METHYLENE BLUE IN PULMONARY
TUBERCULOSIS

Owing to the recommendation of Dr. Althern, of Wiesbaden, Dr. Bronowski, of Professor Tumas's clinic in Warsaw, has employed methylene blue in eight consecutive cases, five of which were in an advanced stage. The remedy was usually given in the dose of 2 to 3 grains (in wafers) three times a day. It was tolerated well by all the patients except one, in whom it occasionally caused sickness. He found that the drug reduced the temperature, but that this effect was much less decided when there was

Tinct. zingiberis,

gr. x.

gr. xv.

mx.

miij.

Aq. menth. pip., q. s. ad f3j.-M. For one dose. To be repeated two or three times daily. Shake well.-Therapeutie Gazette.

RUBIDIUM IODIDE IN SKIN DISEASE.

Dr. Leo Leistikow, of Hamburg, has advantageously used the above salt in a number of cases of secondary and tertiary syphilitic lesions, as well as in a case of gonorrhoeal rheumatism. In the case of syphilis complicated with valvular disease, the heart's action was not in the least influenced by the rubidium iodide. Altogether the rubidium salts have no toxic effect upon the heart like the potassium salts. The taste of the rubidium salt is not as disagreeable as that of potassium iodide.Medical Review.

CODEIA.

In a "Note on Codeia," in the Lancet, Dr. James Braithwaite, of Leeds, says: "Codeia seems to have a special action upon the nerves of the larynx; hence it relieves a tickling cough better than any ordinary form of opium. Two-thirds of a grain may be given half an hour before bed-time. It was in my own case that I first began to use codeia. For more than twenty years, usually once every winter, I have been seized with a spasmodic cough just before going to sleep, which becomes so severe that I am compelled to get up and sit by the fire. After an hour or two I return to bed and am free from the cough till the next winter. In other respects I enjoy good health. Many years ago I found that I grain of codeia, taken about two hours before bed-time, absolutely stops the attack and leaves no unpleasant effect the next morning. In cases of vomiting from almost any cause, 4-grain doses of codeia in an effervescing mixture usually answer exceedingly well, or 2-grain may be taken at rather longer intervals. In the milder forms of diarrhoea 23 to 1 grain of the drug usually na

THE

Medical Bulletin.

JOHN V. SHOEMAKER, A.M., M.D., Editor. THE F. A. DAVIS CO., Publishers. 8. C. BERGER, Business Manager.

Philadelphia, Aug., 1894.

INTESTINal antisePSIS IN

CHILDREN.

HE preservation of the contents of the alimentary canal from pathological fermentation should be as much the aim of the physician as to render the outer integument aseptic is the constant effort of the surgeon. The study not only of bacteria, but also of the chemical toxins which they produce, has thrown light upon pathological conditions which in former years were, it is true, referred vaguely to the digestive tract as their point of departure, but the pathogenesis of which was but dimly comprehended. The doctrine of auto-intoxication, so forcibly taught by Professor Bouchard, has had, in internal medicine, an analogous effect to Listerism in In neither domain has unanimity surgery. been reached as to drugs or preparations which are most efficient in paralyzing bacteria, counteracting or antidoting their products, without coincidently injuring the animal tissues with which they are brought into contact. Much, however, has been accomplished in this direction. The chemist is continually bringing forward laboratory products of antiseptic character. Among the many which have been presented there are a number which undoubtedly possess decided advantage. It has been amply demonstrated clinically that, although they may not absolutely destroy bacterial activity within the human organism, yet they certainly mitigate very markedly the effects produced. The general practitioner is debarred, by the onerous and exacting nature of his daily duties, from studying closely the chemical aspect of the doctrine either as regards the compounds generated within the bowel or the character of the reactions be

tween these bodies and the antiseptic substances by which we seek to counteract their influence. Physicians are, however, keenly alive to the therapeutic effects of the drugs by which it is proposed to cleanse the bowel. They have learned, by clinical experience, that it is now possible to obtain results which far exceed those within our power a dozen years ago. We have been taught also, by laboratory experiments, that many of the older drugs upon which we placed most confidence are of service by virtue of their antiseptic properties.

If these considerations apply to the adult, they are of equal force in relation to infantile therapeutics. The delicate tissues of the young, the activity of absorption and circulation, the responsiveness of the nervous system are vital conditions which favor the swift and powerful action of deleterious substances, whether introduced from without or generated within the body. We have, therefore, read with pleasure the paper upon intestinal antisepsis in children, published by Dr. J. Comby, in a recent number of a valued contemporary.* The emetics and cathartics which our fathers so freely employed had, no doubt, a disinfectant action, but their continued and repeated administration created a drain upon the system. M. Comby points out that, although the digestive tube is a laboratory of poisons, these are, under normal circumstances, rapidly eliminated by the natural emunctories, and especially by the renal filter. If the function of the kidney is imperfectly performed the toxic material accumulates in the blood.

