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out-door exercise in proper wearing apparel. Results: Enjoying good health.
The corset should be supplanted by a neat-fitting waist which does not interfere with any of the movements of the body nor restrict any organ. The skirts should be attacht to the waist, as the weight of all clothing should be supported by the shoulders instead of the hips. Some good dress forms have been advocated, but they have been adopted only by a few. Williamsport, Pa.
E. N. RITTER.
For Constipation in Children.-Veratrum for Fevers and Inflammations.
Editor MEDICAL WORLD:-The best remedy for constipation in children is glycerin. Insert a glycerin suppository once a day at a specified time and keep this up for an indefinit time. It has not failed with me in any case.
The best treatment in many cases of typhoid fever, especially in robust patients, is fluid extract of veratrum. Several years ago I treated a young lady whose pulse kept at about from 120 to 130 in this way with wonderful success. She was very restless and uneasy, and was one of those cases that perspire all the time. I gave her two drops of the fluid extract every three hours, along with one drop of tincture of belladonna. This kept her pulse at 80 to 85 and controlled the perspiration. This combination kept her very comfortable, and she had no delirium. About the twentieth day she was so comfortable that she imagined she was not sick. I said to her, "well, you stop taking those three drops of medicine and I will not call until day after to-morrow and we will see how you get along."
I called the second morning and saw at once she was worse. Pulse 120, face flusht, restless and uneasy, and stated that she had not slept for two nights and was worse than she had ever been. I said, "Well you need those three little drops of medicine every three hours. We resumed the medicine and the next morning she was laughing and happy when I called. She rapidly improved and was soon well. Keeping the pulse slow kept the temperature and restlessness down and my patient was in truth "comfortably sick."
I have used the same treatment in the same kind of cases since and it has afforded me the same satisfaction. It will be in order to add the sulfo-carbolates now-adays.
Veratrum is the treatment for fevers and
inflammations in children. I seldom give aconite under ten years of age.. One drop of fluid ext. of veratrum to a child one year of age every two hours will soon control any fever. If it produces nausea, stop it, as that is an indication that the pulse is below normal.
The only cases of cerebro-spinal-meningitis in which I have been successful are those in which I have kept the pulse down to the normal beat with veratrum.
I call to mind now one case in a boy of ten years. He had all the symptoms. His pulse ran to 120°. I brought it down to 70° and held it at that point for five days and nights, and at the end of that time his delirium began to pass off and he gradually improved, and at the end of five weeks he was well. I figured it this way: I saved his heart from pumping blood into his brain fifty pulsations a minute, 3,000 an hour and 72,000 per day, and so on. Is not that a just calculation, and one worth consideration? I think it looks reasonable and logical. Results justify it.
I want to say to Dr. Cooper that I accept his hand in reference to my misunderstanding of his sentiments. It's all right.
About the second call I ever had was a surprise to me in two ways. It was to see a child three months old. It had a solid scab all over its head from back to front. Its head lookt just like a horse's hoof, and lookt more dead than alive. I thought the child was dead. Having a box of citrin ointment in my pocket, I told the friends to apply it twice a day, telling them I would be back in two days. Having no faith in what I did, I went home to read up. Returning in two days I was surprised to find that my remedy had almost cured the patient. The scab was gone, and the child needed no other treatment.
That has been my remedy ever since, and it is all right. S. C. DUMM, M.D. Columbus, Ohio.
Editor MEDICAL WORLD:-In June WORLD, page 230, middle of second column, should read as follows: "Some patients are as able to assume the upright position on the seventh day as others are at the end E. N. RITTER. of a fortnight."
"I like THE WORLD very much, and your 'Monthly Talks' are the right thing in the right place. Keep them up, as they are very instructive, and just what many voters should be instructed in.' W. T. CHINN, M. D.
Consult Past Volumes.
Editor MEDICAL WORLD:-I have been looking thru the volumes of THE WORLD that I have, 1891-95-96-97-98 and 99, for information relative to different treatments for typhoid fever, diphtheria and pneumonia. I find in different localities a different treatment for the diseases and still some of the sheet anchors are used by all. The treatment I have used in pneumonia with good success was not approximated only by one or two. I depend on muriate of ammonia, from the start, and with that, aconite 1 and belladonna 3, given in about gtts. 6 to 10 for adults every 3 hours, alternate with muriate of ammonia and Dover's powder gr. 2 to 3, with camphor gum is to
grain to allay cough and pain. Also poultice, or oiled cloth, over chest, as circumstances indicate.
The Physician's Office.
