The Symptomatology of Tumors Involving the Hypophysis Cerebri.-J. STEWART* reports two cases of a similar character, as follows: Case I. Perithelial angio-sarcoma of the pituitary body; symptoms were headache, vomiting, temporal hemianopsia; the growth infiltrated into the ethmoid and sphenoidal cells, causing hemorrhage from the nares; there were no symptoms of akromegaly or other forms of nutritional disturbance. Case II. Endothelioma of the base of the brain, causing pressure on the chiasma and obliterating the pituitary body;, symptoms of a cerebral growth, extending over nine years; right temporal hemianopsia, profound anemia; a general appearance not unlike that seen in myxedema; no changes in the osseous tissue. The first case presented the symptoms of a somewhat rapid infiltrating neoplasm of the anterior part of the base of the brain, while in the second the symptoms, in addition to the direct cerebral pressure signs, resembled a mixture of myxedema and pernicious anemia. Urethral Disease and Marriage.-F. W. ROBBINS† dwells emphatically upon two points in relation to this subject: the first is that we should know that a patient is cured before discharging him; when no gonococci have been discovered for two weeks, after repeated examinations; when no pus-threads or commas have been detected in the morning's urine; when the centrifuged urine shows no sediment containing gonococci, we have a right to say a patient is well; it is then better to allow the use of alcoholics to produce urethral congestion and thus stimulate to action any lurking microbes. The second point is the advice. so often given the patient to refrain from marriage for a year; such advice merely proves that there is still a fear that the patient is not free from disease; it is certainly preferable to have latent germs develop after the use of beer and champagne or instillation of silver nitrate solution before marriage than after excessive intercourse after marriage. Recurrent Strangulation of a Left Oblique Congenital Entero-Epiplocele in an Infant.-H. M. STOWE reports the successful operation for strangulated hernia in a child of six weeks. The hernia had been strangulated three times previously, but had been reduced; in the last attack taxis was not attempted; the hernia was tense and congested when seen and fecal vomiting was present; the infant made a good recovery. Stowe advises immediate operation in all cases of over twenty-four hours' standing in which taxis has failed; in which vomiting comes on late after pains and obstruction; in which there are signs of collapse or where there has been violent or prolonged taxis. *Phila. Med. Jour., May 27, 1899. The Effects of Violent and Prolonged Muscular Exercise upon the Heart.-H. WILLIAMS* reports the result of examination of contestants in a 25-mile road race, made before and after the race; the temperature was found to be lowered; the blood pressure enormously decreased; there was relative increase of cardiac dullness, corresponding chiefly to the position of the left vertricle; the heart sounds. were all weak; in eleven of thirteen cases examined systolic murmurs were noted, their point of greatest intensity at the base slightly to the left of the sternum and transmitted downward; these murmurs in all instances disappeared before the athletes left the examining room; the murmurs are regarded as the participation of the valves in the general muscular exhaustion. Drainage for Lacerated and Contused Wounds. -S. C. BENEDICT reports the continued success in the use of rubber tissue as a protective and means of drainage, as advocated by Halsted some years ago. He has used it for all wounds in which closure for primary union could not be attempted, either from loss of skin or extent of injury to deeper tissues. Some of its advantages are that it is non-irritant, is non-adherent to the tissues, allowing free drainage, prevents the dressings from adhering to the wound, and insures perfect drainage. If the wound requires a piece of rubber tissue wider than three-quarters of an inch, parallel slits should be cut into the rubber one quarter of an inch apart and of different lengths crosswise to the length of the rubber tissue; this insures quicker drainage and absorption by the dressing The wound may also be covered by strips of tissue overlapping each other in shingle-fashion. The dressing need not be changed for several days unless it becomes saturated. The General Diagnosis of Syphilis of the Brain and Spinal Cord.