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The after treatment will be according to indications.
The family of THE MEDICAL WORLD will no doubt call me a fogy when they see that I am a great believer in my old text books: Wood's Practise of Medicin, also Eberle's works, and all of the old writers of our young days. I am of the old school. Have been a "pill driver" for forty-nine years-now 70 years old. Will probably pass away soon. Yet I take a great interest in the welfare of my patrons, and may stay with them as long as I can do the work they need.
I started out in the practise in East Tennessee near Sneedville, where our old friend Dr. J. B. Mitchell has such a time
with his typhoid patients amid squalor and filth. I can say that I too was lucky in those cases there; more so than any other locality in which I have done practise, which was in Northeast Kentucky, North Indiana and Southwest Missouri, where I have been thirty five years. I am truly sorry that the practise of venesection has been discarded by the profession, for I am one who can testify to the fact that since it went into disuse over 40 per cent. more mortality in pneumonia and other inflammatory diseases has been the result. A. R. GONCE, M.D. Walnut Shade, Mo.
[In this "test case" of pneumonia, we wish to call attention to the fact that, according to the natural history of the disease, the patient would be at the time given, the seventh day, very near the crisis, or perhaps he may be in the crisis at the time described. In this connection we suggest that those who wish to make a rational study of pneumonia read up carefully on the natural, or clinical, history of the disease, in all the authorities within reach. If untreated, this patient, should he survive the crisis, which would be a matter of only from about 12 to 24 hours, or less should be now in the crisis, would get rapidly better, and resolution would begin and proceed rapidly. Let us beware how we give credit to medicins, either of the material and heroic, or of the infinitesimal kind. However, we do not wish to intimate that the patient does not need treatment. He is sorely in need of the right
kind of treatment-just enuf, but not too much. But the Editor does not wish, at
present, at least, to appear in the contest. -ED.]
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The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.
Read this Before Asking for Help. years. We have never faltered, and have never THE WORLD has posed as a helper for many refused to do the best we could do, and angels could do no more; but we sometimes fear the said angels might make uncomplimentary remarks if they should see some of the communications sent us. If you want the benefit of experience and the use of extensiv libraries, you must tell what you want; but we cannot agree to give "absent treatment." Before writing to us, do all you can for your case, and read up on it as extensivly as your opportunities will permit. If you do not possess late editions of standard authorities, get them. You can't practise your
profession successfully unless you continue to be a student. Your college life was only an introduction to the study as well as the practise of your profession. You should purchase at least several late books per year, and study them. Do not submit your cases to us merely to get us to do your reading up for you. If you write us for information, give us all details without verbosity. One page of manuscript will generally give the history and symptomatology of any ordinary case, even if carelessly written. Age, sex, previous history, sketch of family history if cancer, tuberculosis, or syphilis be suspected, condition pulse and its character, temperament, digestion, of emunctories, state of the skin, respiration, bowels, appetite, and duration of illness, and special symptoms of import, and your treatment to date, with results. If we have such data, we can often suggest help that will be valuable. If such details are not given, we can only reply from what information is furnisht, and our replies necessarily cannot be as accurate or helpful as we would wish. We want to do good every time we answer a letter, and we also want to save our time and space. Many letters we get require much pruning and considerable time, where if the writers used a little more discretion, legibly. Do not ask for personal replies except in very exceptional cases. Sign your name, and give your address. THE WORLD does not go to your patients, and there can be no objection to physicians knowing of the name of the inquirer. In exceptional cases it may be advisable to use a nom de plume, but they are rare. Read the queries and replies as thoroly as you read the
we could answer them in half the time. Write
Mix and add
Tinct. white pine.
Cabonate of magnesia.
8 fl. oz. 10 fl. oz. 4 dr.
Obscure Stomach Trouble.
Editor MEDICAL WORLD:-J. M., male, aged 57, has always enjoyed good health until about eight months ago, when he began to complain with stomach trouble. Has taken treatment from three other phywas sicians, with very little benefit. I called to treat the case June 1, 1901. The following is said to represent its composi- He had been confined to the bed for three
King's New Discovery.
weeks, very weak and very much emaciated. Symptoms: Vomiting from one to two ounces, of a tuf, glairy mucus and bile, slightly streakt with blood, which occurs about once a day, in the morning; during the day he spits up about the same amount; extremely constipated. Gets dizzy and blind whenever he attempts to raise up or turn on right side. Heavy brown coating on base of tongue, and red on tip and sides, but not pointed. Pulse 50 per minute. Has but very little formation of gas in stomach and bowels. Has no pain at all, says he feels well enuf to get up and go about if he had strength. Have not been able to detect any tumor or hardness about the stomach to indicate cancer. I have been giving the following treatment.
