FIBROUS TUMORS.

I have not yet had time to make a long series of experiments on these cases, and can only cite three, which I will report briefly :

CASE 1. Patient 37 years old. A large fibroid tumor made of two lobes, one of which exceeds the size of the foetal head. Painful symptoms from pressure on the bladder; no hemorrhages, the patient is emaciated, and the general condition poor.

I used iodothyrine with a view of reducing the size of the tumor. For nine days the patient took two cacheta containing 0.5 grammes, daily. She then complained of palpitation and a feeling of oppression, and the drug was stopped. I was not able to make out any diminution in the size of the tumor, but by the fifth day the painful dysuria had ceased, thereby producing a considerable improvement in the condition of the patient.

CASE II. Fibroma of the size of the foetal head occurring in a fat patient; very considerable hemorrhage with consecutive anæmia. case I used iodothyrine during two menstrual periods of seven days each. The dose during the first was 1.5 grammes, and during the second i gramme. It produced a very marked change in the amount of the menstrual flow. The loss of blood, which used to be very abundant, did not exceed that of a normal menstruation. The fibroma was not reduced in size.

CASE III. The patient was 47 years old; she had a very large fibrous tumor, almost the size of a foetus at term. She had undergone various forms of electrolytic treatment without result. The metrorrhagia was very profuse, obliging her to stay in bed for sixteen or twenty days each month. I used iodothyrine in doses of one gramme for twelve days, and then raised it to two grammes without noticing any accident due to intolerance. The treatment was suspended at the menstruation, which was less profuse than usual. After eight days of rest, the administration was resumed in daily doses of two grammes for twenty days. The patient was, therefore, under treatment for two months, except for the intermission of eight days. The results were satisfactory. The fibroma, which extended above the umbilicus, had diminished in volume, and no longer caused the fatigue which was previously felt in walking. The patient felt relieved. But what seems remarkable, was the diminution in the metrorrhagia. I was only able to observe two periods, but the hemostatic action of iodothyrine was manifest. The patient was able to be up during her periods, which she had not been able to do for several years.

The results which I obtained were, therefore, favorable: while I may pronounce in favor of the action of iodothyrine as far as concerns the reduction in size of the fibromata, its hemostatic action at least is evident. At any rate, the reducing action of iodothy rine upon the tissues is recognized today by all clinicians. Quite recently (November 27, 1896) one of the physicians of the Paris Hospital, M. P. Marie, has reported to the Societe Medical des Hopitaux, a case of myxoedema treated successfully with iodothyrine (Bayer).

DOSE AND METHOD OF ADMINISTRATION.

My experience and that of numerous physicians who have used iodothyrine, has been shown that the most suitable way is to commence with small doses of 25 to 50 centigrammes each, in cachets, or better yet, in compressed tablets. I have never given more than four grammes, but Prof. Paschkis, of Vienna, has given daily doses of six grammes for fifteen consecutive days, without any inconvenience, in a severe case of psoriasis.

The difference between the minimum and maximum dose is, therefore, enormous. We have heard of cases in which two tablets have caused palpitations and attacks of syncope, while a very much higher dose has produced neither reaction nor concomitant effect. It is necessary, therefore, to ascertain in each individual case at the onset the dosage which can be tolerated. It is then easy to produce the desired effect by diminishing or increasing the dose.

The cases of obesity in general will stand pretty large doses. If they are well tolerated, six tablets of 0.25 grammes each are given during the first few days; after three or four days eight are given; after a week, ten; and at the end of a fortnight, the dose may be raised to twelve. It is necessary to ascertain, then, whether the loss of body weight has been too slight or too marked, and subsequently increase or diminish the dose according to the tolerance of the patient and the results obtained. I have noticed in obese subjects, that it is well to suspend the treatment after fifteen or twenty days, and resume it again in a week. The large doses do not act so well after a fortnight of treatment, on account of tolerance becoming established in certain patients.

Finally, the facts which I have observed permit me to endorse the efficacy of iodothyrine in the treatment of obesity. I first used iodothyrine in cachets, but I found it more advantageous for the patients to prescribe it in the compressed tablets of iodothyrine-Bayer, 0.25 grammes each. I am less positive about fibroid tumors as far as the reduction of the tumor is concerned; but the women suffering from fibroid tumors with hemorrhage are always benefited, as the drug has an incontestable hæmostatic effect. Besides, even if the tumor itself is not diminished the neighboring tissues are relieved of their congestion, the compression of surrounding organs ceases, and their functions are more readily accomplished.

I intend to continue my study of obesity and fibroid tumors, and will communicate the result in a few months.-Journal de Medicine de Paris, January 24, 1897.

ANTITOXIN.-The use of such strong applications as the undiluted tinct. ferri chlor. and the argent nit., I must emphatically condemn, believing that they do positive harm. Diphtheria is a systemic as much as it is a local disease, and the treatment therefor should be both local and systematic, and I believe that in the serum therapy we have a remedy which, if used early in the disease, will prove itself almost, if not entirely, a specific. So thoroughly am I convinced of its efficiency that I keep constantly on hand a supply. The only serum I have used is prepared by H. K. Mulford Company, Philadelphia, Pa.-R. B. Hopkins, M. D., Milton, Delaware.

Beri-Beri Again Prevalent in Dublin-Low Rate of Mortaiity in London-New Medical Fortnightly-Glycerinated Calf Vaccine Lymph-Popularity of the Army Service on the Wane--Fifty Vacancies on the Medical Staff.

LONDON, August 19th, 1897.

There has been a recrudescence of the epidemic of Beri-Beri (referred to in a former letter) at the Richmond Hospital, Dublin; 183 fresh cases, of which four have died. The principal symptoms have been irritability of the heart, sensory phenomena, such as fornication, anæsthesia and hyperæsthesia; œdema has usually been slight and mainly confined to the shins. The origin of the disease is a mystery, as it cannot be traced to any direct infection, food or clothing. It is, however, undoubtedly kept up by the condition of overcrowding which exists in the asylum.

The chairman of the London County Council, Dr. Collins, in a recent address, has called attention the marked decline in the London death rate during the last year, and to the fact that, judged by its rate of mortality, London, notwithstanding its huge population, is far healthier than any of the other large capitals of Europe. For the years 1873-80, the mean rate per 1000 was 22.4, for 1881-88 it was 20.6, and for 1889-96 it averaged only 20.0. Infant mortality, however, has shown little decline, but that from zymotic diseases is a very marked one.

A new medical serial has appeared. It is named Treatment, and is published fortnightly by the Rebman Publishing Company. In addition to containing short, practical articles and editorials, a periscope of current literature in all branches of medical science, under a staff of competent contributors, is made a special feature, and should prove very useful to the busy practitioner who wishes to keep abreast with the times.

The Local Government Board has just issued a report on the preparation and storage of glycerinated calf vaccine lymph, in which the following conclusions occur, viz.: That it is desirable that vaccination, both primary and secondary, carried out under under the auspices of the government should be performed exclusively with vaccine lymph derived from the calf, and that the distribution of calf vaccine from the National Vaccine Establishment should be limited to glycerinated or similar preparations of lymph and pulp material, in air tight tubes or other glass receptacles.

The army medical service has become most unpopular during the last few years, owing to the unfair treatment accorded to its members. At the recent examination for thirty-six vacancies, only twenty-two candidates presented themselves, of whom only nineteen were declared eligible. At the present time the number of vacancies for the medical staff cannot be less than fifty under the minimum effective establishment.

Richard T. Hewlett