Short articles of practical help to the profession are solicited for this department. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline responsibility for the safety of unused manuscript. It can usually be returned if request and postage for return are received with manuscript; but we cannot agree to always do so. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. RECORD COMPARE READ REFLECT A Large Enema. Editor MEDICAL WORLD:-On the afternoon of February 15, 1898, Mr. M., a grain merchant, a large man weighing over 200 pounds, while loading a car with grain jumpt from the car to the ground. He felt something give way, which was immediately followed by a severe pain, located about two inches above the umbilicus. The pain was so severe that in the course of an hour or two he quit work and walkt about a quarter of a mile to his residence, where I saw him in the evening. From the symptoms and history I suspected that the bowel had been loopt or knotted, and ordered enemas of warm water, gave an anodyne for the pain and strict orders that no food of any kind should be taken. The next day the pain still persisted and there was frequent vomiting. Being thirsty he was allowed to drink water, but no food was given; high up and copious enemas of warm water were used frequently, completely emptying the lower bowels. No improvement resulted, and the next day the vomiting was stercoraceous, and all the symptoms aggravated. The prognosis was looking exceedingly gloomy. I sent for my friend, Doctor A., who concurred in the diagnosis of volvulus of the bowel, and we decided to try a forced enema. We attacht a bulb syringe to a large rectal tube, passed the tube full length into the bowel, and with the patient's hips elevated 12 to 18 inches higher than his shoulders, I began to pump in the warm water and Doctor A. to knead the abdomen with his hands. When I had pumpt in about a gallon the patient said, "I believe I'm going to burst." Just about that time he began to vomit, and we noticed the distention and tension of the bowels begin to relax. So we kept on pumping water into the patient and calling for more water, while the patient kept on vomiting it up, until we had used more than five gallons, and until the water was no longer discolored. The patient had no more trouble with his bowels, and is living and well today. The question has often occurred to me since: Would it be possible in all cases where the bowel had been emptied from both above and below, as it was in this instance, to force fluid thru the bowels reversely, as was done in this particular case? It seems not to be physiologically impossible. Is it often done? Who knows, and who can answer? Scio, Ohio. E. E. TOPE, M.D. Quinin Combined with Acetanilid and Capsicum for Malarial Fevers. Editor MEDICAL WORLD:-Most physicians do not know the value of combining acetanilid with capsicum with quinin in the treatment of intermittent and remittent fevers. It is a combination of great value in most forms of such fevers. The following is the most often used formula, but the proportions can be varied to suit the individual need: B Quinin sulfate Pulv. capsicum. . gr. 30 . gr. 20 gr. 10 M. Sig.-Dose, six grains every four hours in remittent fever, and in intermittent fever give four doses daily, one every two hours, beginning so that the fourth dose will come one hour before the chill is due Acetanilid causes the action of quinin to be much quicker, and prevents much of its untoward effect, such as headache, besides being a valuable companion for it if fever is present. Capsicum increases the anti-periodic effect of quinin, and sustains the vital force and the action of the heart. In all cases this treatment should be preceded by some cholagog. The Abbott Alkaloidal Co. makes a tablet or granule (I prefer tablets as the granules are so easily lost) and irisin; also a tablet or granule containcontaining one-sixth grain of each calomel every half hour until six are taken, which ules as before, and so on until it is clean. It Cauthron, Ark. Another Plan Worth $1,000 Per Year. Editor MEDICAL WORLD:-I was much interested in the article on page 284 by Dr. Gaston in this (July) issue of THE WORLD. Pardon me for sending you blanks of my framing. At first I did not collect 60 percent of what was due, but since I started on this plan I have collected $1,000 a year more than before. There may be better plans, but this has suited me. I keep each month's account separate, and at the beginning of a new month open a new account and send in the bill for the last month. I think blank No. I will explain itself. After three months the "Statement" is sent. As for "Comstock": Six years ago an agent of that concern called on me. I, too, signed his trick paper; $21.00 was paid to me by one, the account with whom I had placed with them. A check was sent them, but soon afterwards I began to receive the demands for $30.00, they stating that I had not sent them anything. I have held this return check for six years waiting for the suit which never came. Of late I have not taken their letters out of the office but had them returned unopened. I. N. WOODMAN, M.D. Morrisville, Pa. BILLS MAILED MONTHLY. To Dr. I. N. Woodman, Dr. For Professional Attendance for the month of Paid, Balance, Received Payment, This bill does not include any visits made except in the above named month. [OVER] [On the reverse side is the following:] Office Calls, 50 cents cash-Home Calls $1.00-Calls at a distance, 20 cents per mile extra. Also 50 cents extra on calls between 10 p.m. and 6 a.m. NOTE. Those who make no effort to pay, need not apply for professional attendance. Should Doctors Charge Shop Girls and Widows? Editor MEDICAL WORLD:-The question of charging the clergy has waned into insignificance in our town. We all do this practise gratis, and don't think anything of it. One of our leading physicians has extended this "courtesy "to all shop girls, school teachers. widows, etc. Doesn't matter what salary these young ladies and