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pepto-mangan to raise his nutrition, which, in consequence of his repugnance toward a meat diet, had become greatly reduced and was accompanied by pronounced anemia, to such a level that for a comparatively long period of time the patient was able to get along without any large consumption of

meats.

What further incited me to report these cases was that the experiments so far made with pepto-mangan have been restricted, for the most part, to the field of iron preparations, of which an article by Dr. Roen affords us a very comprehensive view. This author remarks very justly that most of the ferruginous preparations hitherto manufactured consist of albuminous material held in solution by an excessive amount of caustic soda, thus neutralizing the gastric juice, while, on the other hand, through their decomposition the irritating chloride of iron is produced; or they represent peptone combinations containing an excessive amount of mineral acids, and therefore are precipitated by the alkaline intestinal secretion and rendered less assimilable.

Pepto-mangan does not share in these disadvantages, and, moreover, owing to the presence of manganese. that excellent carrier of oxygen, is of the greatest value, especially in chlorosis, anemia, and allied conditions.

I take the liberty of reporting only two more cases from the remaining 14. both relating to chlorosis characterized by severe symptoms, and illustrating very graphically the prompt action of this chalybeate.

The first case was that of a girl, 18 years old, who presented a well developed type of marked chlorosis. There was marked anemia of the general integument; the mucous membranes

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were very pale, and she suffered since the last fourteen days with persistent headache and buzzing in the head. This was accompanied by palpitation and a feeling of weakness, as well as pronounced edema of the lower extremities up to the middle of the leg. Her menstruation was very irregular and profuse. Examination of the blood showed a much reduced color index, 20 according to Fleischl's method. The number of red blood cells was reduced to 3,100,000, the white not being materially increased. Although the patient had taken the greatest variety of iron preparations, they were not well tolerated. I therefore decided to administer Pepto-Mangan (Gude), enjoining at the same time rest in bed, which seemed indicated, if for no other reason than that of the condition of the heart and the attacks of weakness. The patient received at first two tablespoonfuls and after a few days three tablespoonfuls of the pepto-mangan, and this amount in the third week was increased to five tablespoonfuls daily. The effect was truly surprising; without the least disturbance of the gastrointestinal tract, considerable improvement of her entire condition had occurred at the end of four weeks, so that she was able to be up and about. She had a good appetite and menstruation was regular for the first time in months, while the cardiac palpitation, headache and buzzing in the head, as well as the edema, had vanished. Examination of the blood showed 3.980.000 red blood corpuscles and a hemoglobin percentage of 50 (Fleischl). After another four weeks the patient was completely restored to health, with a hemoglobin percentage of 70 and an increase in the number of red blood cells to 4.200,000.

In conclusion I would add that during the administration of the peptomangan no unpleasant by-effects have been observed, and that the preparation has always been willingly taken.

Medical

TO THE MEMBERS OF THE MEDICAL PROFESSION.

At a conference of the officers and Advisory Committee of the American Congress on Tuberculosis, held in New Orleans, May 7, some important changes were made in the plans as previously announced.

The previous plans of the Council to hold the Congress in St. Louis, in 1904, were changed, many considerations favoring Washington, D. C., as the place of meeting. A change of time of meeting was also made to April 4th, 5th and 6th, 1905.

As there is to be an International Congress of Tuberculosis, at Paris, in 1904, it was deemed possible that some foreign delegates might be prevented from attending the Washington meeting on that account. The plan and scope of the American Congress being in reality international, the postponement of the meeting to the spring of 1905 will give the management ample time for perfecting details upon which the success of a Congress largely depends.

One committee has been already arranged to have charge of the Section of Pathology and Bacteriology, as follows: Dr. Simon Flexner, chairman; Dr. William H. Welch, Dr. George J. Adami, Dr. Theobald Smith, and Dr. F. F. Wesbrook. Committees in charge of other sections or departments will be announced later.

Dr. George Brown, of Atlanta, Ga., is practically the Executive Officer of the Congress, and all who desire to present papers before the Congress should apply to him. As there seems still to be a doubt in the minds of many physicians concerning the result of the vote of the New York meeting, which in 1902 adopted a new and definite plan for the next Congress, we beg to assure our readers that the new plan is being followed in both letter and spirit by Dr. Brown and the other officers elected at that meeting.

Any circulars or communications purporting to be in the interests of the American Congress on Tuberculosis, which do

Miscellany

not appear over the name of Dr. George Brown, as Secretary, do not relate to the Congress which was arranged last year, and the organization of which has already so far advanced as to insure its success from every point of view.

DANIEL LEWIS, M. D., President, The American Congress on Tuberculosis.

A very convenient and valuable chart of the principal poisons and their antidotes is published by The Maltine Company, and will be promptly sent to physicians and to hospitals, dispensaries, training schools for nurses, and kindred institutions on application. Address, The Maltine Company, 8th avenue and 18th street, Brooklyn, N. Y.

THE APPOINTMENT OF ASSISTANT

SURGEONS IN THE ARMY.

