A WORKING PHILOSOPHY

The life of the general practitioner is rather humdrum and routine. Not a great deal of variety enters into his life. He is inclined to patter down the same conventional road year after year. He continues to meet with the same old reverses and discouragements sandwiched with just enough good things to keep him from dying of pessimism. About the time he has decided that this is the most ungrateful, undesirable world he ever lived in some fellow drops in and pays something on an old bill and the doctor's viewpoint immediately changes. The old world is not quite so sordid after all. All of which brings us to the point we had in mind. Everybody needs a personal philosophy or religion that will act as a sort of anchor to his emotions when trials beset him. It is hard to throw off troubles, but it is always more convincing if we can reason them out of existence or metamorphose them into blessings in disguise. Therefore, doctor, adopt a philosophy of your own for a working basis. The writer has always found a bit of comfort in the thought of universal compensation, that everything that happens has a lesson in it that may be utilized for good. Read Emerson's Law of Compensation. It will take you a week or two to digest it, but you will be made stronger for the effort. His logic is appealing if not convincing. Note these few sentences from the noted Essay:

"The same dualism underlies the nature and conditions of man Every excess causes a defect, every defect an excess. Every sweet hath its sour, every evil its good. Every faculty which is a receiver of pleasure has an equal penalty put on its abuse. For every grain of wit there is a grain of folly. For everything you have missed, you have gained something else, and for everything you gain you lose something. If the gatherer gathers too much, nature takes out of the man what she puts into his chest; swells the estate, but kills the owner. Nature hates monopolies and exceptions. There is always some leveling circumstance that puts down the overbearing, the strong, the rich, the fortunate, substantially on the same ground with all others."

Pulsatilla, in the form of the fluid extract, in one-grain doses acts promptly in hysterical spasms and reflex paroxysms.

WHEN DEATH COMES

Death scenes are shunned by most people unless it be the morbidly curious. Many sympathetic persons are not reluctant to visit the death chamber when their presence is a comfort to the friends. The doctor as a rule likes to make himself exceedingly scarce when the messenger of death is hovering near. And still we see no reason why the doctor should not be present at the closing of the scene that he may be a solace to the bereaved. The practice of medicine has a good deal of psychology entwined about it these days and if folks ever need the presence of a person of wisdom and poise it is at this time. The doctor knows the family peculiarities and in what manner best to administer to their emotions and heartaches. A great many persons fear choking and strangling when their leave-taking comes. Persons dying of respiratory affections may experience considerable dyspnoea, but as a general thing dying is not difficult or painful. painful. A pall comes gradually over the mind and the nerve centers are gradually lulled into passivity to an extent that obviates physical and mental anguish. The moribund body seems to produce its own anesthetics for the purpose of mitigating the passing out. Many such things as these may be explained to the friends and it will in a measure soften their sorrow.

NOSE AND THROAT HYGIENE

Many acute infections might be averted by daily attention to the mouth and throat membranes. The profession owes a debt of gratitude to the dentists for making a sort of propaganda of oral hygiene. It is only in recent years that anything like general knowledge has become extant on the far-reaching consequences of a neglected pyorrhea. A goodly portion of sore throats might be prevented by proper hygienic measures. Colds and kindred ailments would to a great extent be offset if the throat and nasal membranes were kept clean and healthy.

Calcium chloride is of great value as an internal remedy in the various manifestations of the strumous diathesis. It causes the resolution of glandular enlargements and the calcification of tubercular deposits.

SOME NEW AND NON-OFFICIAL REME

DIES

Under the above caption Dr. Bernard Fantus (Illinois State Journal) gives a thorough consideration of the subject from which the following paragraphs are gleaned, no attempt being made to give the full text of the author.

Creosote carbonate is easier to take than creosote and acts much more kindly on the stomach. It is an excellent expectorant in bronchitis with profuse secretion and in tuberculosis. It is best administered with milk in one drop doses increased up to 30 or more three times daily.

When iodides disagree with the stomach sajodin is a valuable substitute. Somewhat slower and feebler in action than potassium iodide, containing only one-third as much iodide.

