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THERAPEUTICS.

W. T. HIRSCHI, M. D.

The Value of Formaldehyde as an Internal Remedy. Dr. Roseberg (Therapie der Gegenwart, No. 2, 1905) administered formaldehyde internally in more than 200 cases with no toxic or unpleasant by effect in any single case. The irritating and cauterizing effect of formaldehyde is but slight if administered in the proper way. It is very readily absorbed from the alimentary and respiratory tracts, and about 30% is excreted by the kidneys as formaldehyde. Formaline injected subcutaneous causes a destruction of the blood cells, but if formaldehyde gas is inhaled no such destruction takes place. The writer attributes the different reaction upon the blood, between formaldehyde gas inhalations and subcutaneous injections of formaline as being due to an irritant, and not a toxic effect. For this reason it should be administered with other substances which liberate it slowly, and so avoid its irritant effect. Such substances are starch, dextrin, albumins, sugar, menthol and the terpenes. A dog received 50 grains formaldehyde with milk sugar in 10 days, during which time no trace of albumin or casts appeared in the urine. The writer uses formamint tablets which contains 3-20 gr. formaldehyde with traces of menthol pepsin, hydrochloric acid, citric acid and a large amount of milk sugar. The advantages of a solid preparation are that they are easier taken, more stable and uniform dosage. Forty-eight cases of angina, 6 of diphtheria, 7 scarlet fever, 2 erysipelas, 2 cystitis and one case of pyemia were treated with formamint, and the writer believes with better results than with the usual methods. One tablet every one-half to one hour may safely be given to adults for one or two days. Children in proportion to age. Formamint may replace urotropin, as it contains a larger amount of formaldehyde and in a less irritating form.

The Treatment of Snuffles in Infants. —(Dr. Ballin, Therapie der Gegenwart, No. 2, 1905).)-Owing to interference with nursing and respiration, and the great danger of aspiration pneumonia as a consequence of coryza in nursing infants, the latter should receive prompt treatment when it occurs, and in our prophylaxis we must always bear it in mind. Cocaine should be avoided in such cases owing to its toxicity, but cotton tampons immersed in a 1:1000 adrenalin solutions are useful. The tampon remains in the nostril until the swelling and congestion have disappeared. Its effect remains for three to four hours when it must be repeated. Solu

tions of adrenalin soon become inactive, and for this reason tablets are preferable to be dissolved in water as needed. This treatment will not abort the disease, but will lessen complications and make the child more comfortable. In purulent rhinitis ato 1% solution of silver nitrate should be used in combination with adrenalin, best alternating the one with the other. This treatment produces equally good results in syphilitic coryza.

Ice Applications in Lobar Pneumonia.Aurness (J.A.M.A.) outlines as follows a method of treatment that he claims to have used for a number of years with great success in lobar pneumonia: As soon as a diagnosis is made, the patient is given a full warm bath for cleansing purposes, put to bed and given a laxative dose of calomel and soda. The chest area of the lung tissue involved is carefully outlined, and one or more, as required, specially constructed ice bags are moderately but evenly filled with crushed ice and applied accurately over the parts inflamed. Each bag is wrapped in a thin layer of gauze and is furnished with a drainage pipe, the lower end of which empties into a basin below the bed. The main and important feature is this draining of the water as fast as it is formed, thereby establishing a constant and uniform ice application and utilizing the remarkable heat-absorbing quality of melting ice. Examinations are made each morning and evening, and the ice applications adapted to the changing areas of involved lung. There is no danger, he claims to the vitality of the parts, and the ice applications are kept up as long as the disease appears to be progressing and no threatening signs of collapse appear. In the latter event, ice applications are promptly removed, and stimulation is at once resorted to. The internal treatment throughout the disease, aside from stimulants, includes free use of some mild alkaline mineral water, and five to fifteen-drop doses of creosote carbonate every four hours. bowels are regulated by saline laxatives and enemas, the diet is guided by the digestive capacity, and free ventilation of the sick room is secured. It is claimed that this treatment lowers lowers the pulse while regulating and strengthening the heart, relieves respiratory difficulty and chest pains, and shortens the duration of the disease in the majority of cases. If begun within the first twelve hours the disease may be aborted.

