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head of which was flat like a pancake. The Hysteria and the “ New Woman." body had started to decay, and had a foul Editor MEDICAL WORLD:~Will the new odor. When five months' pregnant Mrs. Z. woman have hysterics? Is this form of nervous fell over a woodpile, which fall I think crusht disease less common than ten years ago ? the child's head from side to side, and flattened Physicians with whom I have spoken regarding it as described. There was only one placenta. this matter, think so. It seems so to me. Under careful aseptic treatment, Mrs. Z. made In looking at the etiology of this disease, it a prompt recovery.

is evident that the predisposing and exciting FRIEDE VAN DALSEM, M.D. causes are not as potent as formerly. Women Hudson, South Dakota.

are more self-reliant. They have better mental

and physical development, and more hygienic Short Cord.-Puerperal Convulsions.

surroundings. No great social or political Editor MEDICAL WORLD:-I was called, teaching of Christian science may have had an

question is agitating the public mind . November 15, 1903, to atter.d Mrs. S. in her

influence in this matter. second confinement. Labor was normal.

Grinnell, Iowa. E. C. Bliss, M.D. Cord measured just 13 inches. At about 6 a. m. November 18, 1903, I was

Vomiting of Pregnancy. called to see Mrs. H., a primipara, who was expecting to be confined within the next week.

Editor MEDICAL WORLD:- I notice some inShe was in bed, in no pain, very cheerful, but quiries for a recipe for vomiting of pregnancy. blind. She had suddenly turned blind while Here is one that rarely fails : attending to breakfast. She could not discern R

Bismuth salicylate . light. I soon gave her pot. brom. grs. XX

Cer. oxalas

3 and chloral hyd. grs. X. The expected puer

Menthol .

Cocain mur. peral convulsions and unconsciousness soon

gr. Spt. vini rect.

3j came on. Gave morphin sulf. gr. ss and Elix. auranti, q. s. ad.

Zvj atropin sulf. gr. s hypodermically, and re- M. Sig.-Ziv on an empty stomach. peatedly gave enemas of double the amount San Francisco. T. J. CROWLEY, M.D. of bromid and chloral without the desired result. About 12 m. called in Drs. D. and G.

Help Wanted in Damage Suit. We decided, after dilating os a litile, to de. Editor MEDICAL WORLD:-Aug. 6th, 1903, liver with forceps. Gave her chloroform and Dr. Little called me to assist him in the deabout two hours hard work, turn about, livery of Mrs. C., he having refused to go into resulted in a prolapst cord, dead baby and the case without another doctor, as she was in lacerated perineum. After repairing the the last stage of Bright's disease. The urin perineum the doctors left. Aster the effect of showed 50 percent albumin. She had general the chloroform had passed away the con- dropsy, and had been tapt twice in the perivulsions returned. I repeated the enema and toneal cavity and six times in the limbs, three hypodermic as I thought best. Near 8:45, weeks before confinement. At this time there p. m. I invited my guest and preceptor, Dr. was general dropsy. I found the lady unable N. of Ala., to see the case. She had a hard to lie down or turn in any way; she had not convulsion at 9 p. m. I suggested bleeding. walkt for some time. The first child was born Dr. N. thought it the thing to do. Drew dead, but in good condition; the placenta about five gills of blood and repeated the

caine away in a perfectly normal way. Fiftyhypodermic of morphin and atropin. No three hours later we delivered her of another more convulsions. Conscious next morning. dead baby in good condition. The membranes Uneventful recovery.

were intact all the time, and were ruptured by Unless I previously learn better, I shall myself fifteen minutes before the child was bleed the next similar case the first thing I do. born. It was simply a case of delay between Since this case my preceptor informs me

the births. Ten days later she died of uremia. that he was called to see a lady who had had The other doctor and I have been sued for twenty-five convulsions. After taking about

$5,000. Have also been indicted for mana quart of blood she had a light convulsion. Slaughter. The civil suit has been tried once, He took another quart and she had no more.

and the jury hung 10 to 2, in our favor. The Chattanooga, Tenn. John B. LEE, M.D. manslaughter case is to be tried, also the civil

suit again.

There are many other facts of Editor MEDICAL WORLD :-Inclosed please find my check for interest that I will not report for fear of $3 for four years' subscription to The World, a jo rnal that I

taking up too much space. certainly prize above any other. Your business advice to the doctors is worth $3 of itself. You are doing a great service to physi- I wish to hear from all who have had any cians. I most highly appreciate your valuable services. Richmond, Ky.

