Fatal Bleeding From Incised Gum. Editor MEDICAL WORLD:-August 28, 1901, I was called to help another physician who had incised the gum of a child "to relieve convulsions." He had difficulty in stopping the bleeding, and was pressing the gum. We applied liq. ferri chlor. and other drugs, but without avail. Another physician then came, and I retired from the case. The next day I met one of the physicians, who told me that they failed to stop the bleeding, tho suprarenal capsule solution stopt it for a time. On the sixth day the father called me again, tho several other physicians had been called in the meantime, who had stitcht the incised part. The blood still oozed out. I called an experienced surgeon in consultation. We decided to apply a tight bandage on the head and face, hoping to produce enuf pressure to stop the bleeding, but without success, and the child died the next day. The surgeon said he thought the child was a "bleeder;" but he was circumcised six months previous, and it healed in two or three days without hemorrhage.

Brooklyn, N. Y. H. ROSAHNSKY, M D.

Insane Disorders of Childhood. Editor MEDICAL WORLD: - Physicians who pay much attention to diseases of children see a great many cases of what I call" insane disorders." A brief consider ation of these without elaborate speculation as to causation, etc., may be of some use to the practical physician.

Insanity is rare in childhood when considered from the same standpoint as in the adult; but mental defects are very common, and grow worse with great rapidity untess treated properly.

Acute diseases frequently disturb the cerebral functions, which may not recover when the malady subsides, and then it becomes a very important duty of the physician to carefully direct the educational and disciplinary measures in order to inhibit further structural damage.

I wish to call attention to the causal factors in these cases, which should be carefully scrutinized by the physician as soon as the least suspicion is aroused. Some are the result of deprest physical powers, due to want, misery, crime and vice. Great danger also lies in certain parental tendencies. Vitiated appetites, as for alcohol, opium, tobacco, etc., are good ground for disease of mind as well as

body. I am satisfied that in my own village I can see degeneracy on the increase very noticeably as a result of the early and excessiv use of tobacco.

I have seen families of notably unstable nervous equilibrium, caused by filthy and degraded habits, in whom acute disease played sad havoc. And when all these various causes of mental disorders become superadded by the marriage of a tubercular or alcoholic father to a hysterical mother, disaster, as swift fatalities in the offspring, may be predicted.

The surrounding influences capable of disturbing a healthy minded child are many. Acute febril disorders in children produce a delirium which is a transient insanity. It may pass utterly and quickly away, or it may leave an indelible stain

on the cerebrum.

That surprising condition known as precocity is a source of peril, and frequently is an evidence of mental unsoundness. It should never be a ground for parental congratulation, as it frequently predestins its victim to some neurosis.

The idea that some educators have of "intellectual pushing" is regarded by Charcot as harmful and brutal.

Sudden changes in temperature is another exciting cause, as children do not bear heat and cold as well as adults. Several instances are reported in which the child was driven into acute mania by lying with its head toward a hot stove.

Many transient disorders of the mind are caused by reflex irritations, as in digestiv disorders; the cause being removed, recovery ensues.

Intestinal parasites cause a number of nervous disorders, but very rarely insanity. Superstition and lurid religious teachings often dethrone unstable minds. A brutal, drunken father, aside from parental conditions, causes terror and woe to young children; also, example is almost as powerful for harm as ancestral traits.

Children subjected to long periods of want, misery and exposure are sure to fail in proper mental development, and need special care and attention in planting the seeds of moral and mental conduct.

To gain any statistics from a family in regard to these troubles is hedged with great difficulty, as any suspicion by the mother is kept within her breast as long as possible-until it is observed by the laity in general.

The great body of mental suspects who

escape statistical record are at the mercy of the family doctor, and upon him lies the responsibility of directing their care and teaching.

The majority of these are to be treated at home, and the average medical man assumes a great duty and burden when he undertakes it. Often it is harder to treat the mother than the child. She will frequently tear down all the hope you build

up.

Insane disorders as the term is used here, is meant to include not only insanity, but that mixture of insanity and hysteria, which are so often blended together. It frequently imitates all the neuroses, and it is surprising to see how early in life it is developt in some children.

Moral perversion and intermarriage of relatives, criminals and degenerates are the great means of increasing the insane disorders of children, including idiocy, imbecility, degeneracy and feebleminded

ness.

The only preventiv that I can conceive is the appointing of a medical council to pass on the legality of the issuance of every marriage license.

When this stage has been reacht, and when the family doctor does his duty toward the family by warning parents and -prospectiv parents of the dangers accompanying the development of the child and its moral training, we will soon see and realize a great change.

PERRY WOOLERY, M.D.

Heltonville, Ind.

