TURBATION. BY L. S. WALTON, M. D., be expected to recur and ultimately destroy A CASE OF INSANITY DUE TO MASlife; but operative interference may result favorably, especially if timely. No hard, indolent lump in the scalp should be permitted to remain, even though for years in an unchanging and unchanged condition. Probably benign and to continue such, it may not be so now or in the future. THE USE OF COLD IN SUMMER As the heated term is upon us, we take the liberty of calling the attention of our readers to a practice concerning which we have frequently written, but which we do not think obtains with the profession as largely as it ought to. Any one who watches the mortality lists of our large cities knows that any marked ascent of the average heat record of the thermometer is accompanied by a corresponding rise in the mortality list; also that the rise is chiefly made up of infantile deaths, such deaths in turn being in great part the result of some form of diarrhoea. Whether these cases are called cholera infantum, or summer diarrhoea, or enteritis, or colitis, we believe that they are in great part the direct result of overheating of the body, and that they Of Tullytown, Pa. F. A., aged twenty-eight. On the evening of December 29th, 1887, I was for the first time summoned to see the patient, it being about 11 o'clock P. M. I found him lying on the lounge in the kitchen; I asked him why he did not retire; he said he could not sleep, and had not slept for four or five nights; this, of course, being only imaginary. He complained of dizziness, shortness of breath and palpitation of the heart, also of a distressed feeling through the brain, particularly in the temporal and occipital region. Vision was impaired. Upon examination I found a heavily-coated tongue, bowels constipated, and general derangement of digestion; heart irregular and weak; general tremor of the extremities, muscular weakness, scrotum lax and in a cold, clammy, sweating condition; muscles flabby and relaxed; patella-tendon reflex abolished. He complained of nocturnal seminal emissions, which occurred without erection, and under the influence of lascivious dreams, and also just before or after urinating. I prescribed a cathartic and some potassium bromide. are to be best combated by the use of the cold bath. In all such cases the physician should take the temperature of the little patient, and The following day I found him in about. if, as is generally the case, the bodily heat is the same condition, and on inquiring more distinctly above normal, systematic cold bathparticularly into the history of the patient, ing should be enforced. It may be necessary was told by his mother that about six years to give the cold bath every two hours; it ago he had an attack very similar to the may only be required three times in the twenty-four hours. At first the child usually present. At that time he was treated by some resists the bath violently, and the prejudices of three or four physicians, but with very disthe mother often are like the wall of a forti-couraging results. He was finally sent to a fication; but, whenever we have persevered, the results have been so marked as not only to rapidly overcome the prejudices of the mother, but also to teach the child itself the value of the bath and cause the outcries and resistance on its part to cease entirely. We wish that this treatment would be fairly tried by our readers, and reports made thereon through our col umns. * Therapeutic Gazette, August 15th, 1888. for some time, with about the same results. hospital in Philadelphia, where he remained He was then sent to his home, where he finally recovered after about three or four months' treatment. From what I can learn from the family, the first attack was accompanied by epileptic seizures. After recovering from the first attack he abandoned the vile practice of masturbation, only again to resume it in a short time, with the most deplorable results. Upon questioning the patient, he told me that at the age of eight or ten years he began the practice of self-abuse, once, sometimes twice, daily, seldom leaving it longer than every other day, and continued until the age of twenty or twenty-one, at which time he was attacked as above described. In the present as well as the former attack, he insists that he can never recover. He walks to and fro in his room, almost entirely without sleep or nourishment, continually exclaiming that his soul is in torment, and will be tormented forever. He at times would threaten violence, and becoming unmanageable, he was admitted to the Norristown Insane Asylum, February 8th, 1888. On March 5th I visited him at the Asylum, and found him in an emaciated condition and beyond all hope of recovery. THE TREATMENT OF DYSENTERY.