J. A. Gwynn, M.D experience with delay between the birth of

twins, or of delay in labor in the last stage of Bright's disease. The other doctor and I are not allowed testimony in the damage suit, as the man brought the suit as administrator; so I wish all the documentary evidence I can get for my attorney to use. I will say that all of the local profession are with us.

H. B. VANATTA, M.D. Lerna, Coles Co., Ill.

Rules of Practise and Fee Bill of the Phys.

icians of Assumption, Ill. Adopted January, 1900. Revised July 1, 1903. We, the undersigned physicians of Assumption, Illinois, do hereby mutually promise and agree among ourselves and to each other, to be governed in our practise in the following rules, and charge for our professional services the prices and rates as publisht below, viz. :

First-That we will not bid for pauper practise.

SECOND-That we will not attend the paupers, nor do the eleemosynary or public practise at a less rate than the regularly establisht and recognized Fee Bill of Assumption.

THIRD_That in the distribution of the pauper practise of Assumption, no one particular physician shall be favored in such practise by the public authorities, but the patient shall have the privilege of choosing his own physician.

Dressing, large or dangerous wounds,

requiring the closure of important
arteries, to arrest hemorrhage, ad.
justing fractures and dislocations
involving difficulties, the operation
for hemorrhoids, for hydrocele, for
harelip and strabismus, paracente-
sis, amputation of the breast, castra-
tion, the removal of tumors not in-
volving great difficulties, staphylor-
rhaphy, laryngotomy, iridectomy,

amputation or extraction of the eye, $25.00 to $100.00 Amputation of the arm, leg, foot or hand, 50.00 to 100.00 Capital operation, including the larger

amputations, resections and exsec-
tions, the removal of the parotid
gland, trephining, ovariotomy, her-
niotomy, lithotomy, celiotomy, the
more difficult plastic operations, the
reduction of dislocations which have
resisted previous attempts, the ad-
justments of oblique fractures of the
thigh, and those involving the neck
of the femur or the knee joint, com-
pound and comminuted fractures of
the larger bones and joints, extrac-
tion of cataract and the formation of
artificial pupil

$100.00 and upwards Administering chloroform or ether 5.00 to 10.00 Subsequent attendance the same as in

other cases All Fees considered due when services are rendered. (Signed) J. H. Williamson, J. E. Harper,

A. P. Rockey, F. C. Gale,
O. L. Crow,

R. W. Johnson,
G. J. Rivard,

J. F. Holt.

RATES.

-50 to

2.00 1.00

.50 to

Ordinary office advice, not consuming

much time and involving no unusual
care in investigation (medicin ex-
tra).

$0.50 Careful investigation, by the introduc

tion of a sound or catheter, the em-
ployment of chemical tests, the in-
troduction of an exploring needle,
the employment of a speculum, a
stethoscope, an ophthalmoscope, or
a laryngoscope;

$1.00 to 10.00 Prescriptions, (medicin furnisht extra)

5.00 Single visit in town .

1.50 Night visit between hours of 10 p. m.

and 6 a. m. . Extra patients in the same family, each Mileage-day; $1.50 first mile, 75 cents

each additional mile . Mileage-night; $2.00 first mile, $1.00

each additional mile. Obstetrics, uncomplicated-within three miles

10.00 to 25.00 Detained services in obstetrics more

than five hours, $1.00 per hour extra Delivery by turning, forceps or perforation

20.00 to 50.00 Subsequent visits in town for the first

three days, to be included in the
charge unless complications render

unusual attention necessary. Subsequent visits in the country, the

same as in other cases. Attendance on small-pox, per visit, mile

age extra. Vaccination,

.50 Consultation, mileage extra. Gonorrhea or syphilis, in advance . 10.00 to 50.00 Minor surgical operations, like opening

Wholesome Criticism is Better than Praise.

Editor MEDICAL WORLD :-I inclose you my check to pay for four years' subscription to THE WORLD, and for “ The Story of New Zealand." Now a word concerning The WORLD. I like it and I do not like it, begging your pardon. I love to read it because so many medical men from all over the country express their belief and opinion in its pages, and from all of that we get a great assortment of experiences, all of great value to us fellows doing hard work in the field. I do not like it because it contains so much "trash stuff" at times. Of course I realize that such an expression is not the most pleasant thing in the world for the Editor to hear, and may even provoke a feeling of resentment; still, I feel as tho he would like to know with what esteem we receive his journal. I mean by " trash stuff" such articles that convey so little idea of the real condition of instances upon which information is desired, and which are signed with the names of men who claim the protection of social and medical laws because they prefix their names with “ Dr." I mean by “trash stuff” such articles in which the writer of the article attempts to relate some extraordinary experience, and flatly fails to convey even the most salient features of his tussle. I mean by “trash stuff" such stuff written by some medical man, in which he lauds to the skies some prescription composed of from four to six ingredients, and where he