Veronal is probably the most popular hypnotic at present. Its fatal dose is about 75 grains. Dose ordinarily 5 to 8 grains.

Adalin, another hypnotic, must be administered about two hours before going to bed. Dose 8 to 15 grains. It is not so dangerous. One man took 225 grains with suicidal intent, slept soundly for three days and fully recovered.

Novocain has slight toxic effects, although it may produce vomiting. The anesthetic effects are much shorter than that of cocaine. Quinine and urea hydrochloride has as its main disadvantage the tendency to produce fibrous indurations. This, it is claimed, can be avoided by using solution as dilute as 0.25 per cent. For application to mucous surfaces it is used in solution of 10 to 20 per cent.

Anesthesin is a local anesthetic free from toxicity but being insoluble cannot be used by injection. It is a valuable dusting powder in painful ulcers and is employed internally in ulcer and cancer of the stomach. It is also said to be efficacious in painful throat affections.

Scarlet red is a valuable agency in indolent ulcers, as it stimulates the proliferation of epithelial cells. As a healing agent it is superior to balsam of peru. It should not be used too freely and if it touches the healthy skin an eczema may be set up.

Pyramidon is an antipyrine derivative that is soluble in water.

Erythrol tetranitrite is a vaso-dilator of more prolonged action than nitroglycerin,

hence more useful than the latter as a prophylactic for anginal pain.

Papaverine is a denarcotized opium deriva

tive.

Atophan is a most interesting agent of apparently specific action, as it has the power of greatly eliminating uric acid.

Optochin is "best quinine," believed by its namers to possess the virtues of quinine in a superlative degree.

HOW THE GOVERNMENT IS MEETING THE MALARIA PROBLEM

Of

Four per cent. of the inhabitants of certain sections of the South have malaria. This estimate, based on the reporting of 204,881 cases during 1914, has led the United States Public Health Service to give increased attention to the malaria problem, according to the annual report of the Surgeon General. 13,526 blood specimens examined by Government officers during the year, 1,797 showed malarial infection. The infection rate among white persons was above eight per cent., and among colored persons twenty per cent. In two counties in the Yazoo Valley, 40 out of every 100 inhabitants presented evidence of the disease.

Striking as the above figures are they are no more remarkable than those relating to the reduction in the incidence of the disease following surveys of the Public Health Service at 34 places in nearly every state of the South. In some instances from an incidence of fifteen per cent., in 1914, a reduction has been accomplished to less than four or five per cent. in 1915.

One of the important scientific discoveries made during the year was in regard to the continuance of the disease from season to season. Over 2000 Anopheline mosquitoes in malarious districts were dissected, during the early Spring months, without finding a single infected insect, and not until May 15, 1915, was the first parasite in the body of a mosquito discovered. The Public Health Service, therefore, concludes that mosquitoes in the latitude of the Southern States ordinarily do not carry the infection through the winter. This discovery indicates that protection from malaria may be secured by treating human carriers with quinine previous to the middle of May, thus preventing any infection from

chronic sufferers reaching mosquitoes and being transmitted by them to other persons.

Although quinine remains the best means of treating malaria and is also of marked benefit in preventing infection, the eradication of the disease as a whole rests upon the destruction of the breeding places of Anopheline mosquitoes. The Public Health Service, therefore, is urging a definite campaign of draining standing water, the filling of low places, and the regrading and training of streams where malarial mosquitoes breed. The oiling of breeding places, and the stocking of streams with top-feeding minnows, are further recommended. The Service also gives advice regarding screening, and other preventive measures as a part of the educational campaigns conducted in sections of infected territory.

This study is typical of the scientific investigations which are being carried out by the Public Health Service, all of which have a direct bearing on eradicating the disease. The malaria work now includes the collection of morbidity data, malaria surveys, demonstration work, scientific field and laboratory studies, educational campaigns, and special studies of impounded water and drainage projects.

