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ferent from the hard mass previously formed, and also different from the watery motions obtained by apperient medicines.

When a daily evacuation has been really established the patient may be allowed to get up for two hours daily and go for a walk or drive, but it is usually necessary to continue the treatment for at least six weeks. After this a gradual return may be made to more ordinary diet, but plenty of coarse bread, coarse vegetables, and fat should remain a constant constituent of the diet.

The author considers Von Noorden's treatment by diet to be the best, but if for any reason it cannot be properly carried out, there is no doubt that the Plombieres system of treatment is very useful. In cases in which the attacks of pain are very frequent and in which the patient would be unable to stand the first few days of the Von Noorden treatment the Plombieres "cure" maye pave the way and enable the patient to undergo the more drastic treatment. It consists in the use of a particularly soft water for thorough lavage of the bowel, for drinking purposes, and for external baths; the whole effect being soothing and palliative to the irritable, spasmodic bowel, as well as to the "nerves" of the patient. DIABETIC COMA IN CHILDREN.-Dupuy (La. Clin. Infant) says that prodromal systems are very inconsistent. The odor of acetone was found in but three of seventeen cases. Ebstein's cylinders were not noticed; diminution in the quality of urine was not pathognomonic. As to the perio of invasion, the child often complains of acute epigastric pain, the abdomen is distended constipation is almost constant, and there is nausea and vomiting of watery fluid. When coma supervenes the general state is already very bad, with great wasting and enfeeblement; the respiration is frequent (the inspiration being full and deep, the chest moving as a whole, remaining thus a few seconds and then falling with an effort in a short expiration). The heart is usually normal throughout. In coma the beats are regular, but progressively feeble (120 to 130 or even 150 to the minute). The polyuria which exists at the beginning becomes markedly diminished; the urine is clear, limpid and acid, containing sugar in abundance. but less than before the coma, during which it diminishes progressively until death. The sugar sometimes disappears completely. Albumin may be found, but in small quantities, and quite late. The smell of acetone is less marked in the urine than in the breath. There is no marked aberration in the nervous system; patellar reflex is often abolished the lassitude and apathy of the prodromal period becomes accentuated; somnolence is more marked. When the coma is confirmed the pupils are fixed, equal dilated, or contracted, normal reflexes are abolished; extremities are blue, limbs flaccid, tongue dry, dyspnoea intense respiration 32-48 per minute, pulse rapid and filiform. Death takes place without convulsions.

CAUSES AND TREATMENT OF ARTERIOSCLEROSIS.-Barr (British Medical Journal, January), makes the statement that the most potent disease in the production of arterial degeneration is syphilis. Typhoid fever plays a considerable part, as do acute rheumatism, diphtheria, septicæmia; influenza, malaria etc. He has for some time suspected the toxin of the colon bacillus as being an important factor; examination of the blood of arteriosclerosis shows that in 55 per cent. of the cases it gave complete agglutination with the colon bacillus, as compared with only 20 per cent with the blood from persons free from arteriosclerosis. Among mineral poisons, lead must be mentioned. High

arterial tension being the percursor of arteriosclerosis, all pressor, agents such as coffee, tea, digitalis, must be looked on as playing a part in the causation of the disease. Although alcohol is credited as one of the most potent factors in arteriosclerosis, it really has but little to do with it, except as it leads to the production of gout. The excessive use of nitrogerous foods kills more adult men than alcohol-the mischief being due to the waste products. The disease is essentially one of late adult life, and differs from senile vascular degeneration; it is much more common in men than in women, they suffering more frequently from syphilis, haying more mental worry and being subjected to more physical stram Repeated pregnancies often lead to the disease. Long-continued exposure to cold often leads to degenerative changes in the peripheral vessels. American men, as a race. are especially prone to the disease.

