CLASS-ROOM NOTES.
[From the College and Clinical Record.]

-As a general rule, saline cathartics are easily borne by the stomach, especially Epsom salt. (Bartholow.)

-An early cessation of the lochia is not pathological unless other symptoms indicating such condition occur. (Parvin.)

-Picrotoxin is one of the best remedies for night sweats of consumption; one dose of or grain taken at night generally prevents perspiring for several nights.

-Some preparation of ipecac, preferably the fluid extract, not infrequently arrests a troublesome cough-as a cough preventing sleep-if taken at the bed hour.

M. Ft. pil. 1. Sig.-One t. d. The quantity of aloes may have to be reduced. -A neat way to copiate a deep wound after placing drainage-tube, is to make use of a ligature armed with two needles; pass the needles, one through each side (deeply); cross the threads and pass the needles through the superficial fascia that is, making a figure-of-eight suture and tie; this brings both deep and superficial parts together.

-Prof. Parvin states that of the entire number of deaths among children 33 per cent. are from diarrhea; of this 33 per cent. about 96 per cent. are under 5 years of age. Further, of that 96 per cent. some 63 per cent. are of children under one year of age. It has been estimated that one-fourth of all children die, and this is rather an under than an over-estimate. This mortality usually arises from disorders of digestion.

-Prof. DaCosta states that treatment of hypertrophy of the heart is always the same. Decrease diet, but do not starve, as that may increase the trouble. Place patient upon nonstimulating food-milk and vegetables, but no meat; avoid tea and coffee and use cocoa; also avoid active exercise. Give occasional laxative. The special agents are aconite, veratrum

genital. When drawing the urine from any patient, have him in recumbent position or sitting posture; if erect, the heart's action may be suddenly arrested, causing death. Draw only a portion at one time; wait two or three hours and draw the remainder. The

dangers of suddenly emptying bladder are paralysis of that organ, may rupture small vessels, or cause cystitis.

-Dr. Sajous teaches that in the treatment of simple chronic rhinitis cleanliness is of the utmost importance. The douche is not recommended now as much as formerly, except when the accumulation is great, which is rare. Ear affections are apt to follow the use of the douche.

By all means have patient avoid swallowing, if you use the douche, as it is at this moment that the Eustachian tubes open. Breathe through the nostrils. The atomizer is the best apparatus for cleansing the nares. Liquids for this purpose should always be tepid and alkaline in reaction. The temperature of the liquid which is comfortable for the end of the elbow is about right. Never use a bland fluid to nares, as it is irritating, as much so as an acid solution; must be alkaline; may use bicarbonate of sodium, borax or common salt: one drachm of any of the above to one pint of water is about the right proportion. Sometimes can get better results by combining the above.

Use the atomizer about three times a day; if inconvenient to use so often, use especially at night, as a great deal of damage is done by the long-continued irritation. During the day use some protective, as cosmoline, applied to nares.

One drachm of bromide of soda added to one pint of the spray often allays nervous irritability. Never use strong solutions. Alum is the best astringent to add to the spray. Pinus

Snuff one a day after washing nares; this is especially beneficial when there is an abundant discharge. If enlargement of the sinus manifests itself as a complication, severe treatment is required.

-Before using a gargle take a full breath, fill the mouth with the liquid to be applied to the pharynx. Throw the head backward, and the fluid flows against the pharynx, and is partially applied to the palate by the air which gradually escapes from the lungs. If necessary for the fluid to reach posterior nares, the patient should lie down, take a mouthful of the fluid, draw out the tongue as far as possible with a handkerchief, and gargle while in that position. By throwing the head suddenly forward the liquid may be brought through the nose.

-Under certain conditions, Dr. Sajous considers that cocaine for acute rhinitis is beneficial, say for two or three applications, but for constant use, this agent is exceedingly injurious and may cause paralysis. If the patient consults you early, order three powders, each containing:

.gr. .gr. ij .gr. iv

Sig.-Ft. pulv. j. One every three hours.

After the three powders have been used, continue the same prescription minus the cocaine. When the malady has reached the third or muco-purulent stage, the treatment is more difficult, but we can hasten a cure by two-drop doses of tinct. belladonna every three hours, with the addition of a little quinine.

-A case of jaundice of long standing was recently brought before the class by Professor Bartholow. Had attacks of hepatic colic, each attack followed by jaundice. The following treatment was suggested: Try to effect the solution of the calculus

R Sodii phosphatis...... Sig. Dose, 3 j.

.....