-King's American Dispensatory.
Rub the magnesia with one ounce of the sugar in a mortar, and triturate with the tincture of white pine and the fluid extract of ipecac; gradually add the water, and triturate with the mixture in the mortar. Filter and dissolve the morphia sulfate in the filtrate; mix the chloroform with the rest of the sugar in a bottle and add the liquid above. Keep in a tight vessel. - New Idea.
Editor MEDICAL WORLD:-I have a case of goiter in a very handsome married. woman of about forty. She is distrest, and makes a strong appeal for relief. The left half of the gland is as large as a chicken's egg; the right half is about half as large, and all growing slowly. Now do you believe to your satisfaction that there is a cure for it? Paynes Depot, Ky. W. T. RISQUE, M.D.
[Goiter is not curable by any known. drug or operation in a sense in which we would call a universal cure. Many cases are benefited by the prolonged administration of potassium iodid, ergot, belladonna, or thyroid extract. Thrusting a needle into gland and applying electrolysis has given good results in a few cases.
Surgical removal of the gland has been disappointing; the mortality of thyroidectomy is high. The use of the thyroid preparations offers the best therapeutical resource of the day, but a cure is not to be promist. Local applications of ichthyol have proven useful in some cases, as have also the tincture of iodin, iodoform, and potassium iodid ointments. Tell her you may possibly cure her, and will probably relieve her symptoms if she will undergo a prolonged course of treatment, but be chary of promises.--ED.]
Diet: Milk and beef tea. Medicin: Fowler's solution of arsenic, bismuth subnit., carbolic acid, silver nitrate, iodoform, sulfocarbolates, tr. nux vomica, and nitro muriatic acid. Have kept up an action of the bowels by copious injections of warm water and by use of salines. These medicins have been given a pretty fair trial during the time I have been treating the case, with but little change.
O. R. YOUNG, M.D. West Rushville, Ohio.
[Dizziness on turning on the right side. would indicate liver trouble. Read up on liver diseases. Perhaps some of our readers will discuss this case.-ED.]
Editor MEDICAL WORLD:-I have a patient, female, age 20. Married two years, has no children; family history good, as far as I can get. At present her condition is as follows: Very tender over each ovary; painful menstruation; during each attack there is a continual rotary motion of head and at times there is a peculiar contraction of the muscles of arms, legs and back. In other words, she "draws up in a knot; " can't or will not speak during these spells." During the contractions, and after they leave patient, the pulse is the same; nothing peculiar about breathing when spells are on After leaving, breathing very rapid and loud. Patient does not complain of any pain while these spells are on, only the whole body seems to be asleep "-tingling feeling. I have been treating her for the last four months for painful menstruation, giving her aletris cordial, and cascara to keep bowels open, as she is troubled with constipation. I have diagnosed the brain and spinal trouble to be a reflex from ovarian trouble. Have askt for the removal of the ovaries, believing this will relieve all troubles, but the family will not consent to the operation. In addition to above. treatment, while these "spells" are on, which last four and five days each month, I keep the patient under influence of bromidia; sometimes am forced to give morphin sulf. gr., atropin gr. 1. I think there is a good case of hysteria complicated in the above case. Would like to have opinion of others. J. H. THOMAS, M.D.
[Your case is undoubtedly hysterical. Dilate the os uteri and try to get her pregnant by counseling not too frequent sexual indulgence, and indulgence immediately after the subsidence of each flow. In addition to the attention you have already given the bowels, we would put her on iron, quinin, and strychnin. We would give her bromid of strontium with a generous hand. When she takes her next attack, after she has had such medication for a little time, we would give her a hypodermic injection of an emetic dose of apomorphin, and be sure she gets enuf. Another excellent plan is to combine all the nauseous drugs you can think of:castor oil, valerian, asafetida, capsicum, etc. Do not give in therapeutic doses, but get the odor and taste, and give about two ounces at a dose, with instructions to
repeat every half hour till there is improvement. A few doses will prove as to whether or not she is shamming. There is generally a cause for hysteria, so do not be too impatient with her. This treatment ought to cure the hysteria, and you can search for the primal cause in the meantime.-ED.]
