either antipyrin or antifebrin. This is true of MEDICAL MISCELLANY. it in acute as well as in chronic fever. In the experience of others, as well as in our own, it CLINICAL NOTES € Gossip From Kansas City Medical College. has been known to reduce acute fever in cases in which both of the latter agents had signally failed. Not only does it appear to be the most effectual antipyretic, but it also seems to be free from producing any toxic effects unless it is given in very large doses, while both antipyrin and antifebrin are prone to give rise to these the former to a cutaneous rash, and the latter to a cyanotic condition of the blood. Phenacetin is especially valuable in suppressing the fever of pulmonary consumption. In this as in every other chronic form of fever, large and probably double doses are required to achieve the same end as that which is obtained in acute fever. Of course no iron-clad rule can be laid down as to how much should Reported for Kansas Medical Journal. BY R. S. MAGEE. Prof. Van Eman, clinical lecturer of practical medicine, details regularly two members of the senior class to a ward of the city hospital, assigning them a case, and requiring in writing a complete and thorough diagnosis, prognosis and outline of treatment, with reasons for same, to be presented to him within one week, and read before the class. This is meeting the actual, practical work face to face. It is with pleasure we record the marriage of our senior surgeon, Prof. Halley, and two of our graduates. We extend our heartiest congratulations and best wishes for prosperous futures. Dr. W. J. Beattie, of the class of '85, and Miss Clara Choteau, of this city, were married on the evening of October 2. A tour, including Washington and New York cities, being Dr. Beattie is one of gone about two weeks. our demonstrators of anatomy, and secretary of the alumni. be given in any individual instance. The best guide that can be followed is to give it "for effect." If four or five grains administered every four hours do not suffice to bring down the temperature. there should be no hesitation in giving from ten to twenty grains. Ordinarily it will be found, however, that from five to ten grains is all that is required in such cases. It also has a modifying influence on other symptoms of this disease. Simultaneously with the reduction of fever, the cough becomes easier, the expectoration diminishes, and a general improvement in the patient's condition follows. From this it will be seen that phenacetin does good, not only as an anti-erton, Kansas, and has a good paying practice. pyretic in pulmonary consumption, but also Prof. Tyree, in speaking of foreign bodies as a constitutional tonic-a role which it un- in the vitreous chamber, said that they were a doubtedly plays through its action on the source of great danger. They will set up innervous system; and for this reason it renders flammation of the vitreous, and through the useful service, and its administration should ciliary nerves set up irritation in the fellow be continued in three or four-grain doses three eye, leading to inflammation and its destrucor four times a day after the fever has abated. tion. If it is known to be a piece of iron or That which is true of phenacetin in pulmon- steel, a powerful magnet may be of great servary consumption also holds true in chronic ice in its removal, under the following conbronchitis, whooping-cough, migraine, neu-ditions: Dr. J. R. Atchison, class of '86, and Miss Maggie Tillman, of Dover, Kansas, were married October 30. The Doctor resides at Edg 2. 3. Before foreign body encapsulates. If wound is in the sclera. ralgia, neurasthenia, &c., when it is given in I. If the wound be recent. 4. And especially if foreign body is in anterior chamber. If the lens is pierced by the foreign body, 4. Fibroid phthisis is always an evidence of an attempt at repair. When it fails longer to limit the disease, tubercle-bacilli are found in abundance in the necrotic tissues. the distance the latter would have to be with- under the influence of the bacilli of this name, drawn through the dense, firm substance, are often the primary lesion of phthisis. would render the use of the magnet impracticable. The lens, in this case, should first be removed. The form of magnet used is an electro-magnet, with a variety of different sized points; any desired strength can be had by increasing or decreasing the number of cells. It may be necessary to enlarge the scleral wound to admit the blunt point of the magnet, which, when introduced, should be carefully moved along the edge of the wound. If this fails, it may then be passed on into the vitreous, in the direction the foreign body has taken. If you do not succeed, enucleation is your only recourse, especially when there is no vision left in the eye. The tubercle-bacillus is a minute rod-shaped fungus, measuring from 0.0035 to 0.003 millimetre in length, and about one-third that measurement in thickness. The rods are straight or slightly curved, with rounded ends. After having been stained with methyl-blue or fuchsin, and then washed in nitric acid, (ten per cent.) they retain