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instruct the nurse to notice the cord occasionally for several hours, and tie it again if it bleeds.

Would say to Dr. Waugh (page 405), no indications of bullet yet. Child seems to be all right. A slight discharge from the wound. Kendrick, Miss. C. KENDRICK, M. D.

[Dr. Alice B. Stockham, in her book entitled, "Tokology." says, "Sever the cord when pulsation has entirely ceased in it. Use a dull pair of scissors, cutting about two inches from the child's navel. Following these directions, no tying is essential. This method has its advantages. By tying, a small amount of blood is retained in vessels peculiar to fetal life. This blood by pressure or irritation may prevent perfect closure of the foramen ovale, and be a cause of hemorrhage. Besides. it must be absorbed in the system, causing jaundice and apthæ, so common in young babes." --ED.]

Typhoid Fever.-General Consideration.-Its
Abortibility.-Its Dosimetric Treatment.
-A Simple Rational Treatment of
La Grippe.

EDITOR MEDICAL WORLD:-Ever since these very pertinent questions on typhoid fever were asked by Dr. J. C Campbell, Albany, Vermont, I have hoped to get time to express my views upon this very important subject; but since his report of the replies he received, I have felt so under conviction for not having answered him, that I have kept still until now. To think that out of the twenty two thousand readers of THE MEDICAL WORLD, embracing progressive men in every State and Territory of the Union, besides many in sister countries, treating six to eight hundred thousand cases of typhoid fever yearly, barely thirty of us noticed the Doctor's questions enough to answer his very courteous appeal, is surprising.

Typhoid fever, briefly, is a disease of lowered vitality, following a period of general constitutional depression, by which the body is forced to yield to the infection. Once infected, the poison begins to multiply, its excreta floods the circulation and, being a powerful poison, excites the system to the well known phenomena of fever, and we have a typhoid or toxic condition in which the body is constantly reinfecting itself. This change takes place principally, at first, in the alimentary canal, and the circulation fights hard to keep from taking up the poison and infecting the whole system.

The glands, clogged with debris, exhausted with overwork, irritated by the poisons against which they are heroically fighting, weaken, change their color, become swollen and are on the verge of disintegration.

Now look out or 66 you can't abort typhoid fever," but up to this time, if the patient is not too much run down, if you are seconded by proper nursing and if you use a rational treatment, you can often do so, croakers and expectants to the contrary notwithstanding. Some months ago I had the pleasure of receiving a patient from the hands of one of these, with the satisfaction of treating his own diagnosis and putting the patient on his feet in perfect convalescence in one week, or about ten days of sickness in all.

Now, I put three "if's" in the way and they have got to stay there and will determine our success in each and every case. Regard. ing the first, we must always remember that we are treating our patient and not the disease and can only accomplish what we can help the poor sick body to do.

Nature says to the physician, "So far and no further, my ways and secrets are my own." The second is scarcely less important, and it makes my blood boil to find my ablest efforts go to naught many times by foolishness in this direction. Only last week a case was coming to its close in eight days of fever, with good appetite and digestion, clean tongue, temperature ninety-nine and pulse normal, when an officious nurse, thinking to do a smart thing, got my patient up in a chair, moved her into the next room, changed the bed, let her sit up till she was tired and put her back in a chill. The glands again congested, fever rose, was again aborted and now, after eight more days, under the care of another nurse, the temperature is again ninety-nine in the morning. This is no fancy sketch but practical every day facts, illustrated in the work of progressive men all over the country.

Help

Now this is what I do constantly (and I treat typhoid fever all the year around, more or less) and many another meets with the same result in the same or a different way, but it must be along one main line. Take a lesson from nature and don't check the initial diarrhea, or you will not succeed. If there is no initial diarrhea I will start one with granules of calomel. Can't you hear nature say, me wash out this nasty poisonous mess and make my workshop clean and sweet as quick as you can?" Now, how will you do it? I will give my patient large drinks of water, in which I have dissolved a little seidlitz salt (granular effervescent sulphate of magnesium), proportionate to the necessity, to help nature flush the thirty-six feet of reeking, struggling gland ular surface, and at the same time stop the action of the poison with appropriate doses of sulpho-carbolate of zinc (thanks to my esteemed friend, Dr. Waugh). This done, I will try to keep clean by the same means, and calm the

nervous, irritated body the best I can--aconitine 1-134 gr. to dilate the capillaries and equalize the circulation, thus relieving the local congestion, with veratrine 1134 gr. to help, and thus, the vis a fronte being removed, the tired heart stops its struggles and drops back toward its natural pace. To accomplish this I will use one granule of each together every half hour for a while, till the proper effect has been produced and then q. s. pro re mata to keep it up. If the heart falters, add to the above one granule of digitaline 1.67 gr. and give the three together a few times. When you have done this you have done well. Now sustain nature with a granule of arseniate of strychnine 1 134 gr. every two or three hours, and she will look up and smile, for the victory is half won.

