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“bron-ke-tis," and so on thru the whole list by myself, which speaks for itself as to its conof words of Latin origin ending in "itis." Some venience. One can carry same in pocket, and as physicians use one pronunciation, some the we are not infallible, important questions someother; which is correct?

times may be forgotten. It answers as acute or Buckley, Illinois. O. L. THOMPSON. chronic records, impresses the patient that

[Doctor, we are sorry to say that both are you are not neglectful, then with the symptoms correct. Both methods have high authority, underlined on the card, they afford ample time so it is a matter of taste, or of choice, between

when returning to the office for further considthe two. We wish some one could decide, eration for diagnosis. I have them for sale; once for all, so we might have uniformity; but they are not copyrighted, as I believe we no one can do this, so usage will have to finally should all stand with an open heart to one decide it. Where classical ideas and habits of

another. I can furnish them to the family as thought are prevalent, as in some of the univer- reasonable as they could have the composition sities, there the Italian method is likely to be (type-setting) done alone. prevalent; elsewhere, the English method is I am in most hearty sympathy with your preferred. We decidedly prefer the English attitude toward those who swindle the people method, and we think that it is destined to (and the profession). They outrage justice, prevail. -Ed.]

and are a foul disgrace. I trust they may be

transported to Hades, to his Satanic Majesty, A Form for Statement of Accounts.

that they may deal with the old fellow who

rules there, in place of fastening themselves Editor MEDICAL WORLD:-Observing the upon honorable professional men. various forms of statements, etc., from mem

HERMAN H. LAHKE, M.D. bers of the family, I would present the one in 1542 Linn Street, Cincinnati, Ohio. use by myself. Noting the one presented in (We suggest that those who are interested the August WORLD is mild, and the one in send a postage stamp for a sample of the case September WORLD is exceedingly strong, I record cards, and terms, and if the terms are believe this one to be just about between the too high, you can have some printed for your two.

use by your own printer. The bill form folI also inclose a case record card, as compiled lows.-ED.]

A discount of 5 per cent will be allowed on this bill if paid within 3 days OFFICE HOURS

(This line is printed in red.)

[blocks in formation]

POSITIVELY DO ALLOWANCE or Discount unless REPORTED during discount days,

(This line is printed in red.)

Meningitis.-Clay in Inflammations.

grenous in an old man, amputation would in Editor MEDICAL WORLD:-In THE WORLD all probability have proven fatal. for September I note an article in which the After this the clay doctor was the big man writer urges clay poultices frequently applied in that neck of the woods That was in the to the head and spine for the relief of menin- Indian Territory. I have used clay in pneugitis. I shall try it It is simple and humane. monia. I shall use it in meningitis. I believe in clay. But before I speak of clay I I have applied a clay mortar (previously wish to relate my experience in the Indian boiled and cooled) to pull out old inflammaTerritory with meningitis. It was in the tory exudates in an old ulcerated leg. Thus midst of an epidemic. It seems that every one you establish the circulation and nourishment stricken with it died.

to the parts. Then any antiseptic will heal the A good old woman, part Indian, said to me, ulcer ARTHUR C. BELL, A.M., M.D. “Dock, are you curing any of them?" “No Dallas, Texas. not one, so far." 'Well, you'd jis as well follow my treatment then, they won't no

Case of Strychnin Poisoning. more'n die no how."

Editor MEDICAL WORLD:—A boy came runI said, “What is your treatment?”

ning into my office saying that his father had She said, “Put fifteen drops of tr. belladonna swallowed some tablets and had spasms. in one tumbler of water; put fifteen drops of I at once suspected strychnin poisoning. tr. aconite in another glass of water; give a Went to house with chloroform and chloral in teaspoonful of one, one hour, and the other the my bag. Arriving at the house I found near next hour, and so on."

the bed a bottle containing about 500 tab. I tried it. In such an emergency I would trit. of strychnin sulf. o gr., by Wyeth & try anything. I treated eight more cases; six Bro. The wife said that her husband was recovered but one relapst, leaving five cures drunk, and while she was absent from the out of eight cases. Gentlemen, when your house he had taken a number of these tablets. cases are all dying, don't fail to try the old The patient was 48 years old, strong and woman's remedy. A man would rather live well built; a habitual drinker. My entrance unscientifically than to die very scientifically. into the room brought on a convulsion. I

Now about the power of clay as a poultice. learned that he had taken the drug about two A few years ago I was called six miles into the hours before I arrived ; that he had not eaten country to see a very old man. He had been that day (it was then 1 p. m.). riding on the hounds of a wagon and dragged The tetanic convulsions affected nearly every his leg over a stump five days previous to my muscle of the body. The limbs were tossed visit. I found the leg broken, very black and about and were very rigid; the head was swollen, with signs of gangrene. I thought of thrown forward and then backward ; the enantiphlogistine (which is Colorado clay per- tire body was very rigid. Opisthotonos was fumed and ground), but it would have taken developing gradually. Pulse was 200, temseveral dollars to buy that kind of clay. So I perature 100.5o. The least noise brought on told them to send out to the hills and get a half a convulsion, as did also the pricking of the bushel of clay. Directed them to keep leg in hypodermic needle. These convulsions lasted clay mortar for 36 to 48 hours.

