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ing fleas, as her nice line of already penned have it made by my drug firm in gallon lots, at mosquitos. Let us hear from some of the $3.50 per gallon : brethren regarding the possibilities of this · R tetanus germ being inoculated by the flea.

Ammon. hypophos. . Stason, La.

J. SMITH, M.D.

Ipecac

White pine. [Tetanus germs are found in the soil. We Blood root think your explanation of the cause in this case Pleurisy root. is correct; and it is the first mention that we

Heroin hydrochl.

Menthol have seen of the tetanus germ being carried by Syr. tolu, q. s. ad.

3ј fleas.-ED]

The menthol relieves irritation better than

chloroform, and is more durable. Adherent and Retained Placenta.- Sigos of Elmhurst, Ill. HENRY F. LANGHORST. Pregnancy.-Moist Dressings vs. Dry

Dressings.-Cough Syrup.
Editor MEDICAL WORLD :-Regarding re-

Adhered Placenta. tained placenta, I find the following plan of

Editor MEDICAL WORLD :-In the April service in differentiating between adherent and World, page 154, Dr. Jennett asks,“ do you retained placenta: After birth of child keep think there are such adhesions?” (placental). hand on uterus; while uterus is round and

Your answer, “well rather,'' just expresses my smooth, placenta is still adherent; when con

views in the matter, having had several cases of tour is uneven, or when you can detect a flat

the kind in my nearly fifty years of practise tening of one side, the placenta is detacht.

where I have been obliged to separate the plaAll that is now necessary is to express it. I

centa from the uterus by a sawing motion of had a case when after waiting twenty-five min

the finger nails. utes the placenta was still retained; uterus was

My object, however, in writing this is to deflabby, strongly retroverted, and in such a tail one of my worst cases of the kind I ever position that the hand could not grasp fundus.

had. Was called one night about midnight by Massage of no avail. Slapping a cold, wet towel

near neighboring practician (a German) who over lower abdomen stimulated contraction

wisht assistance. On the way to his patient he and caused uterus to rise. Was then enabled to said, “she," (a German woman) "had just grasp fundus and express placenta. As a prophy- been confined, and her womb had turned inside lactic against infection, especially where manual put and was then lying on the bed between her or instrumental interference has obtained, ergot thighs.' in xx m. to 3j doses is excellent. It closes the I very naturally thought he might be misgaping sinuses by contracting the muscular taken. On arriving, the Doctor stept to the fibers, thereby preventing bleeding and forma- bedside of his patient, graspt the bed coverings tion of clots, and also hastens subinvolution.

and threw them across the foot-board, leaving In answer to W. Y. (page 168), if Johnson's his patient nude from waist down, and pointing sign is present, the woman is pregnant. This said, “see." sign is present earlier than Hegar's, and con

I lookt and saw what appeared to be a large sists of an intermittent softening and hardening clot of blood between her thighs, just such as of the vaginal cervix. It is present as early as

might be expected immediately after confinethe fourth week.

ment. On closer examination, however, I Dr. J. C. Johnson (page 169), will find that found that the Doctor was right, and what made hot, moist dressings or compresses in septic con

it much worse the placenta was very firmly ditions will give him better results than dry dress- attacht to the then outside of the uterus. ings or ointments. Hot dressings of a saturated To break up the adhesions I was obliged to solution of boric acid, 5 percent solution of use much force with my finger nails, the blood echafolta, or 1 percent solution of aluminum gushing out freely the while. After thoroly acetate, are all excellent. Senn recommends cleansing I turned the womb back again, the latter. A i percent solution of aluminum returning it to its natural position, after which acetate can be cheaply made by dissolving 24

she made an uneventful recovery, sitting up in gms. of alum and 38 gms. of acetate of lead in bed on the fourth day, as probably no one but one quart of water. Professor Senn substitutes a German would have been able to do. this for dry dressings in "all wounds that are Brooklyn, N. Y.

G. NICHOLS. or may become infected." If Dr. Vedder (page 171) will use difluor

Editor Medical World:-1 duly received your statement this

morning, and I have much pleasure in inclosing express money diphenyl ointment (antitussin) in whooping order for $3 to pay for The WORLD. I have no excuse to offer cough, he will find it almost a specific.

for not remitting sooner except carelessness. In fact, I always

It's a mean way of atI wish to submit a formula of a cough syrup tempting to get out of wbat a fellow does. THE WORLD occu

pies a unique position among medical journals. that I find palatable, stable, and efficient. I

Watford, Ontario.

