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THE MEDICAL WORLD.
WORLD readers to know how we treat ty- R
äā m 5-10 or less conservative, and in ordinary, un
3-1 complicated cases quite uniform. As soon This gave most excellent results, some as the diagnosis of typhoid fever is estab
we also placed upon salol, gr. v, every four lisht, the patient is put upon typhoid or- hours. We had no further trouble with ders, which, excepting some minor devia- tympanites, delirium, dry, brown tongue tions, are similar in the different wards and similar grave symptoms. and include:
While these measures are all very im1. Pulse, temperature and respiration, portant, there is one in particular which taken every four hours.
is not emphasized and valued enough, and 2. Liquid diet--which means in this in
that is systematic, high colonic flushings stance, almost exclusively milk, 4 to 8 3
at regular intervals. By this means we every two hours, diluted with lime water
insure regular bowel movements, and in when necessary; only where milk disa
thoroly emptying the colon prevent abgrees is a variation in diet (beef juire, al- sorption of toxin, also favorably influence bumitrwater, gruels, etc.) allowed. Plenty any present inflammation or ulceration of of sterilized water to drink.
Peyer's patches in the colon. In addition 3. Sponging for temperature at or above
the watching of the bowels is obviated, 102.5; some of the wards employ sprink- which is a great relief; no catharties are ling with cold water; occasionally the needed after the preliminary “purge”. cold pack is resorted to; the tub-bath is To this factor I attribute the absence of inless convenient to use, requires more as- testinal hemorrhage in our ward. sistance and is hence only exceptionally No stimulants were required, except the employed.
above prescription is called such. 4. Daily morning sponge bath-irre
L. F. SCHMAUSS, M. D. spective of temperature, the same as all
Member of House Staff, Cook County Hospital, acute patients receive.
A Case of Yellow Fever in Ohio.
The results are excellent, and no im- Southern Christian Institute, at Mt. Beuprovement could be desired except in the lah, two miles from Edwards, Miss. direction of shortening the usual course She was there one week and taught but (duration of the disease. During my jun- three days. Upon advice of Pres. Lehior medical service (December 1, 1897, to man the teachers were all directed to leave March 1, 1898) between 50 and 60 typhoid on account of the prevalence of yellow fever patients were admitted to the regu- fever. Miss Beck told him she did not care lar service. of these no deaths occurred, to leave as she was not afraid of the fever. and only one hemorrhage, which also re- He insisted upon them all leaving, for he covered under the ordinary treatment. I said they, bad a serious time of it in Edregarded these results as very remarkable; wards last winter for some of them were in but they are not constantly so favorable. quarantine nine weeks. So he thought it
This fall I noticed a number of deaths best for all of them to leave, as they might from typhoid fever. I believe in intestinal not be able to get out even if they should anti septics. When I entered on service want to go at some future time. So the there were five typhoid fever patients in school was closed and the President charmy ward, every one of which had marked
tered a car.
There were thirteen in the tym panites, some also had active delirium. They took a train at Smith's Station Tupentine, asafetida, ice coil, etc., had above Edwards. But at Edwards five perto be resorted to. After this every patient sons got on to go North too.
One lady was placed on the following prescription, came from the sick bed of her brother-inthree or four times a day:
law, who died two days later with yellow
4 song for
fever. The lady herself never got the fever. When Dr. Palmer saw the case she did not A. T. Ross, another member of their party, possess that yellowness of skin as marktas had the fever at Union City, Ind.
later on. The yellowness of skin was very Mr. Lehman, President of the Institute, slow in coming out. The characteristic who has been thru several yellow fever vomiting also appeared. Her mind was epidemics, and who is a close observer, clear within a few hours of her death. Miss feels quite sure that this lady was the Beck told me (she had a very good idea of source of infection for both parties. He yellow fever and her statements were gen. thinks she carried it in her clothes. Misserally found to be correct) that they told Beck was taken sick one week after reach- her in the South that people of light ing her home, which is in Paris, five miles complexion (she was unusually fair) did from Newton Falls. I saw her in the not always turn yellow but that some of night on Oct. 12, '98, first, after having a the cases instead of becoming yellow fairly chill (she had but one chill). Her tem- bleached or blanched out, and that they perature was 102° F. Her pulse did not did not always have the black vomit. correspond with her temperature, and was Dr. Wood says that “the black vomit, not rapid but extremely weak. Her pulse yellowness of the skin and hemorrhage thruout the disease gave me more un- have been mentioned as attendants upon easiness than any other symptom, for it this last stage, but patients often die without seemed impossible to arouse the sluggish them. The yellowness of the skin to which circulation Next morning her tempera- the disease owes its ordinary name, tho a ture was 101° F.; in the evening 102° F. common, is by no means an invariable On the third day there seemed to be a com- symptom." plete remission in the morning temperature He also says that “in fatal cases, death and hardly any rise in the afternoon tem- takes place most frequently on the fourth, perature. She seemed to be more rested fifth or sixth day, tho sometimes as early and cheerful than she had been at any time as the third, and sometimes as late as the previous, but as Wood says, “it was a de- eleventh day." She died on the morning lusive calm," for next morning tempera- of the tenth day. The suffused redness of ture went up again.
