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Reply to Dr. Cooper.
stools, both as to appearance and odor. The Editor MEDICAL WORLD :-Pardon me for temperature was 103°, pulse 110 and gurgling so soon again using my pen. It is an unavoid- in right iliac fossa. On the fifth day got a able effect, and Dr. Cooper's article, in the pronounced diazo reaction, and on the seventh March issue, page 105, is the innocent cause. day there was epistaxis. It was typhoid fever. Dr. Cooper, to be consistent, would surely not Second. “Never whip the tired heart, etc., complain of my attacking the cause.
etc.” What ! Shall we allow the patient to with Dr. Cooper, that we should seek the cause, die of adynamia, while we wait on nature ? but-not to the exclusion of everything else. What is a doctor for, if he cannot hasten a natDr. Cooper is a clever writer and has the courage ural cure? Has the Doctor never seen a heavof his convictions, but his arguments sometimes ily laden truck caught in a rut or excavaticn proceed from false premises, and at other times which could be extracted only by lashing the lack logic.
horses and pushing behind ? The extraordinA fever patient may be compared to a burn- ary exertions overcame the obstructions and ing house ; every conflagration, even the so- the horses were not injured by their severe called spontaneous combustion, has its cause. treatment. According to Dr. Cooper's logic, when the fire Third. Never use a drug antipyretic-department is called to a fire it should seek the use sponging." Often parents will object to incendiary, or the cause of the fire, and not ex- hydrotherapy in children with high fever. tinguish the fire. But does it? It puts out the Again, water alone may not be sufficient. The fire first and seeks the cause afterward. This exalted condition which calls for the antipymay not be in the exact order of scientific retic will neutralize its depressing effects. methods, but scientific methods are not neces- Fourth. This proposition is too weak for arily the most practical ! !
argument. If no stimulant ever saved a life, Now, as to his "dogmas."
then surely no doctor ever saved a life, and so First. “Never give a purgativ or laxativ at doctors are only an expensiv luxury. the beginning of pneumonia.' How can one Fifth. Emollients relieve by the warmth and tell, on the first call, whether it is pneumonia ? moisture they produce; clay poultices by osI often rely on a calomel purge for a diagnosis,
mosis. to wit: On February 22, 1904, I was called to
Sixth. Counter-irritants do not act on a girl, 19 years old and an attendant of the spaces; they act on the blood vessels, causing State University. The complaint was fever, them to deliver blood from the congested part diffuse pain in abdomen and a slight cough. to the surface. Her face was flusht, but did not evince any Seventh, “Do not deplete in any way; signs of pain, and her intellect was unimpaired. the patient is below par." The patient may Her temperature was 103.4°, pulse rro, and be above par, by reason of the arterial or respiration normal ; her tongue was covered venous circulation being above par, and the with a white fur, except tip and edges. In- treatment is directed to the circulation. quiry developt that she was constipated, but Eighth. “Use only one medicin, as only had diarrhea a few days previous. That she one medicin reaches the cause." Does the suffered from severe headache the past four days, Doctor not believe in the electiv power of and that two days before the headache she at- drugs, or their synergic power. Evidently tended "a party.” That there were numer- not. ous typhoid cases in the university town, due Ninth. “Follow the method indicated and to the water.
all will be well." This I can only answer by Examination of abdomen showed no disten
.?! tion; there was tenderness, especially at Mc- I can only agree with the the Doctor in his Burney's point, but no rigidity of the recti conclusion, that “the foregoing enunciation muscles. There was no tympanites, but a dull,
E. GOODMAN. diffuse pain. Examination of the fauces showed San Francisco. no congestion whatever, yet there was a dry, hacking cough ; examination of the chest was Pneumonia and Labor Combined. negativ.
