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Phosphorus and the Hypophoshites.

One of the great mysteries of pharmacology is the supposed benefit derived from the use of phosphorus and the hypophosphites. The latter has made many pharmaceutical firms wealthy, but never effected a cure. Phosphorus and lecithin have been used a great deal as a brain food. Just why is not quite clear to the average physician. Even in extreme states of exhaustion, such as dementia precox and general paralysis, the brain is plentifully supplied, not only with phosphorus, but also with its special form of phosphorus, lecithin. The amount of phosphorus required for the growth of the brain and nervous system is amply supplied by the phosphorus of our daily diet. We ingest daily about 5 grams of lecithin, which, by the addition of two or three eggs, can easily be raised to 10 grams. Why give commercial preparations of doubtful or inferior value? The popular belief that the hypophosphites have some special influence on nutrition is a myth. Cushny has shown that practically the whole of the hypophosphites administered can be recovered unchanged from the urine.

Intestinal Antiseptics.

There is another class of drugs which are used by a great number of physicians under the delusion that they have decided antiseptic action and prevent fermentative changes in the alimentary canal. I refer to the so-called intestinal antiseptics. This list includes such well known drugs as thymol, salicylic acid, phenol, boric acid, benzoic acid, resorcin, the sulphocarbolates, and a number of others. For the reason that most of these drugs, with the possible exception of boric acid, impair and prevent the action of the digestive secretions, their action as intestinal antiseptics is at best problematical. The widely prevalent belief that these drugs in medicinal doses inhibit the growth of intestinal bacteria is nothing more than a beautiful dream.

Chromium Sulphate.

Perhaps the latest delusion to which I call your attention is the extensive use and wonderful cure-all properties of the sulphate of chromium. One writer says: "The diseases in which chromium has been used with success are cirrhosis of the female breast, castration, menopause, functional impotency in men, locomotor ataxia, exopthalmic goitre and the migraines." This is going some, but the gait is too rapid. Would it not be well to pause and inquire into the action of this metallic salt and see

if it could possibly be of value in any single pathological condition before prescribing the drug in a variety of diseases.

In conclusion and without going into detail, I will simply make brief reference to a few more remedies in general use and which should rank in the same class as those mentioned above; the use of potassium chlorate in sore throat and stomatitis because it is toxic and without value; adrenalin chlorid administered hypodermically as a heart stimulant and to raise the blood pressure. To be of service adrenalin must be given by intravenous injection; the use of the lithium salts in the uric acid diathesis and affections of the genito-urinary tract. Figure out, if you can, the thousands of dollars that have been squandered for water supposed to contain a trace of the useless. lithia; ferric hydrate and magnesia in arsenic poisoning; calcium salts and tannic acid in internal hemorrhage; turpentine in phosphorus poisoning; sparteine sulphate as a heart stimulant, etc. One of the most important questions confronting the medical profession today is that of rational and intelligent therapeutics.

Discoveries in Pneumococcus Meningitis.

Pneumococcus meningitis is generally considered an almost certainly fatal disease, but enough exceptions have been reported to emphasize the rule. Rolly (Deutsch Med. Woch. 17, 1911), reports that out of thirty cases, which have occurred at the Leipzig clinic in the last five years, four have ended in recovery. In three of these the brain symptoms were so nearly coincident with a pneumonia that it might have been questioned which was the primary lesion. In the fourth case there was a slight broncho-pneumonia. In all the diagnosis was assured by the presence of the pneumococcus in the spinal fluid. The favorable outcome seemed to be, in part, due to the repeated lumbar punctures. In one protracted case, in which the patient was unconscious for twelve days, the puncture was made sixteen times in the course of a couple of months, a favorable effect being evident as a rule immediately after each puncture. The procedure probably favors recovery, both by removing germs and toxins, and by making way for fresh fluid laden with antibodies. Large doses of urotropin also seemed to be of service. Gifford (Omaha)

The Treatment of Tuberculosis of Fascia.

Several months ago the writer reported his experience in the treatment of tuberculosis of fascia, in which communication a wide removal of the diseased tissue, as well as the adjacent oedematous cells, was recommended, following which a liberal application of Churchill's tincture of iodine was made, and the wound left open for some four or five days, at the end of which time any tegumentary flaps were replaced and when healthy granulations covered the remaining raw surface skin grafting was done.

Since this contribution we have found that the above plan, while very successful, can be improved upon with respect to hastening convalescence by exposing the uncovered surface to the sun's rays for a half hour each day, for four or five days, the result being that granulations develop more rapidly and show greater resistance, thus allowing skin grafting to be done at an earlier date, and the surface is prepared for more substantial nourishment for the grafts.

However rebellious this disease may appear, either from its extent or from the low vitality of the patient, the above plan offers the most encouraging prospects for a successful outcome. Even in the Amrican Indian, who offers little resistance to tuberculosis, cures have been reached in cases which some years ago would seem almost hopeless.

Allison (Omaha).

Death from Brain Abscess After "Cure" of Meningitis.