-B. SACHS, in a comprehensive discussion of this subject, questions the propriety of maintaining the classification into secondary and tertiary forms, for syphilis of the nervous system is not always a late manifestation of the disease. The brain and spinal cord are affected much more frequently than the peripheral nerves; many of the severest forms have been treated unsatisfactorily in the initial stages. In the brain and cord the disease becomes manifest by the formation of gummata, by gummatous infiltration starting from the meninges, and by disease of the blood vessels. Gummata occur most frequently in the brain and are usually multiple. The self-limitation of syphilitic neoplasm is of the utmost importance and greatly influences the clinical features dependent on it. The arterial disease leads *Phila. Med. Jour, June 3, 1899. +Railway Surgeon, May 30, 1899. IN. Y. Med. Jo r., May 27, 1899. to occlusion of the vessel and softening of the area supplied by it. Syphilis of the brain and cord is characterized by the multiplicity of symptoms and the tendency to remissions and relapses-it may lead to a variety of symptoms, none of which is necessarily complete; no set of symptoms is pathognomonic, but syphilis can be suspected if there is evidence of multiplicity of lesions. The presence of constitutional syphilis may be proven more frequently from a study of the pupil than from any other symptoms present. The only diseases of the nervous system which give rise to a multiplicity of lesions are multiple sclerosis, tuberculosis and sarcomatosis; these can be usually readily differentiated from syphilis. The relation of tabes to syphilitic infection is dwelt upon and the necessity of early and thorough treatment in all suspected cases emphasized. Hen's Eggs in Infant Feeding.-A. C. COTTON* believes that too little attention has been given to egg as a substitute for the indigestible proteid of cow's milk in the feeding of infants; the albumin obtained from the hen's egg is more easily assimilated than the indigestible cow casein. In cities which have the milk laboratory, through which we may order by definite prescription the exact amount of food and the percentage of ingredients required for each infant, the egg white may be readily substituted for the curds of milk casein. The Differentiation of Appendicitis From Other Affections in the Right Iliac and Pelvic Regions. -A. A. BERG believes that salpingitis is the most frequent of the lesions apt to simulate appendicitis; the symptoms resemble each other in many respects, but local examination, including rectal and vaginal palpation, will usually enable a correct diagnosis to be made. A cellulitis behind the colon and peritoneum, usually secondary to infection from the genital organs, may be confounded with inflammation of the appendix; inflammation of the right ureter may be mistaken for involvement of the appendix, while inflammation of the gall-bladder frequently cannot be differentiated from appendicitis and the question must be decided either by further observation or by incision. Of purely internal diseases, in which operative attack is unjustifiable, and which enter into diagnostic relation with appendicitis, are inflammation of the ileum or caput coli, typhoidal or not, diaphragmatic pleurisy, pneumonia of the lower lobe of the right lung, neuralgic pain along the lower lumbar nerves. A careful and thorough examination in every case, however simple it appears, will prevent many errors in diagnosis. *Jour. Amer. Med. Assn., June 3, 1899. Miscellany THE North Missouri Medical Association met at Carrollton on June 15, 1899, under the presidency of Dr. J. D. Brummall. The following officers were elected: Dr. E. H. Miller, Liberty, President; Dr. J. F. Welch, Salisbury, First Vice-President; Dr. U. S. Wright, Fayette, Second Vice-President; Dr. L. W. Dallas, Hunnewell, Recording Secretary; Dr. J. H. P. Baker, Salisbury, Corresponding Secretary; Dr. Robert Haley, Brookfield, Treasurer. The next meeting will take place in Salisbury, June 20, 1900. DR, THOMAS O. SUMMERS, Professor of Anatomy and Histology in the College of Physicians and Surgeons, committed suicide in the amphitheatre of the institution with which he was connected. He was despondent by reason of the fact that he had failed to receive a position on the medical staff of the army. Dr. Summers was an intense idealist, and although his attainments in medicine were of a high order he was a dilletant in matters literary and philosophical. He has contributed quite a few poems of recognized merit. His great passion was army service. boy he was a volunteer in the Confederate army, serving in the field as well as in the hospital department; he was a surgeon in the Franco-Prussian war, and he received the appointment of Surgeon of Volunteers. with the army in Cuba. He was at Santiago during the trying times of a year ago, and acquitted him. self with courage and ability. His work as government expert in yellow fever is well known, As a THE twenty-fifth annual meeting of the Mississippi Valley Medical Association will be held in Chicago, October 3d, 4th, 5th, and 6th, 1899, under the Presi The dency of Dr. Duncan Eve, of Nashville, Tenn. local arrangements are in charge of Dr. Harold N. Moyer, ably assisted by an excellent] committee. Elaborate arrangements have been made for the entertainment of the members, and a special feature will be a series of clinics in every department of medicine and surgery, given in honor of the Associa tion at all of the colleges and hospitals. Full details of these will be published later. Dr. J. A. Witherspoon, of Nashville, Tenn., will deliver the address in Medicine, and Dr. H. H. Mudd, of St. Louis, the address in Surgery. Titles of papers should be sent in early to obtain a place on the program. There will be two sections. a Medical and a Surgical. There will be a flat one-fare round-trip rate, without certificates, on account of the autumn festival to be held in Chicago. Practical Therapeutics. Creosote and Its Derivatives.