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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.
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.
my mite. 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 we 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 makiøg 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 slightest 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 tell 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 fluid 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
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 72 hour for 8 to 24 hours, and mean 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 pever 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 sto 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 104°-I use five drop think the man would have lived just as doses of a good fluid extract of digitalis in 1 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. 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 to 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 í 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 pneu. treated 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 also one of the most powerful respiratory
Pneumonia in Alaska and Michigan.-Cystitis. 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 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 course. 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.]
Editor MEDICAL WORLD:- In the case of a Dr. J. D. Blake, of Carlisle, Iowa, writes young lady who had double pneumonia, I that he always gives acetate of ammonia in found it necessary to envelop the whole chest pneumonia, from start to finish, and with the except the back with a fly blister. This gave best results. He makes his acetate fresh at the relief for about thirty-six hours, when the bed-side as follows: He scrapes carbonate of blister began to dry up, and the symptoms ammonia into white wine vinegar until the again became alarming. The blister was re-ap- acid is nearly neutralized-leaving it slightly plied, with relief for another thirty-six hours ; acid. He calls it his sheet anchor in pneumoanother recurrence of bad condition which nia; acting as a diuretic, liquefying the expecyielded to the Spanish-fly. This occurred again toration, and stimulating the heart. He also and again until the blister had been freshly uses antiseptics, as sulfo-carbolate of zinc, and spread and applied five times, and the disease other drugs as needed. yielded, and the patient is today, after twenty- He also writes that he has been breasting the three years, a fine healthy mother of four of the storms for forty years and never stopt a week nicest young people of our county. In this on account of sickness in all that time, weighs case the consulting physician informed me that 250 pounds, is sixty-five years old, still makes my patient couldn't get well.
night trips over the roads as formerly, but reA. K. VAN HORNE, M.D. alizes that he cannot continue in this way much Jerseyville, III.
Yes, Doctor, better slack up in time and you Calomel in Pneumonia.
will hold out all the longer. Editor MEDICAL WORLD:-One of your readers reported a case of pneumonia last Editor MEDICAL WORLD : -Inclosed find spring, and askt if the pneumonia or the twenty- check for $1.00 for 1904.
check for $1.00 for 1904. I like your journal grain dose of calomel killed the patient. While because it is practical and has no proprietary I am not “doctor" enuf to say whether or not
remedies nor any class of medicins to boost. either, neither, or both, killed the patient, yet Would like to know how the readers of THE I think an hour's rest, repeated every sixty WORLD treat fracture of lower jaw. In regard minutes for twenty-four or thirty-six hours,
to pneumonia, I wish to say that the accepted would have given the patient more time to mortality rate of 20 to 25 percent is greatly wind up his temporal affairs. Bartholow gives exaggerated. This mortality may obtain in utterance to a truth that all should heed, when hospital practise, but am sure that in the he says: * for he who is unmindful of country the rate of mortality is not more than the injury done by ill-directed or reckless medi
5 percent. I frequently have cases that termcation is as unsafe a guide as the most pronounced inate the third to fifth day, and I am no alkatherapeutic nihilist." (I quote the “old loidist, nor eclectic either. I believe that man from memory, and beg pardon, in ad
eclectics can medicinally treat a case of any vance, should I have mis-quoted him.) Very disease about as well as any school, but they minute doses of calomel, triturated with sugar,
are not scientific enuf, and are satisfied to and laid on the tongue, and repeated as indi
treat symptoms without knowing the modus , mand during the crisis of pneumonia. Besides operandi of their
drugs. Empirical therapeu
tics cannot keep pace with scientific or rational its other good effects, it acts indirectly as an
therapeutics. expectorant. But that “twenty-grain dose".
H. F. L. what shall we say of that? I am inclined to suspect that the unfortunate patient and the Blisters in Pneumonia.-Tr. lodin in Puerprescriber of that “dose" were rivals for the
peral Septicemia. hand of the same girl.
Editor MEDICAL WORLD:-I have been using There are three things that we should the fly blister in pneumonia for over twentycarry constantly with us : Our head, our con- five years; have used it in all stages of the disscience, and a never-tiring love for her who ease, congestiv, acute, inflammatory, hepatizawas silly enuf to say “yes ” when we put that tion, and in resolution when it has been slow weighty question to her. Most of us strive to
or unsatisfactory, and have found it a valuable get what we earn. Now, let us, during 1904, remedy. I do not use it in the very young or strive to earn what we get. Let us read; let the very old, for obvious reasons. There is us think!
A. C. GORE. nothing better than a good fly blister to relieve Hohenlinden, Miss.
the severe pleuritic pain seen in some cases.
I have seen two cases of pneumonia with subEditor MEDICAL WORLD :-There are so many little big things in THE MEDICAL WORLD that you don't find in books, that it
normal temperature; both in men past middle makes one love it exceedingly well. “Seems as things don't age, and both cases followed grip.
In one b'long to me till I pass 'em on to some one else.". Emmetts, Tenn.
J. A. Murphy, the temperature was 95° with pulse of 40; the