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ORIGINAL COMMUNICATIONS the alimentary canal of its unwelcome
guests. Short stories on the treatment of diseases and experience with There is still slight fever, varying
new remedies are solicited from the profession for this department; also ditficult cases for diagnosis and treat- hourly, from normal to 101°F., headache
and boneache, but on going into the air Articles accepted must be contributed to this journal only.
The editors are not responsible for views expressed by the fever drops and the aching is easier. contributors.
Chicago is at present suffering an epiCopy must be received on or before the twelfth of the month
for publication in the next month. Unused manuscript demic of influenza. Most of the cases cannot be returned.
have been of the gastro-intestinal variety, Certainly it is excellent discipline for an author to feel that he must
say all he has to say in the fewest possible words, or his reader with vomiting, diarrhea, offensive dark is sure to skip them; and in the plainest possible words, or his
stools, with much flatulence, abdominal reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want pain, aching of the bones and that downright facts at present more than anything else.-RUSKIN.
dreadful headache.” Delirium is by no COMPARE. RECORD, means infrequent. The sudden access,
disproportionate severity of the suffering Typhoid Bacilli, Influenza, Zinc Phosphid,
as compared with the pulse, temperature Yellow Fever, Volatile Oils, Phthisis,
and local symptoms, and the overpowerCalcium Sulfid.
ing weakness, distinguish this affection
now, as in all its protean manifestations. Editor MEDICAL WORLD:-Since the es- Many little children are attacked, my tablishment of our laboratory many doubt- youngest patient being seventeen months ful cases have been diagnosed by micro- old. scopic and bacteriologic examination of An effective routine treatment has been the blood, urine, sputa or feces. Generally to empty the bowels by saline cathartics; the diagnoses confirm the previous conclu- disinfect the alimentary canal by means sions, but every little while they reveal a of the sulfocarbolates with bismuth salyitotally unexpected state of affairs. One cylate; give aconitin and digitalin for the of these will serve as an illustration : A fever, pains and headache ; ipecacuanha prominent Chicago physician, well-known for pulmonary symptoms; gelseminum or throut the country, recently had an acci- hyoscin for delirium and insomnia, and dent. His horses ran off, smashed the follow up with strychnin arseniate the buggy and his foot, besides shaking him moment the acuter manifestations begin up and inflicting numerous small lesions to subside and the debility to manifest and solutions of continuity, that showed itself. Of the latter drug very large doses themselves successively for some days. are required in most cases. I usually be But the chief trouble appeared to be in gin with half a milligram every hour, inhis digestive system. The stools were creasing to a milligram, and leaving the white and costive, becoming dark, un- case on two milligrams every two to four healthy and effusive in a few days. He hours. had some fever, tongue yellowish, swollen, In one case I added zinc phosphid, one indented by the teeth, little appetite, pulse milligram, to each dose of strychnin arrather feeble and rapid.
seniate, and that patient convalesced the In all this there was nothing to indicate quickest of any. Curiously enough, he typhoid fever, yet in the stools we found declared he never had anything relieve his typhoid bacilli, with bacilli coli-commu- cough so promptly. I have previously nis and staphylococci, in great numbers. spoken of the remarkable control exerted As he had had typhoid fever several years by this salt over herpes zoster. From the previous the case seems still more compli- first dose this obstinate affection is under cated. For over a year he has had intes- control. Starting from this point, I have tinal disturbance, with rheumatoid symp- used zinc phosphid in other cases of peritoms. The question comes up, were these pheral trophic manifestations of perverted symptoms due to the local action of the action at the nerve centers, probably due typhoid bacillus in the intestines, the to demutrition. As yet, I have not found patient being immune against the fever? the limits of its action. Abnormal sensiAnd how long can the bacilli continue to bility of the mucous membrane of the exist in the bowels and generate toxics ? mouth and nose, in two cases that had The repeated investigation of the stools defied all local and constitutional treatwill enable us, perhaps, to settle these ment, gave way promptly to zinc phospoints, and to ascertain how long it re- phid. Neuralgias of every description quires for the intestinal antiseptics to rid subside under its use; and I doubt if even a coal-tar product relieves neuralgic pain of consumption most successfully treated 80 promptly as the combination of zinc by creosote, the patient smelt like a phosphid and amorphous hyoscyamin (a smoked ham. The cinnamic odor would mixture of atropin and hyoscin).