OPHTHALMIA NEONATORUM

In a very interesting, as well as practical paper read before the Philadelphia County Medical Society, by Dr. S. D. Risley, and published in the New York Medical Journal, on the subject of "Common Affections of the Eye," the author says:

Regarding ophthalmia neonatorum, it is well to remember that "an ounce of prevention is worth a pound of cure." It is an encouraging fact that since the uniform adoption of preventive measures I comparatively rarely see an example of this disease even in my Wills Hospital clinic, whereas in former years the service was never free from these little sufferers, either in the acute stage or afflicted with its baneful sequelæ. Prevention rests primarily upon careful treatment of the mother prior to parturition. This is important, especially when vaginal discharges are present. A laboratory study of such discharges should be made in every case I urge this for the reason that it is not only an important measure

but because every case of ophthalmia of the newborn babe is not due to gonorrheal infection, but to a variety of other microorganisms, and it is signally important to the family, for obvious reasons, that this should be demonstrated. Derby found 51.3 per cent. to be due to the gonococcus in 149 cases, while Stevenson found in 1829 cases sixtyfive per cent., which Derby thinks too high because of the methods employed in the laboratory study. Bartels, also quoted by Derby, found but fifty per cent. of gonococcic origin. coccic origin. Clinically the gonorrheal infection is usually more virulent.

A second and signally important means of prevention is the care of the child immediately after birth. Suitable methods of cleansing the face, eyelids and eyes of the infant will do much to prevent the entrance of germs into the conjunctival sac. Flushing with water should be avoided until after the cleansing of the lids and lashes with petrolatum ointment, or a weak bichloride, or carbolized oil, and then the conjunctival sac may be flushed with a saturated solution of boric acid, or Dobell's or other unirritating alkaline solution. If these precautions are carried out, viz., the cleansing of the vagina by suitable washes for a few days before labor, and a judicious care in cleansing the face of the child immediately after birth, the use of nitrate of silver will rarely be necessary. Unwisely used, the usually recommended solutions of nitrate of silver may injure the delicate protecting corneal epithelium of the infant and so open the door for infection. I wish to urge the great importance, however, of early and efficient treatment in every case where infection of the conjunctiva has occurred. I cannot recall a single instance in my own experience in which serious corneal involvement has resulted if it had not already occured when first seen. In my personal experience the complete eversion of the lids, and the careful but thorough application of a strong solution of silver nitrate to every portion of the infected tarsal conjunctiva, followed by flushing, has been the most effective treatment. In unskilled hands, solutions stronger than two per cent. should not be used. Care should be taken to avoid injury to the cornea by allowing the solution to come in contact with it, or by mechanical injury.

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DIPHTHERIA SUCCESSFULLY TREATED WITHOUT ANTITOXIN

BY M. O. TERRY, M.D. Ex-Surgeon General S. N. Y.

As many thousands die of this difficulty, notwithstanding the use of antitoxin, the treatment I am suggesting can be used with the antitoxin or without it. When in practice, I saw all of my patients recover without the injection plan.

I have called it the "Night and Day Treatment." Get the following prescription put up: Tincture of muriate of iron, drams two; sulphurous acid, drams three; chlorate of potash, drams three; glycerin, ounce one; pure water, ounces five.

Sig: One teaspoonful taken in a glass onethird full of water every 2, 3 or 6 hours, according to severity of case. Take through glass tube.

Swab throat thoroughly so as to keep the emulsion on as constantly as possible with the following: R Flour of sulphur and glycerin triturated into an emulsion, ounces six; also tripsin one dram and peroxide of hydrogen two drams. Use clean swab each succeeding time and burn when used.

If the glands are enlarged biniodide of mercury 1-100 tablet every two or three hours until better, dissolved on tongue. Without such enlargement: R Mercury cyanuret, one-third grain; honey, four ounces. Sig:-A teaspoonful every three hours between other prescription. Use bromine for evaporation as for typhoid, 3ss to water 01, or can use the formaldehyde and apparatus for diphtheria. There should be no odor from throat after first treatment. It destroys the germs if treatment is kept up day and night. In carrying out the treatment systematically the patient is not allowed to sleep over half

an hour at a time without one of the suggestions are being carried out. I have made the interval 15 minutes in desperate cases.

The membrane will either slowly slough off, or will roll up and come away in large leathery pieces.

