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the doses are quite small, aconite acts as a stimulant to the sympathetic system, and if it is not carried too far, really slows the heart and reduces high temperature in virtue of its stimulant powers and modifying reflex excitements, thus bettering the condition of the patient.
I have known hundreds of sick people killed by phenacetin, antipyrin, antikamnia and such remedies in several of the epidemics of grip and pneumonia that have visited this section of country. As soon as physicians dropt these medicines and adopted a supporting method of treatment, a change for the better came over their practice.
This class of cases is not attended with so much fatality in the country, for many causes. Country physicians are more inclined to be eclectic, adopt more supporting treatment; give smaller doses; are more on social and friendly terms with each other; are better acquainted with each other's way of treating diseases; have a better class of patients to treat, who are better fed and housed. Country doctors are more friendly with one another, and are willing to assist one another on equal terms, so that the alopath and eclectic are better acquainted with each other's practice, exchange ideas and methods freely, throwing away dangerous medicines and studying nature independent of theories, of schools, or sectarian prejudices. The country physician is doing more for a rational system of practice than his city brethren.
The class of cases we have been consider ing require a supporting, half-stimulating, toning method of treatment, good food and properly prepared, plenty of fresh milk, chicken broths, prepared in the way I have mentioned, and fed regularly, during night and day.
I must here remark that the night nursing and feeding, in all these acute diseases are important and must be attended to. During night the defensive powers of the economy are at an ebb, and many cases that have little life in them may be tided thru the perilous periods in which death stands ready to reap a harvest, if the night nursing and feeding are not strictly attended to. I saved an aged woman from death last winter by making the night nurses change her from side to side every hour or two to prevent hypostatic congestions, and give a teaspoon or two of warm milk and good whisky, every 30 to 60 minutes, and a little warm beef essence
made from Valentine's beef extract, repeated every hour.
It is well to remark here, that these beef extracts are stimulants rather than foods, and die out quickly, and must not be fed in too large quantities. Feed a few drops in warm milk; never give alone. Milk acts as a nutrient that helps to sustain the powers of life.
Children and aged people need nearly the same kind of treatment; both are deficient in recuperative powers, nor do they stand large doses. Their food must be specially prepared to make it suitable to their feeble digestive organs. Besides, their assimilating powers are not suf ficiently strong to cope against severe perturbations that shock the nervous system and lower the powers of recuperation.
No beef extract contains food properties to speak of, tho on account of the salts and extractives taken, are quite stimulating. It is not desirable to administer much at a time, only at certain times when life seems to hang on a very slender thread, then it may be administered, hot, somewhat freely to stimulate the heart and the vasomotors, but too much is dangerous. It should be withdrawn after the circulation and respiration have improved. If again depression and failure of the heart set in, give some more and add whisky. When the circulation is improved, stop it for a while, only to be repeated if the failure of the heart reappears. During this time keep the body very warm with dry heat and turn from side to side. You may in this way rescue a case that would otherwise succumb.
Turpentine, in 5 or 10 drop doses, repeated every hour or two, is the best remedy in cases of putrid scarlet fever. In a very severe epidemic of scarlet fever of a low typhoid type, the throat_symptoms were exceedingly severe, color of skin almost black and mottled purple, throat and tongue much swollen, thick, sticky mucus in the mouth and throat, tonsils immensely enlarged, pupils fully dilated. I used turpentine made in emulsion with yelk of egg and powdered gum acacia, each teaspoonful containing 10 drops, repeated every hour, in the worst cases. The color of the skin changed and the eruption came out in a natural form. Besides, the intensely high temperature (105° F.), fell in ten hours to 101°, and pulse rose in strength and stability of action. In 48 hours all the symptoms had very much improved. The odor that
came from the patients' bodies during the worst stage was very offensive; the turpentine certainly removed this stench, and the urine that was nearly supprest was increast in quantity in 24 hours. This was one of the encouraging signs.
THE MEDICAL WORLD.
Turpentine is a certain remedy to arrest hemorrhage, especially the flow of blood from capillary vessels. I have seen it quickly stop bleeding from bones that occurred after operations, after all other known remedies had failed. I arrested hemorrhage that flowed nearly 24 hours from a woman's breast, after a large abscess had been opened and pus let out. The bleeding was persistent and copious; all efforts and remedies had failed to stop it. Finally, I saturated a piece of fine sponge with oil of turpentine and introduced it into the cavity; in five minutes the hemorrhage ceast. The walls of the abscess granulated rapidly, leading to a speedy cure, but the pain was severe at first. Every physician is aware of the very great value of turpentine in tympanites in the middle and last stage of typhoid fever. But it often fails to cure the tympanites, because the dose is too small.
