Miscellaneous Selections,

Bromide of Strontium in Nervous Troubles.

There has always been a vaguely expressed, but generally accepted, opinion that strontium salts participate in the poisonous properties of barium, on account of the close approximation which the two metals hold in their chemical position to the other elements. The new and precise investigations, however, of Dr. Laborde, chef des Travaux physiologiques a la Faculte de Medecine de Paris, have put an end to this legend; the communications made by this savant to the French Academy of Medicine* and to the Society of Biology, have established once and for all, that, far from being harmful, pure strontium salts (Paraf-Javal), have, on the contrary, a favorable influence on the phenomena of nutrition. The same authority showed that the previous contradictions and errors on the subject of the toxic effects of the strontium salts were due exclusively to the greater or less impurity of the commercial products used, containing small amounts of baryta.

Prof. Germain See, in affirming the absolute innocuousness and remarkable therapeutical action of the strontium salts (Paraf-Javal), in certain maladies, mentions the fact that they were already the subject of an inaugural thesis inspired by the late Prof. Vulpian in 1885.

Drs. Constantin Paul and Dujardin-Beaumetz are not less positive of the merits of the strontium salts (Paraf-Javal). Dr. Constantin Paul, referring to his experiments, says: "I gave 6 grammes daily of bromide of strontium (Paraf-Javal) to a young girl suffering from hysterical epilepsy, for two months. The attacks had hitherto returned periodically before the menses and resisted the regular daily administration of 4 grammes of bromide of potassium. The bromide of strontium (Paraf-Javal) appears to have prevented the attacks, for they have not since recurred."

Dr. Dujardin-Beaumetz found that bromide of strontium (Paraf-Javal) possesses the indisputable advantage of being better borne by the stomach than the other alkaline bromides.

Comptes-rendus de la Societe de Biologie (p. 665).

The important position occupied by bromide of potassium in the treatment of nervous diseases, is well known; but unfortunately if administered for any length of time, it provokes intolerance, which, in addition to a disturbance of general nutrition, gives rise to symptoms of intestinal septicemia, followed by cutaneous eruptions associated with intense depression and cerebral torpor. It is, therefore, eminently desirable to find a substitute, a succedaneum, to use a therapeutical term, for bromide of potassium, a drug, in fact, which shall possess all its advantages without its drawbacks. That bromide of strontium responds precisely to this desideratum, has been already proved by the clinical experimentation made. The pure salt in crystalline needles, such as has been obtained by Paraf-Javal, such as is found in the solution prepared by Chapoteaut, is soluble in all proportions of water; it is with this salt, and this alone, on account of its perfect preparation and absolute purity, that clinical researches have been brought to their present pitch of constancy and precision.

At the seance of the Society of Biology (Paris), the 17th October, 1891, Dr. Ch. Fere, in reporting the results observed in his hospital practice at Bicetre, referred to the interesting case of a patient treated with 10 grammes of bromide of potassium daily, in whom the cutaneous eruption persisted in spite of intestinal asepsis. This patient was given the same dose of bromide of strontium (Paraf-Javal), and equally good effects were obtained therapeutically without any undesirable symptoms. Intravenous injections in rabbits have shown that these animals support.85 grammes of bromide of strontium as against .14 of bromide of potassium. This proves that bromide of strontium (Paraf-Javal) is six times better tolerated than bromide of potassium.

Prof. Germain See says of pure bromide of strontium (ParafJaval) that "It never produces any disastrous effect on the stomach even in large doses. It may be taken in doses of 4 grammes (62 grains) at each of the three daily meals. Out of 32 patients suffering from gastric dilatation, several have been improved, and some altogether cured. I believe that the bromide of strontium (Paraf-Javal) will advantageously take the place of bromide of potassium, and especially the polybro

mides in the treatment of epilepsy." (Acad. de Med., Oct., '91.) The abundant evidence at our disposal proves that the pure bromide of strontium (Paraf-Javal) responds to the same indications as bromide of potassium, over which it has the immense advantage of being admirably tolerated; for even in large doses it produces no accidents.

Physicians' Business Methods.

