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The Treatment of Arthritis in Phthisical Patients.-Dr. Sokolowski recommends in cases of pulmonary tuberculosis, complicated with arthritic phenomena, the cautious use of the alkaline bitter waters Marienbad and Carlsbad. The treatment must be based upon the following hygienic-dietetic principles:

1. As regards diet, albuminous food should be proscribed in the arthritic diathesis, but all fatty and starchy foods should be prohibited and alcoholic drinks restricted as much as possible, even when phthisis is present. The quantity of food administered should be in direct proportion to the amount of physical exercise and the age of the patient. Among the foods to be avoided are: milk, butter, cheese, eggs, cake, and sugary and starchy substances. Those which are permissible include: lean meats, fish, venison, well-baked bread in small quantities, vegetablesboth fresh and dry-especially the former, such as peas, beans, salads, asparagus. Potatoes may be allowed in small quantities, despite the abundance of starch in them, on account of their contained potash salts. Of fruits-apples and those containing only small amounts of sugar-may be partaken of. Among beverages, all spirituous drinks are excluded, especially beer; cold water, or a weak alkaline mineral water, like Giershübher or Selter, act very efficiently upon the kidneys.

2. The patient should take a walk of several hours' duration every day in the open air. During bad weather and in cases where the patient suffers from bronchitis during the winter, appropriate gymnastic exercises at home should be employed.

3. The regulation of the intestinal functions is of If disturbances occur, massage great importance. and the administration from time to time of a saline purge are indicated.

Results of a Prolonged Non-Albuminous Diet-Dr. F. Munk has found by experiments on dogs that a diet poor in albuminous principles, if continued for a number of weeks, produces disorders of digestion and a diminished assimilation of the other food substances, especially the fats. The strength and weight of the animals was diminished, there was great loss of appetite, and they became very sluggish. On addition of albumen to the food in place of a part of the carbohydrates no improvement was observed; but when the latter were completely withdrawn and the animal placed on a diet of fat and albumen recovery followed promptly-Medicin. Chirurg., Rundschau, Dec. 15, 1891.

Notes on Breast Milk.-After a thorough study of the subject, Dr. Ivanoff states that:

1. The cellules of colostrum are of epithelial origin.

2. In multiparæ colostrum changes to milk more rapidly than in primiparæ.

3. Puerperal diseases retard the disappearance of the colostrum corpuscles.

4. These corpuscles reappear in the milk after ten months of lactation, and when the infant is only partly fed from the breast.

5. The free hyaline corpuscles, as well as those which are enclosed in the fatty globules, form a constituent of normal milk at a certain period of secretion.

6. Good health, good nutrition, and youth in a mother give a milk richest in fatty globules of large size, as is also true of the cellules.

7. The last portion of milk taken at a feeding holds fewer globules, and these of smaller size, than the first portions.

8. The estimation of the nutritive quality of milk should be based upon the number of fatty globules; and secondarily, upon their size, the quantity of cel healthy condition is the application every day during lular element, and, finally, upon the quantity of gran

4. Attention must also be paid to the functions of the skin. One of the best means of keeping it in a

the entire year of the wet rubbing pack. If this is not well borne luke warm baths followed by brisk friction of the body may be employed at home. Steam baths are attended with danger of pulmonary hemorrhage.

A Simple Method of Dislodging Impacted Gall-Stones.-Lawson Tait describes the following simple procedure, which he has used in one case successfully. It consists in passing a fine needle through the wall of the intestine from below, that is, from the empty part of the intestine into the gall-stone. The stone is thus easily and immediately split up into fragments and passes readily along the intestine, and the grave complication of opening the intestine is rendered unnecessary. The operation is, in fact, little more than an exploratory incision.-Eccl.

ules.

9. Milk which contains a very large number of fatty globules (more than 3 1-2 per cent.) is no: well borne by very young infants.

10. Milk, the globules of which are large, is less nutritive and less well borne.

11. The maximum daily increase of weight of the child is produced by milk which contains a mean quantity of fatty globules of medium size (27.7 grams daily.)

12. The milk which contains few fatty globules gives little increase of weight (16 grams daily); and the same is true if the fatty globules are in too great quantity or are too large (10 grams daily).

13.

