Notes and Queries. To the Editors of the American Practitioner and News: DEAR SIRS: As the sole agents and licensees in the United States for the Diphtheria Antitoxin of Prof. Behring, we desire by means of this open letter to take exception to that part of your editorial article in a recent number of the American Practitioner and News which refers to what you consider the "manifest extortion on the part of the producers of the new remedy," and to your final statement "that the price of the music must go down if anybody but the rich are to dance to the measure." In view of the editorial alluded to, we can not but believe that you have been misinformed in regard to the actual price of the serum, and we therefore call your attention to our announcement in your advertising columns of the same issue, in which we offer to supply the physician with this product direct at the following prices, which include registered mail charges: No. 1, green label, 600 antitoxin units, $1.90; No. 2, white label, 1,000 antitoxin units, $3.50; No. 3, red label, 1,500 antitoxin units, $5.25. At these figures the cost of the treatment does not seem prohibitory to the average patient, especially when it is considered that one vial is usually sufficient for a case of ordinary severity. From the very first we have strenuously labored to to avoid disposing of the serum to parties who have been inclined to purchase it for speculative purposes, and for that reason, under date of January 25th, we mailed to every physician in the United States a circular letter in which we offered to sell the product to him direct at the prices above mentioned. Being thus informed, the physician has no one but himself to blame if the speculative dealer succeeds in inducing him to pay an exorbitant price. As your editorial is calculated to prejudice the medical profession against us as the firm which imports the Behring serum (which is therein specifically mentioned), we trust that you will give equal publicity to this letter in in the columns of your journal. Very truly yours, NEW YORK, March 9, 1895. SCHULZE-BERGE & KOECHL. We are more than pleased to make the amende honorable. The statements in the editorial referred to were based on the figures quoted by the local druggists in January last, which placed an antitoxin treatment, providing all three grades of the drugs were used, at about thirty-two dollars for each case. We are glad to note the very reasonable terms at which Messrs. SchulzeBerge & Koechl have put antitoxin on the market, and we are very glad to call special attention to these low prices by publishing the above letter. We rejoice that a treatment so valuable is now within reach of poor people; and, promising to read our advertising pages more carefully in future, advise all our readers to lay in a good supply of Behring's antitoxin without delay. To the Editors of the American Practitioner and News: In this paper I wish briefly to review a case of compound fracture of the patella. The patient at the same time had a dislocation of the shoulder. On October 21, 1894, Joseph S., aged thirty-five, while driving a wild horse to a road cart, the horse became frightened, kicked violently, and ran away; while kicking the horse struck him on the right knee, laying the patella bare for one and one half inches and fracturing it horizontally at the junction of the middle with the lower third; in attempting to get out he fell on and dislocated his left shoulder; it was a subglenoid dislocation. When the accident happened he was one mile from town, and alone; after dragging himself out of the ditch in which he fell, he tried to walk home, and said he did walk a considerable distance; later he was found and brought in by parties passing. I was called and found him as above described. I wish to say but little about the dislocated shoulder, as they are of such frequent occurrence. I reduced it without giving an anesthetic, and after applying my bandage it gave him but little more trouble. He had a very rough, ragged compound fracture of the patella. I washed it out thoroughly with carbolized water, one in forty, cut away all the ragged and bruised tissue, pressed the fragments of bone together, and held them in position with strips of adhesive plaster one inch wide, placing two above the patella and one below it; the strips were long enough to pass entirely around the leg in an oblique direction and fasten well on the back side. I generally use plaster-paris in all fractures of the lower limb, but in this case I used one long splint reaching the entire length of the leg, with a hole in it for the heel to fit in; the external opening was closed by the pressure from the adhesive strips above and below it, but the plaster did not cover the opening. I dusted some boracic acid over the wound, covered this with a thick layer of Johnson & Johnson cotton (there was no gauze available), and applied a roller the entire length of the leg. I left my patient in a semi-recumbent position, with his foot resting on a folded quilt. On the 22d I found him, temperature 100.5°, pulse 100, and though he had been taking sulph. morpha., in one-fourthgrain doses every two or three hours, he was suffering considerable pain. I put him on quinna sulph., grs. 3, every four hours, tr. ferri chlo., gtts. 10, three times a day; it took five days for his temperature to drop to normal. After the fifth day the external opening seemed entirely closed up. I could not keep him quiet; in spite of his restlessness his leg got along splendidly for fifteen days; on the sixteenth day he took a violent chill, followed by a high fever, temperature 104.5°, pulse 130. For four days I gave calomel, quinna, and antikamnia with but little results. The knee was swollen considerably all the time, but from the time of chill it swelled fast; in two days from time of chill it began to feel boggy around the patella; at the end of four days the bogginess had increased wonderfully. I thought now it must contain pus, and I determined to aspirate it; this I did, and drew off about four ounces of fluid that looked like senovial fluid mixed with blood. After this temperature fell to normal, and he had no further trouble; union was ligamentous; fragments when on a stretch stand one fourth inch apart. My patient has a movable and useful knee, walks without the use of a cane, and is able to do most any kind of work. I take this trouble that came up at the sixteenth day after injury to be caused by the restlessness of my patient. I think in moving about in the bed he must have given his leg a sudden jerk or jar, causing a fresh hemorrhage; the external opening being closed the blood extravasated into the senovial membrane and surrounding cellular tissue, hence the chill, fever, bogginess, and pain, which all disappeared after the aspiration. W. J. SALING, Chairman County Board of Health, Smithland, Ky. To the Editors of the American Practitioner and News: A CASE OF DIPHTHERIA TREATED WITH ANTITOXIN.