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fered with, is brought to us for treatment, we are told that all possible and impossible dietetic measures and household remedies have been tried in vain (and what that signifies we all know) to restore the appetite. The most important measure at this stage is to strictly enforce the prescribed diet, a conditio sine qua non for cure. Frequent but only minimal meals hourly, even half-hourly, from one to three tablespoonfuls and complete omission of all fatty and amylaceous articles, are the first necessities. Even the milk should be decreased in quantity and strength; beef tea may be given several times daily, and its nutritive value depends mostly upon the amount of proteins and phosphates which it contains; likewise the various meat solutions and peptones may be given, as for their ready absorption the gastric juice is not requisite. For the atony of the gastric mucous membrane, Malaga and Pepsine wine in small quantities are of benefit (Pepsini, 10.0; Vin. Xer. 300.0; acide hydrochlo. 1.0: 1-2 teaspoonful ter die). Likewise a domestic prepared gelatine solution with a small addition of rum or wine is an excellent article of diet, which is readily taken and assimilated by most of the small patients. (Rp: Colla piscium 20.0; aq. distill. 300.0; coq. add vin. Xerens, syr. scch. āā 100.0). We can expect but little from drugs, perhaps most as yet from the tonica aud aromatica amara. Tinct. aromatica or tinct. cascarillæ with spir. ether, àā ter die, 10-20 gtt., or Tinct. cascarillæ, tinct. zingiberis, āã 1.0; sacchari. natri bicarbon. āã 25.0; knife-point full per dose. Likewise a combination of pepsine with strychnia may be recommended by the author, especially when marked atony of the gastric membrane is present. Again, others have reported good results from use of elix. aurant. compos. together with tinct. valerian. To overcome the copious vomiting of mucus, the asthmatic attacks, and the frequently relapsing colics, chloral hydrate is to be given (1.0-100.0, Zi ter die). When this treatment is employed, we soon notice that the vomiting ceases, the appetite improves, and the bowels are regulated; then gradually the atony of the gastric mucous membrane disappears, and we can again cautiously allow milk, however at first well diluted, or this interval may be bridged over by giving a whey (0.3 acidi tartarici added to 14 litre of milk while boiling). If from its use constipation should occur, a little syr. mannæ may be added, if the reverse takes place, a small amount of aqua cinnamoni, or instead of the tartaric acid, alum be used in the preparation of the whey,

415 Walnut Street.



The question of consulting with irregulars has again been brought before the profession of Cincinnati. Dr. C. P. Judkins was called in consultation by a physician who had formerly lectured in the Ohio and Miami Medical Colleges, and had been President of the Academy of Medicine. This gentleman took Dr. Judkins into his office and frankly told him that he might be held accountable for consulting with him, as he had violated the code, in that he had a patent medicine. Dr. Judkins was much shocked to hear of this gentleman's downfall, as he had always held him in high esteem.

For the purpose of getting the matter before the profession at large, so that physician's may know with whom to consult, Dr. Judkins moved that a committee be appointed by the Cincinnati Medical Society to meet a like committee from the Academy of Medicine for the purpose of devising means to this end. The committees were appointed, and reported a list of one hundred and seventy-nine names of practicing physicians in Hamilton County with whom it would be safe to consult. Now, as there are over five hundred physicians in Cincinnati alone, the report created no little sensation. The committee explained that these were the only gentlemen that were eligible to membership in the State Medical Society or in the American Medical Association, consequently they were the only ones they could recommend. Of course, the names reported were only those of the members of the different local societies, viz: Academy of Medicine, 134; Cincinnati Medical Society, 54; Walnut Hills Medical Society, 12,—or a total of 200 names, with 21 duplicate names. The committee were not willing to undertake to determine the ethical standing of gentlemen not connected with any society.

The two medical societies were unable to add anything to the report of the committees, and whether the Code question will now be suffered to drop remains to be seen.



MATERNAL IMPRESSIONS.-Dr. Blair D. Taylor, U. S. A., reports in the Medical Record, Jan. 16th, a peculiar malformation which he remarked in a child which he had been called to attend. There was a lack of development of the left arm and the muscles of the left shoulder, and on the front of the shoulder, just over the coracoid process, was a deep scar, about the size of a nickel five-cent piece, and just above the spine of the scapula were three deep scars, about half as large as the other.

Dr. Taylor attributes the condition to the probable influence of maternal impressions. When she was two months pregnant she was attacked by a large dog, which fiercely seized her by the left shoulder; she threw up her left hand, disengaged her cloak which she left in the dog's mouth, and made her escape. When the child was born, the stump of the hand was touching the left acromion process, in exactly the position which the mother's arm was while she was disengaging her cloak. He thought that the scars on the left shoulder resembled those which would have been left on the mother's shoulder had the dog succeeded in biting her.