James NEWELL

try to avoid acts that call for excuses.

6. Deep

Not Twins, But a Case of Double Conception. I was interested, this case was turned over to

Editor MEDICAL WORLD:-In April WORLD, another. This is why I did not bleed. page 152, Dr. K. Taylor, of W. Va., reports a Dr. H. M. Lefevre, page 170: case of “twin” girls with

girls with "seperate placen- ulcers on ankle." Clean ulcer, fill with powtas,” and thinks it must be an exception to the dered opium, and note results, rule, judging from an article he had seen in Helena, Ok.

J. H. MEDARIS. the November, 1903 issue, page 494 of this

U. M. C., Kan. City, Mo. same journal, (written by myself). Now if the Doctor will read this article again carefully, he Bleeding for Puerperal Convulsions. will find that the case of “twin” girls he

Editor MEDICAL WORLD:- I was much interreports is not an exception, nor are they twins proper, but a double conception, altho of

ested in Dr. Lee's article in April WORLD, the same sex.

Each was doubtless envelopt page 156, on short cord and puerperal convulin a separate membrane and fed thru its own

sions. In a practise of nearly forty-six years I placenta, as he reports. The difference be

have had my share of such cases. In the former tween this case of the Doctor's and a case of

it requires quick action on the part of the twins proper (which are always of the same

practician to save the child, and in the latter I sex) is this: The former will not be duplicates,

have always been successful with free venesecwhile the latter will. The November article

tion, and fortunately have never lost a case. makes this plain, if carefully read. The last

My first case was a primipara 18 years of paragraph has it all in a “nut-shell."

age; bled her more than two quarts. She is Middletown, Ohio. T. E. REED, M.D.

alive and well today, and this was more than

forty years ago. My last case was on the 17th Twins and Double Conceptions, Etc.

ult., a primipara 17 years of age. Was called Editor MedicAL WORLD :-Dr. Taylor, on

in consultation when she was in her fifth con

vulsion. The attending physician had been page 152, April World, finds “twin girls with

with her fifteen hours; had given large doses separate placentas." According to my views he found a double conception, and not twins.

of bromid of potash and chloral, and hypoderA few years ago I found twins (boy and girl)

mics of morphin and atropin; had given from one placenta. This is contrary to general

immense doses of chloral per rectum, and had

administered chloroform, etc. teaching. We must dig or go beyond our

I suggested teachers. The sperm itozoa—the seed-is male

bleeding, which was immediately done, full one or female. If a male sperm attacks an ovum

quart in quantity. No more spasms, and she -lives on it-until ovum is attacht to walls of

was delivered of a live child the following womb, thereby becoming a physiological leech

morning. Mother and child at this writing for a period of time, theo expelled, becoming doing nicely, I hope Dr. Lee will not wait in a leech at breast, for another period, we have a

next case he has, to dilate and use forceps, etc., male child. If a female sperm, we have a

but resort to what I am satisfied is the only female. Should there be a male and female

common sense treatment, viz., free venesection.

H. W. CARPENTER, M.D. sperm attack and live on the same ovum, we have twins, male and female. Should there be

Oneida, N. Y. two ovums and a sperm lives on each ovum, we may have two males or two females or male

Possible Ectopic Gestation. and female, but a double conception and not

Editor MEDICAL WORLD :- In the April twins. Let those owning microscopes investigate along this line. According to Sturgis Dr. J. R. Smith's case, on page 155, was one

number of your excellent journal I suspect that (Sexual Debility in Man) his microscopic

of ectopic gestation, and that the fetus was not plates show a difference, especially plate 7. I

in the womb at all. I had a similar case (and hope some one will investigate and report. Io Dr. H. N. Jennett's case, page 154, I

also in negress) in which the cranial and other

large bones could be and were felt not only by think the trouble wholly due to the intestinal

myself but by several other practicians for tract. Genital tract not to blame. The case

several years—in fact, my case and his correswould have got along as well if not better

pond in almost every particular. without “ the cleaning out," "irrigation,

Aiken, S. C.

B. F. WYMAN. etc.

Dr. John B. Lee, page 156 (puerperal convulsions), says: “Unless í previously learn

Oil of cajuput is one of the most efficient of the car

minativs. It is an excellent adjunct to other remedies better, I shall bleed the next similar case the

in the flatulent dyspepsia of the aged. Combined with first thing I do." I have had three cases; opium it is undoubtedly useful in diarrhea with choltwo I bled; they got well; one I did not

eraic symptoms. It has been also used as a rube

facient in muscular rheumatism and as a (local) bleed; she died. Owing to a law suit in which

parasiticide in ringworm. (Stevens.)

