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Croup-Diphtheria.

I have just read the March number of the BRIEF, and am so well pleased with the contents that I am constrained to

take up the pen in order to associate myself with good company and express my thanks for the good already received from its learned contributors.

While I may be numbered among the gray-beards, I am yet a student, and do often learn some valuable lessons from those much younger than myself, and I occasionally offer my mite in return.

Seeing in the last number of the BRIEF numerous references to the much-dreaded diseases, croup and diphtheria, I am led to offer a few hints in a brief way.

It does not appear reasonable that onehalf of the human family dying before the age of five years can be a part of the original design and plan of a wise and beneficent Creator. And, if not, physicians are certainly under great and solemn obligations to the human race to be untiring in their efforts to lessen this great mortality among the little ones.

After many years of careful study and close observation at the bedside, I am a confirmed dualist in regard to diphtheria and croup. And with all due respect for the opinions and conclusions of the unicists, I can not see how any close observer can pronounce croup and diphtheria one and the same disease.

The differentiation would not be a matter of so much importance, if the same treatment were applicable to each. But the successful treatment is widely different.

We can not here enter upon the differential diagnosis, neither the pathology. But will just state, having diagnosed a case of true croup, or membranous croup, you have before you a most active inflammation, with a plastic exudate that has a tendency to produce death by suffocation, or poisoning the blood by cutting off the supply of oxygen.

The treatment, of course, must be antiphlogistic. Bleed your patient the first thing; let it also inhale the fumes of turpentine, or at least keep the surrounding air moist and warm. Then bring your patient as speedily as possible under the influence of mercury. Give calomel heroically, and you will generally save your

patient. If suffocation already threatens, apply an ice-bag to the throat, and you may resort to tracheotomy; but this will very seldom be necessary, or do any good.

Again: Given a case of diphtheria. Here you have a virulent blood poison, a destructive micro-organism whose tendency is to rapidly lower the vital powers. If you use your lancet and calomel here, you will kill your patient. On the other hand, bring into requisition your most powerful antiseptics, with tonics and stimulants, and push them vigorously. Lose no time. You may use carbolic acid, permang. potass., sulphur, tinct. iron, chlor. potass., Listerine, turpentine, sulphide calcium, etc. All are useful, and with one or more of them give quinine and whisky; and if you find the heart failing, with paralytic symptoms showing, drop the quinine and take nux vomica and carb, ammon.

Most of my diphtheria patients who die at all, die from paralysis of the heart, and nearly all are followed with some paralytic trouble as sequelæ. But these generally yield to treatment, and fully C. N. UDELL, M. D.

recover.

Blakesburg, Ia.

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THE MEDICAL BRIEF. tisement page 41, since through it we

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The MEDICAL BRIEF will not be sent ANY LONGER THAN PAID FOR

Write articles intended for publication and matter for editor on separate pieces of paper.

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Use as few technical terms as possible; the best educated writers use the simplest and plainest language.

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Address MEDICAL BRIEF, St. Louis.

Explains Itself.

The following letter from one of our advertisers, who, we understand, has good facilities for meeting demands, of trade, shows something of the great power of the MEDICAL BRIEF with the profession, to lead to sales of articles desired by its subscribers:

CENTRALIA, ILL., March 11, 1889. Medical Brief, St. Louis:

DEAR SIRS-Please omit "ad." of Marshall's Pat. Convertible Buggy Case,

are so overrun and behind in filling orders. We shall increase our force at once, catch up, and return the "ad." to June number. Yours Truly,

W. SCOTT MARSHALL, M. D. Patentee Marshall's Convertible Saddle Bags. Centralia, Ills.

Dr. Lindsey's Patient Needs Specific Medication.

Your case reported in the March BRIEF, Dr.Lindsey,is suffering from chronic irritation of the reproductive organs in general, and possibly of the urinary organs also. Treat it according to specific medication, and you will relieve your patient.

That nervousness, jerking and twitching of the muscles, wakefulness and dizziness, sterility, etc., indicates pulsatilla.

Pain in the hypogastrium and small of the back, or general muscular soreness, calls for macrotys. Give her:

R. Specific Tinct. Pulsatillæ..
Specific Tinct. Macrotys...
Aquæ q. s. ad...

M.

/ drachm. X drachm.

.4 ounces.

Sig. Teaspoonful four times a day.