Otitis meningitis, which until quite recently was regarded by surgeons with as much favor as the devil has for holy water, is now in the list of diseases that may occasionally be cured. Aside from cases of meningismus, or serious meningitis, several cases, where the spinal fluid has been found to contain pus and bacteria, have recovered after radical clearing out of the mastoid and free incisions into the dura. That such cases may be illusory is shown by a case of Urbantschitsch (Arch. f. Ohrenheilk, 84, 5). This patient was presented to the Viennese Society as an example of a cured purulent meningitis, after five weeks of apparent good health; however, he soon developed symptoms of brain abscess and died, after an operation at which two abscesses, one in the temporal and one in the occipital lobe, were opened. The section showed a fresh encephalitis, but no signs of a recently cured meningitis. Gifford (Omaha.)

Indication and Technic for Version.

By Dr. K. Baisch (Deutsche Medizinische Wochenschrift, Berlin, December 22, 1910).

The author cites statistics from Doderlein's and other clinics which show that version is applied on an average in about 1.5 per cent of deliveries and forceps in about 2.4 per cent. In the clinics forceps and version are applied in 4 per cent, that is, in about one-third of all the operative births, while in general practice they are applied in two-thirds of all the operative deliveries. Decapitation and perforation, he declares, amount to 0.8 per cent of all operative deliveries in the clinic and 0.1 per cent in general practice. These figures confirm his impression that the mutilating operations are far too rare in private practice, as these alone are harmless for the mother, while the operations which presumably spare the child, but are fraught with danger for the mother, are far too frequent. His statistics show further that the mortality of the children with version amounts to 50 per cent, not including the infants who die soon after birth, which brings the total mortality from version up to 70 per cent. With this imposing mortality of the children with version, we are fully justified, he says, in seeking to restrict its application in favor of perforation of the fetus. If half of all the versions were omitted and in their place a mutilating operation done, the results for the children would be the same, he declares. but for the mothers it would be incomparably better. In the interest of the mother we must select with the greatest care the cases in which version is indicated. Somers (Omaha)

Some Peculiarities of Atoxic Tetanus Spores.

Schneider (Abst. in Centralblatt f. Bacteriologie, 49, 6, 172), has made a most interesting contribution to our knowledge of the tetanus germ. He finds that, if a spore-bearing culture of tetanus bacilli is heated to 75° C., the spores are not killed, but they lose the toxicity which enables them to develop in the body and cause tetanus. Such spores can be injected freely into a rabbit's veins without causing any untoward symptoms. They are deposited in various organs and they remain alive in the muscles and liver and spleen for many weeks. Animals carrying these latent tetanus spores are extremely vulnerable; any accident or operation resulting in the death of tissue or the accumulation of exudation products is quickly followed by a fatal attack of tetanus. Another influence which can revive the toxi

city of such latent spores is the injection of the necrosis bacillus (which causes spontaneous necrotic foci in some of the lower animals). This causes the non-toxic tetanus spores to produce a rapidly fatal tetanus. Gifford (Omaha)

Treatment of Eclampsia.

(By Dr. J. W. Ballantyne, Jour. of Obst. and Gyn. of the British Empire, December, 1910).

Between the year of 1905-1910 the author acted as physician in charge of the Edinburgh Royal Maternity Hospital during the autumn quarter, and in these eighteen months 2,214 patients were under his care. Thirty-eight of the patients suffered from eclampsia, or 1.7 per cent, and five died, giving a maternal mortality of 13 per cent. During the autumn quarters of 1905, 1906 and 1907 there were twelve cases of eclampsia, with three maternal deaths, or a mortality of 25 per cent; while during the corresponding quarters of 1908, 1909 and 1910 there were twentysix cases of eclampsia, with two maternal deaths, a mortality of 7.6 per cent. The treatment employed in the latter period of time differed very markedly from that in vogue in the former. During the autumn quarters of 1905-1907 the author was still trusting in some measure to rapid emptying of the uterus, while in the corresponding quarters of 1908-1910 labor was hardly at all expedited. In the former years the maternal mortality was 25 per cent, in the latter it was only 7.6 per cent; in the former years the fetal and infantile mortality was 75 per cent, and in the latter it was 42 per cent. Whether the eclampsia develops during pregnancy, during labor or in the puerperium, the author orders venesection, transfusion with saline solution in the vein, washing out the stomach with bicarbonate of soda solution, the introduction into the stomach of a large dose of magnesium sulphate, the use of copious enema of soap and water and castor oil, and the hot pack. Obstetric interference has been put more and more into a secondary position. Somers.

Unsatisfied Desire As a Cause of Insanity in Women.

It is bad enough to have W. J. Robinson and others preach the gospel of fornication, i. e., that the average young man runs serious risk if, being unmarried, he does not indulge in illicit sexual intercourse; but here comes Marcuse (Abst. in Fortschritte der Medizin, December 29, 1910), with the proposition, advanced in all seriousness, that the high percentage of insanity

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