Important For the Physician to watch the character and quality of the remedies used in his prescriptions. Responsibility does not cease when the patient leaves the office, for impure, stale or inferior preparations may be used without his knowledge. Personal examination of remedies prescribed is the best check upon substitution. FERRO Salicylata LIQUID. Merrell. An eligible combination of Methyl Salicylate and Tincture Citro-Chloride Iron, in a pleasant and permanent form. Each fluid drachma contains: True Salicylic Acid-from Oil Wintergreen (Methyl Salicy late)... 5grs Tinct. Citro-Chloride Iron, FLUID 5 minims Ferro-Salicylata is especially valuable in that shade of disease peculiar in anæmic, delicate, poorly nourished or broken-down patients-usually aged people-children or youth-but met with in all ages. In adults, and often in children when the disease is not plainly chronic, there will be a long series of recurrences with intervals of doubtful health. It may also be employed in acute articular rheumatism, and in some cases of acute tonsilitis, especially where the diagnosis is at first in doubt between rheumatic angina and diphtheria; also in acute rheumatism and rheumatic affections generally. Ferro-Salicylata may be used in combination with the Iodides and Bromides of Potassium and Sodium. Associated with the former, it will prove an admirable alterative and tonic in secondary syphilis attended by a debilitated condition of the general system. It also combines well with Chlorate Potassium, the Hypophosphites, with Fowler's Solution, the vegetable bitter tonics, either in Fluid Extract or Tincture Form. Ferro-Salicylata, and all other preparations of this Company,reach the laity through professional channels only. We, therefore, avoid entering into the minute details of their application, leaving the physician to make such practical use of our therapeutic notes as in his judgment may be best suited to individual cases. Please designate "Ferro-Salicylata-Merrell.” 2 The best representative of the drug in fluid form, containing the combined alkaloids in the same proportion as they exist in the root, and especially valuable in all diseases of the mucous surfaces. It will and, being so perfectly bland and non-irritating, may be applied to the most delicate mucous surfaces without unpleasant effects. HYDRASTIS, mix with water, syrup, glycerine, or alcohol, without precipitation, MERRELL. ELIXIR Pinus Compositus Merrell. Each fluid drachm contains: White Pine, Fresh bark...22 grs Balm Gilead Buds... 2 grs Spikenard -2 grs Cherry Bark. Ipecac. Sanguinarina Nitrate. Ammonium Chloride.. Chloroform ............... An admirable combination of well-known and highly approved medicinal agents; recommended in acute, chronic and capillary bronchitis-in ordinary coughs and colds, and wherever a "routine" ex. pectorant is suggested. CAUTION.-Physicians are reminded that the Elixir Pinus Compositus of this manufacturer is wholly unlike the many syrups, etc., under similar names, and the difference will be readily appreciated when tried. In testing the physical properties of the Elixir Pinus, note especially its delicate taste and freedom from the odor of rank syrup, the drastic, harsh and repulsive characteristics of the crude ---1-16 gr blood root, and other coarser ingredients characteristic of competing 11⁄2 gr -1⁄2 minim preparations. 13/ 1 grs 4 gr 1-64 gr "Merrell Co.'s" "Green Drug," Fluid Extracts, True Salicylic Acid, Salts of Hydrastis, Fluid Hydrastis, and Specialties may be obtained of wholesale druggists throughout the United States. Prices current and printed matter cheerfully supplied. Wm. S. Merrell Chemical Company, Cincinnati. ARTHUR J. CONNER & CO., BOSTON. New York. Please mention THE PHYSICIAN AND SURGEON to advertisers. SERVICEABLE SPECIALTIES. PICHI, (Fabiana Imbricata), is an emollient, sedative and diuretic in diseases of the Urinary Organs. It has been found efficient in gonorrhoea, cystitis, dysuria, urinary calculus, and all irritable and inflammatory conditions of the bladder and urinary tract. The pharmaceutical preparations of Pichi are Fluid Extract and Solid Extract Pichi and Soluble Elastic Capsules Pichi, 5 grs. CACTUS GRANDIFLORUS is a heart tonic par excellence. In these days when so many persons die of heart failure, the selection of a heart tonic is important. According to J. Fletcher Horne, M. D., in London Lancet, it is especially valuable in nervous and functional disorders of the heart, where digitalis and s.rophanthus are unsatisfactory, such as palpitation, irregularity. fluttering, intermission, slow or rapid action arising from debility, worry, dyspepsia, or the excessive use of tea and tobacco, comprehensively classed as cardiac erethism. CREOSOTE is of all the methods of treating consumption the most satisfactory. We supply creosote in Soluble Elastic Capsules (Cod Liver Oil, 10 minims, Creosote, I minim,) and Enteric Pills of Creosote coated with a material that