Editor MEDICAL WORLD:-A young man of 35, strong and hale, weighs about 230; has never been guilty of intemperance of any kind; very correct in habits; has been married six years; no children; has a fine, healthy wife. He can perform the act of coitus all right, but there is no ejaculation. I have treated him for some time, with all ordinary and extraordinary remedies, and have failed. This is the reverse from all cases I ever met before. What is the cause, and what the remedy? It is a very important case. I shall be very thankful for any help in the diagnosis or treatment. He never has had any taint of any kind that I can find out, and there is no sign of any.
Wм. M. COOLEY, M.D. Herington, Kan.
[Your patient has aspermatism. If it be organic, i. e., caused by some obstruction to the spermatic ducts, he is incurable. Organic obstruction is generally a sequence of gonorrhea, but may result from traumatism, or non specific orchitis, or epididymitis. Aspermatism is generally of psychic or of physiologic origin. The psychic form generally occurs in neurasthenics or neurotic cases. In this variety, ejaculation may not take place at all, or it may readily take place with some women and not with others. This form is oftenest found in masturbators or those who have indulged freely in promiscuous intercourse. In such cases, it is with the wife that the failure of ejaculation oftenest occurs. The physiologic form is merely the result of excessiv indulgence, and is readily curable by continence for a time. It is sometimes possible that the seminal fluid is thrown into the bladder during coitus, and the male is not aware of an orgasm; in such a case centrifugation of, and microscopical examination of the urin will reveal the presence of spermatozoa. There is another form in which ejaculation does not occur in coitus, no matter how long the act be persisted in, until the penis becomes so flaccid that
penetration is no longer possible; then as soon as the organ is withdrawn the fluid will flow from the meatus. You can at once get at the root of your patient's trouble by gaining his confidence and insisting on the entire truth and complete history, with permission to make complete examination of himself and wife. Has he ever had ejaculation? Under what circumstances? Beware how you alarm him with any leading questions on masturbation; every boy does this, and most men fear punishment thruout their lives. If he has indulged in illicit intercourse since marriage, did he have orgasm? Is his wife passionate? Many beautiful women are devoid of sexual feeling, and could not induce orgasm in any normal man, except as it is induced by masturbation.
Now, as to cure: This depends on the variety of the affection and the cause of it. As a general rule, plenty of encouraging assurance is of great importance; he should have tonics and nervines, the genitals should be bathed with ice water twice daily, and he should sleep apart from his wife and avoid intercourse or masturbation for a considerable time. Get him a good battery and have him use it regularly. If you exclude the organic form, you will cure him, if you follow our directions, and secure the co-operation of himself and wife.-ED.]
Regurgitation of Food.
Editor MEDICAL WORLD:-Below I give description of a case that has given me much thought. I should like your and Dr. Waugh's opinion of the case, the diagnosis and treatment. Patient is a lady 35 years of age, brunette, since childhood has always regurgitated or vomited her food. Previous to the past three years she would have a sickness at the stomach for a moment, and then discharge the contents of the stomach; and would not mind any more about it until the next day, when the same would be repeated. That was her condition up to about three years ago. Since that time she has suffered great pain and soreness in and over region of liver and stomach. I was called to see her last August. Found her in the condition stated above. Have treated her now for nearly one year, and is, I think, somewhat improved. After three months attendance I succeeded in stopping the vomiting and the soreness all disappeared. She gained rapidly and as I thought was
