Current Literature.

Fine Flour and Appendicitis.

Changes in milling processes are re-. sponsible for appendicitis, according to a physician who has been in the practice of medicine for fifty years and who has observed the spread of the disease. This

physician, Dr. H. C. Howard, of Champaign, Ill., asserts that until the trade demand for exceedingly white flour changed the methods of grinding wheat, there was no appendicitis.

To prove this assertion the physician points to the fact that where coarse breads are used the disease is unknown, but that as soon as the fine breadstuffs are introduced appendicitis comes along as a sequence. By this reasoning it is shown that the people of agricultural communities who secured their flour from small mills did not have the disease until the small mills were crowded out by the large ones and fine white flour supplanted the coarse. Then the negroes of the South so long as they ate corn bread they were free from this disease, but when the new process flour began to be used the disease came among them. The same results attended the departure of the German folks from their coarse bread to the refined flour.

"I can remember that prior to about 1875," said Dr. Howard, "there was little or none of the ailment among the people. In twenty-five years of practice among the people before that time I do not think I saw more than forty cases of appendicitis. Now they are common.

"Large and extended change in the diet of people has contributed to this. For example, about the date mentioned there began to be a general change from the old method of grinding grain to the present method of roller mills and excessively fine bolting cloths. This plan of milling began first in the large cities, and appendicitis began to increase first there. Later the new process crowded out the small mills in the country, and the people could not get flour made by the old processes. They bought products of the large milling establishments, and then the farmers began to have appendicitis.

"Still the negroes of the South did not.

As regards general treatment he recommends iodide of potassium, ten to twenty grains daily for months, with periods of rest, and quinine as advised by the late Professor Charcot. However, the quinine should only be tried when other methods fail, as it affects hearing, and leads, if prolonged, to absolute deafness. About six or eight two-grain pills should be given. daily for a week. During these days the noises in the ears and the vertigo increase considerably, but if the drug is suspended for a similar period, a notable improvement takes place. Given again for eight days, the quinine produces less effect, and a second rest of eight days is followed by a still more marked improvement. Treatment should be continued in this manner until a cure takes place. The vertigo due to arterio-sclerosis should be treated with small doses of iodide of potassium.

Iodide of potassium Water

3 j 3 x

The Justus Test for Syphilis.

Tucker (Philadelphia Med. Journal, May 10, 1902) has investigated the value of this test. Justus's test is based on the fact that mercury given either by inunction or injection causes a diminution in the hemoglobin of the blood. In healthy individuals this loss is rapidly replaced, but in syphilitics compensation does not occur till a later period. According to Justus, the reaction occurred in all untreated cases of secondary, tertiary and congenital syphilis, and in thirteen out of sixteen cases of primary sore. Latent and subsiding cases did not give a characteristic reaction, neither was any effect noted when the drug was administered by the mouth. Tucker examined twenty-seven cases, comprising thirteen primary chancres, seven chancroids, three herpes, three genito-urinary tuberculosis, and one secondary syphilide. Of the primary cases, five were positive and four negative; of the chanchroids four were positive and three negative; of the herpes all were positive; of the tuberculous cases one was positive and two negative; the secondary syphilide was negative. Tucker hence concludes that the Justus test has no practical value in the differential diagnosis of venereal ulcers, since the reaction occurs

66

Indian Lancet.

Sobriety a Great Recommendation.

Great as has been the agitation in favor of temperance within the last few years, and many as are the factors urging on the reform, it is doubtful if any greater force has been brought to bear to ensure sobriety than the decision of the great business corporations to the effect that no man who drinks can expect to secure or retain employment by the company.

The time is fast coming when the public will be convinced it does not pay-even from a financial standpoint-to put up with the carelessness and inefficiency which are the necessary result when brains are more or less narcotized and befuddled by alcohol.

So strenuous has become the competion among business houses and corporations. that each employer of labor is obliged to expect of each employé the very best which he has to give, and it has become well established that sobriety is one of the essential qualifications to ensure this result.

In the future, whatever may be the talents and recommendations which the young man may bring to a business career, they will fall far short of the requirements demanded, if sobriety is not reckoned as one of them.

It is not so long ago that many people accepted as gospel truth the declaration that certain men did their best work when they were half drunk. These reciters of fairy-tales told us that certain doctors knew more when they were drunk than others did when sober; that musicians could play better when stimulated by Sir John Barleycorn, and that most orators delivered their greatest orations when fortified by "Dutch" courage. A few years ago one of the great orchestras was obliged to hire a detective to shadow two of its players to make sure that they should be sober enough at night to fulfill their concert engagements. These performers were musicians of most remarkable talents, but an uncontrollable appetite for wine brought all their great gifts to naught, and made them a chronic nuisance to all who were in any way associated with them.

Though one of these musicians was a cello player of such transcendent ability that it was almost impossible to hope to fill his place, yet his intemperate habit finally exhausted the patience of even his friends, and he was dropped from the orchestra.

While we all may be inclined to lose courage when we see how much evil still remains in the world as the result of the abuse of alcohol, yet the advances towards temperance and sobriety brought about even during the past ten years have been most remarkable.