Editor MEDICAL WORLD:-In your February issue J. A. Ellute asks some advice on the furnishing of a physician's office which will be applicable to the needs of the young practitioner. So few physicians "build" offices specially for themselves that I imagine the inquiry relates to young men just starting in the profession and who are compelled to accept such accommodations as are available, whether it be over a country store, in a private house, or in the more pretentious city office building. And further, that it is desired to secure satisfactory results with the least cash expenditure. Having had a varied and expensive experience in this line myself, and having visited the offices of many in the profession, I offer some suggestions,
trusting they may be in the line of the inquiry.
The "exposure" is not a matter of supreme importance so long as you have light enuf-you can hardly have too much-but your windows should not look out upon an unsavory and ill-kept back yard, or anything objectionable to good taste. A convenient size for a room is about 12 ft. square. This to some is small, but it is cosy and compact, and brings you into closer relation with your patient. Larger rooms lack this feature and cost more to furnish.
Taking the reception room first, the most costly item is your desk. This should be a high, roll-top, about four feet long. double pedestal, with drawers on both sides. You will need all the drawer room you can get, and will find it a most desirable piece of furniture. In oak it will cost from $18 to $24. It should be so placed as to secure a left hand light. If you have two windows and the light is not interfered with, it may be set between them. To accompany this you should have a revolving office chair, similar wood, upholstered in leather, costing some $7. Your carpet should be a bright red, or largely of that color, of as good a grade as you can afford. To seat your visitors the cheapest article is one of those four piece suites which may be had in any large city for $15. It comprises a sofa, an arm chair and two plain chairs, or possibly two arm chairs. All are gorgeous in plush, add much to the finish of the room, and are fairly durable as they are not likely to be overtaxed. A small rug in front of the desk and another in front of the sofa will not be out of place. A modest center table, or preferably a strong side table, is needed. On this, on a tray, should rest a pitcher of cold water and a couple of glasses. On the table should also be found a few numbers of the latest magazines, and the daily papers for male visitors. Medical books and novels should not be exposed. Elaborate curtains on your windows are not necessary; a good fringed shade will be sufficient. A couple of china cuspidors will have suggestion in them for some of your callers.
Turning next to the walls, and presuming that they are neatly papered, you will need some pictures. These should preferably be water colors, or a good imitation, in plain white and gold frames. Landscapes and marine views have a restful effect upon the spectator. If the doctor is a recent graduate he may desire to make
a prominent feature of his diploma in a massive frame. Generally, however, it reposes more comfortably in its tin case at the bottom of a trunk. His State certificate, if he has one, in a modest oak frame, would satisfy the inquisitive and allay all doubts as to his standing, and yet not be obtrusive. A neat china clock
on mantel or bracket will serve to warn the visitor of the flight of time, and should have a place. A good mirror, of generous size, easy of access and placed in a good light, is an absolute necessity. On a convenient bracket should be a brush and comb, and in a rack near by a dampened sponge. This must not be forgotten, as lady callers will bear waiting patiently if they can utilize the time in adjusting their toilet.
The operating room, as we may term it, differs entirely from its companion. This room may be severely plain, as it is used for business purposes only. It should, if possible, be a little larger and better lighted. For floor covering use a good grade of linoleum, of small pattern, as it will need to be washed frequently. Here will stand the gynecological chair-preferably the "Yale," if it can be afforded; if not, the "McDannold," costing onethird less. Tables are useful in their way, but for operations on the head they are not available, while an ordinary chair does not give the elevation necessary to the operator's comfort. If the room has running water and a stationary basin, so much the better; if not, the ordinary three-drawers-and-closet commode will answer. Provide with this a neat and full toilet set and an abundance of clean towels. A good five or six-drawer chiffonier, costing from $8 to $12, is necessary for storage purposes. If the latter has no mirror on top, a small glass should be kept in this room for the convenience of the physician. Here, too, his library should be housed. A book case in three compartments is especially convenient. One side section might hold his medical works, the other his miscellaneous books, while the middle section could be used as a cabinet for medicines. Such a case will range in price from $12 to $20. A small but strong table with an under shelf is necessary. If gas is not available, a twoburner oil stove will be convenient for heating water on occasions. If you have light enuf, the lower sash of the window nearest your examining table may be rendered opaque. This is better than half
blinds and collects less dust. Near the window should hang your irrigator, preferably of glass, graduated, with books at different elevations to regulate the force of flow. If this room has no closet, one should be provided-a simple corner one will do-for the convenient storage of broom, mop and slop pail, and these should be in frequent requisition. Two caneseated chairs will complete the equipment.