the original stain, and thus distinguished from any putrefactive or other bacilli. following: R. Tr. Iodini Comp. Inflammation of the sebaceous follicles of Prof. E. W. Schauffler, in a recent lecture the vulva is frequently caused by acrid dison phthisis, said that many of the teachers of charges from the uterine cavity. The orifice our own land are still quite cautious about of vagina becomes very sensitive, accompanied committing themselves to the new doctrine of by an intense pruritus. An eczematous erupthe bacillar origin of phthisis. But I believe tion, covering the labia and upper part of the medical sentiment is drifting that way, and thighs frequently appears. In the treatment that soon no one will teach anything else. of the above, Prof. Todd recommended the Twenty years' ago Niemeyer, the champion of "Catarrhal Phthisis," said, "The great danger to the phthisical patient is, that he may become tubercular." To-day we reiterate this statement, in substance, with a somewhat M. Sig. To be applied locally to the parts. more correct idea of what it means, and would Two or three applications at an interval of say, the great danger to a patient with areas of three or four days, will generally effect a cure. consolidation in his lungs, of whatever origin, The application is too powerful to be applied is, that they may become invaded, if they are not more frequently. It occasions some smarting, so already, by the tubercle-bacillus. In adopting which ceases after a few minutes, leaving the this view I by no means reject the teachings patient quite comfortable. In the interval the of clinical experience, and of the post-mortem patient should be directed to use the following table, to the effect that many cases of phthisis, as an injection and lotion to the parts three or evidently follow catarrhal, or sometimes croup-four times a day: ous pneumonic processes, giving no evidence, post-mortem, of the presence of tubercular nodules. The Doctor summed his position as follows: I. The tubercular nodule is no longer the criterion of tuberculosis, but this criterion is always and only the tubercle-bacillus. Sat. Sol. Acidi. Carbol. āā f3j. R. Sodii. Hypo. Sulph. 3j. Aquæ Dest. 3ij. M. Ft. Sol. This is a germicide, and soothing in its effects. A SERIES of experiments, conducted by Dr. 2. The areas of consolidation following Jos. J. Kinyoun, of the United States Marine bronchitis, lobular catarrhal pneumonia, or Hospital Service, showed that the ordinary sometimes croupous pneumonia, are liable to method of cleansing the hands and nails by be invaded by the tubercle-bacillus, and then scrubbing with soap and water, and then washphthisis is developed. ing in a 1 to 3000 bi-chloride solution, as em3. Tubercular nodules, probably developed ployed by nurses in the service, did not render them surgically clean. Scrapings from the by her physician, who had dismissed the case. hands and from under the nails gave rise to The next night she sent for me. I called at colonies of bacteria, more particularly the midnight on my return from other work to staphylococus pyogenes, in nearly every instance. Satisfactory cleansing was only obtained when the hands were scrubbed with soap and water, immersed five or six minutes in alcohol, and an equal time in bi-chloride solution 1 to 1000 or stronger. Better results were obtained when bi-chloride was added to the alcohol in the proportion of 1 to 3000, and the solution in water made of a strength equal to I to 500. find her suffering greatly with an inflamed knee, high fever, and knee apparently so tender she could or would not be moved, or hardly touched. I directed cold towels applied to the knee. She evidently thought I must be either drunk or crazy, as I was a stranger to her. But her husband, thinking the doctor's word must be law, set about carrying out my directions. At my morning visit pain all gone and swelling going, temperature about normal. I kept track of this An Unusual Treatment for Acute Articular case for two or three years, and she had no Rheumatism. Dr. W. H. Carruthers, at the June meeting of the Minnesota State Medical Society, 1889, in his report on Rheumatism," says: "I believe anything that will combine the two objects I have indicated, viz., reduce temperature and change the blood to an alkaline condition as soon as possible, are the indications for treatment. "My experience has led me to believe that I have a good plan of treatment. I shall not say the best, but one that has been the best in my hands. "Case 3.-Mr. G―, an elderly man, with right wrist and elbow, and left elbow and shoulder afflicted. I directed, as usual, soda salicylate and cold water; when he found how much relief he obtained he got some snow which he put into towels, and packed that about his sore joints. At my second visit he was only complaining of a little stiffness of the afflicted joints, which had all disappeared by the next day, and he went to his office. "Case 4.