The Medicinal Treatment of Menstrual Disorders.

The treatment of symptoms alone, without regard to the underlying condition, of which the symptoms are but the expression, is often looked upon as unscientific and unworthy of the consideration of the true physician. It is, indeed, unscientific, and were it possible always to discover and remove the cause it would be equally irrational and unjustifiable. But unfortunately we are unable always to act upon this principle. We cannot always discover the cause, and, knowing or suspecting it, we are often unable to remove it. This is noticeable so in regard to menstrual irregularities, especially as occurring in young women. The general practitioner is often asked to relieve cases of this nature in girls who would never submit to an examination or operation, preferring rather to suffer pain indefinitely than the shame of a physical investigation into the nature of their trouble. In such cases the physician is forced to try the effect of medicinal agents, groping, it may be, in the dark, before insisting upon an examination. Such being the case, it is well to learn what remedies have been found to be of occasional service in relieving symp toms of this nature which are not dependent upon actual organic disease.

In a very practical paper, read before the Connecticut Medi cal Society at its annual meeting in 1888, Dr. Gideon C. Segur, of Hartford, presents a general review of the subject, giving the results of his own experience and quoting the opinions of several prominent gynecologists whom he has consulted. A brief résumé of these opinions is all that can be presented here, the reader who may desire a more extended presentation of the subject being referred to the original paper.

Amenorrhea. For this condition most of the authorities consulted recommended general tonics, iron, arsenic, and cod-liver oil. Per. manganate of potassium, which was at one time so strongly recommended, does not seem to be in much favor, the objection to it being that it is too irritating to the stomach. Manganese was advised by some, and this is the remedy that the author has found to give the most satis. factory results. Most of the salts of this drug, however, cause so much gastric irritation that they cannot be used in most cases, but the binoxide seems to be an exception in this respect, Dr. Segur having used it in many cases with the happiest results and without seeing any disagreeable effects caused by it. A disagreeable feature of this remedy, in Dr. Mundé's experience, though apparently not in the author's, was its unreliability. It might

afford relief at one time, and yet at another, even in the same case, and seemingly under the same conditions, it would fail utterly to bring on the menstrual flow. The lactate of manganese is also free from the irritating action upon the stomach that most of the other salts of the drug exert. Manganese has the reputation of being an abortifacient, hence some caution is necessary in its use as an emmenagogue. But the maximum dose employed by the author is six grains a day, and this is far below that which has been used to produce abortion. Dysmenorrhea.-The opinions of the authorities consulted by the author concerning this symptom and its relief were most varied. Some thought no benefit could be obtained by any but operative measures, while others spoke hopefully of many remedies. Among those which seemed to have given the most satisfaction to the writers were pulsatilla in three to five-drop doses three times a day; cannabis indica, viburnum, camphor, belladonna, and antipyrine. Dr. Segur found manganese to render good service in these cases also, in many instances. The binoxide was used in doses of six grains per diem. The application of heat, by means of the sitz bath or douche, was a useful adjuvant to the internal medication.

Menorrhagia. For this condition the most efficient remedies were found to be ergot, hydrastis, digitalis, sulphuric acid, fluid extract of gossypium, and gallic acid.

It is rather strange to find such a want of unanimity in the recommendations of these different authorities concerning the most effica cious medicinal agents for the relief of menstrual disorders. It is rather discouraging, also, as the number of remedies vaunted as useful in any particular trouble is generally in inverse proportion to its amenability to treatment. Yet, notwithstanding the discouragements which those who attempt to treat menstrual disorders by drugs often encounter, the physician is many times powerless to treat them in any other way. Dr. Segur has, therefore, rendered good service in collecting the opinions of so many experienced gynecologists, and in giving the results of his own efforts to relieve sufferers of this class, and we hope that the paper will be useful to many who may perhaps be able occasionally to cure some of these disorders by one or other of the remedies men. tioned by the author.-N. Y. Med. Record.

Serious irritation of the kidneys may be produced simply by an abnormally acid urine. And healthy urine is often alkaline after meals, but it soon becomes normally acid. If it remains alkaline, bladder disease must be suspected.

Bleeding from Jugular Veins.

In case of necessity, bleeding may be satisfactorily and neatly accomplished by the introduction of an aspirating needle into either of the external jugular veins.

Estimation of Urea.

In reply to the question of a subscriber as to a simple way to estimate the amount of urea in the urine, we would offer the following: Urea is present in urine in greater quantity than any other constituent, therefore its approximate quantity can be deducted from the specific gravity under ordinary circumstances. Thus, Thus, the normal percentage of urea varies between two per cent. and two-fifths per cent. in urine of a specific gravity ranging between 1020 and 1024. If this specific gravity be increased or diminished, we will find a corresponding augmentation or diminution in the percentage of urea; for example, if the specific gravity is 1014, the specimen contains about one per cent. of urea; if 1028 or 1030, it contains about three per cent. of urea. if albumen or sugar be present, except in small quantities, they must be previously removed; and if the chlorides are absent, the percentage of urea must be estimated as somewhat larger than indicated by this method.