Women who are thin and young in general are the poorest nurses, often making the children dyspeptic and giving them a mean daily increase of weight of only 11.5 grams.-Maryland Med. Journal.

The Medical Calendar.

PUBLISHER'S MISCELLANY.

Gout and Fruit Eating.—In a recent number of his Archives of Surgery, Mr. Jonathan Hutchinson says that he has for many years been in the habit of forbidding fruit to all patients who suffer from the tendency to gout. In every instance in which a total abstainer of long standing has come under his observation for any affection related to gout he has found, on inquiry, that the sufferer was a liberal fruit-eater. Fruits are, by no means, all equally deleterious ; cooked fruits, especially, if eaten hot with added sugar, are the most injurious, the addition of cane to grape sugar adds much to the risk of disagreement. Fruit eaten raw and without the addition of sugar would appear to be comparatively safe. Natural instinct and dietetic tastes have already led the way in this direction; few wine-drinkers take fruit or sweets to any extent, and Mr. Hutchinson suggests as a dietetic law that alcohol and fruit sugar should never be taken together, and he believes that the children of those who in former generations have established a gouty constitution may, although themselves water-drinkers, excite active gout by the use of fruit and sugar.-British Med. Journal.

To Detect Copper Coloring Matter in Tea.--Sometimes worthless and exhausted tea-leaves are restored to their natural color and made to look like a superior article of green tea by coloring with copper or drying on copper plates. The addition of a little aqua ammoniæ to an infusion of tea thus colored will at once produce a blue color, more or less intense, according to the amount of copper present. The presence of copper coloring matter in pickles, preserved vegetables, etc., may be similarly detected. -Nat. Drug.

Raising Children in Bran.-This method was proposed by M. Pue at the Société Normande d' Hygiene Pratique. It consists of a cradle which has the wooden bottom taken out, and is then lined with a strong cloth. In this is placed sterilized bran to nearly half a yard in depth. A hair pillow is used. The baby has only a flannel shirt on and is naked from the navel downward. It is covered with a woolen blanket, and a wool-lined dress is kept to put it in when taken up for nursing. It has thus full liberty of movement in all its limbs, while its dejections pass at once into the pure bran, keeping the child dry and clean, even if there is diarrhoea. This method is a cheap one, the bran not costing as much as diapers.-Erch.

Digestion and Assimilation. Comparatively few members of the profession have paid as much attention to the problems of digestion and assimilation as their importance demands.

In that large list of complaints having for their cause, or at least their intensification, the improper or defective digestion and assimilation of food, few remedies of any real value have been producedPanerobilin, or Bili-Pancreatine, is of inestimable value in giving increased power to the intestinal absorbent vessels to take up and assimilate the most important elements of nutrition. This preparation increases the power to digest fats, and removes the repugnance to their digestion.

In neurasthenia, incipient phthisis, flatulence, constipation, and general debility, its value is manifest and unvarying. Messrs. Reed & Carnick have conferred a great benefit on the profession in the preparation of this remedy. Their more recent preparation of Kumysgen (tablets of milk for the ready production of Kumyss) is exceedingly useful. Thirty per cent. of the casine is soluble in the Kumyss thus prepared, and patients can assimilate it who cannot digest any other form of milk.

Bacteriological Examinations of Butter. Dr. Lafar has examined a large number of specimens of butter, and found from ten to twenty millions of microbes in one gramme of emulsified fresh butter. The number of organisms varied in the different specimens and in different parts of the same specimen. Butter, therefore, contains a much larger proportion of germs than cheese, which on the average contain five millions per gramme. The most numerous organisms present in butter were found to be a schizomycites, termed by him the bacterium butyri colloideum and a fluorescent bacillus ; besides these there were observed the bacillus acidi lactici

and the bacterium lactis aerogenes. As regards the influence of temperature upon the number of bacteria in butter, the author found that exposure for fourteen days to a continuous temperature of 9° C. only diminished the number of germs by one-third; while after exposure for four days in an incubator at a temperature of 35° C., the number was reduced by more than one-half, and after thirty-four days to only 5 per cent. of the original amount. The butter at that time was of course decomposed. The addition of sodium chloride (1 per cent.) produced considerable reduction of the number of organisms, but did not render it completely sterile when higher percentages of the salt were added. In artificial butter there was a much smaller proportion of bacteria.--Centralbe, f. d., Medicin. Wissensch, No. 1,

1892.

