M. ft. Chart. No. 12. Sig.: One every three hours in alternation.

September 5th. Doing nicely in every respect. In the evening parents took buggy ride with the babe, during which it slept soundly for two hours. On return, it took its bottle, and then slept Soundly till two A. M. On waking, it took nourishment again; but a few minutes later the mother noticed slight twitching of the face, then, in less than ten minutes later, it had the most terrific spasms, accompanied with crying and screams.

I may here mention, that this child's head for three days at this time, was rubbed twice in twenty-four hours with a four per cent iodoform vaseline ointment, and covered with an oiled silk cap, which was then removed.

I never witnessed a severer attack of clonic convulsions than in this case. Thus all hope was given up. To satisfy the parents, following was prescribed:

R

M.

Also:

R

M.

Sig.: Twenty drops every hour in alternation.

The convulsions lasted for eight continuous hours, becoming weaker by degrees, and finally the babe passed

into a

tranquil slumber, lasting nearly two hours, from, which it awoke apparently refreshed, took the white of an egg, went to sleep, and awoke at four P. M., taking nourishment.

On my arrival I was very much surprised to see such a wonderful change. Status presens: The child's head, face, and body very red and hot, pupils fully dilated, and responding to the light; the abdomen was hard and bloated; the bowels moved once since the spasms ceased, were yellow and semi-consistent; urine was passed freely, also. A pleasant incident was witnessed by all present, that, when spoken to by its

M. Divide in Chart. No. 12. Sig.: One every two hours.

September 5th. Child improving in every respect; had only two stools since last visit, passed water freely, and took lactated milk in alternation with egg albumen.

September 6th. Improvement continuous, and parents are rejoiced with the hope of its final recovery.

September 7th and 8th. Improvement continued.

September 9th. The child slept well, passed water freely, had no fever, took nourishment when offered, appeared bright, with the exception of that peculiar frowning look. Since last visit it had four stools, rather thin and greenish. Prescribed, two-grain doses of calcium phosphate, one per cent trituration every two hours, in alternation with five-drop doses of tincture bryoniæ albumen, one per cent solution.

September 10th. The mother brought the child in the surrey to my office, saying it was doing well. Ordered

treatment continued.

September 11th. Child slept soundly till after midnight. On waking, it took the nourishment, and soon thereafter became restless and fretful, and about

four A. M. the spasms came on again, but not very severe. On my arrival I ordered same remedies as on the previous occasion, but to no effect. The spasms lasted in a mild degree till eleven A. M., when it expired peacefully.

N. B.-I have treated many cases of this disease during my thirty years practice, they all died except two, and to-day I question my diagnosis of tubercular meningitis in those two cases. Improvement in cases of this character, as a rule, is only of short duration, but in my last case it was so apparent and continuous that I was very hopeful of final success. Concerning the remedies used, viz.: Belladonna, zinc phosphate, phosphide and cyanide, tincture cicuta, bryonia, pulsatilla, calcium iodata, and mild mercury in minute doses often repeated, are easy of administration, and, as a rule, retained by the reflexly irritated stomach. Referring to the convulsions, the chloral hydrate, atropia hyoscine hydrobromine and the bromides in combination had better effect than anything I ever used before. Concerning the salutary therapeutic effect of iodoform by inunction, being the first time I ever used it, I think it had a great deal to do with the visible and prolonged improvement in this case, and I am only sorry that I did not re-apply it after the convulsions ceased the first time, and thus tested its powerful resolvent action. If I ever meet again with another case of tubercular meningitis, shall give it a fair trial.

[Written for the MEDICAL BRIEF.] Writing for Medical Journals.

BY W. P. HOWLE, M. D., Oran, Mo.

The older writers write just in the same way that they practice or think, and that is in a routine way. They sing their song so regularly, and so long, that it becomes musical to them, but to the reader it becomes monotonous. The reader can tell pretty well what is coming before he reads the article. There is rarely anything new advanced by these old-timers. They imagine that they have gained an enviable position, and that they are doing a grand thing

in trying to bring the less wise up to their standard.

They do a great deal of good to the man who reads only once in a while, but, to the regular reader, their efforts are comparatively of no use. These old-timers could do a great deal more, if they could be persuaded to become readers for a short time. If they would take the place of learners for a season, and leave off being teachers for the same time, they might offer something new and refreshing in the place of their monotonous rehashings.

The occasional writer is so afraid that there will be some grammatical errors in his composition, that he loses sight of what he is trying to tell, and, therefore, destroys what might otherwise be useful.

There is another class of writers who imagine that all they discover is new, and they are continually putting their discoveries before the reading public. The critical editor soon checkmates this class by showing them up, or refusing to publish their vaporings.

There is another class of writers that are in demand to-day. They are busy practitioners, and every-day readers of medicines. These men know what to write, and when to stop. They gain practical knowledge at the bedside, and have the capacity to put this knowledge in readable shape, and thus become benefactors. The reader looks for their names and reads their articles, first. He expects to be benefited, and is rarely disappointed.