I have often increast the dose from 10 drops to a teaspoonful, and in some cases have administered a tablespoonful after smaller doses had failed, with positive and beneficial results. I have seen only one case in which turpentine in typhoid fever in large doses caused untoward symptoms when it was administered for tympanites.
When the mucous membrane in typhoid fever secretes a large quantity of mucus along with the "pea-soup" or "scrapedbeef" stools, recurring often, turpentine is the remedy, tho there be no tympanites. In mucous diarrheas and in those septic diseases accompanied by glazed, dry, cracked, red tongue, with sordes on teeth and gums, turpentine is the remedy; and it is best given in emulsion made with yelk of egg and glycerin. The dose should be 5 to 10 drops in 20 drops of emulsion, repeated every hour or two. I regard turpentine in these cases as nearly specific. Yet close attention must be given lest it cause irritation of the genito-urinary tract. As soon as any such symptom presents, stop the medicine and give plenty of mucilaginous drinks.
beats feebly and the frequency is increast with some irregularity of the rhythm. In these cases, 5 to 10 drops of turpentine stimulates the kidneys to increast action, the heart beats stronger and the rhythm is regular. In fact I regard turpentine, in proper doses, as a fine tonic to the mucous membranes when this tissue is suffering from chronic inflammation and an abnormal secretion of mucus.
Singular to say, turpentine is a valuable diuretic in what we call atonic states of the system, and one of the symptoms is much diminisht action of the kidneys. There is not much if any fever, the heart
Before I close I offer a formula I use often with success, in aborting boils, bubos that follow soft chancre, and white swellings. It is rubifacient, anodyne and anesthetic. It can be taken internally in the cramp colics and painful intestinal troubles so frequent in summer, and for which Dr. Squibb's diarrhea and cholera morbus medicine is used with much confidence by the average run of doctors: B
Discussion of Brain Pathology.
Editor MEDICAL WORLD:-B. P. Wilson, M. D., in WORLD for July, page 277, describes a case of convulsions followed by loss of memory, and requests a diagnosis. The train of symptoms delineated in the case suggest various well-known pathological conditions, the influence of any one of which may sometimes give rise to their production. Some among these diseases after slight reflection may be eliminated from consideration; but the degree of probability in favor of the presence or absence of others can be determined only after more elaborate analysis. Foremost among diseased conditions liable to produce similar signs may be mentioned the following: Cerebral hemorrhage, cerebral embolism, cerebral thrombosi, simple (serous) apoplexy, congestive apoplexy, cerebral tumor, cerebral abscess, meningitis, epilepsy, uremia.
Uremic convulsions, even in renal cirrhosis, of all the forms of Bright's disease the most insidious, rarely produce an apo
plexy in the absence of premonitory symptoms. The unconsciousness seems to have been of a more profound and continuous type during and between the convulsive paroxysms than may be expected from this cause, and convulsions caused by an excess of urea in the blood would hardly have terminated so completely, abruptly and permanently unless treatment suitable to the elimination of the urea had been instituted.
The condition of this patient was in many respects similar to the condition no infrequently found in epilepsy and known as the status epilepticus. With no great stretch of the imagination, the vertiginous attack which ushered in the first convulsive seizure might be regarded as an epileptic aura. The apparently normal sleep noted subsequently to the series of spasmodic paroxysms was precisely similar to the post-paroxysmal somnolence of idiopathic epilepsy, and the forgetfulness manifested the following two days was very nearly akin to the dazed, semi-conscious mental state observed in many epileptics for some time after the severer explosions of the disease. However, contracted pupils contraindicate epilepsy, as does the flusht face which soon gives way to lividity. The idiopathic disease developing in a patient seventy-six years of age is practically unknown. The status once set up does not cease in four hours. Altho the initial epileptic explosion may be a very severe one, it does not assume the form of the status epilepticus.
The severe convulsions, contracted pupils, flusht face, and particularly the extreme retraction of the head, amounting in this case almost to opisthotonos, picture a condition met with at times in meningitis. But the limited duration of the attack, the absence during the whole period of delirium and the normal temperature combine to exclude any form of meningitis from the diagnosis.
The case presents some resemblance to the convulsions met with in the course of intracranial growths and cerebral abscess. But many of the general indications of these diseases, as vomiting, intense headache, continuous but characterized by agonizing exacerbations, impairment of vision, due to optic neuritis or consecutive atrophy, as well as the manifold disturb ances of function in the various cranial nerves from pressure on or absorption of their structures, are not in evidence.