The learned professions, theology, law and medicine, have pretty well purged themselves of intemperance, and there is no call and little chance in them for any man, no matter how gifted, who habitually indulges his grosser appetites.

The great railroad corporations, having immense responsibilities to carry, have come to see that they cannot afford to have all the benefits arising from skillful management abrogated by the indifference and carelessness of intemperate employés.Journal of Medicine and Science.

Treatment of Barlow's Disease. Bolle (Zeit. f. diaet. u.physik Therap.) gives an account of a case of Barlow's disease, and draw's some conclusions both as to the treatment and pathology. The patient was a child aged two and a half years. The family history was excellent, the parents being well circumstanced and healthy. At the age of one year the child was troubled with diarrhea, which defied all treatment. It had been fed on a variety of milk preparations and nutrient foods, and at the time when Bolle was first consulted, it was having nursery milk from a well-known firm, from cow fed with dry fodder. The milk was boiled for fifteen minutes in a Soxhlet's apparatus, and diluted with water. In February the child was seen to drag the left foot, and in March the gait became tottery. Since May it had not been able to walk at all. Bolle was consulted on June 28, and found the child lying apathetically in bed, whining and crying out, and not taking the least notice of its surroundings. The parents stated that it had not slept for more than an hour at a time for several days, and had constantly screamed out with pain whenever it moved. The lower extremi

ties were swollen, and a close examination of them were carried out, as the slightest touch produced great pain. The ribs were also exquisitely tender. Below the knee of the right leg he was able to palpate the swelling without causing pain; here he received the impression of crackling. The gums were swollen and congested. The diagnosis of Barlow's disease was made, Bolle saying that it was a very typical case. He ordered compresses of vinegar and water for the painful joints, gave a teaspoonful of "white beer" yeast four times a day, and the child was put on pasteurized cow's milk, diluted with equal parts of gruel. The milk was obtained from the parent's own cow, and was not boiled. On the following day the child passed a firm stool, and was more comfortable. This improvement was maintained and a week later it could sit up in bed and move willingly without pain. willingly without pain. Within a fortnight vegetables, potatoes, and the like were given, and the general condition had become fair. In the course of another week it had put on a considerable amount of weight, and was in good health. That one could attain such a good result in so short a time suggests that the form of treatment applied is specific for the maladay, and Bolle argues that the disease is caused by too long sterilizing or boiling of the milk; and that the essential of the treatment is to give raw milk as long as one can obtain this from a reliable source. Indian Lancet.

Heartburn.

Cardialgia, or heartburn, presents itself in two forms, each of which assumes various grades of severity. It is generally attended by acid or acrid eructations, exciting irritation in the throat and fauces. The acidity of the eructated matters is often remarkable, occasioning the most unpleasant sensations in the mouth and pharynx, with a copious flow of fluid from those parts. The matters brought up from the stomach are sometimes rancid and alkaline, particularly after a meal of rich or fat animal food. In this case a feeling of disgust is excited on each eructation, and large quantities are thus thrown off or regurgitated from the stomach, without either nausea or retching. In either form, unpleasant gnawing, burning pain, and tenderness are felt at the epigastrium,

with distension extending to the hypochondria, and with tightness or oppression in the chest. Cardialgia chiefly occurs during the period of digestion, but sometimes not until an advanced stage of the process. It may be mild, and consist simply of uneasy sensation, gnawing or burning at the cardia, sometimes with light faintness or flatulence; or it may severe, the uneasiness extending over the region of the stomach, attended by depression, anxiety of countenance, and faint

ness.

be

This latter. state has been denomi

nated as "sinking heartburn." It is only when cardialgia is severe that it is accompanied with frequent and copious rancid alkaline or septic eructations.

Heartburn is best treated by medicines which act upon the secretions and move the bowels. Rhubarb with magnesia, and sesqui-carbonate of ammonia, in an aromatic water; blue pill, with Castile soap; and alkaline solutions in bitter tonic effusions, or in lime water, are commonly employed, and are most useful when this symptom is connected with acidity. But when heartburn is attended by rancid, septic or insipid eructations, the mineral acids, as the nitric, the hydrochloric, and the aromatic sulphuric acids, given in simple camphor or aromatic water, or in suitable tonic infusions, will be most serviceable. Dr. Pemberton advises lemonjuice in these cases, and Dr. Todd, the phosphoric acid. When there is a liability to heartburn, wine, spirits, and particularly malt liquors, should be avoided. Hock or old sherry may, however, be taken in great moderation in seltzer water.

All of which taken from London Health, may be very orthodox and scientific in the mother country, as possibly it was a cen. tury ago in America.

There is not a word said as to curing the disease by prevention, which through the adoption of a sensible diet is entirely feasible.

The temporary alleviation recommended is merely sopping up the floor with a sponge while the leak in the soof is ignored. Correct the faulty digestion and theheartburn" will take care of itself.

Even the list of palliatives might be greatly improved and extended.

Fresh, unsweetened popcorn is an excellent absorbent and corrector. Pecans are an immediate and almost invariable

relief.

