Subscription Price, $1.00 Per Year, in Advance, Postpaid. The writers of original articles, who wish to avail themselves of reprints, will please notify the managing editor at the time of presentation of paper; otherwise, full price will have to be charged as the type will have to be reset. ADDRESS ALL COMMUNICATIONS TO THE AMERICAN PRACTITIONER AND NEWS PUBLISHING CO., Editorial. THE subject of diphtheria and the amount of antitoxin to inject in such cases is one of extreme interest and one that there is a wide diversity of opinion upon. In the administration of only an immunizing dose there seems to be more danger in overdosing than were a larger dose given when the disease was actually present. If you recall the Ehrlich Side-Chain theory you will see readily that the body when busy with an infection or rather a toxæmia is less disturbed by the further introduction of a foreign substance into its interior than when it is in its natural state. At the New York Academy of Medicine, Section on Pediatrics, Noember 10, 1904, Dr. Louis Fischer read a paper on the subject of the treatment of diptheria by anti-toxin; a plea for larger doses and suggestions for its hygienic and dietetic treatment. His dosage is as follows: For a "The proper dose of anti-toxin for a mild case of diphtheria should never be less than 2.500 to 5.000 units for a child of any age. severe case of diphtheria with marked toxic symptoms such as a slowness of the pulse and enlarged glands, the dose of anti-toxin at the beginning should be between 5,000 and 10,000 units. When a case of diphtheria has been overlooked, and is seen after the third day of illness, then 10,000 units should be injected. If the symptoms do not improve during the first twenty-four hours, then 5,000 units should be injected after the first twenty-four hours, and every twenty-four hours until there is a marked improvement in the general condition. If a severe case of septic diphtheria is seen after the fourth or fifth day of illness then 10,000 units should be injected. If the symptoms do not improve after twenty-four hours, another injection of 10,000 units should be given. There is no harm done by giving 20,000 units during the first twenty-four hours if a severe case of diphtheria of the nose or a severe case of laryngeal diphtheria is seen. Just enough calomel or belladonna is necessary to produce the proper systemic effect, likewise anti-toxin must be given in proper quantities to neutralize the toxin in the system. If we do not neutralize the toxin in the system by giving the proper antidote, then we must not be surprised to find heart complications (myocarditis), a toxic nephritis or paralysis as a sequela, to this disease." He also says: "A few facts of decided clinical importance have been noted by me at the bedside in the hospital: First, that the temperature alone is not a sure guide as to the outcome of a case of diphtheria. Second, the heart is the guide, hence a study of the pulse is more important in estimating the prognosis of a case of diphtheria." THE American Anti-tuberculosis League will hold its next meeting in Atlanta, Ga., April 17 and 19, 1905, and is intended to be a united effort of American Physicians to better humanity. We are extremely glad to see something large and radical under headway in this country and wish the meeting to be a grand success as also the object of the league. It shall be the editors pleasure to attend and offer anything in his power to aid and abet this worthy project. INTERNATIONAL SOCIETY OF TUBERCULOSIS. A NEW Scientific society has just been founded in Paris, under name of "Societe Internationale de la Tuberculose." Its office is in Paris. Meetings are held monthly, on notice from the General Secretary. The scope of this association is the study of all questions concerning tuberculosis and the centralization of means of defense. Its work will be published. The association is composed of medical men or scientists holding diplomas from French or foreign universities and colleges. Admission may be obtained by application to the President, which application must be accepted by a committee elected at a general meeting. The annual subscription is ten francs (nine shillings). For further particulars and for applications address Mr. le Docteur Georges Petit, General Secretary, 51, Rue du Rocher, Paris, France. THE Bourbon County Medical Society held its regular monthly meeting at Paris, Ky., February 15, 1905, with President Keller in the chair. The subject of grip was exhaustively discussed and a report of cases followed. The officers now are: A. H. Keller, President; C. B. Smith, Vice-President; C. G. Daugherty, Secretary. THE University of Halle, Germany, has conferred upon Dr. Willy Merck, member of the old house of E. Merck, Darmstadt, established in 1668, a very high distinction, namely, the honorary degree of Doctor of Medicine in recognition of numerous meritorious contributions looking to the advancement of the therapeutic side of medicine." THE Ohio State Board of Health has taken steps to do that good which we should like to see all communities get the benefit of. When cases are reported instructions are sent to that party as to the hygiene of his condition. This is especially in regard to the gonorrhoea and syphilis and may do a great deal of good in preventing further spread by hastening a cure in some cases. This is practical in the poorer classes in whom there is a great deal of neglect. The Board has provided a bacteriological laboratory for the examination of specimens where the sick poor can send through their physicians specimens for examination. BOOK REVIEWS. Blakiston's Quiz Compends.