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vents chest complications and meteorism, and also has an action in checking hemorrhage. He prescribes it in the following combination: R Spiritus terebinthinæ.. Spiritus ætheris nitrosi........

.... zij. Spiritus chloroformi

... 3ij.
Emulsion amygdalæ ...... zvj.
M.-Ft. mistura. Sig.–Shake the bottle. Half an ounce for a dose.

Therapeutic Review.

IN CONSTIPATION AND OBESITY. PROFESSOR W. S. BOGOSLOWSKY, (British Medical Journal,) from clinical observations on the action and value of a constant bitter water, draws the following conclusions (Transactions of the Moscow Section of the Society for the Preservation of Public Health, No. VI):

Systematic treatment with Apenta water is especially indicated for constipation produced by atony of the bowels, and it has the advantage that its use does not give rise to subsequent constipation.

Its action is more gentle than that of some other bitter waters because it contains less calcium sulphate and no magnesium chloride. It is probably owing to this circumstance that it does not cause crampy pains.

The efficiency of Apenta as a remedy for the systematic treatment of obesity is clinically established.


Glycogen in the Treatment of Diabetic Albuminuria. M. LAUMONIER, (Bulletin General de Therapeutique, January 15, 1904,) calls attention to the value of glycogen in the treatment of diabetic albuminuria. He recalls the fact that last year he was led to conclude that the hepatic cell in diabetics seemed to have lost the power of fixing glycogen in its cytoplasm. His researches have since been confirmed by Monier, of Liege. This brings to mind the fact that Frerichs many years ago, having obtained by trocar from a diabetic patient a parcel of hepatic tissue, ascertained microscopically the absence of glycogen in the hepatic cell. Albuminuria is a grave complication of diabetes and requires active treatment. Unfortunately, this symptom and diabetes are, as it were, antagonistic, the former requiring a milk

diet, or at least a diet rich in hydrocarbons; the second, on the contrary, demanding a diet from which are excluded as much as possible starches and sugars. Again, considering the condition of the kidneys in diabetics, certain remedies now used, antipyrin and other toxics, cannot be employed. The writer found that the methodic use of glycogen seemed to avoid this difficulty, and mentions a number of cases with charts to sustain his point. The dose administered began, as a rule, with one gramme (15 grains) in the course of the day.—Monthly Cyclopedia, April, 1904.

Icterus from Insect Bites and Gallbladder Disease. W. BAUERMEISTER, Brunswick, Germany, (Therapeutische Monatshefte, May, 1904,) observes that there not infrequently occurs, as a consequence of the bites of various insects, a more or less extensive urticaria with general dyspeptic symptoms of a gastrointestinal catarrh. Sometimes yellowness of the scleræ and of the skin demonstrates a duodenal catarrh. Reciprocal action of the skin and the intestinal tract are common phenomena, but the latter is usually the first factor, as in herpes, furunculosis, and similar conditions. In the cases under consideration the trouble emanates in the skin, and is analogous to the occurrence of gastroduodenal ulcerations after burns, for which the explanation is possibly some physical change in the bile (pleiochromia). Violent irritation of the skin may occasion gastrointestinal ulcerations and lesser disturbances may cause a hyperemic swelling of the intestinal mucosa and a so-called catarrhal icterus. These effects of insect bites the author himself experienced. While visiting a university town in 1901 he was so bitten by bedbugs that he had a severe urticaria lasting two weeks. The attack left him with dyspepsia and so depressed that he had to go to the mountains for recuperation. A violent acute gastroenteritis compelled him to return home. While convalescing therefrom, he was suddenly seized with a gallbladder colic, which recurred at frequent intervals, was accompanied by tension in the region of the liver, and marked swelling of that organ. There was no icterus or marked excess of bile pigment in the urine. The cholecystitis lasted for months, despite the regular use of Carlsbad water.

He then proceeded to a systematic disinfection of the biliary system, as the cholecystitis was dependent upon an infectious catarrh. For this purpose salicylic acid is our most effective remedy ; it is in part excreted by the gallbladder walls, the seat of the catarrhal process, and there develops its antiseptic action. An abundant flow of bile is the best natural antiseptic for the biliary passages, and to effect this we have no agents more powerful than salicylic acid and sodium oleate. The author had pills made up containing 1/2 grains of each, and later added menthol and phenolphthalein as analeptics and to mildly stimulate intestinal activity. These pills, named probilin, are difficult to prepare, but they are easy to take. In the morning before breakfast and in the evening before retiring he took three or four pills, slowly drinking thereafter about a pint of hot water. After two twenty days' courses of this treatment, with a fortnight's interval between, he gradually mastered the gallbladder infection. He ascribes his recovery entirely to the disinfectant and cholagogue effect of this treatment, and is strengthened in his conviction by the fact that he has succeeded during the past eighteen months in practically curing between sixty and seventy cases of cholelithiasis with and without the passage of gallstones; in only two cases was operation necessary. On the basis of these observations he states that the systematic use of salicylic acid with acid oleate of sodium will help when all other methods, such as Carlsbad with and without rest, eunatrol, turpentine, olive oil, and the like, do no good and the sufferer is face to face with the knife. He details a number of cases.

The treatment is equally efficacious in some cases of bile stasis without concretion formation, i. e., as sometimes observed in cirrhosis of the liver. It appears in the form of a chronic cholangitis, with possibly a slight icterus and irregular intermittent fever and slight chills, general malnutrition and concomitant conditions.