.3 iv

Give after the stomach digestion is over. Avoid fats; lessen the quantity of starchy food; every effort must be made to produce alkalinity of the intestines. Cut off the sugar; may give saccharin gr. 1 or 2 and salol gr. I or 2 in a pill; act upon the kidneys. To remove the jaundice, benzoic acid is the best of all remedies; alternate benzoic acid with phosphate of sodium; warm alkaline baths.

-The following is the substance of the treatment for epistaxis recommended by Dr. Sajous: Position is an important element. Have patient stand up, if possible; if not able to stand, lie flat upon the back. Immerse the feet first thing in hot water. Apply blister over liver. Insufflate a powder composed of equal parts of tannin and gallic acid or a drachm each of the above to an ounce of water, and apply with cotton wool.

If all this does not stop the hemorrhage, we must then resort to plugging. For anterior nares use small pieces of sponge fastened to a string, which serves to draw them out. To plug posterior nares, pass a flexible catheter through the nares to pharynx, and bring it out of the mouth with long forceps; to the end projecting from the mouth attach a string which has a plug of cotton secured near the centre; draw the catheter out through the This leaves one portion of string projecting from nose, while the other end hangs from the mouth. In this way you have full control of the plug. Plug should never be left in the nose over thirty-six hours, ten hours the minimum. Remove with care. It is well to apply a spray of warm alkaline water before removing.

nose.

SYMPTOMS OF SPINAL CURVATURE.—When a child complains of weakness on slight exertion, of pain in the abdomen, when it walks with a constrained gait, and picks objects from the floor by bending at the knees only, Prof. Goodman advises that the spine be carefully examined for beginning curvature.

QUININE IN JAUNDICE.-Waugh called attention to the fact that jaundice with high fever and epigastric tenderness is usually of malarial origin, and requires very large doses of quinine. He gives from 20 to 40 grains per rectum, in a concentrated and warm solution. The stomach is usually too sensitive to tolerate a dose large enough to accomplish the cure.

To avert a threatened tonsillitis, Dr. Longstreth advises turpentine. Astringents only harden the tissues. When suppuration is established he uses a solution of tincture of iron.

Dr. Longstreth called attention to the proba

bility of uterine or vaginal secretions being the cause of diarrhea. Injections of permanganate of potassa destroy the morbid products.

RAILROAD CRUSH REQUIRES AMPUTATIONDr. Hunt observed that in railroad accidents the soft parts are injured far beyond the laceration. Hence, amputation should usually be performed high up the limb.

Before his clinic a few weeks ago, Prof. Goodman removed at one operation both breasts of a woman who has suffered severely for some years from interstitial lobular mastitis. Healing was by first intention, and the relief was complete.

In typhoid fever, Prof. Waugh has so far had good success with sulpho-carbolate of zinc. A case was shown at his clinic which had come for treatment when suffering with fetid diarrhea, high fever and hemorrhage from the bowels. Sulp-carbolate of zinc at once stopped the hemorrhages, removed the fetor from the stools, and reduced the temperature two degrees. This makes the eighth case in which Prof. Waugh tried this preparation with similar results.

Prof. Garretson is fond of this treatment for a sessile nasal polypus difficult to snare. He firmly constricts the polypus by means of an ordinary pair of dressing forceps, and allows them to hang on the growth till it sloughs off.

Try the following prescription to abort an attack of acute bronchitis. Prof. H. C. Wood says that it is worth $5000 to every medical student :

vented. This was shown by the temperature chart not varying after the first thirty hours after operation.

SENILE GANGRENE-A case of senile gangrene was shown in a male negro 101 years of ago, involving the thumb of right hand. Attention was called to the effect caused by amputation, in that a fresh impetus was thus given of a new circulation to the part, and that charcoal dressings were most advisable in such cases. He also adverted to the association of this disease with diabetes mellitus, and to the

importance of testing the urine in old people.

AFTER-TREATMENT OF AMPUTATIONS.-Dr.

Deaver amputated the right arm at the lower part of the middle third of the humerus, for osteomyelitis of the ulna, involving the elbowjoint, in a patient 17 years old, at the German Hospital. He showed the case at the following clinic, and removed the dressing for the first time, where it was found that the wound had healed without any suppuration, except on the external end a very little near the drainagetube.

In speaking of renewal or dressing of wounds, be pointed out that whenever the dressing becomes moist it should be removed, or if fever sets, and is persistent, which is an indication that there is septic suppuration.

Sloughing, he says, often occurs, and is due, to too great tension of the sutures, which, therefore, should be injected after each removal of the dressing.

