HARE'S Therapeutics has reached its eighth edition in less than ten years. This is proof of the value of this very practical work. It has met favor with student, but the practitioners also approach its merits as a quick reference book. The new material in this edition has been thoroughly edited, and the cream of progress is thus carefully compiled. The physiological effects of drugs have been given especial attention, so that practical applications of the principles of therapeutics can be more readily made. The consideration of the therapy of diseases, which is a feature of the book, is invaluable; likewise the index of diseases. F. P. N. A TEXT-BOOK OF PRACTICAL THERAPEUTICS. With Especial Reference to the Application of Remedial Measures to Disease and Their Employment upon a Rational Basis. By HOBART AMORY HARE, M. D., B. Sc. Eighth Edition, Enlarged. Thoroughly Revised, and Largely Rewritten. Illustrated with 37 Engravings and 3 Colored Plates Price, $4.00. Philadelphia and New York: LÉA BROTHERS & CO. 1900. THIS forms one of Lea's series of pocket text-books. Although rather small to contain all that is necessary for CHEMISTRY AND PHYSICS. A Manual for Students and Practitioners. By WALTON MARTIN, M.D, Assistant Demonstrator of Anatomy, College of Physicians and Surgeons, New York, and WILLIAM H. ROCKWELL, Jr., M. D., Assistant Demonstrator of Anatomy, College of Physicians and Surgeons, New York. Illustrated. Philadelphia and New York: LEA BROTHERS & CO. the medical student to know of these branches, it is an excellent manual, and is fully up to the high standard set by the previous numbers of this series. The subjects are treated in a scientific manner, especial prominence not being given to those chemicals which are also drugs. An exception is made to this in the chapters on Organic Chemistry, where, on account of the vast number of the carbon compounds, the authors have chosen those which are most important from a medical standpoint. The section on Physics is rendered much clearer by the insertion of numerous illustrations. E. W. F. THE Rev. Dr. D. Z. Sheffield, President of the North China College and Mission at Tung-chau near Peking, was in America when the Boxer riots began, but immediately prepared to return to his post. Before sailing from San Francisco, late in June, he learned of the burning of his college. Dr. Sheffield left behind him the manuscript of an article which will appear in the September Century under the title of "The Influence of the Western World on China." As a result of the author's thirty years' experience as a missionary, he is said to argue strongly against the dismemberment of the Middle Kingdom. Equally timely will be a paper by R. Van Bergen in the same number, on "The Revolution in China and its Causes." The fiction of the September magazine will include a characteristic story of about 20,000 words by John Luther Long-"The Prince of Illusion.' Favorite Prescriptions Styes. The following prescriptions are given by Ohlemann in Ocular Therapeutics: Hydrargyri chloridi corrosivi........... Vaselini.... 3 gr. 20 ...dr. vii and gr. xlij Misce et fiat in unguentum. Signa.-Ointment for eyelids. Misce et fiat in collyrim. Signa. For local use on eyelids. Glycerini, q. s... Misce et fiat in unguentum. Signa.-Eye ointment.-Ex. Treatment of Chronic Summer Diarrhea.. B Bismuthi subgallati... Pulv. opii...、 Pepsin. pulv. gr. xxiv-xxvi gr. vi-xij M. Trit in pulv. No. xii. S.--One every four hours, alternating with the following: B Hydrarg. chlor. mitis.. Cerii oxalat.. gr. ss gr. ij q. s. M. Trit. in pulv. No. xii. S. One every four hours,-ALFRED STENGEL, North Carolina Medical Journal. Irritable Bladder.-The Journal of the American Medical Association credits the following prescription to Todd: R Benzoic acid.. Borax.... Alcohol .... Tinct. hyoscyamus. Syr. wild cherry.. Elixir orange-peel..... Distilled water, q. s. ad... M. Sig.: A dessertspoonful every four hours, followed by a glass of water. PAPERS for the Original department should be in hand one month in advance, and contributed to THE MEDICAL FORTNIGHTLY exclusively. A liberal number of extra copies will be furnished authors, and reprints may be obai ned at reasonable rates, if request accompanies the manuscript. Engravings from photographs furnished free. Contributions, and books for review, should be sent to the Editors, 312 Century Building, St. Louis. Signature of contributor, for reproduction, should be sent with every article, on a separate slip; use heavy Ink, and allow autograph to dry without applying blotter. COLLABORATORS. LEWIS H. ADLER, Jr., M. D., Philadelphia. CHARLES W. BURR, M. D., Philadel- DILLON BROWN, M. D., New York. HOBART A. HARE, M. D., Philadelphia. CHARLES JEWETT, M. D., Brooklyn. J. M. MATHEWS, M. D., Louisville. ERNEST SANGREE, M. D., Nashville. EDWIN WALKER, M. D., Evansville. W. E. WIRT, M. D., Cleveland. Diseases of the Lungs and Pleura. BY ALBERT ABRAMS, A. M., M. D. (Heidelberg), SAN FRANCISCO, CAL. Consulting Physician for Diseases of the Chest, Mt. Zion Hospital and the French Hospital. CHAPTER 1.