'

Diagnosis and Treatment of Gonorrhea in ated. There will be some discharge, and the the Female,

external os will be plugged with a thick, tenaEditor MEDICAL WORLD:- This is a subject cious mucus which is hard to remove. on which we do not find sufficient data in our Treatment: Place the woman on a table, works on genito-urinary diseases and gyne- preferably in the knee-chest position, wash cology; it seems to be “ disputed ground." external genital organs and douche nut the Gonorrhea in the female differs in one essential vagina with warm water and green soap. Now point from that in the male, viz: that it is swab out vagina with cotton and steril water, seldom an acute condition; and because of being careful to get well between the folds of this, the cases are not seen in their incipiency, the mucous membrane ; this will remove all and we are liable to error in diagnosis and con- excess of mucus. There will be some mucus sequently in treatment.

that will remain in the external os; for this use It is not primarily a vaginitis, as is generally a swab of cotton saturated with alcohol which supposed, but a urethritis. The reason for will soften the plug of mucus, when it can be this is that at the time of penetration the male easily removed. Now wash all well with and female urethra come in direct contact and bichlorid solution 1-10,000 or 1-20,000. This here it is that inoculation occurs. The cervix puts the parts in a condition to receive local uteri and vulva are generally attackt before the treatment. Now with a cotton swab apply vagina.

protargol, 20 percent solution; apply this The great majority of cases of urethritis in freely as there is no danger should any of it get women are of gonorrheal origin, and whenever into the uterus or bladder. This should be there is a discharge from the urethra, we should applied every other day, and in the meantime, suspect gonorrhea, whether we find gono- boric acid, 3j to 0 of water should be used. cocci or not. She will come complaining of a Other drugs may be used in same way as proburning, tingling sensation which is increast targol, e. g.: zinc chlorid, 2 percent solution ; on urination. We may possibly obtain a his- silver nitrate, 1 percent; chloral, i percent; tory of the woman having “ laid herself liable," permang. potass., grs. 5 to 3j; lead acetate, but this is seldom.

grs. 10 to zj; copper sulf., grs. 2 to zj; As in the male, we must make a thoro exam- hydrogen dioxid and water, äă etc. Internally, ination of the parts. The most favorable time such drugs as buchu, salol, copaiba, santal, etc. for making this examination is just before her

WM. M. JONES, M.D. monthly period; for at this time all secretions Hendersonville, N. C. are increast. This, however, is necessary in obscure and subacute cases only when the dis

*Osteopathy-What is It? charge is very scanty. She should not void her

No. I. urin just before an examination, as it would wash out any discharge that might be present. religion in its beauty we must approach it in

Truly has it been said, if we would see any On inspection we will find the meatus urethrae red, swollen, hot and painful to the

the spirit of one of its most devout adherents.

This is equally true of any theory, philosophy, touch. Slight pressure will reveal a muco

or science. Approach any subject in the spirit purulent secretion at the meatus. In this pus of antagonism or prejudice, and we thereby we generally find the gonococci; but should we

shut ourselves out from whatever of beauty or fail, it does not follow that the case is not

truth it may possess. Those who peruse these specific. Now examin the vulva, vagina, etc. for any

articles on osteopathy with a desire to find

whatever truth there is in them, will doubtless other places of localization. We will find the

know more of the subject and see more of its vulvo-vaginal glands on the inner aspect of the labiae majorae enlarged and the meatus of the possibilities than those who read only to criti

cize and ridicule. duct surrounded by a red areola resembling an

When two facts seem contradictory, reject ordinary flea bite; this is called the gonorrheal macula. Pressure on the duct will cause an * We have deliberately considered the matter of exudation of pus from the meatus. This con- publishing a series of articles on osteopathy, if emanatdition of the vulvo-vaginal glands is very

ing from a reliable, respectable and able source. This

article is the first of a series of 6. The writer is a graduimportant in diagnosis, as it is the last sign to ate of the Hahnemann Medical College of Chicago, and disappear in gonorrhea, and is therefore an

the Registrar of that institution speaks well of him.

