MEDICAL MEMORANDA. THE psychological depressions and neuralgias so common in the period following a debauch, are lessened or disappear altogether by the use of celerina. CALCIDIN.-Despite the text-books it is generally allowed that there is a distinct membranous croup and diphtheritic croup. In the latter there are profound systemic toxemia; in the former the local symptoms are the main consideration. One is a catarrhal disorder; the other a specific disease due to the presence in the system of the Klebs-Loeffler bacillus. In croup of the catarrhal type, calcium iodized (caicidin) has proven itself to be practically specific. In diphtheritic croup it is, however, only a useful adjunct to other treatment. If membrane forms and there is no profound systemic disturbance; if the temperature does not rise and the disorder has distinct catarrhal form, then calcidin in doses of gr. 1-3 every one-fourth to one-half or one hour will do prompt work. Give it powdered on the tongue and follow with a few swallows of hot water, or make a fresh solution for each dose, or every few doses. The same directions apply to simple croup, but here the remedy should be used at the first sign of "crouping," and it will be found to be promptly abortive. there be any possibility of diphtheritic infection antitoxin should be used promptly. Calcidin is the remedy par excellence for bronchial disorders and moreover wherever iodine is indicated internally it is the best form of the drug we possess, as it never causes iodism. Literature and samples of calcidin will be sent on request to the Abbott Alkaloidal Co., Ravenswood, Chicago, Illinois. If THE THERAPEUTIC VALUE OF PEPTO-MANGAN (GUDE).—(By Dr. Vehmeyer, Haren, Germany.)-The number of older iron preparations is so considerable that it seems on first sight desirable to weed out some of them, rather than to add to the list. If in spite of this the newer preparations have gained the upper hand, the cause must be sought, not in the attractions of novelty, but in the force of success. Hematogen, which is known to almost every one, has been so popularized and so extensively used that there seems to be a disposition already to value it less for its blood-forming power than for its appetizing, anti-scrofulous and roborant action. While I am persuaded of the value of this remedy, which I have prescribed quite frequently and fully appreciate its merits, I have not been able to confirm the statements of those who esteem it on account of its being well tolerated, and have reached contrary conclusions on this point. The custom of many clinicians and experienced practitioners is not to interrupt at once ferruginous medication after the disappearance of the chief symptoms, but to continue it for some time, is in many instances impossible with hematogen. It has repeatedly happened to me, more often in adluts than in children, that the patients refuse to continue the use of hematogen after taking the first bottle. They state that it is too powerful and too satiating, and this is the case, not only with irritable and sensitive persons, but those who have an energetic and resolute disposition, and who can be persuaded to resume its use, but finally manifest such a decided repugnance towards the remedy that their wishes must be gratified and another preparation substituted. In such cases I was led to resort to peptomangan (Gude), which I must credit with being much better tolerated and more agreeable. My observations extend now over a large field, comprising patients of various ages and conditions of life, so that I am able to formulate a reliable opinion of this preparation in the following conclusions; 1. Pepto-mangan (Gude) is incontestably a blood-forming preparation, and in this respect is fully equal to every other preparations. 2. Its use is therefore recommended in all those diseases in which, through an increase of blood and improvement of its quality, a cure or a beneficial influence upon the organism is to be expected; as for instance, in chlorosis, anemia, leukemia, in chronic diseases of the respiratory organs, in many digestive disorders, especially after diarrheas, and in convalescence from various diseases, especially in weak and anemic women after childbirth. 3. Owing to its great palatability and tolerance this preparation does not require any correctives, and is adapted especially in obstinate and protracted disease, in nervous, neurasthenic, and all other persons who are unable to take other iron preparations even for a short time. In people who require iron and are afflicted with nervous dyspepsia pepto-mangan (Gude)is not only by far the best ferruginous preparation, but at the same time a stomachic which has a most favorable influence upon the secretory functions of the stomach. 4. Its blood-forming and in general curative properties depend both upon its power of stimulating the appetite and digestion. Owing to its fortunate composition this preparation deserves general symptomatic employment. 5. Unpleasant by-effects are excluded. Pepto-mangan (Gude) therefore constitutes a valuable addition to our list of remedies. I prefer this preparation, which has never left me in the lurch, to all similar products, and am persuaded that within its field of indication it will prove of equal service to others. As regards the dose, it is advisable in general to follow the printed directions, although in individual cases it may be exceeded without the least untoward effects; for it is one of the prominent advantages of the preparation, that while exhibiting in full its curative effect, it never satiates or becomes repugnant, but permits of administration according to requirements, for a short period as well as many months, and that it is equally well tolerated by children and adults of both sexes without exciting the least aversion. FRESH COLD AIR TREATMENT OF PNEUMONIA IN INFANTS.