— COUGH. HIS is a prominent symptom of disease of the respiratory ap the act is the expulsion products which, if allowed to accumulate would result primarily in dyspnea to be followed by asphyxia. For this reason, the use of narcotics which render the respiratory mucosa anesthetic, are dangerous when the secretions are abundant. The probable direct cause of cough is irritation of the fibres of the pneumogastric nerve or its branches. A cough center is presumed to exist in the floor of the fourth ventricle. The mechanism of cough is briefly as follows: Following closing of the glottis and a deep inspiration, the intra-thoracic pressure by means of the auxillary muscles of expiration is augmented; then, with sudden opening of the glottis, an audible outrush of air ensues which in turn brings with it, the substances forming the sputa. Account must also be taken of the bronchial musculature, which surrounds the entire bronchial tree even to its ultimate ramifications. Inasmuch as this musculature is largely concerned in the genesis of phenomena associated with pulmonary neuroses, a few words concerning it will be apposite. Irritation of the vagus branches will bring these smooth muscular fibres to contraction, and after-section of the vagus in the dog, the bronchioles on that side become conspicuously relaxed. These fibres play an important rôle in coughing and expelling adventitious products resident in the bronchial tree. They confer on the bronchioles a distinct movement, such as we observe in other canals like the intestines, esoph agus, etc. What has been denominated the lung tone is practically nothing more than the normal integrity of these muscular fibres. Under the influence of cutaneous irritation, as we will subsequently show in the study of the lung reflex, these fibres functionate as constrictor and dilator muscles. In the young in whom the use of the muscles is unknown, and for that matter, in many adults for coughing is in itself an art which must be learned, no expectorated material is brought to light. In the old or enfeebled, the musculture concerned in the expulsion of matter is deprived of its normal tone. Pain from any cause may suppress a cough, and for this reason, the use of narcotics may be indicated. Narcotics subserve a useful purpose in diagnosis. Assuming we have a pleuritis complicating a pneumonia in which cough is a prominent symptom. If the cough is suppressed by doses of some narcotic, let us say opium, just enough to control pain, then we are in a position to say, that the cough is probably caused by the pleuritis. When the mind is obtunded, as in brain lesions and the pyrexias, no cough is produced despite bronchial irritation, hence the tracheal mucous rattling, which has been popularly referred to as "the death rattle," is always an inauspicious sign. There are different kinds of cough from which a diagnostic inference may be drawn. The dry cough, unaccompanied by expectoration, is present as an initial symptom of phthisis, pleuritis, and what has been called a nervous cough. of free expectoration. We are all familiar with the paroxysmal cough of A moist cough is characteristic pertussis. According to genesis, we may divide coughs into endo- and extra-pulmonary coughs. An endo-pulmonary cough is a reflex discharged from the respiratory tract in consequence of irritation of the vagus branches which supply this tract with sensory fibres. All parts of the bronchial mucosa are not equally sensitive to irritation, as has been repeatedly demonstrated by animal experiments. Accumulations of the mucus in the lung alveoli are incapable of exciting cough, and, fail to do so until the accumulated material attains the mucosa of the communicating bronchiole. No reliance can be placed on the statement of the patient regarding the source