We have seen the report of his examination before the important point in old and doubtful cases. Illinois examining board, which was very creditable. In girls and young women we may have a We have made inquiries of some of our subscribers in vaginitis also, and the posterior wall is the

Peoria, as to his personal and professional character,

and we have been able to learn nothing of him exone generally selected. The cervix and cept what was in his favor. So we feel safe in presentfornices may be affected, and the symptoms are

ing to our readers matter from his pen; and we believe

that many of our readers would like to learn something those of ordinary inflammation, only exagger- of osteopathy from a reliable source.-ED.

recur

neither, but look for a third fact that will cases, and to that great class of diseases that reconcile the two. This we are apt not to do. fall within the province of the physician, that If we are allopaths and know that opium will osteopathy brings new diagnostic and theracure diarrhea, we are apt to think it can be of peutic measures productiv of such satisfactory no service in constipation. If we are homeo- results to both patient and physician. What paths and know that croton oil is curativ in are these new diagnostic and therapeutic meascertain forms of diarrhea, we are apt to deny ures, and how are such results obtained? A reits usefulness in all cases of constipation. We view of a few anatomical and physiological should reject neither of these facts, but should facts will enable us to give a more concise and look for a third fact that will reconcile them. intelligent answer to these questions. Likewise, if we are an advocate of drug thera- Gerrish gives the following as the origin and peutics, and know that both opium and croton distribution of the spinal nerves, taking them oil are of service in both diarrhea and consti- “as the type on which cranial nerves also are pation, we cannot deny the ability of the osteo- planned.” They originate in the spinal cord path to cure these same conditions by methods by two roots, an interior or efferent root and a peculiar to his system, until by repeated trials posterior or afferent one. After emerging from we have demonstrated that such cannot be the cord these roots unite forming a mixt done. I am not ready to say that nerve. This mixt nerve passes out thru the diarrhea, constipation, and many other con- intervertebral foramen, after which it gives ditions

may not

not be cured by antipathy, off a recurrent branch, which receives fibers allopathy, homeopathy, osteopathy, hydro- from the sympathetic system, and re-enters therapy, electrotherapy, or even by Christian the spinal canal supplying the vertebrae, their science. The thing for us as therapeutists to articular surfaces, ligaments, bloodvessels and do is to search for the third fact that will recon- meninges. The tissues supplied by this recile these seeming contradictions, and to deter- current branch makes its importance out of min, if possible, to what class of cases and proportion to its size. After the patients each of these therapeutic measures is rent branch is given off, the spinal nerve best adapted. These facts can be determined divides into a dorsal and ventral division, only by clinical experience, and until the results each of which receives communicating branof such are at hand it were wise to not become ches from the sympathetics. The dorsal dogmatic. We should not forget that “I division passes backward and supplies the do not believe" is as dogmatic as “I do be- posterior spinal muscles, the integument and lieve."

other tissues in that region. The ventral diWhen I assert and attempt to prove by log- vision passes forward and supplies muscles, inical deduction from recognized anatomical and tegument, and other tissues in the anterior part physiological facts that all pathological con- of body, and thru plexuses sends branches to ditions of a curable nature may be favorably the internal viscera and tissues. Thus the three influenced by osteopathic methods, and even divisions of the spinal nerve arise from the tho ample clinical experience by competent same nerve center or centers in the cord, each observers confirm these deductions, it by no receives sympathetic fibers, and each innervates means follows that these same results may not separate and distinct areas and tissues. So be obtained by other therapeutic measures. intricate and complete is this nervous associa

With these introductory remarks, I will de- tion of the various parts of the body that Kelfine osteopathy not as “A system of quack logg says that every area of the skin periphery medicin in which diseases are treated by man- is associated thru the nerve center which supipulating the bones," as given by Dorland in plies it with nerve filaments, with some special his medical dictionary, but as a science and art visceral periphery or vascular area. Hilton of treating diseases mechanically, by readjust- shows the same nervous connection between inment of tissues to their normal relations and by ternal and external tissues when he says, “the stimulation and inhibition of nerves and nerve same trunks of nerves whose branches supply centers.