doubtless prove more desirable, or, at On page 22, Dr. Fiester describes a very least, less objectionable. interesting case. It was probably yellow The new treatment of whooping cough fever, but in at least three particulars, by calcium sulfid, has proved highly effidiffered from the disease as I saw it in cient in one case recently in my care. The South America while a surgeon in the lime was given in doses of one grain of navy. He does not mention albuminuria, fresh and pure sulfid three to six times a which is pathognomonic. The course was day, and at the latter dose its efficiency unusually prolonged, as a patient with began to be manifest. The patient was yellow fever is generally well or dead in a five years old. When the fear of this week; and I knew of no fatal case with a remedy has been thrown off, its powers temperature under 105°. That point was begin to be appreciated. I have not given a dead line; every case recovered that did it in influenza, bat in diphtheria and not reach it and all died who passed be- gonorrhea it's a “ daisy." I have rarely yond it. Still, in Dr. Fiester's case, the gone above seven grains a day to adults,
, scanty urine, epigastric tenderness, slow but would not hesitate to double this dose pulse, and late development of jaundice if necessary. Give enuf to saturate the and black vomit are highly significant. body so that the odor is exhaled, then lesIn some epidemics it has been claimed sen the dose, giving just enuf to keep up that jaundice only appeared after death. this effect. Suppurations soon dry up It will be of much interest to know if any and infective principles disappear from other cases developt from this one.
the body. Wm. F. Waugh, M, D. A gentleman connected with one of the Ravenswood, Chicago. dental colleges in this city has been making a important series of experiments in Strychnia Poisoning-Recovery Thru the Use
of Lard. regard to the antiseptic power of a number of agents employed by dentists. His Editor MEDICAL WORLD:-Between six method consisted in taking a certain quan- and seven o'clock on the morning of Notity of mutton bouillon and ascertaining vember 2, Mr. A., aged 73 years, who had how little of each agent would prevent the for some time been suffering from melandevelopment of bacteria in it. His obser- cholia, undertook to end the scene by vations placed the oil of cassia at the head taking strychnia. When the physiologic of the list, closely followed by oil of cinna- effects became well markt, he informed mon. Beechwood creosote was not nearly the family of what he had done. A messo effective, formalin hardly more than senger was hastily sent for me, but being half, and carbolic acid about one-sixth. away from home, there was some delay in Eucalyptol was far down in the list, while reaching the place. It was 8 o'clock oil of wintergreen and eugenol did not when I arrived. He informed me that he prevent bacterial growth, even when the had taken a “whole handful of strychnin bouillon was saturated and free oil floated pills.'' I found the spasms severe and on the surface.
frequent, sometimes only one or two minTwo valuable lessons are derivable from utes apart. Sometimes the spasms were these experiments. First, it is not a mat- so close together that they were almost ter of indifference which volatile oil is continuous. The whole nervous system selected, but the widest diversity exists in was very much excited, his agonizing their powers as germicides, or rather anti- moans being heard by a man who was septics. A priori, one would look to oil of working in the barn, à distance of fifty gaultheria (methyl salicylate) as likely to yards away. be especially effective, yet it proves inert. The family had given emetics at first, Second, if these experiments apply equally but without effect. Not having a stomachto the tubercle bacillus, we should seek to pump with me, I at once administered saturate our patients with oil of cassia in- hypodermically three apomorphia tablets, stead of creosote, the former being much each containing 1-20 of a grain, but no pleasanter, as well as more effective. The emesis followed. The case appearing effect of these agents upon the tubercle desperate, in about ten minutes after adbacillus should be tested in the same man- ministering the apomorphia I injected half ner to determine this point. In the cases a grain of morphia sulfate, and while in the
act of doing so I suddenly remembered strychnin as large as an ordinary dose of having read in the MEDICAL WORLD that quinin. lard is an antidote for strychnia. I called We drove to the home of the patient, a for melted lard as quickly as possible and distance of about three miles, arriving fed it to him by the tablespoonful as fast about one hour after the poison bad been as I could get it till he had taken about taken. We found the man sitting up and 12 or 14 fluid ounces.
