A JOURNAL OF MEDICINE AND SURGERY

Publshed Monthly by Western Medical Review Company, Omaha, Nebr. Per Annum, $2.00 The Western Medical Review is the journal of the Nebraska State Medical Association and is sent by order of the Association to each of its members. Entered as second-class matter at the Postoffice of Omaha, Nebraska, under the act of Congress of March 3, 1879.

When a drug exerting a well-defined action has been absorbed into the system conditions may arise which modify the degree of its action. Take, for example, the drugs commonly employed as genito-urinary antiseptics. The degree of acidity of the urine exerts a considerable effect both on the growth of organisms in urine and on the action of the antiseptic drugs. Acidity exerts a restraining influence on the growth of most organisms in proportion to its degree; but staphylococci and bacillus coli will grow readily in all degrees of acidity which it is possible to produce in man.

The normal acid of the urine is the acid sodium phosphate NaH2PO4, and by the administration of this salt by the month

it is possible to convert an alkaline urine into an acid urine, and to double or treble the degree of acidity of an average acid urine. The condition of the urine is of paramount importance during the administration of urotropine. If urotropine be given to a patient whose urine is alkaline or neutral it exerts no particular effect and as a genito urinary antiseptic is valueless. If, however, it be administered to a patient with an acid urine, a small proportion of the drug, varying with the degree of acidity, is converted into formic aldehyde, which may be detected in the urine and which is one of the most powerful of all known antiseptics. The effect of the drug is well shown by the fact that an acid urine obtained from a patient taking urotropine may be kept almost indefinitely without undergoing ammonical fermentation. The significance of this hardly requires to be pointed out, but it may be desirable in infective diseases of the genito-urinary tract to obtain first an acid urine and then give urotropine.

Of the other urinary antiseptics there are two main groups -the coal-tar series and the group of essential oils. Salicylic acid may be taken to represent the former. When given by the mouth it has quite a definite action in inhibiting the growth of organisms in the genito-urinary tract; it prevents the growth of all organisms in much the same degree without exerting any specific action on one or the other, but its action is very feeble compared with urotropine in an acid urine. Moreover, about 50 per cent of the salicylic acid is rendered inactive by conversion into salicyluric acid. Salicylic acid, as is well known, combines in the body with glycocoll, and this renders it inactive; the resulting salicyluric acid is almost non-toxic, and patients suffering from acute rheumatism treated with it derive no benefit.

Derivatives of benzene formed in the alimentary canal as the result of putrefaction are absorbed and excreted in the urine combined with sulphates, which combination greatly facilitates their excretion in the urine, and probably diminishes their toxicity. Nearly all mammals, except man, convert their relatively insoluble uric acid into the much more soluble body allan

toin. Man, unfortunately, does not, and so this non-toxic, though relatively insoluble substance, uric acid, has been blamed for causing every imaginable evil.

The essential oils, of which the oils of copaiba cubebs or sandal wood are most used, since they are less irritant and therefore can be given in larger doses than most others, act unequally on different organisms; they act quite feebly against putrefactive organisms or bacillus coli, but against staphylococci they exert quite a powerful antiseptic action.

In conclusion it may be pointed out that the rate of absorption of drugs from the alimentary canal may be influenced by the administration of other substances, either previously or at the same time. Alcohol is not only absorbed with great rapidity itself, but it facilitates the absorption of other substance dissolved in it. This naturally leads one to speculate whether this action of alcohol may not account for some of the toxic effects associated with indulgence. One fact is clear, that alcohol is not the direct cause of the various cirrhoses which are commonly associated with alcoholism. But may it not be that in some of these people poisonous products are formed in the alimentary canal as a result of putrefaction, and that the alcohol causes their absorption? Whether this explanation be correct or not, one such poisonous product is formed in the alimentary canal of man under certain conditions and its injection into animals leads to cirrhosis.

Even when the rate of aobsorption of a drug from the alimentary canal is known, we are not in a position to state the amount of specific action it will exert, since the degree of specific action depends largely upon the amount present in the blood at any one time, and some drugs are excreted so rapidly in the urine that specific effects are wanting. Other substances may be destroyed or altered in the body so as to lose their specific effect. For example, half an ounce of alcohol taken by mouth, suitably diluted, has no specific action in the body, since it is oxidized completely before sufficient can accumulate in the tissues to exert an effect. The same dose, however, injected under

the skin would affect the central nervous system for such time until its oxidation was effected.

Another Outrage.

Immigration commissioners from nineteen states recently met in Chicago to form à national organization. The commission proposes to publish a "handbook for the guidance of land seekers," which will contain authoritative information concerning farm and mineral lands in the various states. Dissemination of information of this kind will make it less easy for mining promoters, land sharks and other "get-rich-quick" gentlemen in the same line of business, to defraud the public. The book will be distributed free and "will be circulated in every state in the union in opposition to many 'promotion' companies, which draw wondrous pictures concerning land in a certain locality without telling any of its bad features." Here, then, we have again the same unwarranted interference with private business that has characterized the action of Dr. Wiley's bureau. The only dif ference is that in the latter case it was the "patent medicine" business interests that were hurt, while here it is going to be the J. Rufus Wallingfords who do land promoting. We may expect to see a new "Advertisers' Protective Association" formed to fight the immigration commissioners' high-handed interference with a lucrative business. Land sharks and "patent medicine" fakers must deplore the present tendencies of governmental agencies to assume paternalistic roles. Men who make a business of defrauding the public are always believers in the laissez-faire doctrine. They hold that swindling and being swindled are inalienable rights of every free born American. Honest men believe differently.-J. A. M. A.

Half Doing Things.

In the medical profession as well as out of it there is a constant temptation to deal lightly with the relatively unimportant things. This is one of the disintegrating factors in any profession or calling.

The successful attorney is the one who brings to an early and reasonably satisfactory outcome the relatively unimportant case, instead of letting it lag along to the dissatisfaction of his client. This leads to more and more business and to greater profits.

While there are few physically perfect people, there are many who suffer needlessly from some functional disability, and the family doctor carelessly permits the condition to continue rather than insist upon the patient carrying out recommendations which will involve a little trouble.

Success wins other successes just as much in small things as in great. The patient who finds that the family physician is determined if possible to relieve him of the tendency to heartburn or lumbago may do some growling, but he appreciates the doctor just the same.-Monthly Encyclopedia.

Jewish Wisdom.

"My friend, speak always once, but listen twice,
This I would have you know, is sound advice;
For God hath given you and all your peers
A single mouth, friend, but a pair of ears."

"Think not that those are purely sages,

Whose beard and paunch are of a larger size,
Or else the goats through all the ages

Must, too, be classed among the wise."

"Who kneels before his lady fair,
And begs her love in humble mode,

Is like the camel on his knees,
Eager to bear his master's load."

"Make every man your friend,
However poor and weak,
With every solace tend

The humble and the meek.

Do you ask the reason why?

The giant feels the stinging fly.