MEDICAL MISCELLANY

PRESCRIBE A LAKE TRIP.-Doctor, send that patient of yours who is wheezing to the balmy climate of Michigan. A boat trip from Chicago is always refreshing and invigorating. The Graham and Morton line runs elegant steamers to Benton Harbor, St. Joseph, Grand Rapids and all famous Michigan points.

AMERICAN ELECTRO-THERAPEUTIC ASSOCIATION. The preliminary program has been issued for the thirteenth annual convention of the American Electro-Therapeutic Association, to be held in Atlantic City, N. J., September 22, 23 and 24, 1903, and contains the titles of some thirty-five papers. Members of the profession are cordially invited, and those desiring copies of the preliminary program can secure same by addressing the secretary, Dr. Clarence Edward Skinner, New Haven, Conn.

HAY FEVER.-There are many theories regarding the causation of hay fever, including uric acid or other depraved states of the system, micro-organism in the air, and pollen from plants. Whatever theory is adopted and a systemic treatment undertaken to correspond with it, it has been found that intelligent local treatment is productive of great benefit. For this purpose a thorough washing or douching of the nasal passages with a weak hot solution of Tyree's antiseptic powder has been found very beneficial. It cleanses the membrane of poisonous secretions, soothes its irritability, and tones it up and strengthens it to resist further invasion. By frequent repetition as soon as any feeling of discomfort begins to return, the attack can be greatly shortened and the patient made comparatively comfortable throughout its duration.-J. S. Tyree, manufacturing chemist, Washington, D. C.

TO HAVE IN CHARGE MISSOURI'S EDUCATION EXHIBIT.-Prof. G. V. Buchanan, of Sedalia, for some years superintendent of the Sedalia public schools, has been selected by the Missouri World's Fair Commission as Superintendent of Education, and has entered actively upon the duties of his position. Prof. Buchanan will have in charge the preparation, collecting and displaying of Missouri's exhibit in education at the World's Fair. This display will come under the Commission's Department of Education and Social Economy, of which Judge J. H. Hawthorne, of Kansas City, is chairman. The appointment of Prof. Buchanan, because of his large knowledge of school affairs, is commended by educators everywhere. The appointment of Prof. Buchanan completes the organization of the five chief departments of the Missouri World's Fair Commission: In agriculture, H. J. Waters, as superintendent, with J. C. Allison, of New London, as chairman; in horticulture L. A. Goodman, as superintendent and B. H. Bonfoey, of Unionville, as chairman; in mining, H. H. Gregg, as superintendent and M. T. Davis, of Springfield, as chairman; in publication, Walter Williams, as superintendent, F. J. Moss, of St. Joseph, as chairman; in education, G. V. Buchanan as superintendent and J. H. Hawthorne, of Kansas City, chairman.

I am fond of prescribing cactina pillets in those obstinate cases of palpitation caused either by nicotine poisoning, indigestion or derangements of the uterus and its appendages, because it produces such happy and splendid results. TITUS ALBRIGHT, M.D., Hatfield, Pa.

Aletris Cordial (Rio) is an emmenagogue, not abortifacient. It cures congestion of the uterus and ovaries, and favors the occurrence of menstrual discharge. It is also especially appropriate when the amenorrhea depends upon anemia. It regulates menstruation and is useful in all the derangements of menstruation, namely, amenorrhea, dysmenorrhea and metrorrhagia, provided these disturbances be idiopathic. By curing menstrual disease, a common cause of sterility, it will also cure the sterility. It is also recommended in erosions of the cervix and vulvar eczema.

MICHIGAN HEALTH RESORTS.-The curative properties of mineral water in all parts of the world is receiving the attention of the medical world to a very large extent. In the list of such mineral waters, which are recommended by physicians of high reputation, will be found those at Alma, Mich., where the medicinal value of the deep well waters has been the subject of careful investigation, with the result that a great institution has been built up, the Alma Sanitarium. Booklets and descriptive matter will be sent on application to the Alma Sanitarium Co., Alma, Mich. The Premier Mineral Springs, at Benton Harbor, Mich., is another of the health resorts deserving of mention. The baths at this place are said to be especially effective in cases of rheumatism and its attendant diseases. Full information may be obtained by addressing H. R. Smith, manager, Premier Mineral Baths, Benton Harbor, Mich. There are numerous places in the State where the mineral waters are efficacious in the treatment of different forms of nervous and chronic troubles, full information of which may be obtained by addressing a letter of inquiry to H. F. Moeller, G. P. A., Pere Marquette R. R., Detroit, Mich.