Editor MEDICAL WORLD:~Was called, FebI had to differentiate between toxemia, ty- ruary 9th, in consultation with Dr. B. Case : phoid and appendicitis, and possibly bronchi- Lady, mother of five children ; labor had been tis or pneumonia. I did so by means of cal- in progress 12 hours, with no progress whatomel. Ordered calomel gr. 14 and sod. bicarb. ever; the parts were all thoroly dilated ; also gr. j every hour to effect, with instructions to found her in great agony from a badly conpreserve the stools.
gested lung. Pain in lung and shoulder sharp Next morning, instead of the characteristic and cutting, almost beyond human endurance. calomel stools, found characteristic typhoid Found, also, cord prolapst so much that full
two inches protruded beyond the vulva ; also I would like to have the Editor's opinion profuse hemorrhage. On examination found about a mistake that was made in a prescrip. child so high up that it could not be felt easily tion for an old gentleman who had been sick with the finger. When she would have a pain for sometime with la grippe, probably three the pneumonia pain would cut off her breath, months. There was considerable dropsical and, all in all, it was a bæd case; pulse 140 effusion in the lower limbs. The following and wiry, temperature 10472°. She
prescription was intended : blue mass, powd. spitting up large quantities of brick-dust spu- squills and digitalis in pill form, and instead tum. Now, gentlemen, what shall we do? of the blue mass, cerate of cantharides was Shall we work quickly ?
substituted accidently (as you know they look Treatment: 1. Hypo. of ergotin, 2 grs. very much alike), and the prescription was 2. Quinin and Norwood's veratrum,
used several days before the mistake was dis3. Gelsemium, acetanilid and caffein.
covered. What would be the effect of this 4. Chloroform freely.
combination, on the stomach as well as on the 5. Labor set in in good shape. Tried all disease ? I feared that the irritating conthe plans for keeping back the cord, but in sequences that naturally belong to fly-plaster, vain. Delivery in about one hour.
would be manifested on the mucous membrane 6. Gave i gr. ergotin by hypo.
of the sensitiv stomach at once ; but instead 7. Delivered placenta and stopt bleeding. of that there was no complaint made in that
8. Covered the entire lung with a 14-inch direction whatever, and the effect on the discoat of antiphlogistine.
ease for which it was administered was very 9. Ordered castor oil to open bowels, put gratifying indeed, as the effusion disappeared her on Norwood's tr. veratrum, Dover's, am- more rapidly, I believe, than I expected it monium chlor., strychnin and aconitin. Stript would under the original formula, and the the bed, also patient, washt her with wet patient has been recruiting slowly ever since. towels, using carbolic acid, put good diaper Now Mr. Editor, would it be wise to substitute on her and came home. Child dead. Mother that med. again, under like conditions, purdoing well.
G. A. BUNDREN. posely, instead of the blue mass ? judging from Remmel, Ark.
the happy effect it had on this case. Or was it
merely a lucky chance that it turned out so Reply to Dr. Cooper on Pneumonia.
well? The patient was over 80 years old. Dear Dr. TAYLOR :-I will stake my repu
Hoping to get your opinion, even if it is a tation as to success during thirty-seven years of
severe criticism, in April number, I remain,
K TAYLOR, MD. activ practise, with Dr. Cooper or Dr. anybody yours fraternally, else, in the treatment of pneumonia. Had
Slanesville, W. Va. pine cases this winter with no deaths--and
[You do not state the amount of cerate of can't recall when I had a death-and I use a
cantharides given. Strangury is the symptom cathartic in beginning of case, use strychnin
that you should have been on the lookout for thruout case, use an antipyretic when fever
after the error was discovered. The digitalis, goes over 102°, use stimulants in all cases when
being a diuretic, and the squills being slightly needed, use turpentine stupes and blister often.
so, would have a tendency to counteract the Now this is my treatment--the reverse of Dr. disposition toward strangury, which the canCooper's--and success as great.
tharides would produce in sufficient dose. As Woodstock, Va.
W. S. CLINE.
we do not know the dose given, we cannot [Other letters received on pneumonia have
tell whether your escape was due to “luck” been markt and put away till next November.
or the small amount given. Read up on
cantharides.-ED] --ED.] Twin Girls with S:parate Placentas -Can
Possible Vicarious Menstruation. tharidal Cerate Given by Mistake for Editor MEDICAL WORLD :-Mrs. D., age Blue Mass.