10.00

abscesses, dressing bruised fingers,
bleeding, cupping, the formation of

issues, and introduction of set 1.00 to 5.00 Dressing injuries of greater extent or

danger, including the ligation or
acupression of arteries in wounds of
little importance, the amputation of
a toe or finger, circumcision, the re-
moval of the tonsils, the uvula, cu-
retage, etc..

5.00 to 25.00

10.00

new

extols its virtues for a certain named disease.

Nursing in the Country. I mean by “trash stuff" such articles in The following very clear and pertinent rewhich the writer relates stereotyped treatment marks are from a doctor's daughter (whose for a specified disease, pneumonia, for in- father, however, we regret to state, has recentstance. Any medical man of any community ly died). These lines are so apt that they dewho wishes to impart the impression that he is serve a place in these columns : a strictly scientific fellow, and has nothing

Dr. W. C. Abbott, in his article on pneumonia in better than calomel, salts, Dover's powder, March WORLD, says the first step is to

move the papoultices, strychnin, digitalis, and alcohol

tient into a clean, light, airy room.” Suppose he were

here in the Ozarks, where the family all eat, sleep and to offer to his medical confreres for every case live in one room, or the patient is in a stuffy 8 x 10 of pneumonia, and makes that his routine, bed room that opens into the living room, and has an should not be given a page of any editor's

extra bed in it, where two other adults sleep at night,

and the “ nurses” (?) under no consideration will journal.

permit one whiff of fresh air, lest the patient catch I love to read a fellow who has a definit cold."

Country doctors who have to depend upon the neighidea to convey, and who is specific in the

bors, friends and the relativs, to do the nursing, can therapeutic field; who can and does give the not insist too strongly on having the medicin given condition of his patient, and who gives his

strictly as directed. I have seen the medicins passed

around to be tasted and “analyzed,” and compared remedy not because it has been recommended

with what Dr. Blank gave Johnny when he had for a certain named disease, but because there mona," and the dose reduced or increast just as Dr.

Blank had directed in his treatment; and the symis present in the case a particular condition

ptoms studied and compared to those given in the which will be relieved by a particular remedy. family doctor book, which father said are a curse to Does it not look like a pity to hear some

the people and the bane of the doctor.

I am not speaking at random, for the case was my physician go deeply into the study of his

brother, who was very, very ill with pneumonia away case, so far as concerns pathology, diagnosis, from home, and I never removed my clothes or etc., and then when it comes to treatment, to

scarcely ate or slept for eleven days and nights, and absolutely fail to show where he attempts any

we came near losing him thru the other nurses tam

pering with the medicins and knowing too much about thing definit outside of a stereotyped routine ? medicin, learned from patent medicin advertisements THE MEDICAL WORLD gives us many valu

and the family doctor book.

The people need to be educated along these lines, able contributions by able men; to read and and the doctors could do it by means of the press; not study them proves a source of great satisfac- by writing learned essays on How to Nurse the Sick,"

but give a few instances that have resulted fatally, tion and profit. The extraordinary good quali- from not following the instructions; then offset that ties of these more than make good the short- by a few cases where the patient's life was saved by comings of those I have just condemned, and

the prompt action of the nurse, or at least the doctor's

work was supplemented in the saving of it. it is for this reason that I am willing to read

Fowler, Mo.

(Miss) ANNIE HOFFARTH. THE WORLD several years more. Respectfully yours,

J. S. NIEDERKORN. Versailles, Ohio.

Diagnosis Wanted for Epidemic Eruptiv Dis[Frank, manly and respectful criticism is better than praise. We like it and always