Now, the temperature is variable, so in the forenoon I will omit the aconitine and veratrine, and perhaps also the digitaline, and give one granule of arseniate of quinine 167 gr. every one or two hours, according to conditions, only returning to the aconitine and veratrine when the temperature begins to rise again, at which time I will stop the arseniate of quinine until the following morning. The arseniate of quinine, being both defervescent as well as antiseptic, is often all I use after the first day or two.

Treated in this way, even if you are too late to prevent ulceration, your patient, properly nursed and nourished, will skip the long period of convalescence and get out of bed with a clearness of eye, a certainty of step, and an expression of countenance unknown in the old, bound up, expectant (to live or to die) plan. The above is the dominant treatment according to the dosimetric method. Simplicity itself evolved from a rational view of the disease and a clear conception of the work to be done. A variant treatment will often be required according to what inter-current symptoms arise, and the dominant will need to be modified for each individual case.

A successful physician or surgeon must be a large dealer in good, practical common sense. Some days ago, a personal friend, Dr. T. W. Gronendyke, of New Castle, Indiana, in a private letter, reported his first two cases of typhoid fever, treated atter the dosimetric method, as follows: "I have treated two cases by the dosimetric plan. Both patients did remarkably well. Each started out as typical typhoid, high temperature, 103 to 105 F., the gurgling sound on pressure over colon, tympanitis, diarrhea, etc.; but in each of these cases, I had the disease under control in four or five days, fever fell to 99 and 100 F., and did not go above that afterwards, and in eight

and ten days each of them was convalescing nicely. Don't know that I will succeed so well again. The patients were a boy and a girl in different families, each aged twelve years. Don't know that I treated them as you would have done, but I got good results. [That is what we are after, each may have a different way along the main line and each get there just the same.-A.] For the first four days I gave granules of calomel gr. 1-6 every four hours during the day until four were taken each day. Seidlitz salt, teaspoonful each morning. Two granules aconitine 1-500 gr. every hour for three hours, after that every two hours. After four days I give one granule of digitaline 1-67 gr. with aconitine. After five or six days, when temperature came below 100, gave arseniate of quinine granules. Was I on about the right course ?"

You see the Doctor's plan was clean cut, rational and successful. Can any one do better?

Before I close this letter, which may already be too long, I want to say a word or two about "La Grippe," with which our esteemed friend, Dr. Coleman, dealt at some length last month. If such an amount of work is called out by "La Grippe" in his country, I am glad I do not live in Texas, for I could not have carried one-tenth part of the cases I did in Chicago the last two years. Out of several hundred cases I lost only one, and that a plethoric, rheumatic woman at the climacteric period with cerebritis.

Recognizing the sthenic cerebro-spinal irritation, I gave aconitine 1-134 and arseniate of strychnine 1-134, one of each together every twenty to thirty minutes till fever and irritation was controlled, helping with morphine if pain was too severe or acetanilid if fever was dangerously high. Equilibrium being established, quinine arseniate 1-67 gr. every hour or two, and perhaps arseniate of strychnine 1 134 gr. three or four times a day, was all my patients needed. The rapid equalization of

the circulation and hence the abortion of the fever, cut off the possibility of explosion upon vital organs, which was its chief danger. Noting that cases where diarrhea was present got on the more easily, I took my cue from that, and gave, at the outset, a good flush with the seidlitz salt. I trust that Dr. Coleman will pardon the above, as I wish simply to show that La Grippe may be controlled with much less labor and medication in some places than in Texas.

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The true dosimetric treatment of disease is the easiest method on earth. It is simply helping nature when in trouble.

DR. W. C. ABBOTT, M. D. Ravenswood, Chicago, Ill.

