J no. R. Rose, in the Georgia Journal of
Medicine and Surgery for February, reports
an interesting case.
He was called to see a case supposed to
be suffering with cold, and on examination
he found the submaxillary glands swollen
and tender, throat inflamed, deglutition dif-
ficult and painful.
But the most remarka-
ble symptom was presented by the lower
lip. It was edematous and protruded about
one inch beyond the upper lip, having near
the center and about half an inch from the
border a small, whitish round sore about
one-eighth of an inch in diameter.
Patient stated that the lip had been chap-
THE CHARLOTTE MEDICAL JOURNAL.
ped the week before, but had healed over
before the present sore made its appearance.
She was the wife and assistant of the
postmaster, and was in the habit of mois-
tening her thumb with her lower lip in dis-
There was no increase of temperature or
pulse rate. The condition grew worse even
with active local treatment, the pulse be-
came weak and thready, and the upper lip
became infected, and later the throat, when
the systemic effects of the poison became
On the afternoon of the third day 3,000
units of antitoxin were given and the pa-
tient was some better the next morning,
and the recovery was rapid, and in two
weeks she was able to be up and about.
The writer ascribes the patient's recovery
to the timely use of the serum.
The Cause and Prevention of Infant
Ernst Wende, Health Commissioner of
Buffalo concludes his report on this subject
in Pediatrics for March ist.
He says that the milk industry should be
under both state and municipal control and
suggests the following features.
The license system, the fee, periodic
systematic inspections with revoking power
and penalties for dereliction.
The inspection system should include in
spection of herds (tuberculin tests), food
Demanding* sanitary environment and
buildings, correcting existing evils, and
examination and approval of plans, pend-
ing erection of new ones, which should
comply with a standard of sanitary con-
struction, with especial reference to specific
requirements of the business, viz. : separate
milking and stabling quarters, proper cubic
air-space, non-absorbent material.
Scrutiny of water supply, standard feed-
ing, health of employees, hygienic care of
utensils and cans, cleanliness and protec-
tion in milking.
Definite rules governing all procedures,
particularly as to the cooling process, pre-
paration for the market, and the relation to
the varying seasons.
The differentiation of the various charac-
ters of milk by differently colored or shaped
cans, which are properly labeled with date
of milking and time of shipment.
Prohibition of milk preservatives and
coloring agents ; of alteration and of the
marketing of milk from diseased, sick, or
parturient cows ; of the use of disinfectants,
their necessity implying bad sanitation.
The prohibition particularly of refuse or
swill food upon any dairy premises; of any
food by reason of decomposition or fermen-
tation considered unhealthful, and of the
association of other domesticated or hous-
ing animals with cows.
A standard of quality, with periodic
testing and analysis.
Veterinary inspection with distinction
and compensation therein, and quarantine
against the introduction of tuberculous
cattle from without the State. It should
be as rigid as against pestilence in man,
and it is only by this means that the ma-
lady can be circumscribed and its bearing
on human life favorably influenced.
With this standard of supervision by the
State, the municipality should continue the
supervision upon the same lines, which are
outlined as follows.
1. Continuation of the license system
with penalities, together with stringent
ordinances covering quality, adulteration,
sanitary care, and relation to contagious
2. Milk should comply with the State
standard as determined by lactometer tests,
periodically instituted, both in milk houses
and on wagons.
3. Sanitary non-absorbent milk-rooms of
determined size, air-space, ventilation, and
light ;with specifically constructed, indirect-
plumbed cooling and storage boxes not com-
municating with sleeping rooms, privies,
stables, or other influencing rooms.
4. Wagons properly lettered and num-
bered, with protection from summer heat.
5. Stringent prohibition regarding inter-
course with houses containing contagious
diseases, particularly relating to the ex-
change of milk bottles and the prohibition
of refilling milk jars en route. The con-
stant surveillance of contagious disease in
relation to milk routes by means of "tell-
6. Obligatory cleansing of milk utensils
by a uniform method, and of cans before
returning to the dairy.
7. Special supervision of and discourage-
ment, if not abolishment of the sale of milk
in groceries and similar stores where the
business is subordinate to other interests
and consequently lacks protective facilities.