LARYNGEAL SPASM FROM COCAINE SPRAY.-Dr. Hall reported, in The Lancet, Nov. 21, a case of laryngeal spasm produced by a spray of cocaine, 10 per cent. thrown through the nasal cavities. The spasm was relieved by inhalations of chloroform, but it was some time before the unpleasant symptoms subsided.

The feeling of cramp in the throat is commonly experienced even when a much weaker solution is used, but it generally passes off in from thirty minutes to one hour.

SANTONIN IN AMENORRHEA. - Dr. Amand Routh, in The Lancet, Jan. 9th, reports twenty cases of amenorrhæa treated with santonin, ten grains taken on two consecutive nights. He thinks that his cases indicate that the drug thus administered is of value in starting the menstrual flow in healthy, full-blooded women, and this without causing much pain. But where amenorrhæa is due to chlorosis or anæmia, it was not nearly so useful as the permanganate of potash.

IODINE IN PHTHISIS. - In the Lancet (August), the tincture of iodine, in ten to fifteen drop doses, two or three times daily, is recommended in cases of phthisis, where the expectaration of mucus is very free. It has a tendency to stop this secretion without exercising any deleterious effect on the cause of the disease.

CHLOROFORM FOR TAPE-WORM.—Dr. A. W. Perry reports in The Medical Record of August, 1885, a case of obstinate tapeworm treated by chloroform. The patient, a full-grown man, took at 7 a. m. 3i of chloroform in mucilage. This was followed in one hour by an ounce of castor oil, and at half-past ten the whole worm passed away.

There was a considerable degree of stupor lasting three or four hours.

TENDON REFLEXES.-Dr. W. R. Gowers, in an address delivered before the Medical Society of London (Lancet, Nov. 5, 1885), says that in normal conditions, the tende nreflexes are probably always present, -the apparent exceptions to the rule being due to either hidden disease or to lack of skill in demonstrating the reflex.

The knee-jerk may be present in tabes dorsalis. This is the case in which lateral as well as posterior sclerosis is present, when the myotatic irritability, induced by the lateral disease, preserves for a time the knee-jerk. Also there are cases in which in the early stages of true tabes the symptom is absent on one side.

In cases of pseudo-hypertrophic paralysis the loss of the patellar tendon reflex is sometimes of great diagnostic importance, may be “alone absolutely conclusive." The jerk is normal in the early stages, and grows less as the disease progresses. tom is of great importance to differentiate between this disease and congenital plastic parplegia where the calf muscles are large. In the latter disease the knee-jerk is excessive, and in pseudohypertrophic paralysis it never is.

Dr. G. does not believe that the knee-jerk is ever lost in hysterical paraplegia, but that the cases so reported may be due to errors of observation.

Dr. Money, in the same number, says that a convenient way to obtain the patellar tendon-reflex is to “stirrup" the foot in the left hand, with the leg flexed at the knee at a proper angle, and allowing the center of the instep to rest comfortably on the palmar aspect of the hand.

The symp



By the late Charles Hilton Fagge, M.D., F.R.C.P., Physician to Guy's Hospital, etc., etc. Including a Section on Cutaneous Diseases, by P. H. Pye-Smith, M.D., F.R.S., Lecturer on Medicine at Guy's Hospital; Chapters on Cardiac Diseases, by Samuel Wilkes, M.D., F.R.S., Physician to Guy's Hospital etc., and Complete Indexes, by Robert Edmund Carrington, Assistant Physician to Guy's Hospital. Volume I, 8vo., Pp. 1040. Philadelphia: P. Blakiston, Son & Co., 1012 Walnut Street. Cincinnati: Robert Clark & Co. 1886.

Few physicians of the present generation have had better natural and acquired qualifications for writing a comprehensive work on the principles and practice of medicine, as now understood, than the late Charles Hilton Fagg, for so many years identified with the great London Hospital, and well known to all readers of hospital literature for his work as seen in Guy's Hospital Reports. It is to be regretted that he did not live to complete his work.

The completion and compilation of his Treatise on Medicine has, however, been well done by his confrére, Dr. Pye-Smith.

Through the enterprise of P. Blakiston, Son & Co., the first of the two volumes of this work is now presented to American readers.

One can not read the introductory chapter without being impressed with the interesting and candid, yet learned, style of the author, and the thought that the gifted uncle, the famous Charles Hilton, has an equally famous nephew, dawns irresistably upon the reader.

In speaking of the definition of disease, he aptly says: “The art of medicine, however, is concerned not with disease, but with diseases.” Then follows a brief theory of nosology, something of general etiology, and a very clear exposition of the different modes of dying.

Under the head of General Morbid Processes are discussed Contagion, Fever, Inflammation, Tubercle, Tumors, and Syphilis. It will be noticed that tubercle and syphilis are not treated under the head of specific diseases. We conceive that Fagge would hardly

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