GERM DESTROYING AND NERVE SOOTHING.-The following_excerpt from an article in the Virginia Medical Monthly, by Stephen J. Clark, M. D., No. 66 W. 10th street, of this city, plainly outlines the useful combination of two leading remedies in materia medica: "Binz claims specific antiseptic powers for quinine; other writers are in accord with him on this point, and report good results from large doses in septicemia, pyemia, puerperal fever and erysipelas. It is a germ destroyer of the bacilli of influenza (la grippe). Antikamnia and quinine tablets will promptly relieve in this disease. Quinine is a poison to the minute organism, sarcina; and antikamnia exerts a soothing, quieting effect in the nerve filaments. A full dose (two five-grain tablets) of this remedy will often arrest a commencing pneumonia or pleuritis. These tablets are also useful in the typho-malarial fever of the South-particularly for the hyperpyrexia -both quinine and antikamnia, as previously said, being decided fever reducers. They are likewise most valuable in cases of periodical attacks of headache of non-defined origin; of the so-called 'bilious attacks;' of dengue; in neuralgia of the trigemini; in that of 'ovarian catarrh;' and, in short, they are effective in every case where quinine would ordinarily be prescribed and without the 'ringing' which generally accompanies the administration of quinine alone."-New York Medical Journal.

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Volume XXIV

SEPTEMBER TENTH

Editorial Department.

Number 5

IN the August number of the American Journal of the Medical Sciences appears in full the original article by William Osler, M. D., Professor

A New
Clinical Entity
(Osler's
Disease).

of Medicine, Johns Hopkins University, descriptive of a definite clinical entity new to medical science, characterized by "Chronic Cyanosis, with Polycythaemia and Enlarged Spleen. This disease, as described by Osler in this paper and read before the Association of American Physicians, has created interest in this new symptom-complex which many of his friends have designated as Osler's disease in honor of this painstaking, differential scientific inquiry into this group of symptoms. This study is based on cases coming under his own observation and from a number reported in the literature of medicine. After reporting the cases in full Osler gives an exhaustive analysis of the conditions found, viz., chronic cyanosis polycythaemia, moderate enlargement of the spleen with the presence of a trace of albumin in some cases, and pigmentation of the skin in several cases. He describes these features in detail, as follows:

Cyanosis.-"Naturally this attracts most attention and has been the feature which has led to further investigation. As is usual in all forms of cyanosis, it is most marked about the face and hands . . . the skin of the entire body was of a dusky blue. When first seen the suffusion of the conjunctiva and the prominence of the eyes adds a startling appearance to the patient. The cyanosis is more intense in cold weather, and is aggravated by any existing bronchial catarrh. On bright, clear days, with but little moisture in the air, it may lessen. The period over which, the cyanosis has been noticed varies from ten years to three or four years. While constant it may vary greatly in intensity There is no respiratory distress with the cyanosis. While the skin looks full and tense and the hands bloated, yet marked dilatation of the large superficial veins is not noted. On close examination of the skin, many fine, dilated venules are

seen.

Blood. The viscidity is greatly increased. All observers have remarked not only upon the unusually dark, but upon the thick and sticky character of the blood drop. An extraordinary polycythaemia is a special feature of the affection. The maximum blood count was 12,000,000 per cmm. (Cabot's case). In eight of the cases the count was 9,000,000 per cmm., and in the ninth 8,250,000 per cmm. There have been no measurements of the red blood corpuscles. The statement is made that in the polycythaemia of congenital heart disease the red blood corpuscles are smaller than in that of high altitudes. The percentage of hemoglobin has been high, ranging in one case to 165. Usually the range has been 120 to 150. The specific gravity of the blood in one case was 1080; in another 1067 to 1083. In eight of the cases the leucocyte count ranged from 4,000 to 20,000. As a rule in the majority of the cases it has been below 10,000 per cmm.

Spleen. In seven of the nine cases the spleen was enlarged. Urine. In seven of the cases a trace of albumen was noticed, with hyaline, sometimes granular casts. The sp. gravity was low.

