body, when produced in excessive quantity, to cause an "overflow," so to speak, into the circulation.

In my experience with rheumatic affections, I have so frequently noticed this excessive formation of uric acid, as shown by an examination of the urine, that I regard it as symptomatic of a tendency to rheumatic troubles, even before the patient has the attack. Uric acid is produced in the system by a stimulating, nitrogenous diet and the use of alcoholic beverages. In the treatment of rheumatic affections we first prohibit entirely or allow very sparingly, according to the nature of the case and the condition of our patient, an animal diet and alcoholic beverages, especially wines and beers. Next we give the saline mixtures of potassa and soda and the salicylates. Why? Because clinical experience shows such the best course to pursue.

Does not this treatment lessen the quantity of uric acid, which, by its irritating influence upon the lowergrade tissues of the body, gives rise to the rheumatic attack, consequently checking or "curing" the rheumatism? A case of sciatica, due to rheumatism, remains quiescent so long as the excretion of uric acid is normal in quantity, but as soon as the urine shows an excess, exacerbations manifest themselves, which disappear as by magic when the quantity is lessened to normal by a few doses of salicylate of soda or carbonate of lithium-washing out, as it were, the excess of uric acid from the system.

If such be the case, as clinical experience tends to show that uric acid in excess is a sole or prime factor in the causation of rheumatic affections, have we not the "key" of the trouble, whereby we may prevent a rheumatic attack in the education of our rheumatic patients to abstain from too free indulgence in an animal or nitrogenous diet and the imbibing of alcoholic beverages? Also, in the examination of their urine, as to quantity, appearance, hyperacidity, etc.; in the use of the mineral waters-Vichy, Seltzer, Carlsbad, etc.-as occasion may demand.

If such a course were universally followed, how much of the suffering of humanity might be greatly alleviated or wholly prevented! and a step made in advance in the prevention of disease.-W. E. Shotwell, M. D., in Medical News.

Roast and Baked Meats.-A writer in the Lancet (Scientific American, December 19, 1891) says that the adoption of the closed range has to a great extent caused the abandonment of the method of roasting our meats before an open fire, and substituted therefor the process of baking in a close chamber or oven. The latter no doubt is the more convenient and economical method, but it may be questioned whether it is as wholesome. In baking the

meat is, as it were, cooked in its own juices; the vapors exhaled from the warm meat are confined in the close oven and do not escape into the atmosphere, adding no doubt to both the flavor and richness of the food. At the same time the joint surrounded by this dense vapor does not yield its juices so freely as when roasted. Moreover, the gravy from the baked meat when cut always yields more grease than does that from roast meat.

It is this retention of the volatile aroma and unctuous juices that renders baked meat so popular, and no doubt with persons of strong stomachs it is not harmful, but when digestion is weak it is undoubtedly injurious, and when continued its use aggravates or causes indigestion, and in many instances considerable benefit has resulted from the physician's advice to the patient to have his meat roasted instead of baked.

Our knowledge at present regarding the respective digestibility of different fats is very imperfect; still the general and popular opinion is that the more oily fats are less digestible and more "bilious" than the solid, and it is these fluid fats which form the grease of cooked meats.

The author states that he does not wish to raise a

panic with regard to the useful oven, but merely suggests that baking may in some instances be the unsuspected cause of indigestion, in which case a return to the roasting jack and the open fire would prove to be a step in the direction of a rightful cure.

Antipyrine in Chorea.-In a paper recently read before the Societé Médicale des Hôpitaux de Paris (Bull. et Mem., Dec. 25, 1890), Dr. Charles Legroux states the results of the treatment of chorea by antipyrine in sixty cases observed throughout their course. He found that antipyrine had a beneficial effect in two-thirds of the cases, rapidly diminishing the intensity of the disease and shortening its duration; recurrence, however, took place in three-fifths of the cases. In the cases in which the drug failed this was found to be due in some instances to intolerance (vomiting, diarrhoea, etc.) or to cutaneous eruptions; in a few cases the drug seemed to have no effect on the disease. He found it necessary to give large doses and to reach the maximum dose in a short time. Between the ages of six and fifteen doses as high as three to six grammes (about 3 iss to 3 iij) a day were well tolerated for several weeks. Serious symptoms of poisoning were never observed, and in some cases in which an eruption or vomiting was at first noticed, when the use of the drug was resumed after a short interval, these symptoms did not recur. None of the cases treated had any rheumatic symptoms, but none were of a serious character.--Medical Annals.

