ITS DISTINCTIVE FEATURE.

One needs but to review the physiologic activities of the remedies recommended as tonics and reconstructives to realize the fact that practically all of them have some secondary effects which detract from their clinical value. It may be that they irritate the stomach and thereby excite repulsion on the part of the patient or even induce nausea and vomiting; some of them are astringent, others primarily stimulating, but secondarily depressing and so on through the entire category of remedies, objections more or less serious may be found. It is, therefore, a matter of great importance to employ a remedy which is not only free from deleterious by and after effects, but which adapts itself to use as a routine remedy in the many and diverse conditions that call for tonic and reconstructive medication.

The entire freedom of Gray's Tonic from anything like drug effects is one of strongest reasons why the best element of the medical profession have adopted the remedy for routine administration in all conditions associated with impairment of general health, lack of nervous energy, general exhaustion in anaemia, malnutrition, neurasthenia, and in chronic wasting diseases.

CARABANA WATER.

Dr. James K. Crook, of New York, in a recent issue of the Medical Record (June 28th, 1902), had an article on Mineral Waters, from which we extract the following:

"It cannot be denied that in the saline purgative group our native waters do not equal in mineral richness those to be found in Europe. We have no analogy of Carabana, which is the strongest water in the sulphated saline class, containing as it does 7,391.23 grains of solid mineral contents per U. S. gallon, and which is exceedingly strong in sodium sulphate, while containing but very little magnesian sulphate."

Carabana is three times as strong in purgative salts as the Hungarian bitter waters. It is much pleasanter to take, and acts quickly, yet mildly, in insignificant doses: one tablespoonful to a wineglassful. Prof. S. G. Grant, the noted rectal specialist, recently referred to it in one of his lectures at the N. Y. Post Graduate Hospital as a particularly valuable ante and post-operative cathartic.

An interesting monograph has been written on Carabana Water by the well-known French medical writer, Dr. Monin, a copy of which can be had free on request of Geo. J. Wallau, Inc., 2 and 4 Stone street, New York, who are the exclusive importers of this celebrated water.

SEVERE COUGHS.

In many instances cough is rendered more frequent and severe (especially of Phthisis. Asthma and Bronchitis) from the irritation of the pulmonary structures by the accumulation of the secretions which the weakened respiratory efforts are unable to remove. Terp-Heroin (Foster) is regarded as the best of all remedies in such cases, because of its selective stimulating action upon the respiratory center and the muscles of respiration.

It is of marked benefit in relieving cough of this character by rendering expectoration of the accumlated secretions an easy, painless process.

We call the attention of our readers to the advertisement of the Robinson-Pettet Co., Louisville, Ky., which will be found on another page of this issue. This house was established fifty years ago, and enjoys a widespread reputation as manufacturers of high character. We do not hesitate to endorse their preparations as being all they claim for them.

THE KANSAS CITY

MEDICAL INDEX - LANCET.

A MONTHLY Magazine OF MEDICINE AND SURGERY,

-BY

JOHN PUNTON M. D., EDITOR AND PUBLISHER.

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All communications to THE INDEX-LANCET must be contributed to it exclusively. The Editor is not responsible for the views of contributors. Each contributor of an original article is entitled to a reasonable number of extra copies of THE INDEX-LANCET. Reprints of papers will be furnished at cost, order for which must accompany manuscript. All communications should be addressed to

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VOL. XXIII. No. 10.

OCTOBER, 1902.

ORIGINAL CONTRIBUTIONS.

HYPERCHLORHYDRIA,

WHOLE NUMBER 274.

THOS. HUNT STUCKY, A. M., M. D., Louisville, Ky.

Professor Theory and Practice of Medicine Hospital College of Medicine.

In studying the etiology of this affection, many and ingenious theories as to its causation have been advanced. Long ago Von Noordan observed it in melancholia, Jolly claimed that it existed quite often in hysteria, while Jarowski frequently found it among the Jews of Galacia, who are especially subject to nervous disorders. Nisbut, in discussing the affection, classed malaria, alcohol, tobacco and cerrebral fatigue, sometimes auto-intoxication, as causes. As a neurosis of the stomach Ewald says, "That it is usually intermittent and bears a closer relationship to the nervous system than alimentation." Korn or Berlin, in recent observations has said, "The variations of acidity must be explained by a nervous influence, acting in an augmentory or inhibitory way." The clinician of the day, reviewing all the opposing theories of the chemist, and then reflecting upon his cases, is more than ever convinced that the theory of a primary neurosis in hyperchlorhydria does not satisfy the existing condition. The observations of Knapp have shown that hyperchlorhydria as a true neurosis is a rare affection. After fully reviewing the subject, I am more than ever convinced that in the majority of cases hyperchlorhydria exists, not as a primary neurosis, but secondary to involvement of one or more of the important organs in the economy or to an intoxication of the blood itself.

