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and strength and have resumed their regular occupation. With one exception, there was a remarkable increase in weight and a wonderful improvement in the condition of the lungs.

The favorable effects of the serum treatment, however, says Dr. Paquin, must not be overestimated, for improvement in cases of very

advanced disorganization and prostration has not been of long duration, as this treatment cannot be expected to replace lost tissue or cure fatal lesions. It is, therefore, of radical and great importance to diagnosticate tuberculosis at the earliest possible moment, before a too grave mixed infection takes place.-New York Med. Journal.

READING NOTICES.

Ferratin an Organic and Absorbable Iron Compound.-According to M. Cloetta (quotes the New York Medical Journal from the Presse Médical, Paris, February 10, 1897) the organic combination of iron with albuminoid matter is necessary in order to insure its absorption. For instance, two dogs were experimented uponupon as follows:

Their food consisted of a soup made of starch, sugar, glucose, and distilled water. Το the nourishment of the first dog a solution of iron chloride representing sixty milligrammes of iron was added; to that of the second dog, a solution of ferratin representing forty milligrammes of iron. The villosities of the dog to which ferratin had been given presented the characteristic action of the iron absorbed. The iron contained in the intestine of the other dog was not bsorbed and formed masses at the

base of the villosities. The organic iron combined with albuminoids is evidently absorbed in the intestine, penetrates the chyle, and enters the circulation by the mesenteric veins.

Definitely Antipyretic.-Dr. S. V. Clevenger, in an essay on "Pain and Its Therapeusis" (Journal American Medical Association, January 30, 1897) says: 1897) says: "Lactophenin is destined to largely supersede the entire array of analgesics proper, owing to its non-toxic peculiarities and the feeling of comfort described by many physicians as following its use. It is also antipyretic definitely, and being without the heart-depressing effect of the older antipyretics it will come into still more extended hospital and private practice administration.

The unpleasant subsidiary effects of phenacetin are absent from lactophenin."

Ingluvin.-Ingluvin is unsurpassed as a digestant and a remedy for nausea of pregnancy. The experience of the following physicians lead them to recommend it to the profession:

Danville, Va., Feb. 24, 1897. "I find 'ingluvin' superior to pepsin in all the forms of the latter. I can successfully treat cases of persistent vomiting in pregnancy."

B. M. WALKER, M. D. Durham, N. C., Feb. 26, 1897. "I find 'ingluvin' much superior to pepsin as a digestive agent, and a reliable agent in vomiting of pregnancy." L. W. BATTLE, M. D.

"Found 'ingluvin' to be a specific for vomiting in pregnancy where all other remedies had failed." ARNOLD STUBB, M. D.

Greensboro, N.C., Feb. 28, 1896. "I use 'ingluvin' in nausea and sick headache very effectively."

T. I. J. BATTLE, M. D.

Paducah, Ky., Feb. 5, 1897. "I have used 'ingluvin' in many cases of vomiting of pregnancy and it rarely fails to cure."

C. H. ELLIOT, M. D. Princeton, Ky., Mar. 4, 1897. "I have used your 'ingluvin' in. my practice for the past ten years, and find it to be a 'sine qua non' for vomiting of pregnant women. CLARENCE ANDERSON, M. D. Barcelona, Spain.

"I have obtained good results. from 'ingluvin' in organic complaints of the stomach and in the indomitable vomiting and dyspepsia to which women are subject during gestation.”

F. VIDAL SOLARIS, M. D. New York. Durham, N. C., Feb. 26, 1897. "I am very much pleased with the physiological action of 'ingluvin' in vomiting of pregnancy." W. E. FITCH, M. D.

DIURETIN-KNOLL...

A TRUE DIURETIC

DIURETIN is a pure diuretic, and acts by stimulation of the renal cells and renal parenchyma, increasing the flow of urine even in those cases in which the heart muscle no longer responds to the usual cardiac remedies.

DIURETIN is indicated in all cases of dropsy arising from cardiac or renal affections. It possesses no toxic properties, and can be administered in large doses for a long period without fear of consequences, or acquirement of a habit. It is frequently very active even where digitalis, strophanthus, etc., have failed.

The most excellent results are obtained in cardiac hydrops, but in chronic nephritis also, the action of DIURETIN is in most cases superior to that of all other diuretics.

