CITRIC ACID IN RHEUMATISM.-There is a common notion that lemon juice produces good effects in the treatment of rheumatic diathesis, but up to the present the employment of citric acid in acute articular rheumatism has not been spoken of to any extent. Huchard (Official Medical, April. May, 1905) has employed it in hospital and private practice for patients very susceptible to salicylates, and it proved effective both in acute and subacute rheumatism. The dose of citric acid is 75 to 150 grains a day, and may be prescribed as follows: B Acidi citrici.. ..... gr. lxxv-3iiss Syr. tolutan.. M. Sig. To be taken during the day-two to three tablespoonfuls every two hours. Under this medication the pain and swelling disappeared from the joints in twelve hours in some cases.-La Tribune Medicale. CHAPPED HANDS.-Brocq, of Paris, according to an article in Therapeutic Gazette, recommends the following for chapped hands: B Glycerini..... Tinct. peru.. 3iss 3ss 3j 3vj M. Sig. Wash the hands with this solution twice daily; or B Acidi tannici.... Aq. rosae.. gr. viiss 3v 3iij M. Sig. Apply locally to the hands. : As an ointment one of the following combinations should be applied at night: Essentiae Iosae... B Vanillin.. Lanoline.. M. ft. ungt. gtt. j gr. viiss Sig. Apply locally at night; or MEDICAL MISCELLANY DEATH OF MR. W. B. SAUNDERS.-Mr. W. B. Saunders, of Phliadeplhia, one of the largest medical book publishers in this country, died at Atlantic City on October 1st. He had suffered from a nervous disorder for some months, due to too close attention to his large business interests. Mr. Saunders began the publishing business in 1891, and from the start was recognized as issuing books of superior quality and workmanship. EUTHANASIA FOR CRIMINALS.-Dr. Ella K. Dearborn, at the Oregon State Homeopathic LEPROSY is said to be increasing in Roumania. Till 1895 no special precautions were taken, the disease not being considered contagious. Since then, however, so many cases have been discovered that the authori. ties became alarmed, and the rebuildoing of an ancient monastery at Arnota, on the seashore, for the interment of lepers was resolved on. It is alleged that the prevalence of this disease has greatly increased in the districts through which Russian forces passed in 1877-78. BRAIN INJURIES.-D. C. Peyton, Jeffersonville, Ind. (Jour. A.M.A.,) points out the indications for operative interference in cases of brain injuries. He holds that surgery is called for when there is evidence of hemor- Sig. Apply locally at night.-Jour. A.M. tion, followed by recovery, and the second, of fracture of the base, terminating fatally. THE MEDICAL FORTNIGHTLY A Cosmopolitan Biweekly for the General Practitioner The Medical Fortnightly is devoted to the progress of the Practice and Science of Medicine and Surgery. Its aim is to present topics of interest and importance to physicians, and to this end, in addition to a well-selected corps of Department Editors, it has secured correspondents in the leading medical centers of Europe and America. Contributions of a scientific nature, and original in character, solicited. News of Societies, and of interesting medical topics, cordially invited. Advertising forms close on the first and fifteenth of each month. Time should be allowed to submit proof for correction Advertising rates on application. Remittances and business communications should be addressed to the Fortnightly Press Co. Subscription, $2.00 a year, in advance, including postage to any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including Newfoundland, $1.00 a year additional. Entered at the St. Joseph post-office as second-class matter. The Medical Fortnightly will not be discontinued at expiration of subscription, as many of our readers prefer not to have their files broken on account of failure to remit. Unless we receive a distinct request to discontinue, and payment for all arrearages, this magazine will not be discontinued. Subscriptions may begin at any time; volumes end with June and December. Contributors should understand that corrected typewritten copy is essential to clean proof and prompt publication, and is much more satisfactory than manuscript. Original articles should be as condensed as justice to the subject will allow. Editorial offices in St. Louis, Jacksonville, and St. Joseph, where specimen copies may be obtained, and subscriptions will be received. Contributions and books for review should be addressed to the editor, 319 and 320 Century Building, St. Louis, Mo. CLINICAL THERAPEUTICS A forum of original experience, to which scientific contributions are invited. Responsibility for views promulgated limited to author. A PECULIAR FORM OF TRAUMATIC (CHEMICAL CONJUNCTIVITIS.-(By A. M. Hutton, M. D., Navarre, Mich.)-Some miners employed in sinking a shaft near here encountered numerous streams of sulphur water Though a careful analysis of the water has not been made it is sufficient for me to state that it gives rise to an acute conjunctivitis. The pain is most excruciating, and can be relieved only by the use of cocaine, and even cocaine is useless unless preceded by adrenalin chloride. My practice has been to use adrenalin chloride, 1-2000, and to follow this with cocaine, 2 per cent solution, and then to give the patient a boracic acid and cocaine solution to be used until all symptoms have disappeared. The point in favor of adrenalin chloride is this: Cocaine will not relieve this condition, unless preceded by adrenalin chloride. SOMNIFORME ANESTHESIA.