, 1910

, Vol. V.,

The author regards such starvation as totally unnecessary, and in old or feeble patients positively harmful. Even after operations on the stomach he begins feeding his patients at once. In one of his gastro-jejunostomies for pyloric obstruction, he allowed the patient to have two mutton chops and a milk pudding on the third day. He was thoroughly exhausted by months of vomiting, and was ravenously hungry. He thoroughly enjoyed his meal, and was all the better for it. Paterson does not, of course, suggest this as a routine treatment, but mentions the case to emphasize how groundless is the fear of early feeding. If the anastomosis be efficiently performed, the risk of the sutures giving way may be neglected so far as feeding is concerned.

As soon as the patient wishes a drink small quantities of hot water are given, and if this is retained one ounce doses of milk diluted with two parts of water. The quantity is gradually increased up to two ounces hourly. A cup of tea is allowed the same day as the operation if the patient wishes it. On the day after the operation, Benger's food and calves' feet jelly are given as well as milk. As soon as the bowels have been opened the patient is allowed fluid ad libitum, eggs, thin bread and butter, and other soft solids, and usually ordinary diet is resumed in a week or ten days. As a general rule the patient's inclination is a reliable guide to the quantity of food required, although in a few cases some coaxing and diplomacy are necessary to induce the patient to take adequate nourishment. It is impossible to lay down hard-and-fast rules as to feeding, and general rules have to be modified in individual cases. After operation for septic peritonitis no food is given by the mouth until the bowels have been thoroughly well opened. After gastro-jejunostomy for gastric or duodenal ulcer, especially if associated with hyperacidity, the diet must be more limited in quality, although the quantity need not be curtailed. Paterson always urges these patients to keep on a milk diet for at least six months. On the other hand, after gastrojejunostomy, or partial gastrectomy for cancer, he feeds the patients up more rapidly, allowing mutton or beef essence,

Expectorants.1 The best drugs to increase the secretion of the mucous membranes of the upper air tract, says Osborne in the course of a most interesting series of articles, on Suggestions for the Pharmacopeia of 1910, are ammonium chlorid in small doses, ipecac, and iodids.

While ammonium chlorid is disagreeable to take, if given in a sour mixture it is not seriously unpleasant. Just because a patient happens to have a cold of some sort it is no reason why he should have his stomach knocked out, his digestion interfered with, and his appetite lost by nasty, sweet-tasted expectorant mixtures. There is no need for squills in any form as an expectorant. There is no need for senega in any form as an expectorant. The syrup of tolu makes a nice, smooth menstruum, but still is sweet. Tolu has no expectorant properties whatsoever. The syrup of wild cherry is not unpleasant, but still is sweet, and any sedative effects form the minute amount of hydrocyanic acid that it contains is mythical. These last two syrups, however,

10. T. Osborne, M. D., Jour. A. M. A., Feb. 5, 1910.

should be retained in the Pharmacopeia as making a change in the appearance and taste of a cough mixture that must be repeated if the previous taste palls on the patient. There is no use for the fluidextract of wild cherry.

Of all expectorants or stimulants to mucous membrane secretion, there is none yet offered that is better than ammonium chlorid. Small doses of it in the early stages of congestion, frequently repeated, and larger doses, infrequently repeated, in the second and third stages of bronchitis, or an allied condition, should be given.

Ipecac is another valuable drug to increase the secretion of mucous membranes. It renders the mucus more liquid and less tenacious. The dose as an expectorant should be very small, as large doses, of course, will cause nausea. There is also no specific ability of ammonium chlorid and ipecac to act only on the mucous branes of the upper air passages. They are just as valuable for catarrh of the bile ducts, or any other mucous membrane. The following combination as an expectorant is a good one:

mem

gr. iv 3iss

fl.3iss

fl.zi ad, fl.ziv

M. et Sig.: A teaspoonful, in water, every two hours.

The above prescription is simply a frame. The codein might be omitted if there were no unnecessary cough, i. e., cough without expectoration. Heroin might be used in its place, if one preferred. The dose of the ammonium chlorid might be increased, and the frequency of the administration decreased. The ipecac might be omitted, if the expectoration were free. If the patient were a child, the syrup of citric acid might be changed to syrup of tolu or syrup of prunus virginiana, if deemed best.

The protective power of re-vaccination is not sufficiently realized by sanitarians, civil or military, and there is a tendency. to repeat the operation unnecessarily, with the consequent though small risk of

pus infection and the worse risk of stirring up the opposition of the fanatical anti-vaccinationists. Only a very small percentage of persons successfully vaccinated in childhood ever contract smallpox and few die of it, but these failures to maintain immunity make it incumbent upon everyone to submit to one re-vaccination in adult life. There are precious few cases of smallpox in such re-vaccinated persons, and the statistics published some years ago by Welch of Philadelphia, raised considerable doubt as to whether a single one of them, really had been successfully re-vaccinated. That is, there are no cases in which two good normal scars proved to be the results of successful vaccination in infancy and adult life respectively. If this is true, it is unnecessary for a general practitioner to vaccinate himself and all contacts every time he finds a case.