seeming all right, except that he was very In about half an hour the spasms be- badly frightened. On inquiry we learned gan to abate, and continued to rapidly that the mistake was discovered as soon as ease off, both in frequency and severity, it occurred, and that his wife had immediand in two hours after my arrival at the ately melted a pint cnp full of lard and bedside the spasms had completely and
that he had drank the entire quantity. permanently ceased.
Both purgation and emesis followed. No The patient being very much excited poisonous effect could be observed, and, and in great dread lest the fearful spasms after staying with him two hours, we left should again return, I gave him à pill him and were informed later that nothing containing morphia sulfate I grain and worse than a terrific fright and his being atropia sulfate 1-150 grain, and he rested transformed into a seemingly inexhaustiwell during the rest of the day without ble source of lard had resulted. the return of any unfavorable symptoms. Our inquiries made it positive to our
The quantity of strychnia taken can minds that the man had taken at least only be estimated by deducting the num- three grains of strychnin, under the belief ber of pills left in the box from the num- that it was quinin. I have no explanation ber that were in the box previously, show- to offer for the happy result in this case, ing that he must have taken at least one except that the fright bad excited the flow hundred pills, each containing 1-40 of a of the watery constituents of the blood grain of strychnia nitrate, or in all about into the intestines, and the lard, being 21 grains of strychnia nitrate. I may add taken at the same time, the strychnin bethat the pills had been carefully pre- came incorporated with the lard, which prescribed by his own physician and the nec- vented absorption of the drug and, free essary caution given.
emesis and purgation occurring, the entire H. BLANK, M. D. mass was swept from the alimentary tract. [In this most interesting case (the I can see no reason for believing that the names in which are held to prevent iden- lard had any other than a mechanical eftification of the patient, but which can be fect. I mean by this that, it being slow furnisht for further private inquiry if de- in digestion, it had held the strychnin sired), the conclusion is forced that lard in suspension, thus preventing its absorpdoes not act alone as a purely mechanical tion, a sufficient length of time to enaantidote to the action of this powerful ble the peristalsis of the bowels to remove drug, but that it must possess direct anti- the entire mixture. dotal qualities to strychnia. This conclu
SAMUEL HOLLIS, M. D. sion is deduced from the fact of the far Hartford City, Ind. advance of the symptoms, showing that absorption had begun. A further research More Anent Pneumonia and its Treatment. into this matter would be most important, Editor MEDICAL WORLD:-In the Decemsince there has been heretofore no reliable, ber WORLD, Dr. Benedict has told a great quickly-acting antidote for strychnia-pois- deal of truth about those physicians who oning.-Ed.]
claim to cure all of their cases of pneu
monia and other acute diseases by their Lard the Antidote for Strychnia. own favorite methods of treatment. There Editor MEDICAL WORLD:-In response is nothing theoretic about Dr. Benedict's to your inquiry as to whether lard has article; it comes from one who has experbeen used in a human being in cases of ienced some of the shades, as well as some strychnin poisoning, I will relate the fol- of the lights, of the practice of medicine. lowing case in which I believe it prevented When a physician states that he can fatal poisoning.