the face was present a good deal of the time. Wood, Da Costa, Reynold, and other I had to resort to hypodermics to keep good authorities say that yellow fever is a her from vomiting, for she was unable to disease of a single paroxysm which is sel- keep anything in her stomach most of the dom or never repeated, but further on they time. Her stomach was very sensitive to say the fever does not distinctly remit un- the touch. She told me if she only got a til after from thirty-six to forty-eight small amount up, it relieved her for a short hours, when a remission occurs. Upon this time. At first the vomited material came remission the fate of the patient hangs, up by a sort of regurgitation, then she and if the fever goes up, as it did in this made considerable effort to throw it off; case, it usually tends to a fatal issue. The later, she could throw up mouthfuls withhighest I found her temperature at any out any effort on her part. time was 104° F. The day before she died She voided very little urine, and with morning and evening temperatures were considerable pain. She had a pointed 96o. One peculiar feature was that when tongue with white coating, not heavily she had the remission she was about as coated at any time, with red edges. She thirsty as ever.
complained of a terrible exhalation from Dr. Palmer, of Warren, was called in her body. She said the people in the South October 16, but at that time was not will complained of what they called a “terrible ing to affirm or deny that she had yellow odor.” I must confess that I never noticed fever. He said she had all the earmarks any odor like that before. I cannot describe of yellow fever, the excruciating headache, it. It was a peculiar odor. Her breath the ache in the limbs, back and joints, was also very offensive. which are the symptoms of yellow fever, Bowels were very much constipated, exbut she did not possess that yellowness of cept at the fatal issue, when they run off. skin and inky vomiting which are the sure She had a rash after she came home. signs of the fever, and besides that she had lasted but a short time. I did not see it. been sick nearly a week and the authori- Authorities speak of some of the cases ties say this should develop in four days at having a rash early in the disease, before the most. He said, “I am waiting devel- the febrile symptoms develop, which is opments."
very uncommon in other febrile diseases.
Her eyes were very much suffused, and This is the reason I see so much here, had yellow conjunctivas from the first. besides I practised two seasons in the
When Dr. Brobst, secretary of the State swamp. board of health, saw the case on October If you will study the symptoms of yellow 19, she was yellow as an orange. He was fever you will find that you have given a of the opinion it was yellow fever, and most excellent description of the disease: 1, reported the same to the board.
A fever of one paroxysm; 2, rapid rise of Miss Beck told me that they told her in temperature; 3, epigastric tenderness, the South that if it rained the three first very pronounced, and nausea early and days after one was taken down, it was persistent; 4, supprest or scanty urine, almost sure death. It seems that if wet almost always albuminous; 5, tendency weather sets in after a dry spell, the germs to hemorrhage; 6, jaundice. propagate much faster. She said that Now look over your case as you reported after death the germs leave the dead body it and see how beautifully markt a speciand seek new fields. That in the South men you had. But you gave him the one they are much more afraid at this time treatment which always kills, either in yelthan at any other.
low fever or hemorrhagic malaria. Quinin Upon watching the case closely, I am any and all forms is positively contrafirmly convinced that it was a genuine indicated. In the latter, jaundice is rare, case of yellow fever. Would like to have and fever rarely lasts over a few hours. the opinion of the readers of THE WORLD, Had you given your patient nothing save especially those of the South, who have small doses of calomel to unload the bowels, had experiences in yellow fever, and also and enemas of potassium bromid forty their opinion whether the contagion can to sixty grains six hours apart, strychnin be carried in the clothes in the South. 1-40 grain hypodermically every three or Newton Falls, O. H. A. FIESTER. four hours till physiologic effect was seen,
and if stomach would bear it, ergot in full Uses of the Sulfocarbolates.
doses, otherwise ergotole ten minims Editor MEDICAL WORLD:-I have been three or four hours apart by hypodermic, a silent reader of THE WORLD for over a you might have saved your patient. year, and can say it is the best help I When the period of colon (fever begins to have. I began the use of the sulfocarbo- leave) arrives, put nothing in the stomach lates so scon as I began reading THE at all. So soon as collapse appears imWORLD. I have treated several cases of minent, high rectal injections of hot water typhoid this year, and have never had any and wbisky should be resorted to. trouble with the bowels when I saw the Now doctor, see if you cannot trace out case early.
a source of infection, and did you not have I also use these salts a great deal in bowel -in the neighborhood--a good many mild troubles, especially in cholera infantum. cases of fever, one chill, pains in back, calf I usually combine pepsin, bismuth and zinc of leg, headache, etc.? and were not some sulfocarbolate, and have not lost a case of your cases jaundiced? Did it not run under this treatment. The worst cases thru families ? usually recover in two or three days.