The man who imagines he has learned all that is worth knowing, and hence does not study, takes great pleasure in firing into these practical men. If he can not pick a flaw in their teachings, he will misconstrue or try to pervert what they say.

If this should meet the eye of these know-alls, and cause a few of them to reflect, I will have done about all I expected when I began this; but I hope it will cause the man who knows something good to tell it, and never mind about the style of telling. Tell what you know in your own way-and all will be well.

[Doctor, take your own medicine. Let us have something practical, told in your own way.-ED.]

[Written for the MEDICAL BRIEF.] Crowding the Profession.

BY R. C. ELDRIDGE, M. D.,
Clinton, Ia,

What becomes of all the pins? used to be a pertinent inquiry. What becomes of all the new doctors? is as proper. In the State of Iowa are five medical schools, and they have turned out, this spring, a full thousand graduates. Omaha on the border, and Chicago not far off, have let out fifteen hundred or more. The State of Missouri is not far behind Iowa. And the other States of the West?

If we had a war with Spain we could send an army of newly-fledged physicians large enough to take Cuba, and defend our coast beside.

But, seriously, what is to become of them, and how are they to live? Some one says, only a medium per cent of them go into practice. This is a mistake. They will all make the effort; no appreciable per cent of them do not try. Quite a percentage of them do not succeed in establishing themselves, and drift into other business, but in this

latitude their numbers are few. They crowd into the cities and villages, and at every cross-road in the So far, few of them have

country.

starved. They are taking up specialties, and but few, to the honor of the profession, go into open quackery. Judging from the journals that are issued, many take up editing. Many of

them,

or most of them, write articles for these journals, but that is for glory, not for profit. As they get a little older they start new medical schools. There must come an end to this, for there is no field now that affords a living by medical practice. Some, by extraordinary activity and sensational practice, for a time make big fees; and there are wealthy patrons for a few; but, for the rank and file, the land is becoming so overcrowded that it will not sustain them.

The united profession is struggling hard to keep down contract practice and co-operative societies, dispensaries and hospitals. It can not be done much longer. The army is getting so large that all the walls must soon yield.

When the profession was few and far between, irregular practice cropped out in many places, and under many forms; and it was well for the profession to take every means to suppress it, and protect the people from fraud, that they are ever more than willing to patronize: yet, the code of ethics and the associations had more the character of trust-unions than of honest to benefit the people. Learning and acquirements should be at a premium, and in a democratic country there was little left but to combine on fee bills and standard of admissions; yet they were like trusts.

effort

The efforts of the profession to keep up the syndicates have been in the way of raising standards of education, and have lengthened the terms of lectures and the requirements for admission, and are calling for State Boards of Examiners. All this is commendable, for the lives and health of the people should not be trusted in uncultured hands. It has not served the end for which it was intended, and it is doubtful if it has very greatly increased the efficacy of the practitioners turned out. It has, rather. increased the number of graduates.

In the old days a better class of young men studied medicine. They served an apprenticeship with some one in active practice, they did the rough work of the profession, which was more practical and to the point than much hospital work. They read solid books, and then took, for a few weeks, lectures on the essentials of medicine. Much was

crowded into a small compass, but it was solid knowledge.

Then they went out to their work and made work of it, if they expected to succeed. They practiced and learned their profession, as all must do now. They read books and journals for a purpose, if they had time, and studied the subjects in the field, if they did nothing more. Many of them, after a few years of practice, went to the cities to post themselves on what they found they needed. Dr. Byford, an eminent man, said to me: "I began practice on the borders of three States, and had a circuit of forty miles. I did all branches of the pro

fession, and some remarkable surgery and gynecology, because I was forced to it; had only attended one course of lectures, and had assisted the old doctor for a year or two. I learned the profession there, and have only practiced it in the city. My boys, I hope, may excel me, but, with all their advantages, they have not the zeal or zest that I had in the wild country practice." They have not, still.

To-day it is the men who blossom in the country, that supply the eminent men of the profession in the city.

The requirement of four years' study and four courses of lectures, covering most of the time, is devised more to discourage so many from entering the profession, than to make better practitioners. In both cases the ends are defeated. The same elementary lectures are given, and, to pad out the time, a great number of accessory branches are taught-useful enough, but mostly forgotten when out of school, or, if of value or interest, were learned and practiced by the older men when they got away from school. The four years of time spent in lectures and clinics has nothing in it equivalent to the two or three years of field practice or apprenticeship, which must be gone through with afterwards, before success is assured.

Quackery and irregular practice is of so long a life, because much of medicine must be acquired in the field, and many of the old men acquired skill and knowledge by observation, that stood them in as good stead as their better educated fellows, who were schooled.

We are making advances in science, and medicine moves on sometimes by leaps, but they have not been frequent.

The discovery of anesthesia and of antisepsis makes surgery easy, but common medicine has not advanced us much.

The old practitioners kept themselves up with all the improvements, and the short-course men of old could show as much results from the new knowledge as can the longer-course men of the present, who have dawdled for four or six years over their studies.