Ice in Phlegmasia Alba Dolens.-Dr. Jno. A. Miller speaks highly of the efficacy of the cold treat ment of the disease. He first used it in 1886, and since then has used it in six cases. In the first case in which he tried it the patient suffered from severe pains in the limbs, especially in the calf of the leg and inner aspect of the thigh, which could not be relieved by the customary remedies. The following procedure was then employed: An ordinary large towel was dipped into iced water, wrung out and clasped around the affected limb; a heavy flannel roller bandage was then applied from the toes upward to the groin. Flannel is preferable, because it does not get hard when moist, and remains softer under similar conditions than cotton material. On the most painful parts, like the inner aspect of the thigh, the popliteal region and the calf of the leg, rubber bags were laid filled with ice. These were kept in place by a circular binder, independent and outside of the roller bandage. The patient was a little shocked when the cold towel was first applied, but the unpleasantness was only momentary, and then the reaction brought ease and comfort. She desired the ice bags to be removed quite often at first, as she claimed they relieved the pain, as anything else had never done before. The morphine was at once discontinued. The pain was entirely controlled by the cold. The temperature dropped from 103° to 100° the next day, and the patient commenced to improve, which continued uninterruptedly. The towel was freshly dipped from four to six times in the twenty-four hours. As soon as the patient experienced relief, she was quite anxious to endure the temporary chill from a fresh compress, because the limb felt always better for it afterwards; as the towel soon became dry and hot, and this gave rise to painful symptoms again.-Pacific Medical Journal.

Chloralamide.-As compared with sulphonal, the dose of the former is larger, but it is somewhat cheaper in price. Chloralamide acts more speedily, is more readily dissolved, and is followed neither by delayed sleep, nor the mental confusion and dulness which I have noticed after the administration of sulphonal. Only one patient has complained of the taste of chloralamide, and she was in a very dyspeptic state the first time she tried it and speedily recanted.

It seems to have little effect on subduing pain, as my failures with it were in cases of rheumatic joint pains, acute headache and sciatica.

In only one case have I found headache after the drug, and that case was one of violent headache, vomiting and pain in the abdomen, due to over-excitement and dietetic error. Even here the headache disappeared at once after a cup of tea.

In the insomnia and delirium of the acute fevers such as the influenza, and acute pneumonia and pleu

risy, it acts very satisfactorily, and as I think, with ordinary limits perfectly safe.

Also in nervous insomnia from hard work, worry and anxiety, chloralamide, given in a fairly large dose, say 30 to 40 grs., is almost certain to be followed by a refreshing sleep.

It certainly is better than paraldehyde in cases of lung trouble, as it does not provoke cough or disturb the stomach-the latter drug is somewhat wont to do. In delirium tremens again, especially in the stage immediately preceding an actual outbreak, I believe it is of very great value. During an attack it can be freely used without any fear of prejudicial action on the heart, such as may be feared from chloral and opium. Generally speaking, though my cases are too few to draw final conclusions from, chloralamide reduced the frequency of the pulse, and made it fuller. It has one great advantage over its fellows, that patients do not get accustomed to it, and so want larger doses; in fact in several of my patients the drug seemed (after its effect for the night or nights) to produce an excellent habit of going to sleep without draught. Personally, I may say that on several occasions, when I have come home after a night-call, and have been utterly unable to sleep, 10 grs. of chloralamide has brought about sleep in a quarter of an hour which has lasted for six or seven hours, and then I have woke up perfectly refreshed.

For adults 30 grs. (in women 20 grs.) has generally been sufficient; I give it with a little dilute hydrochloric acid and syrup. - By L. M. Sympson in Practitioner.

The Yeast Treatment of Typhoid Fever. -Yeast has recently been tried in this disease by some of the physicians in the Alfred Hospital at Melbourne.