-E. HAWKINS* antiseptic, actol is second to chinosal and thymol, while resorcin and argent Credé have a tendency to increase fermentation. Jarinski, Gildemeister, Tilger, Beyer, Nash, Anj believes that the benefit derived from phenols origi- illini, etc., have all seen very satisfactory results nally given, or subsequently produced in the intestine by the decomposition of compounds of creosote or guaiacol, is due to the fact that these phenols unite with the tox-albumins created by the tubercle bacilli; these products are innocuous and readily oxidize, with the silver-gauze. In blenorrhea of the newborn, its action is far more effectual than that of nitrate of silver. Weiler uses injections of itrol (1-8000 to 1-4000) in acute gonorrhea. One hundred cases thus treated recovered nicely. The injections should be begun. yielding a sulphate of guaiacol which is rapidly early, made four to five times daily, strength 1-8000, eliminated, chiefly by the urine. In this way the system is kept free from the tox-albumins, which are the chief causes of the fever, night-sweats, anorexia and dyspepsia, whilst the destruction of the bacilli is to be sought for by hygienic methods-by light and fresh air. Creosote is used as an antiseptic in pulmonary phthisis; it improves the appetite and prevents fermentation in the intestinal tract. Guaiacol, closely related to creosote, has the same effects, but in addition, when painted over the skin, reduces temperature and acts as an analgesic. Of the salts of these drugs, the carbonate is most frequently used. Crede's Silver Salts and Soluble Silver.- DR. SCHILL† has compiled and reported in this article all of the important literature on the Credé silver salts. Credé found that metalic silver was destructive to bacteria, but that it did not affect the animal tissues. Actol (lactate of silver) 1-1000 destroys virulent germs within five minutes, 1-50,000 prevents the growth of same, 1-100,000 hinders the growth of bacteria in the blood serum. As an antiseptic for wounds it does not irritate, corrode, nor is it poisonous. Itrol (citrate of silver) possesses, as a local antiseptic, qualities even superior to those of actol. Credé It is soluble only in 3800 parts of water. recommends it to be used (1) as a powder on wounds, (2) as a salve 1-50, (3) watery solution 1-5000 for disinfecting the hands and flushing cavities, 1-10,000 for gargling, etc. It is unnecessary to enumerate all the conditions under which the use of these silver salts is justified; suffice it to say Credé recommends them wherever internal and external antiseptics are indicated. Mosse finds that internal administration of these salts produces a decided decrease of the aromatic sulphates in the urine, which argonine and chloride of silver do not. Zajontschkowski finds that the antiseptic power of actol is weaker than Credé maintains. cent solution did not hinder within one-half hour the growth of cultures of staphylococci. A one per Reigner demonstrates that as a gastric antiseptic argentum Credé is active in one-half to one-fourth per cent solutions. As an intestinal *The Therapist, May 15, 1899. gradually increased to 1-4000; the solution should be retained in the urethra each time about ten minutes. Hille used in one hundred cases of purulent affections of the teeth and gums a 1-2000 solution of actol, to his entire satisfaction. The Treatment of Herpes Zoster.-J. A. CANTRELL says that it is seldom necessary to use extreme measures in the treatment of this affection, as usually a local or constitutional reaction calls for special medication. External measures should be especially directed toward unnecessary friction and the rupture of the vesicles. If this occurs the pain is increased. Internal remedies are called for in those types in which there is extreme constitutional depression, such as is described in the ophthalmic variety. For external application, the author gives the following three formula: Treatment of Loss or Impairment of Appetite by Orexin.-E. S. YONGE† says that loss of appetite is often an affection which is amenable to empirical treatment alone and demands to be dealt with per se. No remedy has proved so generally useful in cases of anorexia as orexin, a base obtained from coal-tar derivatives. The preparation chiefly used is the tannate a yellowish-white, odorless, almost tasteless powder, insoluble in water, soluble in dilute acids, and therefore in gastric juice. It shortens the process of digestion by stimulating the secretion of hydrochloric acid and by increasing the motoric ac*Maryland Medical Journal, June 10, 1899. †The Therapist, May 15, 1899. tion of the stomach. The methods of administration found most convenient were, for adults, the powder taken two hours before meals (preferably in hot fluid); and for children chocolate tablets; the dose, which depends on the degree of anorexia, varies from 4 to 8 grains in children, and from 8 to 16 grains in adults. employed almost to the exclusion of others. While the oral method is of value in those with a vigorous digestion, and particularly in the early stages of the disorder, yet it soon loses its effect, and it is necessary to administer the mercury by inunction, or by subcutaneous injection. Inunctions are applied with difficulty, especially in the lower class