-Miss M. In this case I was "I wish to report a few cases with the re- not so successful, but it will do to point a sults of my treatment during the last three or moral. When I called, I found her with her four years. Having used the treatment laid wrists and knuckle joints, and one ankle down in our books with the usual results of Her temperature was very high, having my cases last from ten days to three about 105° I prescribed as usual, and at my weeks, I tried the use of ice cold applications second call found no improvement. to the inflamed joints and the salicylate of surprised, but on close inquiry found that the soda internally. My results have been the cold had been applied not more than two or most satisfactory, and I shall only occupy three times since my last visit. I made a few your time for a few minutes while I give re- pointed remarks, and received a note in an sults in a few of the worst cases I have met hour or two telling me I need not call till sent since following this plan. for. As I have never been sent for, have not called yet; but I learned the lady had a good homeopath to attend her, and remained in her bed almost a month. "My first case was a man with both knees and one ankle inflamed; I gave sod. salicylate 15 gr. every two or three hours. Towels taken from ice cold water and applied every five to ten minutes, or as fast as they became warm. His temperature 104°, at my visit next morning was 100°, pain and swelling nearly gone, having entirely disappeared by next morning. "Case 2.-Mrs. M- had been sick for two weeks with rheumatism, but considered well afflicted. I was "Case 5.-An Irish lad of fifteen years. His left wrist, knuckles and elbow, left knee and ankle, and his right knee. I never saw anybody so bad with rheumatism before or since. His temperature was nearly 106° I prescribed sod. salicyl. in 10 gr. doses and ice cold applications at once. I met some opposition, as a young lady present said she had once been sick seven weeks with the same trouble, and they used warm flannels; but a neighbor, whose confidence I had, went in and set to work to carry out my directions. He told me that he heard the boy crying from the pain when two blocks from the house; but in twenty minutes after using the cold to the joints he became quiet and rested well all night. At my call, fifteen hours after my first, I found him sitting in an easy chair with his temperature 100%1⁄2°, pain all gone and little swelling. In two days more he was about his work. 'My last case, which I wish to report, was a German woman. When I first saw her, her right knee was enormously swollen and very painful. She lived in the country, so could not readily get ice, as it was summer time, but she began using water from the well; that was about ten o'clock in the forenoon. Being at her neighbor's at 8 p. m., I ran in to see her. She had as she said 'gone to bed for the night.' She had taken quite a large piece of ice which she had procured somewhere, under her knee, and several small pieces wrapped in a towel laid upon it. I thought if she could stand it I could. When I called next day she was about the house at her work. "These are some of my worst cases treated in the last three or four years, with the ice water packs about the inflamed joints. None of them had relapses, and most of them I have known to be free from any attacks of rheumatism since. Not one has had the least sign of heart complications. "Dr. Bartholow says, "The acute stage of a rheumatic seizure, if the first one, is not often terminated in an earlier period than two weeks, and is more frequently prolonged to three or even four weeks.' Mr. Fuller's cases show under the alkaline carbonates, an average of eleven days, with only two per cent. of heart inflammations. While I have not a hundred cases to report, I feel sure if carried out carefully, I can show as good results for hundreds of cases. The average duration of my cases was between two and three days, and with no heart complications, is as good a result as I could wish. used to say to me when I was a boy and wo ing for him, 'anything that's worth doing all is worth doing well.' Don't apply cold any other way but well and thoroughly.” Rascality in Medicine. The man who offers to sell his wares cheaper than his neighbors, using the large type to call attention to his liberality and business tact and then fails to satisfy his customers, either giving short weight or inferior goods, soon comes to be called dishonest and loses the confidence of the trade. The politician who makes promises to his patrons of retrenchment and reform in the administration of affairs of which he may have the management, and then proves false to these promises, soon loses his prestige and standing. Why not carry this principle into the every-day business of the doctor, one who stands as high, or should, as the representatives of any other business, and demand the same honesty and integrity in our dealings with life and health, as in commercial and political matters. The doctor who auscultates and percusses a slightly inflamed lung, or irritable heart from indigestion, gives a nasty mixture, with a very unfavorable prognosis, alarms the friends, and then convinces them in a few weeks that he has performed a wonderful cure, nine times out of ten is an impostor. This same