about 30 seconds, and then all muscles became I noticed a peculiar grin on some of the relaxt, only to become rigid again at the next faces of their wise old neighbors. I reflected convulsion. The abdominal muscles were about it a moment, as I was a new doctor in hard, as well as those of the chest. Eyeballs that community. However, I turned and did not stare. Patient was entirely conscious drove home. After I was gone one of them thruout attack. Was unable to tell just how askt my name.

A wag replied, “ that's Dr. much strychnin was taken. Henry Clay, sir; he treats altogether with Treatment. —Stomach pump brought up alclay.' I am told these fellows, wise or other- most nothing ; hence washt out stomach. (This wise, had considerable merriment over the did little or no good, as in two hours almost clay doctor.

all the drug was absorbed). Stopt stomach But when I returned thirty-six hours later all washing at once and gave hypo. of apomorphin had changed. In place of a solid swollen leg % gr. which caused vomiting inside of six I found the clay had pulled out the inflamma- minutes. Every act at vomiting brought on a tory exudate, the swelling had disappeared, convulsion. During convulsions I gave inhalacirculation was establisht, and the limb was tions of chloroform which of course instantly receiving its nourishment. The tissues of that aborted spasms. Between the convulsions I limb were soft and flexible like the other limb. gave morphin sulf. 74 gr., hypo. every twenty I put on a splint and the man made a perfect minutes for three doses. I then gave per recovery. With a leg rapidly becoming gan- mouth (after vomiting stopt) twenty grains of

426

Strychnin Habit-Poisoning by Wine of Colchicum [THE MEDICAL WORLD

chloral hydrate every fifteen minutes. This fate in lieu of the bitter strychnin. The quinin drug should be administered per rectum, but I will not form a drug habit ; of that you may was unable to obtain a rectal syringe of any be sure. variety

Prophylaxis is, for physicians to try and use At the end of two hours after I arrived, less of the drug than they do. Some men seem patient was quiet and resting and beginning to to think that strychnin is the “universal sleep. Convulsions stopt after he had taken panacea,” judging from the way they prescribe sixty grains of chloral and one half grain of it. When I was drug clerk, nearly every morphin sulfate in divided doses. He was other prescription that I put up contained now sweating all over. Before I departed I strychnin; often times for short periods every left a prescription for bromids. The following prescription would contain the drug, and many morning patient felt as well as ever.

of them from the “biggest doctors” in DenWooster, Mass.

MAX BAFF, M.D. ver. Understand, I am not condemning Columbia University, X. Y.

strychnin, which is a useful drug and oft-times a life saver. I am only cautioning about its

careless use. The Strychnin Habit and Its Treatment.

I would like to hear from the “familee" Doctor, did you ever stop to think how what drug habits they've come across. I've many “strychnin fiends," if I may so call seen opium (morphin), atropin, codein, cocain, them, you have made of your patients ?

digtalin, cannabis indica, bromid, chloral, Many physicians will give a patient who is chloroform, arsenic, hyoscin, and trinitrin suffering from some slight disorder and tempo- fiends.

DR. F. AMMON. rary weakness a prescription for strychnin. Lawson, Colo. Usually this is all the patient needs, and after a short time he feels all right, with the exception that he feels weak and “run down" with

Poisoning by Wine of Colchicum. out the medicin he has been taking ; he, there- Editor MEDICAL WORLD:-On the 23d of fore, keeps on taking it without the doctor's last February four Indian boys, pupils of the order or knowledge. Soon he is a confirmed Hoopa Valley Indian Boarding School, drank habitue, and cannot get along without it. He sixteen ounces of the wine of colchicum root. naturally goes to it, as the morphin and cocain Early in the morning of that date two of the fiends do their beloved drugs. Of course the boys entered the school dispensary and stole strychnin habit is not as pernicious a habit as the drug, which was mistaken for port wine, the two just mentioned, but there comes a as afterwards developt. It was carefully stage when poisoning sets in, his jaws feel secreted until after the boys had eaten their stiff, he can't sleep, his sexual desire becomes breakfasts, when they were joined by two extremely great, and he has a “smothery feel- other of their schoolmates, and the four went ing” in his chest, with other kindred symp- into an unoccupied building within the school toms. He soons finds out it is this potent campus, where the bottle containing the wine poison that is causing these disagreeable symp- was passed around in regular order until the toms, and he cuts down the drug for a while. last drop was drained from it. As soon as the superfluous strychnin is elimi- Three of the boys were between the ages of nated, then there is a craving for more, and he sixteen and twenty, and the fourth about starts in again. He keeps on again until he is twenty-four. From one of the youngest I overcome by the poison, or borders on the learned that the drug was drunk between the verge of insanity or neurasthenia. In the ad- hours of eight and nine in the morning of the vanced form of the trouble there are constant 23d ; that, so far as he was able to judge, they twitchings of various muscles, producing a each drank about the same quantity; that condition resembling chorea. There is also a neither of them experienced any uneasiness or great emaciation present, possibly resulting discomfort up to about one o'clock in the from the insomnia and diarrhea.

