like an infant in my office without the least provocation save depression of spirits. Agoraphobia was so marked that she dreaded to go alone into the streets. She did not sleep at nights; was costive, dyspeptic, nervous, and complained of spinal tenderness and a constant dull ache in the right hypochondriac region. She had no pelvic trouble, no signs of organic nervous disease; was well-built and apparently healthy: Living in comfortable circumstances, free from any amatory complications, there was seemingly no cause for her intense melancholia. Ten grains of calomel followed by constant use of mild cholagogue cathartics, regulation of diet and habits, with the administration of electricity and dilute nitromuriatic acid wrought a marvellously prompt and efficient change, and put a ban on the diagnosis of hysteria. It was clearly a simple case of lithiæmic autointoxication. HYSTERIA. Laycock, Gairdner and Handfield-Jones all accept the gouty diathesis as etiologically important in hysteria. Mills has obtained a few successes in the treatment of hysteria with the use of measures directed against the lithæmic state. I can confirm these experiences from two cases, one of a child about 10 years of age, the other of a single woman near 40. EXOPHTHALMIC GOITRE. I have seen this disease associated with a well-marked gouty diathesis, having now such a case under my care. What relation the one bears to the other, I am at a loss to say. The patient comes of a neurotic family. A sister died of exophthalmic goitre. Her father was a victim of the disease, having, however, only the eye and heart symptoms. Frequent have been the attacks of "biliousness" in my patient, so much so that she says she has had to treat herself for them all her life. She now has lumbago and what she terms "rheumatism" in various parts of the body. She has never had an acute attack of rheumatism or endocarditis, nor are there at present any signs of valvular disease. The urine contains a large excess of uric acid, and she is just recovering from a subacute cystitis. I am giving her remedies to keep the excretory organs active, nitromuriatic acid and the phosphate of soda. The goitre has been much reduced with thyroid extract, and the heart action has been greatly steadied. For the past year she has enjoyed better health than for many years past, and it is due in all probability to the abundance of outdoor exercise and regulated dietary, She took to cycling upon her own responsibility, and though her heart action would have led many a one to advise against it it seems nevertheless to have greatly benefited her. Gowers notes that rheumatism has been assigned as one of the rarer causes of exophthalmic goitre. ASTHMA. It is now widely recognized that asthma may be due to lithæmia. One of my patients, a woman 65 years of age, is beginning to show signs of parenchymatous nephritis. She is descended from a neurotic family, and has children, one insane, one dead from pulmonary tuberculosis, one living and typically hysterical. The patient's eyes have been examined by an oculist, and said to show incipient albuminuric retinitis. The limbs are oedematous and the urine contains casts. Over three years ago, when the patient first consulted me for her asthmatic attacks, I warned her of the excessive amount of uric acid in her urine, and urged her to keep herself under observation, lest Bright's disease should supervene. She did so only in a measure, being inclined to neglect herself entirely, or to try some patented nostrums. She is now fully awake to the seriousness of her condition and is more amenable to suggestions, though I fear too late to effect any permanent good. I am inclined to think that the lithamic state was the cause in this case of both the asthma and the renal trouble, acting as in so many cases upon an inherited neurotic constitution. Possibly the nephritic troubles preceded in this case the alloxuria, and even gave rise to it, and thereby to the asthmatic attacks. Kolisch believes that the graver symptoms of gout appear when the action of the kidneys is affected, and that with the total increase of alloxuric bodies in nephritis there is the same or even diminished elimination of uric acid, but a great increase in the xanthin bases. NERVOUS DYSPEPSIA, DIABETES, MULTIPLE NEURITIS AND FACIAL PARALYSIS. These have all been seen in conjunction with the gouty diathesis. It is extremely difficult at times in these cases to determine whether the neurotic trouble is the result of the autointoxication, or merely the expression of that same