From the N. W. Medical and Sugrical Journal.

Cold Water in Dysentery. By F. BLADES, M.D.

If it be the accumulated experience of individuals which gives us our rules in the practice of medicine, every one ought to contribute his mite, if it be of any value. I am, therefore, prompted to send you a slice of my experience.

Last year I had many cases of dysentery to treat. Some of these "wore the livery" of the ordinary non-malignant variety, and were amenable to the usual remedial means; while others the majoritywere of the epidemic or malignant variety, and with surpassing stubbornness, "went their ways," heedless of cure, i. e., by the most practised methods.

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Now, we, who have not a reputation to live on after a defeat, cannot well afford - if I may use a sinister expression to lose many patients consecutively, else we fall into disrepute, and strait-way lose our practice. This motive, which was secondary to the heart-felt interest I had in the recovery of my patients, as also this latter motive, caused me to depart from the calomel and opium, etc., etc., land marks in treating the more malignant variety of dysentery. I have now in my mind a case, which, conjointly with Dr. Fowler, then my partner, I was called upon treat. The malady" waxed exceeding sore" from its onset. The griping was positively excruciating; the straining extremely ardent and incessant; the stools exceedingly large, grayish and bloody, containing membranouslike shreds; the pulse was quite frequent, and not forcible. This is a rudely sketched outline of the condition of the case as was reported to me to have existed prior to my attendance. The doctor who was first called had treated the case with calomel and opium, q. s., castor oil and laudanum, as a laxative, once in twenty-four hours, with other adjuvantiæ now passed from memory, for three or four days, at which time I was called to see this case with him. The above-mentioned symptoms were said to be unabated. The pulse was now feeble and about 120; the tongue was covered with a thick brown fur, and dry, the edges were fiery and the whole tongue was dotted over with elevated papilla- here and there protruding through ihe fur-coat. The stomach was so excessively irritable that it would scarcely rerain a tea-spoonful of water. I suggested an enema consisting of a strong solution of nitrate of silver, which was twice or thrice repeated during the ensuing twenty-four hours. Also camphor spts. and oil of turpentine, equal parts, to be applied, almost hot, to the abdomen. It was of no use. The disease increased in severity. We looked upon the mortal issue as being but a few hours in advance of us. Here was our extremity, and cold water was the straw caught at. · What miraculous buoyancy there was in that dernier resort! We left off medicine entirely little use was it when none would be retained in the stomach and determined to try cold water. We wrapt the patient in a cold wet sheet, and thereupon having previously passed a stool every ten or fifteen minutes · he lay one hour and a half without having desire to go to stool. At the end of this time the surface almost glowed with warmth, and there was the moisture of sweat about the face

and neck. The patient was then wiped dry with towels and placed in a dry bed. This operation was thenceforward repeated every five or six hours for the next five days, after which time it was only used once or twice in twenty-four hours for two or three days longer. Instead of the warm fomentations, which had been constantly applied, cloths rung out of cold water were frequently repeated to the abdomen. As enemas we used cold water, simply-8 or 10 ounces immediately after every evacuation. In every case in the treatment of which we used cold water injections, it was found to be important that it should be administered immediately subsequent to every stool. They were borne without distress, and much longer. I ought, also, to mention that after the first day we used the cold Sitz-bath of the hydropathists. From the commencement of this treatment the irritability of the stomach was entirely appeased; the stools became less and less in frequency, and of a more natural appearance and consistence. As a diet, as well as an auxiliary in the treatment, we ordered the animal broths well salted.

Several other cases I have in my mind of a like character with the above. With the exception of one, however, none of them were so violently attacked. That case being of a more robust habit, the disease did not succumb so readily. I commenced treating with calomel, ipecac, and one grain of morphine every three hours- - at the end of twentyfour hours giving a castor-oil laxative warm fomentations to the abdomen; enemas of cold water and laudanum. This course was kept up with more or less modification until the expiration of a week. I was not flattered by the progress my patient had made for the better. I then resorted to the water treatment - carrying it out as in the first instance. Upon the first using of the wet sheet the bowels were quieted two hours having been previously moved as often as from 15 to 30 minutes. The patient kept right on improving- steadily, yet I confess, slowly. It was gratifying to see the complete relief from the excruciating tormina and tenesmus which followed the "wet-sheet-packing." In this case I used as often as once in four hours, the turpentine emulsion, strongly charged with laudanum. I also occasionally ordered laudanum in the injections.

In many cases, the cold, wet bandage and cold water injections were used as auxiliaries to other treatment, and with a highly gratifying effect. I am so thoroughly convinced of the powerful efficacy of cold water in the treatment of dysentery that I do not hesitate to say I regard it as one of the chief remedies for combating that formidable disease.