The report recently issued deals with thirty-seven cases treated by Drs. Embling, Lempriere, and Barclay Thomson. Dr. Thomson writes: "In all, thirty-seven cases have been treated. Ten were severe, the temperature reaching or exceeding 104°; eight moderately severe, temperature reaching or exceeding 103°; eleven were mild, although the temperature reached 103°; eight were very mild, the temperature never being above 102°. In all, recovery took place without any relapse. When commencing the use of the yeast, it occurred to me that if the theory that relapses are due to reinfection from the intestine is correct, then there should be none under the use of the yeast, as all the bacilli would be destroyed in the intestinal tube. This is so far borne out, for there was not a relapse in the thirty-seven cases under yeast; while in the 107 cases otherwise treated in the hospital there were sixteen relapses. The average proportion of relapses is given by Fagge as 2 to 11 per cent."-Lancet.

To Prevent the Spread of Entozoa.-Dr. Prospero Sonsino advocates the following sanitary measures to prevent the dissemination of entozoa among human beings :

1. If possible the sewers should empty their contents into the sea, but never into a stream. The adoption of a system of irrigation is advisable, if the above is not practicable, provided that the irrigated soil is planted only with such vegetables as are eaten in a cooked state, or better still, with plants which are not edible.

2. If the above-mentioned measures cannot be employed, and the destruction or disinfection of fæcal matter cannot be carried out in general, these precautions should at least be adopted in asylums, schools, and hospitals-the excreta being disinfected by heat, sulphuric acid (10 per cent.) or large quantities of

lime.

3. Persons engaged in certain kinds of work- such as in mines, tunneling, rice plantations, etc., should be compelled to defecate at places where the fæcal matter can be disinfected. The fæces of new-comers should be microscopically examined for entozoa before they are allowed access to the works, and it would be well to examine them periodically, so as to remove the infected persons at an early period.

4. Veterinary inspection of slaughter houses should be made daily, and all organs and parts of slaughtered animals which are found to contain entozoa.

5. The admission of persons infected with entozoa into hospitals should be made easier than it is now. 6. The pens in which hogs are kept should be inspected.

7. Dogs should be kept away from slaughter houses.- Centralbe, f. d. Medicin. Wissensch., No. 2,

1891.

The Treatment of Apepsia.-Dr. G. Hayem (France Medical) describes under this name a condition in which the stomach contents contain no acid. In some cases the hydrochloric acid has combined with the albumens, but these combinations give a neutral instead of an acid reaction, this being characteristic of apepsia. Occasionally the apepsia is obscured by the development of an acid reaction of the stomach contents in consequence of abnormal fermentation. In all the cases observed by Hayem the motor functions of the stomach were exaggerated to such an extent that it was difficult to obtain any gastric juice with the stomach tube. In many instances there are gastric disturbances, although the apepsia sometimes remains latent for several years. For this reason Hayem does not agree with Ewald in regarding apepsia as a gastric neurosis. Owing to the apeptic condition our therapeutics are not very effective. By dietetic measures the condition can frequently be alleviated, although the normal condition of digestion

can seldom be brought about. In some instances kefir (one to two bottles daily) acts very favorably.Dent. Medizinal Zeitg., No. 2, 1892.

Artificial Coffee Beans.-The manufacture of artificial coffee beans has, it seems, reached a stage of such importance in the United States as to compel the attention of the revenue officers. This is no new movement, indeed. It is now more than thirty years since the late Dr. Lindley, the botanist, presented to the director of Kew Gardens, London, a selection of carefully moulded artificial beans intended for mixing with the genuine article. They were made of finely powdered chicory and were an excellent imitation. The ordinary American artificial bean is, however, composed of rye flour, glucose and water, and is prepared to resemble in size and color a fairly good sample of roasted coffee bean. When mixed with the genuine beans these imitations acquire the aroma of coffee. It has been computed that twenty per cent. of the beans sold in the United States are artificial. The spurious beans can be made at a cost of $30 per 1,000 pounds, which, mixed with fifty pounds of pure coffee, finds a ready sale. Coffee substitutes are also sold openly like butter substitutes-one firm making 10,000 pounds a week. The wholesale vender thus escapes the penalty of violating the adulteration laws, but the retailers who buy the substitute know what to do with it. In Germany an imperial decree has forbidden the sale of the machines for making the false berry. Until the prohibition they were largely advertised.-Maryland Medical Journal.

Repression of Drunkenness.-The Congress of Alienist Physicians which recently met at Weimar has passed a resolution approving of the Bill for the repression of drunkenness. The clauses making confirmed drunkenness a punishable offense were, however, disapproved of. Such persons, it was recommended, should be treated as diseased, and as such placed in proper asylums.-British Med. Journal.