Editor MEDICAL WORLD:—There has been welcome it, when given in the proper spirit. an eruptiv disease prevailing in this section for Instead of receiving the above with “resent, the past two months or more, and as the docment," perhaps the Doctor will be surprised tors cannot or do not agree as to the diagnosis to see it publisht, with these remarks. We of it; I want to give you the symptoms of a hope that he will give to “the family," from case I had recently, and ask you or the WORLD his own pen, something that is worth reading. readers to kindly give your opinion of same. We think he can do it, and we will expect Mr. P., a young man 18 years of age, came him to do it. In the meantime, he may be to my office for treatment on February 5th, taken up by some who consider that the rem- stating that he had had severe pain in head and edies he mentions, if used skilfully, are quite back for two days. I found on examination enuf to use in pneumonia. Some of the best that he had a temperature of 103° F., and practicians use few remedies, but use them pulse of 110. I prescribed for him, and told skilfully, and for definit purposes.-ED.] him to go home and go to bed. The next day

he sent for me, stating that the symptoms were Editor MEDICAL WORLD:—About two years no better ; suffering intense pain in head and ago I reported a case of bed wetting and askt back with high fever. I could not get to see for help. I got some very good and whole- him that day, but saw him on the following some instruction. A cure was effected by day, and found him with temperature of 102°, having the boy's eyes examined and fitted by pulse 110; secretions generally inactiv, pains a good oculist, as instructed by a reader of somewhat relieved (due as I supposed to the THE WORLD.

N. H. BAKER. anodynes he had taken). I noticed a few small Gillette, Wyo.

red spots on the side of his face near the chin ;

ease.

at the same time his mother remarkt that while rubbing his back with camphor the night before to relieve the pain she felt some bumps ; on further examination I found a half dozen

or more small hard papules on back and upper part of chest. On February 8th I found him with temperature of 9972°, pulse 66, pain relieved, kidneys acting freely (up to this time they had been very inactiv), and almost the whole cutaneous surface covered with those elevated hard papules. On February 9th, temperature 99°, pulse 60. February 12th, temperature 98°, pulse 60, patient feeling fairly comfortable, with papules larger. On the apex of each was a vesicle filled with serum ; the most of the older ones were deprest in the center. February 14th, I found temperature 100°, pulse 84, patient more restless, with an areola of redness around the base of each papule, while the serum in the vesicles was more turbid. February 15th, temperature 98%2°, pulse 60; some of the pustules are becoming dry and falling off, and the face not so badly swollen. February 18th, temperature and pulse normal. February 22nd, temperature and pulse normal, scabs nearly all off and patient feeling comfortable and has a good appetite.

Now, my diagnosis of this case was smallpox, which I think was almost a typical case, tho the large majority of the cases are not so bad, the eruption not so great, and the secondary fever does not appear in a good many cases. My treatment in the early part of the disease was calomel to stimulate the secretions, and anodynes to relieve pain. When suppuration commenced, I gave calcium sulfid in i gr. doses 3 times a day, and applied 3 percent car

bolized oil to relieve the stinging and itching that he complained of at this stage.

Maxton, N. C. J.D. GROOM, M.D.

[There are many things to be taken into consideration which can be done only on the spot. What effect has vaccination on this epidemic? Has it been tried ? Is it contagious ? If so, have you noticed any difference between the vaccinated and unvaccinated in regard to susceptibility? You say this is one of the worst cases. True, it suggests small-pox in a mild form, but have you thought of chickenpox in a severe form? This thought is not considered as carefully as it should be under such circumstances. Read up on chickenpox and make careful comparison with your cases, and at the same time realize that chickenpox is sometimes quite a severe disease. A number of epidemics that were first thought to be a mild form of small-pox have been discovered to be a severe form of chicken-pox, and your patient above described strongly suggests this diagnosis. With this suggestion, and by carefully reading up the subject and examining your patients with this possibility in mind, you can doubtless reach a decision. It may be small.pox, but we give you the above suggestion. Have our readers anything to say ?-ED.]

Erysipelas. Editor MEDICAL WORLD:-I desire to report a case of erysipelas ambulans, and my experience with the streptolytic serum. Patient, a man aged 50, usual health good, was attackt December 30, the disease beginning about the nose and rapidly spreading over the face, head and neck; then more gradually continuing its course until the entire body had been covered down to the knees. Temperature ranged from 102° to 105°, pulse rapid and weak, delirium in the early stage. On the tenth day pneumonia was strongly threatened. Activ measures, however, aborted this.