In a recent address to medical graduates, the Rev. Dr. Alexander very pertinently remarked that the physician's first duty to society was to make a living and keep out of the poor-house. That this will be a question of most vital interest in the near future with a majority of the young men to whom the remark was addressed, no medical man of ten years' experience will doubt. It is true that the primary object of medicine as a profession is not the accumulation of wealth. A physician who has amassed a fortune by the practice of his profession is an extreme rarity. Many acquire a competence, and it is the duty of every man, professional or non-professional, to do so if it is within his power. The philanthropic idea is stronger in medicine than in any other calling, except, perhaps, that of the clergyman. But the doctor must pay his taxes or rent; he must eat, drink and be clothed; he must be supplied with instruments and books; he must support his family and educate his children. The effusive thanks of grateful patients do not, unfortunately, pay the bills. Fees alone will do that.

We thoroughly believe that medicine is a calling, not a trade; that the tradesman and business man may, with entire propriety, adopt methods that would degrade the physician. He cannot practice his profession on strict commercial principles without losing his self-respect and forfeiting the esteem of the community. There is, however, a business side to medical practice which the doctor is proverbially lax in managing. The amount of work he does is by no means the key to the amount of his income. Laxity in business matters will explain the apparent lack of success of many a physician. Some men are wholly lacking in practical business capacity; others, from indolence or overwork, neglect to give proper attention to their collecting; while others, from failure to appreciate the value of

their own services, obtain less remuneration than is their due. People are very apt to estimate a man according to the estimate he places upon himself. If his price is habitually below the customary fees of the locality in which he lives, and he is diffident in enforcing his claims, he need not be surprised if his patients put a low estimate upon his worth and are slow in paying his bills. Just regard for the poor and the unfortunate is a duty which very few physicians are inclined to evade. The laborer is worthy of his hire, and there is no more worthy laborer than the conscientious physician. He is under no moral obligation whatever to deprive himself and his family of remuneration justly due him from the well-to-do. By cutting rates, he gains nothing in the long run. He injures not only himself, but his fellow-practitioners, by degrading the value of medical service.

There is, perhaps, no more fruitful source of loss to the physician than laxity in rendering bills. There is great truth in the old saying that short accounts make long friends. It is frequently said that doctors' bills are hard to collect. If this is true, the doctor is, in many instances, to blame-not because of lack of professional skill, but because the bill is so long delayed that the patient has forgotten the matter and his gratitude has evaporated. The age of long credits in commercial life is gone. This is largely true also of professional work in the great centers of population. In some country localities, and among certain city physicians, it is not true. They allow accounts to run for months or years without rendering a bill. The doctor's bill thus becomes a formidable thing and is hard to pay, and must usually be discounted. If rendered at short intervals, before it has attained to great size, it is grouped' with the current expenses and is quickly paid with comparatively little effort. The doctor's care, and labor, and sleepless nights are then all remembered, and the patient feels that he is paying money for value received, and does not ask for a discount. Frequent bills, while they need not show a mercenary or grasping spirit, do show that the doctor lives by his practice and expects remuneration for his labor. It is not wise to place anything on a bill that will seem to be an apology for rendering it, such as the statement "bills rendered quarterly."

A bill should be rendered as a matter of course, at stated intervals, which will vary somewhat in different communities.

The struggle to make a living is, for most medical men, a hard one. They enter on their career without having had the slightest instruction in professional ethics or business methods, and the mistakes of the first years are by no means confined to diagnosis and treatment. Success as a practitioner depends almost, perhaps quite, as much upon social and business capacity as upon professional training. There is no person deserving of more pity than the scholarly and brilliant physician hampered by his inability to read and deal with human nature, and cramped through life by bad business methods and lack of financial ability.-Ed. N. Y. Med. Jour.

Diphtheria.

An application destructive to the membrane and at the same time germicidal in its effects, is a vegetable product derived from the papaya carica and possessed of marked digestive powers, known as papoid. It comes in the form of a powder, a small portion of which should be used at intervals of one, two or three hours as may be desired, according to the extent of the deposit which we may desire to remove. The same should be made into a paste with a small quantity of water and applied with a fine camel's-hair brush. I have found this product very satisfactory as a destroyer of the membrane. An additional advantage of this application is that such parts as may be swallowed will serve to help nature to digest whatever food there may be in the alimentary canal. This is not an unimportant point, and right here, in order to emphasize the importance of nutrition, we will anticipate that which will be considered later, and suggest that in the beginning of the treatment the alimentary canal should be promptly emptied and placed in the best possible shape for the securement of nutrition, because we have a "battle of the cells" before us, and the greatest enemy to the Klebs-Loffler bacillus, or any other, is well-nourished blood. Insist upon an abundance of nourishment from the start. Food that is in a form ready to be promptly assimilated, such as eggs, peptonized milk with beef peptonoids, bovinine and raw scraped beef, together with