of patients and those whose personal habits are uncleanly. The The Treatment of Hernia by Injection. This simplicity of Velander's method commends itself for method of treating hernia has not received the extensive consideration in this country which its merits deserve. It is only within the last year or two that the profession has been devoting attention to the subject, an impetus having been given the study of the method by the brilliant paper of LANOLOGUE before the International Medical Congress at Moscow in 1897. Prior to that time, and indeed at the present time, the method was largely in the hands of the quacks and advertising specialists, who have reaped a rich harvest in the treatment of hernia by this method. We would not be understood as recommending injection in preference to operation, but we would call attention to the method as one which is of distinct value in certain cases. There is an old saying "beware of the man of one book," and we would extend this warning to those who have one operation or one method of dealing with certain conditions. That injections in hernia have their limitations no one will deny, but that it does cure a certain limited range of cases there is no question. Just what indications should be cited as between operation and injection, it is difficult to say, and probably must be left largely to the discretion of the individual operator when confronted by the conditions of a particular case. A comparatively small hernia in a person of fairly vigorous constitution, in which the risk of producing inflammation in the sac is not great, is one of the conditions which determine the use of the injection method. A further requisite is that the rupture should be retained by a well-fitting truss. Given these conditions, a considerable portion of cures may be reached by injections. A number of solutions have been employed for this purpose, but perhaps there is none better than the chloride of zinc recommended by Lanologue. This substance can be thoroughly sterilized, and sepsis, the one danger from injections, can thus be avoided. Even if the injection method fails, its application does not complicate a subsequent operation for the radical cure of this. disorder. The Pillow Case Method of Administering Unguentum Hydrargyri.-Sufficient attention has not. been called to PROFESSOR VELANDER'S method of administering unguentum hydrargyri in the treatment of syphilis. In this country the administration of mercury by the skin is neglected, the oral method being use in the out-patient departments of our large dispensaries. It is based on the theory that the absorption of mercury is largely by the lungs, even when it is rubbed into the skin. The ointment is applied to the inner surface of a small bag, about 15x20 inches, fastened to the front of the chest by tapes passing over the neck and around the chest. The application is made first to the chest and then to the back, on alternate days. Each night the inside of the bag is smeared with fresh ointment. About three times a week a warm bath is taken, and the skin of the back and chest is carefully cleansed. The method is claimed to be cleanly, efficient and non-irritating; by it the ointment is not brought in direct contact with the skin, and yet sufficient seems to be absorbed to obtain prompt constitutional reaction. Galvanism in the Treatment of Joints.-The persistent and efficient use of galvanism in removing inflammatory exudates from joints and other structures, is enthusiastically advocated by many who employ this remedy. By "efficient and persistent" use of the remedy is meant the application of a current of considerable volume through large electrodes and its use extending over a period of weeks and months. There is little doubt that galvanism applied in this way is exceedingly efficient in dissolving inflammatory products and in stimulating the tissues to a more normal activity. The value of electricity in the treatment of diseased conditions is questioned by a considerable proportion of the profession. We find in examining this diversity of opinion that those who favor the use of this agent are men who have thoroughly mastered the technique of its application and who adapt the different currents to the varying conditions which they meet. Too often the use of a faradic battery not well constructed, in a variety of conditions, many of them not adapted to this form of electric current, is followed by a condemnation of "electricity" as a remedy for disease. No one well grounded in the theory of electro-therapeutics, and who fully comprehends the relation of tension, quantity, alternation, interruption, and other varying therapeutic effects, will doubt that electricity is of value in reaching a variety of conditions. One of the most important of these we have named in the caption of this article. The Uses and Effects of Gude's Manganiferous Iron Peptone.-DR. JULIUS HEITZMANN.