Adopting a rather dry dietary and the avoidance of too many varieties at any one meal-especially of crude vegetables, will aid in a cure.-Dietetic and Hygienic

Gazette.

The Treatment of Dysmenorrhea.

Dysmenorrhea is such a protean affection that it seems to defy classification, and its treatment is consequently vague and uncertain. Its relationship to uterine disease and displacement is the subject of perennial discussion, and it cannot be said to have any pathology of its own. Roughly speaking, cases of dysmenorrhea may be divided into two classes—the cases in which the pain, once established, is constant, and those in which it is spasmodic or intermittent. Constant pain is believed by some to be indicative of ovarian origin, while the intermittent form is associated with functional distress of the uterus. In the latter form the onset of the pain coincides with the onset of menstruation, and in these cases dilatation of the cervix is often followed by marked relief. The objection to dilatation of the cervix is that the relief which it affords is almost of necessity ephemeral, and in order to render it permanent certain gynecologists advocate division of the circular muscular fibres of the cervix. It is to be feared, however, that this operation, though it may relieve the dysmenorrhea, exposes the patient to the usual consequences of laceration of the cervix-consequences which the operation of trachelorrhaphy was specially designed to qbviate. Restricting the purpose of our remarks to the treatment of dysmenorrhea of uterine origin, in which the pain comes on with the flow, is more or less intermittent in character, and is not relieved by lying down; dilatation of the cervix will afford relief in a considerable proportion. Dilatation does not correspond to any particular size of sound; the essential thing is to introduce larger sizes until resistance has been overcome.-Med. Press and Circular.

PHTHISICAL patients should practice recumbency during the day, in association with deep breathing.-Med. Summary.

IN the treatment of children stimulate early and not wait for a weakened heart, and a low pulse.-Med. Summary.

Translations.

PARISIAN MEDICAL CHIT-CHAT.

BY T. C. M.

The Beginning of a Young French Doctor's Life-His Joys and His Tribulations-An Old Song Set Continuously to New Music-Experience the Only

True Medical Teacher.

Provided with a diploma the day after sustaining his thesis, the young French doctor usually finds himself povertystricken. If he has no guide in his family, if he is not a son destined to succeed his father in medical practice, if he has no relatives or monied friends, his embarrassment becomes great, and his warm ambitious day-dreams take a bad chill. For almost all young doctors the commencement of professional life is rough and painful; we say for almost all, yet except those few who pursue a special career, but even then see the cruelest deceptions after even a most successful existence.

The first care of every young doctor should be the proper choice of a location. Where shall he locate? On every hand he is told of the overcrowding. The majority of physicians are not the issue of rich families, and it is repugnant to many good-hearted young fellows to remain a charge, dependents on parents or families. who have already deprived themselves of comforts in order to educate a physician in the family. True, many apparently good propositions are often made to young doctors, but they should be carefully on their guard, for the vast majority of such offers are full of cruelly deceitful surprises.

Here is the mayor of some small town who offers a nominal subvention and free lodgings to a young doctor, who must settle at his place. This town has often a large but scattered population; the new comer is always expected to render gratuitous medical services to many of the inhabitants. The young doctor, once ininstalled in such a town, now discovers that the free treatment patients are about all he has on his hands. He now finds, too, that the mayor of the little town wishes a rebate of some francs on the small subvention that has attracted the young physician to the place.

Sometimes the young doctor is invited to settle by others than the mayor of the place, for it may be that the pharmacist, the village clergyman, or some member of the legislature desires a new doctor. They will tell the newcomer that their former doctor, who still resides in the town, is a drunkard, a miser, a brute, etc., or that he has made a fortune and no longer cares for attending the sick; that the newcomer will most certainly have an assured practice, especially if he is well thought of and grows popular. Needless to say, the new comer finds that the drunken, brutal doctor, who has no care for the clergyman or politician is still popular, despite his alleged faults. In such cases, as a rule, the tempter is seductive and the young doctor is weak enough to yield. Soon after he arrives, too, he finds that the other physician in the town has a hard time. gaining his bread; that the drunken doctor has struggled to live in the region for many years; that he is much respected, and that those who have sought to injure him by bringing in a new physician, have done so simply to injure a doctor who was independent and would not work for nothing, so that the new comer finds he has been the involuntary accomplice of a lot of dead-beat scamps, and that he in the end becomes the real victim.

Young doctors in all countries should speak the first word of defiance at practices for sale. As a rule, patients are not cattle, and the goods cannot be delivered. Eliminate from the list of practices advertised to be sold in medical journals or by agencies; do this without hesitation. If the practice of some sick confrère, retiring from business for his health, or of a practice held for sale by some doctor's widow or family making the offer, make a prudent investigation, and require the guarantee of a good bond before purchasing; but, of all, remember, never buy any practice offered for sale. On very rare occasions cases of this kind have proved a success, and the young doctor has saved some long and painful delay in ing a practice at the very beginning. Should a young doctor purchase from an older doctor, make the latter go over in joint practice for the space of several months, and present all his clients personally; even then require an indemnity bond.

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Once installed in business, the young