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lodin for Snake Poisoning. Editor MEDICAL WORLD:—A short time ago I read in a Florida paper an article on "Snake Bites," by E. T. Brown, M. D., Leesburg, Fla., a physician well known locally. He says a cup of melted lard is often recommended for snake bites, and continues: "A child, four years old, was bitten by a rattler, and the wrist and arm was much swollen. I applied to the wound iodin, then gave every ten minutes in water one drop of iodin on tongue for about one hour, then every half-hour, about ten to fifteen drops in all. The child was well the next day. A boy, fifteen years old, bitten by rattler in leg, who could hardly stand up, was also treated in this manner, increasing dose to two drops. He was well next day. A cow bitten, and unable to get up, was given ten-drop doses on the tongue. Reported next day as feeding again and about."
I am no doctor, but take interest in what I think benefits mankind. If physicians would experiment on this remedy and make results known, it would redound to the benefit of mankind.
CH. VAN DUISBURG.
Asepsis and Antisepsis in Obstetrics.
Editor MEDICAL WORLD:-In obstetrics the theory of the past and present embraces the extremes of the potent factors, cleanliness and rest, respectively. Not many years ago the professor of obstetrics taught that the factor rest was the allimportant consideration after child-birth; hence the woman was compelled to remain in the filth consequent to the birth of a child until the following day. Now it is taught from the same chair that cleanliness is the all-important matter for consideration, and the woman should be made clean as possible, also the bed; else the physician has not performed his professional duty in accord with the late or modern theory.
No rational physician will attempt to
refute the potency of either or both of these factors; but the ways and means to obtain the best results through these factors can be questioned. It appears to me that the exponent with which to reach the goal is philosophy applied to practice of obstetrics. It appears to me to be very unwise to-day for a woman to remain in an unclean condition after child-birth with the view of giving the nervous system an opportunity to regain its spent force; while, in fact, such condition tends directly to irritate and disturb, and thereby lower the resisting force of the nervous system. Furthermore, the decomposition of the animal matter thrown off tends to produce and generate toxin, with which to contaminate the general system of the person.
The rational way is to clear away from the woman and her bed all foreign matter; thru such you will have removed an irritant to her nervous system; she will feel more comfortable; hence will be more likely to regain lost energy and resisting force. And not this alone, but you will have also destroyed the nidus of microbes.
But, on the other hand, prolong this procedure with too much of the ways and means, while you obtain extreme cleanliness you tend to disturb and irritate the nervous system, and thereby lower the resisting power. Therefore it seems apparent to me that the philosophic plan is not too much, but simply enuf to reach the force and result of both those potent factors, cleanliness and rest.
As to experience, nineteen years ago, when I left college, the chair of obstetrics taught that the woman should not be disturbed until the day following confinement, but I could not see the logic, and in my mind did not accept of the doctrine. However, when I entered the field of practice, for two years I practised as instructed at college, but each time I attended a case of confinement I left the place dissatisfied with the professional service rendered to the woman. But the third year of practice I had gained sufficient courage to assert my own opinion, and I cleaned the woman and bed thoroly. I remember very keenly the exclamation from the woman: "Oh, I feel so much better than when I was confined before." This remark, of course, encouraged me, and from that day to this such has been my practice. The following year I began the use of carbolic acid solution to wash the parts, and as a vaginal douch. But for
the last few years I have been using creolin instead of carbolic acid, in the following solution: One teaspoonful to cup of water, and teaspoonful of this solution to one cup of milk-warm water for vaginal douch, to be used three or four times in twenty-four hours. Order one teaspoonful of this solution used in the water when the parts are washed, and have done four times in twenty-four hour.
I also see to it that all soiled clothing is removed from the woman and bed, and have the napkins removed every hour and clean ones used. I am pleased to say that I have as yet the the first woman to lose thru confinement, and have been in general practice nineteen years.
I think that many of the antiseptic precautions are too extensive and unnecessary. The chief aim is cleanliness, and this should be enforced with as little disturbance to the woman as possible. Observation and practice will in time eliminate the unnecessary from practice, and leave the abstract water and common sense to establish the real theory and practice of obstetrics.
