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I use them as local applications, and use them in equal parts. You might think it will blister the child; it will not. It will redden the skin, but it does not blister it. This may be used three or four times a day with good results.
Another thing which was not mentioned was the use of quinine. I have had cases I have treated for days without quinine, and usually without any noticeable improvement, yet after its use the patients would improve. To children one or two years old I would give a grain or more of the bisulphate of quinine, with one-twelfth to one-eighth of a grain of camphorated Dover's powder, and would get good results in a few hours.
As regards the heavier applications. If you find in examining a patient the first time you see him that he has pneumonia, or broncho-pneumonia, I see no objection to putting on a cotton jacket. The text-books of late years condemn this practice, on the ground that it interferes with the examination of the patient. I have seen fine results from the application of a cotton jacket, covered with oil silk, the chest being covered with a common cotton binder. Children will rest better.
Dr. C. M. Curtis, of College Park: I have found in twenty years' experience in general practice that there is one point that, I believe, has been overlooked by the gentlemen who have spoken. It occurs to me to be very important and that is, in a pneumonia patient, no matter what form of pneumonia the patient has, it is very essential to keep the room at an even and comfortable temperature, either winter or summer. In winter it will necessitate artificial heating, and more circulation of the atmosphere in summer than in the winter time. I generally try to keep the atmosphere of the sick-room as pure as possible through another room that is already heated.
This, with the nourishment of the patient, when it is needed, constitutes the principal part of my treatment. The less medication I give the better the patient gets along.
Dr. B. P. Oliveros, of Savannah: For controlling the cough in cases of pneumonia I have used with gratifying success glycerine, deodorized tincture of opium and a few drops of chloroform.
Dr. O. L. Holmes, of Covington: I find that if drugs are used by inunction in these cases we do not get the bad effects on the stomach as we do by administering by the mouth, incorporating them with lard, turpentine and mustard. I believe we get quicker results by inunction than by administration by the mouth.
Dr. Visanska (in closing): Of course, when a man reads a paper he can not bring out every point in regard to every method or agent he has used in his experience. He can only outline the general treatment he has used and leave it for the discussion to bring out a great many things that the reader of the paper leaves out.
As regards the use of carbonate of ammonia, while I have used it, I prefer the aromatic spirits of ammonia. I have more confidence in it than I have in carbonate of ammonia, as made up and sold by the average druggist. It is much more palatable and does not upset the stomach quite as much as carbonate of ammonia.
In regard to the use of tincture of digitalis, as I stated in my paper, we all differ about the use of drugs, and it is a good thing that we do so. One man is satisfied with his results from using certain drugs, while another is satisfied with using other drugs. I have obtained good results by the use of tincture of digitalis. It is used in New York in most of the hospitals, and they claim excellent results from it. Of course, we all know that tinc
ture of digitalis is used in chronic heart affections and kidney affections with good results; at the same time, if we get good results from its use in some acute condition, I do not see any harm in using it. Unless we try these things, we will not improve our knowledge of therapeutics. To-day we are in the background as regards therapeutics and materia medica, and that is the reason why we are using every Tom, Dick and Harry's preparations, so-called pharmaceutical preparations. We must and should study materia medica and learn how to use these preparations and when to use them.
I was recently called in consultation in a case with a practitioner who was using tincture of digitalis in a mixture that contained water, and therefore he did not get any result. He did not get the result of its active principle. As long as I can get good results by using digitalis in such affections as I have referred to, I shall continue to do so. No man need use it unless he wants to.
THE GENERAL PRACTITIONER AS A FACTOR IN SURGERY.
BY R. R. KIME, M.D., ATLANTA.
The physician bears a threefold relation to surgery. The first and most important is the prevention of the necessity for surgery.
Secondly, the physician may be a causative factor in developing directly or indirectly conditions that require operative procedures.
Thirdly, the physician is often called upon to use his judgment and advise his patient either for or against operative procedures.
While the old-time family physician seems in a measure to be passing away, the new era demands a highclass, well qualified, general practitioner to act as a balance-wheel in the medical profession. Specialism reached its highest point in the past decade, and the profession now realizes that no one organ can be uniformly and successfully treated independently and separately from its relation to other parts of the body. The broad and well balanced specialist should have a good knowledge of general medicine, while the general practitioner should have some knowledge of all the specialties. His duty to his patrons demands that he should know when the services of a specialist would be of benefit to his patient; especially is this true in the line of surgical work.
Not only should he have some knowledge as to when (217)
surgical work is necessary, but he should understand why, and to some extent what, caused the necessity.
To the conscientious physician it should be a matter of no little concern whether he has fully discharged his duty as to the prevention, and that he has not been a causative factor in producing conditions requiring surgical meas
In this day and age preventive medicine is of much importance. So should it be with surgery. Preventive medicine and sanitary science deals mostly with communities and people collectively. Preventive surgery mostly with the individual, hence it is more of a personal equation between physician and patient.
Gonorrheal infection sociologically considered is one of the exceptions to this general rule, because of its general prevalence and so often leading to pathological changes that require operative measures for relief, especially from a gynecological standpoint.
Much could and should be done by the general practitioner in the prevention of the social vices which lead to such grave consequences. This is a grave responsibility and duty neglected by many physicians with serious results, causing much suffering, misery and sorrow in many households. Here it is much surgery is developed from lack of duty and improved opportunities by the general practitioner, to say nothing of the improperly cured or treated cases.
A physician's duty is but half done in preventing disease, relieving suffering and making a living. He owes a higher, nobler and broader duty to humanity in preventing crime, vice and moral disease. This duty he owes to humanity as a slight compensation for that which he and