for the son of a planter, a boy about twenty years old, though he appeared to be only about twelve, anemic, skin of a pearly, clear pale hue, mucous membranes colorless, feet and ankles swollen,heart dilated, hemic murmurs over carotid, eyes swollen, pain in epigastrium, no appearance of beard on face, feminine voice. I ordered ferruginous tonic and did not see patient any more for a year, when he was sent down to me for treatment, with his former condition unimproved. In the meantime I had read a paper on this type of anemia and was better qualified to make a diagnosis, and with the aid of a microscope the ova were found in great abundance. The blood was also examined, with the following results: leucocytes, 20,000 per c mm.; red blood corpuscles, 2,500,000 per c.mm,; hemoglobin, 35 per cent; diagnosis, ankylostomiasis. While the prognosis was not very bright, yet I took an optimistic view of the case and offered encouragement. Two preparations only are necessary to effect a curethymol, and iron and manganese. This patient was starved and purged according to Stiles' and Harris' method of treatment, after which two 30-grain doses of thymol was administered. On the fourth day no ova could be found after repeated examinations. It was at this juncture that he needed the aid of a ferruginous tonic, and I promptly ordered pepto-mangan (Gude), teaspoonful after meals t. i. d. and at the end of a month he was so much improved that his former friends would have hardly recognized him. A second examination at this time of the circulating fluid revealed the leucocytes 10,000 per c.mm.; red blood corpuscles 4,600,000 per c mm., and percentage of hemoglobin to be 78 per cent. The patient was sent home with a supply of pepto-mangan (Gude), and his convalescence continued rapidly and has been permanent. Case II-Mary, daughter of a tugboat engineer, was brought to my office in October, 1899, suffering from "ground itch" of two months' standing, with history of having gone barefooted in the country all summer. This was prescribed for, and in about four weeks the annoying symptoms disappeared. At the beginning of the following summer she was again brought to my office for treatment. On visual examination it was clearly apparent that she had anemia. She was poorly nourished, tongue dry and coated, teeth and gums covered with sordes, skin pale, putty-colored and extremely wrinkled, mucous membranes bloodless, considerable diarrhea, stools reddish brown. An interrogatory examination caused me to suspect uncinaria. A microscopic examination of the stools confirmed my suspicion. Blc od examination as follows: leucocytes, 22,000 per c.mm.; red corpuscles. 2,300,000 per c.mm.; hemoglobin, 35 per cent. She was starved and purged and given the thymol treatment, after which she was ordered to take pepto-mangan (Gude), teaspoonful after meals three times daily. She at once began to improve, and after a sixty-days' course of treatment a second blood examination revealed the following: Leucocytes, 8,500 per c.mm.; red corpuscles, 6,000 000 per c.mm.; hemoglobin, 80 per cent. She was, to all intents and purposes, entirely well and treatment was discontinued. Another observation which I have made is that "ground itch" and ankylostomiasis go hand in hand as it were. In almost all of the cases I have seen, a history of ground itch precedes them symptoms of uncinaria Americana. My clinical experience has conclusively proven that by the administration of thymol and peptomangan (Gude), the anemia of hook worm disease is controlled and results in positive cure. From a close study of this subject, and a critical review of the literature pertaining thereto, and my own experience, I am of the opinion that this is a very widespread disease, and one that as yet is only beginning to be recognized by the profession. Hook-worm disease is among us; it is a grievous burden to its host, and if not recognized and treated properly, it causes mental underlings, physical dwarfs, and ultimate death. THE formula of the Gélineau Dragées which is not a secret preparation, was so arranged that it should contain a remedy for each of the principal symptoms of the distressing affection of which we were just speaking. The formula aims both at the pathological and the symptomatic condition of epilepsy, and its cure, in all of its forms, may be attributed to the use of this remedy. It is of all preparations that which I can most conscientiously recommend.-DR. RATHELOT. AMERICAN MEDICAL ASSOCIATION THE Medical Herald Official Journal Buchanan JOIN THE MISSOURI VALLEY EXCURSION TO Whenever cod liver oil is indicated during the summer months' Scott's Emulsion can be used to better advantage than other cod liver oil prep any aration. The quickness with which Scott's Emul- SCOTT & BOWNE, Chemists, 409 Pearl St., New York. TRI-IODIDES (HENRY'S) Colchicin 1-20 grain. Liquer Sali-lodides. A powerful alterative and resolvent, glandular and hepatic stimulant, and succedaneum of the iodides. Indicated in all conditions dependent upon perverted tissue metabolism; in lymphatic engorgements and functional visceral disturbances, in lingering rheumatic pains which are "worse at night" Bone, periosteal and visceral symptoms of late syphilis; for the removal of all inflammatory, plastic and gouty deposits. A remedy in sciatica, megrim, neuralgias, lumbago and muscular pains; the gouty and rheumatic diathesis; acute and chronic rheumatism and gout; chronic eczema and psoriasis, and all dermic disorders in which there is underlying blood taint. An hepatic stimulant increasing the quantity and fluidity of the bile. Relieves hepatic and intestinal torpor; does not cause the unpleasant gastric symptoms of potassium iodide. THREE CHLORIDES (HENRY'S) Liquor Ferrisenic. An oxygen-carrying ferruginous preparation, suitable for prolonged treatment of children, adults and the aged. Indicated in anemia and bodily weakness, convalescence from acute diseases and surgical operations; boys and girls at the age of puberty, and the climacteric period in women. In children with chorea, rickets, or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration causes "iron headache." never As an adjuvant for potassium iodide the undesirable manifestations known as iodism can be removed. Stimulant to the peptic and hydrochloric glandular system of the stomach, especially serviceable in the impaired appetite, nausea, vomiting and other gastric symptoms of alcoholic subjects. MAIZO-LITHIUM Nascent Chemic Union 1 to 2 drachms. 