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ISOLATION OF CONSUMPTIVES.

A recent report of the Board of Health of one of our largest cities gives 6,000 deaths as the mortality from consumption during the year of 1896-97, which doubtless discloses only part of the truth, because there is the accompanying statement that a conservative estimate would place the number of cases about 20,000, saying nothing about the thousands in the stage of incipiency.

What is said of this city is measurably true of most others, for the fact is there is hardly a neighborhood in the length and

breadth of the land that does not feel the blighting touch of the malady.

The annual harvest of victimes are numbered in the tens of thousands.

The power of this malady for evil is an incommensurable and ever increasing quantity-in support of which compare its tremendous energy with that of other diseases.

No marvel that professional and popular interests have of late awakened in behalf of rational reform for relief and protection, both for the sufferer and for him who may be exposed to its baneful influence. The wonder is that in the near past more effective measures for isolation and scientific treatment were taken; that a broader philanthropy was lacking to make it a problem of the highest interest.

Thoughtful physicians do not now undervalue the importance of that enterprise that would provide suitable homes or sanitariums, where means of isolation and correct treatment could be had. Such institutions have been projected in

various parts of the country, and it is gratifying to know, with a fair share of success. In some instances city hospitals have established branches for consumptives, but have no home or sanitarium especially adapted to the purpose.

If we believe the malady is contagious we must become "more zealous of good works," making our means and efforts harmonize with our philanthropic sense of duty. Plainly, stricter measures should be taken against the spread of the disease ladened germs in places of public resort, in public conveyances and in the homes. No ones rightful convenience and liberty in public will in any way be abridged.

In the home the physician's counsel will be a potent factor in carrying out the reform to establish increased cleanliness, for the removal and destruction of excreta and for the inauguration of better general sanitation.

Such a course is in harmony with the best professional thought of the day, which has gradually crystallized itself in the truth that possession of physical health is a duty to be exercised through intelligent private and public sanitation.

THE CARBUNCLE.

Carbuncle, or anthrax, is a disease of malnutrition, development of which is determined by embolic or thrombic obstruction of the capillaries. Physicians who have a few years' experience have seen one or more cases, and all have had their minds sufficiently impressed with the importance and gravity of the malady before seeing it.

Is it any wonder then that beginners approach its treatment with a degree of apprehension. It is indeed a disease of no little gravity, for usually the soil in which it propagates is a broken down or vitiated condition of the system, such as is commonly met in scrofula, diabetes and

Bright's disease, but with the effective resources at hand that modern research and modern therapeutics supply even the beginner may attack it confident of success. As a rule the general practitioner will prefer non-surgical measures, and if he will exercise ordinary diligence and skill these will amply suffice in the largest number of cases, and the results will be entirely satisfactory to patient. In a general way he will correct certain pathological conditions by systemic measures, as tonics, the promotion of secretions and improved hygiene.

A variety of agents and combinations, from time to time, have been recommended, each of which having succeeded in a small percentage of cases, but none ever becoming generally applicable.

Among the requisites of a topical treatment may be mentioned, promptness and vigor in the application, use of an effective local anesthetic or sedative to relieve the ofttimes intense irritability and pain, to confine the ravages of the disease to original circumscribed limits, and to destroy and remove, as fast as practicable, all necrosed or dead structures, and thereby prevent, as far as possible, extended filtration. To a great extent this plan can be carried out in every case.

The reader, therefore, will pardon us for suggesting editorially such a plan as seems to fulfill all these indications, which has succeeded admirably in a case recently under observation. agents employed were ichthyol, CamphoPhenique and stick of lunar caustic.

The

Ichthyol, full strength or diluted with vaseline, is applied all over hardened base and for some distance beyond and clear up to, but not on, the crater-like sumit. Let application be made once or twice a day. At each sitting touch cone After thoroughly with lunar caustic. each application of caustic, and as often as may be deemed necessary to allay pain, apply Campho-Phenique freely, both by powdering on and by soft rags wet with the same.

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.

I

Write only on one side of the paper.

APPENDICITIS.-OTHER NOTES.

BY H. D. RINEHART, M. D.

AM pleased to notice that such men as Dr. Elmer Lee and Dr. Pepper take the stand that they do in stating that not more than one case in 25 of appendicitis is operative interference justifiable. I believe it is time to call a halt in the surgery of this ailment, though there are cases where nothing but an abdominal section will save the patient. The symptoms

by which one can separate these patients into medical and surgical classes are what I am wanting.

On Oct. 26, 1897, I was called to see a boy of about 14 years who was suffering intense pain in left groin, having had same pain for two days, during which time the mother had been using home remedies, thinking she could certainly control the pain, but these had failed. I found a well defined appendicitis and at once informed the parents, also explained to them the history of such cases in general. I then prescribed opium, just sufficient to make the pain bearable, also small doses of calomel and salines to freely evacuate bowels. As soon as the pain slightly lessened and as temperature was rising I withdrew all opium and prescribed Pil. Analgesine (Wyeth) in its stead, keeeping up the calomel and salines, with enemas, to produce two or more evacuations daily. Locally I applied an ice bag, for this gave relief when hot applications did not. This treatment was persisted in for eight days. I had an abdominal surgeon, however, ready to call at any hour if I found that nothing less would save life, and though the parents rather insisted that I better have the surgical operation, I still persistently applied the medical treatment, and, after a week, was happy to find the mass in the groin, though yet very tender, lessening in size, and after

I have had similar cases previous to

this, and I always fear I shall be compelled to resort to surgical interference, but I have yet to have my first case, in 12 years' practice, to not recover by medical treatment.