the group of muscles moving a joint, furnish To the recognized methods of treating the also a distribution of nerves to the skin over grosser osseous lesions such as fractures and the insertion of the same muscles, and the indislocations, osteopathy adds little either in terior of the joint receives its nerves from the theory or technique, altho the correction of same source." This is equally true of other such lesions being mechanical are a legitimate tissues on the surface of the body; they are all part of this system. To minor and operativ

associated thru some nerve center with surgery osteopathy adds little tho often curing, internal structure. without resorting to operativ measures, certain Kirk, in his Physiology, says: “One of the conditions that are considered surgical. It is chief functions of nerve cells appears to be the to the pre-operativ stage of so called surgical power of sending out impulses to the periphery

om

along efferent nerves in response to impulses secondary to visceral abnormalities may result reaching them thru afferent nerves." In fact, primarily from traumatic or other causes, we may say that all the socalled involuntary in which case the viscus will be affected bodily functions are the result of this reflex secondarily. A recent case illustrates well activity. Afferent impulses pass to their center, this fact. A patient in whom repeated are transformed and sent out as efferent im- analyses of the urin had shown nothing pulses (trophic, secretory, inhibitory, or motor) abnormal received a severe sprain of the along efferent nerves arising from the same back about the eleventh dorsal; urinary center. If the afferent impulse is sufficiently symptoms developt and albumin was found in strong, the corresponding center of the opposit the urin for about two months, or until the side of the cord is likewise affected and a bi- lesion produced by the sprain was removed by lateral reflex results. If still stronger, other appropriate treatment. The albumin then discenters are involved until all the muscles of the appeared and has not since returned. body are thrown into activity. Kirk further Abnormal conditions along the spine, espestates that muscular contractions produced by cially areas of tenderness, as associated with reflex activity are often more sustained than internal disorders, have been observed by those produced by direct stimulation of the others than osteopaths. The lame back with motor nerves themselves.

uterin and kidney trouble, and the pain under As we have seen, efferent fibers from a nerve the right scapula indicativ of hepatic disorders, center pass in three principal divisions, conse- are known even to the laity. DaCosta in his quently impulses reflected from this center will

surgery says of gastric ulcer :

“The pain is pass in these three directions, and the tissues very violent in the abdomen and also passes to supplied by these three nerve divisions will be the back, being located between the eighth affected regardless of the route by which the and ninth lumbar vertebrae" (he evidently exciting afferent impulse is conveyed to this means dorsal instead of lumbar). Hilton, in his particular center. Abnormal impulses from a “Rest and Pain” notes the frequent associadiseased viscus pass to the associated center or tion of sore spots along the spine and many centers, and other abnormal impulses are re- internal disorders. He seems not to have deflected out, not alone over the fibers passing termined the exact pathology at these points in back to this viscus, but also over the other many cases; but only to have concluded from fibers passing from the center or centers, which the pain and tenderness that some abnormality fibers, as shown, supply tissues in other parts of existed there. Absolute rest in bed was his the body. As a result of such reflexes, abnor- chief treatment, and by this means he sucmalities or secondary lesions are set up in these ceeded in curing many cases after ordinary other tissues. Regardless of the location of methods by other physicians had signally the primary trouble, the tissues in and along failed. the spinal column will be particularly affected, Perhaps no more concise and convincing as two of the three nerve divisions mentioned consideration of this subject has come from a supply these parts, sending branches to the medical source than that given us by the late vertebra, the vertebral articulations, the Dr. Hammond. In his treatise on diseases of muscles moving them, the skin over these the nervous system, and more particularly in tissues, as well as the meninges of the cord. his monograph on “Spinal Irritation," he These secondary lesions may take the form of gives the results and conclusions arrived at from congestion, inflammation, increast or decreast his personal examination and treatment of one functional activity, with resultant muscular, thousand cases, with nearly as many from other ligamentous, or fascial contractions or relaxa- eminent observers. His observations may be tions, trophic changes, etc., the resulting lesions summed up as follows: (1) That areas of depending on the tissues afflicted and the nature tenderness along the spine are common, and to of the primary lesion. Congestion and inflam- use his own words, those who refuse to believe mation with soreness and tissue contractions it “must necessarily belong to one of the followare more markt in recent cases, while contrac- ing categories : Their experience must have been tures, relaxations, trophic changes, and bony very limited and therefore they cannot see, or subluxations are prominent in chronic condi- they must have been endowed either with retions.

stricted powers of observation or with minds so Unless these impulses are of sufficient constituted as to cause them wilfully to close strength to affect the corresponding centers on their eyes to the facts that they did not care to the opposit side of the cord, these reflex sec- see." (2) That the patients in many cases are ondary lesions will be confined to that side of unaware of the existence of these areas of senthe body from which the afferent impulses sitivness until called to their attention by an

examination. (3) That this sensitivness may Lesions similar to those just described as be seated in the muscular, cartilaginous, liga

arose.

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