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11 years old except one girl 5 years old. Some started in with high fever from time I first saw them; others moderate fever; but after pushing intestinal antiseptics, all fell in a short time to about 100°, sometimes little over or under, and they all kept this up for over eight weeks and two for ten weeks. I gave these four children during treatment about 2 Oz. of sodium sulfocarbolate; there being no diarrhea, I did not use the zinc salt, but did use bismuth salicylate, salol and beta napthol, and should have tried the new treatment with Merck's sodium bisulfate, of which I got in 2 oz. to give it a trial in the bombardment of the bacillae, but they weakened, health returned and the fever gradually left them, so I have not given it a trial yet. They had arsenite of copper continuously. These cases never felt very ill after the fever got down to the 100° line, seemed in fact so well that a stranger would think very little ailed them. But the fever stuck there steadily right along, in spite of all my antiseptics. Of course I cannot say what it would have been if they had not had this treatment, but I feel confident the antiseptics held the temperature down, because each time I slackt up on the dose the fever rose a little. I began to doubt my thermometer and tried three or four others, but they all told the same tale. Can you or any of the brethren give a reason why in these cases the fever should keep up for such an abnormally long time? I treated them in regard to nursing, feeding and medicin on about the general plan that I treat all my typhoid cases.

THOS. D. HULME, M.D.

Commerce, Iowa. [Was there not some local irritation somewhere that kept up the fever? Was there delay in the healing of the bowel ulcerations? Was there a lack of vitality to overcome the disease? Was there double poisoning, in some way, that would induce a double course? Brotherhood please discuss.-ED.]

Incomplete Bony Development and Queer Placental Attachment.-Removal of Beef from Throat.

Editor MEDICAL WORLD:-On December 10, at I a.m., I was called to see Mrs. X., primipara. The uterus was well descended and pains were moderately severe, but as they continued to wane I left, after having been with the woman about twelve hours. I gave a prognostic guess that labor would come on in about twelve hours-midnight. It over-ran a little, labor setting in about 3 a.m., and the woman was delivered about 4.30, which was a few minutes previous to my arrival. Being in

formed that the child was dead, I proceeded to investigate, and found a deformity and complication which I do not remember of having read about. It was not a spina bifida, and was not hydrocephalic; but there was a lack of osseous development extending from the frontal bone back over the superior and occipital parts of the head, down to the lumbar vertebrae. This structure was about two inches in width, and was rather cartilaginous in character, but presented a reddish, beefy appearance. There were no signs of protrusion of meninges of either brain or cord, and no tumor of any kind existed. There was absence of all bones of the skull except portions of the frontal and parietal. Now, the queerest thing of all was the fact that the placenta was closely adherent to the child's back and occiput. The child and placenta were envelopt in a tenacious membrane on which I used scissors to effect an entrance. The placenta must have had very little uterin attachment. Had I expected to find the placenta thus inclosed, a closer examination before puncturing might have enabled me to have ascertained just the extent of attachment. There was entire absence of the child's neck, but aside from these malformations, the child was normal, and the full period of gestation seemed complete, or nearly so.

I read in THE MEDICAL WORLD once some doctor's experience in removing a piece of beefsteak from an old fellow's throat, a hypodermic of apomorphin being the remedy. Recently an old man, while intoxicated, became choked on a piece of meat two inches square about a half inch thick, which I caused him to expel in just five minutes via the apomorphin W. F. MARRS.

route.

Jewett, Ill.

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Apparently a Double Placenta. Editor MEDICAL WORLD:-Recent issues of your valuable journal have recorded several remarkable cases of labor, which recall to my mind a case in my practise which was at least remarkable to me, having never seen nor read of a similar case. Mrs. J., primipara, gave birth to a well developt eight-pound boy, labor normal. With little trouble I delivered the placenta, which was double, or rather two placentas with about an inch of membrane intervening between the two. What caused it thus? Was it originally a twin conception with death and absorption of one fetus? There was only one cord. Krum, Texas.

J. C. GOSE, M.D.

Conservatism in Medicin. Editor MEDICAL WORLD:-In the December number of THE MEDICAL WORLD appears an editorial on "Therapeutic Cowardice," which may perhaps be misleading to some extent. The writer has high appreciation of the editorials in THE MEDICAL WORLD generally, and even this one may be adapted to the needs of those of long service in the profession, especially if they be level headed; but for tyros in the service it seems to bear a little too strong on the bit; in other words, may cause rashness on the part of young men, and older ones too, who have not given therapeutics a thoro study. It is unfortunately true that too much medicin has been given in the past, and even today the same is true to less extent. Men who have been in the profession for fifty years and more, know something of heroic medication, when venesection was used almost invariably to the detriment of the patient, mercurials used to the loss of teeth and to shattered constitutions, tartrate of antimony to the point of turning inside out, to say nothing of endless purgation with drastic medicins. It is not forgotten that the deathrate of typhoid fever in those days was about 33 percent, and now it is only 1 or 2 percent under proper treatment, which includes scarcely any medicin. In those days Cook's theories and mercurial medication held sway, and doubtless did great damage.

