack. I found her with a temperature of 106° F., respirations 120 per minute, and no pulse that could be counted. The face, hands and feet were marktly cyanosed. The expression of face was one of great anxiety, the play of the nostrils was extreme, and there was retraction of the base of the chest. The respirations sounded like the panting of a dog on a hot summer day. I did not waste time on auscultation of chest, but proceeded to carry out my routine treatment in all acute affections of the chest, viz., to apply ice. Having no ice bags with me I dampened snow sufficiently so that it could be moulded into a solid layer about one inch thick; this was enclosed in two layers of towels and past around the chest, and patient rolled up in blankets. The relief was almost immediate, and in one hour the temperature had fallen to 103°, respiration to 60, and pulse was strong and about 140. I ordered the cold packs to be continued until respirations should reach 40, and went home promising to return the next day. On following day found patient with pulse, temperature and respirations normal and not a rale in her whole chest. If this patient had died, I would have been blamed for freezing it to death, but certainly no other treatment would have saved her. Many of the critics of cold application object to the application because they claim it contracts the capillaries, but this is contrary to my experience; the contraction is only momentary, and the more thoroly the ice is applied the quicker will be the reaction to one of extreme dilation. Rockland, Pa. J. E. TAYLOR, M.D. Suffocativ Catarrh. Editor MEDICAL WORLD:-I have noticed your article on Suffocativ Catarrh of Children (February WORLD, page 46). I read your distressingly monotonous prognosis, and I decided to do what I never did before, to write a short article for a medical journal. It has often seemed strange to me that men who write books have so neglected this and many other conditions. My results were always fatal until I followed the advice of Prof. Thompson, of New York City. Since then my results bave been monotonous, but more pleasing. The treatment is this: Aconite if temperature is high-103°; sweet spirits of nitre, onehalf to one teaspoonful in sweetened water, every two to three hours; belladonna in full doses every three hours. Nitre and belladonna to be persisted in until respiration is easy. The doctor who treats these cases like ordinary bronchitis with ordinary remedies will lose them all. The theory of Thompson's treatment is easy to see: nitre allays bronchial spasm, reduces the fever and calms the nervous system. Belladonna is a respiratory stimulant. Restlessness should not be quieted by opiates; indeed the first sign of stupor is the thing I don't want to see. Tell the attendants not to try to quiet the child; it must fight for air. Keep it fighting for twenty-four hours without stupor and the victory is won. Of course counterirritation Editor MEDICAL WORLD:-Inasmuch as you invite your subscribers to express themselves on various matters, I will take occasion now, in the first place, to gently "roast" the Editor a little bit. Some time ago there appeared a communication in THE WORLD from a Phila delphia doctor to the effect that he had curetted the cervix, or as I should judge, the cervical canal, from his statement that some time later he examined the same patient and found stenosis of the cervical canal. Here followed a too explicit account of how he produced pregnancy by injection thru this stenosed cervical canal. The fault I find with the Editor is this: he should have either excluded the article or else called attention to the fact that it was an error to curette the cervical canal, as the mucous membrane, if removed in the cervical canal, is not, as it is in the cavity of the uterus, renewed, and consequently stenosis of the cervical canal would be the natural outcome of such erroneous treatment. A few numbers back in another communication a prescription was given in which strychnin and iodid of potassium were given together in the same solution. This the Editor should either have excluded or else called attention to the fact that strychnin is incompatible with chlorids, bromids and iodids, and with alkalies. Fatal results have occurred from this very combination. Physicians cannot be too careful about writing prescriptions for mixtures, that the various ingredients shall not be chemically or physiologically incompatible. Not only should the interests of the patient be taken into account, but the physician should also keep in mind that, even if no disastrous results occur to the patient from such a mixture, the druggist who puts up the prescription will certainly not think much of the doctor who writes prescriptions for drugs that are incompatible. A short time ago the writer saw a pre scription from one of our nost eminent surgeons for permanganate of potassium, acetate of lead and tannic acid, with some other ingredients, to be mixt and made into a solution with water. Now what can a druggist think of such a prescription? Our medical colleges are turning out very fine surgeons nowadays, but how many good doctors are turned out with the present system of teaching materia medica? Indeed materia medica is a much neglected subject, and as a result of a lack of knowledge of this important branch, the doctor of to-day in sheer desperation from his failure to get good results in the treatment of his patients, falls an easy victim to the ever present patent medicin vendor who lauds his wares early and late. Finally such a doctor will get to be a therapeutic pessimist and see no good in medicin at all. This was strikingly illustrated in the controversy in THE WORLD over the value of iron. One doctor went so far as to state that iron was of no use, or words to that effect. I was glad to see the able defence of iron by others, but I failed to find that anyone dwelt on the one main point in giving iron. This point is of such great importance that too much emphasis cannot be placed on it. It is this-mark it well! Never,-never under any circumstances, no matter how much it may seem to be indicated, give iron unless the tongue is clean. Attend to the bowels first, and afterwards if there is a tendency to constipation, combine a little aloes with each dose of iron. I am never disappointed with iron. As a rule I use the dried sulfate, like this: M. Div. in pil. No. 60. Sig.