widows are getting, their practise is absolutely FREE; hence he has "drummers" all over the city. There is "method in his madness." This "generous" doctor has a drug store, too. TEXAS. Starch Bandages. Editor MEDICAL WORLD:-I see in your June issue Dr. Bevill has something to say about starch bandages. I graduated in the college here twenty-four years ago; they were much in vogue then, and the late Prof. James F. Heustis was a free advocate and firm friend of them. I have frequently used them, but not very recently, as "there are others" that answer the purpose better. In an emergency, with nothing more serviceable at ready command, I should again make such application, but are they not now somewhat out of date? Mobile, Ala. WM. T. HAMILTON, M. D. Probably a Voice from the Clergy. Editor MEDICAL WORLD:-In a recent number of your valued journal I notice a discussion concerning the physician receiving fees from the clergyman. Among various expressions I find one thinking it proper to make no charge of the country clergyman with meagre salary, but to collect from the city pastor who keeps an "auto;" another expressing admiration of a preacher who rejected free service because it classed him with paupers. It may be that the owner of the "auto" finds it as difficult to live in the style required by the flock he leads as his rural brother to exist upon what he receives; and certainly the clergyman wrongly inferred that he was classed with the destitute. The question is not, however, an eleemosy nary one. The physician recognizing in the clergyman the cure of souls as he himself is the cure of bodies, and appreciating the greater value of the former, gladly accords to him professional services on the same terms as to his brother physician. Moreover, the reflectiv physician feels that he is honoring the gospel and worshipping God by giving time and skill for the benefit of God's representativ; and the man of God accepts this as a tribute to his Master and the cause he represents, a bill indicating to him the physician's lack of delicacy of perception. The physician has a right to charge, and that clergyman is foolish who insists upon free service as a right inherent in the cloth. The placing of the physician's service free of charge to the clergyman is merely what the conscience and common sense of mankind imposes as a custom, and is an additional example of the same principle bserved in the railways and merchants making lower rates for the clergyman, and no right-thinking minister of the gospel is either imagining he is classed with the destitute, outraged, or, taking the same as a personal tribute, inflated with pride. O'Fallon, Mo. B. A. PENDLETON. [This communication does not come from a subscriber, nor is there anything in the above, nor in the letter which accompanied the above, to indicate that he is a physician, and his name does not appear in the Standard Medical Directory. We infer, then, that he is a clergyman, perhaps having borrowed THE WORLD from his physician. Can we consider the above a typical expression from the clergy?ED.] patient every three or four hours. To supply the flesh and strength, give a teaspoonful of codliver oil with maltine three times a day. A cure is certain to follow this treatment. I have used it for 25 years and can truthfully say I have never lost a single case. The common prescriptions I have noticed in THE MEDICAL WORLD Containing bismuth, I have tried time and time again; they are worthless. Let the WORLD readers try this and report results. I guarantee what I say. L. CASE, M.D. Chattanooga, Tenn. Summer Complaint. Editor MEDICAL WORLD:-Let me suggest something that may be of much assistance to some doctors and their little sufferers. Take a piece of cotton the size of the abdomen—or I should say that will cover the abdomen; peel a thin layer off the top and dust about five cents worth of quinin on the cotton, and lay back that which you peeled off. Now place this over the abdomen, with the quinin side to the belly, bind it there, give the child some simple indicated remedy, keep it as quiet as possible, and you will be surprised at results. Waitsburg, Wash. A. D. MAHAFFAY. [Try it without the quinin, and see if the results are not the same. A covering over the abdomen, particularly over the solar plexus, is always a good thing for any abdominal disturbance. If the covering is slightly irritating, all the better. A capsicum plaster is a good and convenient form for such application. If you want absorbtion of quinin by the skin, there are much better ways to secure it than by applying it dry, in cotton. Do you remember the "liver pad" and "kidney pad" craze of some years ago? They claimed to cure by absorbtion thru the skin. They did help a great many people, but not by absorbtion. A few folds of flannel or a capsicum plaster would have done just as well. These simples often do much good, and they should not be neglected, as they usually are.-ED.] I relief every time. Will give a brief outline of treatment: Dose of calomel, 3 to 6 grs., followed in four hours by castor oil. As soon as the oil acts, start fl. ext. chaparro amargosa, 40 drops in a little water every four hours. irrigate the lower bowel every four hours with three pints of normal saline solution. Keep patient quiet, in bed, and on peptonoids and egg albumen as a diet. Hot turpentine fomentations to the abdomen is the best thing to relieve the pain. I never use "antikamnia "-the comp. acetanilid powder does the work just as well. If the members of the " family" will use the following mixture, I think they will stop buying vitogen and other expensiv antiseptic powders: Bismuth subnit. 