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rynx or larynx, and iodin paint over a
different
large secreting cavity are
different condi-
measures called for
tions. The best internal remedy is a
combination of

sodium bicarbonate,

sal volatile, diluted prussic acid, and diluted infusion of a vegetable bitter stomachic, given shortly before meals to relieve the mucous catarrh of the stomach and to promote the appetite and secretion of gastric juice. Night feeding in active phthisis is indicatea by several conditions: that the night is too long for the patient with advarcing tuberculosis to go unfed, patients with pneumonia being fed every two hours; and that broken sleep produces restlessness, increase of cough, sweats and exhaustion.

HIGH ALTITUDES IN PHTHISIS.— According to Van Pacht (St. Petersburg med. Woch., and quoted by the Medical Review, October, 1900), high altitudes when there is great anemia. With increasing elevation above sea-level and diminishing atmospheric pressure the blood becomes more concentrated. Whether the increase in the number of red corpuscles contained in a cm. is due simply to this concentration, or whether there is also an increased formation of red blood-corpuscles, is at present uncertain. If the blood is very watery, and then becomes so concentrated that there are as many as six to seven million corpuscles in the cm., the total quantity of blood is reduced to a third or a half of its volume. The patients consequently deteriorate in health. When there is only moderate anemia the concentration of the blood improves nutrition, and is beneficial. The secretion of the lungs and bronchi is diminished, and, therefore, patients with copious expectoration are benefited. With diminished expectoration there is less cough, the lungs are more at rest, and the general condition improves. When, on the other

contraindicated are

hand, there is dry catarrh, or ulceration of the larynx, the desiccative action of rarefied air tends rather to increase the cough. Such patients do better in a moist climate. In pleurisy, with effusion, the fluid disappears at high altitudes, both by concentration and absorption, more rapidly than in low-lying districts. In "dry" pleurisy, however, the deeper or quicker respirations, necessary at high altitudes, act injuriously by increasing the friction between the pleural surfaces. The deeper respiration may cause collapsed portions of the lungs to expand, and often acts in this way more uniformly than is possible in any form of respiratory exercises. But if acute inflammation is present, deeper inspirations may prove a source of danger; the greater pulmonary expansion increased movements of the inflamed parts and increases the inflammation. There is also more danger of infectious particles being aspirated into still healthy parts. These are probably the reasons why slight pyrexia often becomes high fever when a patient suddenly exchanges the plains for tne mountains; it is, therefore, advisable that patients with pyrexia should travel to high altitudes by slow and easy stages.

causes

THE TREATMENT OF PHTHISIS. Rea (Pennsylvania Medical Journal, 1900) believes that the combination of pulmonary gymnastics with intrapulmonary medication by nebulization under high pressure is a plausible and successful means of fighting this disease. A combination of creasote terebene, oil of eucalyptus, menthol, and a liquid form of petroleum is recommended. This is advocated on account of the belief that such drugs, particuin this manner, larly creasote, used lessen the fertility of the soil by imOf proving the catarrhal condition. all internal remedies that have been

advocated, probably creasote has stood the test of time best. It improves appetite, lessens the bronchial inflammation, decreases autoinfection from the bowels, lessens the fever, etc. Recently, however, he has administered ichthyol almost exclusively in place of creasote, and believes it served the same purpose just as well, and yet did not seem to be so irritating to the stomach. Iodoform inunctions as recommended by Flick he has used and believes that they have virtue. The deficient innervation and impaired circulation must also be carefully looked after.

OPEN-AIR EXERCISE IN PULMONARY TUBERCULOSIS.-Knopf (Pulmonary Tuberculosis, 1899) writes as follows concerning exercise for pulmonary invalids: "One should commence with a walk of a few minutes until a walk of an hour or an hour and a half can be taken without producing fatigue. Whenever it is practicable these excursions should begin up-hill, so that the return is easy. After the promenade the patient's temperature should be taken. If it exceeds the normal it is an indication that the patient has overtaxed his powers. Whether complete rest or simply shorter walks are then indicated will be decided by the variation in temperature of the temperature before and after exercise. When the temperature of the patient only rises slightly in the evening (99 deg. to 99% deg. F.), short walks in the morning, while in apyretic state, may be permitted. A lasting temperature of 100 deg. F. or over is an ab

solute contraindication to exercise.. Tachycardia should also be considered as such. If there is, however, a chronic tachycardiac condition, absolute rest might not be the best policy. But these patients, more than any others, should be warned against the slightest over-exertion. Breathing exercises and walks may be combined."

1.