I have made no provision in the above for an elaborate instrument cabinet. It may be some years before the recent graduate requires such an outfit, and the drawer space I have provided will answer all reasonable demands. It is related of a distinguished professor of surgery in Chicago, now deceased, that some of his earlier triumphs were achieved with a no more elaborate armament than his dissecting case. I would not so limit the aspiring youth of to-day, but when he finds the boundaries I have meted out to him too "cabin'd, cribb'd, confined," he will no longer need the advice of WORLD readers.
Should this expenditure be beyond the means of the beginner, it is possible to reduce it and still retain a good degree of efficiency. The book-case and roll-top desk may be omitted, substituting therefor a combination desk and case. This is ornamental, and the book section will hold some fifty volumes. Select one with drawers rather than a closet beneath the desk. This combination costs about $12. Even a "Chautauqua " desk, costing $5, will be convenient. It affords nearly as much book space as the other, but is not enclosed. The revolving chair may be cheapened, or an arm chair in oak substituted. The plush suite may be replaced by a couple of easy chairs, saving a few dollars. An inferior grade of carpet and pictures may be had, but preserve the color scheme. Should the gynecological chair prove too much of a luxury, you might replace it with the "Acme Hygienic Couch" advertised in. THE WORLD. The largest size, price $12.50, will prove the cheapest in the end. Any carpenter can attach a set of folding legs to the bottom of it, so that when required for examination purposes or surgical work it can be raised to the proper height. If necessary an adjustable foot rest may be attached to the lower end, easily removable when not in use. A blacksmith can make this for you at small expense. Besides, its advantages as a bed in cases of emergency should not be overlookt. A home-made wall cabinet for medicines
forces of the economy. Besides this, these enemas clean out the intestines, removing toxins and the poison that bacteria engender. In the opinion of many distinguisht men who have studied bacteria, the high temperatures arise in consequence of the poisonous matters they engender in the processes of living being absorbed into the blood; and they also act on the nerve centers as depressing poisons. I have seen two cases of pneumonia which were attended by a tremendous rise of temperature, a decided depression of the force of the heart and increase of frequency, great engorgement of the lungs, which caused suffocating dyspnea, delirium and much restlessness, bettered in an hour by cold enemas. I believe the cold encmas saved these two cases.
will be useful if you have no other convenient space available. Instead of linoleum, use the cheaper oilcloth, and you can save a few dollars in the cost of the chiffonier. The changes suggested mean a reduction of about $100 from my original estimate, which will doubtless appeal to many. While urging the better equipment, the inferior one will answer a good purpose, and be far in advance of that in use in many offices.
This reply has already reached inordinate limits, and I must stop. To others I leave the task of recommending the necessary "implements, appliances, splints and drugs," and I hope they will not neglect it, as it is a matter in which I am sorely in need of instruction myself. Toronto, Ont. J. H. GRAHAM, M. D.
Chips From an Old Physician's Workshop.-
tine. A Valuable Formula.
Editor MEDICAL WORLD:-Last fall, while in social conversation with a young physician, the question came up, "How can I reduce high temperature with least disturbance of the patient?" Of course every reading doctor is aware of the facility with which the coal-tar antipyretics will cause high temperature to fall. We all know the dangerous symptoms that frequently follow the administration of these preparations, even in moderate doses, especially in those patients who come readily under their influence.
All these points were hastily reviewed and practical objections referred to. The question in the most proper light would then be, "How can we reduce high temperature with least disturbance of the patient and a minimum of danger to the organic reacting forces of the economy?" Viewing the matter from this standpoint, I remarkt that the systematic application of cold to the body, either in the form of cold baths, ice bags or enemas. Then I alluded to the fact that cold enemas, thrown high up in the lower bowel, in fever cases, will reduce high temperature in many cases, with salutary results, if repeated at proper intervals. I have known cold water enemas to reduce high temperature in almost all diseases in which the force of the heart was not very much diminisht, in an hour, and by judicious repetitions the effect can be kept up without doing any damage to the resisting
Buttermilk is a valuable food in many diseases, acute and chronic. I have known cases of chronic cystitis that were not amenable to any treatment, existing for two years, get well under a strict buttermilk diet, to almost entire exclusion of any other food. Some cases of melituria recover entirely under a strict buttermilk diet, while others are not the least benefited. I have known buttermilk to constitute the only diet of many-typhoid fever patients, from beginning to end, without a death or any untoward symptom. I believe buttermilk acts as an antidote to the toxic agents that are prominent in this fever.
