of some and the infection of others exposed to In a study of one hundred cases of uncomplicated croupous pneumonia, Brunner (Deutsch. Archiv. fur klin Medicin, Hefte 1 and 2, 1891) was able to determine that the disease is more common in males than in females; that most cases occur in the third and fourth decades of life; that those who lead active lives in the open air are predisposed; that the right lung is more commonly involved than the left; that the onset usually takes place in the morning with a chill; and that the disease is most prevalent in winter and in spring. Careful comparative observations upon the mean temperature, the mean humidity of the atmosphere, relative and absolute, the mean barometric pressure, as well as upon other meteoro logical conditions, in conjunction with the number of cases of pneumonia observed at different periods, revealed the fact that most cases occurred when the temperature was low, the absolute humidity slight, the relative humidity great, and the barometric pressure very high or very low. it appeared that those meteorological conditions that increased the physiological activity of the lungs favored the development of pneumonia. The brief period of incubation which characterizes pneumonia may be explained by the almost constant presence of pneumonia-cocci in the air passages, suitable, extrinsic and intrinsic conditions conferring virulent properties upon a hitherto, innocuous agent. From many considerations it therefore appears that merely waging warfare against bacteria will not eradicate disease. The physical difficulties to be overcome alone render such a mode of treat ment impracticable. A rational prophylaxis will have for its object the avoidance, as far as possbile, of exposure to infection to deleterious influences of all kinds.-Med. News. AVOIDANCE OF STIMULANTS DURING HEMORRHAGE.—It is customary, when the accident of hæmorrhage occurs, for the operator, or some by stander, to administer wine, brandy, or some other alcoholic stimulant to the patient, under the false idea of sustaining the vital power. It is my solemn duty to protest against this practice on the strictest and purest scientific grounds. The action of alcohol, under such circumstances, is injurious all around. It excites the patient, and renders him or her nervous and restless. It relaxes the arteries, and favors the escape of blood through the divided structures. Entering the circulation in a diluted state, it acts after the manner of a salt in destroythe coagulating quietly of the blood; and above all other mischiefs, it increases the action of the heart, stimulating it to throw out more blood through the divided vessels. These are all serious mischiefs, but the last named is the worst. In hæmorrhage the very key-stone of success lies so much in quietness of the circulation that actual failure of the heart, up to faintness, is an advanage, for it brings the blood at the bleeding-point to a stand-still, enables it to clot firmly, when it has that tendency, and forms the most effective possible check upon the flow from the vessels. Dr. Richardson (Asclepiad, Nov. 29, 1891), refers to a case in which three pounds of blood was lost and the patient was unconscious, but which recovered. He refers to this as typical, because, if a stimulant were not wanted in it, a stimulant cannot be called for in examples less severe. The course followed was simply to lay the patient quite recumbent when signs of faintness supervened, and, so long as he could swallow, to feed him with warm milk and water freely. Such in my opinion, is the proper treatment to be employed in every instance of syncope from loss of blood.-Dietetic Gazette. THE VALUE OF BICHLORIDE OF MERCURY IN THE TREATMENT OF URETHRITIS.-Brewer (Inter-, nat. Jour. of Surg.,) reiterates his confidence in the efficacy of bichloride of mercury in the treatment of urethritis. His method was as follows: At the first visit the patient was instructed in the proper use of a syringe, and was given a large amount of a solution of bichloride of mercury, varying in strength from 1: 16,000 to 1 : 50,000, according to the sensitiveness of his utrethra and the stage of the disease. This he was instructed to use twice daily, by taking ten injections in the morning and ten at night, holding each one in the urethra one minute to imitate as nearly as possible the result of irrigation. The patient was seen three times a week. As soon as the discharge lost its purulent character, bichloride was suspended and a mild astringent was substituted, preferable bismuth suspended in water. In the fifty-five cases treated in this way, five were not benefited, after an average employment of the method for seven days. In the remaining tifty cases, the average length of time necessary to affect a change in the discharge from pus to thin watery secretion was a fraction over eight days. The discharge entirely disappeared on an average of twenty-one days. Epididymitis occured in three of these cases and posterior urethritis was developed in two. The reporter very fairly states that these statistics are of little value from a scientific point of view, since the cessation of the discharge can by no means be considered as an index that the disease has been cured. He offers his conclusions not so much on the basis of these cases as upon a very large personal experience, and states positively that the judicious use of bichloride of mercury in cases of acute gonorrheal urethritis is attended with better results in subduing the painful and disagreeable features of the disease than is any other agent. The recovery is more rapid and permanent, and the frequency of inflammatory complications very greatly reduced.