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IODIDE OF POTASSIUM IN PHTHISIS.-H. J. Vetlesen (Norsk Mag. f. Lagevidensk), following the recommendation of Sticker, has employed iodide of potassium in small doses in the diagnosis of the early stages of pulmonary tuberculosis. In the twenty-seven cases in which it was used it gave a positive reaction in eight and a negative in nineteen. In these eight cases. the administration of the iodide (half an ounce of a one-and-a-half-per-cent solution thrice daily) was followed in from two to three days by the appearance of cough, or by its exaggeration if already present, by the production or increase of expectoration, and by the detection of rales in those parts of the lungs where previously there had only been slight changes in respiration and a little marked lowering of the percussion note. The rale was found to be almost photographically limited to the suspected area, and did not extend beyond it. In only four of these cases was the bacillus of tubercle found in the expectoration, but in the other three the diagnosis of tubercle was facilitated by the existence of other symptoms, swollen glands in the neck, tuberculous disease of the tibia, etc. In the nineteen cases in which the iodide gave no reaction, Vetlesen believes it proven that there was no tuberculosis; and this belief was strengthened by the fact that several of these cases were also tested by the injection of tuberculin, and gave no reaction. The author has kept the patients within his knowledge for two years, and none of them has developed tuberculosis. The conclusion is that iodide of potassium in small doses is an important auxiliary in the diagnosis of the nature and exact position of apical phthisis, especially for practitioners who are not always able to resort to bacteriological examination of the sputum.-Ibid.

FREE HCL IN THE STOMACH CONTENTS.-Winkler (Centralbl. f. inn. Med.) describes a new test for free hydrochloric in the stomach contents by means of alpha-naphthol. If a small quantity of free hydrochloric acid or filtered normal stomach contents be gently heated with a few drops of alpha-naphthol solution (five-per-cent) and a few granules of dextrose, a bluish-violet color is developed, rapidly changing to an inky color. A solution of grape sugar may be previously added to the alcoholic alpha-naphthol solution. Milk sugar may be used instead of dextrose, or even a few drops of milk. Boas has pointed out that three conditions are necessary for a satisfactory test for free hydrochloric acid in the stomach contents: (1) The reaction must be definite and constant; (2) the reaction must be absent when free hydrochloric acid is absent; and (3) the test must give no result with organic acids. With alpha-naphthol 0.04 per 1,000 anhydrous hydrochloric acid gives a sure reaction. This test gives no reaction when there is no free hydrochloric acid present, but like Gunzburg and Boas' tests it reacts with. sulphuric and phosphoric acids. Neither lactic nor acetic acid gives a reaction. Often the addition of alpha-naphthol to the stomach contents. produces the reaction, as grape sugar may be present as a result of carbohydrate digestion.—Ibid.

UNILATERAL BRADYCARDIA.-E. Moritz (Moscow Congress, 1897.) relates a case of cardiac affection-gummatous myocarditis?-occurring in a man, aged forty-three, with a history of having had syphilis twenty years ago. In the course of four months under antisyphilitic treatment the symptoms gradually improved. The presence of venous pulsation in the patient's neck enabled Moritz to compare the action of the right side of the heart with that of the left, and he came to the conclusion that at one time the right side of the heart was contracting two or three times to a single contraction of the left ventricle.-Ibid.

FOR PELVIC PERITONITIS AND PERI-UTERINE EXUDATE:
R Iodol.,

Ext. glycyrrhizæ,

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M. Ft. pil. No. LX. Sig: One pill four times daily during four days, and then gradually increase until ten pills daily are taken.

Within five days there will be a decrease of pain, fever, and abdominal tension, and the exudate will be quickly resorbed.

DIURETIN IN ACUTE NEPHRITIS.-The drug is valued by Steiner for its efficiency in causing diaphoresis and lessening the dropsical symptoms. It may be prescribed as follows:

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A LOCAL APPLICATION FOR TUBERCULOUS LARYNGITIS.-First anesthetize the larynx by means of a ten-per-cent solution of cocain, and then, beginning with the weaker solution, apply the following:

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M. Sig: Apply with gentle friction for five minutes at bedtime, and then cover with a bandage.

THE TOXIC EFFECT OF ANIMAL PARASITES IN MAN is ascribed by Peiper to the toxic substances they produce, which are absorbed by the organism and cause the nervous phenomena, etc., which have been imputed hitherto to reflex action.-Deutsche Med. Woch.

ILLNESS FROM EATING VEAL.-Sixty students of Vassar College were made seriously ill from having eaten improperly cooked veal.

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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 any thing else.-RUSKIN.

Original Articles.

SOMETHING ON THE DISUSE OF PHLEBOTOMY.

BY RUFUS W. GRISWOLD, M. D.

