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Summer Complaint.

BY C. T. BROWN, M. D.

Then as evidence that indigestible food is not a prime factor as a cause, the majority of children attacked are too young to eat anything of the kind

On page 487, Nov. (1886) BRIEF, we, under the head of Cholera Infan--such as unripe fruits, etc. Prof. tum, stated that "Teething" had nothing whatever to do with the ailment under discussion, and that caloric was the primary and direct cause of producing it.

There is a principle in nature that heat expands and cold contracts, which if applied to case under consideration would demonstrate a priori, how the sluice ways are thrown open and all the fluids of the little body carried off through the bowels, leaving it shriveled and shrunken-presenting the appearance of an old person. Prof. N. S. Davis of Chicago, in his Clinical Lectures of 1873, was the first (that we had seen) medical writer or teacher of any note that taught the "heat theory," exclusive of all others, and his logic is so plain and his language so concise that no one can read it and not be convinced. The real cause of summer complaint and diarrheas of summer is not Teething," from the following facts: The growth of the teeth is a physio- | logical process, and are growing at all times of the year, in January as well as July; and of course if the teething produced disease it would be as liable to occur at one season as another. Then teething being a physiological process, it would be difficult to imagine how a disease could be produced by such a natural growth. The mucous membrane of the alimentary canal the first three years of life is delicate and not completely developed; both the epithelial layer and the multitudinous glandular structures belonging thereto are so tender as to be unfitted for the contact of anything in the way of nourishment except the most simple fluids, such as good milk.

Davis says: To understand the modus operandi of caloric, or high temperature, in producing disease, we must have a clear conception of the normal properties of living, organized matter, and the manner in which those properties may be modified by exterior agents. A careful analysis of the phenomena connected with organization and life, shows that every organized living structure, whether vegetable or animal, is possessed of two properties, elementary and essential to the existence of matter in an organized and living state. The first is an affinity by which the organic atoms are made to assume a definite arrangement, constituting the primary structures and types of organization. This property we call vital affinity. The second is susceptibility to impressions from exterior influences, or capable of being acted upon.

This susceptibility must not be confounded with nervous sensibility which is merely one of the functions of nerve structure, and not an elementary property of organized matter. Caloric is one of those imponderable agents capable of pervading all matter whether organic or inorganic; and it has the property to expand all bodies by causing the atoms of which they are composed to be separated farther from each other. Hence it is the great antagonistic power to affinity, whether simple, elective or vital. Every successive addition of caloric, or increase of temperature increases the expansion of the tissues, and of course lessens in the same proportion the vital affinity between the atoms of which the tissues are composed. If you wish for proof of this place your

finger alternately in hot and cold. water and note the difference in size by placing on same finger a ring after each hot and cold bath. A high atmospheric temperature renders these structures (mucous surfaces) morbidly sensitive, while their expansion renders them more lax, and thereby puts them in the most favorable condition for sudden and rapid fluxes of fluids into and through them. Hence it is that during hot seasons people of all ages are more or less disposed to bowel troubles. Then, what predisposes all classes to such ailments, becomes in children, while the mucous membrane is undergoing development as already described, sufficient to produce disease.

Now, if Dr. J. F. Griffin of Cloutierville, La., will pardon the poverty of my language, overlook repetition and pass unobserved my murderous English, I may "take heart" and write further on the subject.

And in the slang of Dr. G., I say of the BRIEF "Long may it wave," which, being interpreted "May it ever prosper." Newtown, Mo.

means

Succus Alterans in Rheumatism and Syphilis.

We are reliably informed that the preparation Succus Alterans (McDade) is becoming a very popular remedy with the profession, and being very extensively prescribed in general practice as an alterative tonic, aside from its use in syphilitic diseases. The good results from its use in treatment of rheumatism, of chronic character especially, is worthy of consideration. The remedy is certainly growing in favor, and as no great claims have ever been made for it, but simply placed upon its own merit, we think it could possess no higher recommendation.-Ind. Med. Journal.

Hemorrhoids.

(Continued from page 316.)

When this irritated condition has passed away-say in four or five days-then begin the final work of destruction by injecting the sacs in rotation, at intervals. One treatment is sufficient for the destruction of a hemorrhoidal sac, unless the sac is old and the wall hardened until the puncture will not close readily on withdrawing the needle. In this condition, the blood is apt to pass out with more or less of the fluid injected. When there is a doubt as to the medication being retained, it is advisable to not renew the treatment THEN, but wait until the time for the following treatment, then reinject. Now, we can, in most instances, prevent hemorrhage and the loss of the injecting fluid by having a small probang charged with Monsell's solution of iron, ready to apply to the puncture IMMEDIATELY after withdrawing the needle. The needle need not penetrate (even in the largest sacs) more than three-eighths of an inch.