The diet is of the greatest importance; it should be of low proteid value, as adults perform their muscular work with carbo-hydrates. How to eat is as important as what to eat. One should never eat until he has an appetite, then eat slowly, masticate thoroughly and never eat to repletion. Exercise is of the greatest importance; so long as the exerc'se is not excessive for the individual, the more one gets out of doors the better. A course of baths often does much good. He seldom prescribes digestive agents or hypnotics; failure to eat or sleep requires treatment, not palliation. The thyroid preparations are extremely useful, and iodine is often even more valuable. The latter is best given as tincture or syrup of iodine. Nitrites are useful in emergencies, but the r effects are too evanescent for continued use. The benzoates frequently give excellent results especially where the kidneys are involved.

CUTANEOUS TUBERCULIN VACCINATION IN THE DIAGNOSIS OF TUBERCULOSIS.-William J. Butler of Chicago describes the technique of tuberculosis vaccination by the skin as a means of diagnosis. Its action is similar to that of vaccine againt smallpox. A positive reaction consists of a papule, at first bright red, later dusky red, with a slight areola appearing in twenty-four hours after vaccination with tuberculin. Small vesicles may appear at the site, which soon fade and leave slight pigmentation. There are no constitutional symptoms. The test acts best in children, since healthy adults may give the reaction. It also fails in the last days of life in fatal tuberculosis. A positive reaction in a child is diagnostic of tuberculosis, and a failure of reaction does not prove absence of tuberculosis.-Medical Record, February 1. 1908.

MILK-FREE FLUID DIET AND RECTAL IRRIGATION IN TYPHOID FEVER.-A. Siebert, of New York, has used a milk-free diet in typhoid fever in sixty-one cases at St. Francis Hospital, with only one death. Most of the patients were convalescent much sooner than is usually the case in typhoid fever. Irrigation of the bowels were combined with the diet. The patient is given an initial dose of calomel and is then fed on water for twenty-four hours. From that time he takes strained rice, oatmeal, or barley soup with extract of meat and egg yolk. Then other broths and zwieback are added. Hydrochloric acid is given before feeding. All the general symptoms are improved, the temperature is lowered, intestinal and nervous symptoms are improved, and complications disappear. The attack is shortened, the mortality diminished, and the complications lessened.--Mcdical Record, June 20, 1908.

AUTO-INTOXICATION.-Dr. W. D. Partlow believes that, medicines such as intestinal antiseptics are of little or no value. Only such drugs as may stimulate secretions and excretion do good. The kind of remedies and the one to be relied upon more than all others for auto-intoxication is water. Among the recent insane, the one most active and prolific exciting cause, operating of course in those cases inherently predisposed, is auto-intoxication. Especially is this true of acute manias, acute melancholias. and precocious dements. The treatment thereof is of course to remove the cause by cathartics, followed by gastro-intestinal tonics to stimulate secretions along the alimentary tract and in the adjacent accessory glands. The most clearly indicated, however, is the hydrotherapy-large quantities of water internally-by the mouth if the patient will take it, and if she refuses then wa' is to be given through the stomach tube, and by normal saline solution by hyperdermoclysis or intravenous injection. By getting large quantities of fluids into the circulation the auto-toxines are diluted and rendered less noxious, the secretions and excretions are stimulated, the accumulated poisons begin to drift toward an exit and the entire body is flushed, as it were, wherever blood and lymph goes. High enemeta of normal saline solution or boric acid solution given daily through a colon tube is often of much value, especially in those cases who take an insufficient quantity of fluids by the mouth.—Alabama Medical Journal, August, 1908.

PEDIATRICS

Under the Direction of MAY MICHAELS, M. D.

ECZEMA SEBORRHEICA AND FAT DIARRHEA.— Mitteilung, der Ges. fur Inn. Med, and Kinderhk, in Wien, January 16, 1908.) A three-months-old child, with a very diffuse seborrheic eczema and a fat diarrhea. was treated with buttermilk, and the cutaneous lesions disappeared in a few days. The child had been nursed from birth, at first by its mother, later by a wet nurse, and from the beginning had had thin, watery stools containing fat fragments. It had grad-1ally developed an oil seborrheic eruption all over the body. Fatty applications applied to the skin aggravated the cond:tion. Even after the eruption had entirely disappeared vaselin and fatty ointments were borne very badly by the skin. The occurrence of the marked fat diarrhea coming on so soon after birth, without any pathological basis, leads one to the conclusion that the case was one of congenital fat intolerance, and that the normal fat secretion of the skin produced of itself an inflammatory reaction. Escherich emphasizes the importance of fat-free diet in the seborrheic cases.

