ONE DOLLAR PER ANNUM, IN ADVANCE.

SINGLE COPIES, TEN CENTS.

VOL. XX.

No. 5.

complete reversal in the mode of feeding. If, for instance, a patient has been living on milk and the farinaceous foods, then a change to broths, fish and flesh will give the most pleasing results.

Cases of chronic bronchial catarrh, rheumatic attacks, convulsions in children, dyspepsia, etc., have been greatly relieved or entirely prevented by a complete change of diet.

It is stated in one of our contemporaries that "a confirmed dyspeptic was afflicted with insomnia to a most distressing degree. One evening just before retiring, out of sheer desperation, she ate a banana. This was followed by a good night's rest, and, to our knowledge, the practice of eating a banana just before retiring has been followed for some weeks, with no other result than insuring a good night's rest."

Another case reported was "an obstinate diarrhea, which had withstood the efforts of the physician for some weeks. The patient declared that he would then treat himself. He assured the physician

that for three days he ate nothing but crackers and cheese, with the result that he was completely cured."

Of course these are extreme cases, but nevertheless they indicate the way by which favorable results may frequently be obtained where medication alone would not avail. By simply ordering a complete change in the diet almost unexpected favorable results may speedily follow.

This is beyond doubt a field for thoughtful attention and careful consideration, as much of success may at times depend simply upon the adoption of the proper diet for our patients.

ONE REMEDY AT A TIME.

We fully agree with the contributor to one of our contemporaries, who says that "physicians spend too much time in everlasting compounding. Every drug is of itself a compound, formed by a master hand for some useful purpose. Advanced therapy teaches that this single remedy has a special, well defined field of action, and is only hampered in its work by the addition of other compounds."

We believe the above to be a truthful fact, and one that should be in mind whenever we attempt the administration of combinations, although it is the tendency of the present generation of practitioners to avoid incompatible combinations, yet there are sufficient evidences to indicate that the old-fashioned "shot gun" prescription is still made use of to a certain extent.

OFFICE HOURS.

It is taken for granted that every physician has several or more hours each day which he calls his office hours, and having thus set apart a specified time for the purpose of doing business at home, as it were, it at once becomes apparent, as a

matter of business, that the time thus set apart must be carefully observed, otherwise he cannot expect his patients to be prompt in keeping their appointments.

During office hours the doctor should be in his office, and stay there from the moment they begin until the time of their expiration. Whatever else he may do, or in whatever other ways he may be careless, he should observe his office hours strictly, as one of the sure ways of making a success in the profession is to keep office hours promptly.

The business man who leaves his business, and the housekeeper her duties, to to call on the doctor during the hours he has agreed to see them, have a right to expect to find him there when they call.

The physician starting out in his profession with the determination to be at his post during business hours steadily every day, week, month and year, is the one who is pretty sure to be a success in his profession.

HOW DO YOU TREAT BILIOUS COLIC P

Here is a case reported to us sometime since:

At

"A man, aged 73, subject to deranged liver, was taken with colic at 3 p. m., and a dose of calomel was given by his wife, which usually relieved him. 7 o'clock the doctor was called, and he gave him a hypodermic of morphine and went home. This relieved the pain, and the patient went to sleep and awoke-39 hours from time of attack he died. Several hours prior to death he turned a dark yellow color all over the body. The calomel had not acted, probably on account of the morphine."

never

Could our readers have improved on this mode of treatment ?

When will our brethren learn that morphine and hepatic derangements are not compatible?

Original Communications.

Brief and practical articles, short and pithy reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The Editor is not responsible for the views of any contributors.

Write only on one side of the paper.

"THE TREATMENT OF HERNIA BY THE INJECTION METHOD."

BY THOMAS H. MANLEY, M. D. Professor Surgery, New York School of Clinical Med.

IT

T is interesting to note that in many of our modes of treating infirmities we move in cycles, and very often find ourselves, after long grooping, about where we started from. The writer is reminded of this by the recent excellent contribution on the above subject in the SUMMARY for June, 1898.

