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ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

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 is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. COMPARE. RECORD,

READ.

REFLECT.

Typhoid Bacilli, Influenza, Zinc Phosphid, Yellow Fever, Volatile Oils, Phthisis,

Calcium Sulfid.

Editor MEDICAL WORLD:-Since the establishment of our laboratory many doubtful cases have been diagnosed by microscopic and bacteriologic examination of the blood, urine, sputa or feces. Generally the diagnoses confirm the previous conclusions, but every little while they reveal a totally unexpected state of affairs. One of these will serve as an illustration: A prominent Chicago physician, well-known throut the country, recently had an accident. His horses ran off, smashed the buggy and his foot, besides shaking him up and inflicting numerous small lesions and solutions of continuity, that showed themselves successively for some days. But the chief trouble appeared to be in his digestive system. The stools were white and costive, becoming dark, unhealthy and effusive in a few days. He had some fever, tongue yellowish, swollen, indented by the teeth, little appetite, pulse rather feeble and rapid.

In all this there was nothing to indicate typhoid fever, yet in the stools we found typhoid bacilli, with bacilli coli-communis and staphylococci, in great numbers. As he had had typhoid fever several years previous the case seems still more complicated. For over a year he has had intestinal disturbance, with rheumatoid symptoms. The question comes up, were these symptoms due to the local action of the typhoid bacillus in the intestines, the patient being immune against the fever? And how long can the bacilli continue to exist in the bowels and generate toxics? The repeated investigation of the stools will enable us, perhaps, to settle these points, and to ascertain how long it requires for the intestinal antiseptics to rid

the alimentary canal of its unwelcome guests.

There is still slight fever, varying hourly, from normal to 101°F., headache and boneache, but on going into the air the fever drops and the aching is easier.

Chicago is at present suffering an epidemic of influenza. Most of the cases have been of the gastro-intestinal variety, with vomiting, diarrhea, offensive dark stools, with much flatulence, abdominal pain, aching of the bones and "that dreadful headache." Delirium is by no means infrequent. The sudden access, disproportionate severity of the suffering as compared with the pulse, temperature and local symptoms, and the overpowering weakness, distinguish this affection now, as in all its protean manifestations. Many little children are attacked, my youngest patient being seventeen months old.

An effective routine treatment has been to empty the bowels by saline cathartics; disinfect the alimentary canal by means of the sulfocarbolates with bismuth salyicylate; give aconitin and digitalin for the fever, pains and headache; ipecacuanha for pulmonary symptoms; gelseminum or hyoscin for delirium and insomnia, and follow up with strychnin arseniate the moment the acuter manifestations begin to subside and the debility to manifest itself. Of the latter drug very large doses are required in most cases. I usually begin with half a milligram every hour, increasing to a milligram, and leaving the case on two milligrams every two to four

hours.

In one case I added zinc phosphid, one milligram, to each dose of strychnin arseniate, and that patient convalesced the quickest of any. Curiously enough, he declared he never had anything relieve his cough so promptly. I have previously spoken of the remarkable control exerted by this salt over herpes zoster. From the first dose this obstinate affection is under control. Starting from this point, I have used zinc phosphid in other cases of peripheral trophic manifestations of perverted action at the nerve centers, probably due to demutrition. As yet, I have not found the limits of its action. Abnormal sensibility of the mucous membrane of the mouth and nose, in two cases that had defied all local and constitutional treatment, gave way promptly to zinc phosphid. Neuralgias of every description subside under its use; and I doubt if even

a coal-tar product relieves neuralgic pain so promptly as the combination of zinc phosphid and amorphous hyoscyamin (a mixture of atropin and hyoscin).

On page 22, Dr. Fiester describes a very interesting case. It was probably yellow fever, but in at least three particulars, differed from the disease as I saw it in South America while a surgeon in the navy. He does not mention albuminuria, which is pathognomonic. The course was unusually prolonged, as a patient with yellow fever is generally well or dead in a week; and I knew of no fatal case with a temperature under 105°. That point was a dead line; every case recovered that did not reach it and all died who passed beyond it. Still, in Dr. Fiester's case, the scanty urine, epigastric tenderness, slow pulse, and late development of jaundice and black vomit are highly significant. In some epidemics it has been claimed that jaundice only appeared after death. It will be of much interest to know if any other cases developt from this one.

His

A gentleman connected with one of the dental colleges in this city has been making a important series of experiments in regard to the antiseptic power of a number of agents employed by dentists. method consisted in taking a certain quantity of mutton bouillon and ascertaining how little of each agent would prevent the development of bacteria in it. His obser vations placed the oil of cassia at the head of the list, closely followed by oil of cinnaBeechwood creosote was not nearly so effective, formalin hardly more than half, and carbolic acid about one-sixth. Eucalyptol was far down in the list, while oil of wintergreen and eugenol did not prevent bacterial growth, even when the bouillon was saturated and free oil floated on the surface.

mon.