The

The Therapeutic Use of Flourescence in the Human Organism.-W.J.Morgan (J. A. M. A. discusses the production of flourescence in the tissues of the human organism by use of fluorescing solutions, electricity, etc. He holds that it is a sort of phototherapy depen

dent on the same principles for its curative effects. The method includes filling cavities with fluorescent solutions as well as using these latter medicinally. It produces effects by the fluorescent excitation of the absorbed drugs, not due to the X-ray or to radium, but probably to the fluorescent light. What the latter lacks in intensity is compensated for by its propinquity to the tissue. It is also possible by this method to improve skiagraphic effects and fluoroscopic examinations. It has proved of value in determining the position and size of the stomach and other cavities of the body. By this means the thoracic cavity is illuminated on the fluoroscope far more than it can be by the X-ray alone. Morton has found it therapeutically useful in pulmonary tuberculosis, as well as in local tuberculosis elsewhere, and especially in cancer, of which two successful cases are reported.

PEDIATRICS.

A. LEVY, M. D.

Gonococcus Infections in Children.-Holt (N. Y. Med. Jour., March 18 and 25, 1905. The frequency of these diseases in chil. dren's institutions is certainly very great, and perhaps increasing; the reports mention them only casually, and the true conditions are discovered only by personal experience. Most cases of vulvo vaginitis are acquired in the institution itself, often originate from light cases which slipped into the hospital unnoticed. The cure of these mild cases requires no less than six or eight weeks. Hence the manifold opportunity for infec

rare.

Infections of the eyes are fortunately On the other hand, joint inflammations are frequent, often accompanied by severe pyemic symptoms and complete restitution of the joint does not always occur. Many cases resemble rheumatism. The rarity of severe rheumatic joint affections in young children should put the physician on his guard in the diagnosis. The disease is spread by clothing, thermometers, sponges, and perhaps by the bath. It is difficult to explain the frequency of arthritis in boys where no urethritis exists. The principal task is prophlaxis. All girls should be examined before admission for gonococci in the vaginal secretion, and suspected and infected cases isolated. The quarantine should extend to the attendants. The clothing should be washed in separate places. Separate thermometers should be used as well as syringes, milk bottles, catheters, etc., for perfect disinfection by the attendants cannot always be relied upon.

Disturbances of Digestion in Infants Resulting from the Use of Too High Fat Percentages.

(Holt, Med. News, January 7, 1905.)—Feeding of milk which is too rich in fat occurs either through the physician to prevent or cure constipation, or through the mistaken idea that the milk of the higher breeds of cows are best borne. In regard to the latter the author emphasizes the fact that Jersey cows give milk containing 5.5% fat. This is obviously overfeeding with fat, and results at times in injury to the infant.

Anesthesia in Children.-(Erdmann, Brooklyn Med. Jour., January, 1905.)—In the first months of life anesthesia is relatively dangerous. However, it is not often required for the sensibility is still so slight that minor operations can be performed without anesthesia. With the awakening of psychic perception anesthesia is more often necessary; in most cases the need is only momentary, and ethyl chlorid is sufficient. In procedures lasting longer chloroform is less dangerous in young children than in adults, because the heart muscle is usually intact. After the third year the conditions are similar to those of older persons. The element of powerful struggling comes into play. This is best met by beginning the anesthesia with nitrous oxid or ethyl chlorid. Even in these cases chloroform is relatively safe, though many prefer ether. There is particular danger in children of the status lymphaticus in whom sudden death may occur at the slightest narcosis. Therefore caution should be exercised and narcosis avoided of possible where large lymph glands and spleen are found. Rachitic and scrofulous children bear chloroform comparatively bad. author recommends as a good point to begin anesthesia during the sleep of the child, a thing that can often be carried out with a minimum amount of disturbance to the child.

