and, equally important, when not to use them." If such wise injunctions were more often obeyed, such maledictions like that of Voltaire: "That doctors are people who pour drugs, of which they know little, into a body, of which they know less," would prove fatuous in lieu of conveying a moiety of reason. Finally, our vaunted therapeutic progress in the treatment of pneu monia merits the cogent rebuke of Osler, who says, "Pneumonia is a selflimited disease and runs its course uninfluenced in any way by medicine, and can neither be aborted nor cut short by any known means at our com mand." [TO BE CONTINUED.] Department of Clinical Therapeutics DEVOTED TO CLINICAL EXPERIENCE. "Summer" Diarrhea in Infants and Children. In Dr. A. Jacobi's standard work on "Therapeutics of Infancy and Childhood" the author makes the following statement: In acute cases of intestinal (or gastro-intestinal) catarrh with high temperature, application of water, of from 60 to 70 degrees F. to the abdomen will render good service. The cloth must be wrung out thoroughly, covered with rubber cloth and flannel, and changed when warm. Anemic children and those with much pain require warm or hot applications, which may be preceded by a warm bath. Frequent injections of water of 100 F. or more, with or without an antifermentative, such as thymol (1:1000 or 2000) answer well in most cases. In great debility or collapse the water ought to be from 105 to 112 F., and contain some alcohol and opium, or teaspoonful of the tincture of musk. The addition of gum-arabic to the injection, or the use of glutinous decoctions (flaxseed) instead of water has a satisfactory influence. Starch injections have the advantage of adding to the nutrition of the body by the facility with which the colon changes amylum into dextrin, which will be absorbed. Part of the injected water will always be absorbed, fill the blood-vessels, and may prevent intracranial and other thromboses. Indeed, in many bad cases in which the ceret ral symptoms of the so-called hyrencephaloid condition have made their appearance, or are imminent, frequent injections into the rectum of a few ounces of warm fluid contribute considerably to the restoration of circulation." The above is quoted chiefly to show the high value that is placed upon enteroclysis in the treatment of diarrhea in infants and children by such an eminent authority as Dr. Jacboi. The importance of washing out the lower bowel cannot be too strongly impressed upon the general practitioner. In a communication recently received from E. J. Mellville, M. D., of Bakersfield, Vt., he states: "The season is fast approaching when the wide-awake physician must look up his weapons of defense against the intestinal diseases of childhood. Shall we give digestives when the mucous membrane of the stomach and bowels is inflamed and incapable of retaining any nourishment to digest; or shall astringents be exhibited when to lock up the secretions would be but to add fuel to the flame? Should we risk the danger of opium poisoning in order to temporarily relieve some of the most distressing symptoms or to allay the anxiety of anxious parents? No doubt cases occur when some one or all of the above mentioned remedies are imperatively indicated, but the majority of the patients will recover if strict attention is given to diet and hygiene, and a mild antiseptic used to sterilize the prima via. For the past two years I have followed a plan of treatment in these cases which has proved very satisfactory. After due care has been given to cleanliness, fresh air, sunlight and a suitable diet or lack of diet, glyco-thymoline is given by mouth and rectum. This preparation has been chosen for the following reasons: 1. It is pleasant to take and thus easily administered to children. 2. Although a mild antiseptic, it has shown no poisonous effect, even when a large quantity has been absorbed. 3. It is the best of good tonics and favors osmosis from diseased surfaces, thus lessening inflammation and promoting healthy granulation in cases where an ulcerative process has begun. 3. On account of the oily consistency of glyco-thymoline, it remains in contact with the mucous membrane for a considerable length of time, thus acting in double capacity of a protective and an absorbent. This latter quality is easily explained by the strong affinity of glyco-thymoline for the products of inflammation. The following cases may be of interest to the profession: CASE I.