-W. P. Northrup reports two cases of pneumonia in infants, in which the windows of the sick room were kept open day and night; both children recovered. He believes it become more and more the rule to treat pneumonia in this way. Cool, pure air, he says, reddens the blood, stimulates the heart, improves digestion, quiets restlessness, and aids in overcoming toxemia. He concludes with the following prescription for killing a baby with pneumonia: Crib in far corner of room with canopy over it. Steam kettle; gas stove (leaky tubing); room at 80 deg. F. Many gas jets burning. Friends in the room, also the pug dog. Chest tightly enveloped in waistcoat poultice. If child's temperature is 105 deg. F. make a poultice thick, hot, and tight. Blanket the windows, shut the doors. If these do not do it, give coal-tar antipyretics and wait.-Medical Record. It is authoritatively stated that in the treatment of erysipelas there is no better remedy than passiflora incarnata, given in ordinary doses as often as occasion appears to require. TO THE EDITOR: THE CARABANA PRIZE CONTEST. Believing that many of your readers are keen critics of the advertising columns of your valued journal, it has occurred to us that they might be willing to enter into a little contest which we are organizing and for which we shall award $50 in cash prizes, as follows: A committee of three physicians will award, not later than July 1st, a first prize of $25, a second prize of $15, and a third prize of $10, to the doctor sending in, prior to June 1st, the five best reasons why physicians should and do daily prescribe our carabana aperient water. The five reasons should be stated as concisely as possible, not exceeding twenty-five words each. All that is necessary for your readers to qualify will be that they are personally familar with the various uses to which carabana water is put, and that they write from personal experience. In order to ensure fairness, physicians competing must sign their reasons with a "nom de plume," and in a separate envelope enclose their professional card, on which the "nom de plume" should also appear. Address: Carabana Contest, 2 and 4 Stone street, New York. Yours very truly, GEO. J. WALLAU. LE Vol. XXVII (Absorbed the Morgan County (Ill.) Medical Journal, January 1, 1903.) MARCH 25, 1905. Papers for the original department must be contributed exclusively to this magazine, and should be in hand at least one month in advance. French and German articles will be translated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the proof. Engravings from photographs or pen drawings will be furnished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this pur pose. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R. EDWARDS, M. D., Chicago, Ill Mr. REGINALD HARRISON, London, England. HOBART A. HARE, M. D., Philadelphia. CHARLES JEWETT, M. D., Brooklyn. LEADING ARTICLES A CASE OF BRAIN TUMOR; OPERATION; RECOVERY. CURRAN POPE, M. D. LOUISVILLE, KY. President Neurological Society: Ex-Professor Nervous and Mental Diseases, Louisville Medical College; Consulting Neurologist, Louisville City Hospital; Member American Medical, Mississippi Valley, American Roentgen Ray, American Electrotherapeutic, Kentucky State, Jefferson County Societies and Associate Editor Journal Advanced Therapeutics, etc., and A. M. CARTLEDGE, M. D. LOUISVILLE, KY. Professor of Surgery, Louisville Medical College. THE following case has been under observation off and on for the past nine years, and the successful termination has been such as would justify us in making the report in detail: John M. T., age 33, native of Tennessee; American parentage; by occupation electrical engineer; was examined by me in conjunction with Dr. A. M. Cartledge on the 31st day of October, 1895, and at that time. we obtained the following history: His father was living in fair health, but in his No. 6 His youth had been addicted to alcohol. mother 65 years of age, fair health, though she at times suffered from general debility and "fainting spells." He has one brother living, in excellent health; one dead from unknown cause. Two sisters living whose health is good. There is no history of any cancer or consumption in the family. He is married and has one child, a girl in excellent health. His personal history shows that his birth was normal, but he was very delicate until one year old when he seemed to become strong, and during infancy he was in fairly robust health. At the age of ten he fell from a hay wagon head downwards, striking on the middle of the head, but the blow was not sufficient to stun him, as he retained consciousness throughout, although his head ached for hours.. He has had none of the infantile neuroses, and as far as obtained his mode of living has been regular and moderate. He is a moderate user of alcohol, but has never used tobacco. He has had the exanthemata. In physical appearance he is tall and thin, height 6 feet 1 inches; weight in health 145, at present 130. Complexion sallow and dark. He states that he has always had a strong constitution and could stand a good deal. Temperature 98.6 morning and evening. His skull is mesocephalic. Teeth irregular and badly set and presents the appearance of degenerated stigmata perspires easily and there is no