I have often administered the whey of buttermilk to children sick with summer complaints, with excellent effect in changing the character and frequency of the alvine evacuations and moderating the fever. The whey is obtained by heating the buttermilk to about 130° F., when the casein separates. The whey is obtained by decantation. The dose is from two teaspoonfuls to a wineglassful, repeated at intervals of thirty to sixty minutes.
Buttermilk, when it agrees with the patient, may be alternated with sweet milk, with benefit. In some cases of albuminuria it is the best food because it is easily digested and does in some cases diminish the quanity of abumin. Some patients relish it very much when it is several days old. It should be kept in a cool place. Other patients prefer it entirely fresh, and, in this state, it agrees best with the larger number of sick children, who, after a day or two, relish it very much. In measles, scarlet fever, small-pox, etc., it is a most valuable food,
not excelled by any other. The lactic acid and other chemical changes that occur improve the food properties of the milk and make it a curative food in chronic Bright's disease and in some cases of heart disease, especially those of the fatty kind. It is one of the best diuretics I know of, and is to be preferred often to medicines in many kidney and liver diseases, especially when the urine is scanty and the liver is weakened by previous modes of improper living and dram drinking.
A person who has been well fed, housed and clothed, not worked beyond ordinary strength, sleeps and eats well, lives a fairly rational life all around-when such a person becomes sick, from almost any cause, that person's chances to recover are very good, with hardly any thing more than good nursing, good hygienic environments and a little good food properly prepared and fed at stated intervals, in moderate quantities. The less medicines given, and the better attention paid to correct nursing, the better are the chances. I have seen some very fierce symptoms subside after twenty-four hours under proper hygienic care and nursing, without medicines. Such patients have sufficient life in the system to sustain the body if not deprest or illy used by medicines. A little strychnin to steady the heart, and small doses of belladonna to steady and stimulate the regenerating forces are desirable, but only at times, and should never be carried too far.
The food should be fluid, mostly milk and lime water. Often, a broth made of chicken is both stimulating and refreshing. A pound of chicken is pounded and crushed with a mallet, then is put to soak in 30 ozs. of tepid water a couple of hours, stirred every now and then; then put this in a crock and set over a coal oil stove, keep heat down to below boiling, cook slowly three or four hours, add hot water (not boiling) from time to time to make up for evaporation. If the heat is kept below the coagulating point of albumin, the broth when cookt will contain 25 to 40 per cent. of albuminoids in solution.
Beef and mutton may be minced and treated in the same way; beef broth made this way will contain 6 to 8 per cent, of albuminoids and mutton some more. Let the broth cool and skim off all the visible fat; about 2 per cent. of fat will remain. That is of benefit to the patient, but too much fat causes gastric and duodenal catarrh,
diarrhea, tympanites, restlessness, and abolishes the appetite. I am not in favor of too much proteid food in acute diseases. These foods soon cause catarrh and congest the kidneys and liver, besides provoking diarrhea. Always mix some fresh cream with them, and better feed a little at a time, then you will not be liable to over feed or to cause catarrh or congestion of the liver and kidneys. It is well to remember that every atom of albuminoid food that is assimilated leaves the organism as urea, and must pass thru the liver and kidneys. Too much of this food exhausts and depresses the eliminating organs, and what remains in the blood poisons the tissues as uric acid, or it undergoes fermentation in the alimentary canal, and there toxins are formed, which enter the blood by absorption and poison the whole organism. Probably 20 per cent. of the deaths in acute diseases occur from this cause.
When sick people have lived hard, have not had sufficient food or the kind best adapted to make good blood and nerves and muscles, have workt hard and undergone many privations in one way and another, such people present symptoms of noted depression of the organic forces. In them the protective forces of the economy are deficient and they are likely to succumb to causes that the other class will readily override. I have seen such people suffering with acute diseases of the thoracic and abdominal organs at first present symptoms of great force, quick hard pulse, great nervous excitement, heavily coated tongue; apparently the congestions are of the acute active type; however, in a few hours all these apparently acute, active symptoms melt away into the beginning of a typhoid type, the resisting forces are wea. and unable to protect, the tongue becomes red, dry, tending to crack, and in a few days all the symptoms are of the typhoid type. Large numbers of these cases are killed by the "treatment." Especially are the coal tar antipyretics inimical to them, as the protective forces of the economy are much lowered. I am sure the first mistakes made in the treatment are the fatal ones, from which there are slim chances to recuperate. A large share of the deaths in this class of cases is owing to this kind of treatment. Even some eclectics fly at once to small doses of aconite to reduce high temperature and slow the frequency of the heart, in this class of cases. The saving grace of this treatment is, if