12. Purgatives are useful in many cardiac affections, especially in mitral cases attended with dropsy, and in cases in which the right side of the heart is overdis tended and embarrassed, and the organs and tissues are engorged and water-logged. that the rupture was the result of the administration of spirit of ammonia and spirit of chloroform, is a most this drug. He rarely gives it in chlorotic cases or where useful remedy in many cases of flatulent distention of there is fatty degeneration due to disease of the coronary the stomach—a condition which is often the cause of arteries; but he has found it of great use in cases where cardiac embarrassment and sometimes of sudden, alarmthe grave cardiac symptoms seemed to be the result of ing, and even fatal nocturnal dyspnea, with or without a degenerated condition of the myocardium and in angina pectoris. A sixth or a quarter of a grain of which the degeneration was the rasult of chronic myo. solid menthol dissolved in half a drachm of spirit of carditis or fibroid degeneration. Where the pulse ten- ammonia and half a drachm of spirit of chloroform is sion is high the author usually prescribes strophanthus the usual dose. in preference to digitalis. Under such circumstances, if digitalis is given, it should be combined with potassium iodide, sodium salicylate, or some remedy, such as nitroglycerin, which reduces the blood pressure. Dr. Bramwell always gives digitalis in the form of tincture or infusion. He never uses digitaline granules; he has seen, he says, decided poisonous symptoms produced as a result of the administration of Nativelle's granules. 5. Strophanthus is of great value in those cases in which it is desirable to produce a rapid tonic and stim ulating effect. In such cases the author often combines it with subcutaneous injections of strychnine, and, in many cases in which there are grave pulmonary and bronchial complications, with inhalations of oxygen. Strophanthus is useful also in some cases in which digitalis, owing, perhaps, to some idiosyncrasy of the patient, disagrees. It is preferable also in case where the peripheral arterial pressure is increased. 6. Alcoholic, ammoniacal, and ethereal stimulants are of great use for the purpose of relieving urgent symptoms and warding off asystole. Where there is vomiting, brandy and champagne are the most useful. Many persons, says Dr. Bramwell, who are suffering from chronic cardiac disease, who have all their lives been accustomed to the use of alcohol, are, in his experience, the better for a strictly moderate amount of alcoholic stimulant; in many cases of this kind it seems to help digestion; as a rule he gives whisky, well diluted, with meals. In functional and neurotic cases burgundy is often a useful form of wine. 7. Oxygen inhalations are of the greatest use in many very urgent conditions, especially where there is bronchitis, pneumonia, or pulmonary apoplexy. Potassium iodide is an invaluable remedy in ane urysm and in many cases of angina pectoris. In com bination with digitalis it is a most important remedy in some of the so-called cases of senile heart It has also appeared to be useful where there is chronic myocarditis or fibroid degeneration. In some cases in which cardiac lesions or symptoms were associated with symptoms of tertiary syphilis, potassium iodide has seemed to exert a beneficial effect upon the cardiac condition. 9. Sodium salicylate is another remedy from which the author has seen the greatest benefit result in gouty cases associated with cardiac symptoms. 10. Nitro glycerin and nitrite of amyl are the reme dies which he uses for the purpose of producing a rapid lowering of the blood pressure. He thinks they are more reliable and safer drugs than nitrite of sodium. 11. Menthol, given in combination with aromatic In the mechanical removal of dropsical effusions, says Dr. Bramwell, beneficial effects may be obtained by frequently repeated tappings in some cases of ascites due to organic cardiac disease, resulting hepatic cirrho. sis, and portal engorgement. In cases of hydrothorax. the results have, as a rule, been merely temporary and often unsatisfactory. He rarely resorts to puncturing the legs or the scrotum until other measures have failed to remove or lessen the edema; consequently, in his experience, draining the subcutaneous tissues has rarely been attended with any marked or lasting benefit. Massage, he thinks, is a more useful remedy than tap. ping in many cases of subcutaneous dropsy; it aids the venous and lymphatic return, and quickens the circulation in the muscular and peripheral tissues of the body. It is also of great use in many cases in which, owing to the nature of the lesion, ordinary muscular exercise is contra indicated. Venesection is undoubtedly, he says, valuable in many cases in which the right heart is greatly distended and engorged, and it is particularly useful where the engorgement depends upon temporary long complications superadded to mitral disease. Dry cupping is very useful for the relief of congestion of the lungs and other pulmonary and kidney complications. With regard to the soporifics, says Dr. Bramwell, the most useful are chloralamide, paraldehyde and mor phine. In cardiac cases sulphonal is much less certain in its action than chloralamide, and in grave cardiac affections he has almost entirely given up the use of chloral hydrate, on account of the marked depression which it is apt to produce. Paraldehyde is especially useful in those cases where there is bronchitis, and in which morphine is contraindicated. After the breakdown of compensation and in the ultimate restlessness in cardiac cases, small and frequently repeated doses of morphine are often invaluable. The author has seen a marked benefit, even in cases where there was albumin in the urine, result from the administration of the drug, and he thinks that, on the whole, it is the most reliable sedative and soporific. It is an invaluable remedy in some cases of angina pectoris where nitrite of amyl fails to give relief or is contraindicated; for example, where the blood pressure is low and where there is free aortic regurgitation. Morphine should never be given where there is edema of the lungs or much bronchial secretion, for disastrous results have followed its ad ministration under those circumstances.