It is highly necessary, then, to find instances of smallpox after two such normal vaccinations. At present, there is ample justification for the charge that we re-vaccinate too often. Soldiers sometimes have it performed twenty times in as many years and it seems ridiculous. Nothing should be done, of course, to put the slightest obstacle in the way of universal vaccination but it is beginning to be felt that too much re-vaccination is one of these obstacles by causing undue opposition. We hope therefore that there will be detailed reports of every case of smallpox in which it is certain that there have been two successful vaccinations in infancy and adult. life respectively, being careful to eliminate cases of spurious vaccination or those in which pus infection has been mistaken for

a success.

SOCIETY PROCEEDINGS.

EASTERN MEDICAL SOCIETY.

At the regular monthly meeting of the Eastern Medical Society, held March II, 1910, President A. J. Rongy in the chair, the following program was followed in regular order:

1. Presentation of a Case of Congenital, Unilateral, Bony Occlusion of the Posterior Nares, by John Guttman, M. D.

2. Presentation of a New Cysto-urethroscope, Embodying the Nitze Principle, by Leo Buerger, M. D.

3. Presentation of a pathologic specimen cast of the entire male urethra, shed after accidental cauterization with strong silver solution, by A. L. Wolbarst, M. D.

4. Papers. (a) Vesical Calculus, by Martin W. Ware, M. D.; (b) Vesical and Renal Tuberculosis, by A. E. Isaacs, M. D.; (c) Gonococcic Infection of the Bladder, and Urethra in the Female, by Augustin H. Goelet, M. D.; (d) Neoplasms of the Bladder, by Albert A. Berg, M. D.; (e) The Bladder in Prostatic Obstruction, by Parker Syms, M. D.

Discussion by Eugene Fuller, M. D., Ralph Waldo, M. D., L. J. Ladinski, M. D., A. L. Wolbarst, M. D., John F. Erdmann, M. D., Arnold Sturmdorf, M. D., Charles Goodman, M. D., and others.

NOTES ON MODERN PHARMACEUTICAL REMEDIES,

BURNHAM'S SOLUBLE IODINE. Description. Burnham's Soluble Iodine is a dark brown liquid with a slight odor of iodine and characteristic taste. Is readily miscible with water in all proportions.

Formula. The analysis of the Council on Pharmacy of the A. M. A., showed that this product contained approximately 3.0 gm. per 100 c.c. of free iodine and 2.0 gm. combined iodine. The analysis of our committee shows a slightly larger percentage. Allowing for error it is fair to state that the free iodine is very close to 3.5 gm. per 100 c.c. and the combined iodine 2.5 gm. in the same proportion. The preparation is slightly acid.

Physiologic Action. The action of Burnham's Soluble Iodine is that of the iodides generally-alterative, tonic and reconstructive-with the added advantage of being less irritating to the stomach and intestines, more freely absorbable and apparently more prompt in effect. It is not caustic or escharotic, and it is claimed that it can be tolerated by many patients who are unable to take iodine in any other form.

Uses. Burnham's Soluble Iodine has a field of utility identical with the iodides, broadened materially, by its special qualities. It is recommended in syphilis especially in the late stages and in the various sequelae of this disease; in rheumatic and allied diseases; in constitutional disorders such as scrofula, glandular enlargements, goitre, etc.; in many skin diseases, acne, eczema and psoriasis particularly; in respiratory diseases, such as chronic bronchitis, laryngitis, etc; in circulatory diseases, such as arterio-sclerosis, angina pectoris and other heart affections; in many diseases of women; diseases of the eye, particularly those of specific origin; as an antiseptic for surgical purposes and wound treatment in general; finally wherever iodine or the iodides would be properly indicated.

Dosage-Internally. Dose-2 to 30 drops well diluted, 2 to 6 times daily, preferably on an empty stomach.

The dose should be gradually increased in syphilis and other systemic conditions, where large doses are necessary, until the desired therapeutic effect is obtained.

Hypodermically: 2 to 15 minims, 25 to 50%

dilution.

Externally. As an antiseptic 2 drachms to a pint of water will be found effective for the average purpose. This may be increased in strength when necessary.

Special Advantages. Burnham's Soluble Iodine, it is claimed, is more freely and completely absorbable than any other preparation of iodine, with less of the objectionable features common to the usual methods of administration. As a quence, it is claimed that the therapeutic results from its use are manifested more promptly and decisively, a claim apparently well substantiated by extensive clinical observation.

Manufacturers. The Burnham Soluble Iodine Co., Auburndale, Mass.

