The Current Medical Thought.

Tonsilitis-Croup.

Two remarkable articles appear in the editorial columns of The Medical Register, of January 12, 1889, illustrating the advantages of aiming specifically at the cause of disease.

Regarding indigestion and rheumatism as the source of tonsilitis, the writer reports con stantly successful use of salicylate of sodium, ten to fifteen grains every three to four hours If seen after suppuration has occurred, sulphide of calcium, one-tenth grain five to ten times a day, is required. The recognized value of guaiac in this disease would seem to fall in with this line of thought.

The other article relates to croup. "In the early stages of croup, say in a child from two to five years of age, a single two-grain quinine pill, given when it is gasping for breath at about two o'clock in the morning, will be followed almost immediately by relief. In the course of fifteen minutes the voice will return, the parents will be relieved of anxiety, and the doctor can go home and rest contented that there will be no more trouble in that family for the next twenty-four hours."

In regard to the treatment during the day he says: "The treatment of the disease is based upon the fact that we have to deal with an abnormal secretion, and we have a remedy in the sulphide of calcium which will exert a powerful influence upon its development. Instead, therefore, of ordering the nauseating ipecac, we should give a small portion of this comparatively harmless remedy. In the worst cases one tenth of a grain will accomplish all that could be wished for; larger doses appear to exert no better effect than the smaller ones. ** As a rule the first signs of on-coming croup may be satisfactorily overcome by the measures suggested, and for the general class of such cases it will be necessary only that the little patient should continue the treatment for a few days, or; at most, a week." Shall we believe that we may yet feel safe with a case of croup?

The Treatment of Tapeworm.

In reply to a correspondent of the Lancet, several communications are published in that journal, including one from Dr. F. A. A. Smith, of Cheltenham, who says that during his stay in South Africa he treated many cases, his own included, and all with success. The great point in the treatment of tapeworm, he says, is to expose its head, which is attached to the intestine by its hooklets. So long as the head is covered with feces no medicine will do much

good. His treatment is as follows. The day before giving the worm medicine he allows no food of any kind, except plain beef-tea, or other very thin soup, and very little even of these. The first morning he gives one drachm of compound jalap powder, which generally operates three or four times during the day, and effectually clears out the bowels, bringing away at the same time large portions of the worm. The patient, of course, keeps quiet in the house. On the second morning, on an empty stomach, he gives a draught consisting of from two or three drachms of oil of turpentine and one drachm of oil of male fern in sweetened emulsion. After an hour or so he gives a dose of castor-oil. It will not be long before the whole of the worm with its head will have passed, which will be found on proper examination of the stools. The patient can then take his usual diet, and the following day

will be well.
ment to fail.
ed for adults. The frequent failure of the oil
of male fern as an anthelminthic is, he believes,
attributable to the smallness of the dose ex-
hibited, less than a drachm for an adult being
useless. The writer believes every native of
South Africa to be infected with one or more
tapeworms.

He has never known this treat-
The doses, of course, are intend-

The Time for the Administration of Certain Medicines.

Iodine and the iodides should be given on an empty stomach. If given during digestion, the acids and starch alter and weaken their action. Acids, as a rule, should be given between meals. Acids given before meals check the excessive secretion of the acids of the gastric juice. Irritating and poisonous drugs, such as salts of arsenic, copper, zinc and iron, should be given directly after merls. Oxide and nitrate of silver should be given after the process of digestion is ended; if given during or close after meals, the chemicals destroy or impair their action. Potassium permanganate, also, should not be given until the process of digestion is ended, inasmuch as organic matter decomposes it and renders it inert. The active principle of the gastric juice is impaired and rendered inert by corrosive sublimate, tannin and pure alcohol; hence they should be given at the close of digestion. Malt extracts, cod liver oil, the phosphates, etc., should be given with or directly after food.

Abortive Treatment of Syphilis.

(L. Mannicco, Giornale ital. delle mai venerre, fasc. 2, 1887.) "Authorities," says Mannicco, "are becoming more numerous who

think it possible by early surgical intervention to abort syphilis." He himself has had six cases which he was able to observe from the first development of the initial lesion. After the local use of cocaine he destroyed the chancres, and in four cases no syphilitic symptoms developed. That the lesions were really syphilitic, he proves by the long duration of incubation, the unicity and induration of the chancre, and, above all, by examination of the persons who were the sources of infection.