I have a case at present, which-though I believe it is not appendicitis, yet the trouble is in the right hypogastric regionis a conundrum to me, and perhaps some of the SUMMARY readers can help me in finding the cause of this condition. The case is as follows: Mrs. R., 30 years old, married and has two children, youngest is seven years old. On New Year's Day I was called and found her having severe abdominal pains; vomiting, slight elevation of temperature, accelerated pulse, brown furred tongue, some diarrhea. I prescribed for relief of symptoms; diagnosis: probably malaria, possibly typhoid. After treating her for about one week the fever subsided and all symptoms abated, except heavy coated tongue. I dismissed patient, but still prescribed tonic to be continued. On the 9th inst. the husband again called at my office, telling me his wife had severe abdominal pains, constipation, and at each pain a hard mass or tumor would rise distinctly in right lower abdomen. I called to see her at once, and found just what husband described. The pains were similar to hard after-pains and about as regular-every five or ten minutes; the tumor was easily outlined and stood out prominently during the pains; it was about the size of an orange and located just below the umbilicus and to right of the median line of the abdomen. Diagnosis-intestinal obstructionwas easily arrived at, but the cause of the obstruction was and still remains the question. I at first believed it to be fecal impackment, and I believe this was there, for I could feel distinctly a hard mass between pains which I can no longer find. I prescribed a little opiate to control some of the pain, and salines to move bowels. On the following day, as the bowels had not moved nor the conditions changed, and as vomiting all along had been a prominent symptom, I withdrew the opiate and prescribed calomel, gr.

1-10, every 10 minutes, while awake, and salines, as much as stomach would tolerate, with large rectal injections through at rectal tube, introduced by myself about 12 to 15 inches from the anus. This treatment and condition remained about three days, when my patient twice had stercoraceous vomiting. At this time I called Dr. A. B. Frame, of Piqua, O., in consultation, but before he arrived the patient passed, after a large enema, some fecal matter which relieved her, especially the mental anxiety.

Dr. Frame believed the cause of the obstruction to be a spasm of the ileum, and as we succeeded in getting some fecal matter to move and pass we gave a good prognosis. Soon after this the bowels moved frequently and freely without enemas, but the abdominal pain and the abdominal tumor still presented themselves and do so till this day, though the patient is now up most of the time, and has kept, by medical treatment, watery evacuations daily. The only change that I can find in tumor now is that when there is no pain there is no tumor, but with a peristaltic pain, which comes frequently during the day, the tumor, of same size and as hard as an inflated bladder, presents itself. One can feel something give away and hear a gurgling, splashing sound, after which both pain and tumor vanishes. Of course vomiting has ceased now since bowels move regularly, and patient is on the road to recovery, but sooner or later perhaps another complete obstruction will take place which may lead to death, or at least an abdominal section to make the diagnosis and try to remove the cause. Patient says that some four years ago she first noticed at times such a tumor arising with severe peristaltic action or pain, but as it soon passed off she gave it little concern. Patient has a retroverted uterus, but it is freely movable and when replaced is inclined to remain in place when not on her feet too much. My theory of the cause of the obstruction is a stricture of the decending colon, so the lumen is comparatively small, and therefore very active peristaltic contraction on the part of the cæcum to drive the contents through the constriction above causes this inflated

cæcal tumor. Am I right or wrong?

I was very much interested in Dr. W. H. DeWitt's expression on the use of guaiacol by inunction in typhoid fever cases. I have used it similarly in several cases and was well pleased with its effect. In one case of acute tuberculosis I applied several times daily, mv, on epigastric region to prevent vomiting with decided benefit. I never made any special preparation of the skin before applying the guaiacol, which is probably a mistake I made and the cause of not getting the best results. I'll know better after this about the use of guaiacol locally.

I believe the treatment of diphtheria by antitoxin serum is a good treatment in the present age, but what it will be in ten years hence I cannot say. I use it, and so far all my cases have recovered, either from the antitoxin or other treatment. We have had no epidemic of diphtheria here in the last ten years, though all around us they have had, but, however, we have a few cases each year. I have lost but one case and that about ten years ago. It was of the laryngeal form, the little patient dying about 36 hours after I first saw it. Several years ago I learned of the chlorine treatment in diphtheria through a paper read before the Ohio State Medical Society in 1896, by J. E. Fackler, who died recently at his home in Versailles, O. He reported that in 25 years use of the chlorine treatment he, and all others who used it, had not lost a case of diphtheria. With this favorable history of chlorine in diphtheria, and the knowledge that chlorine gas was one of the best germicides, I began its use, and I now depend on the chlorine treatment in all cases of diphtheria whether I use antitoxin or not. I also use it in many other throat troubles, such as tonsillitis, pharyngitis, laryngitis, etc., and am always well pleased with the results. For any one not knowing the detail of preparation and use, I will give it in Dr. Fackler's language:

Take a four ounce bottle, clean, rinced and well drained, put in 3j of potass. chlorate in coarse powder and add âxx of chemical pure hydrochloric acid; stopper the bottle and apply gentle heat to bottle until it is well filled with gas; do