Occasionally, when a sac has originated low down and has existed for a long time, the wall is hardened, tough and dark, but not painful, and it is impossible to return it into the rectum. Of these, the dependent end is generally inclined to bleed at stool or when touched, through an old opening. We can not reduce these, but treat them by injection. When found, hold it with thumb and finger of the left hand, pass the needle in through the old opening with the right hand, and inject. These sacs, which can not be returned and treated within the rectum, occur about one time in fifty cases, and we seldom find more than one sac of this nature in the same person.

When treating piles during the heated season, if the case is extensive

and the parts congested, it is not improbable to find the sudden development of a fissure. (If anticipated, it is best to name this fact at the time of treatment.) When fissure occurs from this cause, it is easily controlled by using salicylic acid (from wintergreen oil) ointment three or more times a day, for a few days.

Parties under treatment for piles, should be instructed to never, while under treatment, resort to the rural posture (squatting) when at stool. They should always go to the closet, sit on a solid seat, erect, and relieve the muscles of the pelvic and lumbar region of all undue strain. This is a point to be remembered.

With what shall we inject?

If there is anything equal to carbolic acid, I am ignorant of the fact. This remedy may be combined with others perhaps (?) to advantage.

Now, the point to observe in preparing carbolic acid for injection is, to get a solution that will not crystalize. There is a way to do this that is not generally known, a process of which certain non-ethical and I might truly say non-scrupulous parties claim pat

ents.

However that may be, it is certain that this process has been known and practiced by creditable physicians for a number of years. It is this: Take of sperm oil q. s. one or more ounces (quantity is immaterial), place the container into an open vessel and surround with ice and salt. At the same time, have your bottle or bottles which contain carbolic acid crystals partly submerged in very warm water, until all the crystals become fluid. Now, after the oil has been in this bath until it is quite cold, say fifteen minutes, begin to add the carbolic acid, SLOWLY, all the time stirring; continue this little game of addition UNTIL the contents of the oil bottle begin to look flaky-that's all that is wanted.

It will not crystalize. Three to eight drops is the proper amount to inject, being governed by the size of the hemorrhoidal sac. Do not use too much; always favor the minimum amount.

The above points, when properly interpreted, will suffice to give us success in the great majority of cases of hemorrhoids. Yet, occasionally, we may find a case so very badly congested that it requires a somewhat modified treatment. W. E. RYAN, M. D. French Lick Springs, Ind. Acute Articular Rheumatism with

Suppuration.

Dr. J. C. Wilson, in October BRIEF, asks for report of such cases.

Sept. 30, 1886, I saw Mrs. S., widow, aged thirty-six, mother of two chil dren, younger fourteen. Her general health was good, until ten days previous to my visit, when she was taken. with chills and fever for which she took quinine. Then followed the usual symptoms of rheumatism, with no heart complications and temperature did not exceed 1021° F. The left knee, ankle and foot were involved. Treatment: Salicylate of soda and such remedies as symptoms demanded.

On Oct. 11, the pain, tenderness, etc., having left the joint, the temperature in evening being 99 to 100° F. Tinct. iron and quin. sulph. given and the soda stopped. On Oct. 17, she sat up some and walked around her bed, but complained of tenderness in ankle and there was some swelling; on 19th, an abscess was noticed just above external malleolus. It was opened and poulticed, and on the 21st one was opened on the instep. Both discharged quite freely and soon healed. They were superficial. Patient convalesced slowly and slight fever in the evening for two weeks afterward. There was no delirium or symptoms of pyæmia or phlebitis in this case. Louisville, Ky. T. E. GOSNELL, M. D.

Prompt Delivery of the Placenta. In answer to our request for opinions on the above important subject, we have received the following replies:

The question now agitating the minds of the readers of the MEDICAL BRIEF is, when to deliver the placen

"A man convinced against his will, is of the same opinion still;" hence, I do not intend to convince any one whose experience teaches him a better lesson than my argument can. I wish, however, to give my treatment of the placenta and the reasons therefor.

