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One Phase of Cystitis in the Female. that "there is nothing the matter there,

By A. G. SERVOSS, M.D. Havana, Ill.

Occasionally it is the luck of the general practitioner to come across a case of cystitis that resists all of the usual remedies, even to stretching or cauterizing the urethra, washing out the bladder with mild corrosive sublimate solution, or all of the routine treatments for this trouble.

The cases which I have noticed in particular, and to which I wish to call your attention, had not so much the symptoms of cystitis as of neuralgia, and might even give a strong suspicion of fissures at the neck of the bladder, but endoscopic examination usually fails to detect the last named condition. Some of them, however, would readily have been classed as cystitis. They usually occur in women who have had no children, and depend on insufficient drainage of the uterus.

Therefore, sterile married women are the most frequent patients of this class. They usually complain of frequent micturation, which is quite painful at the close, but spasms of pain in the region of the bladder and urethra are frequent and severe, usually worse when walking or standing. The urine may be clear or cloudy, acid or alkaline; the patient, in the meantime, showing plainly the effects of pain, worry, and the loss of sleep. Many times these symptoms leave to return with renewed vigor as the patient nears the menstrual period; at any rate, they are made markedly more seve reat

this time.

it is the bladder that needs treatment."

This state of affairs applies not only to the class of cases described, but to all cases where for any reason there is any obstruction to the natural drainage from the uterus, a flexion, for instance, producing the same effect in a woman who has borne children as a pin-hole os or an infantile uterus will in a barren woman.

Treatment.

My treatment for this class of cases has always been dilating the uterine canal, and a forced dilatation by the ordinary dilator is but temporary. I am in the habit of using the negative galvanic electrode with a current of about 25 ma., though 75 to 100 ma. is sometimes used, increasing the size of the electrodes as needed. Treatment is kept up one or two times a week till a large-sized electrode will easily enter the canal. The first sound to freely enter the uterus usually relieves the pain for the time being, the period of comfort increasing till the patient gladly tells you that she has no more pain.

In all of our work, we must examine the whole field, and not fix our mind on the offending bladder or urethra alone. It may be that the rectum is at fault and needs attention, but in this article I only wanted to call attention to the most frequent cause of this trouble.

Of medicinal treatment, you will find that little is required in these cases, but I sometimes give thuja 2 or 3 times a day till it is no longer needed.

Fibroid Tumors of the Helix After Piercing for Earrings.

By A. SCHIRMAN, M. D. St. Petersburg, Russia.

This case being a rare one, I find it not superfluous to mention it.

This condition of affairs caused me to examine the uterus of a patient suffering from this complaint, when I found a pinhole os, the dilatation of which caused a troublesome case to become easy. Since this experience, it has been my practice in each case of intractable cystitis or A girl of twelve years came to my neuralgia of the urethra, to examine the ambulatory, complaining of a swelling, vagina and annexed organs, especially if the size of a walnut, behind her right ear. the patient be a barren female. The On the left ear the swelling had the size results have been pleasing to my patients, of a common nut, and both were immovthough they usually demur on the ground able. I proposed to the girl to come to

my office so as to be operated upon, and she, previously being advised by her relatives, came on the next day. She was operated upon by me under chloroform, for which 25 c.c. were used. After removal of the tumors, several sutures were placed, and a dressing applied to the wound. On the seventh day the sutures were taken off, on the tenth the wound was quite healed, and the patient went home convalescent and very glad.

optical discomforts, it is well to suspect the irritation co-incident with the treatment of the tooth to be the r flex cause of the ocular symptoms. It is then proper to institute such modifications of treatment as will relieve the sufferings of the patient. What this is must be determined in each case according to the circumstances.

These points do not refer alone to the general practitioner of medicine and to the dentist, but to those who devote all their attention to the special senses.

Eye Troubles Due to Affections of Thus oculists would do well to consider

the Teeth.

By ALICE JARVIS, D. D. S. Philadelphia.

It is not generally known that affections of the teeth may make themselves felt, in fact often do, as ocular disturbances. Few men realize how commonly this is the case. The frequency and farreaching effects of dental disease manifesting itself in disturbance of function in other parts is suspected by only a few. Among many of the diseases of the teeth having these remote effects may be mentioned caries, abscesses, a dying nerve, and similar conditions. The canine teeth are the ones most liable to cause eye symptoms when affected. Irritating metal fillings, especially of the canine teeth, may give rise to a slight soreness that can hardly be dignified by the appellation pain, though they, nevertheless, cause marked pain in the eye of the same side.

