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High Temperature Following an Intrauterin Douche.

Editor MEDICAL WORLD:-Mrs. S., second confinement, labor lasting two hours, normal in all respects, placenta delivered by Credé's method, complete with membranes intact. All symptoms normal till the third day, when lochia became offensiv; no rise of temperature or pulse; gave vaginal douche of creolin solution which was followed in one-half hour by slight chill; temperature raised to 102°, lasting six hours, followed by profuse sweat. Next morning all symptoms normal except lochia, which was very offensiv; gave an intrauterin douche of permanganate solution; no debris; in one-half hour the patient began to tremble ; did not feel cold, but trembled all over. condition lasted about twenty minutes, when the temperature had reacht 108° in the axilla, pulse over 200, patient acting as tho dazed, but was not delirious until temperature had dropt to 106°; then mildly so. This was followed by a drenching perspiration, and in turn by frequent attacks of palpitation. The next morning, except for excessiv prostration and the offensiv odor of the lochia, the condition was again normal. No more douches being given, we had no more trouble. A profound anemia developt, which yielded promptly to treatment, patient making an uneventful recovery.

This

Some years ago I reported a case of puerperal insanity, with a temperature of 110°, lasting two days, which developt acutely after an intrauterin douche, recovery being complete and prompt on ceasing the douches. It took me three douches to catch on in the first instance, and two in the last; in both the trouble ceast promptly on stopping the douche. The total absence of symptoms before and after the treatment would seem to eliminate septic infection; or did the expanding of the uterin cavity open up channels of absorption that were closed by the normal involution, and thereby protected until interfered with by distention with the douche? or does the nervous, idiosyncrasy offer the explanation? What would have been the result of continued irrigation? a mistake which might easily be made under the circumstances. MALCOLM G. VIOLET, M.D.

Butternut, Wis.

Carbuncle.

Editor MEDICAL WORLD:-I was called to see a man 74 years of age, on January 27, 1904, with two small carbuncles on back, at upper points of scapulas, eight inches apart. I split them and then cross split them. One grew no more; the other one kept growing. Soon as the skin began to decay, I commenced to cut out the gristle, and would cut a round of it out every other day. I did this to keep

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Dysmenorrhea. -For Colic in Horses.

Editor MEDICAL WORLD:-For the "nine o'clock exacerbation" (Dysmenorrhea, page 167, April WORLD), I would suggest that "M.D." have patient secure a motor for propelling her sewing machine or employ the services of some available boy. This will give her much pelvic rest, and may be a factor in removing the exciting cause. Would also join the Editor in his matrimonial suggestion. At eight o'clock give hypodermic of morphin 4 gr., atropin 1 gr. ; at the same time apply a rubber hot water bottle containing water as near 212° F. as can possibly be borne. Persistence in the use of hot applications will afford prompt relief.

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Page 165 For the benefit of Dr. H. W. Scott or others, I give the following prescription that I have frequently used with my own horses for colic, both renal and intestinal: Chloroform

Spts. nit. aeth. ãā.
Spts. turpentine
Castor oil.

Mix well and give in one dose.

NOLONO

xij

The horse will be relieved immediately. After eight or twelve hours, if bowels have not moved freely, put him into harness and trot him briskly three or four miles and you will wish your dash board had been built higher. A good tonic effect follows the free catharsis. J. WOOLSEY, M.D. Vanderbilt, 1894.

Riddleville, Tex.

Case Record and Account Book Combined.

Editor MEDICAL WORLD:-I am pleased to note article in Feb. WORLD on the important but much neglected subject of keeping accounts. I have a method, originating according to my needs, which I find handy. We who practise at the cross-roads and in villages, of necessity dispense our own rem

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This is more drawn out than I make the entries, as I abbreviate almost all words used. This takes up but little time and space and helps to report a case or series of cases accurately, also enables you to give Willie or Grandma the same R of last spring. by the bottle being returned with label and R number intact; also it is a good witness in damage suits, or a suit of any kind.

As to ledger, I use double entry, 434 x 62% x 5/8 inches, flexible leather, with 200 pages and index, and keep it posted to date as near as possible, and carry in pocket; thus am able to tell patron amount of indebtedness any time and place, and thereby collect many accounts that would be neglected should I have to use the common phrase, "I don't know, call at office," which induces neglect.