The injection method" is no doubt one of the most excellent expedients we have as a remedial agency in hernia, but, to realize its greatest advantages, discrimination must be employed when we utilize it and various accessories should not be overlooked. In a general way it may be said that hernia is capable of being cured by three methods:

First-The most painless and safest is by the employment of the truss alone.

Second. By subcutaneous injections of astringents in conjunction with constitutional and local measures.

Third-By the open incision and free dissection.

THE CONSTITUTIONAL ELEMENT.-Bearing in mind that the hernial infirmity is a veritable disease, with a strong tendency to relapse, we can understand that any measure restricted solely to the local lesion falls short of the therapeutic requirements.

THE COMPLEX ANATOMY.-In many types of hernia the truss or injection must be ruled out:

(a) In the male with ectopia of the testes.

(b) In the female with ovarian ectopia. (c) In all of the irreducible variety. (d) In that not uncommon class of cystic degeneration complicating the rupture.

(e) In the infantile or congenital types. In the above class a simple aseptic, radical operation alone offers the best prospects of permanent cure.

SUBCUTANEOUS

INJECTIONS.-This line

of attack, though appropriate in simple, uncomplicated ruptures, is an unsurgical procedure, because we are compelled to often inject our pungent fluids at random into the tissues without any definite guide. They provoke pain, sometimes extremely severe and require the simultaneous use of the truss.

Notwithstanding the drawbacks in experienced hands, with rest, depletion and constitutional remedies the injection is very often highly satisfactory.

Every case of hernia, as a rule, presents various special features and calling for a diverse line of therapy. It is important, under all circumstances, to keep constantly in mind the fundamental principle that in every instance those means should first be adopted which entail the least discomfort or dangers, and which obviate the necessity of mutilating the patient.

Lannelogue, a few years ago, highly extolled the sclerogenic action of injections of sulphate of zinc in reducible hernia, and showed that in selected cases it accomplished all that was realized by more formidable operations. In my own hands, however, relapses have quite generally followed its employment.

Of late years too much operating has been done for hernia, and there is danger now of the injection plan being carried too far. Each has its place, and the science of surgery comes in in discriminating the cases best suited for either procedure.

115 W. 49th St., New York City.

Cholera infantum (infant cholera) is not a child's disease in the sense of mere age and tenderness. The child is the subject, because the passive or helpless subject of environment and nutritive circumstances, of which the child bears the results. Let us make passing reference to the peculiar exigencies of hot weather as bearing on infantile existence. Overheated, sweated mothers, with uric acidulated breasts and nipples that thirsty infants must lave and suck with their mouths at each nursing, probably a dozen times or more every 24 hours. And in bottle babies" the spoiled milk and other prepared foods that an hour's staleness or a clap of thunder may have transformed to a state of unfitness; the ferments of fouled rubber nipples and uncleansible tubes; the non discrimination by mothers and nurses regarding nourishment that disagrees when heat depresses the tone and digestion; the adoption of this or that brand of ready-made "food," on the uncertain basis of puff testimony promoted by business advertisers, the adherance to a doctor's "favorite" product, that some selfflattering Prof. Blowhorn has subscribed to, "unsolicited," except for having his name pony.ed over the mail routes, monthly, as man-nurse to needy infants; The increased degeneration and rancidity of all stock food preparations in warm weather; the chemical reactions of all tinned, japanned, soldered containers that

tained; the development of sickening animalcula in stock foods to the ruin of nutritious elements; the decay of ingredients that by nature are of transitory stability; the satiation of excess of sweetening, the unsavory lack of salt, the uncanny souring of child's food spilled or ejected upon the infant's clothing surrounding neck and chest and prejudicing with qualms its breathing air; the old butter-and-cheese syrup represented by staling stock of condensed milk foods; the semi-fetid water drawn from the filthy, glutinous insides of range circulating boilers, for diluting milk or preparing other foods, to "save the trouble" of heating fresh water in a clean teakettle. And yet again, the venomous gnats and flies, that perhaps only a few minutes before glutted on the feculence of exposed excrement outdoors, or on the putrescence of some possible rotting carcass, and then drifted for drink into a soak swim of baby's milk supply, to die there in drowning bath, gorged with poison. Any of these, all of these common feeding conditions are active causes that induce the gastro-intestinal toxemia in infants known as cholera infantum and allied disorders.