PARALYSIS IN CHILDHOOD, DUE TO GASTROINTESTINAL INTOXICATION.-(La Pediatrie Pratique.) Notwithstanding the fact that the diagnosis of intestinal intoxication is so frequently used to mask ignorance in obscure cases and the views of Concetti, who primarily ascribed certain disturbances of the nervous system to intestinal toxemia, have been condemned by many authors, nevertheless, i must be conceded that certain cases of paralysis in infancy and childhood have as their etiological agent a toxic condition of the gastro-intestinal tract.

The following case is a very interesting example of this class: The child, age four years and eight months, with an absolutely negative family history. had been nursed up to seven months. After that, mixed feeding was employed. At nine months she had an attack of enterocolitis, which was

cured in ten days. At thirteen months, while apparently in perfect health, the baby suddenly fell to the ground as if suffering from severe vertigo. When picked up, it was found she could not stand. She was apathetic. and had considerable fever. There was no vomiting or convulsion. Following free catharsis, the fever and apathy disappeared. There persisted. however, a paralysis of the left side. Five months later ali trace of this was gone. From two years on the patient had a chronic gastrointestinal disturbance. She was very much! constipated, and every twenty to thirty days would have attacks of diarrhea, with slight fever and very foul stools. These always yielded to catharsis and dietetic treatment. This condition of the intestinal tract persisted for two years. when suddenly, while playing, the child again fell to the ground. She was somnolent when picked up, and had convulsive movements of the whole body. She had very bad and offensive movements of the bowels. In a few days the fever and somnolence disappeared, but there persisted a right hemiplegia and aphasia. An examination four months after the onset of this attack was absolutely negative.

It is evident from the history, that the gastrointestinal tract and the nervous system were involved, but to trace the connection between the two systems it is necessary to exclude the various organic conditions of the brain, which might give such a clinical picture. The author excludes the more marked organic lesions by the total absence of symptoms and physical signs four months after the onset of the paralysis. His diagnosis, "paralysis due to gastrointestinal toxemia," is based upon the views of Concetti, who ascribes such symptoms to microscopical changes in the nerve sells. such as tumefaction of the cromatophilic granules, lesions produced by the absorption of the intestinal toxins.

URINARY TUBERCULOSIS IN CHILDREN.-LeedhamGreen says that instead of regarding it as a relatively rare disease, which, when present, is difficult to alleviate and hopelessly incurable, we now know that urinary tuberculosis is exceedingly common. and when recognized early and the primary focus removed is of distinctly good prognosis. Systematic examination of urine will reveal tubercule bacilli in many unsuspected cases. If in doubt, the opsonic index and the ocular and cutaneous reactions should be resorted to. He notes the weak points of these tests, and says that the only reaction giving a clue to location of infection is that of subcutaneous injection of old tuberculin. He insists on the importance of cystoscopy for estimating involvement of the bladder, and says that it may be practiced in the youngest girl and in boys over 8 years. Chromocystoscopy-the injection of carmine blue subcutaneously, and observing its secretion through the cystoscope is a valuable adjunct. Where numerous tubercle bacilli and transitory hematuria exist without indication of site of trouble a good substitute for exploratory nephroto by is to expose the ureter subperitoneally by a small incision ia the abdominal semi-lunar line, open it by a small longitudinal cut, insert a fine urethral catheter, and collect the urine sedarately. A fine stitch closes the opening in the ureter, which is dropped back to place and the wound is drained for a day or two. British Journal of Children's Diseases.

THERAPEUTICS.

SCOPOLAMINE-MORPHINE AND CHLOROFORM ANAESTHESIA.-In Folia Therapeutica for October, 1902 Dr. H. McNaughton Jores describes his method of administering scopolamine-morphine and chloroform to obtain anæsthesia, as follows: On the night before the operation (which takes place at 9:30 next morning),1-100 grain of scopolamine and 1-6 grain of morphine are injected the last thing. On the morning of the operation this injection is repeated at 7 o'clock, after the bowel has been freely and thoroughly emptied. At 8:30 a. m. an injection of 1-100 grain of atropine

and from 1-36 grain to 1-60 grain of strychnine is given; sometimes the atropine is omitted. The chloroform is administered by the Vernon Harcourt regulator.