-Therap. Gaz. TREATMENT OF DIABETES WITH MORPHINE AND CODEINE. According to Federigo Gori, in the Gazzetta degli ospitali, the diet prescribed by Cantani, while it acts favorable at times upon the glycosuria of relatively recent cases, is not capable of suppressing the disease. This diet is sometimes borne badly; but in general this is not the case if latic acid in large doses (150 grains) is employed at the same time. Both morphine and codeine exert a favorable influence upon the glycosuria; but whereas the former may cause the disease to disappear completely as much cannot be said for codeine. The effect of morphine is always manifest, but is more energetic when the patient is upon an absolute meat diet; the same is true of codeine when the patient is upon a diet largely of meat, but when on the rigorous diet of Cantani its effect is doubtful. The effect of codeine, and probably that of morphine also, though with less intensity, persists after the administration of the drug has been suspended. Morphine undoubtedly exerts its good effect, when the patient is upon a mixed diet, by not only removing the glycosuria, but also by increasing the body weight and improving the subjective feeling of the patient. Both morphine and codeine have, besides their influence upon an existing glycosuria, an inhibitory action, as they prevent the increase or the return of the sugar, although such substances as favor glycosuria are swallowed in relatively large quantities. This action stronger in the case of morphine, which may give valuable aid when it is desired to change from a meat to a mixed diet. Neither the employment of morphine nor codeine causes disturbance of any kind in the general nutrition, but it exerts rather a helpful influence and favors the increase of bodyweight; it always improves the subjective condition of the patient. It appears that the diabetic condition per se, independently, or nearly indepenently, of the diuresis, favors the tolerance of the two alkloids.-Deutsche Medizinal Zeitung, Therap. Gaz. EPHEDRA AS A REMEDY FOR RHEUMATISM.Very recently Dr. Betchine, of St. Petersburg, has reported in the Revue de Therapeutique his studies upon the antirheumatic properties of Ephedra vulgaris, or Ephedra distachya. The plant is widely distributed over Russia, and has long enjoyed a great reputation among the peasants as an anti-rheumatic and antisyphilitic remedy. Dr. Betchine has employed a decoction of four grammes of the powdered bark and root in twenty grammes of water, the dose of which is a desertspoonful every two hours. The remedy appears to be particularly useful in acute articular and muscular rheumatism. In from twenty-four to twenty-eight hours the pain is relieved, the temperature is reduced, and the pulse and respiration are quieted. In about eight or ten days the patient may be said to be cured, and the pericarditis that sometimes exists disappears with the other rheumatic manifestations. Chronic rheumat ism is not so favorably influenced by the drug, and the author recommends it only in cases accompanied with more or less fever. The remedy possesses laxative, diuretic, and diaphoretic properties, to which its favorable influence upon this disease may be attributed. Professor Nagai, of Tokio, has isolated the alkaloid cphedrine from Ephedra vulgaris. This injected into dogs and cats, produces general convulsions, mydriasis, and exophthalmia. It is an efficient mydriatic, but has not yet been put to practical use.-N. Y. Med. Jour. MENIERE'S VERTIGO AND THE SEMICIRCULAR CANALS.-The experiments of Flourens, which seemed to attribute to the semicircular canals the role of maintaining the equilibrium of the body, have been controverted by others to such an extent as to make it appear doubtful whether that part of the labyrinth is the seat of the lesion which determines the so-called vertigo of Ménière. The peculiar character of the vomiting, the fact that the latter symptom may occur suddenly without nausea, after irritation of the membrana tympani, the intimate connections between the pneumogastric and the auditory nerve at their origin, renders it more probable that the vertigo and cardiac symptoms are due to a reflex action in the pneumogastric dependent upon a lesion n some portion of the auditory nerve. The term Ménière's disease serves more frequently to mark ignorance of the lesion which occasions a series of symptoms often analogous but which are under the influence of very different causes.