afternoon; that within half an hour after eating Patients soon find out the advantages of the lunch at noon all four vomited very freely, hypodermic syringe, and will usually employ from which they obtained a degree of relief; it; others will “eat” it, in the form of tab- that the three younger vomited only three lets or sugar of milk triturations which some times more during the entire afternoon, ard “good” (?) druggist will put up for them. that by six or seven o'clock in the evening

The treatment is simply to withdraw the they had been completely relieved; that the drug suddenly, and give fifteen grains sodium oldest young man continued to vomit at interbromid t. i. d., p. c., and one one-hundredth- vals of from one-half to an hour until six in the grain doses of trinitrin between meals. For the evening, when the severity of the symptoms - eaters" give a one-grain tablet of quinin sul- was increast, so much so that the young man

himself, as well as his associates, became in the morning of the 25th a messenger arrived alarmed, and I was sent for.

at the school to report to the Indian agent that I saw the patient first at 7.30 p.m. of the the young man had died at three o'clock that 23d, and it did not take long for me to de- morning. This report did not surprise me at cide the character of the case I had to deal all, but, as I informed the relativs afterwards, with, notwithstanding the young man guarded there was absolutely no necessity for this young his secret so well that I was unable to ascer- man dying ; if the treatment had been continued tain anything that would give me a clue to he would have gone on to complete recovery. the origin of the trouble. His pulse was very

There are at least two points worthy of conweak and thready, his breathing rapid and sideration in the cases here reported: 1. The shallow, and a cold, clammy perspiration was quantity of the drug taken at one time. on the surface, all indicating a consider- 2. The length of time it remained inoperativ able degree of prostration. Every effort to in the stomach. Prof. H. C. Wood states in get at the cause of the trouble being in vain I his excellent work on therapeutics that death began meeting the indications with such reme- has been produced by two drams and a half of dies as I considered applicable. I gave him the wine of the root, and that recovery has sulfate of strychnin and nitro-glycerin hypo- taken place after an ounce was taken. In these dermically and succeeded in giving some relief four cases four ounces each was taken. I thereby, the action of the heart becoming account for the drug remaining inoperativ for more regular and its volume increast. Patient so great length of time to two causes : In the first seemed to breathe deeper also. After I had place the boys had eaten a very hearty breakfast administered the fourth heart stimulant hypo- almost immediately before the wine wasimbibed, dermically I left the care of the case in the and secondly, the drug is very slow of absorphands of a competent nurse for the night and tion. There are two important features conretired, with instructions that I should be called nected with the case that ended fatally that I canif my patient got worse.

not account for satisfactorily to myself: 1. The I was sent for at three the following morn- fact that four boys drank almost the same quaning, the messenger saying that my patient was tity of the wine, three recovered with very

little thought to be dying. When I entered the gastric disturbance, while the fourth and oldest room it did appear to me that the end was not one died from the effects of the drug. 2. There far away, but I decided to change the treat- was an entire absence of purging in all four ment and remain with him until morning. I cases, which is usually one of the most promiprocured two ounces of alcohol and began nent symptoms, according to recognized giving him teaspoonful doses every half hour, authority.

J. S. LINDLEY, M.D. and contrary to my expectations the young Hoopa, California. man began to improve from the first dose. After the fourth teaspoonful had been given

Locations. he went to sleep and slept about two hours. He awoke feeling much better and called for Editor MEDICAL WORLD:- Judging from a glass of milk. I allowed him to have four the numerous letters I have received regarding ounces of sweet milk with lime water, which my observations in Louisiana, there has been was retained. I continued the alcohol at some misapprehension, which I wish to set longer intervals thru the entire day, and by 5 right. It has not imprest me that there is o'clock p.m. of the 24th, patient sat up and an opening for physicians as such in that state. was able to take as much nourishment as I Every town visited seemed fully supplied, with allowed him to have.

the possible exception of Bay St. Louis, a resort At four o'clock in the afternoon of the 24th on the gulf coast east of New Orleans. Here I was called away, about six miles from my there is a great concourse of residents of the office, and did not return until nearly nine southern cities, during the summer when the that evening. I was surprised and vext to gulf breezes are delightful. In winter there is find that the relativs of my patient had taken quite an influx of people fleeing from the him to his home out on the reservation, about northern cold, so that this pleasant place has a five miles from the school. The remɔval was busy season all the year round. As well as one accomplisht over the protest of the nurse, and could judge from a two weeks' visit, there is in their rush and anxiety to get him away room here for a physician who uses modern before my return, the medicin was forgotten methods—and in that I may say frankly I and the treatment ended at the time of their mean the alkaloids.

