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ORIGINAL COMMUNICATIONS over the South and West), to which I have
not been able to reply; and as many of these
are pathetically urgent, and as the paper has Short articles of practical help to the profession are solicited for this department.
not yet been publisht, may I beg space in your
forthcoming issue for a reply to these queries? Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.
Almost the entire number of inquiries has Copy must be received on or before the twelfth of the month, for
been concerning the treatment of morphin or publication in the issue for the next month. We decline opium cases; apparently the alcoholics are not responsibility for the safety of unused manuscript. It can as anxious to be relieved. usually be returned if request and postage for return are
received with manuscript ; but we cannot agree to always do so. In treating a morphin or opium habit case, Certainly it is excellent discipline for an author to feel that he must
there are two methods which may be pursued : say all he has to say in the feroest possible words, or his reader is sure to skip them, and in the plainest possible words, or his
the one, which I prefer, is to discontinue the reader will certainly misunderstand them. Generally, also, a drug wholly and at once; the other, which the downright fact may be told in a plain way, and we want downright facts at present more than anything else.-RUSKIN. subject would prefer and also, probably, most
physicians treating such cases, is to gradually but rapidly discontinue the drug untıl by the
end of the first week the amount given will Consumption and the Opium Habit.
be so small that it may then be wholly disconMy Dear DR. TAYLOR:- The question raised tinued. in your journal, whether morphin takers are If the drug is immediately and wholly disliable or immune to consumption, has brought continued there must be especial preparation out many interesting facts. Dr. Barbour's let- against the reaction, that will begin at from ter in the January World describes the con- twelve to thirty-six hours after the discontinuditions very clearly, and in his statement that ance. The use of the ergot should be begun opium masks the symptoms but does not stop at once, a half dram of the solution injected the degenerativ features, there is great signifi- hypodermically every two hours, or less frecance and reality. Recently a study of the quently, according to the quantity of the drug causes of death in ten cases of morphin takers
used. showed the following: Acute tuberculosis, 3; Only fluid nourishment should be given, and pneumonia, 5; and two cases of nephritis. A that of the most easily digestible character, physician who has had very large experience and not food extracts in alcoholic menstruum. writes me that cerebral hemorrhage has ap- The nourishment should be given every three peared very often in cases under his observation, hours. followed by acute pneumonia, or tuberculosis, In all cases I would give ten grains of blue with death in a few days or weeks.
mass the night before beginning the ergot posed cases of immunity from consumption and treatment, followed in the morning by suffiother acute inflammations of the lungs by the cient saline to thoroly clear the bowels, and use of opium is open to question and doubt. every night and morning, during treatment, That it might occur is certainly possible, the one to two drams of fluid extract of rhamnus same as exceptions to all rules are found. But frangula should be given so as to secure two or this fact can only be establisht by a rigid analy- three mushy stools each day. sis of the symptoms and history of the case. If the subject is calm at the end of forty. There is one fact about which there can be no eight hours, the ergot may be given a little less doubt : that all use of opium lowers the nutritiv frequently; but it should be continued to the functions and lessens the vital powers, both extent of at least two doses a day for a couple mental and physical, and that the germ of con- of weeks, and at least one for one or two weeks sumption finds most activ soil in low conditions longer. of vitality and nutritiv force.
There are three important helps that should Hartford, Conn.
T. D. CROTHERS. not be neglected in the extremer cases, and
they are always valuable. First, galvanization
of the sympathetic ganglia, by stroking with Ergot Treatment of the Opium Habit.
hand electrodes from occiput to sacrum, one Editor MEDICAL WORLD :-It appears that electrode on each side of the spine, the two in the current issue of your journal you made separated about four inches. The current some reference to a paper which I read before should be ten to fifteen milliamperes and the New York State Medical Association, in continued twenty to thirty minutes, daily or October, on the treatment of drug habits by oftener. ergot. I do not know what you said, but it Second, dry cupping, by means of the valve seems to have been enuf to excite inquiry with- cups exhausted by an air pump, along both sides out answering it, with the result that I have of the spine and sides of neck. been deluged with letters (especially from all Third, shock, applied by means of hot and
cold strokings the entire length of the spine. Thiosinamin in Urethral Stricture.—Nitrate Have a bucket of water as hot as the attend
of Silver Injections Over the Pneumoant's hand will bear, and another of cold
gastric Nerve in Phthisis.—Treat
ment of Opium Habitues.water or a smoothed lump of ice that can be
Mass of Adhered held in the hand. With subject in sitting
Intestin. posture and back bared, stroke two or three Editor MEDICAL WORLD:-Inclosed please times with a sponge or cloth lightly wrung find $2 to apply on my subscription to The from the hot water, and follow instantly with WORLD. I like your journal better the more I as many of the ice or cold water. Repeat see of it. It is very like the good old family these alternations half a dozen times.