---Brit. Med. Jour. THE CANADA LANCET. A Monthly Journal of Medical and Surgical Science, Criticism and News. Communications solicited on all Medical and Scientific subjects, and also Reports of Cases occurring in practice. Address, DR. J. L. DAVISON, 12 Charles St., Toronto. Advertisements inserted on the most liberal terms. All Letters and Remittances to be addressed to Dr. C. SHEARD, 320 Jarvis St., Toronto. AGENTS.-DAWSON BROS., Montreal; J. & A. MCMILLAN, St. John, N.B.; GEO. STREET & Co., 30 Cornhill, London, Eng.; M. H. MAHLER 23 Rue Richer, Paris. TORONTO, FEBRUARY, 1892. The LANCET has the Largest Circulation of any Medical Journal in Canada. APPENDICITIS. During the last few years the diseases incidental to the right iliac region have attracted considerable notice, and appendicitis, typhlitis and perityphlitis have been much discussed. Dr. Joseph Price read a paper on appendicitis before the Philadelphia Medical Society recently, which sums up the diseases as understood by surgeons at the present time. Dr. Price says: "The old terms were arrived at by examining old, neglected cases, frequently post mortem ; more recently the one term, appendicitis, is used before laparotomy, before post-mortem, because these two performances prove that so far as the gravity, intensity, and extent of the disease are concerned, the symptoms are unreliable, inadequate. Further, abdominal sections and postmortems have determined what the treatment should be—that is, surgical-under a surgeon from its inception; hence the name impressing the nature of the disease and the character of the treatment, that is appendicitis surgicalis. "Idiopathic peritonitis indicates nothing is an empty term. The terms typhlitis, perityphlitis and paratyphlitis, are useless except to indicate a secondary or late process originating, without exception, in inflammation of the vermiform appendix." This language is misleading. The great majority of right iliac cases are of a mild nature, and amenable to medical treatment. A litttle further on, Dr. Price says: "Thirtyfive per cent. of all post-mortems show residue of appendicitis; thirty-six per cent., over one-third of three hundred autopsies done at random, revealed diseased appendix (Taft). One case of perityphlitis to one hundred of appendicitis (McBurney). Assume that one-third or more of all adults have one or more attacks (Keen)." With these statements we can agree, but were surgical interference necessary in every case, laparotomy would become an every-day occurrence, whereas we know that the majority of cases of appendicitis yield to medical measures, and in fact are frequently so mild in their nature as to remain unsuspected and are put down as colic, or some mild neuralgic affection of the iliac region. The results arrived at from surgical measures, in advanced cases which would not have recovered under purely medical treatment, are certainly most encouraging; but as the surgeon does not usually have his attention drawn to the mild cases he naturally concludes that the disease is a more dangerous one than it really is. A clinical lecture recently delivered by Jules Simon at the Children's Hospital, Paris, shows another phase of the question. The investigations, though made upon children, are applicable to adults, particularly as many of the adult cases are heritages from childhood. One case, reported by Prof. Simon, indicates his general views upon the subject. A little girl æt. six years had been the subject of obstinate constipation from infancy. She presented signs of cæcal obstruction, followed by diarrhoea and inflammation of the region. Under ordinary treatment, at the end of three weeks she was entirely well, not the slightest cæcal thickening remaining. The mother was cautioned to look out for relapses, and particularly to watch for signs of constipation, and to prevent it. In spite of this, these hygenic measures were disregarded, and a year later typhlitis set in, followed by appendicitis and perforation, death ensuing. Simon believed that in this case the constipation had caused cæcal dilatation; the intestinal walls were irritated by hardened fæces, the appendicular orifice became dilated, foreign bodies entered the appendix with the result of perforation and death. This much is certain, obstinate constipation and some form of right iliac disease, preceded the fatal good laws are passed and local boards organized. These appendicitis. "Simon says: "In all the cases that I have investigated, either in private or hospital practice, I have observed the same pathological evolution, and in cases where a special hygiene was observed and suitable treatment, laxative, instituted, the patient always escaped further accidents." With these statement, most medical men will agree. Simon recognizes three stages of the disorder, preliminary to appendicitis: 1st. Simple constipation; 2nd. Engorgement and thickening of the cæcum; 3rd. Stercoræmia or constitutional manifestations from retained fæces. It is not uncommon to meet with cases of sudden pain in the right iliac region, with tenderness on pressure. There may be a nervous condititon, simulating shock, a rapid pulse with mental anxiety, with or without any elevation of temperature. Tenseness of the abdominal muscles, with possibly induration of underlying tissues, is usually