It is also a fact that the treatment of teeth, especially the canine, often materially affects the ocular conditions upon the same side. For instance, a defective tooth, which may have given rise to no sign other than that which is natural under the circumstances, may begin to cause eye symptoms at the very beginning of its treatment. It is wise, on this account, for dentists to govern themselves accordingly. Thus, if a patient with defective teeth, who has complained of nothing but ordinary tooth ache and conditions properly connected therewith, begins to complain of eye ache or other similar

dental diseases as a reflex cause of eye symptoms in connection with eye trouble, and the co-operation of oculists and dentists might often give perfect relief that is otherwise hopelessly unattainable. These remarks also apply to the aurist, rhinologist, and laryngologist. I will relate a case as follows:

Miss M., a trained nurse, came to me complaining of eye trouble at the same time that her teeth required attention. Her eye troubled her a great deal, but she had me treat her teeth (canines) on general principles. I removed the nerves from these, treated the canals antiseptically, and filled them in a suitable manner with the proper material. Her eyes improved during treatment, at the completion of which she laid aside her glasses as useless, and has not required them since. She attributes her ocular improvement to the dental treatment without suggestion on my part, and I agree with her.

I have another case on record: That of a young man who had been under the care of an eminent oculist in this city for more than six weeks, with no appar ent relief. Desiring to make a complete job of the entire matter, he concluded to have his teeth looked after although they were not giving him any special trouble. He came to me complaining of his right eye much more than he did of his teeth. Getting him in position in the chair, I carefully tapped each upper incisor, beginning with the left canine, and working around to the right. There was no response (in sensitiveness) until I struck the right lateral, which caused the pa

tient to utter an exclamation of pain, though the touch was a very light one. He said immediately that he could feel it in his eye. The most critical examination with an electric lamp and mouth mirror revealed nothing more abnormal than a little off color. Suspecting, how ever, that the eye trouble was a reflex symptom of some deep seated disease connected with the lateral incisor, I bored through the tooth from underneath with an electric drill, causing no pain whatever. But when the instrument entered the pulp chamber, pus began to exude. I emptied the canal, cleaned it thoroughly with hydrogen peroxide, and left it open for several days, subsequently completing the treatment. The outflow of pus was immediately followed by relief of the eye symptoms, which entirely subsided with the treatment of the tooth, and never returned.

Though not an oculist myself, I feel satisfied in reporting these cases as I do, and attributing the cure of the ocular symptoms to the treatment of the teeth, because the eye specialist who had treated this young man called upon me and stated this to be his own conviction after we had compared notes. Since then, he has sent me three similar cases, all failing to respond to his treatment, and yet promptly getting well upon passing through my hands. Some particular tooth was the cause of the eye symptoms in each case, this being the wisdom tooth in one instance.

A frequent cause of reflex eye trouble due to dental disease is a condition known as nodular dentine, which consists of calcarious formations in the dentine, causing pressure on the enclosed nerve, with resulting referred pain to the eye of the same side.

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Fecal Accumulation in the Lower Rectum.

By ERNEST HALL, L. R. C. P., EDINBURGH. Victoria, Brit. Columbia.

As the aim of the MEDICAL COUNCIL is to afford practical working information that will be of value to the bedside, the writer wishes very briefly to direct attention to a condition rarely commented. upon, and one which is, not unfrequently, a source of no little inconvenience.

Case I. Miss- aged 20, under treatment for pulmonary tuberculosis, several hemorrhages, the last one completely exhausting her; for several days she lay, apparently, at the point of death. For several weeks she complained of a sense of discomfort in the region of the lower bowel; and, at times, experienced considerable pain. The bowels responded to mild cathartics and enemata. The discomfort and pain continuing, I explored the rectum, finding an oval mass of fecal concretion larger than a turkey's egg, and of almost stony hardness. This was, with difficulty, broken up and removed. Although not appropriating to this mass any importance in the role of causation, in the primary condition, it is interesting to note that the patient very slowly regained strength, with an apparent arrest of the tubercular process.

Case 2. Mrs., aged 69, intracapsular fracture on left femur. Some nine weeks after the accident, she complained of severe burning over the lower part of the sacrum. The bowels had been some

what sluggish, but, for a few weeks, had acted very satisfactorily; enemata having been given every day with effect. Examination showed considerable swelling over the region of the coccyx, with inflammatory action and tenderness in the ischio-rectal fossæ. I was in doubt as to whether we had an ischio-rectal abscess, as the result of sepsis from an angrylooking bed-sore, which had been caused by a rough nurse in changing the bedlinen (brush burn). Soothing applications proving ineffectual, the next day I explored the rectum, finding a hard mass of feces completely filling the lower

rectum.

How there could be regular action of the bowels past this mass, could hardly be imagined. By means of the handle of a spoon, the mass was broken up and delivered. It is needless to say that visions of abscess passed into the great beyond.

Remarks.

The deductions from these cases are self evident. The connection of the

lower rectum with the pelvic-sympathetic only requires to be mentioned to indicate the systemic disturbances that might result from the presence of such an irritation-impairment of digestion, with its train of toxemia and secondary neuroses, etc., and by direct irritation through pressure upon the pelvic plexus, cramping of the muscles of the lower extremities, and even sciatica. What part such irritation played in the aggravation of the pulmonary condition in the first case, and in the general malnutrition of the second, it is impossible to state, but the comfort experienced in each case after the removal of the masses was decided.