* The employment of iron preparations both in essential anemia (chlorosis) and in the symptomatic forms of this affection, produced by severe losses of blood, dates from the earliest times. Long before the chemical relation of this effect was known these remedies were administered on the ground of pure empirical experience. When Hannon pointed out the high significance of manganese, as well as of iron, with regard to the absorption of oxygen by the blood, and when this discovery was confirmed by Ruehle, efforts were made to produce, by combination of both remedies, preparations which would best fulfill the therapeutic indications in all directions. Former attempts of this kind failed to give the desired results. The aim was to combine both metals in such a form as would enable them to be absorbed throughout the entire extent of the alimentary canal, and at the same time be devoid of disagreeable taste which would prevent their prolonged administration. After a series of experiments made in this direction I found in the preparation discovered by Dr. A. Gude (Pepto-Mangan-Gude) a remedy which fulfilled the above requisites, and can recommend it most heartily. Pepto-Mangan-Gude is a clear, dark, wine-red fluid, having an agreeable, non-metallic, astringent taste. The latter property gives it a great advantage over other similar preparations, for the remedy is always taken with pleasure, and may therefore be administered for a long time without exciting the disgust of the patient. No irritation of the stomach is produced, nor is the digestion disturbed in the least respect; indeed, as regards the latter, a stimulation of the long-absent appetite could be demonstrated within a short time. Pre The Pepto-Mangan-Gude, usually mixed with some water, is prescribed in doses of two or three dessertspoonfuls, increased to as many tablespoonfuls per day. An especially agreeable manner of administration is by addition of cold milk, which then assumes a light chocolate color and an agreeable taste. scribed in this form we obtain from this preparation everything that could be expected from a remedy for anemia. The Pepto-Mangan-Gude may also be mixed with white and sweet wines, excepting the red wines which contain tannic acid, and an occasional change in the manner of administration is sometimes of advantage, especially in the case of children. The diet, during the use of this preparation, should consist of milk, meats-especially ham-fowl, softboiled eggs, and other easily digested foods. On the other hand, sour and fatty foods, red wines, and raw fruits are to be avoided. *Allgem. Wiener med. Zeit., XXXVI. The remedy is to be administered for a number of weeks, especially in cases of chlorosis, but in the case of young girls up to 12 years of age it is best to commence with a daily dose of two teaspoonfuls (ten grammes). In adults the dose of the Pepto-Mangan -Gude may be increased in a few days to one tablespoonful twice or thrice daily, or even to ten or twenty grammes. The preparation should be well protected from the light, and preserved in a cool place in a wellstoppered bottle. I have employed the Pepto-Mangan-Gude with much success both in chlorosis and in cases of anemia in girls and women due to loss of blood, menorrhagia, metrorrhagia, inflammation of the pelvic organs, periand parametritis, or prolonged leucorrhea. In almost every instance I observed within a short time increase of appetite, improved nutrition, healthier color of the face, and increase of weight. I was surprised to learn how much more readily the Pepto-Mangan-Gude was taken than similar preparations, without ill-effects even after protracted use. To illustrate my remarks I will cite two cases: I will first report a case of chlorosis treated with this remedy, which was under constant observation. The patient, a school girl, aged 16, began to menstruate one year ago, but after appearing regularly for three periods the flow suddenly ceased, probably in consequence of mental overexertion, and symptoms of chlorosis soon developed. The various preparations of iron were tried, but were either not well borne or excited so much disgust that they were discontinued by the capricious patient. A milk cure was prescribed, but followed for only a short time. When, however, I resorted to the Pepto-Mangan-Gude I was surprised to find that the girl took it willingly and that it was well borne. She made a rapid recovery, and after the use of two bottles had regained her former healthy color, while her strength and menstruation returned. CASE II-A married lady, aged 30, had suffered from leucorrhea due to catarrhal infiammation of the vagina for two years, and although the local trouble had been much relieved, she continued pale and weak. As her chlorotic daughter at the time was taking the Pepto-Mangan-Gude with marked benefit, I advised her also to try this preparation. She followed my advice, and after fourteen days the weak, sluggish, and pale woman seemed as if transformed. She has since regained her former health. These two cases, which were under continued observation, will confirm what has been said above regarding the manner of application and effect of the PeptoMangan-Gude. I regard it as superfluous to cite other cases, since a few closely observed cases teach more than a host of superficial observations. On the ground of my experience I consider myself warranted in directing the attention of physicians to this remedy, and feel convinced that further trials will give equally favorable results. Even in cases where local treatment is necessary the Pepto-Mangan— Gude will prove a valuable auxiliary in our treatment. |