ACTOPEPTINE is a skillfully prepared combination of Meat-converting, Fat- converting and Starch-converting Materials, acidified with the omall proportion of acids always present in the healthy stomach. It is a most valuable digesting agent, and SUPERIOR TO PEPSIN ALONE."-Prof. ATTFIELD, Ph. D., F.R.S., &c., Prof. of Practical Chemistry to Pharmaceutical Society of Great Britain. The most eminent and successful Practitioners consider LACTOPEPTINE the Standard remedy in the treatment of all those ailments in which deficient digestion is the direct or indirect cause of pathological conditions. LACTOPEPTINE. The most important Remedial Agent ever presented to the Profession for DYSPEPSIA, VOMITING IN PREGNANCY, CHOLERA INFANTUM, CONSTIPATION, and all diseases arising from imperfect nutrition. LACTOPEPTINE IN CHOLERA INFANTUM. We desire to direct special attention to the great value of LACTOPEPTINE in Cholera Infantum, and other intestinal troubles incident to the heated term. Send address for our Medical Almanac, containing valuable information. The New York Pharmacal Association, P. O. Box 1574. New York. In these cases we may conclude that unless there is rest there is no cure. Dr. Beverly Robinson, of New York, said that his experience with the class of cases under discussion had led him to believe that, so far as the acute cases are concerned, there are milder measures than the use of an emetic. The use of tablet triturates of chloride of ammonium, repeated as often as once every fifteen minutes, is one of the most efficient methods of overcoming the difficulty. For local application there is nothing better than the carbolized spray. In the chronic form of laryngitis in vocalists we cannot obtain much information from the appearance of the mucous membrane. In these cases he had often found the membranes red, and this may continue after the trouble with the voice has disappeared. Here the difficulty is chiefly in the nervo-muscular apparatus. He found the internal use of a good wine of cocoa with the application of a faradic current to the neck very useful; the faradism to be repeated once or twice a day. Dr. F. H. Bosworth, of New York, said that there is no such disease as laryngitis, as that term is used to mean an inflammatory process. The seat of the disease is not in the larynx, but in the nasal passages. If we apply cocaine to the nasal mucous membrane, causing contraction of the blood-vessels, and follow this by the use of chromic acid, thus eliminating the coryza, it will usually be found that the laryngitis has disappeared. Relaxation has been spoken of as following the application of cocaine. Although he had used the drug in many cases, he had seen this result in only two, and these were cases of hayfever. His preferred method of using cocaine is to suspend it in fluid cosmoline and direct the patient to spray the nose and throat with it. Dr. C. E. Sajous said that the action of cocaine in laryngitis is pernicious. In cold in the head it is useful, but should not be used within four hours of the time when it is desired to use the voice. In the majority of the cases of chronic laryngitis the condition is due largely to fatigue. Quinine and nux vomica internally, with the external use of a weak faradic current, are the best means to employ. Cocoa-wine is also advantageous. Dr. W. C. Glasgow in this class of cases devotes himself entirely to the larynx and does not treat the nose. He usually employs applications of carbolized iodine to the larynx, which is a soothing application and relieves congestion. It also acts as a stimulant and enables the person to keep at his work; but it does not cure. Dr. Morris J. Asch said that the best way to treat the acute cases is that which we pursue in other acute cases, which is the treatment suggested by Dr. Cohen except the emetic. The employment of muriate of ammonia is useful in solution in compound liquorice mix ture. The chronic cases are more difficult to treat, because the patients cannot quit work. In them he had found nothing to equal the application of astringents. He had used the spray in some cases, but found that more good is done by the use of the brush. The solution which he most frequently uses is one of the perchloride of iron, thirty to sixty grains to the ounce. Where a person has to use the voice in a few hours, a single application will put him in a good condition