The Medical Calendar.

PUBLISHER'S MISCELLANY.

DIET IN INFLUENZA.

If there be one certainty in the history of that erratic malady, la grippe, it is that in all its forms, and all its varied manifestations, there is present a condition of general debility.

With the general enfeeblement of the body, there is to be found a special debility of the digestive system, of an analogous character. In the present epidemic there has been little active gastric irritation; but rather a condition of languor, little or no appetite, very rarely any longing for special foods; but marked debility if a meal-time is passed without eating. At the same time the stomach is easily overloaded; and if a comparatively full meal be taken, disproportionate symptoms of indigestion show themselves. If gentle laxatives be administered, such as castor oil, violent purgation is apt to follow, such as occurs when purgatives are administered in the first stages of typhoid fever. From this it is evident that in influenza the food should be such as presents the least difficulty to the digestive organs; it should be given in small quantities and at frequent intervals; while very small doses of gastric stimulants, if any, are to be permitted. The artificial digestants, on the contrary, are to be given in full doses. The raw white of an egg; raw, scraped beef, slightly warmed, and moistened with Proctor's wine of pepsin; junket; custard; kumyss; clam juice and milk; milk oyster soup; café au lait; chicken jelly and stewed tripe are suitable foods. Nothing answers better than a preparation devised by Professor Keen, and already described in this journal, but which will bear repetition: The whites of two eggs are put in a pint bottle, with two ounces of lime water, and shaken vigorously for five minutes. Half a pint of pure milk is added, and the shaking repeated. Then add port wine or brandy, sugar and nutmeg, to the taste, and give at stated intervals; keeping cold in the meantime.

It is better to leave out the sugar, spice, and alcohol, as most invalids prefer the foods without these ingredients.

Whatever food be given, the quantity should not be large; say, a small teacupful, given every two three or four hours. A large bowl of broth will sometimes bring on a violent headache. If the amount of nutriment in the cupful be insufficient, it is best to increase the nutritive value without adding to the bulk. This may readily be done by adding bovinine from a few drops to a teaspoonful, to each cup of food. The alcohol in this preparation is too small in quantity to be

objectionable in any case, and the bovinine acts not only as a food, but apparently as a peptogen.

Bovinine should not be confounded with other hematic preparations, some of which are totally unfit for use in a sick-room, being disgusting to the taste and of decidedly unpleasant odor, and swarming with bacteria, while others are of very little nutritive value. No article whose odor disgusts the healthy can be fit to offer those whose sensibilities are heightened by illness.-HERMAN B. MARCUS, M.D., in Times and Register.

CHEMICALS IN THE KITCHEN.

Said an American professor, speaking of the ammonia with which most of the baking powders are mixed: "No matter how small the quantity, I must decline to be dosed medically without my consent when taking my meals." And so it appears we are all dosed medically when we eat bread or other articles of diet to which baking powder had been added.

It is well known that bakers use ammonia carbonate

gas.

very largely in order to make their bread white and light. The general opinion has been that the heat employed in baking drives off all the ammonia, so that no harm is done. It appears, however, that this is theory only, and a very natural theory it seems, because we know that if a piece of ammonia is placed in the oven the heat will cause its entire disappearance; that, being volatile, it goes off in the form of But ammonia put into an oven and put into bread are not exactly parallel cases. In the latter we must not forget that the ammonia is mixed up with various substances-starch, gluten, and the like; and, according to some careful experiments made by Dr. Enderman, of the American Chemical Society, the ammonia carbonate is not dissipated from the bread in baking. His explanation is, that the ammonia is only made to permeate the dough, but that in cooling it is re-condensed by the formation of ammonia bicarbonate, and this stays in the bread. Again, he says, the ammonia is retained by the gluten in chemical combination, and that the gluten is thereby altered in its chemical properties.