Yellow fever, in your climate, produces Tidwell, Tex.
E. A. HOPKINS. a milder form of fever. One case like you
described, will be followed by fifty or Malarial or Yellow Fever?
sixty, so mild that it is hard to recogEditor MEDICAL WORLD:~Kindly pub- nize it, unless urine is albuminous. Look lish the within letter and answer:
up this for me please, and remember that Dear Dr. Dorris :-To-day in a copy of the fomites of yellow fever produce the The World I saw your note anent “Hem- disease. It is very infectious-provided orrhagic Malarial Fever". As I do not a suitable atmospheric condition prevailslike to criticise a man publicly, I send you but feebly contagious. this letter, and you can publish it if you Natchez, Miss. J. C. BALLARD, M. D. like. In the first place, let me tell you
Chief Health Officer. that I have practised since graduation I appreciate Dr. Ballard's criticism and where we have malaria. Our town is high, comments very much, but differ with him and not affected much, but the people go both in regard to diagnosis and treatment. so often to the lowlands of Louisiana, I did not make a microscopic examinajust over the Mississippi River, and the tion of the blood for malarial parasite, but people over there come here constantly. was so sure from the history of the case
THE MEDICAL WORLD.
that I did not deem it necessary. There last month I had only 143 such underpaid had been no exposure to yellow fever, no letters, for which I had to hand over jepidemic in the country, no other case $14.30, and replying to them separately similar to this one. Patient had had two would mean another $7.15 out of pocket.
for three mild attacks previous, from which A hint also to manufacturers who send i he had not entirely recovered and wbich out drug and instrument literature, mailed
Shad yielded to quinin, but had relapst two as book packets in open letter envelopes. s or three times. Two others of the family Post your printed matter in newspaper
were suffering at the same time with ma- wrappers, or if you will use envelopes paste - larial fever, which yielded to quinin. the flap inside, or during the process of ex. Thus, I think, yellow fever could be ex- amination the Sea or Bombay post office cluded.
may accidentally seal down the envelope The treatment advocated I think is very and treat it as a letter. In this case it is good under some circumstances, but this scarce likely you will hit the addressee for
case I think would have succumbed on the an order by making him cuss. Some for following day under it. I don't think he having to pay perhaps fifty cents letter would have survived another paroxysm, postage for printed matter mailable at two and this I think would have certainly cents. Xcome on had it not been for the quinin. Dr. Robert J. James of Minneapolis. Under the amount of quinin that was used Minn., asks what opening there is for a
there were symptoms on the following young doctor in India, and whether it morning of the second paroxysm, slight would be feasible to run a hospital out rise of temperature, chills and rigors. I here. The sooner he abandons the hosfirmly believe, had it not been for the use pital idea the better, as while it is not easy of quinin, he would have had the second to obtain the Government's sanction for : paroxysm on the following day. This, I such an institution, it is harder still to get think, would have been fatal.
the people to desert the state charitable ( I don't think anything short of thoro hospitals in favor of one run by private cinchonism would have warded off the enterprise. Besides he will have to reckon second paroxysm, and this was what I strongly with the Indian medical service. wisht to accomplish. I think a smaller
I think a smaller who are dreadfully conservative and do quantity would have accomplisht this, but not look kindly on non-official (i. e. indeI wanted to be on the safe side. I would pendent) medical persons. rather use too much than not enuf. I Fuss is the religion of India, and the can't say whether the quinin was contra- more show and fuss a man can make the indicated or not. Any further comments surer his chances of success.
Scope for would be appreciated. S. M. DORRIS. practice there is plenty if a medico can Bandana, Ky.
afford to “cut a dash" and live at the rate
of about $180 per mensem for nigh a twelveDifficulties of Practice in India.
month before he secures his first patient Editor MEDICAL WORLD :-If the circu- from the 270,000 practitioners he will have -lation of a journal be judged by the num- to compete against. Calcutta alone con
ber of references and inquiries it evokes, tains 7,000 doctors to its 6,700,000 in babTHE WORLD must indeed be very widely itants, or one doctor to every 957 persons, read since I have been deluged with letters of whom at least 850 are too poor to be from various parts of the mighty West able to pay for medical attendance. At where floats the glorious Stars and Stripes least 450 of the Calcutta doctors draw govand the Union Jack, saying the writers ernment pensions or salaries which help had read my contributions to THE WORLD them under-bid the non-official doctor in and asking me to advise whether there is the field for private practice. scope for practice in the sunny East. You According to medical ethics a doctor must kindly permit me reply to them col- must not advertise himself. The nonlectively, as I have neither the time nor the official who cannot afford to attend sick * almighty" to write them individu- call for less than four rupees (i. e. $1.28) ally.