Two valuable lessons are derivable from these experiments. First, it is not a matter of indifference which volatile oil is selected, but the widest diversity exists in their powers as germicides, or rather antiseptics. A priori, one would look to oil of gaultheria (methyl salicylate) as likely to be especially effective, yet it proves inert. Second, if these experiments apply equally to the tubercle bacillus, we should seek to saturate our patients with oil of cassia instead of creosote, the former being much pleasanter, as well as more effective. effect of these agents upon the tubercle bacillus should be tested in the same manner to determine this point. In the cases

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of consumption most successfully treated by creosote, the patient smelt like a smoked ham. The cinnamic odor would doubtless prove more desirable, or, at least, less objectionable.

The new treatment of whooping cough by calcium sulfid, has proved highly efficient in one case recently in my care. The lime was given in doses of one grain of fresh and pure sulfid three to six times a day, and at the latter dose its efficiency began to be manifest. The patient was five years old. When the fear of this remedy has been thrown off, its powers begin to be appreciated. I have not given it in influenza, but in diphtheria and gonorrhea it's a gonorrhea it's a "daisy." I have rarely gone above seven grains a day to adults, but would not hesitate to double this dose if necessary. Give enuf to saturate the body so that the odor is exhaled, then lessen the dose, giving just enuf to keep up this effect. Suppurations soon dry up and infective principles disappear from the body. WM. F. WAUGH, M. D. Ravenswood, Chicago.

Strychnia Poisoning-Recovery Thru the Use

of Lard.

EDITOR MEDICAL WORLD:-Between six and seven o'clock on the morning of November 2, Mr. A., aged 73 years, who had for some time been suffering from melancholia, undertook to end the scene by taking strychnia. When the physiologic effects became well markt, he informed. the family of what he had done. A messenger was hastily sent for me, but being away from home, there was some delay in reaching the place. It was 8 o'clock when I arrived. He informed me that he had taken a "whole handful of strychnin pills." I found the spasms severe and frequent, sometimes only one or two minutes apart. Sometimes the spasms were so close together that they were almost continuous. The whole nervous system was very much excited, his agonizing moans being heard by a man who was working in the barn, a distance of fifty yards away.

The family had given emetics at first, but without effect. Not having a stomachpump with me, I at once administered hypodermically three apomorphia tablets, each containing 1-20 of a grain, but no emesis followed. The case appearing desperate, in about ten minutes after administering the apomorphia I injected half a grain of morphia sulfate, and while in the

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act of doing so I suddenly remembered having read in the MEDICAL WORLD that lard is an antidote for strychnia. I called for melted lard as quickly as possible and fed it to him by the tablespoonful as fast as I could get it till he had taken about 12 or 14 fluid ounces.

In about half an hour the spasms began to abate, and continued to rapidly ease off, both in frequency and severity, and in two hours after my arrival at the bedside the spasms had completely and permanently ceased.

The patient being very much excited and in great dread lest the fearful spasms should again return, I gave him a pill containing morphia sulfate grain and atropia sulfate 1-150 grain, and he rested well during the rest of the day without the return of any unfavorable symptoms.

The quantity of strychnia taken can only be estimated by deducting the number of pills left in the box from the number that were in the box previously, showing that he must have taken at least one hundred pills, each containing 1-40 of a grain of strychnia nitrate, or in all about 2 grains of strychnia nitrate. I may add that the pills had been carefully prescribed by his own physician and the necessary caution given.

H. BLANK, M. D. [In this most interesting case (the names in which are held to prevent identification of the patient, but which can be furnisht for further private inquiry if desired), the conclusion is forced that lard does not act alone as a purely mechanical antidote to the action of this powerful drug, but that it must possess direct antidotal qualities to strychnia. This conclusion is deduced from the fact of the far advance of the symptoms, showing that absorption had begun. A further research into this matter would be most important, since there has been heretofore no reliable, quickly-acting antidote for strychnia-poisoning.-ED.]

Lard the Antidote for Strychnia. Editor MEDICAL WORLD:-In response to your inquiry as to whether lard has been used in a human being in cases of strychnin poisoning, I will relate the following case in which I believe it prevented fatal poisoning.

In the winter of 1877, while I was a student in the office of Dr. H. D. Reasoner, he was summoned to see a gentleman who, the messenger said, had taken a dose of

strychnin as large as an ordinary dose of quinin.