evidence of skin lesions. The kidneys are active and show no trace of abnormal constituents. The genito-urinary system otherwise is normal. The respiratory system is in excellent condition, the vital capacity being more than ordinary. Respiration 20. The heart sounds are normal; pulse 104; arterial tension fair. The digestive system has been the subject of considerable disturbance during his life, owing probably to his irregular habit as to meals and deficient care as to mastication. He has suffered from gastric dilatation and fermentative disturbances. His memory is fairly accurate; his emotions easily excited. There are no morbid ideas present. His powers of concentration and inhibition are excellent; disposition cheerful. He On the 23d of September, 1892, he had his first "attacks." For one year prior to this attack he had suffered with intense frontal headache, nearly constant, increased toward He evening and aggravated by exposure to cold or excitement. The latter part of this year, in the fall, he was wiring a building, being in the loft and upon the rafters; it was very hot and depressing weather. While he was sitting upon the rafters he began to feel a numbness or sleepiness in his left leg and was compelled to ask the assistance of a co-laborer to move the limb. The numbness seemed to crawl up to the left nipple, and at this point he gave vent to an exclamation of "oh," became unconscious, gasped for breath. was told that the leg continued to jerk like a pump handle during the entire time that he was unconscious, a period of about three quarters of an hour. Five minuutes after he came to he became intensely nauseated and vomited the meal he had eaten shortly before. He was put to bed and in a couple of hours seemed all right. Seven days later he had an attack of the right side, which started as a tingling sensation in the center of the sole of his foot. He became alarmed and started for a drugstore which was a short distance away. Before he could reach the drugstore he had to step up upon the sidewalk, and as he attempted to do so the leg became heavy and he could not use it. A bystander, seeing his trouble, gave him assistance and he was lifted into the drugstore where he became numb to the nipple on the right side. In a little while the leg commenced to twitch, and as this took place he again cried out, lost consciousness, his face became livid, though he did not froth at the mouth nor bite his tongue, nor void his urine. He remained unconscious for twenty minutes, came to and in five minutes vomited again, and was confined to his bed for two days. Two days later he left his bed he found he could not use his right leg, and this paralysis lasted six weeks. There was perfect sensation, no pain, no ache, simply loss of power. The limb was dead like a log. In six weeks he regained the use of the limb. He was weak but fairly well. In December of the same year (1892) he had his third attack. He was sitting at the table when his left leg commenced to have the same peculiar feeling described by him as "funny" feeling and the jerking commenced. He became unconscious, remained so twenty-five minutes, again came to, vomited and in a few hours was all right. Thereafter the attacks became very frequent. During one he had the numb feeling in the leg, but by rubbing and stimulating the circulation the attack was averted Sometimes the inhalation of a little chloroform seemed to keep the attacks off. Exposure to cold and an attack of indigestion invariably brought them on. He was able to give a very clear and concise description of his trouble. PHYSICAL EXAMINATION. normal, no evidence of any abdominal dis Thin and rather anemic, heart and lungs ease. Some marks of a specific infection from which he suffered five or six years ago. Stig. mata of degeneration well marked. Upon examining the skull a tender spot was located about the center of the cranial box and ex derness had existed for the past three years tending somewhat posteriorally. This teu accompanied by a dull, heavy pressing feeling, which was increased by coughing or sneezing. No atrophy was present; a fine vibratory tremor in the hands. There was slight motor and static ataxia. Dynamometer showed right 100, left 75. Co-ordination normal. There was no evidence of any asphasia. Tactile pain, temperature and muscular sense were normal as to recognition, but all of these forms of sensation were slightly blunted and response delayed. This was particularly marked with regard to the pain sense. right side of the head seemed hotter to the touch than the left. The knee jerks were increased upon the right side, and excessive upon the left, which held good with regard to the wrist jerks. On the right side no ankle clonus was present, but upon the left side it was marked. The superficial reflexes were slightly increased. Examination of the special senses showed the vision and hearing to be practically perfect. The pupils were dilated, but active to light and accommodation; ocular movements natural and no change of color vision. The He was referred to Dr. J. M. Ray for an ophthalmological examination. He reported as follows: "Vision perfect; no contracture of field of vision; no pupillary sypmtoms or scotoma; well advanced "choked disc" in right eye and slight swelling with distended vessels and blurring of the margin of the discs in the left eye; no evidence of trouble in the extra ocular muscles." The diagnosis was then made of tumor cerebri. The presence of such marked Jacksonian epilepsy could hardly lead one to any other conclusion than that the growth