inherited neurotic condition, of which the lithæmia originating in a faulty metabolism is but another manifestation. CEREBRAL APOPLEXY, PARALYSIS AND APHASIA WITH DELUSIONS have been reported as attributable to the lithæmic diathesis. A case of extreme debility with nervous prostration in a woman of 62 is now under my care. She lost her health very suddenly about three months ago, and has lost in weight nearly thirty-five pounds. Remaining in bed she was gradually recovering, when an attack of acute rheumatism of the muscular variety seized upon the whole of the right arm. There was a rheumatic history in the case, but having been so long free from the disease, and being so fond of fruit and lemonade, I allowed the patient to indulge in them freely together with the other dietary which was being given to her at brief intervals during the day. This rheumatic attack caused a relapse in the patient's condition, and for several days after the pains in the arm began to subside she was distinctly aphasic (amnesic aphasia) and had slight delusions. She could not remember the names of things, and with every sentence she tried to utter she would only get as far as the first two or three words, and then turn away with manifest irritability at her failure to talk. The delusions were in regard to persons going in and out of her room, when all the while no such persons had been near her room. She seemed to be cognizant to a certain extent of her condition at the time, and now marvels at it since she has come out of it, and is again beginning to recover her strength. The relapse has left her almost as weak as she was two months ago, though the arm is apparently well except for a certain stiffness, and yet at no time before or after the rheumatic onset has she shown the slightest indication of aphasia with delusions, as she did during the rheumatic attack. I had purposed saying a few words in regard to the treatment of the gouty neuroses, for it is an important question. The different results obtained by different men, and the variableness of those results with the same treatment in apparently the same class of cases, show that each case must be handled upon its own merits, and that in many of them the influence of the inherited neurosis, or of the resultant toxæmia, cannot always be positively predicated. The unavoidable length of the present paper obliges me to postpone that subject to another time. A 4544 Lake Ave. THE SCIENTIFIC ASPECT. S evidence of the valuable and practical character of many of the papers now on hand, we mention the following to appear in early issues viz.: "Surgery of the Gall Bladder and Ducts," by Dr. J. McFadden Gaston; "Beef: a War Paper," by Ephriam Cutter, M.D., New York; "The Hypodermic Syringe and Its Use in Malaria," by Kennon Dunham, M.D., Cincinnati; "Regarding Hypertrophied Faucial Tonsils," by Dr. J. F. Barnhill, Indianapolis, Ind.; "Extra Cardiac Murmurs," by Dr. Cuffer, Physician to Necker Hospital, Paris. Further, the proceedings of leading medical societies and the Reports on Progress will appear regularly, and the editorial writing will continue to be a feature of our policy of management. We promise to avoid personal journalism and give attention to the promotion of the more refined ideals in medicine, broader knowledge in fact to medical culture as opposed to quackery, bunco and vain pretentions. It is and has been the object of the editor to secure papers for publication in the MEDICAL FORTNIGHTLY which are original, and are the products of the author's own observation and study. Such papers meets the needs of the practitioners who read this journal, viz., the progressive, up-to-date and reliable men of medicine. We feel proud of our record as managing editor, now entering upon its third year, and as we glance over our files for the past two years, we are encouraged in our prosperity and the prospect before us, as the journal representative of the practical, yet scientific element of the profession, which believes in results more than theories, in facts rather than fancies. WE E propose to increase the usefulness of the FORTNIGHLY to its readers by the addition of Departments of "Therapeutic Hints" and "Diagnostic Points," in charge of the managing editor. It will be the aim of these departments to present, in concise form, the latest and most practical suggestions and best thoughts of our great medical writers, supplemented by the clinical experiences of the FORTNIGHTLY'S editorial staff. THERAPEUTIC HINTS. BY FRANK PARSONS NORBURY, M. D. JACKSONVILLE, ILL. Physician to Our Savior's Hospital and to Oak Lawn Private Retreat. Camphor internally in three grain doses, thrice daily, will bring about. suppression of milk.