No organ, as is well known, lives on its own funds-the mutual give and take which exists between the several organs of the body is rendered possible upon the principle of greatest economy. Strictly speaking, it is scarcely possible for any part to fail or suffer without some echo throughout the microcosm. We see that the several organs are members of the other, and when one part becomes diseased and suffers organic change, the others react and sympathize accordingly. This, I believe, is the true explanation of hyperchlorhydria of the gastric juice. In a majority of cases there is some primary lesion situated outside the stomach (barring organic lesion of the stomach), and this disturbance of the hydrochloric secretion is a purely secondary affection.

That it may occur as a result of cerebral excitement is assuredly true, but in these cases, it is transient and terminates as abruptly as it began. In

order to explain its occurrence in hysteria the initiation of the morbid series is in the nervous system, and the hyperchlorhydria which may appear to be a central feature is purely an example of secondary involvment.

If one will accept that tone is something more that mere preservation of capacity of a hollow organ at about a normal mean and signifies the preservation of that degree of mutual tension of polarity which, like that existing between the members of the solar system, keeps all parts in balance and in mutual service, in this case a variation in secretion of a particular organ must signify the slakening of polarity between particular parts elsewhere. Thus we have often seen that hyperchlorhydria is a frequent occurence in neurasthenia, as many say as a separate neurosis. To again apply our theory, hyperchlorhydria may occur as a secondary involvement, just as exaggerated motility occurs in a fracture. We know that neurasthenia is a disease characterized by abnormal responses to normal influences. Thus, as a result of this condition, when food enters the stomach the reflex stimulation, true to the general condition is abnormal and a hyperchlorhydria results. In other words, there exists a condition of hyper-reflexivity which in nearly every case is due to some organic involvement in the system.

As examples of this are organic changes in liver, kidney, sexual system and sometimes mitral lesions, which one is to be determined in each case. In cholecystitis, cholelithiasis and hyperthropic cirrhosis of the liver the acidity is high. All evidence in our possession fails to prove the existence of true secretory nerves in the stomach, so this fact strengthens the theory of secondary causation.

Our first effort will be to investigate the liver as to causation. Some interesting experiments carried out in Batkins clinic have demonstrated the influence of bile retention on the secretory activity of the stomach. Siminitzky examined twelve jaundice patients, and found in all of these cases hyperacidity dependent upon the presence of bile salts in the blood. Such acidity dependent upon the presence of free H. C. L. That it was due secondary to the effects of the bile salts was shown by the fact that in every instance this hyperchl. disappeared with the disappearance of the jaundice. In one case when there was a relapse of jaundice, the hyperacidity returned. To reinforce this experiment, a series of observationsup on dogs in whom the gall ducts had been tied, after esaphagostomy, showed the quantity of H. C. L. present on excitation was nearly 50 per cent above normal. Again, to make sure, in a third series, in which an isolated ventriculas had been prepared according to the method of Heidenhain-Pavlov, bilary obstruction by marked increase in hydrochloric acid. Thus we have seen a definite active cause. Fenwick had made this observation. "In a normal state a moderate acidity of the gastric contents was followed by an increased elimination of bile and pancreatic fluid, while in certain functional diseases of the liver and pancreas, hyperchlorhydria has been encountered." Can we not explain this fact by the fact that it is secondary to the condition of the liver, not a neurosis proper at all, but that a more than usual stimulus is required to call forth tardy secretion of the bile (or pancreas). This would explain the fact that Oswald sometime ago called our attention to, the association of chlorosis, in which we so often have persistent jaundice and hyperchlorhydria. That Noordan observed it in melancholia is another fact supporting our theory, as this form of insanity has long been associated with bilary depression.

To go on further, we find in pregnacy both the sexual and functioual influence. During this period there is a tremendous drain on the liver and kidneys. If the liver is able to hold its own, the kidneys get along very well.

But when there is hepatic failure, the work of the kidneys is trippled. Throughout the course of pregnancy we so often have persistent hyperchlorhydria, migraine, hysteria, and epilepsy have a close relationship to the functional activity of the liver. Thus the frequency of hyperchlorhydria in this class of people. Cowie has experimented on stomach analyses of a large number of patients with different forms of insanity, yet though there is evidence in favor of the neurosis theory, we cannot help but call attention to the frequency of cirrhosis hepatica in these patients. Watson is a recent article calls especial attention to the occurrence of hyperchlorhydria in affection of the gall bladder. The location of the pain, if pain exists, and particularly the existence of a fullness and sensitiveness in the region of the gall-bladder and right lobe of the liver are symptoms suggestive of trouble which may account for high acidity.

Ac

Thus we have seen the action of the liver in these cases; we now call attention, reasoning along the same lines, to the action of the spleen. cording to the recent experiments of Pietro Gallenga in removal of the spleen. from a dog, the following facts were noticed:

First-Increased production of HCL at meal time.
Second-Absence of abdominal fermentation.