doctor, in that it wears or improves with This may be employed two or three times a acquaintance. day. All treatment has reference to restoring And now, Mr. Editor, as I have so often tone to the circulation, especially in the spinal been the beneficiary, I will try to contribute centers and brain.
On page 545 of December WORLD, The second method only differs in combin- I find a query from Dr. Diaz, regarding thiosining during the first week some morphin with amin. In an experience of eight years I have one morning and one evening hypodermic of employed this drug in one case. My patient the ergot. If ten grains have been used daily, was a man of 60 years, and he had suffered a let the two ergot-morphin hypodermics con- stricture of the urethra for thirty years. Bladtain one-half grain morphin each the first day; der was enormously enlarged and sacculated, one-fourth grain each the second day; one- and sinuses penetrated the urethra and scrotum eighth grain each the third day, and so continue in many places. I could only pass a filiform lessening each succeeding day 50 percent of sound, and that only when patient was comthe preceding day until the eighth day, then pletely relaxt. As his general health prediscontinue the morphin.
cluded lithotomy at the time, and seeing The solution I commend is Squibb's solid an article on thiosinamin in Journal Ameriextract of ergot, one dram, dissolved in ster- can Medical Association at that time, decided ilized distilled water, one ounce; filter the to try it. I put the patient on three grains solution and add to the filtered solution two of powder after meals, and in three months minims of chloroform, gently shaking until he had so far improved as to be able to it is dissolved. This solution is now made by pass a number ten sound on himself. The E. R. Squibb's Sons, and other manufacturers, sinuses had closed, and the patient's general as Parke, Davis & Co., H. K. Mulford Co., health had greatly improved, and he was able and Sharp & Dohme, make special solutions to pass a fair stream of urin without a catheter. of ergot for hypodermic use.
The difficulty as I lost trace of him, and have not had another to making one's own solutions is the matter of opportunity to try the drug, but it acted like thoro sterilization.
magic in that one case. To be sure, I used ALFRED T. LIVINGSTON. other things as the case demanded ; in other Jamestown, N. Y.
words, I treated my patient to the very best of [See pages 534 and 535, December WORLD, my ability, but something certainly absorbed a for our reference to Dr. Livingston's paper. large amount of cicatricial tissue, and I have The above article was received on Christmas ever given the credit to thiosinamin. One day-too late for our January issue, so swallow does not make a summer, and one case couldn't publish it earlier than this issue. We treated does not fix the status of a drug; and hope that this will reach and satisfy all the having no similar opportunity to try the drug, Doctor's inquirers. Isn't it strange that there I have been reluctant to report this case. are so many opium victims in our country? A few years ago I saw an article in your Every effort of physicians should be put forth, journal upon the curativ effect of nitrate of silnot only to relieve these victims, but to stop ver injections over the pneumogastric nerve in making more. A table of say 100, or 500, or phthisis. I have tried it in probably 100 cases 1,000 cases, tabulated, to show the mode of since, and failed to find that it did anything save starting the habit, or the cause of starting the worry my patient. Not the slightest apprecihabit, would not only be interesting, but it able benefit could be discerned ; did not even would be useful in showing the dangers to ameliorate the cough. avoid. -Ed.]
I have employed ergot in three morphin
cases, by hypodermic injections for a period of Editor MEDICAL WORLD :- Please ask the five days. Results: Hard work to suppress readers of The World to give their favorit abscesses from injections, and larger appetite prescription for a hair tonic-one that expe. for the morphin. What are we to do in these rience has shown to be reliable.
cases? I have a copy of Dr. Albright's book, Columbus, Ohio.
