The least adherent particles are detached, if possible, without injury to the adjacent mucous membrane. These applications are to be made every hour during the day and once in three hours during the night. If the false membrane is very thick and adherent, it is also to be treated with equal parts of the tincture of the chloride of iron and glycerine, two to four times a day. It is also recommended to irrigate the throat after every second application with a glassful of tepid Vichy or boracic acid solution (4-100). Internally a drop of the tr. ferri chlor. may be given in grog or bouillon every hour.-L'Union Medicale. FOR TONSILLITIS. R Ammoniated tincture of guaiac Fl. ex. veratrum viride.. Fl, ex. phytolacca Glycerine. Water qs.. Sig-Give 1⁄2 teaspoonful to child 2 to 5 years old every hour till better, then every two or three hours. This prescription will cure the majority of cases, if seen the first three days. But in some cases, if the febrile excitement is high, give aconite, or if capillary congestion, if the patient is stupid and dull, give belladonna, or if the faece is fiery red give rhus. But those remedies can be given between the first prescription. This treatment will arrest the disease in all cases in less than forty eight hours if called before the fourth day. After that on the fifth and sixth days, suppuration commences in the tonsils, then the tonsils will break or must be lanced, but even then this treatment is indicated. Some use morphia with veratrum and guaiac, but I think morphia had better be left out, as it has a tendency to arrest the secretions, and derange the lymphatic system, and that system is quickly affected by this disease.J. A. Henning, in Chicago Med. Times. In the section for internal medicine of the recent 64th Congress of German Naturalists and Physicians, Professor Aufrecht, of Magdeburg, reports his experience of ten months with tuberculin, embracing 112 cases in all stages of the pulmonary affection, hopelessly advanced cases, however, having been excluded. The usual beginning dose was onetenth of a milligramme (1-640 grain), and five milligramme (1-13 grain) were not exceeded. The results are, 48 cases apparently cured, 37 cases very much improved, 22 cases improved, and only in five cases was no material improvement obtained. Inter-current complications, bloody sputum and menstruation are indications for the temporary suspension of the treatment. Climatic and dietetic measures mended in addition, the remedy being an important aid, but not a specific cure. Other observers reported favorable results and apparent cures, and the consensus of the opinions brought out in the discussions was, that small doses and persistent painstaking administration of the remedy must supersede the earlier methods of administration.* are recom side of the Atlantic by some observers for some This position has been maintained on this months past, and it was especially Dr. Karl von Ruck, of Asheville, N. C., who has cbtained equally good results in his private institution for tubercular patients, and in whose cases thus far no relapses have occurred. He warned against large doses and routine methods as long ago as last January, and pointed out that the fever and constitution reactions are not therapeutic, but the poisonous effects of the remedy. A similar position is taken up by Prof. Loomis in his paper on the subject in the August number of the Climatologist. *Deutch Mediz. Wochenschrifs. Aquæ destil .gr. 1-20 ...dr.j .gr. 1-60 m. xx Sig. To be used as hypodermic injection (arm preferred) three or four times daily at first for one, two or three days, then twice daily, then once daily, then twice weekly, once weekly, and finally, in extreme cases, an occasional "shot," Each case quoted showed a rapid improvement within two hours from first treatment. I am convinced that alcoholism, both acute and chronic, as well as dipsomania, are amenable to treatment, and that we have a rapid, effective as well as a radical cure.-Detroit Emergency Hospital Reports. The Treatment of Bronchitis. Acute Bronchitis. In the spring and autumn, and especially during epidemics like the recent visitation of influenza, cases of acute bronchitis are very common, and generally after sudden changes in the weather patients from different parts of the city come complaining of about the same symptoms, which seem to have appeared about the same time and evidently due to the same cause. Such cases usually recover under the use of some simple expectorant mixture. A favorite one with me has been the following: The dose is smaller in the extremes of life, and in severe coughs it is given every three hours, or even more frequently. This has become a very successful remedy in the large majority of cases of acute bronchitis of short duration and slight physical signs, and, in fact, all lung coughs seem to be improved by it. In a few cases it causes constipation, and