CANADA MEDICAL RECORD APRIL, 1904. Original Communications. ODDS AND ENDS IN ORDINARY PRACTICE By A. D. STEVENS, M.D., Dunham, Quebec, PNEUMONIA. Several years ago I had a couple of cases of pneumonia. that interested me very much at the time. Both were young men about twenty years of age, of the farming class, and not more than a fortnight intervened between the two occasions. The first young man lived with his mother, and the two constituted the household. When I first saw him his face was profusely flushed, he was exceedingly delirious had a full, bounding pulse and other symptoms to correspond. I gave him a few grains of calomel in divided doses, to be followed by a saline cathartic, some syrup scillae co, and applied a mustard paste to his chest. The next day the condition appeared intensified, and I came to the conclusion that unless the young man was pretty thoroughly bled I would lose him. The trouble, however, in doing this laid with the mother, who, I was told, was unfriendly to both bleeding and calomel. Be this as it may, I took the advantage of her absence for a short time, and the helpless mental state of the patient as well, drew a half-pint of blood from his arm, waited for the effect and very soon discovered it. The improvement was so well marked that I felt no hesitation in taking about twice as much more from the same place, when the delirium and other grave symptoms suddenly disappeared. In fact, the young man was cured then and there. The other patient referred to had been, like the previous one, ill for several days, with practically the same chain of symptoms when I first saw him, and he was accordingly, similarly prescribed for. Keeping in mind what had passed a few days before in the instance just related, one would naturally infer that I would have bled him on the spot, but bleeding was out of fashion and required a bold man to do it. About twenty-four hours after I returned, took a general view of the situation, and, in a short time, to my surprise, saw that his mind had cleared up, and, taking him all around, that he was himself again- that is, cured. For the particulars I turned to the father and got them It seems that, during the night, his son had a fearful bleeding at the nose, and, from the appearance of the environment, I have no doubt he told the truth. He further said that he perceived the change or improvement the moment the bleeding ceased. It is true he was thus self-bled, but, like the former, was cured then and there. Whether one considers this a self-limited disease and the proper treatment purely hygienic and expectant or not, it is pretty evident that the vis viva, the vis naturae, was the forcing factor in the very satisfactory termination of this case. TEETHING CHILDREN. I have no idea that we are on the eve of a professional millennium, or that the time is near at hand when all medi cal men will see things through the same media any more than the rest of mankind does, or, if you like it better, we shall probably for some time to come quietly reserve the right to disagree, and it is just as well that it is so. In the meantime, if my views upon the treatment of teething children do not altogether harmonize with those of some of our friends, it is not likely that any serious disturbance will follow. No doubt there are those who regard teething as a simple matter, and, for that or other reasons, overlook or refuse the use of the gum lance upon every occasion. Thisto my mind, is not progression. When I meet a child whose nervous system is unbalanced, whose tongue is heavily coated, whose digestive organs are inactive, who is feverish restless, in pain and possibly in convulsions, I feel it my duty to search for swollen gums, and a greater or less number o teeth making an effort to escape their imprisonment. Now whatever objection there may be to making an incision down to the offending tooth, setting it free and allowing the gum to bleed a little, I confess I have never been able to decipher, if a little caution is observed. Often have I seen and relieved infants suffering as above by timely cutting through the gum with the proper lance and administering afterwards a grey powder or a grain or two of calomel in a dose of castor oil. I know some very good men appear to discredit this method of treatment, but, as I have no intention of assuming the rôle of critic, teacher or dictator, no matter who may have the best side of the argument, we will leave our little difference "to the dim and distant future' for, "when doctors disagree, who shall decide?" There is still another feature of this teething affair that is perhaps worth mentioning and it is this: I have noticed that in winter, if a delicate child is seriously distressed by teething, either the head or lungs would seem to feel the blow the most keenly? In summer it is the digestive tract, but whether in summer or in winter if the little one is equa to the emergency, without undue affliction, I do not pretend to interfere with the natural course of things. Like the majority of labours, the process is, I dare say, a natural one, but there are times when the natural forces are not sufficient for either the one or the other occasion. Teething in infancy is not always so trifling a process as people sometimes think it is. CONSUMPTION. Under the above heading you published several years. ago a communication I furnished you upon the management or conduct of consumption. I have reasons for believing that it was well received. To the remarks then offered my observations and experience since suggest but little advancement in the plan of treatment I then described, but, I believe every man who can throw any light upon the subject or thinks he can contribute an encouraging word or idea to the literature we have, should feel no delicacy in parting with it. Two cases, in many respects similar, that were under my care recently, it has occurred to me, are of sufficient worth to excuse a brief account of them. Both were mothers and also neighbours, about forty years of age, the wives of farmers and in the second stage, the symptoms of which are too well understood to be detailed here. Both, too, had been sleeping in narrow, unventilated rooms situated upon the second floor where there were several apartments and all well occupied by members of their respective families. Neither party had ever been blessed with a very robust appetite or cared much for animal food or its equivalent, though this was not owing to necessity or want of means. So far as the treatment is concerned, I may say that everything to build up and nothing to destroy was done. They were to live in the open air as much as circumstances would admit, to move their sleeping quarters down to larger rooms and purer air. Each to have a room all to herself, and, at night, to raise their windows a certain distance; to encourage the desire for food and strengthen their weak digestion; to take as much fresh animal food, or a good substitute, as they could manage and generally to observe hygienic laws. Fresh milk three time a day, beginning with a teacupful and increasing ths quantity by degrees until two or three quarts a day could be drank, while at night one or two glasses more might be taken, if the want were felt; cheese, fresh fish, poultry, eggs and an allowance of vegetable food and fruit at meal time were all mentioned as aids. The bowels and excretory organs, too-especially the liver-were to be kept active by such means as seemed best. From the constant forcing or cramming process of food taken their tongues would naturally take on a coating, and, when they did, relief would follow, taking one of the improved compound cathartic pills containing podophylin and leptandrin. For the cough and the night sweats nothing, or next to nothing, directly. I my opinion they are the smoke and not the fire; attend to your man as a whole; fortify him to the best of your ability and neither will annoy you very much. Both are effects, not causes. Hemorrhage was only slight and met by a few drops of spirits of turpentine. Tonics were given continuously. Among the best was the tinct ferri perchlor with a dash of quinine in it. Iron strychin and quinine, iron and phosphorus, iron and nux vomica, phosphoric acid and nux vomica, sulphate of iron and quinine, and the like were all prescribed, but no cod liver oie or creosote. To avoid fatiguing or tiring the stomach, a change about from one to another every week or so was made. After a time, in order to see where we stood, these were dis |