That such cases are so seldom observed from the beginning he thinks is due in part to the carelessness of the patients, and to their ignorance. If the public were educated to a proper appreciation of the importance of early treat ment, he is satisfied that in many cases early destruction of the chancre would prevent systemic syphilitic infection. -Deut. Med. Zeit.

Influence of the Iodides on the Elimination of Mercury.

(Souchow, Journal de Médecine; Wien. Med. Woch, July 7, 1888.) It is generally believed that iodine salts hasten the elimination of mercury. Souchow's investigations have led him to the following conclusions: (1) When mercury and iodine are taken at the same time, the elimination of mercury begins later and is less in quantity. (2) When iodine salts are given after the exhibition of murcury, the amount of the latter eliminated is at once di minished; from which the writer concludes, contrary to the conclusions of other authors, that iodine hinders rather than increases the elimination of mercury.

Tubercular Meningitis Cured by Iodoform.

In the N. Y. Medical Times, Dr. Miner, of New York, reports a case of undoubted tubercu lar meningitis cured by inunctions of iodoform. The child's condition is thus described:

"Temperature, 105.4°; pulse, 144, and weak. Child cannot articulate. Swallows with difficulty. Is extremely prostrated. Head drawn back, boring in pillow, and rolling constantly from side to side. Screaming and grating her teeth at intervals. Totally blind and deaf. Unconscious. Automatic motions of legs and arms. Has not taken any nourishment in the last two days. Complete anorexia. Tongue heavily coated yellow. Breath very offensive. The case seemed to be beyond all hope of recovery, and an unfavorable prognosis was given."

The treatmeut was as follows: "The child's head was shaved, a pomade was made of iodoform and vaseline, 3j to 3j, and one-half

drachm of the ointment was rubbed into the scalp twice daily. It was well rubbed in until no traces of the ointment remained. The tincture of ver. vir. was administered in drop doses hourly, and the bromide of sodium used at night only in six grain doses."

There was gradual improvement, and final recovery. Meanwhile an eruption of boils appeared on the thorax and abdomen, over fifty being counted at one time.

[There have been several cases of tubercular meningitis, without doubt as to the accuracy of the diagnosis, reported cured by treatment substantially the same as the above.-ED.]

We have lately seen an urethral discharge (which had not an infectious origin) quickly subside by means of an injection of sulphate of quinine, five grains, and a little glycerine in

two ounces of water.

Calomel on the Kidneys.

Calomel is supposed to increase the elimination of glycogen and urea in the liver, and to cause dilatation of the renal vessels. Therefore it would be contra indicated in renal disease, and serviceable in heart disease. Yet persons with "kidney troubles" seem usually to derive much benefit from an occasional dose of calomel.

Heart Disease in Children.

When heart disease affects children, it is commonly the mitral valve that is at fault, and it occurs more frequently in females than in males. Rheumatism is not the sole factor; rickets, diphtheria, purpura, and extensive losses of blood are among the causes. The symptoms of heart disease in the young are obscure, and frequently overlooked, until adhesions or perhaps embolism result. Absolute rest should be enjoined and digitalis, strophanthus, and iron prescribed, according to indications. Should the patient attain the age of puberty, there will yet be much to apprehend, and the case will have to be carefully watched.

Fresh mackerel sometimes induces aggravated symptoms of urticaria and poisoning, similar to those caused by mussels and lobsters. Eggs occasionally have a like effect.

When the tip of the tongue is protruded to one side, the muscles of the side to which the organ turns are paralyzed, excepting of course cases of structural disease.

General Principles Involved in Amputation. It is sometimes necessary to amputate as soon as consistent with safety. Now, what is to guide the surgeon in his decision of so important a question? In cases of compound comminuted fracture, with injury to the main artery of the limb and with great loss and destruction of tissue in the soft parts, the hemorrhage is often alarming, and amputation is called for imperatively as the only salvation for the patient. What is the earliest moment a surgeon should operate? Never during profound shock, and the rule which must govern a surgeon is to employ all means to control hemorrhage and to bring about reaction from shock, and wait. If the patient has pallor and coldness of skin, weak and feeble pulse, sighing respiration, non-reacting pupils, traumatic delirium, internal injuries, no amputation is indicated. The earliest possible time an amputation can be performed, under great necessity from hemor rhage, is when reaction is beginning; but unless the patient is likely to become exsanguined by delay, the beginning of reaction is an unfavorable period of operation, and it is wise to defer it until reaction is fully established. Amputation should not be performed with a subnormal temperature, a cold skin, a feeble rapid pulse, or during traumatic delirium—especially in children. The condition, then, of the temperature, the skin, the character of the pulse and the mental state, are all important factors in the solution of this problem. I have seen an Esmarch elastic bandage applied above a lacerated wound, over sound tissue, and when the flaps were made a certain amount of sloughing followed from the compression. The wound itself is the proper place to apply firm compression, never above the seat of the wound. This point is one of practical importance, because the elastic bandage, as a means of controlling hemorrhage, has been misused; instead of ap plying the compression over the bleeding part, it has been carried above the bleeding part and over sound tissue. As a result of this, gangrene in the flaps may occur, with its accompanying septicemia.