-A considerable number of local and general anesthetics has been presented for the approval and use of the profession recently, and among those which have merited approval somniforme stands prominently. The editor of our Surgical Department says, after an extended use, that it is a valuable agent. Somniforme is manufactured by E. De Trey & Sons, Philadelphia. It is a combination of ethyl chloride, ethyl bromide and alcohol. The doctor states that it requires few seconds to place a patient under its influence, and the condition of pulse and respiration seem unaltered during anesthesia. Patients recover consciousness almost immediately after the mask is removed, and are able to get off the operating table and walk about without any perceptible difference. No vomiting or nausea follow its administration. For rectal and minor gynecological operations it is commendable. The firm furnishes a special mask for its administration, and should anesthesia be prolonged the anesthetist can very conveniently pour chloroform or ether in the mask and continue anesthesia in that way. The suffocation and sense of choking that follows the beginning of ether anesthesia can be obviated by inducing unconsciousness first by somniforme and afterwards change to ether. Dentists find in somniforme an admirable safe anesthetic in extracting teeth. While somniforme induces superficial anesthesia the inventors do not recommend it where very deep anesthesia is required, or where prolonged operations are to be done. The somniforme outfit is reasonable in price and very valuable in office work as an aid in examinations for diagnostic purposes. D. A splendid treatment for cold is one drop each of carbonic acid and tincture of iodine, diluted. THE NON-INSANE PSYCHONEUROSES. - J. Punton, Kansas City (Jour. A.M.A., Dec. 2, proposes the name "psychosomatasthenia" for a large class of morbid mental conditions, including certain hysteric, neurasthenic and various other neurotic manifestations, which, often occurring after exhausting bodily ailments, fall under the care and observation of the general practitioner rather than that of is liable to be misunderstood. He considers the specialist, and the importance of which these as the forerunners of insanity, differTheir fundamental naing only in degree. ture he considers to be the same, a pathologic Jack of inhibitory control of the higher mental directive forces, with consqeuent nutritional cellular instinctive and physical defects which seriously mar the power of the will, weaken the judgment and intellect, as well as excite or depress the emotional attributes in all degrees of intensity." Their causes are similar being both congenital and acquired while heredity stress and toxicity are the chief fac. tors of each. The psychopathic manifestations dominate direct the prognosis and most urgently call for treatment. They are ourable in their incipiency but become incurable when neglected. Vol. XXVIII (Absorbed the Morgan County (Ill.) Medical Journal, January 1, 1903.) ST. LOUIS, DECEMBER 25, 1905. Papers for the original department must be contributed exclusively to th's 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 purpose. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R EDWARDS, M. D., Chicago, Ill. Mr. REGINALD HARRISON, London, England. J. N. HALL, M. D., Denver. HOBART A. HARE, M. D., Philadelphia. THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago. LEADING ARTICLES MALARIA.* ATTALLA, ALA. JOHN P. STEWART, M. D. FOUR or five years ago an article on malaria would treat with miasma, swamps, lagoons, bayous, heat, moisture and decaying vegetable matter. Today the learned articles on malaria written in the last decade, read as so much fiction; interesting, pleasing, entertaining and, perhaps, somewhat instructive, as they show the mighty efforts of the searchers after truth, as they groped around in the dark, hunting for the cause of this terrible foe to man, and the manner of its infection. In an exhaustive and instructive article on Malaria, Dr. Chas. S. Smart of the U.S.A., in 1886 says: "The most amusing, as well as the most puerile of the theories offered as a substitute for marsh-miasm, is that which refers malarial disease to the bite of the mosquito." I don't know what Dr. Smart thinks now, but the most puerile and the most monumentally ignorant practitioner today, is he *Read before the Tri-State Medical Society, Chattanooga, Tenn., September 26, 1905. No. 12 who shuts his eye to the fact that malarial poison is due to nothing else. Malaria is an Italian term derived from the words, inala-bad, and aria-air, bad-air. Up to a few years ago it was supposed to contaminate the air of swamps, lakes, etc.; this idea was a correct one in the main, for such are the breeding grounds of the mosquito, hence the error. This proboscidian can not live without water, it must have a damp, shaded place to propogate, the more stagnant and foul the water the more abundant the development of the larvae into the wiggle-tails and the winged insect, and when it requires only twenty to twenty-five days for the