But

Important Knowledge that every Man should Possess, and which no Newspaper has

been found that Dare Publish.

The following is from the Working People's Aid Society, Boston, Mass.:

Health to the workingman or woman is their capital in business. It is the wall that shuts off from them and their families want, the hospital, and the poorhouse.

It is an acknowledged fact, that the custom of using patent medicines by working people stands, next to intemperance, as a cause of injury to their health, and consequent impoverishment. Why do working people pursue this suicidal custom?

Philanthropists and writers upon political economy have answered this question in various ways. Some have claimed that it was owing to a want of intelligence, and others to feelings of independence, or the necessity of practicing economy. These reasons are undoubtedly true in more or less cases. The writer of this circular, however, is of the opinion that the principal reason that induces working people to patronize quack doctors, and use patent medicines, is owing to the following:

All quacks, and most proprietors of patent medicines, advertise to cure, or guarantee a

cure. Right here we would call the especial attention of every working person, and of all those who feel an interest in the welfare of their fellow-man, to the following facts:

When these quack doctors and proprietors of patent medicines advertise to cure a disease, or guarantee to cure, provided their medicine is taken according to their directions, they make a proposal. A person suffering from a disease, which they have advertised to cure, reads their proposal, and accepts it. A proposal when accepted becomes a promise. Every promise, and every set of promises forming the consideration for each other, is an agreement. Now if the quack or proprietor of a patent medicine, who is the promisor, fail to fulfil his part of the agreement, or cure the patient, who is the promisee, then the patient or promisee can bring suit and recover damages from the quack, proprietor of the patent medicine, or promisor, for breach of contract. That is, the transaction constitutes a contract, which may be inferred as a fact from the conduct of the parties, and without the exchange of a single word between them. Or, in other words, it is a kind of quasicontract, in which the law will treat the parties as if they had made a contract.

It is hoped that every working person will understand, from the above concise statement of the law, that if they get a cold, have a cough and buy some boasted cough mixture advertised to cure, or guaranteed to cure, and it fails, they can bring suit against the proprietor of the medicine and recover damages for any loss of time, mental or bodily suffering, etc., dependent upon the failure of the medicine to cure the cough as advertised.

In cases of consumption, kidney disease, heart disease, dyspepsia, or any other disease, the law is the same; you can, in case of failure of the medicine to cure, as advertised, recover damages for any loss dependent upon or traceable to this failure. Every regular doctor sees more or less cases every year, in which a disease, easily remedied at first by proper treatment, has been aggravated or rendered incurable by the parties commencing to treat themselves with some cure-all or patent medicine. The cases in which death results from pursuing this course must number thousands every year in every State. In these cases, where death results, damages can be recovered from the proprietor of the medicine, by the heirs of the party, or next friend, the same as from a railroad or other corporation.

Quackery, secretly aided and abetted, as it has been and is, has at last come to be so monstrous an evil that there will be great difficulty in removing it. The credulity of the public is so great that the plainest and strongest facts

brought out, even in multitudinous array, are almost powerless before it.

Moreover, the capital invested in this vast system of imposture is large in amount. It has become one of the greatest monopolies, and is so linked in with other interests in the relations of business as to have a strong-hold in this way upon the public. With the exception of a few of the larger dailies in our great cities, it has even subsidized the press of the country. Furthermore, it has done it so thoroughly, that it has not only muzzled it so far as speaking out the truth on this subject is concerned, but it has compelled it to utter freely the falsehoods which it demands for its purpose.

Not content with advertising quack doctors and their patent medicines, they, for a liberal fee, admit into their columns articles which have the appearance of editorial recommendations, and these are copied as such into other newspapers.

Our legislators, too, are afraid to move in any way against these unscrupulous quacks and their system of imposture, such a hold has it obtained.

Still, though these formidable obstacles are in the way, let organized labor agitate the subject, and bring out the facts; let the truth be told fearlessly, and this evil, grown now to be so monstrous, will at last yield to our efforts.

G. S. WILSON, M.D.,

Supt. Dispensary Working People's Aid Society, 777 Washington street, Boston.

[In reply to the very many who have inquired more particularly regarding the hot-air treatment of consumption, we append the following:

Hot-Air Inhalations in Phthisis.