He made the following experiments. He had three loaves baked. In one he used a pure and genuine baking powder, composed of cream of tartar and bicarbonate of soda. The second he mixed with cream of tartar, tartaric acid, bicarbonate of soda, and carbonate of ammonia. With the third he used carbonate of ammonia only. The result was that, after baking, he found ammonia in the second and third, but not in the first loaf. These experiments were still further prosecuted. He proved not only that ammonia was retained in the bread, but that the nutritive and digestive properties of the flour was much altered. The constant use of ammonia neutralizes the gastric

juice, and therefore interferes with digestion, and further may produce irritation and congestion of the stomach.

Those of our readers who are at all dyspeptic should avoid baking powder that contains ammonia, and should shun the baker who uses ammonia in his bread, and, if he can find him, give his patronage to a baker who does not.-Popular Medical Monthly.

Therapeutic Action of Certain Herbs and Vegetables.--Thyme, marjoram and sage are digestive tonics and antispasmodic. Sage is also slightly astringent and diaphoretic and in an infusion of 30 grammes to half a litre of water is an excellent drink in cases of common colds. Saffron is not used

as much as formerly as a medicine, and very little, if at all, in cooking, yet it is useful as a stomachic in nervous dyspepsia, and as a stimulant drink for children. Anise seeds are carminative and tonic; vanilla, and all spices, such as pepper, ginger, etc., are good digestive stimulants. Ginger has diaphoretic properties; cloves and cinnamon are astringent and antispasmodic, relieving nausea and flatulency in dyspepsia. Nutmeg is a good digestive stimulant if used in moderation. Water cresses, celery and chicory are tonic, diuretic, and useful in rheumatism and nervous disorders. Carrots, radishes and turnips are laxatives and diuretic. Italian singers drink the juice of cooked turnips for impairment of voice. Beets are nourishing, and laxative. Jerusalem artichokes are useful in rheumatism, as well as celery, radishes and asparagus. Potatoes are nourishing and slightly sedative. Cucumbers are purgative, tomatoes healthy and refreshing when eaten raw, because they contain

mineral salts and a volatile oil which is lost in cooking. Lentils are very nourishing; lettuce is diaphoratic, slightly narcotic, and has a favorable action on the digestive organs. All kinds of onions constitute a very valuable food. Garlic, which has a stronger effect than other varieties of onions, when roasted and applied as a poultice, is an excellent remedy in cases of sore throat, earache and toothache. Crushed and applied to the soles of the feet it excites the circulation and nervous system; administered internally it is a good stomachic, expectorant, and antispasmodic, arresting convulsions in children and inducing sleep. Horse-radish is a digestive stimulant of great value, especially useful in scurvy and rheumatism. Mustard is tonic, stomachic and stimulant either in the form of the seed or powder; it is also an efficient emetic. All kinds of pepper are serviceable in malaria and dyspepsia, cayenne pepper being the most useful.-Journal de la Santé, January 3,

1892.

Moral Value of Physical Culture.That a certain amount of exercise is needful for health

is one of the few things on which all doctors are agreed, and one of the still fewer things as to which medical teaching is submissively accepted by the non-professional public. Unfortunately, intellectual assent no more implies practical performance in the domain of hygiene than in that of morals. It is by those "in populous cities pent," by professional and business men chained to the desk of the consulting room, and by women, that exercise is most apt to be neglected. With regard to young ladies, indeed, it is not so very long since nearly all exercise worthy of the name was tabooed by Mrs. Grundy as only fit for "tomboys," and as tending to give an appearance of robust health which was thought to be incompatible with refinement. More rational notions are now be

ginning to prevail, however, and the limp, anæmic maiden, with uncomfortable prominences, is rapidly giving place to a type more like the Greek ideal of healthy womanhood. The ruddy-cheeked, full-limbed girl of to-day, who climbs mountains, rides, swims, rows, and is not afraid of the health-giving kisses of the sun, is a living illustration of the value of exercise. She is healthier, stronger, more lissom, and withal more intellectual, more energetic and self-reliant, as well as more amiable and better tempered than her wasp-waisted, beringleted great grandmother, with her languid elegance and her Draconian code of feminine decorum. In the physical betterment which is so conspicuous in girls of the periol, lies the best hope for the future of our race.-Sir Morrell Mac

kenzie in the New Review.