temporarily. Another point to be considered is that these individuals live usually irregular lives, drinking wine and eating heartily. There is therefore nearly always some hepatic trouble which requires attention. He did not believe it possible to put the larynx of a singer in perfect order as long as he continues to work. Dr. F. H. Hooper: In these professionals there is sometimes an alteration in the quality of the voice, the result of over-exertion, and owing apparently to a want of tension in one vocal cord. To relieve this he had used electricity outside, with the aromatic spirit of ammonia, thirty to forty drops to half a glass of soda-water, internally. Dr. J. N. Mackenzie agreed with Dr. Bosworth with reference to the dependence of laryngeal disease on nasal trouble. The vast majority of cases of laryngitis are associated with disease of the nasal passages, and upon the recognition of this fact depends the successful treatment of many cases of chronic laryngitis. While admitting the existence of chronic primary laryngitis, he considered the majority of cases due to disease higher up in the respiratory passages. A caution is to be observed with reference to the indiscriminate use of cocaine in diseases of the nose and throat. It should never be applied just before a person is going to use the voice. The sensation which it produces in the larynx is only next to that of hanging. In the nose the effect is very pleasant, provided none of the solution be allowed to trickle into the larynx. Dr. B. F. Westbrook, of Brooklyn: While it is true that many of these singers and elocutionists suffer from strain and overwork, it is probable that in the majority of such cases the seat of the whole trouble is in some derangement of the digestive apparatus which predisposes to these affections: therefore an emetic or active purgatives would be useful in many of these cases. After the emetic he usually gives small doses of the mineral acids, frequently repeated,-say one or two drops of dilute muriatic or nitric acid repeated every hour. THE GALVANO-CAUTERY IN THE TREATMENT politics. He hoped that all would endeavor positively object to the cutting operation. There are two methods of using the galvanocautery one is by puncture, and the other by the snare. The number of sittings required varies from five to ten, and not more than three punctures should be made at each sitting. The method with the snare is much the quicker. The current should be used intermittingly, and traction should only be made during the passage of the current. He did not recommend this as a universal operation, for in the majority of cases the cutting operation is easier and better. It is to be used where there is danger of hemorrhage; but in adults he was almost disposed to say that the galvano-cautery should always be used. In the discussion the usual methods of treatment found advocates. NOTE ON A FREQUENT HEMORRHAGE. BY DR. CAUSE OF NASAL The ulcerations in cases of atrophic rhinitis had been a most frequent cause of hemorrhage in the experience of the speaker. He had found himself unable to detach the crusts from these ulcerations either by the use of douches or sprays, so well as by the employment of ointments. In the course of two or three days the patient is able to blow out the crusts. He had found no ointment act so well in imbibing the crusts and producing changes in the ulcerations as the ammoniated mercury ointment of the Pharmacopoeia, of one-half or full strength, made up with vaseline. In applying plugs in the case of hemorrhage, he had found Steele's flexible probe useful, especially in children. He had found the so called sheet-sponge a very good plug. This may be cut in long strips and pushed into the nostril until the bleeding is controlled by the pressure. (To be continued.) THE ASSOCIATION OF AMERICAN PHY- to make the coming meeting of the Congress of American Physicians and Surgeons a success. He announced the death of three members during the year: Dr. Thomas F. RochesNew York, and Dr. E. D. Hudson, Jr., of New ter, of Buffalo, Dr. Thomas A. McBride, of York. The first paper, entitled CIRRHOSIS OF THE LIVER IN CHILDREN, was read by Dr. R. Palmer Howard, of Montreal, who reported two cases in which cirrhosis of the liver was present in children,— brother and sister. He exhibited sections of the organ. DISCUSSION. Dr. William W. Welch mentioned one case in which