It is, above all, in the diseases of the digestive tube that antisepsis plays an important part in the therapeutics of childhood, though affections of other organs, more or less distant, or of the system at large, also receive benefit from the same method of treatment. Insoluble antiseptics are required in all maladies of the gastrointestinal canal, from the mouth to the anus. Without dwelling upon the advantages of buccal antisepsis in stomatitis and eruptive fevers the author named calls attention to the worth of salol in the treatment of acute tonsillitis and phlegmonous angina. All diseases of the

* La Médecine Moderne, No. 41, 1894.

stomach, whatever be their form or their cause, require intestinal antisepsis. The statement may be repeated with emphasis respecting all disorders of the bowel, from simple diarrhoea to cholera infantum. Perityphlitis, dysentery, dysenteriform colitis, and constipation are also equally benefited. In the case of constipation the antiseptic drug is associated with a purgative. The liver, which may be looked upon as an anatomical and physiological annex to the digestive tube, is constantly threatened by the microbes and poisons of the gut. The bacteria may invade the liver by way of the ductus choledochus. The toxins reach it through the portal vein. Intestinal antisepsis is, consequently, doubly indicated from a prophylactic and therapeutical point of view. It is of benefit in catarrhal jaundice, hepatic colic, congestion of the liver, | and cirrhosis. The more seriously the liver is diseased, the greater is the need of this method of therapy, for one of the functions of the gland is the destruction of poisons. In congestion and inflammation of the kidneys, and, above all, at the least indication of uræmia, the bowel must be disinfected in order to relieve the kidneys. Advanced disease of the heart, with broken compensation, in endocarditis, pericarditis, myocarditis, and congenital cyanosis, when the disorder of the circulation extends to the gastro-intestinal tract and embarrasses the secretory function of the gastric and intestinal glands and of the pancreas, the excretory functions of the liver and kidneys, the prompt destruction of the poisons elaborated within the bowel is urgently demanded. The same purification is required in cases of disease of the respiratory system, as broncho-pneumonia, pneumonia, pleurisy, and tuberculosis. In particular it is to be noted that certain cases of infantile broncho-pneumonia appear to depend upon the action of intestinal microbes. An additional reason for intestinal antisepsis in infants is that it removes the sputum which had been swallowed and which is another source of possible infection.

Disorders of the nervous centres, as meningitis, thrombosis of sinuses, and convulsions, paralyze the bowel, induce constipation, and tend to augment gastro-intestinal putrefac

tion, and, for these reasons, demand antisepsis. It may even be asked sometimes whether certain nervous manifestations, such as convulsions, spasm of the glottis, tetany, and nightterrors, do not result from auto-intoxication. The skin of children, even more than of the adult, acts as an emunctory, and a close rela tionship exists between the gastro-intestinal and cutaneous maladies of childhood. In all cases it is beneficial to use antiseptic remedies to the alimentary canal when the integument is diseased. Such constitutional affections as rachitis, chlorosis, and pernicious anæmia, so often preceded or accompanied by digestive troubles, suggest the employment of antiseptics for the removal of one source of ill. Infectious diseases, as typhoid fever, the exanthemata, epidemic influenza, diphtheria, etc., which reduce so greatly the digestive power, require also the administration of disinfectant remedies.

In reference to the choice among drugs of this class, Dr. Comby remarks that although the alpha- and beta- naphthols are efficient, they, unfortunately, are so unpalatable that it is with difficulty that they can be given to children, who, moreover, cannot take them in the form of cachet. They may, however, be prescribed in the granulated form containing one-fourth of the active drug. Betol is more acceptable. This substance is the salicylate of beta-naphthol, is a tasteless powder, and, mixed with sugar, is readily taken by children in milk or water. Betol can be combined with bismuth, magnesia, sodium bicarbonate, or calomel. Benzo-naphthol is an insoluble and tasteless combination of benzoic acid and betanaphthol. It is an excellent antiseptic. The same quality is possessed by the bismuth compounds, as subnitrate, salicylate, and subgallate (dermatol). Calomel is likewise a good antiseptic, but is too powerful to be given to children except in small doses. Hydrochloric acid, creasote, and resorcin are also used for the purpose of cleansing the alimentary tract. The insoluble compounds, however, are to be preferred. Finally, in addition to chemical antiseptics introduced by the mouth, lavage of the stomach and irrigation of the bowel act in the same manner.

For children less than 1 year of age Dr.