When I began looking into medical books preparatory to practice, fifty years ago, the standard authors given us to read were not backward in recommending blood-letting in the acute diseases; and a little later, when an attendant at lectures at the College of Physicians and Surgeons at New York, the professors were not lacking with the like advice. But there has come a change, and so much of a change that, in this section of country at least, the lancet has mostly gone out of use. That the frequent use to which it was put seventy-five or a hundred years ago was not at all times wise is likely; but the extent to which it has been given up is also not wise. Rather more to notice some of the reasons why it has so largely been abandoned than to argue for a reintroduction of that ready and efficient instrument is the purpose of this paper.

A prominent point in the consideration of this comparative abandonment of the lancet is presented in the question: Has there been such a change in the type of the acute inflammatory diseases from three or four generations ago as to render the abstraction of blood less necessary and less useful? There are plenty of sound, hard-headed old doctors who will give a negative reply to this query; and occasionally we may notice some of them putting themselves in print to that effect. A Baltimore practitioner not so very long ago said: "The necessity for the use of the lancet is as great at the present time as it ever was in the

past; the type of the disease has undergone no such changes as to render the abstraction of blood unnecessary or improper in the successful management of all cases attended with a full, tense, and quick pulse." Others speak the like; but the majority of opinion is not pronounced in that direction, but rather adverse. Conversations during a forty-four years' practice with men who began their professional calling sixty years ago, when the lancet was in often call, is to the import that there has been such a change in diseases as renders the frequent resort to blood-letting less important than formerly; that there is less of the sthenic type in even inflammatory fevers, a more general disposition to take on what we call typhoid forms, and thus depletion, either by the evacuation of blood or the exhibition of reducing drugs, is not so beneficial in even the acute inflammatory diseases as formerly. This is the view that has been entertained by a large part of those who began practice half a century or more ago, and this view has been sustained by a large amount of written authority; but it does not go to the extent of justifying that degree of abandonment of bleeding that has prevailed for the last forty years. The general opinion of to-day is, that while positions like that taken in the quotation given are too positive, on the other hand our practice is quite too lax; for while we still believe in blood-letting to some extent, we but seldom make use of it. Now as to the why.

Perhaps the first reason why the lancet is less used than formerly is found in the fact, or rather in the belief, of the change indicated. It is largely accepted as true by the older men in the profession that patients do not bear blood-letting as well as three generations ago. Accepting this as correct, it rationally follows that we should bleed less. But this is only one of the factors in the account, and not the largest one. The opinion that the physicians of the early part of this century used the lancet too often is beyond doubt correct. The doctrine of the purely symptomatic nature of fever put prominently forward by Brousais, and earnestly championed by active and pushing minds a century ago, and which was generally received in Europe and in this country, gave such an unfortunate impetus to the use of the lancet as finally led to its abuse. Patients were bled for almost every thing; not only for the fevers of acknowledged inflammatory type, such as acute pleurisy and the like, were bled for, but also cases of typhus, typhoid, etc., upon the ground that the fever in the case was only a symptom of the inflammatory action and was to be subdued or lessened by antiphlogistic

remedies, chief of which was the abstraction of blood. The theory of the essentiality of fever became lost sight of, and the doctor treated for an inflammation rather than for a fever.

Without giving up the theory in which they had been educated, some physicians began to see that in some epidemics of disease a larger percentage of cases were lost among those where venesection had been used than among those similarly sick who were not bled. The deduction from this was that it would be better to bleed less. But a change was not to be made without a struggle. Reference to the medical literature of the first half of the century shows that there was a deal of warm discussion between the blood-letters and the anti-blood-letters. Out of the observations and discussions made there was cultivated a prejudice, professional to a moderate extent but popular to a large one, against bleeding per se, and without reference to the character of the disease under treatment or to the differing conditions that might exist, which helped to carry the usage from its former abuse at times to the opposite extreme of general abandonment. It is a universal law in nature that the farther the pendulum swings in one direction, the farther will it swing in the opposite on its return. The pendulum of venesection had swung too far forward for the best in the treatment of disease, and the return carried it quite beyond the best in the backward reaction.

Beyond the reasons noted for the present comparative non-use of the lancet, there has been added a pressure of an erroneous and illegitimate nature that has aided to put bleeding under a general ban more unfortunate for the sick than was the former rather indiscriminate use. Somewhat contemporaneously with the warm discussion upon bleeding carried on in the profession, and perhaps partly out of that discussion, there started up in various parts of the country an illegiti mate class of practitioners, mostly illiterate and destitute of preliminary culture, interchangeably known as Botanics, Thompsonians, Eclectics, etc., whose chief stock in trade for public acceptance was denunciation, without regard to the conditions that might be met in a case, of leeching, bleeding, blistering, scarification, and other agents for This denunciation found ready public credit. Not only from the mouths of the class named, but in various other ways, the prejudice they sought to create was widely diffused. Outside of the libraries of the profession you seldom see a medical book; anywhere else they have been rarities. But in many sections of the country for the last

cures.

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