then something else must be substituted, as some of the syrups, etc. Scientific pharmacy has improved so markedly the preparation of drugs, that nauseous and bad-tasting mixtures are rarely prescribed by the physician, who is anxious to please the patient and make a reputation. Instead of liquid medicines, small capsules and tablet triturates have been found very convenient. Tablets of the muriate of ammonia and the compound licorice mixture are very efficient. When the secretions are with difficulty brought up, the use of senega is advised. The syrups are usually so sweet that in adult practice I often prescribe the fluid extracts, using mucilage of acacia or glycerin instead of water. Of course, in a dispensary practice, inhalations and external applications may be ordered, but they are rarely carried out. In private practice a case of bronchitis usually does better in a room in which there is moisture, as steam from a kettle. Besides the internal medication, counter irritation with Stokes' liniment, mustard, iodine, poultices. etc., form an important part of the treatment, and where there is a laryngitis with the bronchitis, inhalations of the compound tincture of benzoin, or oil of turpentine, poured on steaming water give great relief. When the secretions are abundant and not easily coughed up, I find turpentine in emulsion an excellent remedy, not so pleasant, perhaps, as terebene, or terpene hydrate, but rarely failing to do good in properly selected cases. The formula, with occasional modifications to suit particular cases, is :— Ofttimes the cough is of such an irritating character that these ordinary expectorant mixtures avail little; then recourse must be made to a narcotic in some form. Morphine, of course, is a powerful remedy, but it has serious objections, not the least of which is the tendency to form the habit. Codeine, a very use ful alkaloid of opium, has the advantage of not constipating as much as morphine, and the codeine habit is not apt to be formed, as patients rarely recognize it as belonging to the ..gr. viij ..oz. ij M. Sig. A teaspoonful in a little water three or four times a day, and at bedtime if necessary. Of course, where the secretions are abundant, such narcotics do harm, but in the dry, irritating cough of nervous origin-a cough that prevents sleep-such a prescription is necessary. Capillary Bronchitis in the adult is a very discouraging disease to treat, and too often proves fatal. The diagnosis is not always easy. It has been mistaken for pneumonia and pleurisy. The intense anxiety and dyspnea of the patient is very startling to the nurse. The most important step is to keep the room filled with steam from a kettle, and use frequ nt inhalations of benzoin or turpentine. The great difficulty is to dislodge the tenacious mucus from the lungs. Expectorants do little and stimulants do much. In fact, in this disease you must pin your faith to constant stimulation and nourishment. We must also sacrifice elegant pharmacy and give nauseating remedies. Nauseating expectorants cause vomiting, which removes the bronchial secretion. The external use of mustard, Stokes' liniment, and large poultices is of the utmost importance. Even after the use of all these means, the patient, apparently strong at the beginning, will succumb to the disease. Chronic Bronchitis, both alone and combined with asthma, can never be cured. Such cases return for treatment quite frequently, and it is only by palliation of the more acute symptoms that the patient can be kept in comfort. Spasmodic asthma is another disease that requires continual watching. In the class of chronic and incurable troubles I find the iodide of potassium an unpleasant but potent remedy. An attack of asthma often does well under the following: B Potass. iodid.. Potass. bromid. Aquæ..... gr. lxxx .dr. iij ....Oz. iy Sig. A dessertspoonful in a little water three or four times a day. When the disease is, a chronic bronchitis, whether with or without emphysema, I give the iodide of potassium in the following mixture: & Ammon, muriat. Mist. glycyrriz, comp. M. et adde potass. iod. ..Oz. SS oz. iv gr. lxxx M. Sig. A dessertspoonful in a little water three or four times a day, after meals. This is an extremely disagreeable mixture, but the patients will generally put up with it for the good it does them. The results with not. the nitrate of sodium, as suggested by Dr. Fraser, for use in chronic bronchitis, with and without emphysema, were not satisfactory. In some cases good was done, but in most cases In treating these chronic diseases the value of tonics should never be lost sight of. Fowler's solution of arsenic is an excellent remedy in these cases, as also is the occasional use of iron. It should never be forgotten in these cases to keep the portal system relieved of congestion by moving the bowels freely.