For fever after amputation, he gives:

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fzij 3iij

M. S.-Two teaspoonfuls every three hours. PHILADELPHIA HOSPITAL.-Dr. Hearn removed an enchondroma of the finger which had become partly ossified, making the operation practically bloodless and painless by first applying an elastic bandage so as to expel the blood, and injecting a four per cent. solution of

cocaine.

Prof. Tyson called attention to the absence of marked pain over the kidneys in the various forms of Bright's disease. He ascribed some of the pains in this region to renal calculi, but the great majority to lumbago.

.gr. 1-16 .gr. v .qs. fzij

Liq, ammonii acetatis...
For one dose, every two or three hours.

CEREBRAL SYPHILIS.-"When you suspect lose not a moment," says Prof. Waugh, "in that a syphilitic gumma is forming in the brain, attacking it vigorously and in every possible way. give it hypodermically, give it by injection and Give mercury. Give it not only one way, but per rectum; and in addition give all the iodide of potassium the patient can stand-half an ounce or more a day. Half way measures are worthless; and the tumor once formed, there is nothing at present known, either in the pharmacopea or out of it, that will restore the continuity of the broken up nerve fibre."

A COUGH OF REFLEX ORIGIN.-Prof. Woodbury mentioned at his clinic recently, that a man came to him suffering with a paroxysmal and long-continued cough. Nothing wrong could be detected in the lungs; upon continu

discovered in each ear. The wax was removed and the cough immediately stopped.

FOR A SORE THROAT.-Prof. Waugh advised a simple treatment of gargling with salt water and cold compresses to the throat; and to prevent a recurrence, the local application of tannic acid, gr. xxx, glycerine 3j.

A man who suffers from "intoxication" should not be allowed to sleep it off. Here a salt and water enema is good; or, more stimulating, soap-suds containing about one-half an ounce of spirits of turpentine. This will generally restore consciousness when emetics or other remedies may be administered.-Prof. Woodbury.

INJECTION FOR GONORRHEA.-In the veneral wards (Bay View), Rohé has used with very satisfactory results an injection of Labarraque's solution, i to 10, in gonorrhea. The discharge stopped promptly in most cases. Care should be taken to get a trustworthy preparation of the liquor soda chlorinatæ.

ANTIPYRETIC TREATMENT IN PNEUMONIA.Dr. N. T. Carswell, the resident physician, has adopted a treatment in cases of pneumonia which has been very successful. A 15-20 grain dose of antipyrine is given, and followed in two hours with 20 grains of quinine. The temperature is promptly reduced, and never afterward reaches the original point, say 104° or 105°. The patients seem to progress much faster toward convalescence under this treatment than when the usual method of expectant treatment is employed.

REFLEX NEURALGIA OF THE FIFTH.-Garretson relates the case of a naval surgeon, who for two years suffered the most excruciating tortures from a neuralgia extending just along one side of the longitudinal sinus of the dura mater. Garretson gave him instant relief by extracting one of his lower bicuspids. Some years ago, Garretson had discovered a small branch of the fifth pair of nerves that passed back just in the line of the surgeon's pain; so he at once suspected a reflex cause, and found it in an irritating tooth.

When a patient comes to you complaining of edema of the prepuce, without local disease or injury, or edema elsewhere, look for Bright's disease-the cirrhotic form-Waugh.

A NEW ANTISEPTIC.-Keyser considers the new antiseptic, silico fluoride of sodium, as the best in treating the eye. He uses it in his cataract operations, and also in gonorrheal ophthalmia, instead of boric acid; and finds it much more rapid and certain in its action. The solution used is a saturated one-gr. 1⁄2 to the f3.

MAGNESIA DANGEROUS. Stewart advises against the giving of dose upon dose of carbonate of magnesia when it fails to purge. It is likely to make a dangerous stone-like impaction in the intestine. He has known several cases of death from this cause.

PROF. GOODMAN removed the left breast of a woman for cancer. This woman had spent two years and two hundred dollars under treatment by some old woman quack, a so-called "cancer doctor." At the time the growth was removed, the breast was much inflamed from the treatment; and during the two years the patient had suffered tortures from the irritating plasters.

"OBSTETRICAL APHORISMS."-Stewart.-In patient is dangerously weak from loss of blood, cases of post partum hemorrhage, where the do not neglect, along with other measures, to elevate the foot of the bed, so that the brain may more easily receive blood.

Alum, 3j to the pint, is a cheap and good wash for excoriated nipples; so is tincture of catechu. If the excoriation is very bad, try arg. nit., gr. vj to the ounce of rose water. Have the nipples washed though, before the child is applied. Protect the nipples with a shield from being rubbed by the clothing; and if these measures are not sufficient, have the nipple covered by a shield while the child is sucking.