has to pay a license of Rs. 50 (i, e. $16.00) A number of folks jab a two-cent stamp and does not advertise himself, while the on their letters to India where the post- government assistant surgeon, who pays a office treats them as “ bearing letters for license of only four dollars is largely adverwhich the unhappy recipient has to pay tised by the State in all the gazettes and the equivalent of ten cents. During the daily newspapers, and attends out door sick
waty try culo
brundig ush STRE MEDICA
THE MEDICAL WORLD. Lu
25 y calls for
sixteen cents per head besides practice out there and look upon every ceiving his government salary.
fresh arrival as a poaching interloper, A small idea may be formed of the mag- whom it is their duty to wipe out, unless nitude of the State competition against he can set up in grand enough style to which we non-officials have to contend catch the public eye and mind by imposwhen it is known that in a small province ing consulting rooms, flush conveyances, like Bengal there are no fewer than 417 brilliant dinners and soirés, and a moun. government institutions where anyone tain of " outside fuss" to coax a mole-hill who wants it can get medical and surgical of private practice. aid and medicines for NOTHING (i. e. gratu- Sad tale, but true, from vale to highest range, itously).
In Cabul down to southern Cormorin, At home and in Europe, anybody who In rajah's palace or in peasant’s grange. was professionally competent to so do 'Tis love for money kills the love for kin ; ni could medically certify anybody, whether
Gold glosses all and silver rings the change, in official employ or not; and so they
While poverty is thought a deadly sin.
Here lacking "fussy pomp" the doctor dies could in India till 1895, when the Govern.
A starveling's death, his best endeavors fail ment ruled that none of its employés could Where riches cover sins and foster lies file a sick certificate for leave of absence, 'Gainst State who can prevail when ev'ry side' unless it were signed or countersigned by a
Official barriers rise and he must sink presiding surgeon, who was entitled to a
Byneath their weight unless o'er them he ride. fee of Rs. 4 for such signature; but who
With sycoplantic arts that daylight shrink,
Or ought to shrink if truth were paramount, could refuse such certificate if he did not In this bright land where justice and redress himself examine the patient requiring Are unknown things or rare, and riches count such. This examination meant a fee of Most powerful, while he whose heart must bless Rs. 16. Hitherto, patients had as their
In words at least tho not at heart rich hand family physician non-officials, whose an
That smote him worst since poor men right to
live nual contract (or fee) included granting Hold forfeit here, and may not honor'd stand medical or death certificates when neces- Where gaining nought their all poor men must
sary. Prior to the passing of this rule give 1. there were in Calcutta some 14,000 officials To push the rich man further up the tree who paid their family doctor from Rs. 100
Of wealth, where Nature smiles in ev'ry phase to 200 per annum, and obtained sick-leave
Of life, save man’s, whose chiefest aim to see
As his bright gold where'er may fall his gaze. about six times yearly. By this new rule this leave would cost them addi
Cruel and disheartening as seems the tional Rs. 120 per annum for doctors' fees: story I tell, it is unfortunately true, e'en whereas Rs. 150 to 200 per year would se
tho I have not painted it in all the horcure them the attendance and certificates
rors it presents to a sensitive mind. of the presiding surgeon as family doctor.
ROGER S. CHEW, M. D. Consequence, the non-official doctor was
Calcutta, India. given his walking ticket. All this is bad enough, but we have a
Puerperal Eclampsia. still worse evil to face. I do not know Editor MEDICAL WORLD: -- Puerperal who set the lie a going, but in India there eclampsia is of grave import since such is a wide-spread belief that the majority cases must cause the greatest possible anxof American doctors who come out here iety to the best equipped accoucheur. If, are too stupid to hold their own at home, however, he has been so fortunate as to or have “purchased their diplomas." Dr. have had the patient under his care and 0. G. Place, of the Adventist Mission, and observation for some time in a major porI have talked ourselves hoarse and worn tion of the cases avoidance may be had by
out our pens in contradicting this infa- care in diet. Saline cathartics should be mous libel, which it is to the interest of used and the patient should drink freely official doctors and their non-official toad- of water. ies to foster; but while the Medical Asso- Dry cups should be applied to the back, ciation of India will not help us to fight or if there is a full bounding pulse, with the lie out, the Indian Medical Association turgid face, scanty, smoky urine, the pahas too many subordinate officials on its tient complaining of a rush of blood to the rolls to carry weight with the lay public head and vertigo, then venesection to the or to dare to defend non-British doctors amount of one pint would be proper. Even from the vengeance of the Indian Medical a greater amount may be taken when the Service, who claim the monopoly of the patient is very strong and of a full habit,