We drove to the home of the patient, a distance of about three miles, arriving about one hour after the poison had been taken. We found the man sitting up and seeming all right, except that he was very badly frightened. On inquiry we learned that the mistake was discovered as soon as it occurred, and that his wife had immediately melted a pint cup full of lard and that he had drank the entire quantity. Both purgation and emesis followed. poisonous effect could be observed, and, after staying with him two hours, we left him and were informed later that nothing worse than a terrific fright and his being transformed into a seemingly inexhaustible source of lard had resulted.

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Our inquiries made it positive to our minds that the man had taken at least three grains of strychnin, under the belief that it was quinin. I have no explanation to offer for the happy result in this case, except that the fright had excited the flow of the watery constituents of the blood into the intestines, and the lard, being taken at the same time, the strychnin became incorporated with the lard, which prevented absorption of the drug and, free emesis and purgation occurring, the entire mass was swept from the alimentary tract.

I can see no reason for believing that the lard had any other than a mechanical effect. I mean by this that, it being slow in digestion, it had held the strychnin in suspension, thus preventing its absorption, a sufficient length of time to enable the peristalsis of the bowels to remove the entire mixture.

SAMUEL HOLLIS, M. D. Hartford City, Ind.

More Anent Pneumonia and its Treatment.

Editor MEDICAL WORLD:-In the December WORLD, Dr. Benedict has told a great deal of truth about those physicians who claim to cure all of their cases of pneumonia and other acute diseases by their own favorite methods of treatment. There is nothing theoretic about Dr. Benedict's article; it comes from one who has experienced some of the shades, as well as some of the lights, of the practice of medicine.

When a physician states that he can cure, or has cured all of his cases of pneumonia, he makes a pretty sweeping statement. Either his cases have been mild, his patients of a constitution pneumoniaproof, or there must have been error in

diagnosis. There are, undoubtedly, different forms of croupous pneumonia. There is the mild variety, the patient recovering without much treatment. And there is the malignant, septic form, the patient dying in a few days from septic poisoning; the nerve centers being overwhelmed by the virulence of the poison; the heart muscle degenerated; the patient dying from general toxemia, or heart failure, due to the degenerated heart muscle. Here are the two extremes. Shall we treat them both in the same manner?

I recently passt thru the sad experience of losing three patients by pneumonia, members of, or related to the same family, in two weeks. A lad of thirteen was first taken sick. I found him with consolidation of right lung, grunting with every respiration, and other symptoms of pneumonia. He seemed to be doing well, when in five days' time he developed acute intestinal obstruction. The abdomen and stomach above the obstruction were greatly distended with gas, and injections did not relieve. The mother, who had been attending to the boy, was at this time taken with a chill, and in a short time with a severe pain in side. Pneumonia was apparent.

The boy, being a frail little fellow, died before operative interference could be attempted, but this would, without doubt, have proved fatal. A sister came from a neighboring town to assist in caring for the sick woman, and in three days was prostrated by the same disease. Two days after the sister was taken, the husband was afflicted in the same manner; chill, pain in side, severe cutting pain, and fever. The mother developed typhoid symptoms; had delirium, prune-juice expectoration, very weak fluttering pulse, etc. On the seventh day she passt the crisis, and is now convalescent.

The sister from the neighboring town was sick one week, when she suddenly died, probably from heart failure. The husband died about twelve hours after the sister. I thus lost three cases of pneumonia in less than three weeks, more cases than I lost during the past seven years of practice in this town.

The remarkable feature connected with these cases was that four persons should be stricken with pneumonia in so short a period of time in that house. It goes to show that this particular form of pneumonia was eminently infectious. The conditions about the house were unsani

tary, and the patients were in a debilitated condition previous to contracting the disease. If the patients had contracted diphtheria or typhoid, it would not have been surprising. But this bacillus seemed to be a pneumococcus of virulent form, instead of the Klebs-Loeffler, or the typhoid variety.

Previous to my experience with these cases, I had been successful in the treatment of my cases of pneumonia. I have used what I considered conservative treatment: First, clearing out the intestinal tracts with a saline, or calomel; during the congestive stage, small doses of aconite; during the second stage, ammonium carbonate, digitalis, strychnia, nitroglycerin, alcohol and nutritious diet, as seemed indicated in each individual case. If resolution was tardy, I substituted ammonium iodid in place of the carbonate. My treatment of these cases, except in the case of the wife, did not prove effectual. In this case, I substituted ammonium iodid at about the sixth day, in place of the carbonate.