A crop of boils is usually the result of an infection scattered by a single boil, though certain constitutional states, by lowering the vitality of the tissues, may render them an easier prey to the invading germs. Therefore, in the treatment of boils every care should be taken to protect the surrounding skin from infection.

BOOK NOTICES.

Nine

International Clinics. Volume IV. teenth Series, 1909. Published by J. B. Lippincott Company, Philadelphia, Pa.

Medical Chemistry. Seventh Revised Edition. Ninety illustrations. By Elias H. Bartley, B. S., M. D., Ph. G. Published by P. Blakiston's Son & Co., Philadelphia, Pa. Price $3.00 net.

Fundamentals and Requirements of Health and Disease. In three parts. By Thomas Powell, M. D. Illustrated with many original drawings. Published by The Powell Publishing Company, Los Angeles, Calif.

Spondylotherapy. By Albert Abrams, A. M., M. D., (University of Heidelberg) F. R. M. S. Illustrated. Published by The Philopolis Press. San Francisco, Calif.

Diagnostic Therapeutics. By Albert Abrams, A. M., M. D. (Heidelberg). One hundred and ninety-eight Illustrations. Published by Rebman Company, 1123 Broadway, N. Y. Price, cloth, $5.00.

The Dietetic Treatment of Diabetes. By B. D. Basu. Published by The Panni Office, Bhuvaneshvari Ashram 40, Bahadurganj, Allahabad.

Rational Immunization in Tuberculosis. By E. C. Hort. Published by John Bale, Sons & Danielsson, Ltd., 83-91 Great Titchfield Street, Oxford Street, W.

ITEMS OF CURRENT INTEREST.

The International American Congress of Medicine and Hygiene will be held May 25 in Buenos Ayres, Argentine Republic, in commemoration of the first centenary of the May revolution of 1810. In order to facilitate the contribution of papers and exhibits from the United States, there has been appointed by the President of the Congress, Dr. Eliseo Cantôn, and the Minister of the Argentine Republic at Washington, a committee of propaganda, of which Dr. Charles H. Frazier of Philadelphia is chairman, and Dr. Alfred Reginald Allen of Philadelphia is secretary. The Congress has been divided into nine sections, each section being represented in the United States by its chairman in this Committee of Propaganda, as follows: I. Biological and Fundamental Matters, Dr. W. H. Howell, Baltimore, Md. II. Medicine and Its Clinics, Dr. George Dock, New Orleans, La. III. Surgery and Its Clinics, Dr. John M. T. Finney, Baltimore, Md. IV. Public Hygiene, Dr. Alexander C. Abbott, Philadelphia, Pa. V. Pharmacy and Chemistry, Dr. David L. Edsall, Philadelphia, Pa. VI. Sanitary Technology, Dr. W. P. Mason, Troy, N. Y. VII. Veterinary Police, Dr.

Samuel H. Gilliland, Marietta, Pa. VIII. Dental Pathology, Dr. George V. I. Brown, Milwaukee, Wis. IX. Exhibition of Hygiene, Dr. Alexander C. Abbott, Philadelphia, Pa. It will not be necessary for one contributing a paper or exhibit to the Congress to be present in person. Arrangements will be made to have contributions suitably presented in the absence of the author. The official languages of the Congress will be Spanish and English. Members of the following professions are eligible to present papers or exhibits: Medicine, pharmacy, chemistry, dentistry, veterinary medicine, engineering, and architecture. Papers may be sent direct to the chairman of the particular section for which they are intended, or to Dr. Alfred Reginald Allen, secretary, 111 South Twenty-first street, Philadelphia, Pa.

AN IMPORTANT ANNOUNCEMENT.

Those of our readers who are interested in the various forms of physiologic therapeutics (including Hydrotherapy, Electrotherapy, Massage, Hyperemia, etc.) will be glad to know that it is proposed to shortly inaugurate a new journal devoted solely to the delineation of the progress made in these various lines of therapeutic endeavor.

The American Journal of Physiologic Therapeutics will be published bimonthly and the subscription price will be $1.00 a year. The names and addresses of all interested physicians should be sent in and those who are desirous of subscribing at once may enclose their remittance when writing. It is to be hoped that a widespread interest may be aroused in this matter. Write now, while this is fresh in your mind, to The American Journal of Physiologic Therapeutics, 72 Madison Street, Chicago, Ill.

Columbian spleen is the name given to the large spleens so often found post-mortem in Panama. It is partly "an interstitial fibrosis and partly lymphoid hyperplasia," and in no way related to Kala-azar of India. Dr. Samuel T. Darling now reports (Jour. of Experimental Medicine, July 17, 1909) finding in Panama, small round or oval organisms in a fatal disease resembling Kala-azar, though they differ somewhat from the Leishman-Donovan bodies which cause the Indian disease. Perhaps here we have a door opened into a new American pathological field and we may expect further discoveries of profound. importance. Our lurking enemies are being found out with commendable rapidity.