C. W. MUSGROVE.
Case of Erythema (?) After (Rectal) Saline
Editor MEDICAL WORLD:-In case of menorrhagia, during the menopause, I gave an injection of of three pints salt solution (three grains of salt the pint), to fill up the depleted veins. The solution was retained, and, after two hours, my patient was a great deal better. At next visit (eight hours later) I found her covered with a rash, in patches, in appearance a cross between erythema and measles, thick in front of the knees, on the buttocks, back of arms, along the spine and on the face. It faded in thirty hours. Eight hours after, I repeated the injections, when the rash reappeared in two hours and lasted for fortyeight hours. eight hours. Pneumonia complicated the case and the patient died the fifth day. Did the salt solution dissolve the toxins in the bowels and so cause the rash by absorption, or was it a vaso-motor disturbance? I think both causes workt. I have seen a scarlet rash in children which lasted about a day, twice after soap enematas, and which were followed by slight scaling of the cuticle. There was no sore throat. P. H. VON ZIEROLSHOFEN. Croghen, N. Y.
Dr. Harwood's Case.
Editor MEDICAL WORLD:-I don't see where such a prescription as is given by Dr. Harwood was indicated in gastro-enteritis unless he wished to kill the child. From such a dose of quinin would ensue semi-paralysis of the nerves of the lungs, and the child would gasp for breath as in congestion of the lungs. The abdomen would be tympanitic, and there would be palpitation of the heart, great debility, J. K. EBERLE, M. D.
Points Gained From "The World." Editor MEDICAL WORLD:-In renewing my subscription to what I regard as the best medical magazine publisht, I wish to thank you for the many good things it contains, especially the last few numbers on malarial and typhoid fevers.
I have had opportunity to try many of the differently expresst modes of treatment in the latter disease this fall, not having confined myself to any routine practice. In some cases I have used the Woodbridge treatment in a modified form, using mostly his No. 2, and not oftener than every hour. In some I tried zinc sulfocarbolate, listerin, salol, etc.; in nearly all, turpentine in small doses. To control high fevers I used the Brand method, in some cases either the plunge or the pack, but never so cold as recommended by some. Where this was used, as well as where the bath was not used, I resorted to acetanilid, but with great caution.
About half the cases had more or less hemorrhage, regardless of treatment. every case I used calomel in small doses, and followed all cases of hemorrhage with calomel in doses sufficient to arouse the liver and get an action from the upper bowels. If the hemorrhage was severe, I preceded this with bismuth subnitrate, lead acetate and opium, and in all cases got good results.
The fever has run from four to nine weeks, and I cannot say that any special treatment acted as an abortive; but, in the main, where the Woodbridge tablets were used the disease ran a rather shorter course.
To those who think calomel and acetanilid will kill typhoid patients, I wish to say that my patients are all either well or convalescent under the above treatment. I lost my first case last year, and with this I used no intestinal antiseptic. I then began as above, with better results.
H. S. TAYLOR.
[The general developing along the line of internal asepsis and antisepsis, one of the most rational ideas of modern medicine, is most gratifying. The above is a fair sample of the affirmative argument. To have the wheat in the matter thresht out to its fullest extent, all sides should be considered, however, and THE WORLD is open to those holding negative views, in order that they may convince or be convinced.-ED.]
The Clinical Thermometer vs. Asepsis. Editor MEDICAL WORLD:-We live in a period of antiseptic medicine and surgery, but is there not much that is inconsistent in theory and practice of antiseptic course with many of the advocates of asepsis?
Especially is this most markt in the use of the clinical thermometer by the average physician. Altho he may possibly be a religious devotee of asepsis, in ordinary practice he utterly disregards all aseptic laws by the use of one thermometer, perhaps, in the ten thousand and one cases he may be called upon to treat in his general practise. How often do we see the average physician use the thermometer in the mouth of a patient, no matter what the case may be, and, before placing the instrument in his pocket, carelessly wipe it off with his pocket handkerchief, that possibly a moment before he had used to blow his nose on. Would this not leave the thermometer in a truly filthy condition for use in the mouth of his next case?