-One three times a day. It is necessary to use a little aromatic or other powder in order to get a good pill mass. Do not allow the druggist to use any solid extract or other mucilaginous matter in these pills, because the pills melt so slowly then, that irritation or even ulceration of the stomach might be produced from a pill sticking in some fold of the stomach. (Murrell's Therapeutics.) Often I combine grain arsenious acid with each pill. At other times, if there is any suspicion of syphilis, I combine one Now I wish to compliment the Editor on the able editorial on cod-liver oil, and especially for emphasizing the necessity of giving it one and a half to two hours after meals. I like THE WORLD best of all the medical journals that I take. Most medical journals nowadays, it seems to me, have got down to the level of the patent medicin almanac. Sorry only that THE WORLD does not come every week. Minneapolis, Minn. 237 First Avenue, S., A. E. ANDERSON, M.D. [The Editor wishes to thank Dr. Anderson for his frank expressions. He also wishes to say that he does not claim to be infallible. It is hoped that the many details in his busy life will be some excuse for not catching every point as he goes along. However, he wishes to remind Dr. Anderson and all other WORLD readers that THE WORLD is their magazine, and whenever the Editor is lax in any particular, it is their privilege and duty to come promptly forward with criticisms and corrections. WORLD readers are a family of mutual helpers, and they should depend upon one another more than upon the Editor. How I Have Succeeded in Obstetric Practise. Editor MEDICAL WORLD:-I see in the January WORLD, page 16, an article by Dr. H. S. Taylor, of Ashburn, Tenn., giving his experience in obstetrics. I was very much interested in it, as it displays that markt difference existing in the experiences of different men in different localities. My own practise of twenty-five years bears record of a few more obstetrical cases than are claimed by Dr. Taylor. My practise was country four years, the balance city. My use of forceps has been 25 per cent. I have had four lacerations, all of which were produced by the passage of the shoulders, in cases where a very powerful expulsiv effort caught me napping, for it is my custom when the shoulders are at the perineum to restrain the progress with one hand, and manipulate the external parts with the other until a safe degree of dilatation is secured. If then there seems to be any danger to the parts, the labor is conducted very slowly, lifting the child toward the mother's pubes, and carefully pushing out one arm, which so changes the shape and diameter of the shoulders that the labor is completed without accident. the Fraternal help is a thing that increases in the act of giving. Those who give the most are helpt the most. Dr. Cooper did not say that iron is of no use. He said its use as a hematic is illogical and indefensible, but that it is a valuable astringent. No, THE WORLD is not publisht to "boost" the sale of certain preparations. It is not an "almanac." It is a legitimate medical publication, devoted solely to the interests of the profession, having no commercial interests whatever. Hence our subscriptions must be paid in cash. Does the profession prefer such straightforward dealing as this? or does it prefer to pay for its literature once in cash, and many times in the profits on "boomed " preparations? The fact that we have received more new subscriptions this year than in any year heretofore is an answer to this question.-ED.] WORLD four years for $3. In these days, and especially in our large cities, we have to deal with many feeble women. To such the forceps properly used is often a life-saving measure. My rule is to use forceps in all cases where woman is suffering greatly, but making no progress. If the head does not engage the brim, and the os is dilated, the woman suffering greatly, I regard it as cruelty to delay forceps. I use Elliott forceps with sliding bar in handle, which enables the operator to regulate the pressure upon the child's head. Slight compression of the head will usually cause it to engage promptly, while the presence of the instruments is certain to change the character of the pains. No traction is necessary, in fact, never is. The canal thru which labor is accomplisht is a quarter circle, and any direct traction force is a violation of the mechanical laws which govern the process. In my belief direct traction is to blame for very much of the damage charged to forceps. I have seen the doctor pull upon his forceps until literally exhausted, while two strong men were required to hold the patient firmly on the bed. Such work would do credit to a barbarous age, but is highly unfitted to our day. Obey the laws of nature, and follow the road markt out by her, and forceps are as innocent as a toothpick. If I apply forceps at the brim I generally rotate very slightly until I am sure the head engages. I then remove the forceps and reapply them suitably to the changed position of the head. Once satisfied that my grip is correct, I stand up and with the three first fingers of my right hand I press downward on the lock of the forceps, while with the left hand I grasp the end of the handles and lift upward, using as near as I can estimate the same amount of force as with the right. This causes the labor to follow the pelvic curve. When the head is well down and distending the perineum, the forceps are removed, and the first finger of the right hand is past into the rectum, catching under the chin or occiput as the case may be, and manipulation of the external parts carried on with the left, as before mentioned, and in 99 per cent. nature will finish the work without harm, so far, at least, as the head is concerned. If the child should be rather large, care must then be given to the shoulders, as before stated. Let anyone follow this method a few times and he will become devoted to the use of forceps as I am in all tedious labors. labors. We have no agency at our hand which will so conserve the mother's strength as forceps properly used. A few whiffs of an anesthetic, which in nearly all my cases I have managed myself, is all that is necessary to render a difficult labor easy and almost painless. If it is not the doctor's mission to reduce human suffering to its minimum, then what is his mission? E. P. ILIFF, M.D. Newark, N. J. OBSTETRIC RECORD. Editor MEDICAL WORLD:-I purchase a blank book and rule as below for use as an obstetric record.-W. T. BURDICK, Talesboro, Ky. |