-New York Medical Journal. at which time he wished to see her again. She presented herself at the appointed time, when it was found that the condition was decidedly improved; in fact, there were no new lesions present, the old ones were faded in color, there was no scaling, and she was fairly comfortable. He saw her again only a few days before writing the article, and did not find a single lesion present, so that he felt that at last she had received the proper treatment. Her sister bad not continued the treatment for more than a month, but all the lesions had disappeared, and there had been no return of them. N. Y. Medical Journal. had got some relief, but that the disease had never actually been cured. The eruption was found to occupy the back, the chest, and the head, and lesions were found scattered over the extremities. The lesions were Psoriasis Treated with Oil of Copaiba.- papules as first witnessed, but they soon spread, until, In the Therapeutic Gazette for June 15 Dr. J. Abbott at her visit to the authors, he found some of the size of Cantrell says that the use of copaiba oil in the treatment a bank-note, while others had a diameter of seven or of psoriasis has shown such good results in his hands eight inches. The woman had always been in good that he wishes to record the following cases, in which health, and no one in her family had ever had the same other treatment had been employed without the slight- condition. Since that time, however, the author has est abatement of the trouble until the copaiba was had her younger sister under treatment for the disease. used: In the first case, the patient, a woman twenty. When first seen by him he placed her upon five-minim nine years of age, had always been healthy until the doses of oil of copaiba, with instructions that she was appearance of the psoriasis, which had first attracted to keep under strict treatment for at least three months, attention in her seventeenth year. The disease had spread rapidly over the entire body, and at the time the author saw her her condition was as follows: The eruption occupied a great portion of the body surface, the lesions being small and large, some of which had coalesced, making very large areas of affected skin. The lesions ranged in size from that of a pinhead to a patch or two which were about seven inches or more in diameter upon the back and chest, while those upon the abdomen were nearly as large. Those upon the extremities ranged from a pea sized papule to lesions having a diameter of several inches, the latter of which had coalesced, forming an irregular lesion. All of the lesions were distinct, with abrupt edges, being covered A Practical Test for Albumin.-Although a with the characteristic silvery white or mother of pearl number of exact methods for the examination of urine imbricated scales. The girl stated, and she was cor. to determine the presence of albumin have been known roborated by her physician, that the disease had had no for years, for practical purposes it is important to use abatement since it was first noticed, although she had that method which will combine accuracy with ease and never been without treatment for it. She came under rapidity at the sick bed. Ott knows of no reagent the care of her present physician, and was immediately which fulfills this purpose better than sulphosalicylic brought for the author's advice in the matter of treat acid. This will at once show the presence of the smallment. He found that she had been under almost all est amount of albumin in the urine by causing a cloudiforms of treatment; and as the arsenic which had been ness when added to the urine in which albumin is pres. taking had made no alteration in the skin manifestation, ent. The sulphosalicylic acid may be added, either in he advised her to place herself under strict observation, 30 per cent solution, or in substance, as the crystals disand to take five minins of oil of copaiba in capsules solve rapidly in the urine; the reagent can therefore be three times daily. A good nourishing diet and free easily carried in the pocket. All that is necessary for access to open-air exercise were also prescribed. The an examination at the house of the patient is a test-tube case passed from his view, although he occasionally and a bottle containing sulphosalicylic acid in substance, heard from the attending physician, and in the latter as this agent is hygroscopic. A glass stoppered bottle part of the sixth month of treatment the report was is desirable. To examine the urine filtered, a small that she had not one lesion present, and, as that was some twelve or fourteen months ago, the author feels that the treatment is well worthy of attention. He thinks it well to make note of the fact that, as there were no distressing symptoms to the girl on account of itching, he did not advise any local measures, simply because she