A good many cases, similar to the one
under consideration, were diagnosticated by the older writers as congestive apoplexy. Vasomotor changes were held responsible for a sudden determination of blood to the brain, in quantity sufficient to produce the stroke. In a few hours the apoplectic symptoms subside and next day the patient may appear none the worse for the experience. Cases grouped under this category diminish in frequency as methods of pathological research become more exact. The best of authority, however, for believing a few cases actually due to congestion, prevails. But the opinion is now widespread that the convulsive (epileptiform) type is never due to simple hyperemia. So in the light of the most recent knowledge, still further search for the diagnosis is required.
Simple apoplexy is a designation for a stroke occurring in old persons, usually recovered from in a few hours, no brain lesion subsequently discoverable. In such persons retrograde metamorphosis has produced atrophy of the convolutions, and nature has provided an increast secretion of serum, in order to equalize intracranial pressure. As no lesion can be found, the serum formerly was held responsible, and the affection called serous apoplexy. The face is pallid, the circulation feeble, conditions that differentiate the trouble from the case under consideration.
This narrows down the range of probability in diagnosis to one of two conditions: brain hemorrhage or brain softening. If the latter, which was it due to, embolism or thrombosis? Here again the cardiac strength leads to the belief that the formation of a thrombus was quite improbable. It is also unlikely, in the absence of any history of cardiac disease or other source for the production of an embolus, that the mischief resulted from embolism. Could a thrombus from the veins of the affected axillary region or a lymph clot have reacht the brain? Not unless small enuf to have traverst the pulmonary capillaries. Even then, symptoms of greater duration, purulent softening with febril disturbance, must have resulted from its more or less septic nature. If a cerebral artery is obstructed, as a result of septic infection of the general system, either secondary pulmonary abscess or endocarditis furnishes the embolus. The conclusion therefore is that the patient's symptoms of brain disease were due to a minute cerebral hemorrhage. It is now well known that a minute
lesion, a hemorrhage or small spot of softening may occur in some parts of the brain and give rise to only transient and general symptoms. The patient's age (76), weight (200 lbs.), plethora, florid face and cardiac strength all combine to render this diagnosis decidedly probable. loss of memory may be supposed to depend on the general irritation of the cerebral cortex, the receptive centers, which are supposed to be widely distributed thruout the cerebral cortex, recovering from the disturbance of nutrition, in this instance less readily than the others.
The seat of the lesion is a matter of considerable interest. Convulsions indicate irritation, not necessarily direct, of the motor cortical cells. The lesion having irritated the neurons in the immediate locality to a discharge of nervous energy, the discharge itself in turn becomes the source of irritation to adjacent cells. The discharge spreads by direct extension to the cortical motor region, producing local or general convulsions varying with the degree of irritation and the susceptibility of the cortex to discharge nerve force. Contracted pupils suggest the pons Varolii as the seat of the lesion, but a lesion of the pons so small that neither palsy nor anesthesia is produced could hardly cause such severe convulsions. The convulsions appear to have been general, but far more severe on the right side, which justifies the supposition that the lesion was situated in the cerebral cortex, on the medial aspect of the left hemisphere. It was most likely a small hemorrhage in the paracentral lobule, a rupture of a minute ramification from the second branch of the anterior cerebral artery. This lesion may have caused a discharge of nervous energy, which at once irritated the adjacent corresponding part on the right side. The explosion may have extended from these two sources, until the entire motor region -the ascending frontal and ascending parietal convolutions-of each hemisphere was invaded, the extension spreading so rapidly that the convulsions, in reality of local significance, appeared general.
Cases very like the one described are encountered not infrequently in large State hospitals for the insane. Apoplectiform and epileptiform attacks occur among the victims of paretic dementia almost daily. Congestive apoplexy and simple apoplexy, so called, are occasionally met with. Aged males, especially, are subject to attacks characterized by sudden uncon
sciousness, stertorous breathing, long-continued and oft-repeated convulsions. The combination of symptoms constitute a picture of impending death, but on the following day the patient may appear none the worse for his experience. Such a case causes the medical novice in an asylum to exclaim, mentally at least, "Will wonders never cease!" In the existing state of knowledge we believe a positive diagnosis of the case impossible, but think that herein outlined highly probable, and feel reasonably well assured in prognosticating the occurrence of similar attacks in this patient, which may serve to emphasize the diagnosis. W. P. CRUMBACKER, M.D. Athens, O.