cirrhosis had occurred in a child, 12 years of age, who came from the coast of Africa and suffered with malaria. Dr. F. Forsheimer, of Cincinnati, had seen two cases that may possibly be called cirrhosis, which he attributed to syphilis: he thought syphilis the most common cause of cirrhosis of the liver in children. Dr. William Pepper, of Philadelphia, mentioned a case in which cirrhosis of the liver followed measles in a child 8 years of age. There was no syphilitic history. During the attack of measles there were occasional attacks of catarrhal jaundice; subsequently the symptoms of cirrhosis made their appearance, and death soon followed. The whole duration of the case could not have been less than a year. At the autopsy a typical hob-nail liver was found. The liver had been much enlarged, but it had gradually contracted so that at the time of death it was of about the normal size. OBSTRUCTIVE SAFETY-VALVE ACTION IN THE HEART AND DIRECT FUNCTIONAL MURMURS. BY JOHN GUITÉRAS, M.D., OF CHARLESTON. The author had dwelt in a previous paper upon the significance of mitral direct presystolic murmurs, which were proved by the autopsy to be unconnected with any lesion of the mitral orifice. The lesions were those of intense aortic regurgitation. He had attributed the murmurs to the recoil of the blood upon the mitral leaflets holding them tense against the stream of blood coming from the auricle. In the opinion of the late Dr. Flint, direct functional mitral murmurs were limited to a small number of cases of aortic regurgi Asso-tation, but the author thought that functional mitral murmurs were not so rare. Obstructive functional murmurs are common in aortic regurgitation. THE Second Annual Meeting of the ciation was held in the Army Medical Museum Building, Washington, June 2 and 3, 1887. On Thursday, June 2, the meeting was opened by an Address by the President, Dr. S. Weir Mitchell, of Philadelphia. He referred to the purposes of the Association as being purely scientific; it is not concerned about difficult ethical questions and medical Pulmonary systolic murmurs are more frequent than any other form of cardiac mur murs. In examining one hundred consecutive cases, he had found in sixty-two systolic pulmonary-artery murmurs. In these the murmurs were present during tranquil breath ing or during respiration in such a way as to produce changes in the pulmonary circulation. If account is taken of the bruits heard in this region the proportion becomes greater. The clearness with which these murmurs are heard depends upon the proximity of the artery, the thinness of the chest-walls, the nature of the surroundings, and, finally, the proxim pansion of the vessels in order to allow them to apply themselves to the walls. Venous hums and basic murmurs he thought to be of valvular origin. (To be continued.) ity of the main trunk to the capillary distribu- NEW REMEDIES AND CLINICAL tion. Systolic pulmonary murmurs can be developed in the majority of healthy individuals, if we exclude those with thick chestwalls and those who are not intelligent enough to modify their breathing as directed. The author held that such a murmur was a dynamic obstructive valvular murmur, and is produced by the effect of changes of blood-pressure upon the semilunar valves. A certain degree of pressure in the artery must tend to prevent the opening of the valve. This causes a slanting position of the valves and a narrowing of the orifice with the production of a sonorous whirl. The fact that such murmurs are not more frequently developed at the aortic orifice is due to the greater power of the ventricle and the wider distribution of the systemic circulation. There are, however, cases in which increased arterial tension is expressed not only by accentuation of the aortic second sound, but by an aortic systolic murmur. He had heard it in atheroma and in Bright's disease where there was no marked anæmia. Pulmonary-artery murmur as heard in ordinary breathing is confined to the expiratory act, and is loudest at the beginning of the act. The murmur is sometimes only heard with the first beat that occurs with expiration. In order to further develop this murmur it is only necessary to arrest respiration. It is better to stop breathing during expiration, especially at the end of normal expiration. A full expiration makes the murmur louder. At the end of inspiration it is more difficult