Possibly that nose may have been the nose of a catarrhal victim, or even worse, may have had the poisons of syphilis filling it.
Even if the handkerchief is that of a perfectly healthy man, the custom of thus cleaning it is filthy in the extreme, when the instrument is to be placed in the mouth of a patient. Then when we know that the fever thermometer is used recklessly in the mouths of any and all patients, careless of the condition, whether of disease or health, how strange that this is done, reckless of all regard to simple decency, to say nothing of health or cleanliness, to be considered in general practise. Possibly one mouth may be of a putrid condition, or the throat ulcerated, akin to it, yet with the simple rubbing of the thermometer with the handkerchief, too frequently contaminated, or else with a carelessly-picked-up rag, it is ready for the mouth of the next poor helpless sick one,
regardless of the dangers that lurk on this thermometer, and which may mean contagion and death for its victim.
Sometimes scarlet fever or diphtheritic patients are given the thermometer to hold in their poisoned thoats and befoul it to the point of the vilest contagion, and within a few moments it is placed in the mouth of an innocent sufferer from a simple ailment, who, being thus inoculated by the thermometer, may die of the dread disease communicated by the reckless use of a clinical thermometer, an agent that is of very doubtful practical value in ninety-nine cases out of the one hundred cases treated by the physician in ordinary practise.
True, this instrument has its values in a specially few cases, but used in every case a physician examines, it is simply a fad, and too dangerous to be constantly resorted to when so utterly unnecessary to the wellqualified clinician. All intelligent practiAll intelligent practitioners will admit this in their own minds, if not to the gullible public, who are to be so impressed by the use of the clinical thermometer. Isn't this too true?
Now, if the thermometer is to be used in practice, in all cases, necessary and unnecessary, will it not be well that a law be passed by every legislature in all Christendom that shall compel the physician to have an individual thermometer for every case he uses it in, so as to prevent carrying contagion, and sometimes death, to a patient who would be a victim of reckless, indiscriminate use of the clinical thermometer in all cases, necessary or not, as is now done by so many of our practitioners of medicine of to-day, and more especially by the recent graduate?
If every case is to be supplied with a thermometer, as one has his own individual tooth brush, what a falling off in the use of the thermometer will be observed, and it would, doubtless, be astounding to the world how much such a practice will limit contagion and infection.
Just as a disgusting finis I will add that one of the Indiana board of pension examiners has been known to have one thermometer that he uses, indiscriminately, for the rectum or the mouth. Whether always so in private practice, deponent sayeth nothing.
This should convince all of the necessity of a law for providing individual thermometers. A. C. MATCHETTE, M. D.
argument, but it seems as if the adoption of individual thermometers, individual communion cups, etc., was a carrying of the plea for asepsis to the reductio ad absurdum. All that the profession demands is that we should be as clean as possible, not that we should be impossibly clean. The fact that it is not possible to carry any admirable measure out to its fullest lines, does not imply that we should neglect to do what we can along these lines. The use of the thermometer in diagnosis is considered necessary by all the leading modern authorities in this line, and probably more harm would be done thru a discontinuance of its use than would be gained in a possibly more thoro asepsis. Care in its use is what is necessary.-ED.]
Editor MEDICAL WORLD:-The continued presence of this by no means trifling disease has called forth the benefit of our '92 experience, with additions. Our one week of continuous fog in December, so unusual in this locality, seemed to be the exciting cause of our wholesale trouble. Blood tests proved that the grip was intensified with so-called malarial poison. The prolonged cough paroxysms, not amenable to the usual cough or expectorant remedies, proved it of a nervous character, acting like the whooping-cough.
If any lung complications occurred, which they frequently did, the left lung seemed especially selected, either in part or whole, but noticeably in the lower section, next the diaphragm.