-Ohio Medical Journal. Tubercular Ostitis.-Dr. Rugh in the Philadelphia Polyclinic, recommends guaicol benzoate in five grain doses, three times a day, in cases of tubercular ostitis, with suppuration in children. The good effects are due to improved nutrition. Ichthyol is highly recommended by Ottinger in the treatment of stings of flies, gnats, bees, wasps, etc. Its effects are through its vaso-constrictor action. It should be applied pure, and in a thick layer, but may be used in the form of an ointment.-Ohio Medical Journal. Loeffler's Diphtheria Solution.-A very satisfactory agent for local treatment of diphtheria and the throat symptoms of scarlet fever: R Menthol Alcohol... ...grms. 10 q.s. ad. c.c. 26 .C.C. 4 .q.s. ad. c.c. 100 M. S. Saturate cotton swab in solution, squeeze excess and apply every ten or fifteen seconds to membrane. Applications to be made every threehours.-The Laryngoscope. (A very elegant preparation of Loeffler's Solution which we use is put up by the H. K. Mulford Co.) Measles. Dr. Jno. A. Larrabee of Louisville, Ky., in Pediatrics, recommends the following prescriptions in the treatment of measles, to allay incessant laryngeal cough and to develop the eruption: Syrup hydriodic acid.. Syrup dover .... Syrup tolu..... aa zi The dover's syrup to be lessened for infants during the eruptive stage and throughout a broncho-pneumonia. B Pot. acetat..... Spirits mindereri Aquæ camphor.. 3ij ..aaziij Sig.: A teaspoonful every hour to a child and a tablespoonful every hour to an adult. Copious draughts of water should follow. In case of sepsis, diphtheria or debility, one drachm of the tincture of the chloride of iron may be added. This makes a pleasant and effective mixture. (In an epidemic occuring among adults only, the editor found that antipyrine in medium doses promoted the eruption and had local sedative action.) Frank Pneumonia.-Dr. F. G. Morrill of Boston, in Archives of Pediatrics, has presented a thorough "analysis of one hundred cases of frank pneumonia" He uses the term frank pneumonia in defining a disease of the lungs which in children tends to complete recovery in the vast majority of uncomplicated cases after the second year of life is passed. He says regarding treatment: Constipation is first treated by small hourly doses of calomel and subsequently by glycerine enemata. Brandy is used in the majority of cases, also digitalis or strophantus. The amounts varied with aggravation of symptoms. No external applications were used. Opium has been given occasionally where pain was severe. Strychnia hypodermically when heart showed signs of weakness. Cold pack was used to reduce temperature. Itch Ointment. In a series of experiments at the St. Luke's Hospital, Paris, to determine what will cure itch in the shortest time, forty-one different preparations were employed. Of these the following ointment cured in the smallest number of days: B Sublimated sulphur... Subcarbonate of potash.. Adeps simplex.... Apply morning and night. ... The writer of this has been in the habit of adding to the above the oil of bergamot, three drams, thus adding to the flavor and potency of the ointment.--Modern Medicine. Therapeutic Indications of the Salts of Silver. - Dr. Thos. L. Coley of Philadelphia, in the Medical and Surgical Reporter, concludes an excellent paper on the Therapeutic Indications of the Salts of Silver as follows: I. 1. Locally upon all inflammation of mucous membranes, especially acute inflammations where an antiseptic, anti-corrosive, superficial caustic is needed. In leg ulcers where the inflammatory reaction is marked-i. e., not in sluggish ulcers. In laryngitis, pharyngitis, faucitis, tonsillitis, etc. 2. Locally painted over furuncles, felons, etc. 3. In the summer diarrheas of infants by high injections. 4. In dysentery, mucous colitis, enteritis and gastro-enteritis, and typhoid fever in adults combined with internal administration of the drug. 5. In the stomach, in ulcer, erosion, dilatation, acid dyspepsia, nervous gastritis, etc. 6. In the nervous system, in tabes dorsalis. Internally administered the nitrate is best given before meals combined with opium or simply gum tragacanth. Soft Corns.-In Leonard's Illustrated Medical Journal, Dr. W. L. Wilson, of Scipio, Ind., recommends the following preparation: Iodine...... Flexible collodion.. Alcohol...... Potassium iodide.. M. Sig.: Paint the corn every night. .2 grains. |