Dr. Bennett, of this place a practitioner of many years standing, and a correct observer, after being repeatedly disappointed by depending upon the ordinary remedies alone, is, upon fair trial in many instances, enthusiastic in his confidence in cold water as a powerful auxiliary in treating dysentery.

It would be absurd to argue a general rule from such limited experience, yet its effects have been so highly gratifying in the hands of many practitioners, that it is hard to resist the conviction that cold water deserves a more honorable place among the therapia of dysentery than it has hitherto obtained.

EDITORIAL.

The Peninsular Quarterly and University Magazine.

We have received the first number of this humorous periodical. It is edited by J. S. Morton, Esq., and contains articles of much merit. It aims to give

a channel of expression to the literary talent of the west. Those who rejoice to see the progress of our State, will be pleased at the advent of this magazine. The terms are one dollar a year. Letters should be addressed to Peninsular Quarterly, Ann Arbor.

We are indebted to Prof. Baird, of Washington, for valuable documents of the Smithsonian Institute.

Code of Medical Ethics.

Concluded from page 96.

ART. IV. Of the duties of Physicians in regard to Consultations.

SEC. 6. In conclusion, theoretical discussions should be avoided, as occasioning perplexity and loss of time. For there may be much diversity of opinion concerning speculative points, with perfect agreement in those modes of practice which are founded, not on hypothesis, but on experience and observation.

SEC. 7. All discussions in consultation should be secret and confidential. Neither by word or manner should any of the parties to a consultation assert or insinuate, that any part of the treatment pursued did not receive his assent. The responsibility must be equally divided between the medical attendantsthey must equally share the credit of success as well as the blame of failure. SEC. 8. Should an irreconcilable diversity of opinion occur when several physicians are called upon to consult together, the opinions of the majority should be considered as decisive; but if the numbers be equal on each side, then the decision should rest with the attending physician. It may, moreover, sometimes happen, that two physicians cannot agree in their views of the nature of a case, and the treatment to be pursued. This is a circumstance much to be deplored, and should always be avoided, if possible, by mutual concessions, as far as they can be justified by a conscientious regard for the dictates of judgment. But in the event of its occurrence, a third physician should, if practicable, be called to act as umpire, and if circumstances prevent the adoption of this course, it must be left to the patient to select the physician in whom he is most willing to confide. But as every physician relies upon the rectitude of his judgment, he should, when left in the minority, politely and consistently retire from any further deliberation in the consultation, or participation in the management of the case.

Sec. 9. As circumstances sometimes occur to render a special consultation desirable, when the continued attendance of two physicians might be objectionable to the patient, the member of the faculty whose assistance is required in such cases, should sedulously guard against all future unsolicited attendance. As such consultations require an extraordinary portion both of time and attention, at least a double honorarium may be reasonably expected.

Sec. 10. A physician who is called upon to consult, should observe the most honorable and scrupulous regard for the character and standing of the practitioner in attendance; the practice of the latter, if necessary, should be justified as far as it can be, consistently with a conscientious regard for truth, and no hint or insinuation should be thrown out, which could impair the confidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extraordinary attentions or assiduities, which are too often practiced by the dishonest for the base purpose

of gaining applause, or ingratiating themselves into the favor of families and individuals.

ART. V.-Duties of Physicians in Cases of Interference.

Sec. 1. Medicine is a liberal profession, and those admitted into its ranks should found their expectations of practice upon the extent of their qualifications, not on intrigue or artifice.

Sec. 2. A physician, in his intercourse with a patient under the care of another practitioner, should observe the strictest caution and reserve. No meddling inquiries should be made; no disingenious hints given relative to the nature and treatment of the disorder; nor any course of conduct pursued that may directly or indirectly tend to diminish the trust reposed in the physician employed.

Sec. 3. The same circumspection and reserve should be observed, when from motives of business or friendship, a physician is prompted to visit an individual who is under the direction of another practitioner. Indeed, such visits should be avoided, except under peculiar circumstances, and when they are made, no particular inquiries should be instituted relative to the nature of the disease, or the remedies employed, but the topics of conversation should be as foreign to the case as circumstances will admit.

Sec. 4. A physician ought not to take charge of, or prescribe for a patient who has recently been under the care of another member of the faculty, except in cases of sudden emergency, or in consultation with the physician previously in attendance, or when the latter has relinquished the case or been regularly notified that his services are no longer desired. Under such circumstances no unjust and illiberal insinuations should be thrown out in relation to the conduct or practice previously pursued, which should be justified as far as candor and regard for truth and probity will permit; for it often happens, that patients become dissatisfied when they do not experience immediate relief, and, as many diseases are naturally protracted, the want of success, in the first stage of treatment, affords no evidence of a lack of professional knowledge and

skill.