present. In view of the revelation of the postmortem table these cases ought to be classed as appendicitis. In such cases, flushing of the bowel usually brings to light old hardened masses of fæces. An immediate cause, such as shock, injury or indiscretion in eating, may often be found Now, appendicitis would not have resulted from the particular exciting cause had not the predisposing condition been present. So if these cases be appendicitis, then it is only occasionally a surgical disease, for the vast majority of such cases recover promptly under laxative and other ordinary methods of treatment. do not create the public realization of their usefulness. Health acts are now in advance of the public feelings. The people often instead of welcoming them take their enforcement as an intrusion and interference with individual rights and liberties. The masses of the people are not disposed to inconvenience themselves by keeping their bodies and premises clein, and their infected families isolated to gratify the whim of their neighbors or even their law makers. They require to be taught that compliance with health rules and regulations will be a direct benefit to themselves, yea, money in their own pockets ;that non-compliance with such rules and regulations is the cause, indeed the only cause, of disease, with all its attendant pains, expenses and loss of time, that wherever there is a high mortality or a high sickness rate, there surely will be found unsanitary conditions or environment which demand attention. In this education of the people, although not at all akin to the education of the schools, it is very desirable that a spirit of emulation be stirred up, in order that the various districts, or munici palities shall vie with each other in showing a low deathrate, and a "clean bill of health "by keeping themselves free from epidemic and other diseases. It is and has long been the universal opinion of sanitarians that the basis of all public health work and progress, both educational and coercive, is a system of health statistics-of births, marriages and deaths. Beyond this, it has become clear, in recent years, that for the best, or even fair, preventive progress, statements or reports (not exactly statistics, for they cannot practically be complete or accurate) monthly or oftener, of prevailing diseases, especially of any outbreak or cases of infectious disease of importance, are absolutely essential. It will not do to wait for the death returns. Not only the local boards, but the central organization should be early informed of any such diseases. Returns and records of these statistics and reports or statements of prevailing disease would form a vast valuable record, year after year for the Federal-the Canadian government to possess, but to be of practical value, the information obtained from month to month, or oftener especially of prevailing diseases, must be scattered freely amongst the people, at least monthly, as by means of a bulletin. These reports not only show where unsanitary conditions need attention, but they give rise to the desired spirit of emulation amongst the different municipalities. Every community then would have a strong tendency to endeavor to prevent as far as possible any outbreak of disease, each in its own respective locality, and to preserve a "clean bill of health," as ships at sea usually desire to do, for their Right iliac disease is very common. own credit It usually own Now it must be obvious to anybody, even if he be not yields to medical measures. Its danger is in pro- versed in political economy, that it would be much more gressive appendicitis. economical, on the whole, for but one centre in Canada the Federal government, to carry on this work of collecting statistics and reports, recording them, and issuing a bulletin of their condensed facts, etc., than for each province to do so on its own account, while the results in the former case would be incalculably better. If done by the one central government, all the information obtained would be in one central Canadian record, and, more important still, the information conveyed by the returns would then be distributed throughout all the provinces; done by each province, each would only collect and distribute the information within its own bounderies, except perhaps to a few outside officials, and the people of each, would therefore only receive and obtain the information gathered within and relating to their own province; whereas, it is almost as essential for the Eastern or Western provinces, for example, to learn in what special localities any epidemic or prevalency of disease exists in Ontario or Quebec, as in their own provinces, while the same principle holds good with regard to Ontario and Quebec, in relation to the East and West. In short, if TO THE MEDICAL PROFESSION OF CANADA. Robert Farquharson, M.D., M.P., long a prominent member of the Parliament of Great Britain, at the late seventeenth annual congress of the Sanitary Association, of which he is president, said "The foundation of all effective progress in preventive medicine must be education." Indeed it has now been found out in Great Britain