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the antitoxin appear in some instances to be sufficient to prevent a reappearance of the subjective symptoms, while in other instances repeated instillations of the antitoxin were required to produce ultimately the return to normal conditions. But all we know at the present is not sufficient to build therapeutic hopes on, and this for the reason that we are ignorant of the nature of the special predisposition which exists in hay-fever subjects.

CREAM FOR THE HOME MODIFICATION OF MILK.

C. W. Townsend (Boston Medical and Surgical Journal, April 16, 1903) has from his studies of this subject drawn the following conclusions:

Centrifugal cream is probably less desirable for infant feeding than gravity cream. As obtained from dealers it is often far from accurate in percentage. (2) Siphonage for obtaining gravity cream is an accurate method, but one requiring considerable skill to perform accurately and safely. (3) Dipping off the top milk is an accurate and safe method if reasonable care is used. (4) The method for obtaining gravity cream by pouring off the top is very accurate and extremely simple; there is no instrument to be bought and kept clean. By this method it is possible to obtain cream of any desired percentage up to twentysix. (5) To insure perfect accuracy frequent examinations with the Babcock machine are required, but for practical purposes this is not necessary, provided the mixed milk from a well regulated dairy is obtained.

SPASTIC OBSTIPATION.

Singer (Wiener klin. Wochenschrift, No. 14, 1903) describes the symptomatology, pathogenesis, diagnosis, prognosis, and therapy of this malady, of which but little is known, and which is so unsuccessfully treated with laxatives. He differentiates a symptomatic and idiopathic form of the condition. On the boundary between the secondary and purely nervous form of spastic obstipation there frequently occurs a variety accompanied by disturbances of the sexual apparatus; the nervous forms occur in hysteria and neurasthenia. The objective symptoms evidence a contraction of the internal sphincter, a tenderness on palpation in different regions of the abdomen, occasionally colicky spasms occur, and not infrequently mucous casts and blood are passed. The writer emphasizes that spastic obstipation is found independently of other diseases such as hysteria, etc. Therapeutically

he recommends moist heat, oil enemas, and belladonna, and for years he has employed with good results the introduction of English rectal bougies. The dietetic treatment is of little import

ance.

THE VALUE of the Diazo-REACTION IN THE PROGNOSIS OF

TUBERCULOSIS.

Gieseler (Zeitschrift für Tuberculosis, Bd. 111) examined 100 patients for four months in order to determine the frequency of the occurrence of a diazo-reaction. The reagent used was paramidoacetophenon .25, hydrochloric acid 25.0, distilled water 500; one to two drops of a .5-per-cent solution of sodium nitrite is added to this solution, an equal part of urine is then mixed with it and thoroughly agitated, and one cubic centimeter of ammonia is then added. A positive reaction is shown by the foam being colored red. The reaction was demonstrated in all cases of caseous tuberculosis, but with the exception of these cases only six per cent gave a positive reaction, and all of these were in the third stage of the disease. The greater half of all clinically hopeless cases give a negative result. The reaction therefore is not worthy of consideration in making a prognosis.

THERAPEUTICS.

BARIUM CHLORIDE AS A CARDIAC TONIC.

Dr. Schedel (Lancet, April 18, 1903) recently read a paper before the Berlin Verein für Innere Medicin on the action of chloride of barium on the heart. Making his preliminary experiments on himself, he found that when he took 0.02 gramme (onethird of a grain) twice a day after meals his pulse-rate fell from 55 to 51 and from 66 to 61, whilst his blood-pressure as measured with Gaertner's tonometer showed a rise of 10 millimeters. When the dose was increased to 0.05 gramme (three-quarters of a grain) the rise in the blood-pressure amounted to 30 millimeters. The effect was perceptible even three days after taking the last dose, and no undesirable result was experienced. Chloride of barium was then administered to nineteen patients, some of whom suffered from heart disease and asthma, while others were the subjects of pulmonary tuberculosis, leukemia, or chlorosis, in consequence of which their blood-pressure was low. Under this treatment the patients improved very much; cyanosis

and edema disappeared; the pulse became regular, full, and less frequent; the blood-pressure rose; and the secretion of urine increased. The effect on the blood-pressure only continued for three days as a rule, but the improvement in the pulse and in the patients' general condition was apparent even after the lapse of eight days. Chloride of barium might therefore replace digitalis in the treatment of many organic diseases of the heart, whether of the muscular substance or of the valves.

In the discussion Dr. Aronson, of Ems, made a reference to the action of chloride of barium on the intestine. He said that in veterinary medicine intravenous injections of it were given for colic, and that the treatment was followed by serious complications and even by death. To this Dr. Schedel replied that toxic effects occur only when large doses are given; with small doses such as he recommends no action on the intestine is observed.

ACNE ROSACEA AND PHOTOTHERAPY.