Prophylaxis in the Eruptiv Diseases. Editor MEDICAL WORLD:-Seeing a number of articles in the late journals dealing with the prevention and treatment of small pox, I would like to call attention to an article I wrote for THE MEDICAL WORLD Several years ago on a simple and effectiv way of protecting persons liable to infection against the contagion of measles. I stated in that article that tho I had never tried it, I believed it would be equally successful against small pox and scarlatina. I have had an opportunity of testing it in scarlatina, and it proved successful; and tho I have not tried it in small pox for lack of opportunity, an old veteran confederate army surgeon Texas, in reply to the article, stated that during the civil war he was shut up in a northern prison with 2,000 ragged, hungry confederate prisoners, when there

in

occurred fifty cases of small pox among them. Isolation was impossible, and the four doctors among the prisoners met to consult as to what could be done. Small pox there generally meant a funeral. One of the four recalled the Thompson method of preventing measles, and they decided to try it for small pox, and did, with the result that not a single case of the disease occurred among those who used the remedy. The agent is nothing but spts. turpentine. Suspend a flannel bag two inches square, stuft with wool or flannel, around the neck and keep it moist with turpentine. I have never known it to fail if put on before the person came in contact with the disease; and after exposure, by its use and giving the party 25 to 30 gtts. per diem, it will either prevent an attack or render it so mild that they seldom need to take their bed.

If it were something with a long, high sounding name, made in some German laboratory, I believe it would long ago have been in use by our state boards of health and by the profession at large; but it seems to be too much of an old woman's remedy for scientific men to use without more condescension than they feel they can submit

to.

Nevertheless, if your readers will give it a fair trial I know that they will not be disappointed with the results.

Turpentine we all know to be an excellent antiseptic under certain conditions, and I see no reason why we should deny its ability to destroy the peculiar element of contagion in the exanthemata; nor, if it proves successful in one of them, why it would not in all. We all have patrons who we think could not safely pass thru an attack of these diseases, but who, as parents, etc., would necessarily become exposed should their families contract them. It would at least do no harm to try this simple measure when we know that they will necessarily come in contact with one of these diseases, owing to some of the members of the household being attackt.

Many people do not attach as much importance to this class of diseases as they once did; regarding measles, at least, as being in the main a necessary but harmless disease; also small pox in the southern states for the past two or three years, owing to the low rate of mortality among the colored race, where it is mostly confined. And we all know that on account of complications and sequelae, measles is

water to drink.

Anoint body during des

quamation with carbolized vaseline.

For head symptoms give atropin, 3000 gr., every hour till improvement, or very slight dryness of throat. If very nervous, or delirious, use cold pack.

If urin is scanty, give hot drinks of cream of tartar 3j in Oj boiling water, freely; or lith. benzoat., gr., every hour till secretion is free.

Isolate patient, cover lightly, allow cover lightly, allow plenty of fresh air, pure water and quiet. Limit diet to milk, broths, and fresh fruit juices until fever is past; prohibit food for first twenty-hours. Protect from draughts during convalescence.

To prevent the disease, give to those exposed calcium sulfid to saturation, keeping to that point for two weeks; atropin in daily doses of . gr. to keep capillaries flusht, bowels free with saline. Spray or gargle frequently with listerine or some mild antiseptic wash, to prevent lodgment of germs in throat.

Dr. Coleman has shown the fallacy of waiting for a diagnosis-of allowing the disease to produce its effects before commencing treatment. Get after the dis. ease in its incipiency.

In those cases where the patient is rapidly overwhelmed by the poison, the treatment must be correspondingly energeticrapid elimination, rapid and complete saturation with calcium sulfid (and be sure you get an activ preparation), cold packs, and ice cap to head. In convalescence, and in the asthenic form, strychnin arsenate is indicated; the triple arsenate with nuclein being an ideal tonic and reconstructiv. Finally, it is absolutely necessary to attend to the hygiene of the premises. What about the sequela? There are none with this treatment.

If Dr. R. D. Nash (p. 491), in addition to the editor's excellent advice, will use daily lavage with normal salt solution to dissolv mucus from stomach walls, then disinfect with boracic acid solution 10 to 1000, drop all purgativs, using instead abdominal massage, glass of cold water before breakfast, large colon irrigations of normal saline solution to produce daily evacuations, diet easily digested, free from starches and carbohydrates for the first week, HCl dilute if deficient in gastric juice, graduated exercise, freedom from household worries, there will be great improvement. R. J. S.

White Sulphur Springs, Mont.

Scarlet Fever.

Editor MEDICAL WORLD:-In the November WORLD, page 488, Dr. E. S. Harrison, Thompson, Ga., desires "the latest and most successful treatment of scarlet fever, both as to constitutional remedies, and internal and external applications for the accompanying throat troubles."<

Now, I have never written a line for THE WORLD or for any other journal; but for thirty years have seen and treated this malady, at varying intervals of five to eight or ten years. In that time I have had my views, both as to the malady in question and its management, very much modified, if I have not learned the "latest and most successful treatment." I cannot do better than to give a bit of my experience, observations and conclusions.

So far as this experience and observation go, scarlet fever isn't nearly so grave a malady as my idea of it was. I want to add that ideas and not conditions, too largely obtain, even among medical men. By looking conditions square in the face, in a common sense way, caused the modification of my views.