The Spray in Febrile Conditions.-Dr. Preyer (Gyógyászat, 1891), advocates reductions of febrile temperatures by means of spray in place of the cold bath. Placzek has modified the procedure of Preyer in that the nude body is first sprayed with water having a temperature of 15 to 20° C., and then with warmer water. The patient is either immediately rubbed or allowed to remain wet for some time. The same precautions are necessary as those which apply to cold baths, the advantage of the spray over the latter being that it is less troublesome.-Blätter für Klinische Hydrotherapie, January, 1892.

Comparative Effects of Various Bromides.-M. Feré refers to the feeble toxic power of strontium, which is nearly one hundred times less than bromide of potassium. This is a very important fact when it is considered that bromide of strontium seems to fill all the indications of the bromide of potassium even when large doses are required, as in cases of convulsions.-Exchange.

Bonuzzi's Method of Treating Tabes.— Prof. Benedict (Wien. Medicin. Blätter, No. 51, 1891,) states that Dr. Pietro Bonuzzi has originated

Το

a method of mechanical extension, which possesses the double advantage of not requiring the use of an apparatus, and exerting a much more effective therapeutic action than the suspension treatment. The method is carried on as follows: A handkerchief is tied around the ankles, and by means of this the legs are drawn so far forward over the head, that the spinal column is strongly curved anteriorly. This flexion movement is continued to such a degree that the knees are pressed against the forehead. practice this procedure the patient is placed flat on his back, with the head raised by a pillow. In a work published in 1890, Bonuzzi reported a case of locomotor ataxia, in which he had employed this method with striking success. Since the appearance of this publication, Benedict has resorted to this treatment in a large number of cases, and his results are astonishing. Patients who were almost entirely unable to stand, were improved to such an extent that they could take long walks with or without the aid of a cane, and could stand and walk firmly. In neuralgia even more striking and successful results were obtained.

Great caution is indicated in employing this method, as it is easy to produce rhachialgia, swellings on the flexor side of the thigh, in consequence of hemorrhages into the muscles, and even suffusion of the skin. According to Benedict's experience, the method of Bonuzzi completely replaces suspension in the treatment of ataxia.—Blütter für Klinische Hydrotherapie, January, 1892.

Wakefulness.-Continued wakefulness is a crying call to review one's habits and see what is wrong. There is, perhaps, mental unrest, irritation, or overwork, in which case laziness is to be assiduously cultivated. We may depend upon it, there is some want of balance. One chord is played upon too much, others are silent, and so the mental mechanism is all out of tune. Wisdom, then, dictates a reconstruction of habits. At all events, the wise person will not resort to opium, chloral, or any other sedative that steals away life while soothing it, and fixes habits which cannot be overcome.

Much depends upon the power of dismissing thought and becoming almost a blank. Napoleon had this faculty, and many another noted person. The late Lord Napier was believed by the British officers to owe his immense strength and power of endurance to the faculty of going to sleep at any moment when not particularly engaged. One of the famous politicians of Massachusetts, now an old man, yet with the vigor of a boy, has the same gift. In all these and in similar -cases there is both concentration and determination.Good Health.

Feeding in "La Grippe."-The loss to the profession of Sir Morell Mackenzie, resulting from an attack of the "grip," recalls attention to his able article on the subject published in the Fortnightly Review last July. Dr. Mackenzie pressed the opinion that the disorder was a "poisoning" of the entire nerve system, and therefore liable to develop itself in any tract where lesion existed or where the duty of function was not minimized. He cites the "stirring up disorder and pain in different parts of the body," sometimes locally transient, but a "profound impression on the nervous system," with a "deterioration of nerve force, prolonged and sometimes permanent." He points to stimulating and a building-up diet, inferring the value of dietetic and hygienic treatment to ease and assist functional activities.

Dr. Delafield, in a recent discussion of epidemic influenza before the New York County Medical Society, noted the importance of full nutrition, but also said that "acute catarrhal gastritis, where nothing could be retained on the stomach, was another bad sympHe said that food must be forced on patients by way of the stomach; there were frequent cases of people starving to death when they took only champagne or whiskey.

tom."