cure, or has cured all of his cases of pneuIn the winter of 1877, while I was a monia, he makes a pretty sweeping statestudent in the office of Dr. H. D. Reasoner, ment. Either his cases have been mild, he was summoned to see a gentleman who, his patients of a constitution pneumoniathe messenger said, had taken a dose of proof, or there must have been error in
diagnosis. There are, undoubtedly, dif- tary, and the patients were in a debilitated ferent forms of croupous pneumonia. condition previous to contracting the disThere is the mild variety, the patient ease. If the patients had contracted recovering without much treatment. And diphtheria or typhoid, it would not have there is the malignant, septic form, the been surprising. But this bacillus seemed patient dying in a few days from septic to be a pneumococcus of virulent form, poisoning; the nerve centers being over- instead of the Klebs-Loffler, or the tywhelmed by the virulence of the poison; phoid variety. the heart muscle degenerated; the patient Previous to my experience with these dying from general toxemia, or heart fail- cases, I had been successful in the treature, due to the degenerated heart muscle. ment of my cases of pneumonia. I have Here are the two extremes. Shall we treat used what I considered conservative treatthem both in the same manner?
ment: First, clearing out the intestinal I recently passt thru the sad experience tracts with a saline, or calomel ; during of losing three patients by pneumonia, the congestive stage, small doses of members of, or related to the same family, aconite; during the second stage, amin two weeks. A lad of thirteen was first monium carbonate, digitalis, strychnia, taken sick. I found him with consolida- nitroglycerin, alcohol and nutritious diet, tion of right lung, grunting with every as seemed indicated in each individual respiration, and other symptoms of pneu
If resolution was tardy, I substimonia.
He seemed to be doing well, tuted ammonium iodid in place of the when in five days' time he developed acute carbonate. My treatment of these cases, intestinal obstruction. The abdomen and except in the case of the wife, did not stomach above the obstruction were greatly
In this case, I substidistended with gas, and injections did not tuted ammonium iodid at about the sixth relieve. The mother, who had been at- day, in place of the carbonate. tending to the boy, was at this time taken What have I learned from my sad exwith a chill, and in a short time with a perience? In looking up the statistics, severe pain in side.
Pneumonia was from the opinions formed by leading memapparent.
bers of the medical profession, and from The boy, being a frail little fellow, died the experience of my brother practitioners, before operative interference could be I am forced to believe that the mortality attempted, but this would, without doubt, from pneumonia is increasing. One phyhave proved fatal. A sister came from a sician says that the use of the coal-tar antineighboring town to assist in caring for pyretics has conduced to this increase in the sick woman, and in three days was the mortality. Another believes that there prostrated by the same disease. Two has been a change of type, that the dis. days after the sister was taken, the hus- ease is becoming more malignant. I have band was afflicted in the same manner; had two attacks of pneumonia myself, and chill, pain in side, severe cutting pain, and recovered under the carbonate of ammofever. The mother developed typhoid nia and digitalis treatment. symptoms; had delirium, prune-juice After my personal experience with the expectoration, very weak fluttering pulse, disease, and also from observation of cases, etc. On the seventh day she passt the I believe that the treatment of pneumonia crisis, and is now convalescent.
must be radically changed. It seems to The sister from the neighboring town me that there are times when digitalis and was sick one week, when she suddenly strychnin would do more harm than good, died, probably from heart failure. The i. e., in a condition where the heart muscle husband died about twelve hours after the is greatly degenerated and weakened. I sister. I thus lost three cases of pneu- see cases reported where aconite is used in monia in less than three weeks, more cases the second stage of pneumonia, simply than I lost during the past seven years of because aconite is good for pneumonia. practice in this town.