8-oz. bottle Two $1.00 Liquor Lithium Maizenate. A genito-urinary sedative, and active diuretic; solvent and flush indicated for the relief and prevention of renal colic; a sedative in the acute stage of gonorrhea, cystitis and epididymitis; in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied manifestations of gout, goutiness aand neurotic lithemia, periodical migrainous headache, epigastric oppression, cardiac palpitation, irregular, weak or intemittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in action and definite in results than mineral waters. Those cases of irritable heart, irregular or intermittent pulse so frequently met with by insurance examiners and found to be due to excess of uric acid, are special indications for Maizo-Lithium. HENRY PHARMACAL CO., LOUISVILLE, KY. OFFICIAL JOURNAL: Buchanan County Medical Society ST. JOSEPH, MO., JUNE, 1905. Contributed Articles SOME CLINICAL AND OPERATIVE PHASES OF APPENDICITIS. A. H. Cordier, M. D., Kansas City, Mo. Professor Principles and Practice of Surgery and Clinical Surgery. University Medical College; Chief Surgeon Kansas City, Mexico Orient Railway. N the early history of the clinical phases of appendicitis, the discussions were mostly along the line of diagnosis. The question of typhlitis, peri-typhilitis and other supposed pathological changes in the ileo-cecal region were discussed, at length, by the greatest medical minds of that day. Later, the fallacies of those who maintained that the symptoms now recognized as those of appendicitis, were dropped, and the true condition was recognized and accepted by most surgeons and physicians. Then a new discrepancy developed in the minds of the profession; that is, How shall these cases be treated? Along this line there has been written more essays and longer discussions have been held, and more varied opinions expressed than on any other problem ever before the profession for proper solution. That those entering into these varied discussions have been sincere and honest, no one will deny. That there exists a want of unanimity is only too true. The lay papers ever ready to enter into scientific disputes, have not made this disagreement an exception, and the vast amount of harm done, and the number of lives lost, as a result of this source of information to the lay reader, would be hard to estimate. The diagnosis of appendicitis offers to the experienced physician very little difficulty. The determining of the exact location of the pathology in the appendix and the extent of that change, is not so easy, as a rule. However, in many cases, the experienced surgeon can tell quite accurately the character and extent of some of those changes before the operation. This uncertainty in foretelling the condition of the appendix is in, and how the case will terminate, lead to the most bitter discussions entered into on this subject. It has lead to one class of surgeons taking a position of waiting until what they call definite prognostic symptoms develop; while another class maintains that to delay is dangerous, as the so-called characteristic symp toms may not appear at all, or may be delayed until the safe period for operating has passed. A third class of surgeons say, wait in all cases, and operate in the interval of the attack; and yet another class is found who oppose operations in every case, and continue signing death certificates. "Peritonitis, inflammation of bowels, obstruction of intestines," etc., etc. All kind of medical management have been advised, from opium narcosis, to total abstinence of all food and liquids by the stomach. With all this array of varied professional opinion, can we wonder much at the articles appearing in the lay press Why should this diversity of opinion exist in this day when opportunities are so frequently presented to all to gain a similar knowledge on this subject? Basing the operative indications upon a purely conjectural (in many cases) pathological classification will often lead to error in staying the surgeon's efforts at relief. To say that this case is one of appendicitis gangrenosa, or that it is one of so-called catarrhal variety, and deciding for or against operation, will lead to serious mistakes in many cases. I do not wish to create the impression in this paper that an operation is imperative in every cases of acute appendicitis, far from it, I do believe that sixty per cent of all cases of acute appendicitis recover from the primary attack, thus leaving 40 per cent in the uncured and doubtful class, to run the gauntlet of recurrence and dangers incident thereto. My position with reference, when to operate, would be, if every case of appendicitis was operated on as soon as the diagnosis was made, that the mortality would be reduced to practically nothing. Dr. Lloyd. of New York, kept track of twenty-five cases of this disease that have been observed for a number of years. Twenty-four per cent died seventy per cent had recurrent attacks. Fitz' figures are about the same as Lloyd's. The medical man and the waiting surgeon, should keep their cases under observation a much longer time before reporting them cured without operation. Many a case of appendicitis is reported by three or a dozen physicians as having been cured by medicines, the same case having been operated on by some surgeon later, who reports the case as one case. Many cases of acute appendicitis never have an interval, if a delay in operating is permitted. In many cases the pathology in a first attack of appendicitis is of such a character as to leave no doubt that the patient had been having unhealthy changes in the appendix for weeks or months. A fecal or other concretion may have remained in appendix for months, slowly but surely destroying the surface epithelium, thus breaking down Nature's protective barrier to the invasion of the deeper structured by septic microorganisms. In a primary attack of three hours duration, far as clinical history is concerned, an ulcer through the mucous muscular or even a perforation may be met with; the patient giving no history of previous acute attack, or even many obscure or remote symptoms of the changes taking place in the appendix. I have operated on large healthy young men within six hours after the development of the first acute symptom, and found a perforated appendix, or a complete stricture at the base of the appendix from old inflammatory changes at that point, the appendix being much dilated and filled. with virulent pus. |