* A seasonable matter to which we desire to call the attention of our readers is the treatment of dysentery. The modern tendency is to strain evidence to prove the contagiousness of individual diseases and to magnify the importance of the rôle played by bacterial organisms. Dysentery has not escaped this medical fad, and there is a marked inclination to consider it as a specific constitutional affection. The intestinal diseases of camps, prisons, and other places where people are crowded together in swarms, are probably constitutional, due to the presence in the blood of a definite poison, but to our thinking ordinary sporadic dysentery, the result of excessive heat, conjoined with imprudence of diet, and often exposure to cold at night or other times, is as much a local disease as is pleuritis or sunburn. It ought, therefore, to be readily affected by local measures. In fact, if we examine the most effective methods of treatment, we find that they all have a direct immediate influence upon the affected parts. The saline depletes directly from the engorged portal circulation and stimulates the glandular apparatus of the colonic mucous membrane into activity; the mercurial labors with the *Therapeutic Gazette, Aug. 15th, 1888. hepatic viscus and also with the diseased mucous membrane; while the black, tarry discharges, which are the harbingers of ipecacuanhic convalescence, demonstrate the action of the Brazilian root upon the alimentary glandular apparatus. The point we want to call the attention of our readers to is the a priori probability that direct medication of the colon will afford the most successful, as well as the simplest (because involving least the general system), means of curing acute colitis. In chronic colitis we long ago practiced the method with extraordinary success. Injections of a half gallon of medicated water into the colon once or twice a day have been attended with phenomenal results. On the whole, the use of a drachm of nitrate of silver has been the most satisfactory; but in some individual cases the persulphate of iron, nitric acid, and various other medicaments have produced the best results. It must be remembered that it is a local, not a constitutional, effect that is desired, and that the solution must be strong enough to be effectual. The enema is always returned inside of five minutes, and we have never known of any evidence of absorption of the drug. It so happens that we rarely see cases of acute dysentery, and we therefore appeal to our readers to try upon an extended scale local treatment of the acute affection, and to report in our columns. We know that large injections of ice-water often allay most markedly the tormina and tenesmus, but have had no experience with the direct applications of medicaments in acute colitis. The materials used should conform with the results of experience with other mucous surfaces. Subnitrate of bismuth presses to the front as a claimant for trial, one or two drachms at a dose. Nitrate of silver may act here as in angina. Hydrastin, and even acetate of lead, are to be thought of, and especially would we suggest trial of nitric acid, in the later stages. The field of colonic therapeutics seems to us open and inviting. Will not some of our readers enter therein, and give to us the fruit of their labors? The method of giving the enema is important. The best plan is to bring the patient into such a position that the buttocks, resting upon a bed-pillow at the edge of the bed, are so elevated that the natural tendency of fluid entering the rectum will be to run into the colon. The best form of syringe is the fountain syringe; if any of the forcing or pumping varieties are used, great gentleness must be practiced. An intestine which may angrily resist a rapid injection may often be readily persuaded to tolerate a large amount of fluid. The pipe which is introduced into the rectum should be large and flexible, and the effort should be to get it well up to the sigmoid flexure. In many cases of acute dysentery the lower part of the colon is probably alone affected, so that it is not always necessary to wash the upper portions of the gut; further, not rarely the injections should be practiced every two or three hours, and it does not seem necessary for the doctor himself to administer them. Any intelligent nurse can be readily taught to give them, but the practitioner should thoroughly assure himself that the drugs are really applied to the mucous membrane of the colon. TREATMENT OF CATARRHAL JAUNDICE.