Summary Gleanings.

Stigmata, ustilago and viscum album are excellent oxytocics.

In puerperal fever salicin has a much more prompt effect than quinine.

Gelsemium promptly relieves neuralgic, congestive or periodical headaches.

Dr. Ebstein, after a long trial, deprecates the use of thyroid extract in obesity.

Remember that nux vomica is a most excellent remedy for atonic dyspepsia.

Headaches at the menopause, with the flushes followed by perspiration, are relieved with gelsemium.

Suppositories of ichthyol, 5 to 10 grains, are recommended in prostatis. They are used morning and night.

Fluid extract conium, in half drachm doses, is claimed to have given good results in threatened abortion.

Bryonia effects the muscles and, but more especially, the tendons. In rheumatism and pleuritis it may be depended on.

For abscesses, take boric acid and acetanilid, equal parts, and glycerin to make a thick paste: spread on a soft cloth and apply.

Dr. Hermamie used orexine, four grains, three times a day, in nine cases of vomiting of pregnancy with entire success in every case.

A combination of the Crede and Dublin methods is the best method of finishing the second and completing the third stage of labor.

Belladonna is indicated in dullness, delirium, vertigo, headache, distention of the veins, epilepsy and in typhoid fever with delirium, etc.

Dr. J. Mount Bleyer asserts that violet rays of light, applied to the human system by means of electricity, is an absolute cure for consumption.

Uricedin, now so extensively used in uric acid conditions, is composed of sodium sulphate, chloride, and citrate acetate, tartarate pomate and pectorate, with a small quantity of limonin.

Dr. Peterson recommends for favus softening the crust with a one per cent. carboated vaseline ointment; wash with soap and water and paint with iodine.

Hebra's formula for diachylor ointment is considered the best. It is composed of 15 ounces of olive oil, 3 1-2 ounces of lead oxide and two drachms of oil of lavender.

Honesty in the practice of medicine will finally bring its own reward, though you may find your patience sorely tried by seeing the quack and the charlatan thrive, while you wait for business.

Dr. Phelps says, in the N. Y. Med. Jour., that from personal observation he can state positively that alcohol is an absolutely safe and sure specific against the escharotic action of pure carbolic acid.

Baptisia (wild indigo) is one of our best antiseptics or antizymotics. It has a good effect in diphtheria and in all septic diseases. It is valuable in typhoid fever, where it may be alternated with sulphocarbolate of zinc.

There is evidently a fixed law in nature that controls disease, but there are so many idiosyncrasies in individuals that each case must be a separate study, and we must treat the symptom, or that which the symptom indicates.

Before giving ether to patients suffering from catarrh of the nasal passages, wash these out with an alkaline solution. This will, by cleansing out the secretions, allow much easier breathing, and hence increase the facility with which anesthesia can be induced.

Finger stalls of thin rubber are useful in curing the habit of nail-biting, in retaining ointments and other applications in paronychia and nail diseases, and are invaluable to the genito-urinary surgeon as a protection in examinations of uterus, prostate and seminal vesicles.

Dr. J. Inglis recommends cimicifuga in rheumatism of the womb; caulophillin in menstrual spasms; pulsatilla for menstrual headache, when the patient is pale and nervous and the menstrual flow scant, when there is a feeling of uterine weight and dragging, causing great mental irritability.

VOL. XXI.

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THE PHYSICIAN SHOULD BE LIBERAL.

In order to keep well up in the advance of medical progress it is not essen

tial that our minds should be carried away with every innovation, but, for the best interest of our patients, a certain degree of conservatism in our attitude toward things new, whether in therapeutics or elsewhere, is eminently important to safety.

Our thought is correctly expressed in the following, the language of one of our contemporaries:

No. 7

"When conservative instinct causes us to refuse to examine new things and, even when tested by others and declared good, keeps us from trying them under any circumstances, it becomes a dangerous obstruction. Justice to himself, to his patient and to the race demands of every physician that he constantly seek to give the very best remedy known, so that he may reach the maximum of cures. Unless a doctor keeps informed of the discoveries in materia medica he cannot expect to reach this maximum. If he allows himself to be misled by the specious appeals of the enemies of progress or by his natural desire to let well enough alone, he is sinning against reason."

