Nature and Treatment of Chorea.

According to Coombs, (A. M. A. Journal, July 15, 1911,) chorea is an organic disease implicating the cells of the cortex cerebri, and those of the mid brain and pontomedullary nuclei in a less severe degree; that it is due to the action of rheumatic toxins on these cells; that all parts of the cortex suffer equally, and therefore the disease should not be regarded as one of motion only; and that, in spite of its extraordinary persistence, due to repetition of active phases, the general tendency is toward recovery. The motor symptoms are partly due to loss of inhibition, partly to cortical irritation. In chorea the fallacy of the distinction between "functional" and organic nervous diseases is exemplified. Chorea can be fatal without the occurence of meningeal inflammation. This fact, with the phenomena of latent chorea, suggests that chorea may be due to direct intoxication rather than gross infection of the cranial contents. The tendency of chorea is toward restoration of health to the brain. Treatment consists of (a) removal of the cause, active rheumatic infection, by rest in bed with administration of salicylates during the active stages; (b) prolonged mental and bodily rest during convalescence; (c) improvement of general health by fresh air, full diet, and tonics; (d) quieting of excessive movement by sedative drugs or packs, and cure of paresis by massage. The full-dose arsenical treatment is useless.

Sea-sickness. Kendall tried methyl valerianate and obtained complete relief from his sea sickness.

Joseph M. Aikin, (Omaha)

Placenta Praevia.

J. F. Baldwin, Columbus, Ohio (Journal A. M. A., July 29), reports a case of placenta praevia in charge of a very competent physician where he was called in. It was decided to adopt the Braxton-Hicks procedure, and with no difficulty he brought down a leg, as he had done in many previous cases. Everything seemed to be going well and there had been very little apparent hemorrhage. An hour later he was called again, as the patient was in collapse, and a glance at the abdomen showed the uterine tumor much larger than before, so that the diagnosis of internal hemorrhage was obvious. The child was immediately delivered forcibly by pulling and pressure from

above, and the birth was followed by the largest discharge of blood and clots he had ever seen, the patient dying a very few moments later. In spite of the very considerable literature on the subject of placenta praevia, he has failed to find any mention of the danger of concealed hemorrhage after the leg had been brought down by the Braxton-Hicks method. This case, however, showed that it is a possibility, though probably very

rare.

Carbohydrate Metabolism.

The work of Pratt and Spooner is of moment in studying the problem of carbohydrate metabolism; it shows that there is at least a compensatory mechanism for the pancreas in carbohydrate utilization. Complete atrophy and sclerosis of the pancreas can be produced by tying off the ducts in a dog. The atrophy is rapid and becomes practically complete in two months. The average glucose limit in normal dogs is 11.5 gm. of glucose per klio. In one dog 312 months after ligature of ducts the limit of assimilation was 6.5 gm. per kilo, at the end of 1 year 5.1 gm. The sclerosis of the pancreas was complete. Their experimental work carried out in several dogs is summarized as follows:

"There is a rapid decrease in the power to assimilate glucose after the onset of atrophy of the pancreas.

"The persistence of a low limit of assimilation for more than a year shows that the other organs of the body compensated imperfectly if at all for the pancreatic insufficiency. Diabetes did not develop in any animal, although in two the atrophy and sclerosis of the pancreas were extreme. It cannot be denied that the retained ability to consume sugar in animals with the pancreas almost totally sclerosed was possibly due to some compensating action elsewhere in the organism.

"The limit of assimilation in a dog with atrophy of the pancreas which had been under observation fourteen months was increased more than 100 per cent by feeding fresh panDunn (Omaha)

creas.

Magnesium Sulphate in Acute Articular Rheumatism.

Five cases of articular rheumatism are reported by Jackson, (A. M. A. Journal, July 15, 1911), in which he had excellent results from intramuscular injections of magnesium sulphate. The discovery of this active therapeutic agent in rheu

matism was the result of a last resort. A number of other cases of rheumatism were treated with magnesium sulphate by injections, local applications and internally. So far, the results in all have been excellent. Jackson gives the salicylates a chance first, but, when they fail to give results, he employs the magnesium sulphate treatment. The only reason he has for doing this is that many patients, especially nervous women, will object to the injections until after other measures fail. No pain, however, follows the injection, because the drug acts as a local anesthetic. He has not yet noted any unfavorable signs from its use despite the fact that we are told that magnesium sulphate injected into the circulation is a cardiac and a respiratory depressant. The technic is simple. Jackson employs an all glass Luer syringe of 5 c. c. capacity, observing all aseptic precautions, and selecting any muscle that is handy as the point of injection. At present he is using a 25% sterilized solution and injecting 4 c. c. into adults. Up to this time he has treated no children, but he says he should use it without hesitancy in the proportion of 1 c. c. of the 25% solution to each 25 pounds of body weight. In some cases the injections produce active purgation, and in others they have apparently no effect.