resists the action of the gastric juice but dissolves in the duodenum. Send for literature or samples of these products. PARKE, DAVIS & COMPANY, DETROIT, NEW YORK, AND KANSAS CITY Please mention THE PHYSICIAN AND SURGEON to advertisers. (6) These cases are very susceptible to treatment when the measures are applied scientifically and with full knowledge of the causes. Their inebriety is more positive than that of other inebriates. The drink impulse is often controllable and frequently disappears with treatment. This class requires the most careful medication and study. (7) Medico-legally the most important problems are associated with these drink paroxysms. Each case requires special study and is to be judged from general principles of physiology and psychology. (8) Such cases of necessity have impaired nerve control and cannot be measured by the rules or standards of mental health. (9) All these cases should receive careful study and examination. Tabulated facts of sufficient number and accuracy are needed from which to draw accurate conclusions covering the laws which govern this class of neurotics. Their curability is assured when the causes are known and by the application of means known to science. FRAU GELLY: A UNIQUE THROAT SUBJECT. FRAU GELLY enjoys the probably unique distinction of being the only person engaged in her occupation. Nearly every medical visitor to Vienna within the last ten years will remember her. She is employed as a nurse in Schnitzler's throat clinic in the general hospital and acts as an assistant instructor; but her forte lies in hiring herself out to medical men as a subject upon which to practice laryngology and rhinology. She comes to your room by appointment and brings all her own instruments. If you are a beginner, she explains the proper position for patient and physician, the adjustment of the forehead reflector, and the introduction of the throat mirror. Her throat is so insensitive that even the most awkward manipulations produce no gagging or other reflexes. She is able to tell whether the throat mirror is in correct position and to guide your and so that you must see the vocal cords. She next points out with a probe the different structures to be seen. The next step is for the student to paint the larynx with some bland solution, and after that to touch the different parts with the probe as if applying a solid caustic. When you have become quite expert she introduces a glass bead so that it rests on one vocal cord and lets you remove it with Schrötter's forceps. The amount of confidence she has in your dexterity is indicated by the fact that she keeps a very tight hold of a thread attached to the bead. Passing on to the nose, you are given practice in making applications with a brush or probe to the different fossæ, in passing a catheter into the Eustachian tube, and in posterior rhinoscopy. It gave me a very queer sensation the first time I saw her introduce the Eustachian catheter herself. Frau Gelly has the reputation of being crafty. At the first lesson you can not help seeing every portion of the larynx, but as you become more expert she makes it more and more difficult, until finally she is worse than the most refractory dispensary patient. Her object is apparently to show you the necessity for an indefinite continuance of the sittings. But it is just at this point that most men stop. Last year an American physician was working in Vienna on a modification I* (not yet published, I believe) of O'Dwyer's tubes, and during his experiments he intubated Frau Gelly's larynx a thousand times. She receives about eighty cents an hour and is harder to make an appointment with than Professor Bilroth. When she does make an appointment she never intends to keep it, but makes her appearance a week or two later. Why should not New York produce a Frau Gelly? There are students enough in the post-graduate medical schools to render the occupation profitable if not agreeable.-Dr. Sinclair Bousey, in New York Medical Journal. THE DISEASES AND INCIDENTS OF GREAT CROWDS. THE medical history of the great Columbian celebration, which produced so much enthusiasm in this city last week, deserves some attention, and if it could be completely written would prove most interesting. There were probably four hundred thousand or five hundred thousand visitors during the week and perhaps a quarter of a million persons crowded the streets along which the parades were held. It is estimated that two hundred persons were more or less hurt or taken ill. The census as gathered by newspaper reporters from the police reports and hospitals makes the number about one hundred. Our readers will be interested in the list, as showing the accidents and diseases of great crowds. It is as follows: Fainting, thirty-five; hysterical seizures, three; epileptic fits, eleven; sprains, three; run over, three; fractures ten-one of the arm, two of the skull, seven of the