Russo Reaction in Typhoid.-Other Urin Tests. DEAR DR. TAYLOR:-I notice there is quite a bit of discussion of late as to the merits of Russo reaction in typhoid fever. I have this to say about it: I have used it in every suspected case since September, and the course of all cases has proved its value. I find it very useful in clearing up doubt between typhoid and malaria, both of which are very prevalent here. I always use a control of normal urin and prepare my solution from tablets such as are used in gonorrheal treatment. If in doubt as to reaction I test urin for bile. For the benefit of Dr. Vinson, of Spadra, Ark., I will say that I have Parke, Davis & Co.'s pocket reagent case, and find it very useful in bedside work, but for office work I prefer the old way. I notice you recommend to him Fehling's or Loewe's solution for sugar test. I have never used Loewe's, but prefer Haines' solution to Fehling's, because the test is more easily made and I believe it is more delicate. The solution is easily prepared and will keep indefinitly. G. C. PLUMMER, M.D. Thomasville, Mo. Solanin for Epilepsy. DEAR DR. TAYLOR:-The communication in your January issue, page 35, from Dr. Anneta Kratz, concerning a case of epilepsy in a boy 16 years old, and your reply to same, attracts my attention. While I thoroly agree with the main content of your reply, will you permit me to say that I think it a little more pessimistic than the modern state of the matter warrants. Under the old bromid treatment, to be sure, the outlook of epilepsy was pretty hopeless. No one ever pretended that the bromids cured. The most that can be claimed for them is that they reduce the number and severity of the fits, which invariably return as soon as the bromids are withdrawn; and I have long since abandoned their use as a routine in epilepsy. The truth is, of course, that epilepsy is a biologic disease, and it is extremely doubtful whether any medicin can exercise any curativ effect upon it. But, like many biologic disorders, it has a natural tendency to right itself; or, rather, there is in the patient's constitution a natural tendency to restore the stability of this particular phase, if only it be given the chance. Part of this chance consists, as you have pointed out, in removing every source of reflex irritation and nerve draining. The positiv side con sists in furnishing the instable cortex with just enuf sedation to steady it, but not enuf to intoxicate certainly not to tear down its cells and bring about all those metabolic disasters which the bromid salts precipitated. I have found an ideal cortical sedativ for this purpose in solanin, the activ principle of solanum, which gives all the desirable results of the bromids without any of their ill effects. Under its administration (accompanied, of course, with careful attention to hygiene) fully 50% of my cases are cured; by which I mean that at the end of a period varying from six to twelve months the remedy may be permanently withdrawn without any return of the seizures. This is simply a statement of my own personal experience, which any one can verify for himself. I do not mean that it is a cure-all. I know only too well that many cases of epilepsy are hopelessly incurable. But, on the other hand, many hand, many cases, especially in young people, get well under this treatment; and therefore, I feel sure that you will gladly lend your pages to the publicity of the matter. T. G. ATKINSON, M.D., L.R.C.P. (Lond.). 1826 Sunnyside Avenue, Chicago, Ill. [In THE MEDICAL WORLD for February, 1893, page 48, Dr. J. W. Selman, of Greenfield, Ind., reported cures of even severe cases of epilepsy-grand mal-by the use of solanum carolinense, beginning with teaspoonful doses and increasing until the seizures were stopt, then continuing with teaspoonful doses 3 times a day for as long as seven months in some cases, after which it was discontinued. Some cases took as much as 2 ounces a day for a short time. One case became stuporous and the remedy was discontinued until the stupor wore off and then the solanum was again administered.-ED.] Crotalin in Epilepsy, Etc. EDITOR MEDICAL WORLD:-I have just been credibly informed that several druggists in this city dispense crotalin for hypodermic use at the extravagant price of $10. for one dozen ampules, each ampule containing 1/100 or 1/200 grain. This is a prohibitiv rate, especially to the poor, and, as I am the original sponsor for the hypodermic method of giving crotalin, and since it has proved itself valuable in the treatment of pulmonary diseases, epilepsy, and other intractable nervous diseases, in the hands of others, as well as in my own, I am unwilling that this rate should prevail and ...m. 100 ....m.400 M. et ft. sol. Sig.: for hypodermic use. Dose: From 1 to 71⁄2 minims. Children, 1⁄2 to 5 minims. Always begin with the smaller doses. I have occasionally used the hypodermic tablets of equal strength, but prefer the solution because it is always ready for use. Among the many thousands of injections that I have given, I never encountered an abscess or any other serious mishap. In this form it may be obtained at a very reasonable cost from druggist Charles H. Clark, 1900 Pine St., Phila., or druggist Ambrose Hunsberger, 1600 Spruce St., Phila., and the dried venom is furnisht by the Armstrong Snake Co., Commerce and Steves Sts., San Antonio, Texas. THOMAS J. MAYS. 1829 Spruce St., Philadelphia, Pa. Efficiency of Treatment of Rheumatic and Gouty Conditions. EDITOR MEDICAL WORLD:-The recoveries from inflammatory rheumatism average about 97% with or without treatment, the duration of uncomplicated cases being from two to three weeks and some cases are prolonged to five or six weeks. Many authorities claim, as did Garrod, that it is a "self-limited disease," sometimes running a long and sometimes a short course, and that "colored water" is about as potent as anything else to abridge its duration, but most of us prefer to take drugs for