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Hypertrophy and Stenosis of the Pylorus in Infants. Wachenheim (Amer. Jour. of the Med. Sciences, April, 1905) reports a case which ended fatally in the seventh week of life. The autopsy showed a stenosis of the pyloric lumen of 2 to 3 mm.; the circular muscle layer was 4 mm., the longitudinal 1 mm. in thickness, both of course hypertrophic, otherwise everything was normal. Owing to the size of the liver the hard and swollen pylorus was not palpable during life. There was also a diarrhea. The uncontrollable vomiting in spite of careful diet pointed to the diagnosis. The author concludes that organic stenosis usually cannot be differentiated from pyloric spasm. The differentia diagnosis is best established by the succes of the therapie of Freund and others. Un

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fortunately, however, in cases of true stenosis, by waiting we miss the best time to operate and the question of surgical interference in a particular case is very difficult to solve. Contrary to many authors, the writer believes that a true hyperplasia exists in the typical cases.

The great increase in volume of the pylorus, in the author's case three times the normal, would be unexplainable merely on the spastic theory. On the other hand, there are doubtless cases of pylorospasm which take a favorable course under proper treatment.

The author is not enthusiastic about the new theory of Ibrahim, that the pylorus stenosis is cured spontaneously by compensatory hypertrophy. The unsatisfactory results of operative treatment as opposed to the fairly successful internal treatment explains the preference of the physician of the latter.

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ROOF GARDENS.-Sometime ago we spoke of moderns as a race of cave-dwellers. stead of hollowing out the rock into rooms and passageways, the rocks are taken and built in such shape as to resemble a small hillside, in which are certain cavities called rooms, with passages connecting them and openings connecting them with the outer air. The difference between a cave and a house is only in name. In that communication we referred to the value of the roof, the most neglected spot, and at the same time the most available for an open-air life. Nothing it would seem would be better adapted for both comfort and fresh air than these open spaces in which the air is relatively pure at least it is free from the coarser dust of the streets- and which by reason of their elevated situation are free from observation. Occasionally some realizes the value of this space. W. P. Northrup (Medical News) has a very interesting account of how a roof garden was provided for three children who remained in New York during the winter. The children were aged The children were aged 3, 5 and 7. The family had a summer home on Long Island, and the children regularly. returned each fall to town in robust health. They gradually lost their appetite, became restless, sallow, and languid, caught cold, were confined in the house, were classed as grippe patients, went from bad to worse, until they were finally taken to the country. This had been repeated in all three times. Once in the country the children spent much of their time in the open air and became well and hearty. Northrup says that the question might well be asked why they were not sent to the park, which was only half a block away. As a matter of fact they were, but

they soon came to loathe the thought of going out. They could only walk in the park, but while in the country they could spend many hours playing in the open air. They lived in the open air. The parent's town house had a half-story on top which left a space 24 by 24 feet facing south and covered with a tin roof. It was 60 to 70 feet in the air, flooded with sunshine, and above the dust line. The tin roof was covered with a flooring of narrow strips. The area was surrounded with a wire net. A permanent partition was raised on the northern half of the west side. An awning was spread over the north third, rolling down from the house corners upon a frame. If it snowed or rained heavily the awning protected eight or nine feet of the north end and kept it dry. The roof playground stood the test of all weathers. Within two weeks the smallest boy, who had been drooping, was found to be better than he had been for a couple of years. He had always been fatigued in getting the needed amount of outdoor exercise. For five hours every day, blizzard days included, the children were out on the roof playing. The younger and more delicate child, for whom the roof garden was made, has been on the street but once during the winter. Is it possible to calculate how much it would do for child life to have a playground on the roof of every house?-Medi

cine.