to develop the murmur, for several reasons: 1, because it requires entire arrest of respiration to produce engorgement of the main trunk; 2, because prolonged inspiratory effort is accompanied by a continued hum of the intercostal muscles; 3, because the expansion of the lung interferes with the transinission of any murmur that may be present. A slight murmur is frequently heard in inspiration if the arrest of breathing is pushed far enough. The speaker asked, "Are we not justified in assuming that there is a safety-valve action in this attitude of the pulmonary valve which, together with the leakage at the tricuspid orifice, tends to prevent engorgement of the lungs by retardation of the flow of blood in the systemic veins, so that continued for a time it does no harm?" In reference to the murmurs of anæmia, the author thought that they were due to some disturbance of the valvular apparatus. In this condition there is a marked reduction in the quantity of blood. The valves require a certain amount of ex NOTES. EXPECTANT TREATMENT OF EXTRA-UTERINE PREGNANCY.-Dr. Beugnies-Corbeau, of Givet (Ardennes), describes in the Union Medicale of April 2 a case of extra-uterine gestation which had been left to nature owing to the mismanagement of a former medical attendant. He saw the patient in 1883. She was robust, and about 50 years old, and was subject to epistaxis. Twelve years previously she was pregnant for the first and last time. During her pregnancy she was subject to violent attacks of abdominal pain. Her physician believed that she was not pregnant, but that she had ovarian disease. At term she was seized with labor-pains. The physician came with all his instruments, and, after waiting for three days in the house without diagnosticating the case, went away believing, it seems, that he had to deal with an inflamed ovarian cyst or some kindred disease, which he was pleased to call "dropsy of the ovaries." After three years of ill health, an enormous abscess developed on the gluteal region, fragments of a foetal skeleton came away through it, and a sinus was left which was very slow to heal. A second abscess opened in the same region on the opposite side, a third in the hypogastrium, and a fourth in the perineum. Both hip-joints became fixed apparently through muscular spasm. The last fistulous track discharged one of the scapula, which took five months in passing through the perineal structures. Being exceedingly tortuous, this fistulous passage remained open for two years. After so many years of suffering the patient was restored to perfect health. This case does not speak volumes in favor of the expectant treatment of extra-uterine pregnancy. CORROSIVE SUBLIMATE IN THE TREATMENT OF CHRONIC BRIGHT'S DISEASE.-Dr. John C. Peters, of New York, says that in chronic catarrhal or tubal or parenchymatous nephritis milder remedies, like citrate or acetate of potassium, liquor potassæ, etc., may be tried first, aided by buchu. But sooner or later recourse may be had to corrosive sublimate, for which the fluid extract of buchu will prove a good and acceptable vehicle. It is also useful in some cases of cirrhosed or even lardaceous kidney, and there seems no special reason why it should not also be restorative in that most common and most important variety of kidney-disease,-viz., chronic diffuse nephritis. Its most obvious effect is an increase in the quantity of urine, which often rises from half a pint to three quarts and more per day, followed by a steady diminution of the dropsy and gratifying relief from all the most urgent symptoms. There will always be a large number of cases of kidney-disease in which no cure is possible, but only palliation and prolongation of life. Hence too much must not be expected, and a hasty rejection or abandonment of a good remedy should not be indulged in. For the kidney is not equally affected throughout all its parts, and the less injured portions may carry on reasonably well the depurative functions. We must conserve what is left of the kidneys. To get the full effect of corrosive sublimate upon the kidneys, salivation must be sedulously guarded against. The dose is one-twentieth to one-eighth of a grain with cinchona.