that much greater progress can be made by educating the masses than by trying to coerce them. In Canada, our Provincial Legislatures may enact laws, and local Boards of Health may be organized by hundreds, and although all this is a good beginning and essential, much more still remains to be done. Sanitary work is but begun when one and desirous that it shall ever remain thus liberal, free, 66 But done by the one centre, all the provinces would get th good of all the information obtained; if done by each separate province, each would only get that relating to itself a vast and most vital difference. There appears to be a good deal of misapprehension amongst members of the profession relative to this question of Federal and provincial public health legislation and action, arising apparently from want of time amongst the busy practitioners to consider thoroughly the whole question in all its bearings. Coercive legislation, enactments, by-laws, etc, and the carrying out of the same, must remain as now under provincial and municipal control. But any one who will give the subject due thought and consideration will surely see that the collection of the proposed statistics and reports and utilization of these for the public instruction and benefit, as above indicated, can be much more thoroughly, economically and profitably done by one centre than by many-with vastly better results in every way. In agriculture, the one Central Experimental Farm can be utilized for the education of the farmers of the whole Dominion much better than for each province to sustain such a farm and attempt the instruction separately. Somewhat similar it is in relation to the analysis of food, etc., in the Dominion; and to the quarantines and diseases of animals. Moreover, it may be well to note here that, if we desire to make Canada as soon as we can the great country she is surely destined to become, while defending in a large measure provincial rights and privileges, we must as far as possible encourage a spirit of Canadianism, a unity and oneness, in all possible questions and subjects and not manifest too much "provincialism." As already in several of the provinces there is in a large measure provision for obtain ing a record of births, marriages and deaths, it has been well suggested that, at least for some time to come, each province may as well in its own way collect such statistics and then allow them on some terms, to be utilized by the Central Department and dealt with for the public benefit in all the provinces; those provinces which have not now a system for this purpose being induced in some way to provide such. It appears that it is now proposed to endeavor to obtain for the statistical department in Ottawa the information above indicated, from physicians in all parts of the Dominion, relating to the prevailing condition of the public health-i. ., reports of any epidemic and cases of the most important diseases, by providing the physicians with blanks for this purpose. Doubtless the Government, any liberal government, would be quite willing to pay fairly for such reports, if the people through their representatives in parliament were willing to vote the money for the purpose. Are the people willing? Many members of parliament, including at least one physician say, decidedly no: that if they were ON THE RELATION OF EPILEPSY TO to vote for a sum requisite for such purpose they would be censured by their constituents. Then we can only, or must, first of all, educate the people up to a right appreciation of the importance and necessity for such informa tion. They will then doubtless be willing to pay fairly for it. Now this is largely, almost wholly, in the hands of the medical practitioners of Canada: what will they do in its behalf? It has been repeatedly said by a few of them that physicians now do too much without remuneration, more than their share, etc., and that the government, i. e., the people, of course, should pay for all such information. This is very true; the people should pay; but as it is now, they will not pay, at present. Shall we not then endeavor not only to teach them the value of having it done for their own sakes, but also to be willing in course of time to pay for the same?-teach them without pay, for a time? What else can be done? Medicine, it may be observed, is not a business, but a liberal profession, perhaps the most liberal of all the professions, once chiefly practiced free by the priesthood. Is not the profession now, are not the members of it as a class, worthy and INJURIES OF THE HEAD. In concluding a paper on the above subject J. J. Putnam, M.D., says (Boston Med. and Surg. Jour.) (1) The causes of epilepsy are numerous; and we cannot hope in most cases remove them all by early trephining and care to the wound, though these measures, and especially the removal of fragments, are probably very important. (2) The local and the general injury of the brain are probably of prime importance, as causes of epilepsy, and are to some extent independent of fracture. The former may perhaps sometimes be treated as suggested by Keen, but the latter can only be reached by general treatement. |