Established •1879. RH.ANDREWS M.D.Editor and Publisher, 2321 Park Ave Philadelphia,Pa CHOREA IS ONE OF THE NERVOUS AFFECTIONS IN WHIGH ARSENAURO HAS DEMONSTRATED ITS GREAT VALUE. NEW PREPARATIONS, ETC. R. H. ANDREWS, M. D., Editor, 2321 Park Avenue, Philadelphia, Pa. VOL. XXV. . TERMS: PHILADELPHIA, MAY, 1903. Subscription $1.00 per year, in advance, including postage to any part of the United States, Mexico and Canada. Postage to any foreign country in the Universal Postal Union, including Newfoundland, a5 cents a year additional. Subscribers failing to receive the SUMMARY should notify us within the month and the omission will be supplied. When a change of address is ordered, both the new and the old address must be given. Subscriptions may begin with any number. How to Remit.-Payment can be made by Postal Money-Order, Bank Check or Draft, or Express Money-Order. When none of these can be procured, send the money in a Registered Letter. All postmasters are required to register letters whenever requested to do so. Receipts.-The receipt of all money is immediately acknowledged by a postal card. Important Notice.-The printed address label which appears on the wrapper of your SUMMARY Indicates the date to which your subscription has been paid. Subscribers wishing the SUMMARY stopped at the expiration of their paidin advance subscription must notify us to that effect, otherwise we assume it their wish to have it continued, expecting to receive a remittance at their earliest convenience. Address THE MEDICAL SUMMARY, No. 3 ical honesty demanded. What caused that headache? "O, I never just studied that out, perhaps nervousness, probably constipation had something to do with it;" or, "O, it is a kind of a systemic habit with her, she has them regularly." There is a cause for every headache, and the patient who consults you for relief from headache is just as much entitled to your diagnostic skill as the patient who calls you to diagnose and cure some obscure affection in the right illiac fossa, and you have no right to dismiss the case without attempt at diagnosis and with the grossest kind of empirical treatment. Granting that the most common cause of headache is from impaired functional activity of the digestive organs, your next carelessly handled case may be the warning signal from renal functions dangerously near complete suspension. Headache may be functional or organic, and either variety may be general or localized. The functional headache in order of frequency may be stated as (1) Due to digestive disorders. (3) An expression of nervousness or neurasthenia with or without anemia. In the first class there may or may not be the accompanying phenomena of constipation or diarrhoea, nausea or vomiting, "heart- burn," etc. You may get a history of ingestion of indigestible food or unwise indulgence in drink, but most likely this will be wanting. Such a headache is in reality toxemic in origin, hence it does not appear till some time after the vicious meal; several hours or even a day may elapse before the retained toxins have acquired virulence enough to cause appreciable symptoms in the head. It is commonly frontal in location, and is congestive to such a degree that the face is often flushed and the eye congested. They are generally described as "pulsating," and are often accompanied by nausea and vertigo. Such a headache is often prevented or relieved by a cathartic, but the cause remains, and it will promptly return and attack the patient when he is in less fit condition to withstand its ravages. A hot foot bath will often relieve the congestion temporarily, but the cause remains. Vomiting, (after the congestion induced by the act itself has passed away) will relieve such headaches, but the cause remains. Now, it is rational to ascertain the cause, and remove it. There are two thoughts to keep in view: First, the irritated stomach and bowel have caused this cranial congestion through reflex action which has interfered with the cerebral circulation and thus affected the sensory nerves of the head; hence, soothe the gastro-intestinal irritation and allow the circulation to regain the normal. Second: the poisonous products of fermentation and putrefaction which are being absorbed must be neutralized and exnelled; hence give a purgative and follow with an intestinal antiseptic. Now, it was probably more than one meal or indiscretion in diet that caused the trouble; these poisonous products had been undergoing elaboration and absorption for some time; they should have been destroyed by the liver, but the liver has become congested and overburdened, and not only can not destroy the poisons but is also unable to supply sufficient billiary secretion:-hence, owing to lack of the antiseptic power of the bile and the concommitant constipation, the poison is elaborated faster and in greater amount and is thrown into the blood stream. Now the indications are plain: (1) Careful diet. (2) Not only a cathartic to unload the bowels, but a cholagogue cathartic that will relieve the engorged liver. (3) Soothing digestants. (4) Intestinal antiseptics. The routine treatment of headache hardly fulfills the requirements. Study every case