If there is any tenderness of the abdomen, add one-half drachm specific tinct. dioscorea; or, if there is burning sensation in the urethra or anywhere in the hypogastric region, alternate the above prescription with:

R. Specific Tinct. Rhus Tox.
Specific Tinct. Apis....
Aquæ...

.5 drops.

5 drops.

.4 ounces.

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Inject the above amount into the bowel every morning, beginning at 6 or 7 A. M., and postpone a few minutes each succeeding morning till trouble is relieved and use again if indicated. For adults, use double or thrice the amount used for infants, in like manner.

I. N. Love, M. D., of St. Louis, Mo., a gentleman whom I admire, for medical ability, etc., wrote a short article, about one year ago, in this journal, in regard to the use of it for children suffering from chronic constipation, causing irritative fevers, etc.

Only a few weeks ago, I treated a patient, a boy, aged nine, double pneumonia, both lungs being afflicted; was very bad. On ninth day of illness, had slight collapse, soon rallied. Knowing that this disease can not be successfully treated without keeping bowels frequently opened, I from the beginning of the first day, prescribed a cathartic, and second day oil, and we thought that we had accomplished all in that respect necessary, mild cathartics had been given occasionally even after this, and the child's bowels would move slightly every day, but on the tenth day I was summoned in great haste, found the child comatose and almost moribund, pulse at wrist not discernible, respirations stertorous and abdomen tympanitic "tight as a drum." The father had used injections of water, soap, molasses, milk and whisky had been used frequently, three times since early morning till 2 P. M., when I arrived. But they would pass away and gave no relief. Something more must be tried, so I ordered a clyster of

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I am safe in saying that it was not two minutes until the bowels moved, and quite a quantity, and among the defecated matter were whole butter beans, eaten the day before he took sick.

Last year the boy had pneumonia, pulmonary collapse on seventh day, rallied after a hypodermic of one grain of cocaine. After a few hours he suffered intensely with enteralgia, which was relieved by small dose of morphia. By repeated injections throughout the day, he evacuated fried eggs and grapes undigested, after which, he began to show signs of convalescence.

The above is the best clyster ever used by me. Have used it a great many times. Let the profession try it, and be convinced and benefited by it. With charity for the profession at large, I am yours faithful "to the work."

Groveland, Ind. N. S. WOOD, M. D.

Salivary Calculus.

I will report a case of salivary calculus, showing careless diagnosis. A negro (barber by trade) came to me with what he thought to be caries of the left superior maxillary, having been told so by some M. D. or D. D. S., of Memphis.

On examination, he threw up his hands and screamed out, telling me not to touch his cheek for it was so sore he could not stand it, and that he could not chew on that side, had not for some years, and that it was very painful to eat anything at all. He would scream out at the slightest touch or pressure on the left cheek.

I found on examination, however, that the case had been improperly diagnosed, for I found he was only troubled with a calculus deposit from Steno's duct. I slipped an instrument into his mouth and removed calculus, weighing twenty-five grains, one corner of which was imbedded in his cheek the eighth of an inch or more. I gave the gums and cheek a dressing of Listerine, full strength, dismissed the negro, and the granulations healed nicely.

The brethren should be more careful with their examinations.

Success to the BRIEF.

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Worms in the Urine.

I send you, by to-day's mail, a specimen of worms passed with the urine of one of my patients. He has passed quite a quantity of them.

He complains of a heavy aching in the bladder and lower part of abdomen, often throbbing, and pain in the kidneys. Says just before. he passes them it feels as though they were biting or pinching him in the neck of the bladder and prostate gland, and, in fact, all along the urethra. The urine is usually clear and normal in quantity.

Please tell me what they are, and what to give him to destroy them. He has a child, seven or eight years old, that also passes them, but not in such quantities. T. D. HAWKINS, M. D.

King's Ferry, Fla.

We presented the specimens sent us to Dr. Chambers, for inspection, and below will be found his statement, accompanied by an illustration:

EDITOR MEDICAL BRIEF:-The specimen of worms which you sent me for examination are of much interest, considering the portion of the body from which they are derived, viz.: the urinary canal. They are of the oxyuris vermicularis variety, commonly known as the pinworm, mawworm or thread worm.

The cut here given is the best that could be procured, since they shortly became opaque after being removed from the alcohol in which they were sent by Dr. Hawkins. I had no trouble in determining the species to which they belonged, since they were semi-transparent before the alcohol evaporated from them and made them easy to ex

amine.