The difficulty of obtaining young men graduates of medical colleges who are able to pass the examination for appointment as assistant surgeons in the army must, sooner or later, engage the attention of the authorities. Surgeon General O'Reilly has a plan in contemplation which he hopes to see realized before he finishes his term of office. It is his idea to take graduates and, after examining them as to their general qualifications, admit them to the Army Medical School in Washington and give them a training in special branches for a year or more, subjecting them to examinations as they progress, and at the end of the term select from among them those who are deemed competent to fill the vacancies in the medical corps. Such as do not find a place in the regular establishment would be of use in the national guard organizations, which latter will be benefited by hav ing available young men who are specially trained in military medicine and surgery, hygiene and sanitation. In this way the state troops would have at their bidding surgeons who have a practical knowledge

of their military as well as professional duties. Surgeon-General O'Reilly is also in favor of requiring that the young men who enter the medical department after this preliminary education shall be required to serve at least five years.-Army and Navy Register.

FOR THE DIAL.

The skull of Oliver Cromwell is shown in the London Museum. "It is exceedingly small," said an observer, one day. “Oh,” said the ready guide, "this is his skull when he was a little boy."

An observer of the famous Siamese twins remarked that it was exceedingly fortunate they were brothers. It would have been very embarrassing if two strangers had been joined in that way.

SEVERE REFLEX PAIN.

J. H. Tilden, M. D., of Denver, in the June number of the Chicago Medical Times, in an article advocating the use of tampons in gynaecological practice, reports, among others, a case which was characterized by severe reflex symptoms and which had not yielded to the treatment accorded by two other practitioners. Dr. Tilden's procedure was, the introduction of a glycerine tampon and the administration of antikamnia in ten grain doses (two five-grain tablets) to relieve the pain. The tampon was removed each night at bedtime and followed with hot water injections. The patient on being discharged, remarked, that since following this treatment she could run the sewing machine without the usual pain and tired feeling.

Celerina is a powerful stimulant without the depressing after-effects of alcohol, caffeine, nitro-glycerine, etc. It is also a reliable nerve tonic. A pleasant exhilaration is experienced after a dose of one or more teaspoonfuls, and under its continued use a renewed capacity for mental and physical exertion results. It is indicated in all forms of exhaustion, mental inertia and senile weakness.

FLAT AND SHARP. Place, restaurant: Flat-Here, waiter, I found a hair in the honey.

Sharp-I do not understand how that could be, the honey was combed.

ice.

Flat-(tried again)-Here is a hair in the

Sharp-How could that happen, when the ice was shaved?

Not quite subdued, Flat made one more attempt to be smart. "Here," he said, "is a hair in the baked apple."

Sharp-That is remarkable, for the apple is a Baldwin.

A New Anaesthetic.

At the meeting of the French Academy of Medicine, held on March 17, M. Courtade gave an account of a new local anesthetic. It is rara-amido-benzoin ether, and has been named anesthesine. It is a derivative of orthoform, and is but slightly soluble in water, but freely so in glycerine and in fatty bodies. It is not poisonous, which gives it a great advantage over cocaine, while its action is much less transitory than that drug. M. Courtade has used the drug especially in cases of patients suffering from tuberculosis or syphilitic ulceration of the pharynx, which rendered swallowing very painful, or even impossible. After an application of anesthesine in powder they were able to swallow without pain.-The Lancet. Urates.

Young lady reading report of urinary examination: "Doctor, what are urates?" Doctor: "Five dollars per visit."

Old Methods of Treatment Which Are Not Necessarily Obsolete.

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H. W. Syers decries the use of so-called hypnotics and an ipyretics in the treatment of fevers, to the neglect of opium. This he considers the most reliable and the safest and most satisfactory drug in these cases. The antiseptic treatment of the alimentary canal in typhoid fever he believes to be as hopeless a proceeding as to undertake to empty the Thames with tablespoon. Mere reduction of the temperature is of little value, and has a deleterious influence on the circulation. Ice packing gives too great a shock. In many cases of perityphlitis, in which there is no evidence of suppuration. medical measures should be preferred to surgical. The tendency to discard the use of opium, he thinks, is simply disastrous, and the foolish view that it should be denied must inevitably lead to a large number of cases being operated upon when such a

the aid of which it might be safely withdrawn! This suggestion was excellent; it dissipated all doubt and difficulty; it was a very quod erat demonstrandum of the question, and the society testified their approbation by great laughter and applause.”

Knife-blade In the Ear.

procedure might easily have been avoided. In chronic renal disease, too, opium should not be denied. Bleeding in many diseases should be restored to favor; wet or dry cupping and flying blisters have their place in therapeutics. There is danger of overdoing the open-air treatment and the overfeeding practiced in phthisis, and there is the greatest possible danger in the craze for the treatment of heart disease by baths and exercise. Gout can be better treated by the resin of guaiacum given in cachets than by modern methods founded on the uric-acid theory, the same drug being effective in rheumatism. The author would also call attention to the value of stimulating liniments in the joint affections of these diseases. Free purgation is less used than formerly in all cases, and in these days of self-indulgence and overfeeding this is a mistake. The author believes that there will be a reaction in favor of many of the methods of treatment which are at present considered obsolete.-Treatment, February, 1903.