did not wish to be obliged to use ointments if there was a reasonable hope of her getting well with. out them, as that had been the main treatment which she had been under for the previous years, and she stated that it was very disagreeable to her. In the second case the patient stated that the disease had existed for fifteen years, but that she had been continuously under the care of physicians, and that she glass funnel and filtering paper are necessary, all of Another reagent, which, though not as convenient, is Glycerin, pure, 8 gme. 4 200 Of this solution a small quantity up to 1 to 2 ctm. is poured into the test tube, and the urine, which has been made slightly acid with concentrated acetic acid, is added to it. This is an extremely sensitive reagent, which will show traces of albumin when none of the well known methods will do so, being almost superior three phases, but where the two first are not exceeded to the sulphosalicylic-acid reaction in this respect. they fall into a chronic state, during which the principal Prof. Dr. A. Ott, in Prag. Med. Wochenschrift; Amer. Med. Surg. Bull. The Role of the Bacillus Coli in the Genesis of Disease.-The role of the bacillus coli in the genesis of a certain number of maladies has become of great importance, and it is indispensable that the medi. cal practitioner be well informed upon the nature of the morbid affections it can produce. In its normal conditions the bacillus coli has its domicile in the digestive tract of man and animals, from the mouth to the anus. It exceeds by far all the other species of microbes in the gastro-intestinal tube, and while the other species are fairly numerous in the stomach, becoming rarer as they descend, so as to be almost completely absent in the large intestine, the bacillus coli is, on the contrary, so abundant in the colon that it has been computed that from twelve to fifteen thousand millions are evacuated every day through the feces! manifestations are drowsiness, emaciation and diarrhea, to which they finally succumb. At the autopsy the intestine is found to be congested, ulcerated in patches, and even gangrenous. As already stated above, the bacilli coli affect all the digestive tube, but they can also affect the abdominal organs, such as the liver, the bladder, the ureters, kidneys, testicles, the uterus, the ovaries, and through the ordinary channels of circulation, a large number of other organs, and more particularly the heart. They have been found in chronic tonsillitis and the false membrane of scarlatina, as well as in other affections of the throat and mouth. But it is in the abdomen that the most part of their ravages are consummated. Simple diarrhea, acute or chronic, cholera nostras, infantile cholera, dysentery, etc., have all been attributed to this microbe. In typhoid fever it invades the mesenteric glands and the spleen, and it is certain that a number of symptoms met with in the course of that affection are due to its influence; its role in perforation of the intestine is very imThese conditions easily explain how the skin and the portant, as to it may be ascribed the peritonitis which mucous membrane of the genital organs can be contam. follows. According to Gilbert and Dominici, the bacilinated by this microbe; how they can be met with in lus coli is the principal factor in the origin of biliary milk, on clothes, on the ground, on plants, and in water. calculi, while metritis and salpingitis in women, and It is also easy to understand how the bacillus coli can cystitis in both sexes, have frequently known no other penetrate into the organism of the newborn infants, its cause. mouth coming in contact sometimes with the fecal mat ter of the mother; the milk can also be the channel of infection, and it is thus that at the very debut of its existence the infant lodges in its digestive tract this microbe, which will never quit it. Again the bacillus coli enters our system by the water we drink, and the vegetables we eat, which have per haps been watered with fecal matter. The presence of these microbes in the intestine is certainly hurtful; they take up a certain quantity of substance destined for the alimentation of the individual, and determine the forma tion of odorus matters, of numerous gases, and of toxines. In the physiological state these toxines can be arrested by the intestinal epithelium, which, according to M. Denys, prevents their absorption. A considera ble portion, however, pass into the circulation by the portal vein, and are eliminated by the kidneys; in this way the toxines are inoffensive. But where there exists a lesion of the intestinal epithelium, of the liver, or of the kidneys, symptoms of uremic poisoning supervene-convulsions, mydriasis, coma. When toxines are injected into veins of a rabbit they produce symptoms of poisoning of three different degrees of intensity. The first is characterized by mydria. sis, cutaneous anesthesis, muscular weakness and coma. In the second degree, and in addition to the above, are witnessed convulsions, nystagmus and hyper-excitability of the skin and of the organs of sense. The third phase is signalized by violent tetanic contractions terminating in death. Ordinarily the animals die when the toxine has been given in sufficient quantity to produce the After this summary the vast extent of the pathological domain of the bacillus coli can be easily understood. The germ thought to be innocent is in reality a vigilant and dangerous enemy concealed in the organism and ready to profit by the weakness of the latter. When the favorable opportunity for exercising its baneful influence is wanting during life, it seizes on its pray im. mediately after death, invades all the organs, and thus becomes one of the principal agents of decomposition. Dr. A. Gilbert in Med. Press and Circ.; Amer. Med.Surg. Bull. The Relation Between Angina and Acute Articular Rheumatism.