United States and City act in unison in
this, where interests are identical, the adop-
tion of arbitrary interdiction or destruction
at the city line of all milk coming from un-
Systematic reports, and mutual warnings
and notification of imperiling conditions.
THE CHARLOTTE MEDICAL JOURNAL
Two cases of idiopathic hematuria are re-
ported by T. J. Elterich, in the Archives
of Pediatrics for March.
The first was in a male child 8 years old,
had never had any malarial symptoms,
blood first appeared in the urine three years
before from no apparent cause and had con-
tinued at intervals ever since. The mother
stated that the appearance of the blood was
paroxysmal and was apt to occur after some
mental excitement as punishment or scold-
ing. The liver and spleen were normal
and there was no sign of tumor in the region
of the kidney. The patient is not very weak,
is not sick and complains of nothing.
The second case was in a male child age
5. The hematuria of ten weeks duration
and it was absoutely the only symptom.
Sometimes the urine is perfectly clear, at
other times it contains a considerable quan-
tity of blood.
Bacteriologic examination was negative.
White blood corpuscles 5250, red 2493-
800 or I to 475.
In the treatment rest in bed is emphasized
as an essential and important measure.
The mineral and vegetable astringents
may be tried.
Calcium Chlorid as an Hemostatic.
A case of hemoptysis is reported by J.
Lee Hagadorn, in the Southern California
Practitioner for February, in which he gave
two grains of calcium chlorid every two
hours with the very best results.
He gave it in the form of a ten per cent,
solution and the effect was at once noticea-
ble, the hemoptysis ceasing altogether in a
few hours and never returning.
The patient had been injured by two me
jumping on his chest in a fight.
The author also used it in two cases of
excessive flowing at the menopause with
very prompt and gratifying effect.
He thinks it promises to supply the much
longed-for clotting agent in hemophilia as
it has already removed from this alarming
condition much of its danger.
njured tissue becoming dead. The treat-
ment is to prevent the entrance of germs
or their products and to destroy and re-
move them when present. In regard to
the cautery we should render the parts
aseptic and afterwards protect the cauter-
ized part with an ample aseptic dressing.
In regard to injuries, we should first en-
deavor to thoroughly cleanse the wound with
soap and water and a hand brush, giving
an anesthetic if necessary.
Stitches should be avoided if they at all
interfere with free drainage, a moist bich-
loride dressing not stronger than 1-4000
covered by a protective is placed next the
wound, poultices are not allowable, dry
heat as by hot water bottle is indicated,
pressure with position and rest completes
The word gangrene suggests anything
else but aseptic processes, says C. B. Par-
ker, in the Cleveland Medical Gazette for
February, but such a thing is possible in
certain cases. He discusses the gangrene
produced by the surgeon's cautery as well as
those occurring in open, contused and lacer-
ated wounds, compound fractures, severe
inflammations, and all injuries in which
there is a probability of some portion of the
Fracture of the Base of the Skull.
A case of fracture of the base of the skull
with recovery is reported by Newell C.
Bullard in the New England Medical
Monthly for March.
The case was a male, aged 21, who had a
fall from a bicycle causing the fracture.
The right ear bled freely until the next
morning when the discharge changed to a
serous fluid (cerebro-spmal fluid) and con-
tinued to run freely for three days.
Within ten days he was able to sit up,
though troubled with dizziness, hearing was
absent for two weeks and then gradually
returned. Total loss of smell is the
only remaining mark of the injury.
The doctor does not tell of" any measures
used to prevent infection.
The only treatment mentioned is' stimu-
lants and morphia.
Alcoholic Cirrhosis of the Liver.
The occurrence of alcoholic cirrhosis in
the very young is doubted by some, but R.
Abrahams, in Pediatrics for March ist, re-
ports a well marked case in a girl baby only
16 months old.
The child from early infancy had taken
a glass of lager beer every day, with the
hope, on the part of the parents, of im-
proving the baby's nutrition and develop-
After tapping the case improved with
salts, acetate of potash and infusion of digi-
The liver is smaller than it was six weeks
ago, but the author is undecided whether it
is becoming atrophic or gradually returning
to its previous size.