** BY R. N. KITTRELL, M.D., Of Gadsden, Ala. When only a single recovery can be adduced in support of a certain line of treatment there is usually some room for doubt, but when five cases occur of the same disease, all conducted to speedy recovery by the same therapeutic measures, there is just reason to believe that the remedial agents are efficacious, and that a true sequence of cause and effect exists. As my cases are identical in every respect, I will discuss them collectively, for fear of wearying the reader by tiresome repetition. In each case there were frontal headache, an intensely yellow integument and conjunctivæ, a bitter taste in the mouth, and tongue covered * Medical Record, August 18th, 1888. with whitish fur. The bowels were, for the most part, constipated, and, if moved, the dejections were of a light color. The urine presented the appearance, as one of my patients graphically described it, of mustard and water. The respirations were shallow, as more or less pain was usually produced by taking a full inspiration. The pulse varied from forty to sixty-five beats per minute, owing to the sedative effect of bile upon the circulation. In all the cases there was slight pain and tenderness in the epigastrium and lower portion of the right hypochondriac region. This symptom led me to believe that there was subacute inflammation of the duodenum, and that the jaundice was due to absorption, caused by the obstruction of the ductus communis choledochus by mucus. An examination of the urine confirmed this opinion. By means of Pettenkofer's test I detected the presence of biliary acids in the urine, and thus clearly proved that the jaundice was due to the absorption and not to the suppression of bile, for, as is well known, the biliary acids are formed by the liver, and, if it had been a case of suppression of bile and the liver had struck work, no biliary acids would have been formed, and consequently their presence in the urine could not have been detected. On the other hand, in the case of absorption, bile is formed by the liver, but being dammed back upon the liver by an obstruction in the biliary passages, the biliary acids along with other constituents are taken up by the lymphatics and capillaries, are eliminated by the kidneys, and consequently can be detected in the urine by the proper tests. I fear that my readers will accuse me of being too prolix and didactic, but this is the mode of reasoning by which I arrived at my diagnosis, and they will pardon me for reproducing it on paper. Having settled the matter of diagnosis satisfactorily to myself, I next considered the treatment. In each case I employed a drachm of the phosphate of sodium three times a day, and externally an application to the right side of dilute nitromuriatic acid. A flannel jacket was made, sufficiently large to cover the entire right side, and confined by tapes attached to the borders of the flannel cloth and tied under the left axilla. This flannel was worn constantly, and was kept saturated with the dilute acid. Under this treatment the longest time required for recovery was thirteen days; two cases recovered within a week's time, and two in about ten days. I attribute the good results in these cases principally to the phosphate of sodium, for one of my patients neglected to use the acid, and recovered promptly in about a week's time. I consider that I have attained very good results in the treatment of this affection, and if any one can show better results from the employment of other remedies, I shall be glad to profit by his experience. ANTISEPTIC METHOD OF TREATING BURNS AND SCALDS. Prof. S. W. Gross, of Philadelphia, suggests the following as by far the most efficient and painless method of managing burns and scalds.* It is that practiced by Mosetig Moorhof, and it is the one invariably employed by Prof. Gross. The vesicles having been opened and excised, the entire burnt surface is smoothly covered with dry compresses of 20 per cent. iodoform gauze, over which gutta-percha is placed. The whole is then surrounded by a thick layer of sterilized absorbent cotton between layers of corrosive gauze, which is secured by a roller with a moderate degree of pressure. Such a dressing rapidly relieves pain, prevents contact of air and infection by septic pus, and by its permanence keeps the part at rest. It should be allowed to remain from seven to fourteen days. In burns of the second degree one dressing suffices. In the worst burns, there is relatively little suppuration, and the eschars thrown off are aseptic. For burns of the face iodoform ointment (one part iodoform, vaseline twenty parts) is used, and covered with a gutta-percha tissue mask. The ointment should be renewed daily. * Practice. CALCIUM CHLORIDE IN GLANDU- Professor of Diseases of the Chest in the Philadelphia In the progressiveness of medicine many of our old and important remedial agents are, without adequate reason, pushed aside, and become superseded by something else which has been more recently placed in the therapeutic market. Such has undoubtedly been the history of calcium chloride—an agent held in the highest esteem by the earlier practitioners of medicine. It is hardly recognized by therapeutic authors of the present day. It is not mentioned by Wood (H. C.), Ringer, Bartholow, Stillé, Binz, Köhler, Schmiedeberg, and Nothnagel and Rossbach. Dr. George B. Wood ("Therapeutics and Pharmacology," vol. ii, p. 369) says that before the discovery of iodine, calcium chloride was among the most popular remedies in scrofula, and that the united testimony of many prac titioners shows that it possesses useful powers in these affections. It was likewise a favorite remedy with the late Dr. Warburton