On the Use of Citric Acid in Uterine Hemorrhage.

The Lancet, March 14, contains the following: "In No. 8 of the present volume we give an abstract of a paper read on this subject at the Royal Academy of Medicine, on January 13. Dr. Macleod, considering the introduction of a lemon into the cavity of the uterus to be a novel, not to say an ingenious procedure, submitted it to the notice of the Westminster Medical Society. for the purpose, we suppose, of eliciting the opinions of the persons present respecting it. A discussion ensued: Dr. Granville expressed himself as opposed to the remedy, considering it to be unsafe and ineffectual, Some gentlemen conceived that there would be great difficulty in getting the lemon out. It might be introduced easily enough, but how was it to be extracted? A silence followed: the question was so important that it required the most serious deliberation, and such it received. With the greatest imaginable gravity, and with the air of one 'profoundly skilled in analytick,' Dr. Copeland arose-Dr. Copeland, physician to the Queen's Lying-in Hospital, cum multis aliis honoribus-modestly suggested 'that a small bit of string should be fastened to the extremity of the decorticated lemon, by

us.

J. C. Thompson reports the case of a man of twenty-seven years who had a bloody and purulent discharge from the right ear for seven weeks. Examination showed a mass of exuberant granulations in the meatbathed in a bloody pus. A probe passed through the speculum to press these granulations out of the way encountered a hard. foreign substance, which felt like a piece of steel. After part of the granulations were curetted away a black substance could be seen in the external meatus. It was grasped with forceps and an attempt made to remove it, when it was found to be so firmly fixed that it could not be withdrawn. A hook passed behind it failed to dislodge the foreign body. Examination was then made behind and below the ear, and a foreign substance extending down an inch into the tissues of the neck could be plainly felt. When the projecting portion in the ear was moved by the forceps the portion in the neck could be seen and felt to move. Further questioning revealed the fact that the man had been stabbed two years previously. Under local anesthesia through an incision behind the ear, there was removed a broken knife-blade more than an inch in length and of the usual width. The part projecting into the ear is very much corroded. That buried in the deeper tissues of the neck. while blackened, showed little signs of oxidation. It lay below the deep cervical fascia, and was partly imbedded in the fibers of the sternomastoid muscle.-Cincinnati Lancet-Clinic.

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with threatening perforation at numerous points. At least four large areas of this character were found upon the small bowel, the uppermost being apparently near the middle of its length, i. e. a long distance above the cæcum. It now became a question whether to undertake several intestinal resections or to remove the entire length of bowel which contained these gangrenous patches. The patient's condition was bad and it seemed that the measure most indicated was that which could be most quickly performed.

Accordingly, a Murphy button was used, and with it the ascending colon was connected with a loop of intestine just above the uppermost gangrenous area. The mesentery was then tied with a series of silk ligatures, and the entire section of small intestine involved was removed down to the ileocæcal valve. A considerable part of the cæcum being gangrenous, the colon was divided at this point by an oblique incision, and in this way all of its gangrenous portion was removed. After the operation the portion of intestine which was removed was straightened out and carefully measured. Without undue stretching it was found to measure 265 cm.-8 ft. 9 in. The Murphy button did not come away until

nearly four months after its insertion. The patient had a tedious convalescence, but eventually made a perfect recovery.—Buffalo Medical Journal.

Glycocholate of Soda.

Charles I. Hill, from a very considerable experience in the use of this drug, is convinced that it is of the greatest value in all cases of hepatic insufficiency, and that it is almost a specific in hepatic colic. It is contraindicated when the duct is occluded, as an increase in the amount of bile during this condition will increase the amount in the circulation. The dose is fifteen grains per diem, and upward, though the minimum dose is usually sufficient, as the drug should be administered over a considerable length of time, its effects not being observable till after a week or two of treatment. From its bitter taste it can be administered only in capsules, and even then it sometimes produces nausea for the first few days, which disappears if the medicine is persevered with, a few grains of magnesium oxide with the capsule will often prevent the nausea. Occasionally it produces diarrhoea at first, but after a day or two this also subsides.— The Carolina Medical Journal, March, 1903.

Weight Losing

Consumptives will gain weight on Hydroleine
where they lose weight on plain cod-liver oil.
The plain oil will cause diarrhoea, oily eructations,
or pass through unchanged; while Hydroleine
will be eagerly taken up by the lacteals, and
produce a steady gain in weight, and a marked
improvement in the general health. Hydroleine
aids and restores the functional activity of the
pancreas and rapidly develops an appetite.

Sold by druggists generally.

THE CHARLES N. CRITTENTON CO., 115-117 Fulton St., New York
Samples free to physicians.
Sole Agents for the United States

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