The conclusions drawn are, that the spleen probably plays an important part in the digestion of albumenoids, dependent upon some internal secretion, influencing either the quantity or quality of pepsin. Thus, with the absence of splenic secretion the peptonization of these albumenoids is diminished and thus nature compensates by an increased secretion of hydrochloric acid. This explains the occurrence of hyperacidity in chloranæmia, malaria and other splenic affections. Thus hyperchlorhydria in this case was a compensatory effort of nature, and entirely secondary to the action of the spleen. Recent observation made by Dr. Murray upon the result of pancreatic fistulæ have shown that hyperchlorhydria was associated in no small per cent of What was true of bilary secretion might indeed be justly applied to the pancreas. Nature is consistent, if anything, in her efforts.

cases.

We have shown very clearly that hyperchlorhydria may and does exist as a result of primary lesion in either the liver, spleen, pancreas, and sometimes the kidneys. It now remains to look into the constitutional causation.

There are two affections, gout and rheumatism, during the course of which hyperchlorhydria may occur. The explanation of this as a secondary lesion, I believe is clear.

It may be assumed that the H. C. L. is derived from the chlorides of the body, especially as it has been shown that the formation of the acid ceases when food is given containing no chlorine compounds. Gout and rheumatism, both are diseases associated with an acid compound in the blood, and amorphous chlorine compounds are deposited in the joints. With such a source as then exists, the occurrence of hyperchlorhydria in these conditions is easily explainable. That both may be, and usually are, associated with constipation, autointoxication would also lead us to believe that hyperchlorhydria in such cases is purely secondary, not a neurosis.

Thus we have seen that such a condition as a hyperchlorhydria as a neurosis does occur, it is a rarity, while in the majority of cases it dose exist as a secondary affection due to organic or functional lesion in some part of the body, and may at times be associated with some constitutional affection.

STUDIES OF THE ETIOLOGY OF INEBRIETY.
T. D. CROTHERS, M. D.,

Superintendent Walnut Lodge Hospital, Etc., Hartford, Conn.

Every case of inebriety is marked by some cerebral defect and enfeebled will power, with perverted nutritive functions which begin in some previous special condition or event, effecting the structure and function of the organism. Every case will be found to follow a certain progressive march from stage to stage, with long obscure halts, or rapid strides to chronicity and death. Both exciting and predisposing causes are at work; the one may produce changes of functions and structure, which may bring on diseases, or awaken latent tendencies to it; the other may induce such a state of the system favoring this disease, or weakening the power of resistance. The causes divide most naturally into three classes or groups: First, causes which come from inheritance, direct or indirect. Second, such general causes followed by inebriety in common with insanity. Third, special conditions and circumstances which favor the development of inebriety.

First Hereditary influence. No other disease is more certainly transmitted, not in the desire, always, for alcohol or its compounds, but in nerve degenerations and perversions, which develop into inebriety depending on some obscure conditions. The very poor and the very wealthy furnish the most striking illustrations of this fact. The former who suffer from irregularities of hunger, satiety, and bad quality and conditions of food, with perverted nutrition and diminished vitality, always transmit inebriate tendencies; the wealthy through continuous stimulation and excess, with neglect of healthy activity of both body and mind, develop nutritive degenerations both functional and organic, which appear in the next generation in inebriety. Both occupation and mental condition at the time of procreation are active factors in the causation. Persons who are engaged in intense mental work, and leading a sedentary life, such as literary men, clergymen, bankers, bookkeepers, etc., have often inebriate descendants. Inebriety not only follows from inebriate parents, but from excitable nervous persons, who have an unstable mental organization, with disordered emotional faculties, and unbalanced nutritive functions manifest in a capricious. irregular appetite for unusual foods and fluids. An inebriate diathesis can be noted in many cases, which from the absence of some special exciting causes not always develop into inebriety. This can be studied in the practice of any physician, for there are many persons in every community who possess all the latent tendencies to inebriety; nothing but the absence of exposure to some peculiar exciting causes prevents them from being inebriates. Not unfrequently persons discover this peculiar diathesis, and avoid with great care all temptation, or conditions of surroundings which encourage the use of spirits. This diathesis is not unfrequently associated with general organic degeneration, marked by anaemia, neuralgia, affections of the heart, rheumatism, dyspepsia, tubercular deposits, and constant tendency to exhaustion, etc. The intellect is active, but uncertain, changeable, vain, sometimes with the force of a genius and the weakness of a child, but always emotional, sensitive and sympathetic. The body and mind are developed out of proportion, unnatural special developments are present, the functional activity is intense, and they are either on the verge of eccentricity, or abject feebleness.

Second-Such general causes which are common to both inebriety and insanity. Of these traumatism or injury to the brain, or spinal cord, has been noted in many cases. These injuries are followed by al