The popular idea is-and that idea is shared by some medical men that scarlet fever is a very grave affection; and that it is almost, if not quite, wholly dependent upon contagion for its spread. So far as my experience and observation extend, neither of the above propositions is any more than partially, and very partially, true. During the past summer and fall, till now, this disease has been very prevalent here, in mild type for the most part. The writer has seen and managed a fair share of these cases, and it is his deliberate opinion that not more than ten per cent. of them were fairly attributable to contagion. No loss by death has he sustained so far. Many of them have haslittle other treatment than the frequend use of a salty bacon rind for [the intolert able itching, and laxativ doses of Epsom salts for the bowels. In some of these cases, twenty-five per cent. perhaps, there were varying degrees of severity of nasal, throat and ear complications; a still smaller percentage, one or two per cent., have had renal complications. One case, a girl of four years, has bad, and still has, very troublesome and very obstinate nasal, throat and ear complications, and abscesses of neck and behind the ears. Little constitutional treatment was used. Cases in which there was a high grade of

fever and delirium, aconitin, digitalin and veratrin were used. For the nausea, bits of ice. For renal congestion and deficiency of urin, nitre, tr. belladonna, or digitalis, sometimes combined with broomtop.

Throat complications had sulf. zinc. gr. viii to 3 water; or chlor. pot. xv gr., mur. tr. iron 3ss, glycerin 3j and 3j water. Ear and nasal complications had boracic acid and glycerin sprays, For the abscesses mentioned, the knife at once; afterward drest with cloths dipt in solution permanganate potassium. Whether up-to-date treatment or not, it has proved fairly satisfactory.

About the preventivs, I know nothing of either belladonna or sulfite of sodium. In a few cases I used sulfid calcium as a preventiv of abscess, but did not get the results hoped for.

Have no experience with or observation of the effects of formaldehyde fumigation. In one house where I treated the fever, sulfur was burnt to destroy the fever germs, as they said with how much or how little success, if any, I do not know. On that line it appears to me there is far more "tomfoolery" indulged in than sense, even by doctors. But that is the idea of the laity, and the doctor wishes to please. So he shuts one eye, pulls his moustache, looks high and wise, and says, "Yes, fumigate, burn, quarantine, and be sure you change clothes."

Another thing, not in line to be sure, but I wish to say it now. The widely prevailing idea of medical men and others carrying the germs in their clothing, and thus spreading the malady all over the country, is little, if at all more, than a "scapegoat" for ignorance and laziness a lack of intelligent, diligent study and observation. How often is it true that the doctor, without change, goes from a scarlet fever house to a non scarlet fever one, and no fever results. On the other hand, in another house where he has not been, nor any one, so far as he knows or can learn, we have it breaking out. Besides, in their own (doctor's) homes, many of them, there are children, but no fumigation, no change, and they escape. How is that to be accounted for?

The first case I ever saw, more than a quarter of a century ago, was in a family of five children. This case was in May, a single one. In October there was another. The remaining three escaped. Five miles

from this family there was another, of four children. Two of these had it in June. same year. There was no communication, and there were no other cases in the whole county then or for five years after. After five years it broke out in a community fifteen miles distant, and there were twenty or more cases, three or four of them proving fatal. Eight or ten years later there was a single case in a family of ten; no other case in the county so far as I could learn. Will contagionists and germ carriers tell me how this little niece of mine got it? It was in this family again the summer past; a sister, three brothers, a sister-in-law and niece having it, the niece who had it before escaping.

Now I do not say it is not at all contagious, or that the germs cannot be transported in clothing or otherwise; but I do say it is not dependent upon these for its development and spread in a community. We get it often as we do a cold or other malady.

I now step aside. Whet your blades, and at me! Then I may have something to say of "crowd poison" as a factor in the gravity of this affection in the cities and large towns, and the absence of it the explanation of its lack of gravity in the rural districts.

W. P. LEAGUE, M.D.

Simpsonville, S. C.

We

A Case of Diphtheria. Editor MEDICAL WORLD:-On Sunday, October 6th, I received a telephone message to meet Dr. L. in a case of diphtheria. I reacht the bedside of the little patient, that of a little girl of 3 years, about five p. m., and found that Dr. L. was not mistaken in his diagnosis. had a bad case of diphtheria to deal with. Temperature 103.2°, pulse 180. Losing no time we made all due preparations, and at 5.30 gave a hypodermic of 2000 units of antitoxin (Parke, Davis & Co.) Gave 2 drops of digitalis every three hours. Used spray of one part each of water and peroxid of hydrogen and listerine, every four hours, followed with a saturated solution of boracic acid. Also exhibited tr. ferri chlor., glycerin and potass. chlorate. There was no change whatever in three hours; in six, temperature had fallen to 102°, and pulse to 140: nine hours, temperature 101°, pulse 120; twelve hours, temperature back to 103°, pulse 135. At three p. m., m., Monday,