T. M. LIPPIT. and have tried his remedies without the slight
est avail. I have used hyoscin, the most prom
My Line of Treatment for Pneumonia. ising drug yet offered, and failed-abandoned Editor MEDICAL WORLD :-Inclosed find it on account of its extreme depressing effects. check for $3.00 for subscription to THE WORLD. Now will some kind brother tesl me how I am You ask your readers how we will treat our to withdraw the morphin and support my pneumonia cases this winter. We cannot patient? I wonder how many of the profession treat all cases alike, but I shall try to give you have witnest the extreme torture the poor my line of treatment. wreck is subjected to, when the drug is with- Hygienic.- If possible I have my patient put drawn. I have begun the treatment with a in a large, well lighted room. I instruct the brisk calomel purge, followed by salines, and family or nurse to hang a thermometer in the have kept the bowels open with salines; but room and to keep the temperature at about my last patient, a little delicate woman, per- 68° F. I have them keep a dish for expectorasistently refused food for three days - could not tion that I may see it, and if they note any deforce it down her; and when it seemed that cided change in its character to place a piece death was imminent, I relented and allowed of white paper over the already expectorated the drug, and she has returned to her regular sputum that I may note the change. I have allowance and is up doing her work. I might the patient use a bedpan, and do not allow add that this patient, a Mexican girl, has been him to get out of bed. I disinfect stools, urin taking the drug for the last eight years. Now and sputum. I do not allow visitors. Somewill some kind brother enlighten me on this times I instruct the family how to use a clinical subject? How am I to procure sleep and thermometer and how to count the pulse and appetite and otherwise sustain these patients to keep a record of the same. I give my while under treatment? My past bitter patients plenty of fresh air. experience has led me to believe that the treat- Diet.—I have my patients drink plenty of ment should cover a period of two or three water. I don't feed much the first 48 hours. years in these old cases; four or five days After that I feed a liquid or semi-solid diet at would only serve to bring the physician into regular intervals. This usually consists of a general disrepute with his patient. I have glass of good rich milk with a raw egg and a kept my patients in bed, fed them milk and tablespoonful of whiskey; also buttermilk, had them bathed with hot and cold water, as beef juice, rice, toast, sometimes liquid pepsymptoms required, administered all sorts of tonoids. I feed once in four hours, six times drugs save opium, and yet I failed. I have daily. I watch the stools and see that the food about concluded to send my next case to some I am giving is being digested. I do not oversanitarium for the treatment of such cases, load the stomach, or give food or medicin that believing that the country doctor should avoid nauseates my patient. them.
Medicinal Treatment : Local.-If seen early, One more thing and I am done. A short I apply a mustard plaster until surface is well time ago I was called to administer an anes- reddened, then sometimes a clay poultice, thetic to a patient for appendectomy; operation warm and changed once in 24 hours. I like a by a neighboring physician. Upon examina- cotton jacket. For a local application I use tion, found a large flat movable mass in right lard and oil of amber, mixt together without inguinal region ; diagnosed matted intestins. heat. If pain is severe I use mustard for Patient was operated upon next day, and my counter-irritation, then laudanum and Auid diagnosis was found correct-so much so that extract of aconite, 6 to 1, warmed; I saturate abdomen had to be reclosed without removing a cloth in this and apply to side. Change any part of appendix. The man had had often and cover with a warm poultice. attacks for the last six years, as I afterwards Internal Treatment.--I always clear the inlearned. Is there anything to be done when testinal tract, usually with to gr. calomel one adhesions cannot be judiciously broken up? I or two every 1/2 hour for 8 to 24 hours, and
any procedure whereby patient will a heaping teaspoonful dose of sodium phosbecome immune from further attacks, and still phate or Epsom salts every four hours; then keep his mass of adhered intestins and appen- laxativs, usually sodium phosphate or a c. c. dix. What becomes of such cases ?
pill to get one or two stools daily. I always I am barely out of bed from a severe attack examin the abdomen for signs of tympanites of pneumonia ; hence poor writing.
and toxic absorption, and if necessary change WALTER K. CALLAHON, M.D. or withhold diet. I seldom use intestinal antiOwyhee, Nev.
septics. [Doctor, suppose you tell us, from your If seen early and the patient is robust and recent experience, how it feels to have pneu- the temperature high, and the pulse full and monia. We will leave your questions open for bounding and we are just getting a congesdiscussion.-ED.]