-The case was as follows: Miss A., aged thirteen years and six months. Was called to see her on February 18th; found her with temperature 102°, pulse 120; membrane on tonsils, uvula, posterior nares, and fauces. I began treatment by using hydrogen dioxide, applied with spray, tinct. ferri chlo., 10 drops every four hours, milk and whisky freely. This treatment was continued three days, at the end of which time the patient was much worse than when treatment began. Stridulous, croupy cough of laryngeal invasion had set in; breathing very difficult; occlusion of the nasal passages was complete. I found that one of two things, either intubation or the use of antitoxin, should be resorted to at once. I chose the latter. On the evening of the fourth day, with the above symptoms present, I made the first injection of antitoxin, using half the contents of No. 3. At the end of twelve hours from time of injection temperature had fallen to normal, pulse from 120 to 105, respiration easy, membrane on tonsils and uvula beginning to loosen. At this time, twelve hours from first injection, I made another injection. Twelve hours later, twenty-four hours from first injection, temperature was normal, pulse 95, membranes nearly all gone, breathing easy, patient sleeping well, and taking nourishment without the least trouble. Forty hours from first injection membranes entirely gone from throat and nose, temperature normal, pulse normal, respiration normal. The case has gone on without any return of membrane or fever, and is now, the seventh day after the first injection, able to sit up a portion of each day, and takes nourishment well and sleeps well. My experience with antitoxin has been limited only to this case, but I feel that its action in this case was marvelous. LOUISVILLE, KY. J. M. MORRIS, M. D. 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 any thing else.-RUSKIN. Original Articles. THE DOCTORATE ADDRESS OF THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF LOUISVILLE, SESSION OF 1894–95. BY H. A. COTTELL, M. D. Professor of Medical Chemistry and Microscopy and Clinical Diseases of the Nervous System in the University. I love the young. They are the "heirs of all the ages." They are the delight of the present and the hope of the future. Civilization and society are to-day what they are because of the advent of the young. How wonderful, how beautiful, is the complete life! It comes in like the morning, fresh and fair, in garments rosy and golden. It waxes to noontide in robes agleam with the full, white light of day, and it gently wanes to its setting in vesture of mellow, dissolving tints. As the world goes, young men are naturally divided into three classes they who float, they who retrograde, and they who advance. Like drift upon the river, some move upon the surface of affairs. What their fathers were, if it be easy, they are content to be. They float their little distance adown the stream of time, obedient to every current, the sport of every eddying whirl, and should their lives develop any thing of note it is incidental or accidental. Like meteors pulled from their course by Earth's superior attraction, others become the slaves of appetite and animalism, and, as meteors take fire when they traverse the earth's atmosphere, so these scintillate as they disintegrate in the downward plunge to death. Like earnest travelers, others set out upon the doubtful journey of life. They wish for something better than they have known, and they push into the unknown with courage, with strength, and with patience. They know full well the difficulties and dangers of the way; the stony paths, the barren wastes, the steep ascents, the hidden pitfalls, the yawning chasms, the raging torrents, and the thundering avalanches which must be traversed, overcome, avoided, or escaped. But yonder is the mountain of their hope, fair in the purple distance, and here and there along the way are the footmarks or the blazemarks which show that others have made the journey, and on the mountain is the temple of success, perhaps of fame. So the travelers toil on, and in toiling become telling factors in the affairs of men. Gentlemen of the graduating class, with these last I rank you, and bid you full welcome to the profession of medicine. You have joined an army more noble than any which followed Hannibal, Alexander, Cæsar, Napoleon, or Wellington; than any which ever wasted or defended a country, for your office is to save life, not to destroy it; to keep the "temple and the tower" in peace, not to cast them to the ground. And now, looking down the vista of your long future, let each one of you try to see himself moving there as he would like to be seen. If you go there masked, or as the player of a part, the sham may work, but not for long; for "life is real, life is earnest," and as your object is, so will your movements be. One sees himself pursuing wealth, another sees himself following fame, but each must see a man not afraid of work nor discouraged by reverses. How many doctors are rich? Few, indeed; and these few as a rule have secured the treasure at the hymeneal altar. As for fame, it is far more difficult to gain than wealth; for Fame is a maiden more coy and more indifferent to the addresses and protestations of her lovers than any heiress who ever wasted her goodly treasures upon a fortune-hunting doctor. The physician who aspires to eminence among his contemporaries may attain it if he be healthful and strong enough to win it by incessant labor through long and doubtful and discouraging years. But eminence in his own day gives him no hold upon real or posthumous fame. Says Carlyle: "It is good to understand that no popularity and open-mouthed wonder of all the world, continued even for a long series of years, can make a man great. . . . Popularity is as a blaze of illumination, or alas! of conflagration, kindled round a man, showing what is in him, not putting the smallest item more into him, often abstracting much from him, conflagrating the poor man himself into ashes and caput |