— W. B. Canfield, A. M., M. D., in Therap. Gazette. They Have Eyes, But See Not. It has always been a problem in therapeutics how best to introduce iodine within the system. The iodides of potash, soda, ammonium, have been regarded as the most feasible, and have proved fairly satisfactory. Nevertheless, there has been a lurking feeling that there must surely be something better, evidenced by the fact that all the antiseptics of iodine origin have been administered internally-with but small success, however.Canada Practitioner. Such items as the above are a never ceasing source of wonder to us. Where are people's eyes? And ears? Things are advertised week by week that are of a value beyond all estimation to the doctor, and yet he never seems to know of them. One man once bewailed the absence of an efficient remedy for diphtheria. We asked him if he had used peroxide of hydrogen. No, he hadn't heard of it. We looked at him sadly, and informed him that Mr. Marchand had been telling him of the virtues of that wonderful remedy every week for over a year. But he hadn't read the advertisements." A few weeks later he was simply wild about peroxide. Such men are hopeless. They show enough animation in complaining of the inroads of specialists, quacks, and advertising druggists; but it never occurs to them that if they took some pains to inform themselves of the improvements in therapeutics there would be no field for quacks. If the treatment of alcoholism had received the attention it deserved, there would have been no Keeley. Mr. Carnrick finds the greatest difficulty in the way of his food lies in the ignorance of the practitioner concerning the physiology of digestion. Mr. Gardner has gone to great expense in calling the attention of physicians to the value of hydriodic acid, as a means of overcoming the difficulty alluded to by our Canadian contemporary. And so with many other articles that we might mention; whose neglect by the profession is simply incomprehensible. Years ago we made it a rule to give a trial to every new thing that seemed to warrant it. The result has been so satisfactory that we turn eagerly to the advertising pages of our journals to see what new prizes are offered. Of course, some prove to be failures, and may even carry their failure on their face. For instance: An agent of the irrepressible type, one of those the profundity of whose ignorance is only equalled by the amount of his gall, spent some of our time in endeavoring to convince us that the only possible way we could get iron into our patients' blood was by the use of some German mess he advocated. His argument was, that as the use of iron blackened the stools, none of it was absorbed. We mildly insinuated that we had succeeded in giving iron, as shown by actual tests, with the hemacytometer; but this argument he treated with the contempt it deserved. His preparation proved to be a very mild chalybeate, not any better in any way than a number of the ordinary ferruginous preparations. These remarks apply to all classes of the profession. Frequently, in consultation with men of acknowledged standing, whose names are known far beyond the limits of the com. munity in which they reside, we have been struck with their ignorance of the newest materia medica. Professor Tom wanted to know why we suggested the normal liquid instead of the tincture, when his patient's heart needed exactly so much digitalis and no more. Surgeon Dick proposed calomel and jrlap, when the flatulent dyspepsia with chronic constipation called for maltine with cascara; and great gynecologist Harry, who has reluctantly agreed to spare the ovaries while we cure the dysmenorrhea and headache with antikamnia, thinks that if hypodermics of morphine and atropine fail to cure, it's hardly worth while to try these new fangled things. Butwe started in to refresh ourselves with a good growl, and the result looks very much like an advertisement!-Times and Register. Enlarged Prostate not as Common as Supposed. I HAVE studied the "old man's racket" with zeal, and found that the inexperienced in such matters are generally too heroic: they fly to diuretics, and harm their confiding patients. They should go slow, and be sure to do no harm. Tell the elderly patron to take Epsom salts in broken doses; to drink lemonade made directly from the fruit; to lay in a barrel of crab cider in the late autumn, end drink a little every day after the apple-juice has fermented. The urine of the old fellow is often alkaline and charged with phosphates. The digestion may be feeble, the brain worried, and the body wearing out, with waste not escaping freely through the emunctories. To give the old man another chance," he must be managed on common sense plans. Be discreet in the use of sounds, catheters, and other implements. To repeat, the prostate gland is not hypertrophied half as frequently as we have been supposing. The gland not infrequently swells, and thereby occludes the urethra, or in some unknown way obstructs urination. It is a curious kind of hypertrophy which all at once prevents micturition, and in two hours afterwards permits the passage of a full stream..