tion of the lung tissue, I give aconite, 10
drops of a good fluid extract in a glass full third day, and when I told him he had pneuof water, teaspoonful doses every fifteen min- monia he laught at me and said he had for utes until the pulse responds, or five drop years spit up blood when he got a little cold. doses of Norwood's tr. veratrum every hour. The sputum was rusty and very tenacious, and In fully one half of my cases I do not use these at the last it was almost impossible for him to remedies at all, and never except in the con- get it from his mouth. He was jaundiced on gestiv stage. This treatment usually covers the fourth day, and there was a foul odor to the first 24 hours. Then I give strychnin, the perspiration. He died on the sixth day of about to gr. once in four hours, and whiskey illness. I tried almost everything except in the milk in tablespoonful doses ; tepid baths oxygen inhalation and venesection, which for the high temperature, and if temperature the family would not allow. I sometimes still runs high-102° to 1040-I use five drop think the man would have lived just as doses of a good fluid extract of digitalis in 4 long without a physician. The other two of a glass of water every hour—sometimes more cases were 54 and 68 years respectivly; the often. If cough is irritable and annoying and first had valvular heart trouble, the last a weak the patient nervous, I give five to fifteen drops intermittent heart.
intermittent heart. Everything possible was of fluid extract of camphorated opium once in tried and done. Physicians in consultation, two to four hours. If the arteries are sclerosed, trained nurses, normal salt solutions, ether I use so gr. doses of glonin in place of the hypodermically. Nothing did good. strychnin. This brings us near the crisis, and The mortality of pneumonia depends entirely now in a case of lobar pneumonia I like to see upon: (1.) The patient, the age, and the my patient often—if possible once in four heart; a man of 30 may have a heart of 70. hours, always twice daily. If the heart is (2.) The degree of involvement-one lobe, two doing well I do not change the treatment; if lobes, of one or both lungs may be involved, not, I increase the strychnin and give plenty of and the greater the area of lung tissue involved whiskey-an ounce hourly--sometimes a pint the graver the prognosis. (3.) The virulency or more in 24 hours. For collapse, whiskey of the infection. I belive pneumonia, like and strychnin hypodermically and ammonia scarlet fever, may be of different degrees, mild inhalations; oftentimes in place of whiskey by or severe, and that all deaths that occur at or the mouth I give spirits of camphor in hot near the crisis are caused by nothing more nor water, and early hypodermic injections of less than a septicemia. ether, 15 to 30 m. every 1, 2, 3, or 4 hours. When I read of a physician treating 100 or
I seldom give quinin, never the coal tar prod- more cases of lobar pneumonia with none or ucts, no cough mixtures, occasionally the one or two deaths, I think either he has been salicylates if I think there is uric acid. If I very fortunate in having light cases, or that he can get good leaves I substitute the infusion diagnosed some cases of congestion of lungs or for the fluid extract of digitalis. I always acute bronchitis as pneumonia. give plenty of water, and if I think the patient Scio, N. Y.
E. W. LAWALL. is not drinking enuf I often order a cup of
University of Buffalo, 1897. catnip tea to be given with the medicin. After Treatment.--I keep patient in the house
Digitalis and Strychnin in Pneumonia. for a week, sometimes with no medicin; again,
Editor MEDICAL WORLD : Dr. W. C. malto yerbene and a preparation of the hypo- Cooper says in January WORLD, Page 15, phosphite or iron; often sodium phosphate for “ Never whip the overworkt heart with digiten days or two weeks.
talis or strychnin.” In answer to this I wish Concerning Results. --Until last winter I to say, use digitalis and strychnin in pneuthought I was the “ whole thing" in treating monia, as in any other disease, when the pneumonia. Prior to then I had treated fifty- symptoms call for their use. No drug should two cases with two deaths. Last winter I be given simply because the patient has pneutreated thirteen cases with four deaths, and monia, but when indicated by the condition these in succession. One was an alcoholic, 52 of the patient. H. C. Wood says, in his exyears old. Helived twenty-four hours. Post- cellent work on therapeutics: “When in any mortem revealed fatty degeneration of liver, form of pneumonia the right heart is yielding heart, and kidneys; the right lung was solid to the strain of forcing blood thru the puland seemed to be drowned, or waterlogged. monic capillaries prest upon and reduced in This man's temperature was not above 101°, their aggregate lumen by exudation, digitalis but the minute the disease put an extra strain may be of the utmost service." on the heart the pulse got rapid and thready, Some years ago I read a discussion on the and heart stimulants did absolutely no good. treatment of pneumonia in which one of the Another I saw on the second day of the disease; speakers said: “Do not harass the heart by the a man 62. He refused to go to bed until the use of digitalis." Dr. H. C. Wood arose to
answer these remarks, and said that we might But heat is transmitted directly thru the chest as well talk of harassing a starving man with a wall to the seat of pain. It does not have to bowl of soup as to talk of harassing the heart circulate in the blood and thruout the body to with digitalis in pneumonia. Of course he get there. Heat does not act at all like a blismeant when symptoms point to the use of this ter; and the latter should not be compared to drug; viz., when the pulse is rapid and feeble, the former.