The manner in which these worms reach the urinary organs must be through some fistulous opening, and it is my private opinion that at some time this man has had a renal abscess which opened into the colon or rectum, and has left a fistula. I believe the opening communicates with the colon, since the majority of these full-grown worms are females, and the females usually go into the colon to deposit their eggs.

This species of worm is exceedingly fertile. It has been estimated that a single ripe female contains from 8,000 to 12,000 eggs.

The manner in which this condition was acquired by the parent was likely acquired by the child, yet it is possible that the child inherited the parental defect. It is, however, a very singular coincidence that both should be so affected.

The only treatment I would advise is to completely remove the worms, if possible, and I would direct my treatment to the alimentary canal. Turpentine is very destructive to this class of worms, and turpentine acts more powerfully on the kidneys than bowels. I would give it first a fair and thorough trial, and would mix it with castor oil in order to hold as much of it in the alimentary canal as possible. I would use the following:

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Buffalo Lithia Water in the Treatment of Bright's Disease of the Kidneys, Chronic Catarrh of the Bladder and Uric Acid Calculi.*

BY DR. R. D. BASKERVILLE, SWEPSON, VA. Member of Medical Society of Virginia.

I have prescribed Buffalo Lithia Water, Spring No. 2, with decided beneficial results in both forms of chronic Bright's disease of the kidneys. In a case of acute parenchymatous nephritis, occurring in a lad fourteen years old-the first stage of Bright's disease of some writers-the large smooth kidney of English authors -the urine gave a faint acid reaction, specific gravity 1006, and contained about three per cent of albumen, œdema of the feet and legs extending to the knees, face puffed almost beyond recognition and considerable effusion in the great cavities. Buffalo Lithia Water, Spring No. 2, was ordered at once, and in twelve days the dropsy was entirely relieved, the specific gravity had risen to 1012 and the albumen had disappeared to a mere trace; the water was continued for a few weeks and the patient was entirely well and has remained so to this time, a period of more than ten months. In a case of chronic catarrh of the bladder, in a lady fifty years old, due to the presence of uric acid calculi, which was passed almost daily, aggregating over one hundred stones, varying in size from a grain of wheat to that of a small pea, after the failure of other treatment, Buffalo Lithia Water, Spring No. 2, was directed, which gave her immediate relief, and its persistent use for a few months effected a cure, and now at the end of four years she declares herself well.

Reprinted from the Maryland Medical Journal, of February 23, 1889.

Hydrocele.

I would say to Dr. J. A. Matthews that iodine will cure some cases, and some it won't. For the past fifteen years, I have used almost exclusively fluid extract of ergot with far better results than with iodine. It is not, by a long ways, so painful, and the results are generally satisfactory. C. H. MERRICK, M. D.

Seattle, Wash. Ter.

Ovaritis Complicated with Endometritis.

Will one or more members of the BRIEF family kindly give therapeutic assistance in this case? It is a case of ovaritis complicated with endometritis.

The case is that of a woman thirty-one years of age, married twelve years, has two children-one aged ten, the other three. She is a woman of dark complexion and spare habit, and much of the time is melancholy. She has had this difficulty since the birth of first child, and it has been worse since the birth of the last. The left ovary is the one affected. It is slightly enlarged at all times; sometimes the enlargement is considerable, and it is always very sensitive, soreness and pain being very prominent.

She has almost constant leucorrheal discharge, generally yellowish and excoriating. Menses irregular, generally early, scanty, intermittent, and very painful.

She suffers much from shifting pains; at one time in the head, then in the back, then in left ovarian region, then in lower extremities. She has pain in one of these regions constantly. Much of the time she has slight nausea. She is fairly well nourished, and the excretory organs act normally. There is marked vaginal hyperæsthesis, as also of other pelvic organs.

She is a constant sufferer from the pains above referred to, to the extent of being almost constantly confined to the house.

Thanks to any one who may favor me with helpful remedial suggestions. Aurora, Ill. T. M. TRIPLETT, M. D.

Scleroderma.

This disease is both rare and interesting, and one seldom seen, excepting in large hospitals.

A case of the same came under my observation during the month of January, 1889, and, as its treatment may interest some of the readers of the BRIEF, I have concluded to send my method.

The patient was a woman, aged thirty years, of full habit and good constitution. On or about September, she noticed that the knee joint became stiff, and on the leg appeared patches of discolored and

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