keep urine slightly alkaline; potassium iodide and colchicum should be tried in cases that drag on after acute stage is over; wrap joints in cotton batting of flannel; methyl salicylate may be applied locally; then envelop joint in gutta percha tissue and flannel bandage; cold baths for hyperpyrexia; keep in bed for a week after pain gone and temperature normal; iron during convalescence, with massage and hot water or warm baths for persistent stiffness and swelling; iron, quinine and cod-liver oil in addition to usual anti-rheumatics, and change to warm climate for subacute cases. Gastrointestinal Arteriosclerosis.-Walter L. Bierring (International Clinics) states that the gastric symptoms of this disease type includes anorexia, hypochlorhydria, delayed proteid digestion, mucous vomit, occasionally hemorrhagic, and gastralgia, altogether sometimes closely simulating gastric cancer. The intestinal symptoms are chiefly enteralgia, constipation and meteorism, often localized and simulating obstruction. These symtoms are due to ischemia of the abdominal vessels. The evidences of arteriosclerotic changes in other tissues, as claudication, stenocardia, albuminuria, glycosuria and sclerosis of palpable peripheral arteries should be taken into account in forming a diagnosis. Excessive peristalsis, as by purgatives, and too great taxation of the digestive function, predispose to thrombosis in these cases. The treatment in brief embraces a rational and strict regime; potassium or sodium iodide, 3 to 5 grains t. i. d. with 5 grains of sodium bicarbonate and a stomachic bitter; small meals (milk, fresh vegetables, animal food sparingly), eating slowly and drinking before or after meals; no alcohol or tobacco; mild aperients; for the heart, a few doses of nitroglycerin or a long course of strychnine; tepid baths of short duration, with friction of skin; regular, moderate exercise in good air, always stopping short of fatigue; avoidance of emotional disturbances and of exposure to extremes of heat and cold; warm clothing; a bright, genial climate. Asiatic or Indian Cholera. This dread disease has been indigenous since remote times in India, but was unknown to the ancient Greeks and Romans. The delta of the Ganges has been the starting point of every pandemic. Cholera first appeared in Europe in 1823, at Astrakhan on the Caspian, but was cut short by a cold winter. Again in 1826 an epidemic in India spread gradually into Europe, arriving at Paris in the spring of 1832, and in the same year was carried to America by Irish emigrants, reaching its climax in 1837-38. A third pandemic was most prevalent from 1853 to 1855; and a fourth in 1865-66 and 1872-73, since which latter date there has been no outbreak in the United States. The fifth great epidemic, 1887-92, raged chiefly in Asia and Egypt, being spread by way of the Indian pilgrims to Mecca. It caused many deaths in Spain, Chili and Argentina, and threatened North America. In 1892 the disease invaded Russia from Persia and was carried westward to Paris, Havre and Hamburg. In the latter city from August 16 to November 12, 19,956 fell sick with cholera, and of these 8,605 died. Comparing Hamburg, then supplied with unfiltered water, with closely connected Altona, with filtered water, we find that the number of cases of cholera per 10,000 population was 256 for the former place and 35 for the latter. Many of the residents of Altona, moreover, worked in Hamburg, and doubtless contracted the disease there. From Hamburg as a center of infection, cholera broke out in 267 other towns and cities, though with much less fury as a rule. In 1893-95 localized outbreaks occurred in Germany, Turkey, Africa, Western Asia, Brazil and the La Plata States, and great epidemics continued in Russia. More than a thousand deaths from cholera took place during the past winter in Calcutta, where stupid religious customs and prejudices make efficient sanitation well nigh impossible. In the month of March alone 1,129 deaths from cholera occurred in the Hedjaz, over half of these being in the "Holy City" of Mecca, whither the unwashed multitudes of Moslem pilgrims congregate from all parts of the Eastern Continent. The disease is again raging in parts of China. The word cholera, as used by old European medical writers, signified simply a condition accompanied by pain, vomiting and diarrhea, and was applied till 1817 to what is now termed cholera nostras. The spirillum of Asiatic cholera was discovered by Koch in 1883. Treatment of Acute Peritonitic.