-Medical Latin. Designed Expressly for Elementary Training for Medical Students. By W. T. St. Clair, A. M., Professor of the Latin Language and Literature in the Male High School, Louisville, Ky.; author of "Cæsar for Beginners," "Notes to Cæsar's Gallic War, Book Three," etc. Second Edition. Revised. Philadelphia: P. Blakiston's Sons & Co., 1904. We know of no one better prepared to write a book on Medical Latin than Prof. William St. Clair. If his old work could have lacked anything it might be its vocabulary of common medical-latin terms. In the present work we may safely say it is exhaustive in its vocabulary and relevant words to certain subjects are judiciously placed, i. e., nearest those exercises in which they are used. This work is one of the Blakiston Compends but enjoys the distinction of exhausting its text. Qualitative Analysis Brief.-By Allard Memminger, M. D., Professor of Chemistry, Hygiene and Clinical Urinary Diagnosis in the Medical College of the State of South Carolina; of General and Applied Chemistry in the College of Pharmacy of South Carolina, and Member of State, National and International Medical, Pharmacal and Scientific Societies, Active and Honorary, etc., etc. Second Revised Edition and Rewritten. Philadelphia: P. Blakiston's Sons & Co., 1904. We find Memminger's Qualitative Analysis Brief a very convenient concise treatise on the chemical tests, chemical methods and requisites. Those doing college laboratory work will appreciate its value. It has 124 pages and was designed by its author for his class work. It is sufficiently illustrated and is inierleaved for notes. We are glad to see a book of this kind. One Hundred Years of Publishing (1804-1904).-A Brief Historical Account of the House of Wm. Wood & Co. Illustrated. New York: Wm. Wood & Co., 1904. The above little book is not only a pleasant announcement to the medical book world, but an exponent of that firm's successes, which Wm. Wood & Co. are not the only ones to be proud of. "Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downwright facts at present more than anything else." -RUSKIN. Original Communications. AT ACUTE ABDOMINAL DISTURBANCES. Are They Ever Functional and Temporary or Are They Always BY EWING MARSHALL, M. D. T first blush my subject looks enormous because it embraces all the cavity. In other words, peritoneum. I take it that whether it be the stomach, the intestinal canal and its appendages, the bile ducts, the ureter, etc. wherever we have a mucous and muscular coat covered by the peritoneum, the conditions surrounding them vary but in degree and that for all purposes of study, any light thrown on the one will assist in the understanding of the others. One brilliant surgeon, writing on lesions of the appendix said: "The ideal plan of treatment is to remove every diagnosable inflamed appendix before the peritoneum is involved." fixed As John Hunter wisely said "A principle fixes the mind but a doubtful one leaves it no rest. Operation in this first stage can be carried out with no greater risk or difficulty than in the interval' stage and the patient will get well forth with without a dangerous and prolonged illness." I, as a general practitioner, heartily endorse this opinion but the excuse for this paper is that I find so many cases where I am not reasonably satisfied that the appendix is inflamed. I wish in general terms to state a case to which we have all been summoned in consultation. The prominent feature in the case is pain in the abdomen. This may * Read before the Louisville Clinical Society, Feb. 7, 1905. vary from a slight uneasiness to such agony as to call forth distressing cries, extreme restlessness, and even spasms. The temperature may be from slightly sub-normal to 103° or 104° Fahr. The pulse from 50 to 150 -from a small wiry to a full bounding--may be regular or irregular. Previous history: may have had similar attacks before or this may be the first. Duration of present attack from a few minutes to recurring paroxysms extending over many days. May be a history of imprudence in diet, with exposure to cold, wet, and loss of rest. May be nausea, diarrhoea or constipation, frequent micturition or the reverse. All of these symptoms may have been more or less in evidence. The attending physician recalls the following things which may produce this train of symptoms: Traumatism, acute indigestion, neuralgia, flatulent colic, spasmodic stricture, obstructed bowel from hernia, intus-susception, volvulus adhesions, tumors, etc.; appendicitis, gall stones, renal stones, floating kidney, aneurism of abdominal aorta, ovarian troubles, lead colic, etc. However, by careful examination generally we can localize our case to some certain organ. For this paper, I have supposed that we have by exclusion determined that the trouble is connected with the alimentary canal. I have seen it stated that Celsus-who lived about the beginning of the Christian era-wrote: "Whenever there is an injury from which survival is possible the immediate indications are two-to see that neither profuse hemorrhage nor inflammation terminate life." This is an axiom governing us to-day. The latter horn of the dilemna is the one which especially concerns us to-night. Shall we delay until we perceive the signs of inflammation hazarding the chance that they are perceived too late and the patient thereby risks a general peritonitis or shall we presume upon its coming and forestall it by an operation to the greater safety of some cases? Now the headings under which I desire to discuss this side of the case are: First-Are there functional troubles due to a temporary acting cause which may produce this train of symptoms? Second-Granting the above, may they be the forerunners or the associates of the initial stage of inflammation? Third-Granting the second proposition, should the abdomen be opened in every case presenting severe intestinal pain? I take it none would disagree with the statement that certain substances improperly ingested, are capable of producing acute indigestion and a variagated eliminating treatment is sanctioned but the limit of this treatment is really the point under discussion. Sir Thomas Watson wrote nearly a hundred years ago very plainly on this subject—Watson's Practice, p. 806—“Now under these afflicting circumstances the question will force itself upon you: How long am I to pursue the purgative system? Common sense and common humanity answer: You must stop it |