50 percent, acetanilid 25 percent; boracic acid 25 percent. Keep the part clean with peroxid of hydrogen and creolin water, and use the above powder freely, and your wounds will heal rapidly. The WORLD readers should appreciate Dr. Taylor's efforts to take care of them. Boykin, S. C. J. T. HAY. Notes on Obstetrics and Summer Troubles. Editor MEDICAL WORLD:-The " rigid os of obstetrics and especially the "dry labor os " (where the membranes have ruptured before dilatation) is best dilated by introducing the index and middle fingers into the os, pulling it down, separating the fingers widely, and then raising the os near the pubes. Hold the fingers there some time, and, if necessary, stimulate the pains by kneading the fundus with the other hand and watch the results. The most important duty of the physician in normal labor, except being clean and aseptic, is the protection of the pelvic floor. When the presenting part presses the pelvic floor, keep it there until the parts have time to dilate. Time is the best perineal stretcher. Keep the head pusht back with your hand and turn off the steam. Tell the woman to "quit bearing down" and let her cry out. Always, if possible, slip the head over the perineum between Milk and Malaria.-Dysentery.-An Inexpen- pains. siv Dressing Powder. Editor MEDICAL WORLD:-On page 297, July WORLD, Dr. Hall mentions sweet milk as a possible cause of malaria. I have often noticed, during four years of activ practise in this malarial section, that sweet milk in a large number of cases causes the liver to become torpid. We all know that when that organ is not performing its work properly, malaria is the usual outcome. I saw an article in one of the Spring numbers of THE WORLD, recommending chaparro amargosa for dysentery. Since then I have employed it in a number of cases, with quick Examin every pelvic floor by inspection after labor, and if torn, repair it then and there. Don't tie the umbilical cord till pulsation ceases. When the child fails to breathe and cry, the first, handiest and best thing is to dilate the sphincter ani-insert your finger. Never make any traction on the cord. Avoid, if possible, introducing your finger into the os after the second stage of labor. Deliver the placenta by pressing down the perineum with the fingers of one hand, and grasping the fundus firmly with the other, squeezing it out (Credé). Never, under any circumstances, give ergot until you are sure the uterus is empty. Its only indication is an empty, flabby uterus. Maintain firm contractions of the uterus by kneading the fundus; teach the patient and husband how to do this, which is surely the best means they could employ in case of hemorrhage or after-pains. Summer troubles in children are now on hand. Never, never forget the old tried and almost sure remedy-calomel-and don't prescribe one of the fancy proprietary remedies. Clean out the alimentary canal thoroly with small and repeated doses of calomel. Don't give calomel tablets or any of the shot-gun mixtures when there is nausea and vomiting, but give it in a plain, dry powder dusted on the tongue. After the canal is cleansed with calomel, then treat the case as indicated. Large doses of bismuth subnit. fill the indication for more cases than any other single remedy. Where there is pain in the belly, add camph. tr. opii to your bismuth, and you have an ideal treatment for enteritis, even if it is old and sounds simple and plain. If vomiting continues after action of calomel, try ingluvin powders, grs. ii to iv, powd. ipecac% to 4 grs., or cerium oxalate, but try your remedies singly. and ridicules those who believe that two placentas ever exist in twin pregnancy. My experience in this connection has been very limited. I have attended but two cases of twin labor, yet in one of these there were two separate and distinct placentas, the placenta of the second child being expelled ten minutes later than that of the first. The membranes were also entirely separate and distinct. The fact that Dr. MacMurphy has never seen a case in which there were two placentas does not preclude the possibility of such an event, and I wish to warn those who may have attacht undue importance to the Doctor's remarks, not to leave a case of twin labor before the expulsion of a second placenta, unless the first has both cords attacht to it. Oakdale, Neb. Twins. MAX KOETTER. Editor MEDICAL WORLD:-In reply to Dr. MacMurphy's article on single and double placentas with twins, will say for the Doctor's benefit that I have delivered eight sets of twins, the last set March 25, 1904; both breech presentations, with two separate and distinct sacs of liquor amnii; the second sac I ruptured after delivery of first child; after the second one was delivered I removed two separate and distinct placentas, nor did I wait a twelve hours for the second placenta, as the Doctor states he knew one doctor who did. These children weighed seventeen (17) pounds Rest is the first indication in inflammation anywhere, so don't forget that it holds good here, and don't crowd the stomach with food. Give no food at all for twenty-four to fortyeight hours, and then give albumin water followed by pepsin; later give milk and oyster-boy nine pounds, girl eight pounds. This soup. Kempville, Tenn. WALTER DOTSON, M. D. Unusually Large Twins. Editor MEDICAL WORLD:-On Sunday, June 19, I was called seven miles in the country to attend a lady in confinement. She had been in labor twelve hours before sending for me. After about an hour I gave her chloroform and performed version and delivered her of a boy, and in fifteen minutes after I turned a second baby and delivered; both boys. The first weighed twelve pounds, and the second eleven pounds. Twins and mother doing nicely. The reason I report this case is on account of the weight of the twins-it is the largest I ever heard of; but perhaps some of THE WORLD readers have delivered larger ones. Single placenta. E. M. CLAY, M.D. Renville, Minn. Twins and Placentas. Editor MEDICAL WORLD:-In the letter of Dr. MacMurphy, in June WORLD, page 251, the writer states that he has had an experience of seventeen cases of twin births and "has yet to see a case where there were two placentas," was the second set in succession, boy and girl each time; one of the first died in four weeks; the last still survives. J. T. ABSTON, M.D. Hickory Flat, Miss. |