In my practise if when the case was first seen the bowels were loose, a tengrain dose of blue mass was given, followed by a dose of some saline cathartic. If the bowels were torpid a fulldose of calomel was given, followed also by a saline. For the coryza, inhalations of strongest alcohol were used frequently
Bourbon, Ind. [There are some good points in this and continued for ten minutes at a time.
Constitutionally a No. 1 capsule filled with equal parts of salicylic acid and the bisulfate of quinia with one-tenth grain extract cannabis indica, was given every three hours until the specific ringing in the ears occurred.
For the intense frontal headache, which often occurred, I gave five-grain doses hourly, if necessary, of antikamnia, either alone or with a fractional dose of codein. Painting the sides of the neck over the course of the pneumo-gastric nerves frequently with equal parts of menthol, gum camphor and chloral hydrate, rubbed up together, relieved the spasmodic cough. The only cough preparation used was the old-time muriate of ammonia and Brown mixture, with one grain of chlorodyne to each ounce, given in teaspoonful doses every two or three hours.
To sum up the whole modus operandi was to unlock the portal system-antisepticize the blood-eliminate thru the skin and kidneys what remained of the poison, with the happy sequel, even with complications, of saving our patients time and suffering.
Lately, it has fallen to my lot to see an unusual number of cases of the carbuncles, mostly in middle-aged persons, the lesion occurring upon the side of the neck, as well as on the back of it. Locally I applied over the center of the carbuncle, if large, a bunion plaster; if small, a cornplaster, the inner edge of which was smeared with lard. A piece of caustic potash, one-quarter of an inch in thickness, large enough to fill the opening, was introduced, this covered with antiseptic cotton. The patient for an hour, if not too painful, was instructed to so lie that the top of the sore was uppermost.
After taking off, the part was washed thoroly with carbolated soap-suds, and the opening dressed with an ointment made with one dram of solid extract belladona, four drops of carbolic acid and one ounce of basilicon ointment.
Internally the patient was given a onegrain pellet of calcium sulfid every three hours, and I had quick and good results in all cases. One case, a drummer in a band, was about three days after the caustic was applied. The surrounding swelling, which was immense, began to subside as soon as the caustic potash had eaten a hole.
The old plan of making crucial incisions is too slow. A quick deep suppurative surface is what you want to get rapid
cures. This may not be new to some, but those who have not tried it will find the quick curative results gratifying.
Some doctors are great for pinning their faith on poultices of various kinds. I look upon them as nasty things. In '52, when I listened to Dr. Willard Parker at the College of Physicians and Surgeons of New York City, at a time when poultices were much in vogue, he tersely told us that there were only three kinds of poultices in existence: 1. Simple, consisting of heat and moisture; we could get that best and cleanest from hot water, 2, anodyne poultices; and, 3, antiseptic. Laudanum or other anodynes added to the simple. made the anodyne poultice - charcoal, yeast or other antiseptics with the first constituted the antiseptic poultices. If necessary all could be united, making a simple anodyne and antiseptic poultice.
I do not use poultices on carbuncles. When I have a colicky child and want warm fomentations I use thick spongeline, with the outside coating of rubber, now so happily manufactured. It can be wet quickly, and will hold the heat for a long time. It is always ready, always cleanly. The laity are welcome to flaxseed, slippery elm, mush and other poultices. ELIHU B. SILVERS. Rahway City, N. J. Practical Experience with Pneumatic Treatment in Tonsillitis.
Editor MEDICAL WORLD:-My experience in treating tonsillitis may appear unique, as no internal remedy has been resorted to nor have any "weeks," much less "months," been passt treating any acute case.
My first pay case was treated December 25, 1892, at 6 p. m., and three hours later the patient, a lady of fifty years, was sleeping sweetly, tho an intense sufferer for many days previously, under other treatment.
The second treatment was given at my office the following day, and the patient was advised to return for one more application. This advice was ignored, the patient believing herself cured. A little later, however, another cold brought on a new attack of tonsillitis, which was cured permanently in two treatments. At least there has been no return since, tho the trouble was frequently recurrent before.
Two years ago, a young man of twentyfive or six came to me, whose tonsils had been enlarged for fourteen years, suffering