L. C. ALLEN, M.D. and the right heart shows signs of failure.
Hoschton, Ga. Strychnin too may be of the greatest value when the heart shows signs of failure. It is
Pneumonia in Alaska and Michigan.-Cystitis. also one of the most powerful respiratory stimulants, and a tonic of great importance. Editor MEDICAL WORLD :-Having had conBy the intelligent use of these drugs, and siderable to do with pneumonia here and in alcohol, we may be able to save patients at the Dawson and Alaska, I should like to endorse crisis of pneumonia or later in the disease. a few things already advocated, and emphasize Randolph, Ohio. JOHN J. ORTON, M.D. others overlookt. Give veratrum viride in early
stages, and calomel, and you will often abort
the disease, or prevent it from invading other The Spanish-fly Blister in Pneumonia.
portions of the lung. Continue calomel in Editor Medical WORLD:- Is not Dr. A. K. small doses all thru. Give strychnin and whisVan Horne, in the December World, too posi- key freely. When required, blood letting in tiv about the good effects of the fly blister in well selected cases works well where the disease pneumonia? How does he know that the blis- sets in very severely in a full-blooded, strong, ter was the “determining cause that enabled fleshy person, and promises to run a very rapid many to recover from pneumonia that would
Also when you have exhausted your have died without it?" How does he know resources, and your patient is going to shuffle that the “dozens” of cases of pneumonia that off in a short time, do give him the one chance were “relieved” by the Spanish-fly blister for his life, and bleed freely. It will relieve would not have recovered just as quickly with- the heart and lungs of the engorgement, and out it? How can a blister, antiphlogistine, or your patient will feel better almost immediately; any other application to the skin of the chest, and this will save many of your patients, when “draw serum from the lungs?" Is not the everything else has failed. Don't be afraid of proposition absurd ? There is no direct anatom- it. Antiphlogistine I consider the best external ical connection between the skin of the chest application that can be used, if properly apwall and the lungs. Does not the serum plied. brought out by a blister or other application to
This line of treatment will save over 90 perthe chest wall come from the general circula- cent of pneumonia cases. Of course, keep up tion? Would not the same amount of serum the strength by good, nourishing diet. Avoid drawn from the bottom of the feet or any other expectorants; they are worse than useless. part of the body do just as well ? Would not a Have plenty of fresh air and an even temperahydragog cathartic, like epsom salts, accom- ture thruout, with moisture. plish very much more and leave no annoying Before closing, I should like to ask your sore on the skin? Would it not be better still treatment for a case of chronic cystitis of five to dilate all the arterioles thruout the body and years' standing. Man, 36 years old, single, no allow the blood to flow from the congested history of specific trouble ; suffers severe pain arterial system into the veins, thus relieving the while urinating, but no other time; and the congestion in the lungs and diminishing the pain is near the end of penis. Passes water labor of the overworkt heart? This can be every hour or two, day and night. Urin alkaaccomplisht by the administration of Norwood's lin, with large quantity of mucus and pus. He tincture of veratrum viride. The best treat- has been the rounds, and had the bladder washt ment of the first stage of pneumonia, in my out, and claims that it always made him worse. opinion, is epsom salts and veratrum in suitable He says he feels perfectly well excepting this doses, especially in sthenic cases. I have trouble. He has been under my care only a never been able to see what good a blister could short time. His family history is good. When do a diseased lung. I may be wrong. I do not he had the first attack, he was laid up for two "know," as Dr. Van Horne does. I am open months, and passed a large quantity of blood. to conviction. But bare assertions do not What would you advise, Editor and readers ? instruct. “Let us give a reason for the faith Sault Ste. Marie, Mich. T. N. ROGERS. that is in us." In pleuritis, alone or accom- [See yearly index, in December WORLD, and panying pneumonia, a blister might possibly look up the references under the head of cyst. do some good. I am sure that heat, dry or itis. Has your patient been examined for moist, gives much comfort in painful cases. stone ?-ED.]