THE HYDRIATIC TREATMENT OF TUBERCULOSIS.-By Dr. J. H. Kellogg. This article is the concluding one of a series on the subject. The author summarizes the essential features of hydrotherapy as applied to pulmonary tuberculosis, as follows: Both general and local cold applications to the skin. 2. Careful graduation of the intensity, duration and frequency of the application, by modifying the temperature and mode of procedure, keeping always within the limits of the patient's ability to react. The best methods are dry friction, wet handrubbing, wet mitten-friction, cold towel-rubbing, wet sheet-rubbing, half baths, the general douche. 3. The application of compresses, hot and cold, as a means of relieving pain and controlling the local blood supply, especially the use of the chest-pack to relieve cough and to aid the tissues in: combating the disease, and the employment of the hot sponge-bath and various other hydriatric means for relieving special symptoms.

A dry, elevated region is a condition essential for the best results in a majority of cases. It is possible, however, to effect a cure without this advantage.-Medical News.

DEPARTMENT OF SURGERY.

TREATMENT OF TUBERCULOSIS OF THE KIDNEY.-Tuffier (Journal des Practiciens, June 9, 1900) states

that he has performed nine lumbar nephrectomies for tuberculosis of the kidney, with a complete recovery in.

In seven cases he perevery case. formed nephrotomy, with the result that two recovered, two died, and the remaining three had fistulae. The diagnosis should cover two important points the recognition of the affection and also the exact determination of the condition of the kidney of the opposite side. The diagnosis is not always easy, for the seat of the tuberculosis may be in the parenchyma of the organ, or there may be an obliteration of the ureter of the affected side. Again, in those cases accompanied by profuse hematuria, it may be impossible to find the bacillus. The most difficult part of the diagnosis is in determining the condition of the kidney of the opposite side. Although the catheterization of the ureters is a well recognized procedure and aid to diagnosis, still, at the same time the operation is not without danger, and in one case caused the death of the patient. It should only be resorted to in cases of absolute necessity.

Each case must be a law unto itself in regard to the indications for operation. In all cases, where possible, lumbar nephrectomy is the operation of choice. Nephrotomy should be reserved for those grave cases of pyonephrosis with marked fever and cachexia, and in which a long operation would only increase the chances of death. The nephrectomy may, if necessary, be done at some other time. ultimate results of these operations are very encouraging. The ureteral canal should always be carefully explored at the time The of operation. operations for the treatment of "ral tuberculosis give brilliant, durable results, and are a distinct step forward in the therapeutics of this disease.

MAUNSELL'S

The

END-TO-END IN(EmTESTINAL ANASTOMOSIS. met.)-Catch the two ends of intestine by a stitch in the lower part of eacn gut against the mesentery, including the mesentery, and do the same at the

top, leaving the stitch long, after tying it. On the proximal or distal side make a slit or buttonhole one and a half or two inches from the excised end. Pass a forceps through the buttonhole and catch the two threads, one binding the top section, the other the lower. Then drag upon them. 'The two ends of the gut are face to face, and are dragged through the buttonhole, inverting one, the other following. There are now two serous surfaces edge to edge, make union at that point a quarter of an inch below the border, putting in eighteen or twenty-through-and-through sutures, dividing in the middle, tying them, and cutting as you go. When this union is made, work down and draw the gut into its old place, stitch the buttonhole, wash off the gut, close the abdomen, and the patient should recover. This operation is reported by Wiggin, in the Medical Journal of December, 1895.-American Journal of Obstetrics, May, 1900.

THE SURGICAL TREATMENT OF TUBERCULOUS KIDNEY. Konig (Med. Press, Mar. 7, 1900) divides tuberculosis of the kidney into two forms. In one, isolated foci, tending to caseate and form cavities, occur in the renal substances, but do not communicate with the pelvis of the kidney. The second form, the pyelitic, arises from the extension of the primary form to the pelvis or from an ascending infection. The first or socalled hematogenous form is difficult of diagnosis and can rarely be controlled. The symptoms of tuberculous pyelitis include a gradual and progressive illness with renal pain of variable intensity and character, the symptoms of chronic catarrh of the bladder; usually with frequent desire to urinate and pain in the urethra. The urine is turbid and contains epithelium, partly from the pelvis of the kidney and pus. Blood is commonly

present and flooding may occur, especially at the commencement of the disease. Tubercle bacilli are only rarely to be found in the urine. As the disease progresses emaciation and anemia develop and ulcers may often be found in the bladder in association with swellings at the ureteral orifice. The treatment consists in extirpating the entire organ. Resection is rarely feasible and is not advised. In a case of horseshoe kidney Konig successfully removed one part. Solitary kidney is suggested by the absence of the testicle upon one side and by the presence of but one ureteral opening in the bladder. In cases of tuberculosis of a kidney, there is said to be no certain means of ascertaining the healthful

ness of the remaining kidney. Even ureteral catheterization is open to error, and may induce an ascending infection. Of twenty cases error occurred in two. In one there was a simple pyelitis, although the lungs were tuberculous; in the other the smegma bacillus led to error. Simultaneous disease of the bladder, testicles, prostate, or other kidney do not contraindicate nephrectomy. Of eighteen patients, three died from causes conthree of nected with the operation; continued general tuberculosis, eleven recovered and one case is too recent to consider. Nephrectomy, therefore, offers the hope of curing or prolonging life in the majority of cases.