about 32, mother of four children, all living ; Editor MEDICAL WORLD:--If I remember family history good, menstruated after birth of correctly, I think it was stated in the October or first three in about eight or nine months. November number of last year's WORLD, that After birth of fourth child had not menstruated, twin children of the same sex have but one pla- tho child was near thirteen months old. After centa, and of different sexes have different pla- enjoying, as she stated, unusual good health centas. If such be the case generally, there thru the summer, and while still in good must be exceptions, as I delivered twin girls health, while churning in the month of Seplast month, and each had a separate and distinct tember was seized with (as described to me) a placenta. The placentas were so distinct that rather profuse pulmonary hemorrhage. I was they might have come from different wombs. called in eight days afterwards on account of persistent daily recurrent hemorrhages. Found that he has a case that will not tolerate the temperature 102°, pulse 120, respirations 42, ordinary forms of quinin that he give some of with entire left lung consolidated, and all the the tasteless preparations a trial. In my pracear marks of typhoid. Did not treat the case, tise I use no other form of quinin than one of but death resulted. Was this a vicarious the tasteless preparations, preferably saloquinin hemorrhage ? or the usual hemorrhagic diathesis or euquinin. I give them to promote pain and causing nose bleed in incipient typhoid, or hasten labor, also to prevent or check afterboth combined ?
pains. They are nonirritating, and can be Dr. Rawls, in February WORLD, speaks of borne by the most delicate stomach, producing tr. iodin in puerperal septicemia. I have al- none of the unpleasant symptoms that follow ways found Lugol's solution in half strength, or the use of the ordinary forms of quinin. Give less, to be all desired.
them a trial (not particularly these preparaSneedville, Tenn. J. B. MITCHELL, M.D. tions but any reliable tasteless quinin) and you
[It looks much more like pneumonia than will never use any other. S. E. LUCKETT. typhoid, according to the symptoms mentioned. Campbellsburg, Ind. Doubtless the lack of menstrual flow had something to do with the bleeding, but just how much no one can, at this time and distance,
Editor MEDICAL WORLD:-It is funny how
few of the doctors who report their successful After-Pains.
treatment of the most prevalent diseases of the Editor MEDICAL WORLD:-I notice with country, can diagnose their cases. I admit I considerable interest the short opinions of the am not a first-class diagnostician, but I try to contributors to your journal on the treatment find out what the trouble is during the course of after-pains. One thing particularly strikes of the disease, and some how or other my cases me as being rather singular, viz., to see one get well, whether it's thru my knowing what's contributor recommending ergot while another the matter with them or not. I have been a will recommend nitroglycerin. As is well medical student for twenty-eight years. Got known, these two drugs have an entirely oppo- my degree in March, 1880. I expect to be a sit effect on both the blood vessels and all un- student as long as I have the faculty to learn. striped muscular fibers, still they are recom- For croup, the best thing I have found is mended for the same thing where both the iodized lime, 13 gr. to i gr. every 15 minutes blood vessels and unstriped muscular fibers are to 30 minutes until better; then every hour or most concerned. As to the use of ergot for two. Empty stomach and bowels as soon as after-pains I will say that I can not see where you can. there is to be anything to be gained beyond We have had an epidemic of measles this causing the uterus to empty itself of any blood winter, and in cases where the larynx was much clots that it may contain; beyond this I think affected, and the voice and cough hoarse and it perfectly useless, for as is well known it will croupy, the iodized lime gave relief and stopt cause pain in the unimpregnated uterus. As the trouble in twenty-four hours. for the use of glonoin for after-pains, I will say The brother who is looking for a cure for that from a theoretical standpoint it certainly after-pains, can prevent them by giving strychwould be contraindicated, from the fact that it nin. My plan is this: Shortly before the child causes a dilatation of the blood vessels and a is born, give from st gr. to is gr. of strychnin relaxing of unstriped muscular fibers, thus arsenate, either by mouth or hypodermically, favoring hemorrhage. It may be claimed by according to the severity of labor. This counthose who advocate the use of it that it de- teracts the shock and prevents hemorrhage. creases the blood pressure, hence there is ro In one or two hours after birth of child, begin danger of hemorrhage from its use; but so with y gr. strychnin, and give it every three does hemorrhage do this, but it does not over- hours during the day. At the end of twentycome its tendency to produce death. I have four hours give a cathartic-enuf to move nothing against the opium treatment of this bowels a couple of times. Have bowels move condition, but think there are other remedies once every twenty-four hours afterwards. Give that are just as good and without any of the 10 gr. of the triple sulfocarbolates every three dangers of opium in any form. I note what hours, to keep down fermentation in bowels. Dr. Fretz has to say in regard to the use of After the bowels move, feed liberally of nourquinin in the treatment of after-pains, and can ishing, digestible food. If there is nothing thoroly endorse him in his views on this rem- serious to prevent, let mother sit on vessel for edy. I have used nothing else for the past ten bladder and bowel movements. Keep patient years, and have the first time to see it fail to be in bed for twelve or fourteen days. No doucheffectiv. I will say to him that the next time ing, unless something comes up that makes it
gr, vij gr. xviij gr. xxiv
gr. iss gr. x . gr. 38
absolutely necessary. With this treatment my perature 1045°, pulse 138; bowels yielded to women are pleased, and so am I.