Owing to this over-treatment, the way was made plain and easy for the introduction of eclecticism, homeopathy, and, in later times, for Christian science, and healers of various kinds. The tendency of the profession is continually toward less medication, and the people demand and will have less physicking. It is a notorious fact that the vis medicatrix naturae is sufficient in the vast majority of cases to effect cures if only a fair showing shall be given it. This wonderful restorer of lost balance should never be overlookt or ignored. It is too true that

many, especially young men, give it little heed, and attribute cures to medication when in many cases the cure has been effected in spite of medicins. All doctors of much experience know this to be true.

As doctors grow old in experience, they place less faith in medicin and more in the efforts of Nature to restore the lost balance in disease. Their own shortcoming in efforts to relieve disease, assisted by investigations to find the truth, has taught them this valuable lesson.

Of course it is understood that the editorial does not favor over-medication, nor heroic treatment, only under certain conditions, and to produce certain effects thought to be desirable. Now, to meet these indications with powerful medicins often puts too great a risk on the life of a patient, especially when used by the inexperienced and thoughtless. Many a time the practician cannot see his way clearly, and in that case it were better to trust to nature, and render her whatever aid may be plainly indicated. Better to be on the safe side than to take extra risks, and in nine cases out of ten it will redound to the good of the patient.

Some effects thought to be desirable in the treatment of disease are very questionable; such as the reduction of the pulse in certain diseases, and the reduction of heat in others. Forty-five years ago Norwood's tincture of veratrum viride was considered the sine qua non in the treatment of pneumonia. The medical journals were filled with its wonderfully curativ effects in this disease. To the writer the idea seemed to be based on a false theory. It was believed by him that the pulse should come down because the disease was being subdued, and not from the effect of a powerful heart depressant, the pneumonic pathological condition still existing. Such treatment did not seem to be consistent with science nor common sense.

About that time two healthy negro men in the prime of life were taken down with the disease and occupied the same room. One of them was treated in a mild way by the writer, assisting nature, and the other was treated heroically by another doctor with veratrum. He said in two or three days that his patient was doing well, the pulse down from 120 to 70. The writer remarkt to him that when the pulse of his patient came down to that point he would turn him over to the cook. The result was, in a few days the patient with the deprest pulse went to his grave, while the other recovered in due time. Repeated observations of a like kind seem to prove that such treatment is not only of no good, but is full of harm. After a few years' trial, the profession gen

erally came to the same conclusion, and the remedy went into disuse, or nearly so, along with venesection, mercurialization, large doses of tartar emetic, etc.

The antipyretic treatment of disease thru the depressing effect of the coal tar preparations was originated by the Germans, and was par excellence the treatment demanded in this country some fifteen or twenty years ago. The Germans saw the error of their ways and called a halt on that line, followed finally by the medical fraternity in this country; but not before many a poor fellow suffered the consequences. I well remember that in 1888 in one locality as many as twenty cases of grip, disposed to go into pneumonia, succumbed to this treatment, one after another; while a different treatment by others had no such fatality indeed, scarcely any. The idea is false in theory and most harmful in practise, as is now generally admitted.

To reduce the pulse rate and the temperature, if possible to do so with safety, it is only necessary to avail ourselves of the help given by nature's therapeutics, which are ever at our command. In bringing them into full play, no risk need be taken on the life of the patient. "Therapeutic cowardice," says the editorial, "is not overcome by knowledge of drugs, many of the most learned being the most timid." This is perhaps true; but why so? It seems they have been made more cautious because of having learned the great potency of many drugs and fully realized their danger in over-dosage. It further says, "Experience alone does not do it, for that also begets much caution." But why? Simply because experience has taught them many valuable lessons that the young still have to learn, one of which is to stay the hand in case of doubt and uncertainty. It is not so much "a spirit of kindliness" that actuates men of experience as it is a conscientious discharge of duty to the patient from the best lights shed on the case. It is quite plain why "the young and inexperienced practician shows more therapeutic bravery.' Undoubtedly, because he lacks the "knowledge of drugs" and "clinical experience" at the bedside. A half century ago this "tyro bravery" found no place in medical doings. For the past two or three decades it has, however, come prominently to the front, not only in medicin, but in all other professions. From the obstacles in the way and the nature of the calling, it is more difficult to sustain in medicin and do no harm than in any other pursuit. Because of so many inventions and practical improvements in the onward march of progress, the people seem to have concluded that the younger members of various professions have all the new "wrinkles." But it does not

follow necessarily that this is true, especially in medicin, since older men have the benefit of extensiv information thru medical journals, new books, and the post graduate course; besides, they have experience, which is so valuable as to more than offset any disadvantages.