Was the Treatment Polypharmacy. EDITOR MEDICAL WORLD:-The true physician will, without regard to name or pathy, use anything in earth, air or water that he knows will benefit his patient. Dosimetry is not simply a pharmaceutical reform, nor does the method consist alone of the exclusive use of the alkaloidal granules, nor does it forbid the use of massage, cups, rubifacients, blisters, or any other external applications that are known to be beneficial. Hence I fail to see the justice of your criticism and the charge of polypharmacy in the sense in which that word is generally used. If by it you mean the great number of medicaments used to treat a single case. then dosimetry teaches polypharmacy; but we call it polypharmacy to administer a single dose of opium, nux vomica, or any other crude drug from which three to a dozen alkaloids may be extracted. I followed Dr. Burggraeve's first law of treatment. "To acute maladies we must oppose sharp and active treatment," and I administered each medicine till the desired effect was produced. I did not describe each hour's treatment for I was not writing for first course students, and the first prescription was given only one hour, four doses, altogether 12 milligrams, or about onefifth grain. In the other prescriptions the intervals were lengthened as the desired effect appeared, and during the fifteen or twenty hours of active treatment required to jugulate the disease, neither patient took of the combined nineteen medicines named, more than ten centigrammes, or 123 grs. altogether, less in amount than a single dose of any one of the petroleum products so vaunted in the treatment of this and kindred diseases. These were typical cases and violent attacks of the disease, yet the patients with this small amount of medicine were able to leave the bed on the third day without suffering from any of the sequelae of the disease, while I know of a number of cases whose attacks were not so violent but who suffered for months afterwards because

the disease was not controlled and the pathological lesions prevented.

I notice one error in my last. I said or intended to say: I enclosed each dose of these granules in a capsule-that is, when three or four were to be given at a dose, for convenience and to prevent mistakes by the nurse. W. L. COLEMAN, M. D.

Houston, Texas.

Were All Those Drugs Necessary? EDITOR MEDICAL WORLD:-Dr. Coleman's letter, "Dosimetric treatment of disease-La Grippe," is a sore disappointment to me. I was almost inclined to believe that the system

was easier, more pleasant, less complicated and more certain than the other established methods of combatting disease, but for the life of me I cannot see the good Doctor's reasoning in the selecting of the medicines used in cases described, nor any extraordinary speedy relief of distressing symptoms or more speedy cure than by the simpler though older methods. That the one escaped pneumonia and the other meningitis is simply guess work, and the socalled jugulation of diseases which are not present is asserting too much. There can be no doubt of the value of the isolated active principles of drugs, but are we any more certain of getting granules always true to quantity and quality of drug contained than we have been before granules were introduced? I have great confidence that the leading manu facturing pharmacists use every effort to secure exactness in the preparation of the goods they issue, but cannot see why a granule maker will be more exact than others, all depending on supposed trustworthy employees. There is no fixed dose of anything used in medicine which does not admit of variations, and there are no specifics absolutely infallible in the treatment of disease; the trouble is we have too many medicines and do not learn them thoroughly. Some practitioners have better success in using the medicines contained in a well filled vial case than many others who prescribe through the vast list of medicines as kept in the elaborate pharmacies, simply because they carry with them those medicines which they have well learned how to use. Of course additions to one's materia medica must be constantly made, and some pruning done to keep up with the times, but dosimetry will not prove useful to me until it is shown that we can adopt it in treatment with less worry to the patient and physician than is related by Dr. Coleman in the article under consideration. The treatment described in those two cases could not be carried out in general practice, as the case of these two, would occupy one's whole time, for if all these things were necessary to be done no attendant

could be trusted to manage the case to the Doctor's orders in his absence.

Lansingburg, N. Y.

THOMAS H. SALMON.

Dosimetric Medication, and LaGrippe. EDITOR MEDICAL WORLD:-In the November number of THE MEDICAL WORLD, I see about three articles on the subject of dosimetric medication, and, with your permission I will drop a few suggestions touching that system of the treatment of disease. I see nothing really new, or any improvement upon the old therapeutics, except the "small dose" and use of the alkaloids.