high enema. For the benefit of those who think there is I then started the following shot-gun : no need for intestinal antiseptics except in R typhoid fever, I add the following, which I Calcium sulf. think I got from the Alk. Clinic: All diseases
Quinin sulf. except traumatism are caused by intestinal de- Ext. nux. vom.
gr. ij rangements. Who can prove the contrary? I
Pepsin (scale). have this written down in a place where I can Strych. sulf.. see it often.
J. H. FERGUSON. M. et ft. cap. No. xij. Sig., one capsule each two Colorado Springs, Colo.
After the third capsule she began perspiring. Editor MEDICAL WORLD :-Tell Dr. Shirk to About the same time I called. Without an antry the following for after-pains :
esthetic I cureted, using a sharp instrument. R
Besides fresh coagulum I got out probably a Tinct. macrotys
3 ss teaspoonful of debris. I told the nurse there Water, q. s.
Zij was nothing there, meaning, I did not find M. Sig.–Teaspoonful every two hours, with gr. iij of quinin every four hours. Also use hot applications
enuf to produce the disturbance we were havlocally.
ing Searcy, Ark. H. C. JONES, M.D. Immediately the temperature went down and she made a nice recovery.
What was it that The Retained Placenta.
did it? The quinin, the cleaning out of so Editor MedicAL WORLD:-I read with con- small an amount of secundines, the “irritation" siderable interest your editorial (February is- or medicin contracting the womb, or all, or sue) on the above subject. The first case of what? this kind with which (the after-treatment) I May I comment a little on your editorial ? had to do was attended by an old country doc- I do not see how you can leave a placenta tor. He said the patient was delivered by longer than fifteen minutes. I did leave one means of the instruments, and that he had to once an hour—my freshman year–because I insert his hand and “scratch" the placenta did not know where it was ! But I find if the loose. (Do you think there are such adhesions?) placenta does not appear soon the blood does, Infection appeared promptly and the patient and that's time enuf for me. died, without curetment.
Again, I do not see how you can grasp and Recently I had a retained placenta case in twist a placenta in the vulvar opening! The my own practise. On the birth of the child I placenta is an awkward, slippery thing, and to could scarcely get cord enuf out to “get at it" make enuf turns to form a cord of the trailing to tie, and on making slight tension I found parts seems to me not practicable. there was no “slack;
slack;" the thing was fast. I believe in asepsis and sterilization in obThe “placenta not appearing promptly and stetrics; but after you wash the pubes and exCredé's method failing to speedily dislodge it," ternal genitalia don't forget to dry them, especthe husband saying, “growed fast like the ially the mons veneris, because it is always other one ?" I inserted my hand,“ the tips of poorly washt and the water easily runs over the my fingers shaped like a cone" (?) and scooped top, the wrong way, and by your neglect this it out. I did not "scratch.'
The cord was soapy and dirty water may drain down aftersixteen inches long. The skin at the umbili- ward into the vagina. H. N. JENNETT. cus extended out “to meet the cord” nearly Kansas City, Mo. an inch. The placenta was examined care- [“ Do we think there are such adhesions?" fully in a “ basin of clean water" and found well, rather. We have been forced to pinch the to be whole and intact.
placenta from the uterin wall and to separate Everything went along nicely; no temper- bands which were fibrous in character, by cutature, no hemorrhage. The fifth day I dis- ting thru them with the nails of the thumb and mist the case.
the index finger, the woman bleeding meanTwo days later I was called because the wife while. We never had to do it but twice, but had two chills; temperature 101°, bleeding the memory of both occasions will never fade. for twenty-four hours; bowels blockt for three In neither case did we have a curet with us, days; subinvolution. I detected no odor, but and in both cases we had time only to give the irrigated the womb with formaldehyde. For exploring hand a hasty washing and a quick two days more the fever went up; the bowels dip in bichlorid solution of the usual strength. would not move; the irrigations continuing We expected infection in both cases; one made twice and thrice daily. The milk was not an uninterrupted convalescence, and the other affected. Ninth day after confinement, tem- had a mild purulent endometritis of a few weeks duration, but not of sufficient severity to keep of the uterus had never dilated at all. He left her in bed beyond the usual time.