Place Taxation Where It Should be Borne. The following press despatch will be of interest:
Washington, July 13.-It is altogether probable that the next annual report of the Internal Revenue Bureau will recommend a number of changes in the War Revenue act. In the main the law has workt satisfactorily, and has produced almost exactly the amount estimated by the Commissioner. This, however, was something less than the estimates generally accepted by well-informed members of Congress. The internal revenue officials are of the opinion that the law might properly be extended in certain directions without becoming at all burdensome to the public, and in a way to produce a considerable revenue. One of the propositions now under consideration is to assess a tax on the sale or rental of all patent protected articles. In speaking of the matter to-day, one of the officials spoke of the telephone companies in this connection, and at the same time said that there were many inventions producing an enormous profit which could well stand a revenue tax.
It probably will be suggested to Congress that express and telegraph companies doing a money exchange business be required to pay an annual tax for the privilege. Altho taxes are now paid on receipts and telegrams respectively, the customer does the paying. It is probable that each express office and telegraph office in towns having over a certain population, if the views of the Treasury officials are approved by Congress, will be required to pay a certain yearly tax for the privilege of doing an exchange business.
Section 20 of the War Revenue act, defining what shall be taxed under Schedule B has been a source of much trouble to the internal revenue officers. For instance, the whole group of coal tar extracts have been decided by the Courts to be not subject to the tax. A pound of phenacetin costs in Canada, it is said, from 12 to 15 cents, and yet in the United States the price is uniformly $1.00 a pound. This drug, it is thought, could well stand a heavy tax.
The last paragraph is of chief interest to doctors. If foreign manufacturing chemists, who enjoy the protection of our patent laws, will not sell their products to us as cheaply as to Canadians, we should tax them for the difference. Now we protect phenacetin and kindred preparations by our patent laws, but do not tax it at all, for by a strange decision, it is relieved from all war taxation, while every cough mixture or box of pills is required to bear a war revenue stamp. We tax ourselves but protect the foreigner, and at the same time this same foreigner charges us several times as much for the same article as is charged in Canada. Are we crazy?
Questions are solicited for this column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication) will not be noticed.
The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.
Editor MEDICAL WORLD:-Will one give the best formula for the injection treatment of hemorrhoids?
Can you give the prescription used in the Daney treatment. Boone, N. C.
T. C. BLACK burn.
Editor MEDICAL WORLD:-THE WORLD has been a valuable helper to me four years. Will you please answer the following query? A woman aged 32, German, the wife of a farmer, two years ago while helping her husband haul hay got caught in the rigging some way and was thrown over a fence, falling on her face and left breast. No bones were broken, and she was up in a few hours; but since that time she has complained almost continually with pain in her chest, changing from place to place, remaining in any one place only a short time.
is simple, but very painful; hence cocain anesthesia is necessary.-ED.]
Editor MEDICAL WORLD:-I would like a little assistance in the following case: Patient, a little girl aged three years. fairly well nourisht, of healthy parents living on a farm. Was taken about the first of August, 1898, with what was supposed to be a slight cold. I was called. I prescribed, and she seemed to get all right. But about the middle of September following, not being so well, the parents, acting upon the advice of friends, took her to another doctor, who examined her urine and found it loaded with albumin. He treated her continuously up to April, 1899. without any apparent benefit or lessening of the albumin, when they returned to me for further consideration of the case. Now, I have not been able to ascertain what treatment the child has had all this time, but upon examination I found fully twentyfive per cent. albumin. I have put her upon etherial tr. of iron and nitro-glycerin with an exclusive diet of milk. There is no history of febril trouble-diphtheria, scarlet fever, etc.
What will I do to stop this waste and benefit my patient? If I have not made the case sufficiently plain, I would be glad to answer any questions.
Bad Axe, Mich. M. C. MCDONNELL.
Editor MEDICAL WORLD:-I wish you would call for a general write up on Bright's disease. Your thousands of active, practical, progressive readers must have gained some new points over the text-book treatment in the last few years. I have some cases of interstitial nephritis on hand which worry me, and I wish the brethren would help me, thru the grandest medical journal of them all, THE WORLD, or by private letter. What is best for the congestion of the kidney? For the low specific gravity (defective eliminations)? For the high-tension pulse? What of diet. medication, climate?
J. T. WALLACE, M. D. Oakesdale, Wash. [Doctor, suppose you lead out with what you have gained from the text-books, giv ing some of your most puzzling cases up to date. Do you make any external application, as a plaster, or a pad for warmth This simple thing is usually over-lookt and neglected because it is so simple. It