The

Within forty-eight hours, or the so-called "three days," you may have milk fever. temperature may rise even as high as 103° or 104. This fever can usually be avoided by keeping, the mother on mild unstimulating diet for the first three days after childbirth.

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In treating this fever, I have found that a continuation of saline purgatives will muct decrease, or perhaps stop the flow of milk.

Accordingly, I use other preparations-compound licorice powder, a good 3 to the dose or, better still, castor-oil. When the milk is deficient, cocoa in some form is generally of good service to increase the flow.

Impending attacks of asthma and migraine may, it is claimed, be cut short by the timely administration of a teaspoonful of common table salt, taken dry.

Persistent hiccough may, it is also said, be arrested by applying cold water to the lobes of the ears, or by closing the external meatus or both sides with the fingers, while cold water slowly given to the patient by a third party.

Eclampsia of pregnancy is probably due t a poisoning of the nerve-centres by the defici ent excretion and consequent retention of ur nary products, most likely, urea in the system

I must express my appreciation of Dr. De Armond's thoughtful letter on croup (page 140, April WORLD), though I do not agree with his conclusion. My conviction is that croup is sadly over-treated; that the results of treatment, outside of surgical means, are no better than when no treatment is employed. In spite of turpeth, alum, quinine, emetics, et id omne genus, the little creatures nearly always die. Let us hope that while these powerful remedies fail to prevent death, they do not hasten it.

We know that croup is a disease of limited duration; that if the child can be tided over the week, recovery will probably occur through the natural course of events. The indication is then to sustain life until the danger is past.

If the fever be really excessive, it should be moderated by the use of such antipyretics as the physician in charge is best skilled with: quinine, antipyrine, cold water or aconite. Yet caution must be had lest the heart be depressed and pulmonary edema brought on. For it is edema which kills the child; almost never suffocation. Antipyretics, sustaining measures, and perhaps a little opium, to calm the restlessness which brings about the attacks of dyspneathese are the only indications during the first stage.

Experience has abundantly shown that retraction of the abdomen during inspiration is the certain forerunner of edema; and this, then, is the imperative call for tracheotomy or intubation.

This done, our duty is again to sustain the strength; bewaring of opiates or depressants of any sort.

Whether the steady administration of calo

mel hastens the loosening of the false membrane, I am not able to say. It has appeared to do so in a few of my cases. It has, at any rate, done no harm, and is given without causing a struggle with the child.

In treating croup, one feels so much like jerking off the coat, rolling up the sleeves and "pitching in," that it seems hard to be held back and compelled to watch the progress of the case, while apparently doing nothing. But battles must be won with brains as well as with muskets; and the physician must enact the general's part, who, in the midst of the turmoil, is coldness itself; waiting for the critical the leash;" saving his reserves until the time moment; holding his forces "like leopards in when they will be of the most use.

death. The patient died of heart-failure, with On page 147, Dr. Kinsley asks the cause of rapidly supervening hyperemia of the unaffected lung. I have not found it advisable to continue the use of antipyrine after the first decided fall in the fever-in this case from 105° to 101°; but have substituted tonics and wine, with careful feeding.

Dr. Grime's case may be one of stone or of urethral disease, ulcer or caruncle. A local examination would show which.

Dr. Rufy (page 151) might try oil of erigeron for his case of enuresis, as there is a lack of power in the sphincter vesica, which this drug relieves.

Dr. Stanley's case did not live long enough to permit a certain diagnosis to be made, and that of typhoid is not wholly satisfactory. The lumbar pain looks as if there might have been congestion of the kidneys. The convulsion looks still more so. Was the urine suppressed, albuminous or bloody?

Dr. Frederick's patient would be much benefitted if he would draw a half-inch stripe with lunar caustic along the whole length of her spinal column. Internally, give strychnine and iron, with aloes.

Dr. Burkett's case (page 156) is evidently one of reflex irritation, from some uterine or ovarian disease, impossible to diagnose except by examination.

If Dr. H. A. Smith (page 157) will try Aletris Farinosa for uterine pains during pregnancy, I would be glad to hear the result. The remedy proved effectual in one of my cases.

Dr. Symmes (page 157) had better resort to electricity if strychnine and ergot do not relieve the vesical palsy.

Dr. Powell (page 158) may find in succinate of soda the remedy for gallstone colic.

I am very glad to hear from Dr. Gregory on jaborandi for erysipelas. That man has a practice bigger than that claimed by Flower, or a