Treatment: Nourishing diet, tinct. mur. iron, quin., strych. and echinacea; locally I used ichthyol, tinct. iodin, tinct. mur. iron and other usual applications. Under this treatment the disease would occasionally seem to be checkt, only for the inflammation to return with renewed energy. On the twenty-eighth day of the disease I injected two bulbs, 20 cc., of streptolytic serum in the twenty-four hours; waited twenty-four hours longer, saw no change whatever. I then injected at one time four bulbs, 40 cc.; at the end of twenty-four hours more found patient no better; at this time I used two more bulbs, 20 cc. In twelve hours' time the temperature fell from 103° to below normal ; patient was greatly prostrated and cold, requiring heat and activ stimulation for

[graphic]

two hours before any reaction. The tempera

Gained a Minute, Lost a Month. ture was soon normal and remained so for Editor MEDICAL WORLD:-Inclosed find several days. The inflammation was complete- P. O. money order for $3 for which please ly controled. Meantime patient had com- continue THE WORLD four years. Four weeks plained of aching pains in the joints, which ago I sustained a fractured clavicle as a result seemed to grow worse. At the end of the week of my horse falling on the rough, frozen what appeared to be a violent case of inflamma- ground.

ground. This is my first accident in six years' tory rheumatism set up, with symptoms closely country practise, and would like to say to the resembling lockjaw accompanying. Rheu- brethren that there is truth in the old axiom, matic treatment was used, which entirely re- When you want to go fast, go slow;" for in lieved these symptoms in two weeks. The my effort to gain a minute I have lost a month. patient is just now, at the end of ten weeks, Physicians are liable for malpractise to their able to be out, and is convalescing very nicely. patients, corporations for injuries to its em

This is my first use of the streptolytic serum, ployes, and yet the country doctor has neither and whether these unpleasant complications recourse nor sympathy from his patients when were due to the large amount (80 cc.) of serum injured in their behalf, which to me suggests used or not, I am unable to say. I should be the organization of a Physicians' Mutual Benefit pleased to hear from others who have had ex- Association. Let's hear from THE WORLD. perience with the serum in the treatment of Millville, Mo. J. MORSE GRIFFIN. this disease. B. DECATUR SMITH, M.D. [Such associations are usually local, and perCincinnati, O.

haps better so, for then the management can Ninth and Baymiller Sts.

be simpler, and there are less chances for dis

honesty. For example, there is a physicians' Did the Chickens Have Erysipelas ?

benefit association connected with the PhilaEditor MEDICAL WORLD :-Inclosed find P. delphia County Medical Society. However, it 0. order for $3, to pay for four years' sub- pays death benefits only, I think, and not illscription to your valuable journal. Not long ness nor accident benefits. -Ed.] since, a lady patient of mine developt a very classical case of erysipelas. She had been Simplified Method for Giving a Hot Vaginal visiting her brother who has a large flock of

Douche. poultry, and some of the fowls were suffering Editor MEDICAL WORLD:- It is often necesfrom what poultrymen call “swelled head.' sary to prescribe hot water as a vaginal douche, *The sick chickens had been doctored by and it is not often given in a very efficient smearing plain vaseline on their heads. Dur- manner. As a general thing women use the ing her visit, my patient developt an acute douche sitting on a vessel. The different textcoryza, and took some of the chicken's vas- books describe how it should be done, but it is eline to smear over the bridge of her nose, very seldom that we can get our patients to use hoping to thus relieve some of the disagreeable two to five gallons of hot water. I have a plan full feeling in her head. The coryza got which I have never seen described or recombetter, but about five days later erysipelas de- mended in medical journals by which as good velopt. The eruption and swelling com- results can be obtained with the ordinary two menced on the bridge of the nose and spread quart fountain syringe as with the more elabover the entire face and scalp. Now, Mr. orate douche-can or irrigating apparatus. It is Editor, the interesting question is, did those used as follows: Either lying with hips on an chickens have erysipelas?

ordinary bedpan or lying across the bed with Point Arena, Cal. D. A. MARSAN, M.D. feet on chairs and hips over the edge of bed, a

rubber sheet or several folds of newspaper beWe find that our criticism of Dr. Waugh's ing utilized to conduct the water into a tub as article, page 121, March WORLD, was not just described in works on gynecology, two quarts to him. He gave the case, “ An instance," as of very hot water can be made to answer the an illustration of the point he made in the first same purpose as several gallons under the old part of his article, viz., the widespread lack of plan. The difference is simply this: Have the accuracy in diagnosis. If the case is read in water in the fountain syringe considerably hotthat light only, we see that it is a good illus- ter than with the ordinary douche-can, then tration ; and he writes that this only was his before inserting the nozle of the syringe into intention. So he did not fall into the very the vagina, insert a spon

or several sponges error that he pointed out, as we supposed. or a strip of gauze up near the uterus, large

enuf to distend the vaginal folds slightly, then If the old “fly blister" were employed more fre- insert the nozzle back of the sponge or packing. quently in cases of chronic sciatica and lumbago, we

Next, have the cut-off or stop-cock well under would see fewer cripples. Use but small blisters, and apply them frequently.

control and let the hot water into the vagina

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