development from the egg to the full grown mosquito, you can readily see what an army may be produced from one rain barrel in a summer. And why the mosquito was not recognized as a factor, in this disease, earlier, is a mystery, as it was a constant accompaniment to all other requisites that produced this trouble. Lets take a leading article written on malaria in '87., viz.: "The evolution of malaria is known, by the experience of ages, to be most active in warm climates and in warm seasons. Hence the singularity of the fact that the warm period of the day corresponds in no locality with the greatest diurnal activity of the poisonous influence; on the contrary, it is well known there is no danger on marshes that are notorious for their fevers, provided the individual be not exposed after night fall. Jungles and other pestilential regions may be penetrated with impunity when the sun is high in the heavens, but beware of them in the shadows of the night time." How are these facts explained? "The hot rays of the sun dissipate the miasma, etc." We who have experienced a sojourn in these same regions by day and by night, can tell you the reason, the mosquito is only active when the sun has ceased to shine, they are nocturnal ramblers, and it is at night that they get in their deleterious work. In this same article I noticed another remarkable statement, to wit: "The utility of large fires at night time in dissipating malaria, or protecting from its evil consequences has long been a settled belief. Hippocrates considered that protection was thus attained, and in modern times troops operating in malarious sections have resorted to this as an agreeable preservative measure. It was believed that the heat drove away the miasma. We now know that they were cnly smoking out the mosquitoes. Malaria is known to disappear with the clearing of swamps, draining of ponds and lakes, curbing of water ways, the filling in of pools and lagoons; the reason has been attributed to the lessening of the damp soit from which miasma, emanated, when in reality it was the destruction of the breeding grounds of the mosquito. I believe it was due to Laveran in 1880 the honor of the discovery of the malarial para site in human blood. In 1879 Klebs and Crudeli announced they had discovered the malarial bacillus in the soil of marshes, but the experiments made by our own Sternberg showed that this bacillus would not produce malaria, and besides it was found in other localities than malarial. The study of the parasite in the blood was then pushed forward with such a degree of energy that all its peculiar forms and cycles were made clear to the investigators, but as how man was infected remained as yet a mystery, as the red corpuscle seemed the only situation in which it could be discovered. A most exhaustive search was made for it in the air, water, and soil of all the malarial dis.. tricts of the world, yet it could not be found. As late as 1897 so great authorities as Loomis and Thompson, in their work on practice, assert that the manner of infection is wholly unknown, and how and where the parasite lives is absolutely an undiscovered state and locality. In 1898 Ross discovered the parasite in the grey mosquito. He was led to his research by Manson's theory, derived from Laveran's suggestions as far back as 1880, that the mosquito poisoned the water, and the water, man. Ross, continuing his investigations, succeeded in inoculating mosquitoes by allowing them to bite sparrows infected with protoesoma, a vegetable parasite of the same family traits as the malarial germ. Continuing this idea, Grassi, Bignami and others began their, now historical, experiments, and in November, 1898, Bignami obtained his first experimental case of malarial fever in man, through the bite of the mosquito. Since then the study of the question has been marvelous in its extent and results. Now of the great family of this pestiferous. proboscidian (whose name is legion) there seems to be only one kind of mosquito that carries the malarial germ, the anopheles. This is very fortunate, as there are so many of these insects. A recent investigation in Florida, alone, revealed the fact that they had twentyone different kinds. Of the anopheles family there are five species, but the female of the A. Claviger seems to be the most active inalarial infecter. It is a well known fact that the mosquito ning water, but still or stagnant water. cannot breed without water, not a clear runIt does not require marsh, muck, mud, or damp earth, or decaying vegetable matter; a rain sufficient, no matter how clean. barrel, a tin can, a cistern, or a slop basin is Although the anopheles prefers filthy or slimy water, pitcher. They do not breed in lakes or even have seen them breed in a porcelain lined Fonds containing fish, unless in little pockets or pools along the edge of such, inaccessiby a close and persistent hunt for their ble to the fish. They are easily destroyed breeding grounds, and a thorough draining and curbing and screening of all waters, and when impossible to drain or screen, a covering with kerosene oil, and you have succeeded in their entire annihilation. That the disappearance of fevers follows. the destruction of the mosquito has long since been acknowledged by the most skeptical. "Reports from all parts of the