-The author believes that his own experience and the rather voluminous liter. ature justify the following conclusions: 1. Pain and swelling of the joints, giving the impression of rheumatism, are often observed after or during an attack of angina. 2. The same pathogenic micro-organism has been found in the exudate of angina lacunaris as in the synovial contents of the joints in acute articular rheumatism. 3. A general infection, particularly manifest in the joints, may take place from the fauces, especially from the tonsils. With these data we are compelled to look upon articular rheumatism following angina as a consequence of general infection, and it is highly probable that the particular organism gains entrance through the tonsils. Heretofore, little attention has been bestowed upon the cavity, or to a swelling of the bone at the great sacrosciatic foramen, the point of exit of the sciatic nerve.— Dr. J. Schreiber in Wein. klin. Wochenshrift; Amer. Med. Surg. Bull. fauces during acute rheumatism; but since the author weeks, the symptoms of sciatica are due either to a combegan to study the throat in these cases, he has very mencing tabes dorsalis, to a new growth in the pelvic frequently found a red, swollen, irritated condition of the fauces which is not infrequently overlooked by the patient. Furthermore, it is not altogether improbable that the point of infection may show little or no abnor. mality, while the disease manifests itself in other local. ities. There are cases of angina which produce very slight local irritation, yet they are infectious and may be followed by very serious manifestations. Consequently it is obvious that the time elapsing between the attack of angina and the appearance of articular rheumatism will be variable. The Use of Alcohol in Diabetes.-Hirschfield (Berlin Klin. Woch.) discusses the question as to when alcohol in moderate quantity should be allowed and when altogether prohibited. The author does not agree with the view that alcohol may be an etiological factor in the production of diabetes. In cases of diabetes closely investigated he found the addition of a small quantity of alcohol (30 to 70 grammes per diem) had no ill effect. The quantity of nitrogen in the urine was only temporarily increased. With the use of alco When the pyogenic organisms have gained admission to the body they make themselves felt at the least resistant points, which are the joints. Knowing that verrucous endocarditis and rheumatic pleurisy are the most frequent associates of acute rheumatism, hol more fats could be taken, and hence the increased and that they are caused by pyogenic cocci which are always found, it is rather far fetched to attribute the cocci found in the joints to a secondary infection; but it is probable that a large number, if not the majority, of cases of acute rheumatism are caused by attenuated micro organisms. It is not probable that a specific or ganism will be found to be the causative factor in this trouble, but more likely, as in the case of osteomyelitis, endocarditis, and pneumonia, the clinical appearance may be produced by one of several pathogenic micro organisms. Dr. Buss in Deutsche Archiv f. klin. Med.; Amer. Med. Surg. Bull. Care Necessary in Making the Diagnosis "Sciatica.”—Schreiber calls attention to the fact that in older persons who apply for relief from the symp toms of sciatica, the disease may sometimes be caused by some new growth in the pelvic cavity, which exerts pressure upon the sciatic nerve. He relates the case of a physician suffering from severe double sciatica, who consulted him, for the purpose of mechanical treatment. The patient was 57 years old, and presented the typical symptoms of sciatica; his extremely anemic appearance, however, and the rapid loss of flesh and strength, caused Schreiber to suspect the possibility of the presence of a malignant neoplasm in the pelvic civity. An examination per rectum was made, and a hard extensive tumor speading toward the right side could easily be felt immediately above the sphincter ani. Consequently, mechanical treatment was out of the question; the pains increased in severity, and not many weeks later the patient died. This case demonstrates that in older per sons presenting the symptoms of sciatica, a careful examination of the pelvis both externally and per rectum is indicated to arrive at positive diagnostic conclusions. It is quite possible that, if an examination and diagnosis had been made early enough, an operation might have been followed by improvement or cure. In regard to the mechanical treatment of sciatica, a large number of observations have shown that if cure is not effected after treatment covering a period of six feeding is made more easy. In two cases with some Treatment of Ascites.-Finsen (Ugeskrift fuer Maeger), who for ten years had suffered from ascites (due to congenital heart affection and hydatid of the liver), and had tried all usual remedies in vain, attempted to "dry up" his ascites by bringing as little fluid as possible to the system. For nine days he took only four hundred grains of fluid in the twenty-four hours, with the result that three or four days after commenc ing the dieting his diuresis increased in quantity from SURGERY. The Treatment of Acute Peritonitis.