Sec. 5. When a physician is called to an urgent case because the family attendant is not at hand, he ought, unless his assistance in consultation be desired, to resign the case of the patient to the latter immediately on his arrival.

Sec. 6. It often happens, in cases of sudden illness, or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under these circumstances courtesy should assign the patient to the first one who arrives, who should select from those present any additional assistance he may deem necessary. In all such cases, however, the practitioner who officiates should request the family physician, if there be one, to be called, and, unless his further attendance be requested, should resign the case to the latter on his arrival.

Sec. 7. When a physician is called to a patient of another practitioner, in consequence of the sickness or absence of the latter, he ought, on the return or recovery of the regular attendant, and with the consent of the patient, to surrender the case.

Sec. 8. A physician, when visiting a sick person in the country, may be desired to see a neighboring patient who is under the regular direction of another physician, in consequence of some sudden change or aggravation of symptoms. The conduct to be pursued on such an occasion is to give advice adapted to present circumstances: to interfere no farther than is absolutely necessary with the general plan of treatment, to assume no future direction, unless it be expressly desired; and in this last case, to request an immediate consultation with the practitioner previously employed.

Sec. 9. A wealthy physician should not give advice gratis to the affluent; because his doing so is an injury to his professional brethren. The office of a physician can never be supported as an exclusively beneficent one, and it is defrauding, in some degree, the common funds for its support, when fees are dispensed with, which might justly be claimed.

Sec. 10. When a physician who has been engaged to attend a case of midwifery is absent, and another is sent for, if delivery is accomplished during

the attendance of the latter, he is entitled to the fee, but should resign the patient to the practitioner first engaged.

ART. VI.—Of Differences between Physicians.

Sec. 1. Diversity of opinion and opposition of interest may, in the medical, as in other professions, sometimes occasion controversy and even contention. Whenever such cases unfortunately occur, and cannot be immediately terminated, they should be referred to the arbitration of a sufficient number of physicians, or a court medical.

Sec. 2. As peculiar reserve must be maintained by physicians towards the public, in regard to professonal matters, and as there exist numerous points in medical ethics and etiquette through which the feelings of medical men may be painfully assailed in their intercourse with each other, and which cannot be understood or appreciated by general society, neither the subject matter of such differences nor the adjudication of the arbitrators should be made public, as publicity in a case of this nature may be personally injurious to the persons concerned, and can hardly fail to bring discredit on the faculty.

ART. VII-Of Pecuniary Acknowledgments.

Sec. 1. Some general rules should be adopted by the faculty, in every town or district, relative to pecuniary acknowledgments from their patients; and it should be deemed a point of honor to adhere to these rules with as much uniformity as varying circumstances will admit.

CHAPTER III.— OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF THE OBLIGATIONS OF THE PUBLIC TO THE PROFESSION.

ART. I.-Duties of the Profession to the Public.

Sec. 1.-As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens; they should also be ever ready to give counsel to the public in matters especially appertaining to their professions, or on subjects of medical police, public hygiene, and legal medicine. It is their province to enlighten the public in regard to quarantine regulations-the location, arrangement, and dietaries of hospitals, asylums, schools, prisons, and similar institutions; in relation to the medical police of towns, as drainage, ventilation, &c.—and in regard to measures for the prevention of epidemic and contagious diseases; and when pestilence prevails, it is their duty to face the danger, and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives.

Sec. 2. Medical men should also be always ready, when called on by the legally constituted authorities, to enlighten coroners' inquests and courts of justice, on subjects strictly medical-such as involve questions relating to sanity, legitimacy, murder by poisons or other violent means, aud in regard to the various other subjects embraced in the science of medical jurisprudence. But in these cases, and especially where they are required to make a postmortem examination, it is just, in consequence of the time, labor and skill required, and the responsibility and risk they incur, that the public should award them a proper honorarium.

Sec. 3. There is no profession, by the members of which eleemosynary services are more liberally dispensed, than the medical, but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain public duties referred to in sec. 1 of this chapter, should always be recognized as presenting valid claims for gratuitous services; but neither institutions endowed by the public or by rich individuals, societies for mutual benefit, for the insurance of lives or for analagous purposes, nor any profession or occupation, can be admitted to possess such privilege. Nor can it be justly expected of physicians to furnish certificates of inability to serve on juries, to perform militia duty, or to testify to the state of health of persons wishing to insure their lives, obtain pensions, or the like, without a pecuniary acknowledgment. But to individuals in indigent circumstances, such professional services should always be cheerfully and freely given.

Sec. 4. It is the duty of physicians, who are frequent witnesses of the enor