-Therapeutic Gazette, December 15, 1886. MISCELLANY. THE Thirty-Eighth Annual Session of the Medical Society of the State of Pennsylvania was held at the Bedford Springs Hotel on June 29 and 30, and July 1, 1887. The account of this meeting will be published in our next issue. DR. WILSON BUCK BY has removed to No. 1744 Diamond Street. OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF OFFICERS SERVING IN THE MEDICAL DEPARTMENT U.S. ARMY FROM JUNE 19, 1887, TO JULY 2, 1887. COLONEL CHARLES SUTHerland, SurGEON.-Granted one month's leave of absence, with permission to apply for an extension of one month. S. O. 126, Division of the Atlantic, June 23, 1887. LIEUTENANT-COLONEL A. K. SMITH, SURGEON.-Will be relieved from duty at West Point, New York, on September 30, 1887, instead of on August 28, 1887. S. O. 144, A. G. O., June 23, 1887. MAJOR J. C. MCKEE, SURGEON.-Granted three days' leave. S. O. 149, A. G. O., June 29, 1887. MAJOR C. H. ALDEN, SURGEON.-Leave of absence extended to include September 29, 1887. S. O. 144, A. G. O., June 23, 1887. MAJOR J. H. BARTHOLF, SURGEON.-Granted leave of absence for two months, to take effect about July 5, 1887. S. O. 141, A. G. O., June 20, 1887. CAPTAIN CHArles Richard, Assistant-SURGEON.-Sickleave extended two months on surgeon's certificate of disability. S. O. 139, A. G. O., June 17, 1887. CAPTAIN JOHN J. COCHRAN, ASSISTANT-SURGEON.-Granted leave of absence for one month. S. O. 143, A. G. O., June 22, 1887. FIRST-LIEUTENANT WILLIAM N. SUTER, ASSISTANT-SURGEON.-Designated as medical officer for the Rifle Camp at Creedmoor, New York, July 5, 1887. S. O. 124, Division of the Atlantic, June 21, 1887. CAPTAIN GEORGE T. BEALL, MEDICAL-STOREKEEPER.— Granted four months' leave of absence. S. O. 150, A. G. O., June 30, 1887. CAPTAIN A. V. CHERBONNIER, MEDICAL-STOREKEEPER.— Directed to take charge of office and perform duties of acting-assistant-medical-purveyor in St. Louis, Missouri, during absence on leave of Captain George T. Beall, Medical-Storekeeper, now performing those duties. S. O. 150, A. G. O., June 30, 1887. OFFICIAL LIST OF CHANGES IN THE MEDICAL CORps of thE U.S. NAVY FOR THE TWO WEEKS ENDING JULY 2, 1887. MEDICAL-INSPECTOR C. J. CLEBORNE.-Ordered for exami nation preliminary to promotion as Medical-Director. PASSED ASSISTANT-SURGEON G. P. LUMSDEN.-Ordered to Receiving-Ship" Franklin," Norfolk, Virginia. MEDICAL-DIRECTOR P. J. HORWITZ.-Permission to leave the United States for six months. ASSISTANT-SURGEON H. N. T. HARRIS.-Commissioned MEDICAL-INSPECTOR J. C. SPEAR.-Detached from Naval Detached Ordered to MEDICAL INSPECTOR MICHAEL BRADLEY. PASSED ASSIstant-Surgeon C. G. HERNDON.-Remain on present duty until June 17, 1888. PASSED ASSISTANT-SURGEON C. W. DEANE.-Ordered to the Naval Rendezvous, San Francisco, California. ASSISTANT-SURGEON H. N. T. HARRIS.-Ordered to the Naval Hospital, Mare Island, California. MEDICAL-DIRECTOR A. C. GORGAS.-Remain on present duty until December 31, 1887. MEDICAL-INSPECTOR C. J. CLEBORNE.-Remain on present duty until December 31, 1887. SURGEON BENJAMIN F. MACKEY.-Remain on present duty until December 31, 1887. MEDICAL-DIRECTOR J. MILLS BROWNE.-Will remain on present duty as member of Retiring Board until June 30, 1888. MEDICAL-DIRECTOR RICHARD C. DEAN.-Will remain on present duty as member of Retiring Board until June 30, 1888. OFFICIAL LIST OF CHANGES OF STATIONS AND DUTIES OF MEDICAL OFFICERS OF THE U.S. MARINE HOSPITAL SERVICE FOR THE TWO WEEKS ENDING JULY 2, 1887. GUITERAS, JOHN, PASSED ASSISTANT-SURGEON.-Detailed for temporary duty at Key West, Florida, June 23, 1887. WASDIN, EUGENE, PASSED ASSISTANT-SURGEON.-Relieved from duty at Marine Hospital, New York; ordered to Marine Hospital, Chicago, Illinois, June 23, 1887. NORMAN, SEATON, ASSISTANT-SURGEON.-To proceed to Charleston, South Carolina, for temporary duty, June 23, 1887. HEATH, F. C., Assistant-SURGEON.-Relieved from duty at Chicago, Illinois, June 23, 1887. ARMSTRONG, S. T., PASSED ASSISTANT-SURGEON.-Relieved from duty at Marine Hospital, Memphis, Tennessee; ordered to Marine Hospital, New York, June 27, 1887. PECKHAM, C. T., PASSED ASSISTANT-SURGEON.-Relieved from duty at Marine Hospital, Wilmington, North Carolina; ordered to Marine Hospital, Memphis, Tennessee, June 27, 1887. GLENNAN, A. H., PASSED ASSISTANT-SURGEON.-Ordered to Revenue Cutter "Crawford" for temporary duty, June 30, 1887. BROOKS, S. D., ASSISTANT-SURGEON.-Ordered to examination for promotion, June 27, 1887; relieved from duty at Evansville, Indiana; ordered to Marine Hospital at Wilmington, North Carolina, June 27, 1887. |