legs; falls, eleven; cramps, one; dislocation, one; burned, mortally, one; struck by a brick, one; "taken sick," thirteen. Total ninety-four. This shows that fainting is the most frequent pathological phenomenon, that crowds are bad for epileptics, that falls and fractures are numerous, and that delicate people are liable to be "taken sick." On the whole, the record is not a bad one, considering the enormous congregation of people. The reports also show that the sick and injured were promptly and efficiently cared for; and our much abused ambulance service evidently did yeoman's duty on that occasion. -Medical Record. SURGERY. SHOCK AND ITS TREATMENT. KOTTMANN (Wiener med. Presse, 1892, Number XXI, from Correspondenzblatt für Schweizer Aerzte) states that the most important signs of shock are weakness of the heart, faint respiration, skin pale and covered with cold sweat; face drawn out, sunken eyes and livid lips; consciousness remains; sensibility reduced. Shock appears when certain very sensitive organs, as testicles, bones, or bowels, have been subjected to contusion or other serious injury. Shock may occur from hæmorrhage, and is then associated with functional changes in the body of which there are no post-mortem evidences. Two theories are advanced: the first defines shock as a reflex paralysis of the heart and vessels caused by the trauma. According to the second the injury causes, reflexly, exhaustion of the medulla oblongata and of the spinal cord, and, as the nerve centres are affected, there is debility of heart and respiration. The fever which accompanies shock is, according to Kottmann, the consequence of trauma. The substances causing the fever are here chemical, and not bacterial, are freed from normal tissue matter by the injury, and include hæmoglobin, fibrin firment, and similar The author objects to confounding shock with debility due to hæmorrhage. In the latter there is rapid pulse, quick, deep, panting respiration. In shock, the patient does not present the evidences of cerebral irritation, noises in the ears, affected vision, palpitation, yawning, and even convulsions. In severe cases of shock the usual remedies-alcohol, ether, caffeine, and camphor-may be used without relief. The similarity in the appearances resulting from hæmorrhage and from shock induced Kottmann to use salt-water transfusion in four cases, with good results. By the neuro-pathological theory the explanation is that the effect of the salt solution is to stimulate the centres with which it comes in contact, and with increased arterial pressure the central nervous system would receive more blood and recuperate more quickly. If the hæmo-pathological theory is accepted the explanation is even more simple: the salt-water would fill the empty heart and vessels, and the hydraulic requirements would be fulfilled while the blood in the distended abdominal vessels was being restored to the circulation. Patients suffering from shock often require severe operations, especially the amputation of members. Experience shows that chloroform anæsthesia in these cases is attended with unusual danger; which is less with ether, which acts as a heart stimulant.-American Journal of the Medical Sciences. SYMPHYSIOTOMY. AT a meeting of the Philadelphia county medical society held on October 12, Dr. Barton Cooke Hirst read a paper on this subject, in which he said: Symphysiotomy has as remarkable a history as any procedure in surgery. Suggested for the first time in the "Surgery," published by Pineau in 1598, and first performed upon a living woman in 1777, the idea may be said to be three hundred years old, while its practical application dates back more than a century. From the year of the first operation until 1858 symphysiotomy was performed eighty-five times in different parts of the continent of Europe and once in England, with a mortality of thirty-three per cent. The frequency of the operation diminished after the first few years, until in 1858 it had practically died out. It was revived, however, in Italy in 1866, and in the succeeding twenty years seventy operations were performed with a mortality of twenty-four per cent. Italy continued to be the exclusive field of the operation until a year ago, when it was again tried in Paris by Pinard, whose interest in it was aroused by a visit of Spinelli from Italy. Ten operations have since been performed in Paris, two in Dresden, and one in Strassburg. From January 1, 1886, there have been fifty-two operations with only a single death, due to septic infection before the operation was undertaken. Twenty-three symphysiotomies have been done already this year, and the last thirty-four women have all recovered. We owe the introduction of symphysiotomy into this country to Dr. Robert P. Harris, who, as is well known, has long been interested in the subject, and at the recent meeting of the American gynecological society in Brooklyn, read a paper tracing the development of the operation, showing by the most laboriously |