If I were asked the question: "Why do dilating and bearing-down pains come and go? Why do they not continue, when once commenced, until the os is sufficiently dilated and the child expelled?" The answer is: To save the woman; save her from so long continued suffering, from exhaustion, from death. Why not deliver the placenta immediately after the birth of the child? To allow the mother time to rest, after a two, three, four or more hours' severe and painful battle, such as no man ever fought. He who feels that the poor woman needs no sympathy and no rest after the expulsion of her child, let him remove the placenta at once, and vice versa.

Immediately after the birth of the child, the womb contracts. This is nature's effort to dislodge or loosen the placenta from the walls of the womb. It may succeed during its first effort, and it may need two, four or even six contractions. After it is peeled from the walls of the womb, and the woman has had rest and time to breathe and regain strength, the placenta is ready to be removed, and if the physician is not in a hurry, nature will do the work herself.

Not to remove the placenta at ouce, be an argument as a cause for

may

hour-glass contraction. Who knows whether there may not have been hour-glass contraction after the delivery of the placenta as well as before?

I have read arguments in medical journals against the use of the binder after delivery, also against cutting and tying the cord. The reasons assigned were, that nature did not need such interference, since in animals the cord was never tied and the female never bandaged. If this is good logic, then the fact that animals do not deliver their placentas immediately after the birth of their young, waiting in most instances at least an hour or longer, is a very strong argument in favor of waiting for the delivery of the placenta after the birth of the child.

Ever since I am able to reason for myself and to know from experience, I always wait for the delivery of the placenta. After the child is born, I place my hand upon the abdomen of the mother, to learn whether the womb has contracted. If it has, I ask for a good string and a pair of scissors. I now tie the cord at two places, about an inch apart, and then cut between the two ligatures. The two ligatures may not be necessary in many cases, but in case of an adherent placenta they may save the life of the mother by preventing a flooding through the cord. This has been my experience. After the mother is carefully covered over in bed, I proceed to wash and dress the child. After this is accomplished, I make an effort to deliver the placenta, bandage her abdomen moderately, give all necessary instructions, and then leave. No physician has a right to run a risk with the life, safety and comfort of his patient. He should even care for the strongest as well as for the weakest of his lying-in women. FRANK R. BRUNNER, M. D. Eshbach, Pa.

Dr. McCarty requests experienced obstetricians to give their views in regard to prompt delivery of the placenta. I have, for twenty years past, made it my practice to deliver the af terbirth shortly after the child was born, and with the best of results; and I have delivered a great many women in my time. I draw steadily but gently on the cord until I can reach the afterbirth, then I grasp it and bring it edgewise (as directed by Prof. Meigs), then I turn it in my hands to twist the membranes into a rope-like shape to get it all away. I see Dr. Livezey censured Dr. McCarty for his promptness. It is good that we are not all of one mind and do not operate alike. The more we argue these cases through the good old BRIEF, the more we learn. All these controversies are profitable; let us have them often. I often thank a brother physician for thinking differently from what I do; we all have room to learn. Lord have pity on the doctor who knows it all! We have just such ones in this city-what they don't know is not worth knowing; some of them are old and gray-headed, and they have a few old books, perhaps fifty years out of date, and in their estimation medical journals are a humbug; and some of them are boys, fresh from a college where they are graduated at the end of one term. What extremes in this medical world of ours! A. S. GISH, M. D. Abilene, Kan.

As the BRIEF calls for the views of its readers on the delivery of the placenta, I answer that my practice of obstetrics extends over a period of about thirty years, and it has always been my habit to deliver the placenta promptly, notwithstanding all the authorities I had read recommended delay; and I have never had occasion

to regret my practice. As soon as the child is born and the cord ceases to pulsate, and the child has received the last drop of blood that it is going to receive from the mother, I tie and cut the cord and hand the child to some one, and grasp the uterus between my two hands and make gentle pressure until the womb contracts firmly and the placenta is almost or quite expelled from the organ. Then I take hold of the cord and make gentle traction, and a little pain comes along about that time, and the placenta comes into the external world, and a turn or two in my hands twists the membranes into a cord, and all is

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On receipt of the October BRIEF, I noticed an article of some importance on the subject of when to deliver the placenta. Now, my experience is that the sooner the afterbirth is delivered the better for the patient. After a practice of thirty years, I will positively state that I have always removed the afterbirth as quickly as possible after the delivery of the child, and never wait for anything. I introduce the hand and bring away the afterbirth as soon as it is possible to do it, and never have regretted it. All the students I have had have done the same, and there is not a more successful lot of men in the profession than they (as well as myself) have

been.

Men who are placing their sole dependence on what the old text-books

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