of the expectoration. I have instituted inquiries in this direction among my phthisical patients, and the majority of them refer the source of the sputum to the upper part of the chest. tracheal mucosa is extremely sensitive, and it is along the course of the This is no doubt due to the fact that the trachea that the patient first feels the dislodged sputum. The relegation of a cough to its correct etiology is a perplexing problem. The intensity of a cough and the quantity of expectoration are usually proportionate. When this relation is disturbed we must look for an extra-pulmonary cause for the cough. Cough is an art that must be learned. Patients may be disciplined to inhibit a cough, and they may be educated to dislodge mucus by a single expulsive effort. Dettweiler, a well-known phthisiologist, informs his patients, that to cough in public is as much a breach of etiquette as to scratch one's head when it itches. At Falkenstein where there are a hundred patients, it is rarely that one hears a cough. To my mind no chest examination is complete without the use of the Roentgen rays; I employ them as a routine measure, as I do the low ob jective on my microscope, reserving the high power for detail work. I do not complete, but initiate an examination with the Roentgen rays, and having located a suspicious lung area, the usual methods of examination are employed to interpret its significance. It not infrequently happens in our chest examinations, where auscultation is alone of value in diagnosis, that no anomalies of the respiratory sound are heard unless special maneuvers are invoked. Natural breathing is of no value in such instances. The patient must be taught "Diagnostic breathing." The muscles of expiration must be brought into forcible action, so that expiration is intensified and prolonged. Auscultation of the lungs in different positions will, by increasing respiratory activity in definite areas, bring out certain sounds. One must not forget that in some persons, forced expiration causes a bronchospasm and develops sounds not unlike those of asthma. In such a contingency amyl nitrite inhalations are valuable. If the subject inhales the drug, we need not fear mistaking the sounds provoked by voluntary spasm of the bronchial tree. In some forms of bronchitis spasm may be an element in the dyspnea, and conversely a catarrhal factor may complicate an attack of asthma. Nitrite of amyl by inhalation removes the dyspnea, if occasioned by spasm, but does not influence it if dependent on bronchitis. To differentiate the rales caused by bronchitis from those of asthma, auscultate the chest after nitrite of amyl inhalation; the rales of the former persist, while the latter are dissipated. This drug, when inhaled, will bring out certain sounds which would otherwise remain unnoticed. Extra-Pulmonary Coughs.-Such a cough must only be suspected when a systematic examination of the lungs proves negative, although we must not forget that the conventional methods in the examination of the lungs. are not always crucial in negativing the presence of some anomaly. Since the advent of the Roentgen rays in clinical medicine, this fact has been most cogently demonstrated by skiascopy. Spasm of the bronchial muscle is an undoubted element in many coughs notably in bronchial catarrh. In the latter affection I have frequently encountered a spasmodic cough, which was practically asthma without the paroxysmal characteristics, and which persisted despite the use of the conventional remedies. In such instances, atropin was diagnostic by its curative action. Spasmodic coughs rapidly yield to this remedy. I usually administer it in a solution-five grains to an ounce of water, one drop for a dose representing approximately grain of the sulphate of atropin. Beginning with one drop three times a day, it is gradually increased by one drop daily until the physiologic effects (dryness of the mucous membranes and persistent mydriasis) become manifest. It is a superb vagus antispasmodic, and curtails the swelling and secretions of the bronchical mucosa. lodide of potash is another valuable drug in diagnosis. In suspected apical lung affections, where a modified respiration is present without rales, the latter may be produced artificially by the administration of the iodide. The same agent will also intensify the auscultatory phenomena of an old pleuritis by augmenting the pleural transudate. Bromoform is also an aid. |