it. There are 100% of recoveries from that disease that is betwixt rheumatism and gout known as muscular rheumatism; for it is not dangerous to life, but sometimes difficult to eradicate and in chronic cases to ameliorate. It is that faulty metabolic condition where the fluids of the body are saturated with nitrogenous waste, but do not contain lactic acid, as is the case in inflammatory rheumatism. Acute gout is rarely fatal, but chronic gout shortens life. The question of efficiency of treatment. then, is not one of the percentage of recoveries, but is one of the shortening of the time of the subsidence of the symptoms of these diseases and the length of interval be tween recurrent attacks. Another factor in determining efficiency of treatment is the removal of the stiffness of the joints in the cases of chronic articular rheumatism and of the many deposits of biurate of sodium from the joints in the cases of chronic gout. When the rheumatic poison permeates the body, or its fluids become saturated with nitrogenous waste, efficiency of treatment requires the neutralization and removal of these factors. To neutralize the infection of diphtheria there should be used the full amount of the antitoxin necessary to counteract all of the diphtheritic poison. The same principle applies to the treatment of inflammatory rheumatism, whether treated by an antitoxin or by adding an agent to the circulation thru the gastro-intestinal tract. To neutralize the effects of uric acid poisoning, as well as the effects of the other purin bodies, there should be used the full amount of the agent capable of counteracting and removing from the fluids of the body all of these disturbing factors. The results from my use of acetyl-methylenedisalicylic acid prove that enuf of it can be used to act as a counteracting agent on the cause of the disease without injurious action on the human organism. These results depend upon the manner of administration. Its stimulating effect in promoting the flow of 20 to 30 grains every hour or two serve of bile and its purgativ action in full doses to establish the size of the following doses and frequency of administration. After two years of experience, during which I treated cases with it without any apparent benefit, I found the cause to be insufficient dosage. Since I have pusht the dose to obtain a laxativ action the vast majority of my rheumatic and gouty cases have been markedly benefited from it by the shortening of the duration and the lengthening of the interval between recurrent attacks. It is the best remedy in the treatment of rheumatism and gout which I have ever tried. With 90 grains administered in 30grain doses, I have entirely removed all of the pains from a most severe attack of lumbago. In illustration, that can be repeated by all who use the medicin in adequate dosage, I cite one of many such cases: A man 49 years of age, with a lifelong lithemic history, was awakened from a sound sleep by the severe agonies of an acute attack of lumbago. So terrible was the suffering that for a time he rested solely on the back of his head and his heels, without his buttocks touching the bed. He was given three doses of 30 grains each of acetyl-methylene-disalicylic acid 15 minutes apart. Within one hour he rested in complete ease, without a trace of pain. He took 30 grain doses four times a day afterward to complete the scavenger action of the medicin in ridding the system of nitrogenous waste. J. D. BRITTINGHAM, M.D. 4010 Chestnut Street, Philadelphia. Psychology of Childhood. EDITOR MEDICAL WORLD:-We have seen that the mental development during early infancy is characterized by the rapid growth of the sensory and motor capacities. These two aspects of the young mind continue their progress thruout childhood, but on a higher plane, so to speak. The world of sense-perception is gradually supplemented and enriched by the appearance of mental images. These processes form the constructiv material for memory, association of ideas, imagination, reasoning, and finally also emotion and will. The Development of Imagery. There are perhaps as many kinds of images as there are different senses, altho in any given individual certain kinds predominate, so that a distinction is frequently made between eyeminded, earminded and motorminded persons. But such sharp distinctions can hardly be said to exist among children. If it is permissible to take the first records of children's dreams as the earliest indication of the appearance of images, we may fix the extreme limit at approximately the third year. These early experiences are pure object-images. Schoollife is usually held responsible for the strong development of symbolic wordimages, in terms of which most of the thinking and higher reasoning processes in adulthood are carried on. Children's imaginativ creations resemble in many respects the mythic productions of our ancestors. Their imperfect knowledge of truth and falsehood, of reality and delusion, makes them incapable of distinguishing between experiences that may and those that may not be realized in their daily life. As long as the imaginativ powers do not lead the child into serious conflict with reality, there is no need of interference or correction, because at this stage of intelligence these fancies satisfy the childish conception of the world. The stage of mythmaking is as necessary to the child's mental growth as it was essential in the racial history of human evolution. It need not at all conflict with a simultaneous training in accurate sense-perception; neither should it be difficult for tactful and sympathetic parents and teachers gradually to bridge the gap between the fancied and the actual world. At about nine or ten years of age children begin to outgrow their more primitiv ideas, while at the same time there begins a more intense development of their memory, based on clearer sense-impressions and on closer associations of their images and ideas. At first memory