A Few Practical Suggestions.

F. A. PINELES-MONTAGU, M. D., DRURY, NEW ZEALAND

In the July number of this excellent journal, Dr. A. W. Dortch requests a diagnosis and treatment of a peculiar case—that of a lady, age 45. I am of the opinion that the lady is suffering from inflammation of the pancreas, or possibly of scirrhus of the pancreas, and I should prescribe, two drams of citrate of caffein, one dram of the tincture of the chloride of iron, and five drops of specific nux vomica. A small quantity of glycerin should be added, and enough water to make four ounces. Of this a dram should be taken three times a day, in a little water. If this should cause constipation I would give a vegetable cathartic pill, and a restricted diet. Peptonized food would materially improve the condition of the patient.

In the July number, Dr. J. C. Dunn requests the diagnosis of the case in which there is presented some peculiar symptoms. It is my opinion that the gentleman is suffering from neuralgia of the 5th nerve—infra orbital. I should prescribe salol in from five to ten grain doses, only when the pain is severe, and if possible on an empty stomach, the salol to be placed upon the tongue and washed down with a small glass of cold water. I have also the opinion that his blood must be greatly deficient in red corpuscles and he most likely suffers from constipation.

For this I would give a tabloid of Blaud's pill, with cascara three times a day. I should also advise him to wear colored glasses of a green tint, in the sunlight, and have his spine massaged with olive oil every morning, for a week. I should demand that he did no reading for at least one month and that he do not on any account wash his face or his neck in cold water.

I do not think there is any connection between the pain in the eye and the action of the heart. Of course the drugs mentioned in the request are heart depressants. There may be, perhaps, neurasthenia spinalis, or perhaps a slightly enlarged prostate gland, or progressive prostatids, in which latter case I would prescribe an elixir of saw palmetto with santal compound, and I should restrict his smoking and his drinking.

Mrs. M. aged 55, complained of pain in the stomach. I had found my patient in bed, with a look of depression and anxiety on her countenance. The pain was in the epigastric, right lumbar and umbilical regions. She had been in bed some days, when I was called. She also complained of a suffocating feeling and tightness of the chest, with shortness of breath on exertion.

Temperature was 99.6°; pulse weak and compressible; both the impulse and the sounds of the heart were feeble. The tongue was broad, flat, furred and covered with a creamy coat. I diagnosed the case as one of fatty infiltration of the heart, accompanied with indigestion. She suffered greatly, also, from anorexia, constipation, and insomnia.

For the above conditions I prescribed 16 drops of cereus grandiflora, five drops of the tincture of nux vomica, B. P., two drams of the tincture of cardamon, B. P., in two ounces of water, and advised that two drams of that be given every three hours.

I called the following day, and found the temperature to be 98.6°; pulse stronger; breathing easier. The pain in the stomach and bowels had disappeared. The patient had had a good night's rest. I changed the medicine and gave the following: Fluid extract of cereus grandiflora, 64 minims; tincture of cardamon compound, three drams; water sufficient to make eight ounces. Of this, I advised that two drams be given every four hours.

For the constipation I prescribed the vegetable cathartic pill of the U. S. P. (No. 808, in the catalogue of Parke Davis & Co., of Detroit,) and advised that one pill be given pro re nata for this condition, as the pill was needed.

Diet. For breakfast, bread and milk or bread and butter, with weak tea or milk and water, and a lightly boiled egg. For dinner, mutton or chicken broth with bread. Farinaceous puddings, custards all made with plenty of milk. For tea, the same as breakfast with the addition of a biscuit soaked in tea.

I allow the patient to be up after three days, but order that she should do no manual labor of any description. I saw her a couple of months after, and all the symptoms had disappeared.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.