Joseph M. Aikin, Brandeis Bldg., (Omaha).

Cerebro-Spinal Fluid.

Kaplan summarizes his experiences in the examination of over 3700 cerebro-spinal fluids. The globulin reaction, cytodiagnosis, Fehling's test and Wassermann reaction were made on all cases. The absence of the Fehling reducing substance in the C. S. fluid is always associated with an acute meningitis. In chronic meningeal involvement the substance responsible for Fehling's reduction is always present. In acute meningitis the Fehling reducing substance begins to disappear as early as 24 hours after the first symptoms with the appearance of a violet color change; cause of the reaction is unknown. "The time is at hand when one will be able to exclude spinal cord or meningeal changes from a thorough analysis of the C. S. fluid." Affections of brain and cord leave definite impressions on the C. S. fluid. Therapy and the curative powers of the organism have a definite influence on the prevalence of the pathological constituents in the C. S. fluid. The absence of findings in patients not treated argues strongly against involvement of the cerebro-spinal system. Differentiation between the acute infections and chronic degenerative meningeal forms can

be decided by a study of the fluid. A history of syphilis and a positive serum Wassermann does not signify cerebral or spinal involvement even in the presence of nervous manifestations in the face of a negative C. S. fluid. Therapy affects first, the globulin content, then the serum Wassermann, thirdly the C. S. Wassermann, and lastly the pleocytosis. Dunn (Omaha)

The Wassermann Reaction and Alcohol.

Drs. Craig and Nichol's note (The Journal A. M. A., August 5), raises a very important practical point. The Wassermann reaction, though it has been found to occur in a few other diseases, has come to be pretty generally accepted as a practical test for syphilis, at least in this climate, and surpassing all others as a test for latent infection. If, however, we are to find it unreliable in case of alcoholics or, speaking more broadly, that its value is abolished by even moderate alcoholic ingestion, its practical use is seriously embarrassed. Most subjects of syphilis are at least occasional users of alcohol and if the test can only be accepted as of positive value when it can be definitely proven that they have not indulged in the use of alcohol for at least twenty-four hours or, still better, for two or three days before the test is made, then it will be only in hospitals or where the individuals can be kept under restraint that any positive conclusion as to the existence of syphilis can be obtained. A general public knowledge of this fact might vitiate all the Wassermann tests being made and this aspect of the matter is one worth considering.

Potassium Iodide.

George Dock advocates the use of potassium iodide until we are certain that we have something better in the iodine line to offer our patients. He uses a solution containing 1 grain of the potassium to the drop, and administers this solution in milk. He has not yet found a patient who could not take it or who had any difficulty from the local effect on the stomach. He objects strongly to the statement of the retail man pushing new iodine compounds, that patients cannot be got to take iodides owing to unpalatability or gastric irritation. He gives it in rather large doses, about 15 grains t. i. d. without any difficulty. Iodism, he thinks, is most likely to occur with small doses, and depends largely on lack of cleanliness in the skin and mucous membranes. Rarely we have to deal with a special

iodide idiosyncrasy, and some of the cases of iodide coryza with headache may well belong to this class. The more general symptoms, with nervousness, emaciation, tachycardia, etc., are really due to thyroid intoxication. With regard to the newer organic compounds, which are alleged by the manufacturers to have many advantages over the inorganic iodides, he points out that the actual pharmacological proofs in favor of these contentions are conspicuous by their absence. He concludes that while all the new preparations may be worth investigating, those who wish to do so should begin with a careful and unprejudiced study of potassium iodide. In his experience potassium iodide can be taken easily, with safety, and in adequate quantities by most patients who need it. Other preparations may prove to be better, but need to be tested; and recommendations based on the inferiority of potassium iodide should be looked on with suspicion.

In Arkansas.

The physician had taken his patient's pulse and temperature and proceeded to ask the usual questions.

"It-er-seems," said he, regarding the unfortunate with scientific interest, "that the attacks of fever and the chills appear on alternate days. Do you think-is it your opinionthat they have, so to speak, decreased in violence, if I may use that word?"

The patient smiled feebly. "Doc," said he, "on fever days my head's so hot I can't think and on ague days I shake so I can't hold an opinion.'

Obeying Instructions.

Judge (to burglar on trial)-Have you anything to say, prisoner?

Burglar-Yes, your honr, I was only actin' on me doctor's advice ter take something afore goin' to bed.-Exchange.

A college professor, noted for strict discipline, entered the classroom one day and noticed a girl student sitting with her feet in the aisle and chewing gum.

"Mary," exclaimed the indignant professor, "take that gum out of your mouth and put your feet in."