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applications, blisters and leeches must be used according to indications. I usually use atropia sulphate and cocain, four grains of each to the ounce of water. This solution should be used every half hour until the pupil is as widely dilated as possible, and thereafter enough to maintain this dilation. As the inflammation subsides the intervals can become longer. In severe cases I generally use the atropia every two hours for twenty-four to forty-eight hours, and then every three hours, and as the inflammation subsides, every four hours. I find that it cannot be used less frequently until the inflammation has nearly disappeared. Atropia may be used too frequently and for too long a time without producing any good results, and I have seen it used every two hours for a week and no change for the better, and just as soon as the interval was lengthened to four hours a marked improvement took place. I have seen this tried several times, and always with the same results. Atropia is indicated only often enough to maintain the dilation of the pupil.
In some cases atropia is not well borne. These are usually cases of cyclitis and irido-cyclitis, with increased tension. We should watch these cases, and if pain is increased by the atropia, or if the tension is above normal, we often have to suspend the atropia and sometimes use esserin instead.
When the inflammation and pain are severe, the application of hot water or a hot poultice gives great relief. Cold is not usually well borne, though sometimes when hot applications increase the pain, cold applications will relieve it.
Blisters to the mastoid or temple relieve pain, though I prefer three to six leeches in the early stage of the inflammation, if there is a great amount of congestion. Hypodermic injections of pilocarpin to produce profuse sweating sometimes rapidly relieve the pain and congestion.
A pupil that has obstinately refused to dilate under atropia, will sometimes dilate rapidly after leeches have been used or after the use of a hypordermic of pilocarpin.
Paracentesis of the cornea is of much benefit where there is increase of tension, and deposits in the anterior chamber, and if the acqueous is turbid.
During an attack of iritis the eyes should be protected by colored glasses. No violent exercise should be allowed; no stimuants of any kind; diet should be plain and nourishing, and bowels should be kept freely open. No straining of the well eye to read until after the inflammation has subsided and the pupil has returned to its normal size. Pain, if severe, and
not controlled by atropia and hot applications, requires an opiate.
In severe cases of specific origin the system must be gotten under the influence of mercury as quickly as possible, and I prefer doing this by inunction.
Traumatic iritis is often best treated or perhaps prevented, by early application of cold water for twenty-four hours after the injury, atropia should also be used from the start.
Iridectomy is performed in occlusion of the pupil to restore in some measure the sight, and in seclusion of the pupil to reestablish the communication between the anterior and posterior chambers, thereby preventing increase of tension and loss of the eye.
THE NEW FRENCH MARGARINE LAW
If dealers elect to sell butter it is absolutely interdicted to them not only to sell, but even to have in their possession a small quantity of margarine, for their own personal consumption; and they are told to observe that the designation margarine applies hereafter to all products which, not being butter, have any resemblance to it and can be applied to the same uses. If, on the other hand, the dealers decide to sell margarine, they can sell under that name all substitutes for butter, but they must watch that these products do not contain any coloring matter; and, moreover, must display on their warehouses an external sign, bearing in plain characters, at least thirty centimetres high, the words "depot" or "debit de margarine." Beyond this all blocks of margarine must be of cubic form, and bear an impression of the word margarine. This word must also be inscribed in plain and indelible characters on the wrappers, with the name and address of the vender.-Ex.
At the last examination of the Pennsylvania State Medical Board 445 candidates appeared, of whom 83 failed and 4 were expelled for copying.
SOME PECULIAR FORMS OF ENTERIC FEVER.
By J. A. Geisendorfer, Arlington, Oregon.
[Read before the Oregon State Medical Society, June 9,
Every member of this society has, no doubt, observed in this state, the departure of the symptoms of typhoid fever from the typical fever witnessed in the Middle and Atlantic
There is a general amelioration of all the symptoms from the fulminating typhoid, so characteristic of the Mississippi and Ohio valleys and the Atlantic Coast states. Especially does typhoid fever present peculiar, mild forms as ambulatory or abortive types in the eastern, arid and mountainous. part of this state.