man is always finding and removing cancers, tumors, malignant growths, and magnifying simple surgical operations which are performed silently and skillfully by nearly every physician in the country, into wonderful examples of skill and knowledge, and all the old women in the neighborhood are constantly sounding his praises, while the really honest and conscientious practitioner is obliged to keep silence in the matter, on penalty of being called jealous and envious of this wonderful man's reputation. Such men are a disgrace to the profession of medicine, and should be exposed by all of us in a way to cause their downfall. We all know men of this character. Pulverize them. G. C. IRWIN, M. D. EFFECTS OF OUR LATE WAR ON SOLDIERS "A word of caution: An old friend of mine -Dr. Coe, in the N. Y. Medical Journal, calls ttention to the fact that nearly all the promi- changes in the tissues were very considerable. ent generals on both sides of the late war The lungs of gold miners were generally injave died prematurely. He says that obser- durated and atrophied; the dust in these cases. rations made during three years' service in is exceedingly fine. Sand produced numerthe late war, and a service of several years as ous circumscribed hard nodules and thick inpension examiner since, indicate that those durations. In cloth manufacturers, the lungs, soldiers who bore the tremendous hardships in spite of their contact with an enormous and privations of the field without becoming quantity of organic dust, presented but few disabled thereby, have since become prema- indurations. In the lungs of two stonemasons turely old and decrepid, some of them without induration and tuberculous disintegration were any assignable cause save the premature ex- observed; all the other lungs were entirely penditure of the reserved vital forces; others free from tuberculosis of any kind, an observafrom faulty nutrition, indicated by degenera- tion which was verified by the absence of tution or sclerosis of the spinal cord and arteries, bercle bacilli in the muco-pus in the vomicæ. and resulting disease of the heart, and chronic-Lance. rheumatic troubles affecting mostly the spinal and sciatic nerves. THE California State Board of Health has stirred up a hornet's nest in the southern portion of the State by protesting against consumptive patients being invited to come there. The board insists that the mingling of a large number of patients with consumption among the healthy is a menace to the health of the latter, urging that "consumption is never contracted except by association or by living in tempt to interdict immigration, but points out the danger involved. The danger from sputa is unquestioned, and it is to be hoped that the disuse of handkerchiefs for spittoons will soon come about, and that only proper receptacles, frequently disinfected, will be used for sputa. Dr. Kunze, in his inaugular thesis for the M. D. degree in the University of Kiel, publishes as a contribution to the diseases caused by the inhalation of dust a series of examinations of lungs so affected. In all these dust was found microscopically, and after chemical tests in the various anatomical and histiolog- close proximity." The board does not atical parts of the lungs, and in the anterior of the lymphatic vessels, numerous leucocytes were found covered with the dust. Being arrested in its progress it causes inflammation, producing hyperplasia of connective tissue, especially where a dense network of lymphatic vessels exists. Dr. Kunze also proved that the degree of alteration in so-called "dust The usefulness of good Hypophosphites in lungs," depends not merely on the quantity of pulmonary and strumous affections is generthe dust inhaled, but also on its greater or less ally agreed upon by the profession. We commorphological power of injuring the tissue. mend to the notice of our readers the adverHe concludes from his experiments that even tisement on page xii of this number. "Robthe greatest alterations in these lungs-such inson's Hypophosphites" is an elegant and as nodes, indurations, and vomica-are mainly uniformly active preparation; the presence in produced by the inhaled dust, and that tuber-it of quinine, strychnine, iron, etc., adding culosis is only an occasional coincidence. The highly to its tonic value. least serious alterations in the lungs resulted from the inhalation of lamp-black, the particles DR. CHARLES ADAMS, of Kansas City, deof which are very fine and little injurious; the serves credit for reporting the cases in his most serious, from dust inhaled by earthen- paper in this number of the JOURNAL. It ware manufacturers and stonemasons. The requires nerve to report our failures. The lungs of a locksmith showed only a moderate physician who claims he has no failures, hyperplasia of connective tissue, the dust con- either has an extremely limited experience or sisting partly of the finest particles of iron. lies. That man can be trusted who on proper In a worker in oxides of iron the lungs were occasions reports his failures that the profesfound full of small granules, and the morbid sion may be benefitted. |