In all cases of chronic disease, especially when the patient is compelled to lie partially upon one side, as in Case II, we should ever be on the lookout for rectal accumulations, and remember that the regular action of the bowels is no proof

that such accumulations do not exist.

As many subscription renewals are due, we hope that each one will renew promptly.

We are pleased at the many new subscribers constantly coming in, but we are even more desirous of holding all our old friends. The COUNCIL has been steadily improving and enlarging, yet we have many plans in progress for its still further improvement in the future. We are grateful for the exceedingly complimentary letters which accompany subscription renewals, and hope to deserve them still more as time passes.

If you do not get your COUNCIL regularly, kindly drop us a card, and we will investigate.

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First Case. The important points about this case is the treatment used.

Patient aged 40, male; has been healthy all his life, but was of a peculiar nervous temperament; unfavorable for

typhoid fever, and became delirious on the second day. I was called to see him on August 24th, last. He had just returned, the previous day, from an excursion to Chicago. His morning temperature was 1012, evening 1031⁄2, and reached 104 in the afternoon, and continued this way until the first part of the third week, then began to decline. There was some delirium, diarrhea, stools two to four per day, very offensive, tympanitis, and subsultus tendinum from the beginning. At the beginning of third week, the bowels were checked and became very tympanitic, delirium grew worse, singultus set up, and the prognosis was

very unfavorable. Counsel was called.

Treatment.

This is brief, and, I think, is the only rational and scientific treatment we have for typhoid fever, viz., good feeding of the proper kind of diet, such as milks, soups, fruits, soft boiled eggs, egg albumin water seasoned to suit the taste, and hydrotherapy, both internally and externally, from the beginning to the end, and if we will lay aside all our drugs, unless for special symptoms, and treat our patients strictly by this method, about 98 per cent. will recover. I have used this treatment for the past twelve years, and have probably had 125 cases, and my

Account Books for Physicians' Use.

The occupation of the physician is a peculiar one. While he does a far larger proportion of his business on credit than persons of any other occupation, yet he is very poorly situated for keeping his accounts systematically. The merchant has his books open on his desk, and enters the necessary charge before he waits on the next customer. The physician, on the contrary, waits upon his patrons at their homes, and when he returns to his office there are often calls to other places awaiting him which he must attend at once, or, if not, he is often more anxious to hastily look up the literature on a puzzling or critical case than he is to make record of what he has earned. Often he

comes in so tired, hungry and sleepy, that he must attend to himself rather than to his books. Thus several days may pass without his books being written up, and then he has such confused ideas of the events past that many charges are not entered at all and none are legally entered, since the law requires the original entry to be made within twenty-four to forty-eight hours of the time the service is rendered. A pocket account book of original entry seems to be the only practical method.

Convenience of Collecting. There is another and equally important reason why large office books are impracticable for professional use.

The merchant, the manufacturer and others are usually to be found, either in person or by representative, at the regular place of business. The customer comes in, learns how much is due and makes payment. The physician, on the other hand, can seldom be absolutely depended upon to be found in his office, and the knowledge of that fact gives the debtor an excuse for spending his money for other purposes, after having called at the physician's office to settle his account and not finding him in. The physician must be prepared in some way or other to show his patron the state of his account whenever asked for it-on the street, on the country road or at the patron's home. A pocket abstract from

the office book involves so much extra writing and is so impracticable in every way, that it is not likely to be extensively adopted. A pocket account book of origi nal entry, again, is the only feasible plan. Legal Requirements.

But the ordinary pocket visiting list has been tried and is found to be no record at all in the eyes of the law, since the services are not described, but are indicated by a series of arbitrary signs, which have to be interpreted. The law does not allow the doctor to explain the charges by verbal testimony; and, of course, such records are of no earthly value to his family after his death. On this account thousands of dollars are lost every year by foolish and shiftless doctors who depend upon such slip-shod methods of preserving what is often the only form of life insurance they ever carry for their families-their book accounts.

The law requires that an account book of original entry must show in plain language and figures, which can be read by judge and jury without personal explanation, the name of the person against whom the charge is made, the name of the person for or to whom the services or supplies are rendered, the date, the description of services, and the charge must be definitely carried out in dollars and cents. The entries must also be made

while the transaction is still fresh in the mind-not later than the next day.

The Physician's Pocket Account Book.

It has been quite a problem just how to get a book that would give such a complete record and yet come within convenient pocket size. We present here a brief description of a book that has been found after two years' experience to exactly and completely fulfill all the requirements. This is the Physician's Pocket Account Book. We believe that all physicians who have any regard for their business interests will desire to investigate it, and hence we give it this full presentation.

The Pocket Account Book consists of a book of 208 pages, 41⁄2 by 734 inches, bound in heavy manilla, with cloth back, and for convenience of carrying, it is enclosed in an elegant, substantial leather

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