-Was called to see Mary P., aged 8, on July 4th, 1900. Family history tubercular. Pulse, 102; temperature 100 F. Diarrhea, vomiting, pain, tenderness and tumefaction over small intestines. Dilatation of pupils, loss of appetite, flesh and strength. Night sweats. Other organs healthy. History of recurring attacks every two months for past three years. Gave glyco-thymoline, one drachm to four ounces of water every four hours, and high rectal injections in knee-chest position of one ounce of glyco-thymoline in a quart of warm water every eight hours, having the patient retain as much as possible. Diarrhea and vomiting controlled in 36 hours. Convalescence unevenful. Continued glyco-thymoline in thirty minim doses three times a day for three weeks, when further medication was considered unnecessary. Prescribed an easily assimilated diet, rest in the open air, and cool sponging of abdomen daily. No return of symptoms to date, May 28th, 1902. CASE II.-Saw G. H. F., aged 3 months, on August 3d, 1901. Cholera infantum. Pulse 170; temperature 105; respiration 44. Vomiting and purging of blood and mucus. Tenesmus of rectum. Symptoms of collapse. Ordered hot saline baths, followed by a brisk alcohol rub every two hours. Discontinued all food for thirty-six hours. Gave hypodermics of brandy, thirty minims, every three hours, and twenty minims of glyco-thymoline in one drachm of water at the same time. High rectal enemas of one ounce of glyco-thymoline to a pint of hot water three times daily. Vomiting controlled in forty-eight hours and diarrhea much lessened. Gave twenty minims of glyco-thymoline in four ounces of broth every four hours, which was retained, and continued rectal injections for five days, when all untoward symptoms had disappeared. Uneventful re covery. CASE III. Was hurriedly summoned on September 8th, 1900, to Maggie G., aged four years, who having convulsions. Temperature per rectum 107 F.; pulse 135; respiration 49. Purging of greenish colored fluid. Stools numbered thirty in past twenty-four hours. Hot mustard bath, followed by a brisk alcohol rub. Mustard to extremities. Glycothymoline, four ounces to three quarts of water as hot as could be borne by rectal injection, allowing the fluid to flow out alongside of nozzle and injecting it slowly. This was repeated every four hours. On the following day the child's temperature was 104; pulse 138; respiration 48. No convulsions in past twenty-four hours. Gave thirty minims of glyco-thymoline in two drachms of water by the mouth every three hours. Temperature now began to fall rapidly and was accompanied by a corresponding decline in pulse rate, respiration and number of evacuations. Child began to ask for food and was given hot beef juice, two ounces every two hours. From this time on improvement continued rapidly, and in four days the patient was convalescent. Continued glyco-thymoline for four weeks in twenty minim doses four times a day well diluted with cold water. the end of that period a normal condition was established. TRAVELING OPHTHALMIC DISPENSARIES IN EGYPT.-Mr. A. F. MacCallan, M. B. Cantab, F. R. C. S., has been appointed by the Egyptian Government to direct the ambulant dispensaries which, as already announced, are to travel in Egypt for the treatment of ophthalmia in accordance with the arrangements made under the trust formed by Sir Ernest Cassel. Mr. MacCallan, who was formerly senior house-surgeon at the Royal London Ophthalmic Hospital and is at the present time clinical assistant there, will have the title of Inspector of Traveling Ophthalmic Dispensaries, and is leaving for Egypt immediately. Each dispensary will have a couple of tents with beds for the more serious cases and for those requiring operative treatment.-Brit. Med. Jour. RACE SUICIDE IN FRANCE.-The yearly numerical mean of births in France has fallen from 932,000 in the period 1881-86 to 884,000 in the period 1886-91, and to 877,000 in the period 1891-96. An article by Pinard and Richet upon the pathological causes of the diminution of the birthrate in France is of much interest. In presenting the results of their investigations they show very clearly that a fall in the marriage-rate cannot be accounted as the cause. The percentage of the marriage-rate is practically the same in France as it is in England, viz.-7.5 per cent, as compared with 7.4 per cent. As a matter of fact, the number of marriages has risen from 282,079 in 1881 to 295,752 in 1899. In 1900-1901 there were 827,297 births and 853, 285 deaths recorded; in 1901-1902 the figures stand 857,274 births to 784,876 deaths. MEDICAL MISCELLANY CARDIAC STRENGTH AND WEAKNESS.