I also keep a cash and expense account in small double entry book, but have never kept a comparativ statement; also issue bills at regular intervals, and at termination of cases; and where there is no response, I see the debtor personally.

Am an advocate of "deadbeat lists," compiled often and freely exchanged, and am liberal to deserving charities, but draw the line close. B. FRANK WIndle, M.D. Barnes, 1897.

Valley Park, Mo. [The above seems rather crude, but it shows what can be done with an ordinary blank book which can be gotten at any stationer's. -ED.]

Case Records.

Editor MEDICAL WORLD:-In the April number of your journal, one of your subscribers wanted a case record blank. I have devised a system I use in my practise and inclose you I do not have these samples of my cards. blanks for sale, but have them printed here in the city and use a Macey card box on my desk for daily reference.

At the end of the year I file all closed cases in a Macey filing case, and mark the year on the end of the box.

An

In my desk box I have two sets of alphabet guide cards and two guide cards, one markt open cases and one markt closed cases. open case is one which I still have under observation. When the case is dismist I note the date and the results or condition of the case when it passed from my care, and transfer it to the closed case side. In making my record of acute cases I have a leather pocket to hold the record blanks and carry it in my coat pocket. The record is made at the bedside with a fountain pen, as it is then permanent.

One who has not tried it does not realize what an advantage such a record is to a physician. It impresses the patient and his friends that you are a very particular person, and it gives them greater confidence. If at any time a dispute should arise as to your conduct of the case, you have your record to refer to, which is a great deal better in law than a memory record. To me it is a pleasure to know I have a record of my cases. I think it just as important to keep a record of cases seen in the home as cases seen in the hospital.

Since I have formed the habit of keeping a record of all of my cases, I know I am a better physician. I am more observant, more careful in my diagnosis, and more careful in my prescribing. I have the case for study at my leisure and, let me say, a library of your own cases, your own successes and failures, is of more real value than the theories of others.

At my first call to an acute case I take down the history of the case prior to my being called. This I write in on the face of the card before making any record of the present condition.

The chronic case, urinalysis, and obstetric record blanks are self explanatory. If more than one card is used in a case I use an envelope to hold all the cards of that case.

CLIFFORD E. HENRY, M.D. Minneapolis, Minn. Jefferson Medical College, 1896. [See accompanying card forms. The card system is now used for many purposes: in libraries for cataloging books, as a system of book-keeping for keeping accounts, etc.

This

is our first knowledge of this system being used for case records by physicians, but it is a good suggestion.-ED.]

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Editor MEDICAL WORLD:-Was called to a confinement April 13; labor was very slow but normal. Six days later was called to the house again and was told that the baby was passing blood. I askt some questions, then made an examination and found that the baby was passing blood from the vagina. Normal child except for that, with no history to account for the flow of blood. I left some fluid ext. of ergot in child's doses, and have not been called since, but was told that flow lasted three to five days. C. H. HAZEN.

East Corinth, Vt.

Dr. D. W. Hunt, of Glendale, Cal., writes very earnestly concerning proprietaries, his chief objection being that they are usually prescribed in original packages, and then the literature that usually goes with the bottle or package, goes directly into the patient's hands. The next time, the patient goes directly to the druggist for the medicin, leaving the doctor out entirely. Furthermore, the patient shows the literature and recommends the preparation to others, who go directly to the druggist for it, omitting the doctor entirely. He pertinently asks, why should doctors work for pro

prietary medicin manufacturers, and against their own interests in this way?

A further objection is, that patients not being able to determin their needs, frequently injure themselves, and lose valuable time before finally visiting the doctor. Also, the evil could be prevented by directing that an original package be not supplied, or if so, all wrappings and labels be removed, and the doctor's directions be pasted on.

Youth and Age Should Work Together.

DEAR EDITOR:-Our grand profession has made rapid strides during the last decade. This is shown by the requests in THE MEDICAL WORLD during the last few months for the description of the technique of methods diag nostic and therapeutic familiar to the recent graduate but a terra incognita to many men who graduated years ago.

On page 165 of the April WORLD is the request for method of application of normal saline infusion.

On page 160 of the same number are questions regarding the use of antistreptococcic serum, and in a previous number the technique for the Widal reaction in typhoid was askt.

Requests for other new methods, such as the

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