Symptoms.-The symptoms have been very varied. Most of the patients complained of headache, weakness and prostration. Attacks of nausea and vomiting were reported in some cases. Cough and shortness of breath were each present in one case. No fever in any case. The pulse was of high tension and the vessels sclerotic. There was no edema of the skin. The torpor, mental and physical; the sensation of fulness in the head, with headache, vertigo and in some cases nausea and vomiting, remind us of the symptoms to which mountain climbers and aeronauts are subject.

Remarks.-Chronic cyanosis, a common enough feature in clinical work, is met with:

1. In organic disease of the heart, particularly in congenital malformation, in chronic myocardial and tricuspid lesions in children and adults, and in cases of adherent pericardium.

2. In certain diseases of the lungs, particularly emphysema, and in long standing pulmonary tuberculosis of the fibroid type. Practically there are only two conditions in which patients walk into the hospital or the consulting-rooms with extreme cyanosis, congenital heart disease and emphysema.

3. In methemoglobinemia of chronic poisoning with coal tar products, as antipyrin and acetanalid, etc. In this condition too, the patient may startle one by the marked cyanotic appearance.

There are a good many people whose normal condition is one of great fulness of the blood-vessels of the skin, so that in cold weather there may be marked cyanosis of the ears and of the face. Cyanosis, local or general, indicates one fact-diminished oxygenation of the blood corpuscles. In the deepest cyanosis of the ear or of the finger tip the blood count may not be above 5,000,000 per cmm. Occasionally most

extraordinarily cyanosis occurs in adherent pericardium. Polycythaemia.-There are two classes of polyglobulism-relative, in which the condition is due to a diminution in the quantity of the

plasma of the blood, and true, in which there is an actual increase in the number of blood corpuscles. Much work has been done of late years on this subject. Relative polycythaemia is very common. It may be caused by a deficient amount of fluids ingested, which possibly may be the cause of polycythaemia of the newborn, more frequently it is caused by loss of liquids, either by (a) sweat; (b) diarrhea (by far the most common); (c) increased diuresis. (d) In another group of cases there is a loss of liquids by secretion or transudation, as in narrowing of the pylorus with dilatation of the stomach, and in the constant loss of liquids from the blood in recurring ascites. It is interesting to note that in some of these cases. the polycythaemia is of a high grade and may persist for months, or even for years. It is not necessarily associated with cyanosis, as is in cases of dilated stomach and in diarrhea. There is also a toxic polycythaemia described in poisoning by phosphorus and carbon monoxide, which, too, is probably relative. The polycythaemia of vasomotor disturbances, after the cold bath and exercise, also comes in this class.

True Polycythaemia.-It is met with where there is a difficulty in proper aeration of the blcod, as in high altitudes, or in heart disease, congenital and otherwise; and also in the obscure cases of this form here under consideration... It is by no means easy to offer a satisfactory explanation of the polycythaemia with cyanosis here under conisderation. It does not seem possible to connect it in any way with the moderate grades of enlargement of the spleen, and yet there are one or two observations in the literature which are of great interest in this connection.

With our imperfect knowledge of the physiology of polycythaemia it would be premature to discuss at any length the pathology of this remarkable group of cases. We need:

1. A study of all forms of chronic cyanosis with polycythaemia, particularly those associated with heart disease and emphysema. (It is to be noted that the cases here reported have the highest blood count on record, much higher than the average in congenital heart disease or in dwellers at great altitudes.)

2. A more accurate study of the blood in this class of cases-the volume, the viscosity, the state of the plasma and the serum, the amount of hemoglobin, the specific gravity, and the diameter of the corpuscles. As increased viscosity of the blood, with resulting difficulty of flow, seems the most plausible explanation of cyanosis, it is especially important to test the viscosity by accurate physical methods and to determine the relation of the number of corpuscles to the viscosity of the blood.

3. The relation of the splenomegaly to the cyanosis and polyglobulism should be carefully observed. It may not be anything more than the effect of the chronic passive congestion."

Future investigation will determine whether we have here in reality a new disease. The clinical picture is certainly very distinctive; the symptoms, however, are somewhat indefinite, and the pathology quite obscure. This clinical entity described by Osler so fully should keep clinicians. on the alert to observe in detail cases presenting this symptom-complex. We would be pleased to receive reports for publication. F. P. N.