The hygienic conditions are most important in affecting the mortality. Patients in the country do better than those in the city, and the latter do better in private practice than in hospitals. Always secure for a patient abundance of fresh air and plenty of sunlight. Too much stress cannot be placed upon his hygienic surroundings. While the weather, age of patient, seat of amputation, the part of the bone sawn through, whether for injury or disease or deformity-above all and beyond all, the hygienic conditions stand out foremost; and if we exclude serious organic disease, nothing is

The preparation of the patient consists in a careful study of the patient's history, and also the special preparation of the member to be removed. Before the operation the heart and lungs should be examined, the urine analyzed, the general habits of the patient inquired into with reference to intemperance, and opium habit, or previous disease, and other points of interest which influence the treatment after operation, as well as the mortality. In other words, the surgeon should study thoroughly the individual upon whom he is to operate, and make himself complete master of the situation.

The local attention to the part consists in thorough ablution, shaving, and free irrigation with carbolic acid or bichloride of mercury solution.

There is no real inconsistency between antiseptic surgery, as now understood, and treating a wound openly. A careful study of the principles of antiseptic surgery shows that both methods are in accord with its precepts, only that in the open method the wound heals by secondary union, and still the wound is aseptic. In the open method the stump is irrigated every few hours with carbolic acid solution. Balsam of Peru is used to stimulate the granulations, and in ten days the granulating surfaces upon the flaps are approximated, and healing takes place between these two granulating, instead of between two fresh, surfaces. In epidemics of diphtheria I have found the open method preferable, because a healthy granulation surface is a barrier to the entrance of septic poison.

In conclusion, endeavor to obtain primary union in all amputatians by using every detail requisite to success. When the conditions are unfavorable, aim at secondary union by the open method. Dr. Dennis, in Jour. Am. Med. Assoc.

A Small Point Worth Knowing.

(L. L. Von Wedekind, M. D., Senior of Staff, Chambers Street Hospital, New York.) By simply pressing on the supraorbital notches with a steadily increasing force, you may, with a certainty of success, detect a malingerer; bring an unconscious alcoholic to his senses, and thus differentiate on the spot between alcol holic and other comas; cause cessation of hysterical convulsions, and in many instancequiet violent alcoholic delirium.

The best way of applying this test is: When the patient is in the recumbent position, the physician, standing at the head of the cot, or kneeling when the patient is on the ground, fixes the tips of the thumbs over the supraorbital notches, as above described, never minding the occasional yell or struggle, pressing steadily,

gradually increasing the force, and in half a minute or a minute the result is accomplished. In a varied and extensive ambulance service, extending over eight months' continuance, I have applied this test so frequently and, as my statistics will show, with such marked and remarkable success, that I feel constrained to publish my results.

To the physicien' in private practice it may be of comparatively little use; but to such as are in the hospital service, especially in the ambulance department, or to those employed in the army or navy, or elsewhere where large bodies of men are at work, and where malingering and alcoholism are common, it will be of great value.

And

For let it be remembered that if the application of the test fail in obtaining the desired result, the physician may rest assured there is something more than simple alcoholism, or those other forms mentioned in the case. so, on the other hand, what a comfort it is for him to know that, after the heroic and protracted efforts of the police and other parties have failed, he can step in and in a moment have the patient on his feet.

During my ambulance service at the hospital, the following particulars may be mentioned: Out of 1620 ambulance calls, 213 were to alcoholics; 26 to malingerers; 18 to hysteria cases, and 28 to delirium tremens.

Of the 213 above mentioned, 137 were comatose, the police and friends being utterly unable to arouse them, and this treatment brought 128 of the 137 to consciousness. Of the cases where no result was obtained, 5 were, besides alcoholism, suffering from cerebral concussion, 2 fracture of the base of the skull, I uremic coma and I syncope from valvular heart trouble.