We would not, in any way, depreciate longer courses of lectures and more

studies, or stricter examination for degrees, but wish to lift our voice in warning to the multitudes that are entering the profession, that there is not a living in it for so many, neither a life of ease and elegance, and that lengthened courses of lectures and State examiners will neither decrease the numbers entering the profession, nor make superior practitioners. An old professor said that there facilities for the study of anatomy at schools, which was essential, all the rest a smart man could learn at home, and ought to.

[Written for the MEDICAL BRIEF.]

were

A Case which Breaks the Record on Burns and Scalds.

BY M. R. BAILEY, M. D., Elliott, Ill.

I write this, thinking it will be of interest to the profession.

I was called to the home of Mr. R. K., October 1st, 1897, to attend Lloyd, three years eight months old boy of the above-named gentleman, who, while playing with matches, set fire to his clothing, and, while in flames, ran towards the house crying fire, and leaned against a coal house, setting fire to the boards, when an older sister reached him, tearing the burning clothing from off the child, burning her own hands to the wrists in blisters.

When I reached the patient the neighbors had gathered in. One applied .sorghum molasses, another flour, and the third finished the paste by adding starch. My attention was first directed to restoring the child from shock. He was suffering terribly. I gave him small repeated doses of brandy, and, at the same time, proceeded to remove molasses, flour and starch paste, which was rapidly becoming dried, from the burnt surface. Eyes, ears, and nose being filled, my green soap and warm water came very handy on this occasion. I lathered him from head to feet, and removed all burnt clothing and dirt until I came down to a clean burnt surface, and applied Listerine, wrung out with cloths, as an antiseptic, and also

to draw out fire and relieve pain. It acted like a charm.

I will now proceed to give the parts involved, which is very interesting, owing to the patient living twenty-six days from date of accident. Beginning at a line across the face below orbital arch, involving both ears downward; skin superficial and deep fascia involved, and in places superficial muscles and fat fried. Anterior part of neck very deep under chin, and left inferior maxillary, side, both shoulders, the left arm extending down to fore-arm, the right arm entirely, and exposing axillary artery; right shoulder, and from a line drawn from left axillary space to left hip, across the thoracic and abdominal space to spinal column on right side, to the back, also right leg two inches below the knee. Over this area the skin, superficial, and deep fascia were burnt into one hard shell, and the fat underneath fried, so that each muscle could be as clearly defined as on the plates of a manikin. Capillaries and nerves all destroyed.

In

a few hours the child seemed to

show signs of recovery from the shock. I worked with him, and during this time applied Listerine dressings, after which, having as clean a surface as possible, under the circumstances, proceeded to dress burnt surfaces permanently.

For this I first applied an antiseptic powder; I had a one to six solution of one-half raw linseed and one-half malaga olive oil boiled for one hour, I then wrung out oiled silk in the oil, and laid over the powder; next, a layer of iodoform gauze, ten per cent, soaked in the oil, which I covered with a layer of absorbent cotton (antiseptic), and run a plain gauze bandage, beginning at right hand, run up arm to shoulder, then figure eight around shoulders and neck, down left arm, back to figure eight, over thorax and abdomen, and

down right leg to below the knee. Patient rested fairly well, but for a bronchial cough, during the first night, for which I gave him syrup white pine.

I might say here, I needed no counterirritation in this case, no opiates, whisky and albumen, white of egg beaten in

brandy regularly, with nourishment every two hours.

Saw him second day, removed first dressing, and re-applied the same dressing, after thoroughly washing the surface with green soap and warm water (carbolized). Pulse full, but rapid, one hundred and twenty, respiration twenty, and temperature 10112°.

After second day he was fully restored to consciousness, and called for toast and tea, which was given him. Used small doses of hydrargyri mite, and got a good, large, yellow passage from the bowels, no diarrhea, and repeated this every second day, during which time I let the bowels rest.

week.

This treatment, dressing daily (owing to amount of suppuration) Fellows' Hypophosphites, white of egg and brandy, toast and tea (he would not take milk or prepared food of any kind); occasionally a spoonful of egg-nog, constituted the treatment for first Slept greater part of nights (no opiates). I changed my dressings, for fear of absorption of carbolic acid, the eighth day, and used five per cent borated linseed and olive oils, vitogen, dry on surface, the old skin (dry) beginning to peel up, and I removed it as I could, and where it still remained I opened it to get drainage when washing.

This treatment: washing, vitogen, borated oil, oil silk next to burnt surface soaked in oil, removal of burnt shell as it peeled up, egg and brandy; nourishment every two hours was continued. After tenth day he took some milk (which he had never done in health). Daily dressings. Large amount of sloughing. Got large, healthy granulations. Always felt bright after dressing. There yet remained over right side portion of old shell; all the rest of surface looked healthy and clean. Artery exposed in the right axilla. Ulceration of chorea until the twenty-third day. Slight retention of urine in beginning. No bowel trouble. Mind clear. Appetite began to fail twenty-fourth day. Exhaustion began to show rapidly twenty-fifth day, and died from exhaustion the morning of twenty-sixth day from date of accident.

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