-Anders directs to secure perfect quiet in a comfortable position, and give four to six ounces of pancreated milk every two hours-rectal alimentation CONTENTS. A Case of Spleno-Medullary Leukemia Cured by the X-Ray; By Thomas B. Eastmen, M.D., Normal Obstetries-The Obstetric Anatomy of the Pelvic Soft Parts-Chapter Two; By Editorial Department.. Editorial Items. Books.... Selections 113 115 .... 124 137 .146 .154 .157 INDEX TO ADVERTISERS. "Thialion has proved of marked value Extract from a paper published in the New England Medical THE VASS CHEMICAL COMPANY, INC., if the stomach is intolerant. Give a saline purgative in concentrated solution, one or two drams every two or three hours, to maintain several copious serous discharges daily. If the patient is robust with a full, tense pulse, give one-half grain of calomel every hour until purgation, then salines. When collapse symptoms not due to perforation occur, use opium in moderate doses. When perforation or abscess is known or even suspected to be present, make a prompt laparotomy, followed by the free use of salines. Locally one may apply twenty or thirty leeches to abdomen at onset, if the patient is strong. When there is not much meteorism apply t. i. d. an ointment of one part each of ung. ichthyol and ung. hydrargyri and two parts of ung. belladonnae. Turpentine stupes or injections containing turpentine (two drams each of turpentine and oxgall to four ounces milk of asafetida and six ounces of warm water), or the long rectal tube, may be used for tympany. Opium is useful for pain; chipped ice sprinkled with brandy. for thirst; small quantities of carbonated waters or iced champague or one-drop doses of creasote, for vomiting. -24 Local Hyperidrosis. This derangement of excretion is usu ally most marked on the palms, soles, genitals and in the axillae; local sweating may be due to hysteria (sometimes bromides or hematidrosis); migraine (one side of head); peripheral neuritis or neuralgia (along course of nerve); cervical carries, thoracic aneurysm or tumor pressing on cervical sympathetic (one side of face, neck or chest, with contracted pupil and congested face on same side); rickets (head and neck during sleep); chronic pleurisy (one cheek sometimes); exophthalmic goiter (sweating may be confined to head); Raynaud's disease (affected parts); or paretic dementia. The palm is hot and clammy from excitement, recent exertion, rheumatoid anthritis, etc. Excessive sweating of the hand is sometimes seen in progressive muscular atrophy. By way of treatment Cushny recommends local applications of belladonna ointment, liniment or plaster. Frank uses local applications of a ten to twenty per cent solution of formalin in alcohol, or tannic acid and formalin. Beverages. Dilute alcoholic liquors increase the flow of gastric juice and are rapidly absorbed, being burned in the capillaries to the extent of 1% or 2 ounces of alcohol daily. When used contiually they probably combine with the nervous tissue of the brain; they interfere with proper metabolism and predispose to disease. The alkaloidal beverages, tea, coffee, cocoa, chocolate, kola and mate, are nerve stimulants and are closely related to uric acid. Hence their constant and excessive use is very likely to excite migraine and other uricacidemic conditions. Cocoa is the most nourishing of these drinks, since it contains 50 per ceut fat and 12 per cent proteins. Tea and coffee, if used, should be prepared by a few minutes' infusion with nearly boiling water, as prolonged boiling drives off the aromatic oil and causes the water to take up bitter, astringent tannin, a radical foe to eupepsia. Lemon juice, containing about thirty grains of citric acid per fluid ounce, is of special value as a preventive of scurvy and is also very useful in chronic rheumatism. The prevalent pracof swilling soda water, phosphates and the like during warm weather, tends to derange digestion through fermentation and to increase heat production by the oxidation of the sugar in these sweet drinks. |