In cases of hysteria I had absolute success; no one case failed to respond, and the same with malingerers. Nine of the delirium tremens quieted down and spoke rationally; in the remainder I had varying degrees of success, some becoming more quiet, while in others but little change was noticed.

I have tried it in forty-seven cases where no result was obtained, and where something more serious than alcoholism or malingering was suspected.

Of these cases 26 were cerebral concussion; 9 fracture of the base of the skull (diagnosis confirmed at autopsy); 4 cerebral hemorrhage ; 6 uremic coma, and 2 simple depressed fracture of the skull. These cases are mentioned as proof of what is above stated. Where no result is obtained, there you may look for some intracranial lesion, or other cause of coma.. Med. Record.

Camphoric Acid as an Anti-Catarrhal, as a Dermatic, and as an Anti-Diaphoretic.

A paper recently read by Dr. M. Reschert before the Berlin (Germany) Medical Society attributes to this acid, which hitherto had no therapeutic use, an eminently beneficial effect in both acute and chronic inflammatory affections of the mucous membranes of the entire respiratory track. Likewise in various acute diseases of the dermis.

A topical application of a 3 to 6 per cent. solution of camphoric acid effects a contraction of the surface-tissue (dermis or mucous membrane) within as little as two minutes, thus immediately causing a sensation of relief and palliation of pain, which phenomena are combined with an essential reduction of the inflam

matory symptoms. Acute coryza has repeatedly yielded to the nasal douche charged with a solution of 1 in 500, or to a cotton-wool tampon with a 2 per cent. solution.

Withal, this acid exhibits no caustic accessory effects; on the contrary it actively promotes granulation (in laryngeal ulceration, etc.), and solutions of but 0.9 of one per cent. act aseptically.

It may be exhibited subcutaneously or topically in 4 to 2 per cent. solution, or as an inhalant in 1 to 2 per cent. solution.

The probabilities are, that this substance may prove beneficial also in other directions besides those named. (Tuberculous processes, however, are not influenced by it.)

Dr. Furbringer, for instance, reports its prompt efficacy-in at least 50 per cent. of the cases treated-in stopping the night-sweats of consumptives. He uses, for this purpose, either 15 grains three or four times through the day, or 30 grains in the evening. This is said by Dr. F. to be the only specific action possessed by camphoric acid, which he terms: "an agreeable, very slightly toxic, and very little irritant, antiseptic."

Camphoric acid is in thin, colorless, scalelike crystals, or in large, limpid, monoclinic crystals, of acid taste; melting-point 178° C. (352.4 F.); little soluble in water; easily so in alcohol or ether Fats and oils dissolved up to 2 per cent. of it.-Merck's Bulletin.

Dr. Barwell reports to the Lancet a case of regular menstruation after entire removal of both ovaries.-The Polyclinic.

Naphthalene Enemata in Dysentery. Guitergoff (New York Med. Abstract) has had most excellent results with gr. vij to gr. viij of naphthalene to f3j of water for a single enema. He finds this quickly relieves the

tenesmus and anal burning. Rest and sleep follow, and, in some cases, a cure results without any repetition of the enema. In other tervals of a few hours. cases two or three enemata are required, at in

Why don't prostitutes conceive? Answers requested.

Chorea and Convulsions.

In chorea there are irregular, uncontrollable contractions of the voluntary muscles, alternating with their atony, and occurring without pain. In true convulsions, the muscles, after having been thrown into a spasmodic state, only return to their normal condition; in chorea, on influence occurs, so that the muscles become, the contrary, a further diminution of nervous in all marked cases, entirely passive or inert in the intervals between their irregular and involuntary actions. Chorea of childhood usually occurs at about eight or nine years of age, and mostly but not always affects girls.

Brown sugar passes through many hands, and may fairly be credited with the suspicion of being an occasional cause of threadworms in children.

The percentage of nicotine determines the "strenght" of tobacco. Havana tobacco contains about two per cent. Anything exceeding four per cent. is an intoxicating agent.

Tar-Water as a Hemostatic.

Distilled tar-water or "eau-de-goudron" is a powerful hemostatic, arresting bleeding as effectually as hamamelis. That prepared from the pine wood is the best. About a wine-glassful may be taken in the twenty-four hours, in pulmonary, uterine, and renal hemorrhage. It is extolled by the French in the hemorrhage of phthisis.

Cranberries are utilized in Russia, where they grow wild in enormous quantities, as a source of citric acid. They yield about two and a half per cent. of the gross weight; but the supply is sufficiently great to make the process profitable. Is this not possible in our own country?