The mother's milk, the wet nurse's milk is not always wholesome, but by being persisted with, impairs the child's system, stomach and bowels included. Many physicians, who unfortunately have had no preparatory experience as farmers, believe theoretically in strict adherence to milk. They usually talk sagely on "one cow's milk," or even vagrant goat's milk, asses' milk, for infant feeding. But if that cow is in poor health, or stable kept, or fed on offal from the kitchen, or drinks from stagnant pools, or roams the woods, where there is no exemption from occasional "gnab" at toxic plant and unwhol some foliage, such "one cow's milk" is little less than continued peril to the digestive integrity of the infant. And who has ever imagined that condensed milk," the original vitality of which has been annulled by heat, is the product of "one cow's milk," or that the milk was scrupulously purified from depraving matters?

of good dairy product, where the cows roam in the fresh air of the pasture fields, methodically cared for, furnished with good water, guarded against toxic weeds and vines by owners. This is the quality of milk I can depend on in the management and cure of cases of gastric toxemia or cholera infantum and marasmus. But I want that milk fresh as practicable, as near to the animal life in interval of time as we can obtain it, while it is yet a living fluid, before the process of decomposition has advanced to imperceptible fermentation.

I have said that infants are the passive subjects of what is fed into them. Their natural nutriment is milk during the critical months of their helplessness. It is of vital importance, if cholera infantum is to be guarded against or cured, that the milking of the cows be done in cleanly sanitary manner, free from filth contaminations of manure-soiled, possible scabby udders, dandruff and hairs from the cow's skin; that the milk be perfectly strained at the dairy, and re-strained by the housewife at home, using a double thickness of washed cheese cloth, before being fed to babes.

Woven wire strainers have fixed single meshes that never shrink, but allow filth particles and small cowhairs to be carried through with the milk. All media of corruption and irritation needs be early strained out, or gastric suffering naturally ensues and the relieving purposes of medical treatment are thwarted. While milk as it is pressed from the healthy cow's udder is perfectly wholesome, the amount of defilement that goes into the milk by heedless modes of keeping cows and of milking is often dreadful in view of infant feeding, as may be demonstrated by examining the toxic settlings of milk pitchers, and by re-straining through muslin and applying the magnifying glass to the nauseous catches.

Since the birth and raising of children are general experiences in civilized society, by the business acumen of enterprise the manufacture of "substitutes for mother's milk " is made a means to lead to fortune. Each maker claims the prestige of superior science, adopts some master's theory, formulates a combination of ingredients and capitalized process, sets

When one has devoted nearly two score of years to the work of rallying the dismantled energies of infants buffeting with the throes of gastric toxemia, as evinced by depression, vomiting and purging, he feels bound to regard the lessons of ripened experience, rather than bound to keep step to every new bugler whose tune strikes the fancy and mood of versatile enthusiasts. I have made a just trial of the prepared substitutes. Each of these conventionalized foods, when it happens to suit the personality-phase of certain cases, serves its intentions as adjuvant nourishment. For without nourishment we cannot lift the infant to a convalescent plane. And again, however, each of these foods is equally a failure with the other; again, a change of these foods at intervals, for awhile, help to tide the child to a point where good milk becomes its standard and best basis of diet.

All talk to the contrary, the quality of the popularized milk substitutes varies as does the phase of the moon. The ingredients are not of equal perfection and excellence with every batch made up. They degenerate with age as certainly as they contain vegetable and animal matter. Let no one be deceived on this point who values infant life. A box or bottle of degenerate "food" will injure an infant's stomach and bowels as certainly as will spoiled vegetables and stale eggs. Because of the inevitable degenerative tendency of age and of season in formulated nutriments for infants, kept as commercial stock foods, even one month, probably six months or more before it happens to be administered, the ipse dixit of the advertising promotors of such foods should never be made the law of their using in the summer diseases" of infants unless improvement of cases is prompt. Twenty-four hours is ample