If one is to accept the statements of Dr. A. Stern at the last meeting of the Section on Practice of the New York Academy of Medicine, the desideratum that has been so long and so fruitlessly sought for, a positive cure foulmonary tuberculosis, has

This cure, Dr. Stern deir is enected by D. Weigert's hot-air inhalation apparatus, which he exhibited, and the use of which he explained. It is simple in construction, consisting of two copper cylinders, one within the other, and the air to be inhaled, which is heated by means of a Bunsen burner to a minimum temperature of 212°, and thus rendered perfectly aseptic, passes up between the two. The inhalation is to be used for four hours each day-two hours at a time—and it can be taken either in a sitting or reclining posture. It is advised,

however, that when first commencing the treatment the patient should use the apparatus for thirty minutes only twice a day. The temperature of the air inhaled is gradually increased from 212° to as high a point as the patient can bear without suffering inconvenience, 482° being the highest temperature as yet reached in any case in these inhalations.

As a result of the hot-air inhalation, it is claimed there is an acceleration of the pulse, while there is a diminution in the frequency of the respirations, and inspiration becomes deeper. There is at first an elevation of the body temperature, the rise being 1° to 2°, but after about an hour the temperature again subsides. Under the continued use of the inhalations the difficulty of breathing incident to consumption is soon markedly relieved, and there is at first a lessening, and then a total cessation of cough. There is at first an increase, then a decrease, and finally total disappearance of expectoration. All catarrhal symptoms disappear, as do the fever and night-sweats. There is a clearing up of the infiltrated portions of the lungs, and cicatrization of cavities, when these exist, is brought about; while the strength, weight and appetite of the patient gradually increase. The microscopic examination of the sputa generally shows at first an increase in the number of the bacilli tuberculosis, but afterwards there is a total disappearance of the bacillus, and a complete cure is effected. The shortest period, in which total disappearance of the bacilli has been noted, is four months. This method of treatment, Dr. Stern said, in conclusion, has now been employed in one hundred and fifty cases, fifty of which were published in Vi

enna.

All this reads like a fairy tale, but it can be safely assumed that it will not be long before the method has been given a sufficiently extended trial to enable the profession to decide upon its merits. Dr. Weigert, the inventor of the apparatus, is a graduate of the College of Physicians and Surgeons of New York City, and is now residing in Berlin. We learn that Dr. Trudeau, of Saranac Lake, N. Y., has

eady used the hot-air inhalations with succes in a number of cases. There is but little doubt that this method of treating phthisis will be extensively tried. It is to be hoped that the trials will be as careful as extensive, so that whatever of value there may be in the method will not be vitiated by any wrong conclusions drawn from improper and careless experiments and administrations.-Jour. Am. Med. Assn.

[Wm. Snowden, 7 South Eleventh street, Phila., handles the apparatus. Price, $65 to physicians-ED.]

Original Communications.

Short articles on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treatment. Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them: and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

In these columns, ▲ is frequently used instead of 3

The Climacteric Period; Its Physiology, Pathology and Diseases.

Editor MEDICAL WORLD:

INTRODUCTION.

In treatises on diseases of women, the critical time and its infirmities are generally dismissed with about half a page, and in none of our clas sical works have I found diseases of the change of life brought within the range of the laws of general pathology and general principles of treatment; not even in the works of those who think it wrong for a medi al man to make diseases of woman the sole study of his life.

I am desirous of laying before the many readers of THE MEDICAL WORLD a subject with which every medical practitioner should be familiar, at least to some extent, and I wish to make the followin bold assertion: "That too little regard is paid to the dangers of the mens rual crisis; and when the threatening consequences of mismanagement or misapprehension have become startling, those fatal mutations are attributed to some trivial cause, and the victim passes away to the sound of the passing bell, and no increase of knowledge acquired by such a mournful experience stands in the way of the next victim to a management as unwise as it is thoughtless."

The complaints which women often make at the change of life are frequently hushed with the unsatisfactory reply that such complaints are owing to the change of life and are likely to cease whenever the change shall become complete." A physician has no right by his opinion to put to sleep the anxieties of his patient, and to save himself the trouble of thinking, by so unphilosophical a way of procedure. Whenever, therefore, a female at this period, which is univers lly admitted to be a critical and dangerous time for her, comes to complain of symptoms referable to some morbid con 'ition of the reproductive tissues, it is clearly our duty to give a considerate attention to her case, and not

to dismiss her until our judgment should be fully satisfied as to the therapeutic or hygienic indications of the case.

"You will be all right after the change," is the glorious professional answer a woman of forty gets, when complaining of any chronic pelvic ailment.

Gentlemen, this prediction fails as often as it

comes true.

The foregoing remarks I wish every professional reader to put in his pipe and smoke, and study most carefully the evil effects of the change of life. No intelligent physician has a right to prescribe for such cases until he fully understands the pathology of those diseases which appear at the clima teric.