So adverse to the usual type of typhoid fever is the disease that the profession has for years warmly discussed, with little harmony of opinion or scientific investigation, as to the etiology, pathology or classification of this disease, designating it abortive typhoid, desert fever, or simple continued fever. It is for the purpose of calling the attention of this scciety to this disease and awakening a discussion of its etiology, pathology and classification, that I present this brief paper, and not with a view to present anything new or to meet a "long felt want."
The reports that I have received from fellow practitioners located through Eastern Oregon, Western Idaho and Northern California, clearly indicate that the haematozoa of Laveran, together with humidity of atmosphere and altitude modify the symptoms and add to or lessen the severity of the disease. Seasons, age and social position exert little or no influence.
The fever usually commences by malaise. The patient exhibits the usual prodromes of the typical case of typhoid, two or six days of lassitude, partial anorexia, cephalalgia, myalgia and lumbago, with a temperature ranging from one hundred and six degrees Fahrenheit, which has a daily remission of two degrees during defervescence. Fifteen per cent. of the one hundred and seven cases I have treated were ushered in suddenly by a chill, followed by a temperature of one hundred and five degrees Fahrenheit. The nervous symptoms are either wanting, or they appear about the fastigium, demonstrated by restlessness, hyperesthesia, headache but no delirium, coma, subsultus tendinum, deafness or aphasia. Many cases present no evidence of any pathological lesion. The symptoms are those of simple continued fever. The tongue is slightly coated, with red edges. Later it is dry and brown but never fissured. No sordes appears.
In twenty-five per cent. of the one hundred and seven cases observed, the diet was the ordinary regimen of solids, viz: nitrogenous and hydro-carbonaceous foods. The temperature was not elevated nor the abdominal symptoms aggravated by this diet. Constipation prevailed in seventy per cent. of the cases. The stools were well formed, hard or dark and offensive, containing inspissated bile.
Enterorrhagia occurred in ten per cent. of the cases in an altitude over six thousand feet. Dr. J. C. Smith thinks this is more of a capillary oozing than a hemorrhage, from necrosis of the vessels. Microscopical examination of the feces revealed the presence of the bacillus of Eberth in seventy per cent., and the bacterium coli commune present in all cases thus examined. The abdomen was distended with gas and tender in twenty per cent. of the cases, but marked tympanites, with gurgling on pressure over the right iliac fossa, and rose colored eruptions were rarely present. The lymphoid structures of the colon, ileum and mesentery were rarely involved and peritonitis appeared in only six cases. The liver was hypertrophied and the portal system congested. The spleen was hypertrophied and tender on pressure.
The peculiar forms of this exhibition of typhoid fever are, I believe, due to influence of climate and altitude and the absence of all malarial influence. The short duration of the disease, the speedy recovery, the mild symptoms, especially of abdominal sypmtoms, the ability of the patients in twenty
five per cent. of the cases to eat solid food with impunity, all point to this conclusion.
The use of medicine to abort the disease has proven nega tive in my hands. However, cathartics and intestinal antiseptics have proven useful in lessening the severity of the symptoms and in hastening convalescence. There was but one death in the one hundred and seven cases and this resulted from perforation of the intestines and fatal peritonitis. Unfortunately the privilege of post mortem was refused, hence I have not made a study of the pathological anatomy. The average duration of the disease was fifteen days. The shortest period was six days and the longest period fortyseven days.
There is much typhoid fever throughout the area described which is of typical form and with fulminating symptoms, but the large proportion of cases are of a peculiar, mild type. If the mollifying factors are the absence of malarial poison, great humidity, and the arid and equable climate, could not the removal of some of the factors greatly modify typhoid fever in the geographical districts where this disease is so fatal?
In reply to a correspondent, Dr. W. F. Waugh advises the use of Europhen-Aristol in the treatment of endometritis, which has never failed in his hands. He mixes the powder with enough oil to make it of creamy consistence, and injects about ten drops into the uterine cavity. This is repeated twice a week.-Medical World, September, 1896.
Approval of the Marine Hospital Service.-A resolution was recently adopted in the Georgia legislature providing that in all future epidemics all quarantine matters be turned over to the United States Marine Hospital Service, and memoralizing congress to pass a national quarantine law.
Sanarelli, the discoverer of the yellow fever organism, is receiving honors and rewards for his excellent work.