DEPARTMENT OF NEUROLOGY.

THE TREATMENT OF EPILEPSY Spratling IN INCIPIENCY. ITS (Amer. Med. Quart., Apr., 1900) classes the causes of epilepsy which occurs in early life under six heads. These are heredity, accidents at birth, difficult dentition, etc., under peculiar conditions, improper feeding, accidents of early life, and the changes of puberty, particularly in persons of a neurotic tendency. He divides epilepsy into true and false, the latter being properly spoken of as epileptiform convulsions. Unless relieved, the false epilepsy becomes the true.

The proper

diagnosis being made, the form of treatment to be carried out must be decided upon. This is either institutional or home treatment. if the latter is chosen, parental sympathy must be eliminated, as discipline is most important; the use of advertised nostrums must be prohibited and most careful attention to diet insisted upon. In institutions the treatment is medicinal, dietetic and moral. Of these the

young.

dietetic is least understood by the general profession, yet most important, Food particularly for the should be such as can be readily absorbed and assimilated, and should be utilized to the greatest extent that is safe and possible, for the purpose of checking the waste of tissue which is associated with every epileptic seizure. Meat should be used in small quantity, only once a day and at noon; fried food and pastry should be prohibited, and cereals, breadstuffs, milk, fruits, ute the eggs and butter should con principal diet. Discipline is essential to successful treatment, because the epileptic is liable to suffer a break in his continuity of action. Medicinally, every case is a law unto itself. In addition to the bromids usually employed, even replacing them temporarily, the fluid extract of horse-nettle berries (ext. solani Carolin. fl. f. oz. ss) can be used. Simulo is another drug excellent recently reported to have qualities. Systematic exercise, espe

cially for those with weakness of a limo or of a portion of the body, gives good results. The epileptic-paralytic cases which so often find their way to orthopedic clinics frequently obtain great benefit from properly administered gymnastic treatment or the use of tools which call into play the affected members.

A DIGEST OF RECENT WORK ON EPILEPSY.-Clark (Jour. Nerv. and Ment. Dis., June and July, 1900) carefully reviews the work of the last two years on this particular disease and finds that its etiology is as undecided as ever. Hereditary or acquired instability of the cerebral cortex as a causative agent has been almost ignored, although degeneracy has been given the principal place as a predisposing cause. Other factors which have been emphasized are alcoholism, cardio-vascular conditions and physical states due to premature senility. Advances in physiology, physiologic psychology and physiologic chemistry have proven of value in opening the way for the development of theories as to the action of the lymphatic and hepatic systems, of paraxanthin and o uric acid. The toxicity, or rather changes in the toxicity of the urine have given a basis for the "autotoxic theory" of epilepsy; and acetonemia has furnished the idea for the "acetonic epilepsy" of v. Jaksch. The relation to the disease of arterial pressure and of vasomotor changes has been studied. No pathognomonic sign of epilepsy has been discovered. Loss of consciousness has not been found to be a constant symptom. Many and various manifestations of the disease have been studied, and to many tne qualification "equivalents" has been given. Among these are psychical conditions, abnormal states of sleep, peculiar attacks of laughing, periodic and transient paralyses and inordinate hunger. The reason for the nocturnal

occurrence of epileptic attacks has not been ascertained. Researches as to the secretions have been made, but the results obtained are not harmonious. Among the post-paroxysmal conditions are those of exhaustion paralysis, postepileptic anesthesia and dysesthesia, hyptonicity or post-epileptic rigidity and contracture. Knowledge of the status epilepticus has not been greatly increased. The cause of the phenomena and an explanation of the fever, pulse and respiration curves have not been determined. According to statistics, the time of the occurrence of status has been shown to be earlier in the cases developed later in life than in those in which the epilepsy has long existed. In the line of treatment nothing has superseded the bromids, and potassium and strontium hold the general favor. Decrease in the amount of sodium chlorid daily ingested has been followed by good results in those cases where continuous bromid medication has had to be employed. In some of these instances the dose of bromid has been greatly lessened. In the handling of cases of epileptic status treatment has been directed to the individual case. Hypodermatic bromid medication, despite its severe effects, has been efficient in the worst cases of status. Following the hypodermic administration of serum, used to avoid possible autointoxication, the dose of bromid has been greatly decreased, three grs. sometimes giving good results. Trional, sodium salicylate and antipyrin have all been used with varying results. Dietetic treatment and the comparatively recent colonization of epileptics give promise of great good. Surgically, but little progress has been made. As the predisposition in epilepsy is paramount, surgery should be used only in cases of recent trauma, where hereditary factors are not great. Resection or section of the cervical sympathetic has not proven practical.

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