The exact reason for the increased passage of concretions under the probilin treatment is not quite clear. Two halves of a gallstone, equal in size and weight, were immersed in plain water and a probilin solution. The first showed no change after several days, while the second was noticeably smaller and covered with a sticky, slimy coating which the microscope showed to be composed of saponifying cholesterin crystals. The cholesterin rhomboids were softened and polypoid at their edges, showing that they were undergoing solution. The crystals were finally replaced by a mass of softened matter. While this may not occur to the same degree in the gallbladder, it must do so to some extent, since both salicylic acid and soaps are excreted into the viscus. Laboratory reactions also show that not all concretions are equally subject to this solvent action. Bilirubin limestones, pea-sized, examples of which are found not infrequently in the common duct, are recalcitrant to it. And since the salicylic-oleic acid medication acts on these also, its effects cannot be attributed to chemical solution alone.

When the concretion is not simply entangled in the duodenal papillæ, so that it is washed down by the fluid from the stomach, the effect must be due to the increased vis a tergo from the cholagogue action of the remedy, together with the diminished mucosal swelling from the effect of the salicylic acid on the catarrhal process. In point of fact the softness and friability of the calculi found in the gallbladder and ducts when operating on patients who had had probilin, were very noticeable.

In a postscript the author expresses his gratification at the fact that Dr. Kuhn, chief physician in the Elisabeth Hospital at Cassel, a well-known authority in hepatic disease recommends, in the Berliner Klinik of June, 1903, salicylic acid and oleate of sodium as the two most reliable drugs. In the Congress of Naturalists at Cassel, Kuhn reiterated his belief in their efficacy and advised the addition thereto of menthol, which is virtually the composition of probilin.

Treatment of Menstrual Disorders. WILLEY, Louisville, (South. Practitioner) says the term amenorrhea which is used to mean the total absence of the menstrual discharge, or a marked deficiency in the quantity of the flow, may be physiological or pathological. During pregnancy the absence of the menstrual discharge is physiological and is not here considered. When pathological, the cause of amenorrhea may be said in general to be: (1) taking cold, at or near the menstrual epoch; (2) severe mental perturbation, as fright, sorrow, or great elation of spirit; (3) it may be symptomatic in several affections, as tuberculosis, anemia, chlorosis, syphilis, typhoid fever, nephritis, pelvic peritonitis, and other morbid conditions ; (4) obesity ; (5) luxurious life, or overtaxing the nervous system; (6) stenosis or atresia of the cervical canal, or imperfect development of the tubes, ovaries or uterus; (7) vicarious menstruation may make the condition obscure, there being a discharge at the regular monthly periods from the nose, lungs, bladder, stomach, nipple, or other part.

Treatment should be addressed to removing the cause. When the amenorrhea is caused by having contracted cold, the patient should have a warm sitz bath, and hot applications should be applied to the abdomen and thighs. Often a hot vaginal injection will serve a most useful purpose, and a laxative, perferably a saline, will greatly aid in bringing on the flow.

In amenorrhea, delayed menstruation and dysmenorrhea, ergoapiol has acted in his hands in a most satisfactory manner. In scanty menstruation he found it particularly valuable and cites the following case:

A lady, aged 33, had scanty menstruation which had covered the period of a year. At no time in the year had her menstrual period been longer than eighteen hours, but generally twelve hours told the tale. Her menses were not only scanty, but the color of the menstrual blood was pale, and the odor disagreeable. This woman had no associated disease that most searching examination could bring out. Still she had steadily increased in flesh for the last two years, and to this I attributed the amenorrhea.

This patient was put upon systematic exercise and a dietary that was rational, and ergoapiol (Smith) was administered withi regularity, a capsule four times a day. After two months her menstruation became normal and the remedy was discontinued.

Another case cited is as follows:

A girl 20 years old was sent to Willey by the matron of a boarding school. She enjoyed good health prior to entering the school, but for three months had not menstruated, and was suffering constantly with vertigo and had attacks of hysteria. Attributing the amenorrhea to change of conditions of life—that of an open life on a farm to that of a shut-in inactive life, ergoapiol (Smith) was given after each meal for two weeks prior to the day of her usual menstruation. Her menses soon appeared and she has since had no further trouble.

In the course of the article the author cites a number of cases and says:

"My experience with ergoapiol (Smith) is such that I regard it as an indispensable remedy in all expressions of amenorrhea along with proper remedies for any diseased condition associated in the causation of the affection. Of course those cases where the amenorrhea is due to atresia of the cervical canal, and to any other condition which is remedial only by surgical means, drugs will prove of no avail. The same can be said of instances in the amenorrhea due to a rudimentary state of the female organs of reproduction."

Antitetanic Serum as a Prophylactic. DR. Joseph McFARLAND, (Journal American Medical Association, July 4, 1903,) reports the results of a series of observations upon eight hundred horses which illustrate the value of antitetanic serum as a prophylactic agent. During a period of four years there had been a death-rate of 10 per cent. from tetanus, in spite of all precautions. A systematic immunisation with antitetanic serum was then begun. Injections of 10 to 25 c.c. of serum were given every three months. As a result, the deathrate from tetanus rapidly decreased, and in the second year had been reduced to less than 1 per cent. The author believes that

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