BLACKENING OF THE TONGUE BY HYDROGEN DIOXIDE.-Attention has been directed by M. L. Bizard (Les Nouveaux remedes; The Lancet, October 31. 1908), to the phenomenon of black tongue as caused by the use of hydrogen dioxide as a mouth wash. He cites the case of a smoker who used a mouth wash daily for eight days consisting of a tablespoonful of hydrogen dioxide in half a glassful of warm water. A marked blackening was then found on the dorsal surface of the tongue, but on ceasing to use the mouth wash the coloration disappeared in a few days. The patient was in good health, except that an examination of the tongue showed that the lingual papillæ were hypertrophied. The same effect was produced in the case of two patients undergoing mercurial treatment by the injection of grey oil, who were in the habit of rinsing the mouth with hydrogen dioxide. It was at first thought that the color was due to the action of the hydrogen dioxide alone, as has been shown. may produce the same effect. It is remarked by the editor of The Lancet that, as hydrogen dioxide has now come into general use as a mouth wash, these observations are of great interest and value. Apart from the blackening of the tongue, which may result from too free a use of this preparation, the question arises whether the general employment of antiseptic mouth washes and dentifrices is advisable in healthy persons, Where decay is known to exist there is no doubt that a moderate use of antiseptic agents tends to prevent the spread of the invading organisms. But when the mouth is in a healthy condition it would seem preferable to rely upon cleanliness rather than on antiseptics. The bacterial flora of the mouth may contain organisms that naturally tend to preserve it in a healthy condition but the continued use of antiseptics is calculated to destroy favorable as well as harmful bacteria. ANGULAR CONJUNCTIVITIS is advantageously treated with zinc salts, according to a writer in the November number of The Practitioner, who recommends the application of the following lotion:

[graphic]

R

Boric acid,

Zinc sulphate,

Distilled water.

M. Ft. Collyrium.

.gr. viii;

.gr. ii

.ad 3i.

This lotion should be diluted with an equal part of water. which has been previously boiled, and used warm to the conjunctival sac.

OINTMENT FOR THE RELIEF OF PRURITUS ANI.Lockhart Mummery (The Practitioner, November, 1908), prescribes the following ointment, which is said to give relief in itching about the region of the anus, especially if applied at night:

R

Calomel,

Bismuth subnitrate,

Tincture of aconite,
Glycerin

Ointment of elder flowers,

M. Ft. unguentum.

.3ii;

3iss;

.mviii;

.3ii;

.3i.

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FORMULA-Benzo-Salicyl. Sod. 33.33; Eucalyptol .33; Thymol .17; Salycilate of Methyl. from Betula Lenta .16; Menthol .08; Pini Pumilionis .17; Glycerine and solveutsq. s. 480.

TACHYPHAGIA

has been declared to be our national vice, and
impaired digestive functions are a feature of
many ills that flesh is heir to. The relative im-
portance of pepsin or acid, achylia, hypo-or hyper-
chlorhydria, while of interest to the clinician,
is of less moment than the relief of the patient.
Such corrective agents are to be exhibited as have
been time-proven and found clinically not wanting.
LACTOPEPTINE (N.Y.P.A.)

which has for years stood the test of time and
trial, is a combination of digestive and enzymo-
genic agents in proper proportions to secure
results by stimulating impaired digestive ac-
tion and activating gland secretion. Indicated
in all conditions that require physiological aid to
restore digestive function.

Lactopeptine (N. Y.P.A.) is furnished in Powder
(dose x-xx grains), Tablets (dose 4-6), and Elixir (dose
one tablespoonful), after meals.

Elixir Lactopeptine (N. Y.P.A.) will be found to
be an elegant and efficient vehicle, carrying in perfect
solution and covering the taste of Bromides, Iodides, Sali-
cylates, Chloral, etc.

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