DIURETIN-KNOLL is a white powder clearly and readily soluble in distilled water, forming a permanent solution.

The best mode of dispensing it is in a mixture or in capsules, in doses of from 10 to 15 grains.

Sample and Literature free

on application to

McKESSON & ROBBINS, New York.

THE ST. LOUIS CLINIQUE.

A MONTHLY JOURNAL OF

CLINICAL MEDICINE AND SURGERY.

EDITOR: THOMAS OSMOND SUMMERS, M. A., M. D., F. S. Sc. London.

VOL. XI.

ST. LOUIS, Mo., FEBRUARY, 1898.

No. 2.

ORIGINAL COMMUNICATIONS.

INFLUENZA, AND THE LAWS OF ENGLAND
CONCERNING INFECTIOUS DISEASES.

MR. PRESIDENT AND GENTLEMEN:
HE question which I ask you to

THE

consider to-night is whether anything can be done to check the spread of influenza, and whether any of the laws affecting public health can be of use in helping to secure this object. Owing to the present state of ignorance which exists amongst the people of this country with regard to disease, it is advisable that sanitary authorities should not use any powers they possess without a fair chance. of their being successful in accomplishing the end in view. The old idea that an Englishman's house. is his castle still exists, and is strongly held by the masses of the people, and all interference with what is considered personal liberty is strongly resented. Should inconvenience and expense be caused to the public without obvious and

corresponding advantage, the 107 ple will begin to resent all sanitary interference, and in the present state of sanitary law and of sanitar y authorities this would undoubtedly lead to much strife amcrgst thos e various representatives of the peo ple who are now selected to for m those authorities. And so the progress of sanitation would be checked, for under the present system no arrangement made by popularly elected bodies can be efficiently carried out without the tacit consent of those who elect the members of those bodies. Whe ther this state of things is satisfact cry I will not here pause to consi de1. It is enough to allude to it as a factor which cannot be ignored.

The preliminary questions which naturally arise are:

(1.) Is an epidemic of influenza of sufficient national importa rce

to make it worthy of attention? (2.) Do we know enough about the mode in which influenza is spread to justify us in saying that it is infectious?

charts

It is impossible to give in accurate numbers the sum of those disabled and of those killed by an epidemic of influenza, or more than roughly to estimate the money loss to the country of such an epidemic as that of 1889-90. The show the increase of mortality in London during the epidemics of 1803 and of 1889-90, and the bills of mortality of the cities of Petersburg, Berlin, Vienna, Paris, and New York, during the epidemics of 1889-90. These charts do not show the number of deaths which were due to influenza, but they do show the increase of death rate which accompanies epidemics of the disease. "It is found that during an epidemic many people who already suffer from organic diseases which would ultimately prove fatal, die sooner than they otherwise would because they are not strong enough to overcome the depressing effects of influenza in addition to those of pre-existing disease. It is common for diseases of the respiratory organs to follow an attack of influenza, and the maladies thus set up may not end fatally for weeks, months, or even for years.

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The report of the registrar-general which has been recently published, shows that the number of deaths directly ascribed to influ

* A paper read before the International Congress of Hygiene and Demography, August, 1892, "On the Prevention of the Spread of Epidemic Influenza."

enza in England and Wales in 1890 was only 4,523, but the registrar-general points out that this by no means truly represents the number of deaths which is really caused. He says: "If we assume— as we may, though not with certainty, yet with much probability— that the increased mortality from pneumonia, bronchitis, and diseases of the organs of circulation, as compared with the nine preceding years of the decennium were due to the same cause as were the deaths directly ascribed to influenza, the total number of deaths due directly or indirectly to the epidemic influenza was not merely 4,523, but 27,074, or 91 per million living." On this computation the increase in the death rate due to influenza was 941, or nearly 1 per 1000 inhabitants. But only a small proportion of cases of influenza end fatally, and the amount of suffering endured by patients who live through the disease cannot be represented numerically. Nor should the money loss of such a visitation be entirely ignored. But I think it will be admitted that an epidemic of influenza is a serious national disaster, and that, therefore, if we know how the disease is spread, it is of importance that this knowledge should be put to some practical use.

How is influenza spread? Gray and Haygarth, amongst our older physicians, taught that it was spread by contagion. Hirsch, who is possibly not well acquainted with English medical literature,

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