-It is extremely difficult, and, at times, well-nigh impossible to measure the strength of the individual heart in a casual examination. This strength can alone be properly estimated when it is submitted to many tests. The apparently vigorous man, in whom the heart's action appears unimpaired, where no valvulitis or signs or symptoms of insufficiency are in evidence, rapidly develops an acute dilatation when an unusual strain is brought to bear upon his cardiac functions. This strain need not necessarily be produced by an affection of the pulmonary organs, but may be caused by hurrying for a train, running up the "L" stairway, or any form of exercise to which the individual is unaccustomed. The heart beats regularly and performs its duties normally when there is no exhaustion of the cardiac musculature, and though excessive demands may be made upon its muscular fibre, it rapidly recovers its tone and vigor where the individual's cardiac strength is commensurate with the unusual demand. But the amount of physical strain which an individual may bear without untoward effect cannot be ascertained in a twenty minute examination, and that frequently carried on under unfavorable surroundings. Acute cardiac dilatation, supervening upon a moderate degree of exercise, moderate for most men, but immoderate for the individual affected, is an indication of inherent weakness. The heart approximates to the requirements of that individual in the ordinary routine of life, but not at any extraordinary demand. If the cardiac muscle be healthy, with the exception of more or less loss of tonicity, or contractile power, its complete integrity may be restored. We examine a patient again and again where the slightest doubt exists as to his cardiac condition, but in applicants in the ordinary course of examination we have to be satisfied with the "findings" as they then present themselves. One of the greatest difficulties associated with a diagnosis of "weak heart" is to determine whether the weakness depends upon muscle impairment, or whether it is of nervous origin. Again, the interpretation of the condition may be entirely one of personal equation; one examiner may be positively certain of its existence, and a few days later the home office gives the man a "clean bill of health." In this class of cases there may be neither irregularity nor intermittency, the apex is normally situated, and yet we are impressed with the idea that the applicant could not stand a severe strain of illness. The difficulties of the situation are generally enhanced by our lack of intimacy with the applicant's mode of living, for if we were better acquainted with his habits, a diagnosis of alcoholic dilatation would be more frequently made. The applicant's affirmation concerning his habits, and his categorical denial of excesses in any direction, often given with the best of good faith, when physical evidences of dissipation are to be found, should lead to an exhaustive examination of the principal organs, and in this investigation the heart should maintain a position of supreme importance. It is the barometer of the systemic forces, and by it the rise and fall of blood pressure, so important in the pathological as well as physiological relations of the system, may be at least approximately determined.Medical Examiner and Practitioner. Favorite Prescriptions Camphor for Ulcers of the Legs.-Schultze finds that camphor gives the best results in ulcers of the leg. The following are his prescriptions: B Triturated camphor. or Zinc oxide.. Lard, q. s. B Triturated camphor.. Zinc oxide... Olive oil.... 3 371 36 31 33 33 -N. Y. Med. Journal. gr. v gr. ss gr. xv 3iv 3ss q. s. ad zij Sig. Spray the nose and eyes every two hours.-Ingals. Treatment of Ozena.-Vaquier (Jour. des Praticiens) recommends copious douches of hot water containing sodium chlorid, sodium bicarbonate, lysol, gomenol or naphtol in solution in order to detach the crusts. A small quantity of one of the following ointments may then be introduced: The injection of antidiphtheric serum has been used to aid the catarrhal secretion which eliminates the crusts. Local application of iodin or the iodids after cocain anesthesia has given excellent results. The following may be used twice a week by means of a cotton applicator: Iodin..... Potassium iodid.. aa 15 grains The internal administration of from 1 gram to 2 grams (15 grains to 30 grains) of potassium iodid daily for 15 days causes an increase in secretion and acts as a stimulant to the nasal mucous membrane.—Jour. Am. Med. Ass'n. |