129 DEPARTMENTS PEDIATRICS. IN CHARGE OF HUBERT WORK, M. D., PUEBLO, COL. President of the Colorado State Medical Society; Ex-Member Colorado State Board of Medical Examiners Physician in Chief to the Pueblo Children's Home, and to the Children's Department Pueblo Hospital. Hyoscyamine in Retention of Urine.-Two years ago I attended a very severe case of typhoid fever in a patient twelve years of age, in which I was confronted with retention of urine, To have applied the usual treatment (catheterization) would have required an anesthetic or strapping down. In my dilemma I thought of the relaxing effect of hyoscyamine, and so gave every fifteen minutes until the desired effect was induced. I have since tried it in a number of cases, and though it requires four or five doses I never failed to relieve the patient.-Fretz, in Medical World. For Croup. Two drops of fluid extract Jaborandi every hour will be found to afford material benefit. It is especially indicated in those susceptible to hoarse cough suggestive of croup, on every change of the weather. Infantile Therapeutics.-Luzet (British Med. Jour.) gives a critical review based on the work of Legendre and Broca. The special points really consist in the phases of development in the infant, in the special feature of disease which here proceeds rapidly towards aggravation or recovery, and in the physiological peculiarities of more active metabolism, or more rapid absorption and circulation, of intact emunctories, and of a more impressionable nervous system. In regard to feeding, the regular increase in weight must be depended upon. A tuberculous nurse must not be employed, for if bacilli do not pass out with the milk, toxines can; in addition, the milk is less rich in fat and caseine. Overfeeding the nurse must be avoided. Of course artificial feeding is only a method of necessity. The therapeutic bath is used to reduce temperature; the bath is then gradually cooled from 2 degrees F. below the child's temperature to 80 degrees. F.; it is useful in enteric fever, severe scarlet fever and cerebral rheumatism. The bath with increasing temperature, is of value in collapse, such as occurs in diarrhea; it may also be a vehicle for certain medicaments. More strictly therapeutic measures are then discussed in the following order: 1. Evacuating medicines. The stomach tube is very useful, as well as intestinal injections and emetics. Apomorphine is dangerous. 2. Promotion of excretions. The best diuretic is water. Large rectal injections of cold water constitute a good method of inducing diuresis. In uremia, icterus, and all intoxications, large injections are useful. Cold baths are also of service in increasing renal excretions. Digitalis is well borne by children. Diaphoresis is best obtained by physical agents-heat, wet sheets, hot drinks. Diuresis is more efficient than diaphoresis. 130 3. Sleep should never be interrupted in disease, with very few exceptions. It may, at times, be necessary to induce sleep. This may sometimes be done by removing something which interferes with sleep. Physical agents are again the best means, such as tepid baths, etc. Opium requires caution; chloral is useful; bromides and antipyrine may be of service. 4. Fever is controlled by external agents, baths, etc. Quinine, antipyrine, and sodium salicylate may be useful adjuncts. 5. Food is the best tonic. Alcohol is the best stimulant. 9. Antiseptic medication plays a very important part in infantile therapeutics. Carbolic acid in any form must be avoided. The mouth should be cleansed with alkaline lotions. Glycerine is a good non-fermentable medium. Antisepsis of the stomach may be procured by washing it out, and, together with the intestine by the use of bismuth salicylate, salol, etc. Calomel is a powerful intestinal antiseptic. Antisepsis of the large intestine is obtained by means of irrigations containing naphthol, etc. It is indicated in typhlitis, appendicitis, membranous colitis, etc. Acute and Chronic Urticaria.-Dr. R. Abrahams (Med. Rec., N. Y., 1894, xlvi, 342) advocates the use of hydrochlorate of pilocarpine. For a child one year old the dose is from one-twentieth to an eighth of a grain in distilled water every evening at bed-time. For a child from two to three years old, the dose is from one-fifteenth to one one-sixth of a grain. By administering tae alkaloid gradually, feeling one's way as it were, no untoward action should be anticipated. What is the Duty of the State and of Medicine as Rfgards the Congenital Idiot, the Hopelessly Insane, etc.?-This is a question that presses more and more upon our attention. Some two thousand years ago Plato praised the physician who should refuse to lengthen their lives. In a recent paper read before the University Extension Classes at Oxford, England, our esteemed colleague, Dr. Billings, has also asked why we should expend time and money to prolong these lives. Dr. Billings hazards no answer to to the question, but its mere asking implies that, economically at least, there is but one answer. But the economic aspect is by no means the only one. Leaving aside sentiment and religion, we may consider it simply scientifically. The idiot and the insane may be considered as scientific problems. However impossible the solution just now, the presence of these problems, the existence of the beings themselves, keeps before the mind the everlasting interrogation. We would only put the problem out of sight, not answer it, by killing the problem-maker.-Med. News. Large Dose of Sulphonal for a Child.-(Hill, in Med, Rec.)