was cortical. The marked involvement of the left side, greatest in region of the leg, but at times extending to and involving the right limb, and the fact that the predominance of the attacks were so largely upon the left side made me believe that the growth was located on the right side of the brain in the leg area, a short distance from the longitudinal fissure, and possibly extending back and involving the region of the trunk. I believed that there was likely a complicating meningitis. The opinion expressed by us prior to the operation was that the growth originated from a seat of injury brought by a fall from the hay wagon in early youth; that this had probably been followed by a specific on gumma that had become organized. It was decided that the best and only thing to be done was to trephine and remove the growth. On the 1st day of November, 1895, in the operating amphitheater of the Louisville Medical College in the presence of Drs. Dugan, Vance, Skinner and a large class Dr. Cartledge operated. DESCRIPTION OF OPERATION BY DR. CARTLEDGE. Dr. Pope has covered the ground so fully in regard to the history and symptoms of this very interesting case that it only remains for me to say a word in regard to the method of localization and operative technique. Believing, as he says, that the pathologic condition was fairly well localized about the left foot and leg center, that is to say, posterior to the fissure of Rolando and near the longitudinal fissures on the right side, we selected that point for exploration. The de sired point was selected in the usual way, the scalp having been shaved and cleansed. The superficial markings were made with iodine, so as to keep a clear landmark of the areas beneath. A large horseshoe flap was made over the foot and leg center, the convexity of the flap upward. This flap took everything including the pericranium. A large trephine two inches in diameter was now planted directly over the supposed lesion and a button removed. The unique is often occurring in various departments of practice, but in none have I seen it more so than in this case, for, upon raising this large button of bone the diseased dura was at once evident, bulging, thickened and firm into the wound. The remarkable thing to relate is that the trephine opening was as centrally over this tumor as it was possible for a thing to be. The tumor, about one and one-half inches in diameter and almost circular, was quickly removed simply by nicking the healthy dura at the margin of the severed bone and running a curved pair of scissors around, excising it. The tumor which had evolved from the under surface of the dura pressing into the brain substances, as I said before, it was about an inch and one-half in diameter, and almost symmetrical. The operative work was simplicity itself. As far as we could ascertain the surrounding dura seemed healthy. There was little blood. The pericranium and skin flap were stitched back and a tiny gauze drain, extending to the tumor bed, was brought out of the lowest angle. The man made a rapid operative recovery. The headache, which had been such a fearful feature of his case, was completely removed. He had slight convulsion about the sixth day, lasting for a few seconds only, and again about the third week. The convalescence to his present good health was slow, because of an intestinal trouble which interfered with his nutrition. However, after a year he grew stout, his headaches never returned, except an occasional headache which could be attributed to usual causes, and he has been now for six years under observation without any return of his former malady. He was kept upon anti-specific treatment, together with constructives for a period of nearly two years. This was a case of unusually large circumscribed and organized gumma. The case is peculiarly interesting in that it shows that syphilitic disease of the dura may sometimes be found so circumscribed as to lead to brilliant results from operative interference. It also illustrates that occasionally we may be very fortunate in coming directly upon the diseased part and remove it with a minimum of trauma. The case is very interesting also in that we have been able to observe him for such a length of time, which enables us to believe the relief is permanent. Such cases as the one reported should be treated jointly by the neurologist and the surgeon in order to get the best results. There are few busy surgeons who have the time to compass the detail knowledge so necessary in diagnostic differentiation in such an obscure pathologic field. THE ASSOCIATED PRESS. -The wires of the Associated Press, that great organization for gathering and spreading the news of the world, form a network across the continent from St. John, N. B., to Seattle, Wash., and from Duluth, Minn., to New Orleans, Galveston, and the City of Mexico. The news it gathers during twenty-four hours, from every part of the world, amounts to thirty-five columns of a newspaper of average size. Seven hundred papers use this service. Melville E. Stone, the vice-president and manager of the Associated Press, has written of the organization, aims and workings of the association; and the story will run through several issues of The Century. The April number will tell of its operations in Europe, and how its present efficiency was brought about. The present satisfactory conditions abroad were gained only through considerable diplomacy and through Mr. Stone's personal presentation of the matter to the Pope, the President of France, the Emperor of Germany and King of Italy. |