British Empire show, "says the Journal of the American Medical Association, "that the anti-mosquito campaign is being carried on with gratifying success. For instance, last year, in six months time, at Ismalia, a little town on the Suez Canal, the A. Claviger mosquito has been almost exterminated, and as a consequence, they have had only three cases of malarial fever in the hospital against 52 for the same period the year before." I know from my own experience that where my people protect themselves with screens and nets, they suffer less with malaria than those who have no protection. Attalla is peculiarly situated as a most typical point for the demonstration of the mosquito theory. North and west of us are mountains, east and south creeks and swamps full of mosquitoes. An east and south breeze fills the town with mosquitoes, the mountains prevent them from being blown further. And I've noticed this year the mosquitoes have been more numerous, and malaria more prevalent than I've seen them in ten. Since the beginning of July I've had 400 cases of malaria, and one death, but while I've had only one death, I've had untold suffering, and perhaps permanent sequelae that will tell its fatal story at some future time. I attribute my remarkable success to the fact that I have recognized the source of infection, and made an early diagnosis. I would immediately secure protection from the mosquito, and give plenty of quinine. The diagnosis of malaria is easily made, if you have a microscope, and are uncertain from the symptoms. You take a drop of blood from the finger (having previously cleansed the finger), it is well to wipe away the first two or three drops, place your thinnest cover glass in contact with the top of the drop, avoid touching the skin, then turn your cover glass over on a slide and press firmly down so as to spread the drop out in a thin layer, that the red corpuscles may not be mounted one upon the other, thus you can examine the cell singly (Of course the cover glass and slide must be thoroughly cleansed in alcohol). Lay this aside until you can return to your office, the outer edges of the drop of blood become agglutinated, and protect the center fresh for several hours. With a good lens magnifying 400 or 500 times, the parasite is easily found, little grains of black pigment will serve as a guide. You will also notice that the white corpuscles contain this pigment in almost every case, in fact, I believe, I've never examined malarial blood that I haven't found the white corpuscle pigmented. Now I have not been able to distinguish the kind of malaria I have had. If it is absolutely necessary to know this, for practical purposes, I am not sure. There are three kinds of this parasite distinct, and distinguishable by the expert, the Quotidian, the Tertian, and the Estivo-autumnal. I have failed (with my microscope) as yet, to recognize the special kind in a given case, however the symptoms will be an almost sure guide, and the treatment varies very little in all cases. I do not use any stain in my search for this bacillus. For a more minute, histological study of this organism, Romanowsky's method of staining is considered the best. I would be pleased to refer you to any of the leading recent works on microscopy for that method. As to what produces the chill and the fever, we are still at sea. We do know that the life cycle of the parasite corresponds with the different stages of an attack, beginning with the sporulation at the onset of the chill, and as the young parasites make their exit from the red corpuscles and mingle freely with the blood, the fever comes on, the red cell disintegrates and is lost in the plasma, the so-called "residua" of segmentation is taken up by the phagocytes, and so the process goes on and the sweating stage is ushered in. The young parasites then enter other red corpuscles, and they go through a like period of evolution, according to their kind, quotidian, tertian, intermittent or remittent as the case may be. The red cells are rapidly diminished, and the patient soon becomes anemic, and should the attack become persistent, the several viscera become involved, the spleen, the liver, and other organs. The fever then becomes pernicious or malignant. In the sections that I have studied this disease we have many clinical varieties of malaria; of chills we have every day, every other day, every third dav, seventh day, and so on; of fevers, we have the remittent, the intermittent, the hemorrhagic and the "swamp,' the latter including the pernicious and malignant. And it is my belief that yellow fever is nothing more than another type of malaria, still more malignant and fatal, notwithstanding all of the alleged discoveries of Sanarelli. In the treatment of this disease, in any of its forms, there is nothing better than quinine, given in the right form at the right time. First get rid of all the debris and poison in the system, as you can, by the great emunctories, the skin, liver and kid. neys, by giving calomel and salines; then give quinine in such manner that the last dose will come about one or two hours before the chill time, or cold stage, is expected. I prefer to give quinine in a sol. of sulph. acid, making a bisulph of quinine easily absorbed and quickly assimilated. My favorite prescription is: |