That alkaloids are superior to concentrated tinctures prepared of uniform strength from the recent or green herb, I think is a mistake. And when I drop v-x gtt. of specific tinct. of aconite into water oz. iv-give a teaspoonful every half to one hour, and obtain the quiet, certain influence of the drug in a few hours, surely this is just as good as if I had given aconitine. When I use the tinctures of digitalis, veratrum, cactus, lobelia, bryonia, rhus. tox., belledon., nux vomica, in similar small doses, and obtain a direct and certain effect curative, and as much "jugulative" as the alkaloids, what has the alkaloid gained over its more simple preparations? I speak whereof I know. I have used both the alkaloids and the specific tinctures, and prefer the tinctures, on account of their cheapness, compared with the alkaloids; the former costing only from $2 to $4 per pound, while same amount of the alkaloids would cost many times that much. They are perfectly miscible with water, and owing to their great concentration, a two oz. vial is enough to carry of most any of them, and unless the doctor has a very large practice, he then will not find it necessary to refill oftener than every two days. I like the dosimetric physician because he gives small doses of medicine and often repeated; thereby getting the quiet influence of the drug. But the use of sugarcoated granules is unnecessary, very expensive, and is too monopolistic to ever become general. My chief objection to dosimetric principles of curing disease is, that it gives no rules, or pathological indications where we may know when to give a remedy. It seems to have no particular indications for aconite, veratrum, digitalis, etc., but gives them, one after another, or together in a routine way, and, according to the old nosological indications-prescribing for names—an empirical basis.

Dr. Burggraeve did a good thing in his advocacy of the proximate principles of drugs, and small doses of the same; but further than this, I believe he is not entitled to credit. What we want to know in the treatment of disease, is, what remedy is indicated? This fact can be, and has only been learned by experience; and that experience can only be obtained by giving a drug in different size doses, noting the effects, and the particular pathological conditions present. In this way we have learned how and when to use aconite, veratrum, digitalis, nux vomica and its alkaloids, and many other drugs, with such a degree of certainty, that practitioners need seldom fail to obtain the desired result. And, "armed with these methods of precission," to wit: a saturated tincture or a pure alkaloid, a correct understanding of the indications, and surely he then can practice medicine rationally, and with satisfaction to himself.

I was called to see a little child a few days ago, that had been treated two weeks by a brother of good standing. The case had been called continued fever. I found its pulse 130, small and wiry; temperature 103; dark flushed ace; pupils dilated and immobile; patient unconscious; muttering and picking at the bed clothes. Here were indications for two remedies, and here they are: Specif. tinc. aconite, gtt x, specif. tinc. belladonna, gtt x, water, oz. iv. M. Sig.--Teaspoonful every hour.

Now I felt just as confident that from the administration of these two little remedies, there would be improvement from them, as if I had already seen it. After four doses of the prescription, the child became conscious, the fever cooled down, and next day, when I returned, there was such improvement that it seemed to be well. This is no fish story, but an actual fact. So when I am sure my diagnosis is correct, I always feel certain that my remedies will not fail me, if there is sufficient vitality in the patient's system to respond. I do not mean by diagnosis the mere naming of disease, but a full comprehension of all the indications, and these I learn from the pulse, tongue, the eye, the skin, the tissues, the excretions and secretions. I care not for the classified name. If I wanted to practice by receipts, or in a routine way, then the name would be of great importance. Dr. Burggraeve has never attempted to formulate, or systemize conditions of disease or therapeutics; but simply stops at the innovation, "small doses—often repeated," and the advocacy of the proximate principle of drugs.

Dr. Coleman says "La Grippe is a disease of lowered vitality." Correct I believe it, and will add that I am sure that there is a perversion of innervation-a wrong in the cerebrospinal system, which is paramount in the initial stage. Further, that the cause is one that induces irritation of these nerve centres, and is manifested by the extreme aching pains, the sore and bruised feeling, the accelerated circulation, irregular action of the heart, the hacking cough, the sneezing, the pleuritis, gastric and abdominal disturbances, and others too numerous to mention here. These will suffice to show that the disease is at first one of irritation, which, by excessive nervous action, is soon followed by an atonic condition of both the spinal and vegetative nervous system. And often we find that through the excessive action of the vaso-motor nerves, a determination of blood to the bronchi, lungs, pleura, kidneys, stomach and bowels, has been produced, and if not removed, will pass into congestion, and from this to inflammation. The force, volume and rapidity of the pulse will be different, in different