THE CHARLOTTE MEDICAL JOURNAL.
Digitalis and its Aids in Chronic Cardiac
When the evidence of failing power ex-
ists, showing the inability of the heart to
meet the demands upon it, digitalis is doubt-
less our chief remedial agent, says J. B.
McGee, in the Cleveland Journal of Medi-
cine for February,
As the drug is slowly eliminated, doses
at long intervals are sufficient to maintain
its effects when once produced.
Among the aids to this drug he mentions
rest, strophanthus, caffein, theobromin,
diuretin, strychnine, nitroglycerine, mer-
cury and apocynum or black Indian hemp.
Strophanthus he considers second to digi-
talis in therapeutic worth and in certain
valvular disorders with bradycardia he pre-
fers strychnine to either.
Nitroglycerine, opiates and the iodides
are valuable when we desire to lower ten-
Calomel in one grain doses three times
daily excels as a diuretic and the benefit is
usually marked not only from the diuresis,
but by the stimulation of secretory activity
and lessening hepatic congestion so uni-
versally present in chronic cardiac diseases.
limb until the requisite strength and thick-
ness are secured.
The interrupted splint for resection or
compound fracture may be readily made as
for simple fractures.
Ampng the many advantages which the
;plint offers are : That it can be applied
immediately ; is light and neat, there is no
necessity of padding with cotton ; it is not
apt to produce decubitus ; it may be re-
moved and put back in place in a very short
time, and the cost of the material is but
very little. No other splint will adapt
itself so perfectly to the form of the limb
as this one.
The Schcenborn-Beele splint is described
bv Edward H. Lee in the Chicago Clinic
It is made with plasterparis and strands
of hemp such as are used in making rope.
The water and plaster are mixed slowly
with plenty of stirring until about equal parts
have been used or until a somewhat mushy
substance has been used.
A bundle of the hemp fibers, parallel
and of equal length, is dipped in the plas-
ter and drawn through the fingers to take
off the excess of plaster and then laid on
the limb or part to be secured.
This repeated, layer on layer, until a
sufficient stiff splint is formed, which is
parallel to the longitudinal axis of the limb.
If suspension is required as many rings as
may be necessary are worked into the splint
as it is being built.
Extention may be applied by adhesive
strips or glue dressing.
The kind of splint will vary according
to the seat of fracture of course.
The width of the splint should be about
one-third the circumference of the limb and
is secured after hardening by roller
The author instead of using hemp uses
simply the roller plasterparis bandage which
after wetting is carried up and down the
Practical Abnoniinal Surgery.
A. C. Bernays, in the Railway Surgeon
for February 6th, gives some very practi-
cal points in regard to abdominal surgery
in the hands of the general practitioner.
He notices the fact that the modern ten-
dency is to treat all such cases in hospitals
so that less and less of the cases are being
treated surgically by the country doctor.
This is doubtless best in many cases, but
some surgical cases will not stand the trans-
portation to a distant city and some are
emergency cases which demand prompt in-
The country air is freer of bacteria than
many of our hospitals and in that one re-
spect is favorable to surgical work. A new
house is also a good place in which to ope-
The diagnosis is difficult and oftentimes
can only be guessed at until the abdomen
is opened, but this fact should not scare the
Operating by a text-book is bad and there
is nothing like assisting a competent sur-
geon for awhile as preliminary to abdominal
Don't give opium or any of its prepara-
tions for abdominal pain with fever. He
says the ordinary mortality rate must be
multiplied by six in "opiated cases."
So many patients would do. better if
opium was taken out of the hands of the
practitioner in such cases and castor oil and
salts put in its place.
Drain thoroughly all suppurative cases
with gauze alone or with tube and gauze,
but never with tube alone. Use no catgut,
Close the abdomen by the through and
Plenty of soap and water is the best way
to avoid infection.
Cases of obstruction with distention of
the intestines by gas and putrid, liquid
feces are very dangerous, but may be treated
THE CHARLOTTE MEDICAL JOURNAL.
by making two enterostomies, one at right
iliac fossa in the cecum, the other in the
left iliac fossa in any distended loop of small
intestines presenting and the gut fastened
to the abdominal wall.