What have I learned from my sad experience? In looking up the statistics, from the opinions formed by leading members of the medical profession, and from the experience of my brother practitioners, I am forced to believe that the mortality from pneumonia is increasing. One physician says that the use of the coal-tar antipyretics has conduced to this increase in the mortality. Another believes that there has been a change of type, that the disease is becoming more malignant. I have had two attacks of pneumonia myself, and recovered under the carbonate of ammonia and digitalis treatment.

After my personal experience with the disease, and also from observation of cases, I believe that the treatment of pneumonia must be radically changed. It seems to me that there are times when digitalis and strychnin would do more harm than good, i. e., in a condition where the heart muscle is greatly degenerated and weakened. I see cases reported where aconite is used in the second stage of pneumonia, simply because aconite is good for pneumonia.

I would suggest that Dr. Benedict name his treatment antiseptic, instead of "alterative." I think he is on the right road, and that his success is due greatly to the antiseptic properties of the iodin, bromid,

etc.

Pneumonia is an infectious disease, caused by a specific germ, which elaborates

its toxins very rapidly, and the patient is quickly poisoned. Osler says "drugs will not affect the cause of the disease; it is self-limited." Self-limited, why? Because of the production of the antitoxin, which antidotes the toxin, and then the crisis

comes.

In pneumonia the blood must all pass thru the lungs and the toxins are rapidly carried thruout the body. Year by year we are adding to our knowledge of the underlying conditions which are the cause of disease. We know that cold is not the sole cause of pneumonia. It may be a predisposing cause, the blood being driven to the lungs and there causing a condition whereby the real cause, the pneumococci, are enabled to elaborate the toxins, which cause the fever and degenerated condition of the heart, and produce toxemia, which is analogous to septo-poisoning. We have found the antitoxin of diphtheria. When When shall we find the antitoxin of pneumonia? Until the antitoxin of pneumonia is found, I believe the treatment should be founded upon strictly antiseptic lines.

First, clear out the intestines; second, administer intestinal antiseptics; third, administer an antiseptic which will be eliminated by the lungs, thus bringing the drug in contact, so far as possible, with the cause of the disease; fourth, the atmosphere of the apartment should be impregnated with an antiseptic.

This will, in my opinion, be the basis of the coming treatment of pneumonia: If we cannot drive the "bug" from his lair, we should try to inhibit his action, so far as possible, until the antitoxin is discovered, when we shall be able to treat pneumonia as effectually as we now treat diphtheria.

I suppose Dr. Benedict refers to physicians who practice in a routine manner, using a certain formula, irrespective of conditions present. I consider Dr. Waugh one of the leading up-to-date practitioners in America.

When I first began the study of medicine seventeen years ago, nothing was heard of toxemia; pneumonia was a disease manifested by a stage of congestion, hepatization and resolution. Heart failure was due to the effort of the heart to propel the blood thru the lungs, because of the obstruction formed by the solidified lung. It was merely a mechanical phenomenon. But we now know, that, in addition to the mechanical obstruction in the lung, we have the germ, toxin, etc., and a condition

of blood poisoning following. Years ago cold was the supposed cause. It seems to me that antiseptics must be used more freely in the treatment of this dreaded disease. I think that if we could always see our cases in the stage of congestion we might limit the disease by administering veratrum viride, aconite, etc., as indicated. But unfortunately we do not see the case until grandma's remedies have been unsuccessfully used, and we find the lung solidified; our efforts must then be directed toward keeping the patient alive until the antitoxin is found, and the crisis comes.

Back of the failing heart, the failing respiration, vaso-motor spasm, paralysis, etc., are the nerve centers overwhelmed by the poison evolved by the pneumococcus. The renal hyperemia is due to the irritation caused by the kidneys eliminating these poisons. Our treatment at the present time is aimed at the effects of these poisons. How shall we prevent their formation.

I write this to prevent any misunderstanding. It is not my intention to attack any one. I am looking for "more light." It seems to me that we are soon to formulate a treatment of pneumonia which will prevent the wholesale systemic poisoning which takes place in some cases of this much dreaded disease.

I presume the question with regard to the administration of aconite in pneumonia depends upon the effect which is desired. Dr. Mastin says, "small doses of aconite will stimulate the heart." This is the teaching of the eclectics. But to the average physician, the administration of aconite in the second stage of pneumonia would seem to be malpractice.

Ipswich, Mass.

WM. H. RUSSELL, M. D.

[Doctor, you have mastered one fact that THE WORLD has always maintained: that theory in medicine is good, but that it has its limitations. After all, nothing can take the place of experience, altho this needs a good theoretic foundation to be most effective, giving basis for comparison thru which so much true progress is made. Our readers understand that there is nothing personal in our discussions— only an earnest seeking after the truth. Sometimes the method of expressing doubts might be improved upon, but the spirit of inquiry should never be suppresst.-ED.]

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