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cases. So will the tongue, the skin, the eyes and general expression present different appearances, owing, in great part, to the particular organs affected, and state of the blood. indications for treatment in the first stage will be to allay irritation of the nervous system; and I prescribe aconite or veratrum, or sometimes both combined, owing to the state of the hearts' action as influenced by the cardiac ganglia. For the cry of pain in the muscles, I combine with my sedative, either the tinc. of cimicifuga, or the muriate or bromide of ammonia, and sometimes the tinc. of arnica, according to my ability to define the meaning of the special indications of the case. I seldom

use more than one of the latter remedies with the sedatives before mentioned; for, if rightly selected and persevered in, it will bring the desired result in a short time. To aid these

remedies, for the soreness of the inuscles, a good rubbing with the tinc. of arnica will do a great deal of good. I speak of this remedy because I have used it with special benefit in my own case. I remember I had an intolerable aching and soreness of the muscles between my shoulders-a bruised feeling, which made me miserable. Knowing that the tincture of arnica would relieve the pain and soreness of a strain, and as that feeling in my back felt more like that than anything I could compare it to, I had my back and extremities bathed with it, and relief was instantaneous, and permanent. I had hitherto tried mustard, turpentine, and chloroform liniment without relief. Since then when there was no inflammatory condition, I have combined it with my sedatives in small doses, say -1⁄2 drop at a dose, with just as decided effects as when it was applied externally. To restore the strength, after sedation of the irritation, I give quinine, nux vomica, arsenic,

etc.

If I strike a case that has become chronic, I treat the condition as I would any thing else, presenting the same local lesion -taking due note of the condition of the blood (which is generally in a septic condition from either too much acid, alkalies, or retention of waste matter, or excessive elimination). These conditions I determine by the appearance of the tongue, the pulse, the secretions, excretions and tissues in general. These organs always carry an index, which, if properly understood, will point out the remedy-as acids, alkalies, sulphur, lime, soda, potash, arsenic, nux, silica, quinine, phosphates, iron, etc. So it will be seen that my method of practice is to understand the meaning of the symptoms manifested by pathological conditions, and to introduce a remedy that will oppose the morbid condition, remove it, and

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EDITOR MEDICAL WORLD:-October 7th, 1891, at 9 o'clock in the morning, I was hastily notified that Mrs. A. E., a farmer's wife, livi-g three miles away, was "having fits." Knowing that she was pregnant and at full time, I was soon at her bedside. She is 23 years old, and this is the third pregnancy. While seated at the breakfast table pouring the coffee, she fell to the floor and had a violent convulsion. They recurred at short intervals, six having occurred before my arrival. The pulse was full and bounding, the breathing rapid, general condition plethoric. tion plethoric. She had been totally unconscious from the time she fell. I at once bled her thirty-two ounces. I also injected pilocarpine, one-quarter grain, hypodermically. In two hours she had another convulsion. I again bled, withdrawing sixteen ounces. was very dark and coagulated rapidly into almost a solid mass. I injected one-sixth gr.

of sulphate of morphine.

As the pilocarpine had no effect on the skin the convulsions recurred with undimin ished severity about every two hours. At 5 p. m., I used chloroform, and the convulsion did not recur for three hours. I could hear the beating of the fetal heart. The os uteri was then dilated to about the size of a silver dollar. I sent a messenger to Dr. John Lander, of Aftonda, requesting his assistance. The doctor arrived at 9 p. m. The os was now fully dilated. We catheterized her and gave Norwood's tincture of veratrum viride, 5 drops, ergotine, 20 drops, hypodermically, and decided to apply the long forceps at the superior strait, provided we did not get prompt results from this plan of treatment. The pulse grew softer, the skin moist, and in one-half hour we repeated the injection. She had vomited occasionally all day, dark colored material which we supposed came from the tongue that had been bitten during a convulsion as she had swallowed nothing else. In one-half hour more the heart was beating 60 per minute and pulse quite soft, and evidence of uterine contractions occurred. She would remain perfectly quiet a short time, then would leap from the bed in a frenzy and, staring wildly about, make frantic efforts to escape. It required the active work of 3 and 4 persons to restrain her during one of these paroxysms. At the apparent close of one of them she would struggle towards the bed and attempt to throw herself violently down. This scene would be repeated about every ten minutes. By external

and internal examinations we discovered that these outbursts represented the period of active

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