I would suggest that Dr. Benedict name The remarkable feature connected with his treatment antiseptic, instead of “alterathese cases was that four persons should tive." I think he is on the right road, be stricken with pneumonia in so short a and that his success is due greatly to the period of time in that house. It goes to antiseptic properties of the iodin, bromid, show that this particular form of pneumonia was eminently infectious. The Pneumonia is an infectious disease, conditions about the house were unsani- caused by a specific germ, which elaborates
its toxins very rapidly, and the patient is of blood poisoning following. Years ago quickly poisoned, Osler says "drugs will cold was the supposed cause. It seems to not affect the cause of the disease; it is me that antiseptics must be used more self-limited." Self-limited, why? Because freely in the treatment of this dreaded disof the production of the antitoxin, which ease. I think that if we could always antidotes the toxin, and then the crisis see our cases in the stage of congestion comes.
we might limit the disease by adminisIn pneumonia the blood must all pass tering veratrum viride, aconite, etc., as thru the lungs and the toxins are rapidly indicated. But unfortunately we do not carried thruout the body. Year by year see the case until grandma's remedies we are adding to our knowledge of the un- have been unsuccessfully ased, and we find derlying conditions which are the cause of the lung solidified; our efforts must then disease. We know that cold is not the be directed toward keeping the patient sole cause of pneumonia. It may be a alive until the antitoxin is found, and predisposing cause, the blood being driven the crisis comes. to the lungs and there causing a condition Back of the failing heart, the failing reswhereby the real cause, the pneumococci, piration, vaso-motor spasm, paralysis, etc., are enabled to elaborate the toxins, which are the nerve centers overwhelmed by the cause the fever and degenerated condition poison evolved by the pneumococcus. of the heart, and produce toxemia, which The renal hyperemia is due to the irritais analogous to septo-poisoning. We have tion caused by the kidneys eliminating found the antitoxin of diphtheria. When these poisons. Our treatment at the presshall we find the antitoxin of pneumonia ? ent time is aimed at the effects of these
Until the antitoxin of pneumonia is poisons. How shall we prevent their found, I believe the treatment should be formation. founded upon strictly antiseptic lines. I write this to prevent any misunder
First, clear out the intestines; second, standing. It is not my intention to attack administer intestinal antiseptics; third, anyone. I am looking for "more light." administer an antiseptic which will be It seems to me that we are soon to formueliminated by the lungs, thus bringing the late a treatment of pneumonia which will drug in contact, so far as possible, with prevent the wholesale systemic poisoning the cause of the disease; fourth, the atmos- which takes place in some cases of this phere of the apartment should be impreg. much dreaded disease. nated with an antiseptic.
I presume the question with regard to This will, in my opinion, be the basis of the administration of aconite in pneumonia the coming treatment of pneumonia: If depends upon the effect which is desired. we cannot drive the “ bug” from his lair, Dr. Mastin says, “small doses of aconite we should try to inhibit bis action, so far will stimulate the heart." This is the as possible, until the antitoxin is discov- teaching of the eclectics. But to the averered, when we shall be able to treat pneu- age physician, the administration of aconmonia as effectually as we now treat diph- ite in the second stage of pneumonia theria.
would seem to be malpractice. I suppose Dr. Benedict refers to physi
WM. H. RUSSELL, M. D. cians who practice in a routine manner,
Ipswich, Mass. using a certain formula, irrespective of conditions present. I consider Dr. Waugh [Doctor, you have mastered one fact one of the leading up-to-date practitioners that THE WORLD has always maintained: in America.
that theory in medicine is good, but that When I first began the study of medi- it has its limitations. After all, nothing cine seventeen years ago, nothing was can take the place of experience, altho heard of toxemia; pneumonia was a disease this needs a good theoretic foundation to manifested by a stage of congestion, hepa- be most effective, giving basis for comparitization and resolution. Heart failure was son thru which so much true progress is due to the effort of the heart to propel the made. Our readers understand that there blood thru the lungs, because of the ob- is nothing personal in our discussionsstruction formed by the solidified lung. only an earnest seeking after the truth. It was merely a mechanical phenomenon. Sometimes the method of expressing But we now know, that, in addition to the doubts might be improved upon, but the mechanical obstruction in the lung, we spirit of inquiry should never be suphave the germ, toxin, etc., and a condition presst.-Ed.]