At a recent meeting of the Paris Academy of Medicine, M. Leredde (Lancet, April 18, 1903) gave a most interesting account of his experience of the above mentioned treatment. Acne rosacea is in general a most stubborn complaint, and has to be treated for a long time with ointments, scarification, and electrolysis. Phototherapy, however, has advanced the treatment very considerably, and Finsen has met with success from this method even in severe cases which had lasted for a long time. M. Leredde gave an account of eight cases treated by him in this manner, in all of which a good result was obtained. At first the treatment took a long time, for he was afraid that if he gave sittings of over half an hour troublesome scarring would result. But little by little he found that the patient could be safely exposed for just as long a time as in cases of lupus, and he never met with any scarring as a sequela. Following out these lines of treatment he had been able in two or three weeks to cure cases of acne rosacea which had resisted other much more severe methods for months.

THE TREATMENT OF CARDIOPTOSIS.

Max Einhorn (Medical Record, April 25, 1903) says that improvement of nutrition and strengthening of the nervous system must be considered the main objects in treating cardioptosis. The first is accomplished by a generous diet, the latter by methodical strengthening of the body by means of cold ablutions, mod

erate gymnastic exercises, and sojourn in the open air. Besides these two points any factor that tends to affect the position of the heart should be avoided. The patient will therefore have to be told not to remain too long in a stooping position. During sleep it might be advisable to place the head and thorax as nearly horizontal as possible, or in a position only slightly elevated. Means for direct support of the heart are hardly indicated. A suitable support might be applied at the beginning of the lower third of the thorax, exerting an upward pressure. A woman's corset with a left breast pad might serve as an example. The writer, however, has no personal experience with this procedure, and he would not discuss these mechanical means further.

Encouraging words, and occasionally a sedative like bromide of soda, tincture of valerian, etc., are sometimes necessary, and in patients who are excited over their condition, or who have been worried about their health, are often of the greatest value.

HYGIENIC AND DIETETIC TREATMENT OF SYPHILIS.

Block (Zeitschrift für diat. und physik. Therapie, Bd. 6) calls attention to the necessity of preventing bodily and mental fatigue and obtaining the requisite amount of sleep in the treatment of syphilis. A heavy and luxurious diet is injurious, and light, simple meals and large amounts of milk are to be recommended. As alcohol predisposes to the degeneration of the nerves and vascular system, its use should be limited, and the danger of leucoplasia oris may be lessened by abstinence from tobacco. Syphilogenous neurasthenia and depression may be overcome by mild hydropathic treatments combined with a sojourn in the country. Regarding the psychical treatment the author believes it expedient to thoroughly advise the patient regarding the conditions and results of the disease so that he may not underestimate or exaggerate the malady.

THE TREATMENT OF WHOOPING-COUGH WITH QUININE.

Paul Heins (Medical Press, April 29, 1903) writes that he has treated eighteen cases of whooping-cough with quinine with good results. In the case of children under a year old he gave, at three times, as many centigrammes as they were months old. Children from one to four received as many decigrammes as they were years old. Children over four received 12 grammes once daily; then, for three days together, twice a day; after this the dose was diminished. The whole treatment lasted from ten

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to twenty days. The quinine shortened the disease and mitigated the attacks. Improvement was often observed from the second. day. Antipyrin had no favorable effect. He was of opinion that quinine was borne better by children than by adults. The treatment was the more successful the earlier begun.

ABORTIVE TREATMENT OF FURUNCULOSIS.

Reich (Zeitschrift für diat. u. phys. Therapie, Bd. 6) bases his treatment on the belief that by the application of dry hot air to the skin the heat is easily transmitted to the tissues. Furunculosis is due to the invasion of cocci, and the foci of invasion are superficial, thus the agent readily reaches them. Air heated to 100° to 120° C. is sufficient to reduce the virulence of these staphylococci, and the hyperemia thus produced brings about a rapid absorption of the infiltration. The first day two or three applications are advisable, later once a day is sufficient. The author finds the results exceedingly gratifying, and demonstrates them by a number of clinical histories.

OPHTHALMOLOGY AND OTOLOGY.

UNDER THE DIRECTION OF R. W. GILLMAN, M.D.,

Clinical Professor of Ophthalmology and Otology, Detroit College of

Medicine.

FISTULA OF THE CORNEA.

To obviate the danger of injury to the lens during the treatment of a corneal fistula, J. M. Ball (St. Louis Medical Review, April 11, 1903) proposes the following operation:

The keratome is to be introduced into the anterior chamber, as in the first step in the operation for iridectomy. The tip of the instrument is to pass beyond the fistula area, and the instrument is then to be held in situ while a cautery is used to destroy the epithelial lining, the tag of iris tissue which is often present in the fistula, and the bulging bleb of Descemet's membrane. The keratome is to be withdrawn carefully to avoid injury to the lens. Atropine and a compress bandage are to be used in the after-treatment. During the operation the lids should be separated by a speculum and the eyeball should be fixed with forceps. It is necessary that the forceps should be placed several millimeters behind the point at which the keratome is to be introduced. If the forceps be placed on the globe at a point opposite the place at which

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