The

The unusual state of uterine congestion during the largest period of the time allotted to sexual involution, renders woman liable to inflammatory affections of the uterine mucous membrane, even when their sexual organs have been previously sound. The change of life is a detective of disease that has been sneakingly progressing for a considerable time. critical nature of a period is shown by its effects on the health in after years. It not only terminates critically many complaints of the preceeding years, but it governs the state of health during the whole subsequent period of life, so much so, that from the manner in which the crisis is accomplished, I believe it possible to predict whether in after life health will be good or bad. Invigoration of health sometimes occurs accompanied by very great improvement of personal appearance, when the emaciated put on a fair amount of fat, which "suave incrementum" is both comely and conducive to health. Others have to sacrifice some feminine grace, their appearance becoming more masculine, and tweezers are required to remove stray hairs from the face, and sɔmetimes the services of a tonsorial artist are re

quired. I have said sufficient in the way of introductory remarks, and in the next issue I shall dwell upon the Physiology of the Climac

face. The eruption was very pale, with little heat, no fever, but weakness. I gave her jaborandi in doses running up from twenty drops to a drachm, with no effect on the erysipelas, and scarcely any sweating or salivation. Digitalis was given, as needed, at the same time. Thinking the jaborandi might be of poor quality I procured another sample; but it did no better. As she had become too weak to risk the jaborandi, I stopped it and gave her iron; whereupon she changed at once for the better and made a good recovery. I also gave a trial in this case to ichthyol, applied locally, and found it useless.

In a later case, I found the jaborandi exerting no special influence on the erysipelas, and very little on the secretions, until I increased the dose to two drachms, which I felt free to do in this case, as the patient was a strong and healthy woman. As soon as free sweating was produced, the erysipelas was checked, and the woman was well in a week. I am not sure yet that in these cases the drug was reliable; but, if it was, the conditions present in my first case constitute an exception to the rule for the employment of jaborandi, an exception which I believe to be as important as the rule itself. I think that one of our brethren from California reported in THE WORLD some failures in cases resembling mine.

I am sorry that the duties connected with my new weekly prevent my writing at greater length to-day, but next month I hope to take up the very interesting letters in the May WORLD. W. F. WAUGH.

Cocaine Poisoning.

Editor MEDICAL WORLD:

It is well nigh impossible to take up a medical journal at the present time without stumbling across a paragraph or more detailing poisonous results following the exhibition of cocaine as an anesthetic. Deaths have been reported from this cause. Many of these cases of cocaine poisoning are simply warnings against the use of this valuable drug in an improper manner. When an elastic ligature is applied about a part in such a way as to completely control the circulation, cocaine may, with safety, be injected subcutaneously in sufficient quantity below the gature to secure complete anesthesia during such an operation as the amputation of a finger or the removal of a small tumor. So complete may the anesthesia be made in some cases, that I have had patients raise themselves up from the bed or operating chair and express surprise, when they saw, for the first time, that

over. In such cases, the cocaine injected seems to flow out of the tissues with the blood lost during the operation, and no untoward effects from the anesthetic occur after the ligature has been removed. On the other hand, if no ligature is applied, so quickly is the alkaloid absorbed, that we must expect comparatively little local effect, and an effect upon the general system proportionate to the amount used and the idiosyncrasy of the patient. This fact becomes all the more apparent, when we remember that several min utes must always, elapse before any local anes thetic effects from the application of cocaine become apparent, and that, during that interval, there is usually ample time for complete absorbtion of a hypodermic injection. When cocaine is applied to a mucous membrane its absorbtion is much slower. It would be difficult to imagine how cocaine applied to the eye as an anesthetic could produce untoward effect upon the general system, unless a large quantity of a concentrated solution were used, and that, flowing into the nose and throat, was swallowed. Such accidents are not common, and can be prevented by pressing with the firger upon the upper part of the nasal duct. For cataract operations it is not best to employ over a two per cent. solution, because the stronger solutions destroy the corneal epithelium; while for strabismus, pterigium, operations, etc., a four per cent. solution gives an anesthesia which is more profound and prolonged, than where a stronger solution is used. The local anesthesia, however, does not occur as quickly. The same thing is true when cocaine is used as a local anesthetic in nasal operations. When cocaine is used inside the nose, it should always be employed by placing a pledget of absorbent cotton saturated with a four per cent, solution in contact with the parts where its effect is desired; because, if the atomizer is used, it will be impossible to prevent some of the solution used from passing into the throat and being swallowed. All the reports of cases of cocaine poisoning from its use inside the nose that I seen have been those in which it has been so used that the cocaine could easily have escaped from the nose into the pharynx, where it invariably produces the most disagreeable sensations of fullness and dryness of the parts, with reflex circulatory and respiratory depression.

There is little doubt in my mind that in many of the cases of untoward effects following the use of this anesthetic in the nose, the shock of the operation, pain, and fright, have been the main factors in producing the symp toms described. It is not unusual for patients to feel "fainty" and "weak" after a trifling operation where no local anesthetic has been