It would seem really that younger men of today need a little restraint than otherwise. Only a few years ago one of twenty-six years arose in a state medical society and declared that he had entered the abdominal cavity in search of diseased ovaries and fallopian tubes in fifty-three cases in the previous eighteen months, with only one death, and that was a crazy woman. As he lived in a small town in an out-of-the-way place in a new country, this was thought to be first-class work, perhaps about as well as any of the big gynecologists did in the same length of time in Chicago or New York City. Much might be said opposed to the new "rage for cutting" in appendicitis and other like troubles which would indicate the necessity for conservatism in all branches of medicin. B. F. HART, M.D.

Seattle, Washington.

[The above remarks are very sensible. The trouble is that we reach so many different kinds of physicians that it is impossible for us to meet the needs of all in a single editorial. Many need the editorial referred to, and many, like the above writer, do not.-ED.]

Bee Sting in the Larynx.

Editor MEDICAL WORLD:-A boy sixteen years old was brought to my office from a neighboring village about twelve o'clock in the night, about a week ago. He was suffering intensely from dyspnea and pain in the throat. His brother had obtained some honey from a hollow tree in the woods, and the whole family ate heartily of it. Shortly after supper the boy experienced a sensation of fulness in his throat, and later pain with dyspnea. These symptoms grew rapidly worse until, in a few hours, he could scarcely breathe. He first supposed there was a piece of wax in the throat, from the honeycomb. Accordingly vomiting was induced with a view of expelling or dislodging the same, but of no avail. He was then hurried to a doctor.

The patient spoke in a whisper. Examination of throat revealed great swelling (edematous) of the epiglottis. Because of the large epiglottis it was impossible to see the vocal cords. Besides, the patient always had a desire to swallow and was easily gagged. Undoubtedly the cords were similarly swollen. Careful examination with the laryngoscope finally located the foreign body. It was a small dark speck on the laryngeal surface of the epiglottis, and was best brought into view

by the gagging and retching. It was finally removed with a curved forcep, and proved to be the sting of a bee. The patient felt relief in a short time. Solution of adrenalin chlorid was then applied to aid in reduction of swelling. He was quite comfortable in about an hour, and seven or eight hours later the tumefaction had almost vanisht.

St. Cloud, Wis. C. W. LEONARD, M. D.

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My Experience with the Automobile. Editor MEDICAL WORLD:-I purchast an automobile last May. Having four horses I placed two in the pasture and kept two to drive in muddy traveling. I had the "auto hauled home once, on account of the five connection pins breaking. I was stuck in a muddy road once, and was pulled out by a team. One man fell from his carriage and broke three ribs, by his horse taking fright and running while passing, but we were at a "stand still." I have a good man to run my machine, who also takes care of it. On account of bad roads it is idle this winter, but I will use it next O. W. BURNS, M.D. Dartmouth, 1876.

season.

Winneconne, Wis.

Questions.

1. When a man calls upon a doctor and says, "I wish you to attend my wife in about a month, when she will be confined," should the doctor, if not specially requested, call to see this prospectiv patient prior to the expected time of confinement?

2. Should the physician engaged for such a case (no retaining fee being paid), in the event that he is not called when the child is born, send a bill?

3. Could such a bill be legally collected? the doctor being able to show that he had postponed a trip away in order to be ready in the event of this call.

Smithfield, Utah.

C. E. BOYNTON, M.D.

Corn Remedy.

Editor MEDICAL WORLD:-I wish to report a corn cure that I accidently blundered on. I have several soft corns between the toes and have tried every corn cure I could run across, but none was of much benefit. They would return, and the cure in some instances was as bad as the disease. One night on retiring my corns hurt so much I concluded to anoint them with vaseline as had been my custom, to soften them a little, but as I was undrest for bed and just before me was a small tin box of Lloyd's thuja ointment I had been using for

other troubles, I concluded that it would do to grease my corns, and it felt so good I tried it for several nights. It completely and painlessly cookt my corns so that the warm foot bath and the point of my knife completed the job. B. K. WOOD.

Anadarko, Okla.