Begbie, and Dr. S. Coghill, of the Royal National Hospital for Consumption at Ventnor, in a communication to the Practitioner (vol xix, p. 247), states that he has "again and again seen chronically indurated and enlarged glands, which absolutely amounted to deformity, and which had resisted all previous treatment, yield, even in adults, to the administration of this salt. In children and young persons, when the sleep becomes restless, the breath fetid, the tongue foul and coated, the tonsils enlarged, I know of no remedy approaching it in value. The colliquative diarrhoa which so often accompanies this condi tion, and, above all, that obstinate lientery which is seen with hypertrophy of the mesenteric glands, yield to the solution of the chloride of calcium like a charm." I have used this agent for a number of years, both in private and public practice, and can fully endorse the strong views expressed by Dr. Coghill, especially in so far as scrofulous. * Archives of Pediatrics, August, 1888. affections of the neck are concerned. Very often one meets with pale, rickety children, who have swollen cervical glands, poor appetite, coated tongue, constipation, and in whom there is a general indication of mal-assimilation. Such patients usually receive the routine treatment of cod-liver oil internally, and iodine, and perhaps cod-liver oil, externally. This succeeds sometimes, but oftener fails. Here the chloride of calcium acts admirably. It reduces the enlargement, promotes nutrition, and is generally more efficacious than anything I have ever prescribed. Its resolvent power is equally marked in the glandular swellings of adults, although here it requires a longer time, and its action is facilitated by the simultaneous application of iodine. This agent must not be mistaken for the chloride of lime-the ordinary disinfecting powder-the composition of which is entirely different. By prescribing the granular calcium chloride, this possible error will be avoided. The dose is from two to four grains for children, and from ten to twenty grains for adults. It can be given in milk or water, but the best vehicle for it is the syrup of sarsaparilla. THE SALICYLATE OF MERCURY. Dr. Henry T. Inge reports in the Atlanta Med. and Surg. Journal* a number of cases of syphilis treated by this preparation, but it does not appear to be as favorable in its actions in general as the bichloride. The dose given internally may range from grain up to 4 or 5 grains a day. The advantages of the salicylate over the bichloride may be summed up, according to the author, as follows: 1. It is supported easily by the stomach without bad effects. 2. It has decided curative effects on mucous patches and syphiloderms when used externally. 3. It does not produce mercurial ptyalism. 4. It is of great advantage in the treatment of a parasitic disease. 5. It is effective when the bichloride has no effect. * Quoted in Therap. Gazette. TREATMENT OF EXOPHTHALMIC GOITRE. BY AUGUSTUS A. ESHNER, A. M., M. D., Resident Physician, Philadelphia Hospital. Extract from Prize Essay, Jefferson Medical College, 1888. The materia medica has been ransacked in an endeavor to find a remedy for exophthalmic goitre, and in vain. Iron, digitalis, quinine, belladonna, ergot, strychnine, arsenic, iodine, veratrum viride, aconite, electricity and nitroglycerin have all been used, lauded on the one hand, rejected on the other. Graefe found iron useful only at certain stages-in the milder grades of the disease and contraindicated in the severer forms. Digitalis has been said to be entirely useless, disturbing the digestion and affording not even temporary relief. There is no specific remedy. Rest is an important factor in the treatment. The general health should be improved, the diet carefully regulated, symptoms treated as they arise, force conserved and complications prevented. If the heart is weak, digitalis will be useful. If hypertrophy exist and the heart is over-acting, aconite will be required. The treatment throughout should be sustaining. With convalescence, arsenic, quinine, iron and strychnine may be used. Should eye complications arise, they are to be treated as they would be under other circumstances. The best results have been reported from the use of electricity. Chvostek has reported a series of twenty-three cases treated exclusively by the galvanic current, in all of which manifest improvement and, in most, complete recovery, took place. Recently, Charcot has strongly recommended the electrical current as the sole means of treatment, and supports the recommendation by the recital of cases which have entirely recovered by carrying out the method he proposes. He directs the use, first, of a faradic current, the anode applied to the nape of the neck, the cathode firmly over the carotid below the angle of the jaw, then lightly over the eyes; and next, that the goitre, the sterno-hyoid and sterno-thyroid muscles be faradised. Following this, the galvanic current is used, the anode placed at |