for objects, especially their form, shade and light, is better than memory for temporal, spatial and causal relations, while still more abstract ideas are not remembered until near high-school age. Experiments seem to show a general decline of all kinds of memory, except the visualverbal, toward the beginning of puberty; but later on memory improves again until maturity, and does not, as a rule, decrease until all the other mental powers also begin to decline. The Rise of Instincts. The motor capacities which during early infancy manifested themselves mostly in random movements are now gradually guided into definit channels of activity thru the rise of instincts, a number of which are already present at birth, but the greater number and the more important ones reach their highest degree of efficiency during childhood. Instincts may be defined as definit, complex, inherited responses to definit changes. in the environment or in the body. They differ from reflexes in four respects: (a) instincts require much more complex movements; (b) they involve some consciousness of both stimulus and response, while pure reflexes take place entirely unconsciously; (c) instincts are periodical in duration and vary in intensity while they last, and (d) they may be modified by experience. The simplest classification of instincts is based on the necessities that arouse and perpetuate them. On this basis we have (a) individualistic instincts, as obtaining food, escaping or combating enemies, rivalry, etc.; (b) social instincts, as gregariousness, leadership, submission, COoperation, etc.; (c) family instincts, as courting, mating, home-building, rearing of the young, etc.; (d) adaptiv instincts, as play and imitation, and (e) environmental instincts, as roving, exploring, collecting, hunting, etc. It is self-evident that these instincts cannot make their appearance until the bodily structures underlying them are properly developt. There is often a variation of one or two years between different children in the maturing of these structures. Sometimes the rise of an instinct may be delayed, due to lack of the proper stimulus. No instinctiv tendency can or should be entirely supprest, but it may be subdued, strengthened or perpetuated by proper treatment. The instinct of fear, which must be distinguisht from emotional fear, has been observed as early as the second month, but is most prominent at three and four years of age. Conscious imitation arises in the second half year and is strongest between four and seven. The instincts of play and exploring occur in the second quarter of the first year and remain normal thruout schoollife. The migratory or roving instinct may show itself as early as in the second year, and if it is not subdued before adolescence may become a permanent tendency. The collecting instinct appears not later than the third year and is usually at its height at about ten. From these few examples it will be seen that a child on entering school is a bundle of instincts which crave for realization. The fullest psychologic description of these instincts is found in James' "Principles of Psychology," vol. ii, chapter xxiv. We hear it often said that animals are creatures of instincts and men are creatures of reasoning; but, as a matter of fact, we have many more instincts than even the highest animals, and reason does not guide, as a rule, more than one-tenth of all our daily actions. In early childhood the instincts are still more predominant, because both habit and reasoning are just beginning to appear. Before taking up the subject of habits, which differ from instinct in just one essential-namely, they must be acquired by the individual himself, while the instincts are inherited-it may be well to add a few remarks about heredity in general, and especially about mental heredity. Physical and Mental Heredity. We mean by heredity the likeness between organisms due to blood relationship and include under this not only certain peculiarities, as left-handedness, color-blindness, synesthesia, etc., but every kind of physical and mental resemblance. The scientific study of heredity has been attackt from two different. sides. On one hand, embryology is trying to discover the material substrate or vehicle which is responsible for the transmission of heritages, and, on the other hand, biometrics endeavors by statistical comparisons of successiv generations to classify the various kinds of heritages and to arrive at general laws. In this way Galton's law of ancestral inheritance, which says that the share contributed by any given generation to the heritage of any given individual is represented by the nth power of 2, and its corollary that the offspring tends to approach a type or norm, have been found to hold true in many respects. But it must be supplemented by the Mendelian principle of the segregation of unit characters, which assumes that every organism is the abode of a number of separate and isolable characteristics, some of which are dominant and others are recessiv; that is, the former reappear in the offspring from either parent, while the latter remain latent and may disappear entirely. Mental heredity seems to depend upon the physical inheritance of neural structures. It is difficult to get at the facts, because they are complicated by social influences, as tradition, education, social milieu; in other words, every individual is the resultant of nature and nurture. The various mental characteristics that seem to be subject to heredity may be divided into three classes: The first group contains certain characteristics peculiar to the human mind as distinguisht from the animal mind. such as the greater differentiation of our senses, the possibility of paying voluntary attention, while animals give only involuntary attention, the facts of memory and recall, while animals have only recognition. and last the occurrence of free ideas with its consequences of reasoning, imagination, art, etc. The second