FREE MILK TICKETS IN BERLIN.- The German Association for the Reduction of Infant Mortality has instituted a system of tin checks, each stamped 5 pfennigs. Physicians are supplied with these checks to any amount, and they are distributed to indigent mothers, who can obtain for three of the tickets a quart of pure milk at any of the substations of the association. The physicians write the name, residence and date of slips furnished with the tickets. The milk is sold generally for 15 pfennige, less than 4 cents a quart.

TUBERCULOSIS IN BELGIUM.-While actual statistics are not available, it is estimated that the deaths from tuberculosis throughout the Kingdom of Belgium in 1904 were 13,467, of which number the Province of Liege contributed 1742, the city of Liege giving 398. This malady is seemingly on the increase and efforts are being made to provide sanitariums for the afflicted. The Province of Liege has already expended 1,300,000 francs ($250,900) in this matter, and will go further in its endeavor to offer medical care and attention to the afflicted-Consular Reports.

THE MEDICAL FORTNIGHTLY

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CLINICAL THERAPEUTICS

A forum of original experience, to which scientific contributions are invited. Responsibility for views promulgated limited to author.

BRIEF CLINICAL REPORTS ON IMPOVERISHED BLOOD.

JOHN GRIGGS, M. D.

FARMINGTON, CONN.

Probably the most frequent and important conditions which the average physician is called upon to treat, are of an impoverished blood supply. Blood impoverishment is a condition rather than a disease and may be met with in all walks of life and at any age. It is symptomatic as many diseases and cases are observed where it seems to be the chief clinical symptom; where no well-defined or ganic disease can be observed, but where many indefinite complaints due to blood impoverishment are plainly in evidence. Whatever concomitant conditions exist with anemia and regardless of whatever special treatment may be demanded by plainly existing established organic trouble, it is, nevertheless, a fact, that the most complete and rapid cures are by restoring to the blood its normal elements. Consequently, the physician is justified in treating all cases of anemia with regard to the anemia itself, but, at the same time, not overlooking the care of other pathological conditions which may exist.

A large hospital experience has given me ample opportunity to study these blood

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conditions and compare the action of the many therapeutic agents employed in the treatment of blood impoverishment. efforts have been constantly directed toward finding the remedy which will give the most complete and rapid results in restoring the red blood corpuscles, thereby affording the surest and quickest relief from the weakness and general debility which always accompanies blood impoverishment.

In the beginning of my experiments I noted these therapeutic elements containing a food product and a stimulating vehicle have shown the most satisfactory and prompt results while those purely of a drug basis seemed to have a limited usefulness. The conclusion reached by my experiments extending over several years, leads me to unhesitatingly endorse bovinine as being the best tonic stimulant and food.

AN AID ASSOCIATION FOR MOTHERS.-From a French exchange we learn of a novel method of encouraging women to become mothers. A society exists in many towns in France known as the Mutual Maternal Association. Members of this society are taxed sixty cents a year, and when a member in good standing becomes a mother she is entitled to draw from the funds of the society $2.40 a week for the first four weeks, with an addition of $2 if she nurse the child. The reports of the association show that during the past ten years between four and five thousand women were thus aided, and that the mortality of infants has been reduced to six per cent, while the birth-rate has increased very much. Those interested in race suicide in this country might do well to turn their efforts toward organizing similar associations. Med. Age.

CHRONIC DYSPNOEA.-In the treatment of chronic dyspnoea due to vascular changes, Foxwell recommends the following combinations:

R Liq. strych. (1 %).

Tinct. strophanthi.
Liq. trinitrini (1 %)..
Sodii bromidi

Tinct. card. comp.

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M. Sig. To be taken in two or three divided doses, alternating with the following: R Pulv. rhei.

Hydrarg, chloridi mitis.... gr. 20-10 Ext. hyoscyami..

gr. i-ij

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One such capsule once or twice

M. Ft. cap. no. j. Sig. daily.-J. A. M. A.

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Look well to your prescriptions-a careless or dishonest pharmacist may ruin your reputation.

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