In reply to the question, "Is it proper for a physician to employ a proprietory drug," we append the following from an editorial in a late issue of the Med News:

"It seems to us that this question should be answered in the affirmative, giving as one reason for that conclusion the fact that a physician has no right to deprive patients of chemical products which are indicated because the methods of their manufacture or protection do not meet with his approval."

How much more successful we would be in our practice, and how much more would suffering humanity be relieved if our poor little bigoted skeleton minds were swept clean of the dust and cobwebs

of the puny little dimp of prejudice that makes us turn our backs and sneer at any good in any "pathy" but our own.

That is a weakness in most of us which causes us to see the mote that is in our brother's eye and hides the beam in our

own.

Oh, that we might be more liberal! We should use the best of everything and acknowledge it, no matter from what source it comes. It would be wise for all medical practitioners to follow the advice of Paul, "prove all things, holding fast to that which is good."

AUTO-INTOXICATION.

Under the above caption, in the May number of Merck's Archives, occurs an article by Dr. Nesbitt, in which he concludes that in cases of intestinal obstruction sufficient choline or neurine to give rise to poisoning may accumulate, and that the products arise only in the alimentary tract as a result of bacterial activity.

He throws aside, as of minor consideration, putrescence, fermentation, etc,, and holds that the auto-poisoning is from obstruction of the bowels, a single loop of which may, in the course of 36 to 48 hours, produce enough ptomains or choline to produce disastrous effects.

This reminds us of a case in our early practice. A young married woman, with several children, sent for us, and on arriving at her bedside we at once noticed her dispondency, and inquiring about it learned that she had been treated by another physician for the previous week or 10 days without any result for the better or worse, and that she feared a long spell of sickness, etc.

A general examination revealed to us no real cause why this woman should be sick in bed, but on inquiring we learned that her bowels had not been moved since

the other doctor commenced treating her. This gave us the clue at once, and we lost no time in administering a brisk cathartic, and, as discovered afterward, this was really all the medicine that she needed, for on the third day she was a well woman.

This was one of the many incidents that impressed us years ago with the fact that regular and entire emptying of the bowels every day is the only means of keeping healthy; so much so that we never forget to inquire about the condition of the bowels of our patients before commencing treatment.

Of course, a statement from the patient that the bowels are moved even daily is not a guarantee that they are sufficiently moved, as it is a well-known fact that constipation may exist even under such circumstances.

The bowels should be thoroughly moved, that is, we should have clean bowels, before commencing any line of treatment, generally.

Original Communications.

Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department.

Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors.

Write only on ONE SIDE of the paper.

ग

TYPHOID FEVER.

BY S. L. KILMER, M. D.

HE near approach of the season in which typhoid fever, in varying degrees of intensity, will prevail, makes the consideration of this disease and its treatment appropriate and pertinent. In this locality, fortunately, we do not have as serious epidemics and endemics of typhoid fever as exist in some other less favored localities, nevertheless there are always a sufficient number of cases here in the special season of the year to enable a physician to maintain familiarity with its peculiarities. It is not my purpose in this article to detail the various symptoms that indicate the disease, still it may not be out of place to mention a few of the characteristics in which it differs from what is supposed to be its character, as laid down in the books.

In the first place, instead of being usually attended by diarrhea, it has been my experience that constipation prevails in at least three-fifths of the cases, and, while generally, it has a premonitory stage of a week or more, still this is not always the case, or, at least, sometimes this premonitory stage seems to be altogether overlooked by the patient himself, who has been feeling as well as ever, until all at once he is overtaken by a storm of disease, so to speak, which may consist of a chill with headache and backache, followed by an intense fever, which remains at an unusual elevation and yet being, as subsequent results show, a genuine typhoid fever, while simulating malarial fever is not affected in the least by antimalarial or antiperiodic treatment. Of course, there is always more or less tympanitis, but this prevails as much with constipation as with diarrhea. There

is weakness, or rather prostration; more or less mental hebetude, but not necessarily delirium; more of a dull or listless character on the part of the patient.