When the membrane gets into the trachea do not forget the calomel vapor. With difficulty of breathing apply hot Trask's ointment, and heat it in with a hot coal shovel. This gives wonderful relief in addition.

Diphtheria demands the best and most loyal nursing day and night.

The philosophy of the treatment consists in the destruction of the diphtheritic microbe which will prevent septicæmia or blood poisoning, caused by the absorption of ptomains, the latter being due to the action of the microbes on tissue.

The internal medication is a most wonderful antiseptic combination, the sulphurous acid being one of the most powerful antigermicides in existence that can be taken internally. Strange as it may seem, the usual weakness and pallor is not noticeable after this treatment which is tonic and antiseptic.

THE PHYSICAL EXAMINATION OF

CHILDREN

BY M. A. BLANTON, M.D.

The specialty of the general practitioner of medicine is diagnosis. Upon his diagnostic power will depend the choice of his methods of treatment. If he is unable to recognize serious conditions, valuable lives will be wasted. He may not have the skill and experience to undertake delicate surgical procedures, but diagnosis he must know, for the good of his patients and the honor of himself.

In the work of a country doctor, the larger part of it is diseases of children. This being true, how essential it is to be able to early recognize the diseased conditions of this little folk, that we may apply or have applied the proper treatment.

In accordance with this idea, I have prepared this brief essay on "The Examination of Children," mainly confining my remarks, however, to "The Physical Examination of Children."

We find three classes of young children which the physician will be called upon to examine-first, the so-called "Good baby" that will let you do most anything to him that you wish. The examining physician, if at all on his watch, will not overlook important symptoms in this case.

In the second class we find the highly neurotic, excitable, timid baby, that has never been permitted to cry for fear crying might injure him; the family's words about him have been whispered ones and they have never walked about his couch of slumber except on tip-toe. The examination of such a child requires patience. Proceed slowly, approach him gradually, let him handle your stethoscope and find out for himself that you mean no harm. Do your work thoroughly but not in a hurry.

The third class, or spoiled and vicious child, is the one that has always given me most trouble. They will yell at, kick, bite and scratch any physician who attempts to examine them. Waste no time about the examination of this class of patients. Begin your examination at once and pay no attention to the child's whims or wishes. It will do no good to try to reason with such a child. Papa will probably suggest that if you would let him place the thermometer in Willie's

rectum, that he would not kick and bite half so much. Mama thinks that if you would let her hold the spoon you could see in Willie's throat much better. Pay no attention to these whims, but do your own work and do it thoroughly. I am very often made to think, while examining one of these vicious children, of the horse-trainer, who first proceeds to throw the horse, cracks a whip over him several times and tells him to stand up. The horse is now a different animal. The trainer demonstrates in this procedure three facts-respect, confidence and obedience. This may seem to some of you like side-tracking from our subject, but it is the keynote to success in the physical examination of these vicious, spoiled children.

The first thing on entering the room of a sick child, ascertain his name, if you do not already know it. Better if you could know his name before entering the room. Accustom yourself to crying babies. Did you ever hear a doctor say that he could not hear anything upon auscultation because the baby cried so much?

The fact that the baby cried should make no difference to the trained ear of the examiner. Be deaf to their cries and yet an expert in differentiating them, for the various cries mean much.

It is well to get a history of a child's sickness, even before you have entered the room, if this is possible. It might be well to take the temperature early in your examination, for one hard-crying spell might send the child's temperature up a full degree. Weight is an important factor in the examination of infants and small children. Mensuration is also to be carried out. If the child is asleep when you arrive, do not wake him, butsit down and carefully note his color, respiration, pulse and actions. Is there a grunt or sigh going with each expiration? Is the child cyanotic, pale or flushed? Are there any convulsive movements present? Is there jaundice? Is the child unusually quiet? These also apply should the child be awake.

After you have finished inspection, take up palpation-count the pulse and respirations, noting carefully the important points in each. Before a physician's hands touch a child's body, he should be sure that they are warm. Go over the entire body, noting any rales, tremors, fluids, enlarged glands, etc.