nearly well. At this time her menstrual
J. B. H. CUSHMAN, M.D.
[We would try to do without the morphin. We would try bromid of strontium for some days before a menstrual flow. We would purge her well twenty-four hours before its appearance. We would have her eyes examined by a good oculist. You hardly have a true case of idiopathic regurgitation. Such vomiting is often a symptom of acid dyspepsia, and the uterin action at the monthly flow may aggravate it by reflex irritation of the gastric nerves and mucosa. We would try to still the stomach by cocain by the mouth, at the first appearance of irritability. Restrict her diet for a few days at that time. Try depleting the pelvis by glycerin tampons, and dilating the cervix. You do not make it clear whether she is married, or has borne children; and this would be an item in forming an opinion. You do not tell us how you have excluded uterin disease, and we could not guess. Endometritis often exists without ordinarily producing symptoms which cursory questioning would lead one to think of pelvic trouble. Begin with the eyes, and exclude ocular trouble; go over the stomach, and exclude all forms of indigestion and gastric dilatation; exclude gall stone; exclude autointoxication from the bowel; exclude
congestion of any pelvic organ; exclude, or regulate any irregularity in her sexual habits; arrange her digestion and excretions as properly as possible. Go over the case from start to finish again, even if you have done so many times before. There is a cause for the trouble. We may give you nothing new, but we believe you will find the cause if you follow this plan. We shall be pleased to have Dr. Waugh and other readers offer you suggestions or diagnosis.-Ed.]
Editor MEDICAL WORLD:- I have a patient, male, aged 50, who for eighteen years has been suffering with neuralgia over the region supplied by the supraorbital branch of the ophthalmic and temporal branch of the facial nerve. The first two or three years he would have a couple of attacks a year, then they commenced coming weekly and have done so the most of the time since. The attacks last from twelve to twenty-four hours, and during that time he suffers the most excruciating pain. He will toss from one side of the bed to the other, have a member of the family bear his or her weight on his forehead, or tie a handkerchief as tightly as possible, at times will tighten it with a stick-anything for a minute's relief. One week it will be on his left side, the next on the right, or both may be involved. He spent the summer of 1886 in the mountains and received some benefit, having only two attacks. Upon his return home the neuralgia returned. Last fall he went to the mountains but did not receive the benefit he did the first time. He also has trouble with his stomach and bowels, for which he has taken more or less treatment. He tells me he has been treated by thirty-four doctors and has not received any permanent relief. For the neuralgia I have given him acetanilid, Dover's powder, papine and various other drugs used for the relief of pain. They would not give any relief. A hypodermic of one quarter grain of morphin is the only thing that gives relief. That has to be used two or three times during an attack. I always give it myself. During the last two weeks I have been giving him Fowler's solution, and an aloin, strychnin and belladonna pill night and morning. My reason for giving Fowler's solution is this: This man has lived in a malarial country the majority of his life; our town is located
on the bank of the Missouri river, and there is plenty of malaria here. Could chronic malaria be a factor in this case? Have given him numerous drugs hoping to give this man relief. So far they have met with failure, as did the treatment of the thirty-three doctors before me. Has any of the WORLD family had a case like this? If so did you give them relief? and how? Am anxious to give this man relief, as no one knows how he suffers. FREDRICK E. KRAFT, M. D. Brownville, Neb.
[This is one of the cases that "try men's souls." Your anti-malarial theory seems a promising one. A large dose of quinin (15 to 30 grains) from twelve to twenty-four hours before an expected attacked might ward off the attack, or modify it. It is worth trying. If you have facilities for examining his blood for the plasmodium malariae, this would throw definit light on the diagnosis. Let us hear further from this case. The science of medicin should be able to do something for it. Make this case the subject of your study, and even of your dreams, rather than allow it to baffle you. The fact that it changes sides indicates that the course of the nerve is not impinged upon.-Ed.]
Editor MEDICAL WORLD:-I have a case in which I need help. I think that it is one of indigestion. of indigestion. Patient suffers from vertigo and general weakness; temperature 97° to 981; pulse 50 to 65. Eating any kind of meat, fresh bread, pastry or sweet potatoes causes headache. Anything that he eats seems to ferment in the intestins, the stomach not being especially troubled. But eating too much of any thing seems to produce the severe headache and the lowering of the circulation. I have tried him on the bitter tonics, arsenic, bromids, pepsins, electricity, etc; also fruit breakfast, and almost exclusiv fruit and milk diet, and every thing else I could think of in the line of diet; grape nuts, shredded wheat, malted milk, etc. There has been some little improvement, but he is in a bad condition yet. Alcohol in any form nauseates him. He says it was brought on by over work. If the Editor or any member of the WORLD family will help me it will be highly appreciated. F. G. THOMASON, M.D. Punta Gorda, Fla.
[In all probability he needs judicious exercise and massage. Put him on freshly