The canal in the gut is then washed out
but not the wound.
Pus cavities that are properly drained
need no irrigation.
He recommends that each town and vil-
lage support an operating room, and a few
sick rooms, for emergency cases. Such a
place could be used by all the local physi-
cians, or by a consulting surgeon who might
be called in. On the other hand the great
complications and refinements of modern
surgery are not always attainable, and they
are not always necessary. It is time to in-
sist that simple means will achieve good
results, and that aseptic work can be done
in private houses and ou farms with satis-
The Treatment of Chronic Morphinism.
The sanitanum treatment of the mor-
phine habit is described by Dudley Fulton,
in Modern Medicine for January.
The patient is given a preparatory treat-
ment lasting from two to four days and the
withdrawal of the drug is then begun
by reducing one-third or one-half the
amount taken the preceding day. With
the average patient it is useless to delay the
entire withdrawal longer than the fourth
day, as the suffering is only prolonged.
The patient is fed on liquid foods, malted
nuts and kumyss and given sedative baths
at the temperature of the body. Gal-
vanism, faradism, massage, fomentations,
etc., are all used and something is done
every moment to lessen the pangs of the
Goto bark and bismuth are used for any
The neutral bath is used for insomnia
ana the patient is allowed to sleep from
Five cases are reported treated by this
method with complete recovery.
heat, turpentine stupes and belladonna sup-
The dorsal decubitus is strictly enforced
and he says if the appendix should rupture
no harm will be done, as the general cavity
is protected by l^mph.
He thinks that most cases under this
treatment will become appendicitis obli-
He quotes Fenger's advice to operate
after the second attack, but as the patient
may not live through two attacks the ope-
ration may not be needed.
The Treatment of Appendicitis.
A treatment that will give only a mortality
of one per cent, in this disease is outlined
by Thomas Parker, in the Medical Senti-
nel for February.
The principle is rest to bowel not by the
administration of opiates but by rectal feed-
Laxatives are admissable when the pa-
tient is first seen, in one dose and no more.
For the pain be uses an ice bag or dry
Painful Ulcer and Tissure of the Rectum.
This condition is very often overlooked
by the general practitioner and the patient
treated for internal piles or something else,
says Livius Lankford in the Richmond
Journal of Practice for February.
Though a simple matter, it may rapidly
destroy the patient's strength and under-
mine his general health.
He recommends a free incision through
the base of the ulcer, but not through more
than one-third of the external sphincter.
Local anesthesia under cocaine is sufficient.
When the base of the ulcer is gray and
hard it should be removed with a sharp
curet, before cutting. If the ulcer involves
the internal sphincter, then cut through the
internal sphincter into the cellular tissue
and always make your incision at right
angle to the direction of the muscular
Gonfine the patient to bed until the wound
is healed and be sure and cure him the first
time. He assures us that a man whose
sphincter has been cut without a cure will
never forgive us and there will be no op-
portunity for a second operation.
The Treatment of Stuttering.
The treatment of this condition involves
five principles, according to R. Goen, of
Vienna, in the Laryngoscope for February.
The first consists of breathinggymnastics,
the principal movements being the deep
continued inspiration, the short inspiratory
movement of the breath, the gradual pro-
longed expiration and the holding of the
The second principle is used by enumer-
ating slowly the vowels and diphthongs
then gradually increasing the intensity and
rapidity of of their vocalization.
The third principle includes the second-
ary cause of stuttering and the treatment
will vary in individual cases, but in all we
endeavor to eliminate the spasmodic periods,
diminish the excitability of the nervous sys-
THE CHARLOTTE MEDICAL JOURNAL.
tern and increase the activity of the muscle-
of sp ech.
The fourth principle concerns the will
power of the patient, and it is here that
the skill of the medical instructor is of
greatest value. The fifth and last princi-
ple involves the stimulation and toning up
of the general system by tonics, sedatives,
stimulants and best of all hydrotherapy,
massage, and frequent and regular fresh
These principles of therapeutics for the
relief of stuttering are the result of an ex-
perience of twenty-five years in the treat-
ment of speech defects ; energy and per-
sistency in their application are the secrets
of success, for we deal with a class of cases
which frequently call into question every
resource of the physician, to which should
be added an acquired high degree of pa-
tience and determination in the practical
This disease was described and rightly
classified by Hippocrates 480 B. C.