Wherever we went, as departure from the school. If I had returned was inevitable, people began to ask “ the old before dark I should have followed and forced doctor” about their ailments; and after a his relativs to return the young man where he little friendly dosing with these remedies there could have had proper care. At six o'clock would be a group of patients anxiously inquiring where they could find a physician who from twenty to forty dollars a month. The would use them, since the manufacturers did proletariat in the South is unwieldy. not sell to the laity. This was also the case at Now, I want to say a word to my brethren Baton Rouge, but at Bay St. Louis there seemed on the subject of changing locations. When I to be a dearth of physicians of any and all first graduated and surveyed the field for an sorts.

opening, it seemed to me that every point that There is a fine medical school in New Or- could support a physician had two already. leans which fills the state's quota with well- The only place where there appeared to be an qualified men of the highest professional stand- unfilled need was a mountain hamlet, where a ing. The physicians I visited seemed fairly man wrote me a doctor was badly needed ; that well-to-do, and from what I saw of their deal- he would be glad to introduce one, and would ings with patients, the southern doctor must board him reasonably; but he spoiled it all by have been free from the financial stress so try- adding that he had a large library of medical ing to the practician in the northern cities. books for sale! Relics of some poor fellow's But I did not see evidences of affluence any- failure to make a living, I thought, and dewhere. The office was always shabby, and the clined. doctor never notably well dressed. Nor was Every place is full, but when you consider his equipage modern or kept in the spick-and- that some are morally unfit for the trust that span neatness of a thriving practician in the must be given the doctor, that some dull their North.

faculties with drink, some are lazy and do ro: The financial problems require careful hand- keep up with the times, it seems as if a really ling, and in this a stranger would be very apt good man could creep in. to fail. Half the population is colored, and Put it the other way—your wife is ill; and what fees the doctor gets from them on which where will you find a real doctor? Prof. A. he can count with certainty are those paid is the big mogul—but he pays no attention to when the service is rendered. I imagin that any case that has not a $500 operation in it. credit to this part of the community shades B. has the consulting practise, but he blames into the charity list. With the whites, on the everything on the heart, while his rivals C. and other hand, the largest hearted benevolence D. see only. uteri and nerves respectivly in and courtesy rules. The physician who charges everything that comes within their ken. E is a lady teacher or clerk full fees and insists on not so bad, but he is never known to advise prompt payment is apt to get himself disliked.

any treatment except fifty-grain doses of quiUnhappy is the doctor who has no means and nin; while F. has his hypodermic syringe out no wealthy kin, but must live on the produce before you have told him who is ill. Fact is, of his daily labor.

when you need a real doctor, one who can Now I am giving simply my impressions, diagnose a case properly, and knows comegathered during a seven months' residence in thing of the action and uses of medicins, he the state. The Louisiana doctor may be is none too easy to find. amused by this, or edified, as to how he looks But such as we are, in we go all together in to a visitor ; or he may feel like correcting my this great struggle for existence, and the fittest crude impressions and explaining how I have to survive survives, and the unfit are crowded erred. I would like to hear from him per- out. May be that the fittest is not the best, sonally. But I am firmly of the opinion that but he possesses the Anglo-Saxon traits in the state does not need more doctors, but greater perfection; and what these are we learn mechanics and farmers; men to do the work, from the history of the race. Anyhow, in the to develop the great resources and till the rich struggle one man wins and the other has to fields now lying idle, and feed the hungry starve or look for a new location. But he will people with their products. Men who know probably find the same struggle anywhere, and how to farm can make almost any sort of if he allows himself to be crowded in one place arrangements with the owners of land ; lease, he will be crowded in the next; and so the buy, or work for wages, and with ordinary old conflict comes again. industry and forethought can be independent I fear there is a great deal of false teaching in a few years. Men who have a little capital extant, in copy and Sunday school books. and know how to manage it, can find more Pick out the leader in any city, “the great openings and less competition than in the surgeon," and ask his competitors who in that North. Men who know how to “do things' burg steals most patients, does most mean get big wages there, and seem to be in demand, tricks, drives closest to the edge of the code, as even in New Orleans we heard of the diffi- and it may not be the great man—but I fear culty in securing carpenters and other me- you will find it is. Why? Because he has in chanics, even for four to seven dollars a day. him the traits that make for success; and sucOn the other hand, young men in stores get cess must have a firm financial foundation,

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