The important article in our February number on "The Starch of the Banana as a Food for Invalids," by Dr. Wm. Gilman Thompson, showed some remarkable results in retention and easy digestion with this "starch of fruit" when prepared as Bananose for enfeebled digestion.

Dr. Thompson's experiences show that this new food material makes less demand on the digestive fluids and organs than cereal starch food, while it is stated to carry an additional value in nitrogen. This may prove of interest in any case where digestive duty should be minimized, as Sir Morell Mackenzie indicates for the "grip."

Administration of Alcoholic Beverages to Children.-The Journal de la Santé calls attention to the habit many persons have of giving infants and children alcoholic beverages like whiskey, brandy or beer to induce sleep. This practice cannot be too strongly condemned, for aside from the injurious effects of alcoholic drinks upon the child's system, the restlessness can be more effectually controlled by a tepid or warm bath given at bed time, especially during the period of dentition. When young children are delicate, a few drops of brandy given occasionally in milk, may have a good effect, if the child suffers from digestive trouble. It should be remembered that 15 to 20 drops are ample for a baby and a larger quantity should not be administered without the physician's advice.

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 43.)

He holds that the excess of uric acid in the blood (actual urate of soda) does not signify the materia peccans which irritates the gouty joint; it does not furnish the cause of the local manifestation and basis of the local deposits; but, on the contrary, the uric acid dyscrasia of the gouty is really the consequence of a disturbance of tissue metamorphosis in the affected parts, especially in the joints. In this change of the innermost function of the histological elements of the tissue (perhaps in certain ones as in the joints, etc.), in this alteration of the chemical consumption activity, and not even in its anomalous products or in the presence of uric acid, instead of urea, nor in the deposits of urate of soda; does Cantani find the real nature of the gouty diathesis. He regards it as an anomaly of the constitution of the individual, a disease of tissue change. Consequently, gout may be termed the result of a partial retardation of the latter with a stasis of the metamorphosis and oxidation of nitrogeneous substances in the grade of uric acid. The apparent contradiction existing between the theories of the most able exponents of gout, may fortunately be readily reconciled therapeutically.

With regard to Rheumatism we have a similar difference of opinion. The retention of lactic acid is according to Senator and other judicious observers, the essential element of this disease. The great tendency of muscles and joints to diseases due to cold is well known. Says he (Diseases of the Apparatus of Locomotion, Ziemmsen's Handbook XIII.). "In both there are active processes of tissue change, especially are lactic acid and phosphate of

potash formed in the muscles. These are not normally eliminated when the skin is suddenly cooled; hence they accumulate. This is proved by the occurrence of rheumatism in diabetic patients, reported by Foster and Kuelz, as having been treated by prolonged use of lactic acid." Here, too, we have a perverted nutritive process, whose products are turned into faulty channels. For therapeutic discussion therefore, we may combine these maladies; though they differ essentially in many respects both as to their etiology and nature.

We have in both diseases the manifestation of a vicious mode of life or of exposure to other deleterious influences, combined nor ot with inherited tendencies; which but too often play an important role in etiology. We must address our treatment in both to improving the digestion and assimilation of food, increasing elimination of effete products, and, by supporting the strength, enhance the patient's powers of resistance. The utter futility of medicinal treatment for these purposes is evidenced by the multiplicity of remedies which have accumulated in our books upon the subject.

To accomplish any valuable result in such a malady, to rearrange as it were the entire nutritive system, to divert it from its vicious tendencies, to remove products of retrograde tissue metamorphosis and to prevent their reproduction, experience has shown may best be done by physiological agencies, as diet, exercise and certain hydriatic measures.

It is my custom to give these patients a diet containing the smallest possible quantity of nitrogenous material. Red meats are forbidden; also the white of eggs, fermented liquors-indeed all foods or drinks which tend to increase the production of urea and uric acid. So long as the best clinicians are unable to agree upon the true pathology of these diseases, and the best diet for them, a nutritious, medium diet, like the above, has seemed to me to be the most valuable. As Semmola has shown, there is no method of treatment which has given such remarkable result in these disturbances of tissue change as judicious diet, and exercise, combined with hydrotherapy. Massage in the more painful stages, passive exercise in the sub