—The child was eighteen months old, and had taken 34 grains of sulphonal in a little over six hours. The child was apparently unconscious, pupils contracted, breathing shallow but regular, pulse 120. The case ended in complete There was one very apparent peculiarity, viz: ptosis of both eyes, which continued for four days and was very marked. 131 LARYNGOLOGY AND OTOLOGY. IN CHARGE OF WILBUR W. BULETTE, M. D., PUEBLO, COL. Laryngologist and Otologist to Pueblo Hospital; to Pueblo Children's Home; Member American Medical Membranous Croup.-Woodburn, (Jour. of Amer. Med. Asso.) in an article on this subject, concluds as follows: I. That there are two forms of membranous laryngitis; one a true diphtheria, produced by the KlebsLoeffler bacillus, and the other non-contagious membranous laryngitis, produced, if you please, by streptococci, staphylocci, etc., and that both of these types are verp fatal. 2. That membranous croup, as we have heretofore understood it, is a disease of much less frequency than was formerly supposed. 3. That it being impracticable to make a bacteriological examination of the membrane in many cases, and as this is the only method by which we may be absolutely positive of our diagnosis, the same precautionary measures should be taken to prevent a possible spread of the disease as would be adopted in a case known to be diphtheria. Those who believe that a non-contagious membranous croup does not exist, will hardly be favorably impressed with the idea of guarding the house, isolating the child, and causing any other children who may be members of the family to remain from school several weeks, but in the light of our present knowledge upon the subject, it is the only safe method to pursue, unless a careful microscopic examination by a competent bacteriologist has demonstrated the absence of the Klebs-Loeffler bacillus. Pathogenesis of Diphtheria.-Th. Escherich (Wien. Klin. Wochenschr.) says that the investigations made in the last few years have demonstrated the fact that the characteristic bacteria alone, found in certain diseases, are by no means always sufficient to cause that disease, but that certain other points must come into consideration. For diphtheria, he believes the following points to be of great importance for the pathogenesis of the affection. I. In the production of the diphtheritic affection, the presence of a specific susceptibility of the organ to be affected, is necessary, besides the bacillus, and the possibility of its invasion. 2. The effect of the local and general disposition being secondary, the greater or less degree of virulence of the bacillus will determine the course of the individual affection. 3. Other, even sophrophytic bacteria and their chemical products may be of influence in the extent and clinical course of the disease. The cure of the disease is effected by the making immune of the diseased organ, so that the previously present disposition can be removed, or even changed to the opposite. The immunity, however, is of short duration, and cannot guard against a second attack, though the latter is, as a general rule, light. 132 Our Book Table. DOSE-BOOK AND MANUAL OF PRESCRIPTION, with a List of Official Drugsand Preparations, and also many of the Newer Remedies with their doses; By E. Q. Thornton, M. D., Ph. G., of the Jefferson Medical College, Philadelphia. W. B. Saunders, Publisher of the New Aid Series, pp. 334. 1895. We can cordially commend this book. It embraces every thing a physician desires in such a work. Every medical student should have it; and the great majority of practitioners will find it very useful. A new feature in such books which the author has presented, many practitioners who write prescriptions, and have not studied Latin, may not fully appreciate, but they will find it instructive. This part of the book may be studied with profit by all such. NOTES ON THE NEWER REMEDIES; Their Therapeutical Applications and Modes of Administration; By David Cerna, M. D., Ph. D., Demonstrator and Lecturer on Experimental Therapeutics in the University of Pennsylvania. Pp. 253; price, cloth, $1.25. W. B. Saunders, Publisher, Philadelphia. This is the second edition of this work. The interval of two years offered the author the opportunity to revise his book and add such matters as the two years had brought out. It is difficult to keep pace with the synthetical remedies that monthly make their appearance. In this book the author has considered the most important; so that the physician has in it a newer materia medica limited almost to the synthetical products. It is a book that every physician ought to have. THE PHYSICIAN'S VADE MECUM; Being a Hand-Book of Medical and Surgical Reference, with other Useful Information and Tables; By Sebastian J. Winner, M. A., M. D., with Additions by Frank S. Parsons, M. D., Editor Times and Register. Philadelphia: Medical Publishing Co., 718 Betz Building, Publishers. 1894. Pp. 483. Price, $1.00. Looking at the contents of this little volume and the range of subjects. which they embrace, we might entitle it omnia in uno; more than multum in parvo. We may almost say that nothing is omitted that is of immediate. and practical interest. We can cordially commend it to every beginner in medicine, and to the general practitioner also, as something he will often find very useful. TWENTIETH CENTURY PRACTICE. This is the title of an international encyclopedia of modern medical science to be issued by Messrs. Wm. Wood & Co., of New York. 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