class includes those mental traits which characterize the different human races, as the slow and patient deliberations of the German, the flashlike brilliance of the French, the preference for abstract thought among the Europeans, and the American readiness of application to concrete instances. In the last group we have those differences of mental constitution and special talents which lead us to classify people as bright, or ill-tempered, or impulsiv, etc., and make us puzzle over curious family traits, as aptitudes for music, for law, for mathematical computations, etc. Several experimental studies of children from the same families and especially of twins have already been undertaken with a view toward correlating inherited mental and physical traits, and valuable results are being collected, particularly from the schools. of New York City, under Professor Thorndike's direction. The Formation of Habits. We may now take up the formation of habits and define habit as a definit, complex mental and motor reaction acquired by the individual thru repetition and tending to recur under given physical and mental conditions. The possibility of forming habits depends upon the plasticity of the nervous tissues; the greater the neural plasticity, the easier it is to establish habits. The law of habit-formation is as follows: the perfection and definitness acquired in the process of habituation depend directly upon the number of attentiv and pleasurable repetitions and inversely upon the number of exceptions. Repetition leads to accuracy and speed in performing the habitual act and eliminates unnecessary movements, thereby avoiding waste of energy and delaying fatigue. Habituation involves not only muscular but also mental economy. When we first learn a new action, such as writing or playing golf or riding a bicycle, our consciousness is simply crowded with details, we seem to be aware of every muscle in our body and of every detail of the objectiv stimulus, particularly as to how it looks, or sounds, or touches, or moves, etc. The whole situation appears so strange and complicated that it seems almost impossible ever to master it, and the first few repetitions are usually not very encouraging. gradually some of the movements and mental contents become more familiar as they are recognized as having occurred before. This is the first step toward the successful establishment of the habit. From now on the repetitions become more hopeful and pleasant; some of the movements are done almost unconsciously, many peculiarities of the stimulus that first attracted attention are now entirely overlookt, and the unpleasant feeling of fatigue sets in much later and is less intense. Finally, the whole act is performed without consciousness of any bodily movements, with very faint consciousness of the stimulus, and with a strongly pleasant feeling of confidence. The vague consciousness of the stimulus is sufficient to start the whole motor mechanism, and thus consciousness is left free to occupy itself either with entirely new topics or with greater specialization But along some particular line of the same act, as in learning certain tricks, etc. The breaking up of bad habits is, from the medical standpoint, perhaps as important as the formation of new habits. Just as habits are more easily formed in childhood than later, so they are also more readily broken up. This has several reasons. In the first place, the child's habits have not been so long and deeply establisht as those of the adult. Secondly, the factors that can be used as inhibitiv forces-namely, suggestion, imitation, and fear of authorityare most activ in childhood. Thirdly, the stimulus or environment provoking the habit may be more easily removed or changed in the case of the child. And, last, but most effectivly works the substitution of a new habit. The success of therapeutic treatment of bad habits is largely due to the application of these psychologic principles-namely, change in environment, suggestion with or without hypnosis, and substitution of other activities. Conclusion. We may conclude our account with a Clark University, and the greatest Ameriquotation from Stanley Hall, President of can authority on genetic psychology. He writes: * The years from about eight to twelve constitute a unique period of human life. The acute stage of teething is passing, the brain has acquired nearly its adult size and weight, health is almost at its best, activity is greater and more varied than it ever was before or ever will be again, and there is peculiar endurance, vitality and resistance to fatigue. * *Perception is very acute, and there is great immunity to exposure, danger, accident, as well as to temptation. Reason, true morality, religion, sympathy, love and esthetic enjoyment are but very slightly developt. But the senses are keen and alert, reaction immediate and vigorous; and the memory is quick, sure and lasting; and ideas of space, time and physical causation and of many a moral and social licit and non-licit are rapidly unfolding. Never again will there be such susceptibility to drill and discipline, such plasticity to habituation, or such ready adjustment to new conditions. * * Athens, Ga. L. R. GEISSLER, PH.D., Professor of Psychology, University of Georgia. DEAR DOCTOR TAYLOR:-I am inclosing $2, for which please send me four sets of collection letters as per November WORLD offer, page 470. I used these letters a year ago and came nearer cleaning up my accounts with them, by far, than anything I have ever tried (including one collection agency)! They are certainly wonder workers. Some of those accounts paid in full were accounts I had given up as worthless two or three years ago. Your "Business Talk to Doctors" in THE WORLD is a feature alone worth many times the price of subscription, and I feel sure is appreciated by medical men far more than you have any knowledge. Keep it up, and long live THE WORLD. C. S. AMBROSE Mount Olive, Ill. |