Malarial toxema of long standing is the
cause, says Bat Smith, in the New York
Medical Journal for February 3rd. The
poison is specific, as there is no other known
agent capable of producing the same mor-
On autopsy we find a yellow or bronze
color of the skin, the muscles dark red-
dish, rigor mortis strongly marked, the
heart is firm and natural except as to color
which is dark, purplish red.
In a few cases congestion of the lungs
was found, but in the majority they were
The stomach is usually congested and its
mucous membrane discolored by bile.
The liver is enlarged and a deep slate
The conditions of the kidneys were most
important. Externally they were a dark
bluish color with here and there black spots.
Extreme congestion of the whole organ,
in fact an active inflammation. The tubules
were desquamated and almost entirely de-
nuded of their pavement epithelium.
The brain is very much congested with
considerable eft'usion and urea was found
in large amounts throughout the substance.
The spleen is very much enlarged and in
one case it was ruptured.
The blood is thin and watery, the red
corpuscles being greatly diminished in num-
ber and contain pigment granules.
The disease is usually ushered in with a
chill, slowly or rapidly developing, which
Vomiting sets in, the pulse is hard and
frequent at this stage, the germs are usually
a bluish leaden hue.
The chill lasts about an hour and the hot
stage comes on gradually.
The skin now assumes a golden yellow
color which deepens as the disease advances.
The headache is increased.
In all cases seen by the author the hemor-
rhage came on during the cold stage or im-
medially after. The urine contains much
kidney debris, blood coloring matter and
corpuscles, its specific gravity is low 1013
to 1017, acid reaction.
The pulse is slow compared with the
temperature. Death may occur by collapse
or suppression of the urine or coma.
Forcible Correction of Spinal Curvature.
Calot and Redard deserve the credit of
reviving this operation, writes Frank
Greenwell, in the Fort Wayne Medical
Journal-Magazine for November.
He thinks it better to apply the correct-
ing force by means of the hands according
to the method of Calot rather than by lever-
age as practised by Redard.
As in all surgical procedures there is some
danger. Paralysis, shock, activity of latent
abscess, or inflammatory action may occur
The most promising and safest for opera-
tion are those cases in which the deformity
is in the lower dorsal and lumbar region.
After the age of 20 a very firm anky-
losis should be let alone unless paraplegia
The operation will stay with surgery, but
will be found applicable to a much smaller
percent, of cases than Calot at first thought
and after all the deformity is only corrected
so far as the erect position is concerned.
Stone in the Bladder.
In discussing the treatment of stone in
the bladder, C. B. Parker, in the Bulletin
of the Cleveland General Hospital for Oc-
tober, says that the only successful treat-
ment is the surgical.
Litholapaxy he thinks advisable when the
stone is small and soft, the urethra patent
to the passage of sufficiently large instru-
ment and the bladder capable of holding at
least two ounces of water.
Thus the operation is more suitable in
middle and later life.
In lithotomy the lateral incision is recom-
mended for the perfect drainage which it
gives to the bladder, as there is nearly al-
ways cystitis. And in children it is diffi-
cult to secure the necessary treatment de-
manded by the suprapubic wound.
He admits, however, that in some cases
THE CHARLOTTE MEDICAL JOUEHAL.
the suprapubic is not only the best, but the
only method by which the stones can be
certainly and successfully removed.
In a case reported the suprapubic opera-
tion was done as the urethra was strictured,
the prostate greatly enlarged and the stone
was very large.
A plea for greater care in physical diag-
nosis is made by William Porter, in the
North American Journal of Diagnosis and
Practice for February.
The matter is taken up in a logical way
and he insists first, that the chest should be
bared for inspection and that this inspec-
tion should never be neglected. Mensura-
tion is also important and for this purpose
he recommends the calipers as far prefera-
ble to the tape, remembering always the
value of comparing the two sides. This
comparison is also of great value in per-