Removal of Corns.

Corns

Editor MEDICAL WORLD:-In recent issues of your valuable journal I have noticed several items on the "cure of corns." I would say there is no cure for corns. Corns should not be considered a disease, but a condition. They may be removed or prevented. are but the thickening and hardening of the cuticle, which is begun in self defense in trying to protect the more tender tissues beneath. They occur from two causes: Ill shaped feet that no shoes will fit; or, from ill fitting shoes. The patient may not be to blame for the former, but he could mitigate the latter. What I believe to be one of the greatest causes of corns is the wearing of shoes with toe-caps, or box toes, where the hard unyielding seam comes directly across the toes. Such shoes never ought to be worn, altho fashion decrees that they are the proper thing for the present

season.

Many remedies have been devised for the cure of corns, or for their removal. To me the problem of removal is far more simple than the prevention. For soft corns, which occur between the toes, the application of a tuft of absorbent cotton saturated with salicylic acid will soon give relief. If the cotton does not readily stay in place, then tie it there with a bit of white woolen yarn. Hard corns should never be cut. That method is always a source of danger, besides leaving a hard, impervious surface. Many of the caustic remedies used affect the tissues too deeply, causing a condition more painful than the corn. The true and most philosophical treatment is to remove them with a piece of medium sandpaper. This is on the same principle of the fine file of the Chinese chiropodists, which leaves the surface soft, pliable and pervious to the secretions of the tissues beneath. same treatment is applicable to all calluses of the feet or hands. It never hurts nor does harm, yet all hard corns may be perfectly removed in this manner with careful and proper manipulation. D. D. ROSE, M.D.

Valparaiso, Ind.

The

In children prone to enlargement of the cervical glands, it is not well to wait too long after constitutional and local measures have failed. Abcesses make cicatrices more unsightly than incisions, and you invite extension of infection by delay. Incise and enucleate under chlorid of ethyl anesthesia.

Rheumatism, the Bane of the Human Race. -How to Successfully Treat and Cure it. Editor MEDICAL WORLD:-Malarial poison and a bad condition of the liver and stomach are the contributing causes of this disease. To my mind, from a long experience, the first essential of cure is the rectification of a torpid liver, a careful attention to the digestiv tract, and the elimination of the uric acid which has formed in the system. How to bring about these desideratums is as follows: Give ten grains of blue mass at night, following it with phosphate of soda, the effervescing kind, early in the morning, continuing the phosphate for a number of mornings, early. If the patient is a dyspeptic, then use the non-effervescing phosphate in as hot water as can be swallowed. This will keep up a continued action on the liver and help digestion.

The human stomach is made a sort of a slop jar of the body, and from our earliest years it is so used. I take it that in most of the diseases to which flesh is heir, we should deferentially take off our hats to this much abused organ.

After the above named medication has been carried out to create a healthful action of the stomach and liver, we can specifically attempt to eliminate the poison from the blood. My plan, very successfully used, is to give four times a day one of the following capsules:

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Alkaloids in Chronic Troubles. Editor MEDICAL WORLD:-A great many physicians who employ the alkaloidal remedies in acute troubles either seem to forget them or to doubt their value in the treatment of chronic diseases. My practise consists almost wholly of this class of cases. It is very seldom that I have a case that has lasted for less than two years; many of them are troubles of twenty years' standing; most of them have run the gamut of treatment and have survived the attacks of several schools of practise, and most of the patent medicins with which the market is flooded. The various alkaloidal preparations, as indicated, give me excellent results, much better than I have ever been able to secure with any other line of treat

ment.

The diseases which are most common in my practise are rheumatism, neuralgias of various sorts, consumption, neurasthenia, chronic genito-urinary troubles, pelvic troubles in women, especially neuroses, sexual weakness in both sexes, digestiv troubles, asthma, tertiary syphilis, and locomotor ataxia. In the treatment of these cases I use the alkaloidal granules almost altogether, and prefer those made by the Abbott Co. The advantages of the granules are accuracy, reliability and convenience. With the single exception of bioplasm, a remedy which has given me very great satisfaction, I almost never make use of any other internal remedies.

Perhaps a few notes in regard to my treatment of such cases may be of interest to your readers. As you probably know, the first principle of alkalometry is to clean out the alimentary canal and keep it clean. In my practise at least ninety-nine patients out of a hundred have chronic constipation. I am almost ready to assert that this is the beginning of all diseases. One thing is certain it is useless to try to cure any chronic disease unless this principle is carried out. Epsom salts will do the work if the patient will take it, which isn't often. I use the saline laxativ, an effervescent preparation of the salts. This is the be

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