Cleanliness.-History shows that by cleanliness epidemics may be checked, many of them at least ; that police regulations, disinfection, and isolation are potential factors in stamping out the invasion of epidemic diseases, all this, too, without the least regard to the relative position of "Jupiter and Saturn." This is what should be fastened upon the public. Let all theories of epidemics go. Get clean and remain clean; see that overcrowding is avoided, that streets are cleaned, that back alleys and cellars are dry and clean; bathe regularly, disinfect privy vaults and all questionable places. These matters well attended to and epidemics will at least lose one of their favorite foods-filth.--Texas Health Journal.

Dietetic

THE

and Hygienic Gazette

A MONTHLY JOURNAL OF PHYSIOLOGICAL MEDICINE.

NEW YORK, MARCH, 1892.

Contributions and Selections.

THE SUCCESSFUL TREATMENT OF CHRONIC DISEASES. A PLEA FOR THEIR MORE METHODICAL MANAGEMENT.1

BY SIMON BARUCH, M.D., PHYSICIAN TO THE MANHATTAN GENERAL HOSPITAL, NEW YORK JUVENILE ASYLUM AND MONTEFIORE HOME FOR CHRONIC INVALIDS.

(Continued from page 23.)

The respiration is gently but slowly deepened when ever the cold water impinges upon the skin. The heart is made to contract with more vigor when the peripheral circulation is improved by the shock, and consequent contraction and subsequent dilatation of the cutaneous capillaries. The appetite is improved, tissue-change increases, and if there is a rise of temperature it is subdued mildly but surely. Of course these effects depend upon the intensity of the cold and the manner of its application.

TONIC EFFECT OF HYDROTHERAPY. That hydrotherapy has demonstrated its value as a tonic agent is a well-known fact. Its value in phthisis has been recognized by Brehmer, who even claimed to be the first one to apply it in this disease. Winternitz has shown that it must be an agent of decided tonic power, inasmuch as out of 2,400 guests at his institute in Kaltenleutgeben, which I have personally visited, 56 per cent. showed an increase of weight. Therefore, as nutrition is the chief aim in phthisis-therapy we possess in this method a powerful weapon which, rightly used, has demonstrated its value.

But, aside from this important consideration, the predisposition to repeated colds and consequent probable aggravation of the local processes and general symptoms may be diminished by the neuro-vascular discipline to which the skin is daily subjected by applications of cold water in some appropriate form. This hardening process has long been recommended for those predisposed to phthisis. Ziemssen speaks of

it in his lectures on treatment of tuberculosis as 66 a remedy of extraordinary value for persons who are predisposed to have acquired phthisis."

case.

TECHNIQUE.

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The technique of these procedures varies with each Brief applications of low temperature, as by the douche or rain bath; the wet pack, or rapid ablutions, are followed by rapid reactions, and, if well borne, are exceedingly useful as tonics; while, on the contrary, in cases suffering from elevated temperatures and great debility more gentle procedures and higher temperatures are required. I have myself seen damage done to these cases by too cold applications, which are better indicated in a febrile or mildly febrile, condition. This is contrary to views usually entertained on the therapeutic action of cold baths. My observation at the Montefiore Home for Incurables, in which cases of the most forlorn type, so far as previous hygienic surroundings are concerned, are received, has led me to adopt the following course, because the skin of many of these poor people have long been strangers to cold water, or, indeed, water of any kind.

After a thorough cleansing warm-bath or soap ablution, a day is allowed to elapse. The patient is now wrapped snugly, quite naked, in a woolen blanket, so that his entire body is excluded from air; other blankets are piled over him; the windows are opened, and he is given a small glass of iced water every ten minutes. Having lain in this position an hour, now hour, now one part of the body is exposed and bathed as follows: A basin of water at 75° 18 ready, into which the attendant dips his right hand, covered by a mitten or glove of Turkish toweling. With the wet glove the face is well bathed. Now one arm is exposed and rapidly washed and rubbed, then dried and replaced under the blanket. Other parts are then successively treated. At the termination of this ablution the patient is rapidly rubbed all over with a coarse towel. This treatment is repeated daily, the temperature of the water being reduced two degrees on each occasion.

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