There is doubtless more necessity for considering the treatment of the disease than there is its diagnosis, as comparatively few cases are required to enable a physician to judge and diagnosticate correctly, but the great difficulty has been, usually, in fixing upon the proper plan of treatment which shall be successful and terminate the disease at the earliest possible moment.

As above stated, in genuine typhoid fever antiperiodic treatment, such as quinine and arsenic, has been, in my experience, of very little benefit except as a tonic. Calomel, or mercury in some form, has served me exceedingly well in many cases, even where there was diarrhea; not because of its cathartic properties, but because of its antiseptic and alterative properties. When given in small doses of 1-10 grain of the mild chloride once every two or three hours, and kept up continuously for a period of from a few days to a week or 10 days during the early stages, it has often been of great benefit. The dry and brown coating on the tongue has disappeared or become moist and gray, more or less loose; sordes have not accumulated on the lips and teeth to any great extent, and there has not been that excessive mental hebetude.

In connection with this I have often been greatly pleased with the results of the use of turpentine in small doses of from three to five drops about three times a day. This may be given in an emulsion or dropped on sugar, and has an excellent effect upon the distention of the bowels, producing a very satisfactory diminution of the tympanitis. However, in some cases it produces unpleasant conditions, one of which is nausea and another hiccough, so that its administration has to be discontinued. In some of these cases I have then been able to give carbolic acid and iodine in small doses of from one-half to one drop each, in emulsion, with good results.

If the illness has continued for any very protracted period of time the administra

tion of iron has always seemed appropriate, and the results have demonstrated that such was the case.

A few years ago I made use of the Woodbridge treatment with some quite satisfactory results in some cases, and in other cases the results were not of such a nature as to encourage me to continue in that line. It seemed to me, however, that in various cases, while it did not appear to abort or cut short the disease, the condition of the patient was not SO serious as it might otherwise have been. The greatest objection I have found to that treatment is the fact that patients become very tired of continually swallowing the capsules, or "bird eggs," as they are often inclined to call them (the size being objectionable); besides, in some cases at least, they seemed to have affected the digestive organs unfavorably. This may have been due, perhaps, to the disease rather than to the treatment.

For some time past I have been using Antisepsin with the most gratifying results, patients recovering more speedily than they have from any other treatment, and with less malaise, fever, mental and physical weakness, anorexia, delirium, tympanitis, etc., and the duration of the disease has been materially abbreviated. This seems to have been the best general antiseptic and germicide which I have met with.

In the convalescing stage some mild bitters like the tincture of cinchona or a preparation of iron, composed of the muriated tincture of iron and dilute phosphoric acid, of each two drachms, combined with elixir pepsin or simple elixir, in sufficient quantity to make four ounces, and a teaspoonful given every three hours, has served me exceedingly well. Sometimes the elixir calisaya, iron and strychnine seems to be attended by the best results, and, as indicated in the beginning of this article, as a tonic at this time quinine may be very advantageously made use of.

Nothing has been said above regarding the diet, but my general rule in this regard is to let the patient eat small quantities of almost anything for which he has a desire, and never to crowd any food upon him that he does not like. In

this way I find that many patients find something that they wish and like, and that is not injurious, but altogether helpful to them, and by not keeping them overloaded they take a larger quantity of food than they otherwise would. The overloaded stomach never can accomplish its functions of digestion properly, and when it is thus overloaded it is pretty certain that bad results of some kind will follow. Milk, for those who like it, is one of the best, if not the very best diet that can be made use of, but as there are many people who do not like milk, and to whom it apparently is almost poison, this could not be universally adopted as a diet any more than can any other single article. Soups of various kinds, moderately rich and in small quantities do quite well in many cases; meat extracts or essences in small quantities are also good, but, as above intimated, my general rule is to let the patient make the selection and then I simply regulate the quantity which is partaken of.

It is better, in my opinion, that the patient should take small quantities and take them frequently than to endeavor to take a large quantity once, twice or three times a day. It is sometimes necessary to give some form or combination of pepsin in connection with food in this disease as in any other, still, if the rule is pretty generally followed out of allowing the patient to select the kind of food he desires, and simply regulate the quantity, there is not generally much need of artificial digestants, as the indications of the stomach for the food which it desires generally indicates as well the food which it will digest; at least, such has been my experience.