When we her in one or two hours after all pains stopt, could have produced the curet at the bedside, and told her to let him know when pains rewe doubted the wisdom of using it. The curet turned. Three months after that she told the is not a universal panacea, by any means, and doctor that for the last month, quite a lot of we believe some women die because the curet something like flesh was passing from her, and has been used, who might have gotten well if she said, “I brought a quantity with me left alone. Some authorities worthy of credence thinking you would like to see it; and also to believe cureting, under certain conditions of tell you that for the last day or so it smells infection, increases the chances of virulency of bad.” The mass consisted of decomposed the infection.
remnants of the child, and in the mass was The longer you practise, Doctor, the fewer some of the bones of the feet and hands. For times you will “pull on the cord.” We never two weeks after that time she passed all of the do it. If traction is made on the cord, one is smaller bones of the child; all except the almost certain to bring it down in improper pre- thigh bone (femur), tibia and fibula, and the sentation for expulsion. There are many so- bones of arm and fore arm and skull. This is called “growed fast" cases, where the placen- what Dr. Foy told me. ta is merely retained, and is not adherent. Five years after her illness I examined her The placenta may lie in the vagina or in the and could easily (thru the walls of the abdolower part of the uterus. The retained placenta men) feel the skull and leg bones and possibly is best removed by inserting the aseptic hand, arm bones. Ten years after, and five from working the placenta into the palm, and gently the last examination, my brother, a physician, withdrawing it during expulsiv effort; the truly and I examined her again ; all the bones Í adherent placenta is only removed by the pinch- have before mentioned were still present. ing process.
Since that time I lost sight of her, and heard We cannot think the quinin gave the re- today that she died last summer upwards of 65 sults. It is quite likely the removal of the de- years old. She did not have any septic trouble tritus did. Very small quantities of retained at all, and kept at work all the time, even when secundines will make serious trouble oftentimes. she was discharging the fetus. I will also state
We have observed cases where the placenta that I made a vaginal examination each time, was retained many hours (no physician being and found the mouth and neck of uterus norin attendance) without hemorrhage. If you mal, altho the body of uterus showed quite grasp the placenta firmly so that the nails will large. be imbedded in the “awkward slippery thing,” Since writing the above I have heard from a you will be able to twist it sufficiently to form trustworthy source that at her death the bones a rope of the following membranes, provided were plainly felt in the uterus. The above your motions are sufficiently gentle and delib- case was a colored woman belonging (formerly) erate.
to my uncle. After the “surrender," as the Your suggestions as to drying after washing negroes all say, she went to Madison (this are good ; you might have added, “let the State), seven miles from her old home, and towel be steril.” Every case of obstetrics engaged her services to Dr. Ben. Foy, and was should have a liberal supply of old cloths which with him when all of this that I have written have been sterilized by baking for a time just was happening. After Dr. Foy's death she short of the scorching point, and then wrapt moved to a small house in the village and did in a large cloth similarly sterilized, to await washing for several of the towns people. demand.-ED.]
Stoneville, N. C. J. R. SMITH, M.D.
Duration that the Dead Fetus can Remain in Editor MEDICAL WORLD:-In answer to the the Uterus.
question, “How long can a dead child remain Editor MEDICAL WORLD :-In your Febru- in the uterus ?" (MEDICAL WORLD of February, ary WORLD, page 72, under “ Quiz” column, 1904, page 72), I will give one of my G. Huston Chapman asks: “ How long can periences. December 1, 1903, I attended a dead child remain in the uterus ?" Allow
Allow Mrs. Z., primipara, whose labor had begun me to cite a case: Twenty years ago Rachel
Twenty years ago Rachel several hours previous to my arrival. In the Scales, colored-ginger cake color-the mother course of two hours a healthy boy was born. of three or four children, the youngest 7 years Shortly after this, I applied my hand to the old, a stout, healthy woman, sent for her abdomen to deliver the placenta by Crede's physician to attend her in confinement. Dr. method, when, to my surprise, there came Foy, her physician, attended. She had pains forth another bag of water, much smaller in as other women ; she was in labor about eight size than the first one, and which contained a hours, when all pain stopt, and yet the mouth dead fetus of about five months' gestation, the