— Writing on this subject, Gant, in the Ontario Medical Journal, first points out that the feeding is important. The stomach is not in a position to receive nourishment, and what is taken usually remains unchanged and is returned unutilized. Let the patient have as little food as possible by the mouth, and some ice to quench the great thirst, and trust more to rectal feeding. Opium and morphine should be given as sparingly as possible, and should not form part of a routine treatment. They hamper treatment and mask symptoms. Aperients, within the last few years, have been revived chiefly by Lawson Tait. His treatment has been spoken of as "the treatment of peritonitis by aperients," as if it could be used with advantage in every case. What Mr. Tait says is, "I have never said that purga. tive treatment will cure peritonitis, for, once it is estab lished, peritonitis is a practically incurable disease and almost uniformly fatal." eight hundred cubit centimeters on the first day to eleven hundred to twelve hundred cubic centimeters on the third to the fifth day-an amount which he had not passed for years. At the same time the other distressing symptoms disappeared. He has since been able to keep his ascites in check by being careful not to imbibe too large quantities of fluid, and when he finds it in. creasing pain, adopting a dry regimen. By the way of experiment he once brought on an ascites in ten days and got rid of it in another ten days. When the ascites was great and the diuresis small, the treatment was slower in taking effect. When the diuresis was eight hundred cubic centimeters it was easy to get rid of the ascites by a not very severe diet; but of late years, when it has often been only four hundred to five hun dred cubic centimeters, the author has had to be much stricter in his dieting. He found by experiment that when the diuresis was five hundred cubic centimeters he had to drink three hundred cubic centimeters less daily to get the same result as when it was eight hun dred cubic centimeters. To expediate matters, he has of late years combined the dry dieting with seven to eight gramme doses of light magnesium daily or every There is no doubt that there is within the intestine day, and was able to free the system from seven hun- in these cases an amount of noxious matter which be dred to eight hundred cubic centimeters of fluid by comes septic as soon as the normal condition of the purging only. In spite of this treatment, the author bowel is interfered with, and that these matters can, was able to carry on his work. He also tried five within certain limits, be got rid of by aperients and gramme doses of chloride of ammonium and dry diet- enemata. It has been pointed out by Mr. Tait that if ing, but, though less exhausting, this method was not an action of the bowel can be obtained at the outset of so rapid as dry diet and magnesium. As regards the the symptoms, either by the administration of a purgaincrease in the diuresis, which was almost in inverse tive or enema, the trouble, in a large proportion of proportion to the fluid imbibed, the author is inclined to think that, whenever there is a retention of fluid in the body in open connection with the lymphatics, ab sorption from it will not commence until the blood has reached a concentration requiring dilution. As a rule, the increase of urine began first a few days after the commencement of the dieting, and these first days were the most distressing, with great thirst, dry tongue, and salt taste of the saliva. As soon as the diuresis began -generally on the third or fourth day-these symptoms disappeared. It must be assumed that the blood during the dry diet becomes concentrated, and when it has reached a certain degree of concentration the absorption begins from the lymphatics, and it would seem as if the absorption, having once begun, becomes more and more easy. And by the commencing absorption of the ascites the diminished intraperitoneal pressure on the liver and kidney allows a freer passage of blood through them. It is well known that after tapping an ascites or anasarca, a diuretic which previously had no effect now produces diuresis, which might be explained in a similar way.British Medical Journal. cases, passes away and the patient makes a good recov ery; but a purgative, like an emetic in acute poisoning, can only arrest symptoms within certain limits. Once general peritonitis has established itself, an aperient is without avail. Operative measures are represented by incision, drainage, with or without irrigation, and, more recently, puncture or incision of a distended intestine. Generally speaking, we have two series of cases to treat. In one there is a vigorous, well defined inflam mation, the local symptoms are marked, pus is produced in greater or lesser amounts, and the exudation localized. Examples of this are: peritonitis started from appendix trouble, pelvic peritonitis, and also certain cases started from injury or perforation. In the other series the peritonitis is diffused, the constitutional symptoms are more prominent than the local, the changes in the serous membrane are comparatively slight, and are out of proportion to the general disturb. ance. This form is illustrated by cases of general septic intoxication starting from the peritoneum, puerperal peritonitis, etc. In the first series of cases surgical interference by in cision or drainage ranks with the opening of a large abscess. In the second series the incision, flushing, and drain. Now is the time to subscribe for the MEDICAL age are comparable to washing out the stomach after REVIEW an acute poison has been taken. |