— A. J. Howe, M. D., in Eclec. Med. Jour. A tablespoonful contains three and fourfifths grammes (or about fifty-seven grains) of bromide and one and eight hundredths grammes (sixteen and two-tenths minims) of the tincture. The medicine may be given in divided doses instead of in one full dose, half a teaspoonful being given at first twice, then three times, then four times, a day. Poulet reports five obstinate cases treated in this manner. These were cases where bromide alone failed to cure. In In number one the fits were formally six or eight a week (grand mal). After a year of the new treatment, no return of the epilepsy, this patient the tincture of calabar bean is occasionally replaced by eserine, in the dose of one milligramme to each gramme of bromide (one sixty-ninth grain of eserine to each fifteen grains of bromide); the result has been the same. No contraction of the pupil has been observed during the administration of the medicine. Number two, a most obstinate case, had been epileptic for eight years. Eight or ten fits a day. Failure of bromides, given alone, also of bromides and picrotoxine. Definitive cure under bromides associated with tincture of calabar bean. Number three was also a case of chronic, inveterate epilepsy. Several months' treatment by the combination above specified has given exemption from all convulsive accidents. Number four was a case of grave epilepsy at the menopause. Frequent daily vertiginous attacks, ending in convulsions and stupor. At first the disease was successfully combated by bromide of potassium associated with picrotoxine; this combination afterward failing, sulphate of atropine was substituted for the picrotine, six grammes (ninety grains) of bromide of potassium, one milligramme (one sixty-fourth grain) of atropine, daily. The latter treatment has been kept up for a year, with complete cessation of the vertigo. Number five was a case of cardiac epilepsy. The grand mal attacks were followed by hemiplegia, with stupor and hebetude (etat de mal). A combination of bromide and digitalis caused disappearance of the epilepsy, eight grammes (two drams) of bromide, associated with two grammes (half dram) of tincture of digitalis in divided doses, daily. Poulet terminates his article by the following conclusions: The bromides remain the sheet anchor in the treatment of epilepsy, and by the term bromides we have especial reference to the bromide of potassium, which alone is truly efficacious. There are, however, a great many epileptics whose attacks are only mitigated or postponed, not completely suppressed, by bromide of potassium. In such cases, if we associate the bromide with some medicament which possesses properties identical with those of the bromide,-that is, being capable of anemiating and decongesting the nerve-centres and paralyzing the system of voluntary muscles-we generally obtain results which are perfectly satisfactory in essential epilepsy, and even in partial or Jacksonian epilepsy, on condition that, in the latter, we begin by the specific treatment of the determining cause. The substances that have been the most successful are calabar bean, picrotoxine, and belladonna. In chronic epilepsy, digitalis must be added. We may indifferently substitute sulphate of eserine for the preparations of calabar bean, sulphate of atropine for those of bellanonna, and digitalin for digitalis-Boston Medicat and Surgical Journal. Pain-Its Diagnostic Value. PAINS coming on in paroxysms are neuroses, and usually involve nerve troubles. Rhythmical pains always belong to nonstriated tissues, and are usually associated with some one of the hollow organs. Coldness, chilliness, heat, burning, itching, creeping, crawling, and similar pains are peculiar to the skin and mucous membranes. Sticking, darting, stabbing pains are always found connected with serous membranes or connective tissue. Throbbing, tearing, aching, and pressing pains indicate that solid organs are involved. Hyperesthesia and anesthesia indicate that the sensory divisions of the cerebro-spinal nerves are involved.-Dr. Owens, Cincinnati, O., in Pulte Quarterly. THE following are some of the hospitals, the formulæ of which are given in "The Official Formula of American Hospitals": University Hospital (Philadelphia.) Children's Hospital (Philadelphia.) Roosevelt Hospital (N. Y.) Long Island College Hospital (Brooklyn.) Mass. General Hospital (Boston.) Chicago Marine Hospital, and many others. The book is a neat, cloth-bound volume of 272 pages, and the price is only $1.00. It is worth many times the price, and should be in every physician's library. Published by THE MEDICAL WORLD. Order when you send your subscription for '92. SEE order blank on page xxiv. |