of headache; it will pay both your patient and yourself. THE USE OF PEPSIN, The Eclectic Medical Gleaner reprints a recent editorial of ours on Pepsin, and takes us to task somewhat for commending peptonized meat for use by enema. We would not discourage altogether the use of pepsin, and in the editorial in question deplored only its "indiscriminate use in stomachic affections,” and cited other conditions wherein its use was beneficial. The Doctor says:-"We can make peptonized messes of milk and meat-of anything. But, can we prove that they are more readily assimilated?" Yes, doctor, it is readily demonstrable that properly peptonized meat prepared as directed is readily assimilable. It is no longer merely meat and pepsin, but it is changed into peptones which are quickly absorbed by the mucosa of the intestine. The Gleaner is generally notable for its fairmindedness, but Dr. Cooper must modify his prejudices somewhat if he would get the best there is out of everything. UNDER date of January 5, 1903, Dr. T.. E. McBrayer, of Shelby, N. C., writes:I send herewith $1.00, the price of the SUMMARY for 1903. Send it along regularly. I still like it, and cannot get along. without it. Original Communications. the external condyle I found the bone soft and broken down and the medullary canal easily reached. "Brief and practical articles, SHORT and PITHY reports of interesting cases in practice, new methods and new remedies as applicable in the treatment of diseases, are solicited from the profession for this department. Articles intended for the SUMMARY must be contributed to it exclusively. The editor is not responsible for the views of contributors. Write only on ONE SIDE of the paper. IT A YOUNG SURGICAL CASE. BY FRANK R. Brunner, M. D. T may be just as important and necessary to report isolated cases as to report frequently occurring cases. In a practice of forty-two years I have not met a similar case, as far as age is concerned, to the one I am going to report. Dr. A. O. Gehry, a young and levelheaded practitioner, came to my office and asked me to see his patient, where he gave the following history: A female child, aged five months, had a swelling of the knee joint some five weeks ago and he was called to see the little sufferer. He found the leg swollen at and above the knee with a small red spot on the inner aspect of the thigh. He lanced it and a small quantity of pus escaped. On the following day the swelling had shifted to the outer part of the leg and a red strip extended up, nearly to the hip joint. He applied first, Antiphlogistine, for several days, followed by a mixture of lard and flour. The latter, he said, reduced the swelling and redness and in several days thereafter he opened an abscess a little to the outside of the median line of the femur. The opening continued to discharge pus for several weeks and he concluded that he had a case of periostitis to deal with and he wished me to see the little patient and, if necessary, to treat the patient with an operation. The child was placed under the influence of ether and chloroform, and upon exploring the opening I found the upper portion of the femur denuded of its periosteum but the surface of the bone smooth. Above I opened the wound sufficiently large to allow freedom to curette the femur back of the articular end of the bone and scraped away considerable dead bone. The shaft of the bone was also scraped but not severely. The cavities were carefully and thoroughly washed out with a one two-thousands solution of the bichloride, after which the cavities were plugged with iodoform gause and the leg bandaged from below up to the knee and the thigh from the hip down to the knee. The wound was irrigated daily with the bichloride solution and at the end of a week the doctor phoned me saying that the little patient was doing very well and that if I was not anxious to see the child it did not matter. What was interesting to me was the extreme youth of the child, not quite four months when the first symptoms showed up. The next was no especial cause for the trouble that the parents knew of, and so it was attributed to a cold. If you ask me-what is a cold? I will answer-I do not know. The doctor said that the child had a small "mother's mark" at the inner side of the leg, that it ultimately cracked and that the crack in the skin might have set up the inflammation and to uphold this opinion he quoted from one of his text books on Diseases of Children, where such cases are given in such young children. In my mind this may be possible but not very probable. An uncle and an aunt of the father of the child died from consumption. This may have been a remote cause, if not the immediate cause. Another feature in the case was the early surgical interference. Had not a free incision been made, the foreign matter removed and nature given an opportunity to help itself, there is no telling where the trouble would have ended. Another important factor in such a case for the young doctor with the training and experience he is able to get during his four years at college, is, to prepare himself to meet all such cases himself and attend to them in their homes instead of rushing |