simply because the journals are sent to him for nothing? Wouldn't you rather have something of your own, something that is publisht in your interest exclusivly, and bay for it? Isn't it cheaper, and better in every way?

The True Etiology of Eczema, and a Rational Method of Attacking It.

Eczema has a well establisht place in medical nomenclature as a distinct disease, and it is generally treated as such. We believe that the malady would lose much of its terror for practician and layman if we altered somewhat our point of view. The patient sees the local lesion and expects us to "put something on it," and we can generally gratify him in strict accordance with our selected line of therapy; but we should not allow ourselves to be swayed by his ideas to an extent that will be certain to blind us and make our course obscure, and cause us to neglect searching out the primordial cause. If we would but consider eczema as a symptom rather than a disease, our local medication would appease the patient and our remedies directed toward the vicious constitutional diathesis would cure him.

Careful study of any given case of eczema will convince the clinician that the disorder has its fount in one or more of the following constitutional conditions: (1) The strumous diathesis. (2) The uric acid diathesis. (3) The nervous temperament. Therefore, the basis of a rational attack must be determined by the stronghold of the causativ vicious state. Our effort should be to eradicate that, or so nullify or neutralize its effects that we may gain ascendancy over the local lesion. No known local remedy will cure a severe case of eczema due to the uric acid diathesis. The patient is a victim of a metabolism which continually produces large quantities of uric acid; but, increase the elimination of the uric acid and limit its production, and probably some discarded local application will speedily "cure the eczema." In the strumous diathesis, the logical method of attack is along the same lines, but the method of assault may be more difficult and the best route hard to find; yet, just so soon as we succeed in making an impression on the constitutional condition by attaining an improvement in the general health, just so certainly will the eczema improve, and perhaps more rapidly if aided by local medication. That variety of eczema noted in nervous persons, and which is so often accompanied by pruritus, or in which the pruritus seems to be the sole symptom, is extremely obstinate and intractable, but it, too, will yield if the nerves have not undergone organic change, of if the excited functions can be calmed down.

These three conditions are often found so blended in a given individual case as to complicate a diagnosis; for example: the eczema of a rheumatic patient is frequently intensely aggravated by sudden profound emotion or great mental strain, and if we do not recognize the nervous influence our redoubled efforts against both the diathesis and the local lesion will be of no avail. The strumous case may be both nervous and rheumatic. The nondescript eczema which we often see as a consequence of a worn-out syphilitic taint, inherited from remote ancestors, may be properly classed as belonging to the strumous class.

Certain characteristics of eczema in certain individuals give us an insight into the diathesis we have to meet. When seen in a child, and the lesion exudes pus, it may generally be classed as strumous, and calls for iodids, codliver oil, iron, etc. The eczema of those in adult life is generally traceable to uric acid, and indicates alkalin purgativs and stimulants.

The local treatment includes the removal of any source of irritation from clothing, heat or cold in excessiv degree, filth, parasites, etc. The numberless drugs commended may be judiciously chosen from as regards their soothing, stimulating, and protectiv qualities. The oleates of lead and zinc are good applications ; tar, oil of cade, oxid of zinc ointment, etc., are old reliables.

When we realize that eczema is always the local expression of a diathesis, and that such a local manifestation may originate thru and be kept up by local irritation, then, indeed, we have adopted a rational line of reasoning that will bring us quick success.

What Will You Do for THE WORLD in 1903

The first issue of any given year brings solemn thoughts to the Editor of every journal. He feels not only his shortcomings by omitting to do things he ought to have done, and his transgressions in having done things he would better have left undone, but also the weight of the same delinquencies on the part of his subscribers oppress him.

We do not intend occupying much space by moralizing. If you are not better this year than you were last year, ask yourself why. After a thoro physical examination of THE WORLD we are glad to state that inspection reveals a clean, helpful, up-to-date medical magazine conducted in the interests of the profession alone, and untrammeled by entangling alliances with interests in the sale of any proprietary remedy or any other drug; palpation gives a normal vocal fremitus, the voice of the profession, from those arduously working in the ranks; auscultation discloses no abnormal or adventitious sounds; percussion by a few

adverse criticisms does not injure the chest wall, and the resonance has the true note; mensuration proves a rapidly increasing circulation which extends to every part of this great country, with a subscriber here and there all over the world.

We hope the members of the family are all at peace with the world and themselves. Our cuisine will continue to furnish a choice diet of ready assimilable mental food fresh from the experiences of general practicians and specialists.

Pre

THE WORLD will maintain its lead as "the popular medical magazine of America," and the editors will spare no effort or pains to merit our steadily increasing subscription list. The family will certainly do as it has always done-give the very best from the experience of the workers. Now let us get to work. pare at least one good article from the fund of your experience for publication in THE WORLD. Send a few of your favorit prescriptions. Get a medical friend to subscribe. These are some of the things you can do for the support of the family, and even the youngest member is expected to help.

Calcium Chlorid as a Hemostatic. We believe it was Mayo-Robson who first called attention to the wonderful power of this drug in checking hemorrhage after laparotomies. Since that time it has been used by many foreign surgeons in a variety of obstinate cases of hemorrhage from all manner of causes. Kehr praises it in operations for gall-stone. Formerly it was given only after the hemorrhage made its appearance; but its use has now extended until it is given before the operation as an additional safeguard. It is said to act by increasing the coagulability of the blood. It has the advantage of only requiring a few doses to produce the full effect and of acting promptly after ingestion.

We call attention to it because of its reported efficiency from so many different competent observers; because its use seems unlimited along this line in that no contra-indications or adverse effects are recorded; because the latest text-books are silent regarding it, or merely mention it without describing it or giving its indications; and because we should not neglect such a valuable agent. We do not suggest or advise the practician to attempt untried experiments, but we implore our readers not to neglect a drug which has proven of such use where our older medicaments are too slow or are totally inefficient.

We have not seen its use advised in typhoid fever to prevent or check intestinal hemorrhage, but it should be tried there. It should be used in the hemorrhages of hemophiliacs.

Obstinate hemorrhage from any cause would seem to call for its employment.

Mayo-Robson (Diseases of the Pancreas, just off the press) describes a severe case of oozing from a laparotomy wound which was almost immediately checkt by calcium chlorid. Kehr (Gall-Stone Disease) gives it both before and after operation. Mayo-Robson directs a dram every two hours for two doses, then half a dram every two hours for six doses, then three times a day. This was just after hemorrhage began. Kehr gives 1.8 grams three times daily for several days preceding operation, and 3.6 grams by enema following operation. It is not best to give it in full dosage longer than four consecutiv days.

The Walcher Position in Labor.

The country practician who is often beyond the reach of aid or counsel, compelled to grapple with the sternest problems the obstetrician ever is called upon to meet, should be familiar with every harmless device which will facilitate labor. The Walcher position, properly assumed at the right stage of labor, is of great assistance, yet many text-books do not mention it at all, and comparativly few medical journals have given it enuf space to describe it comprehensivly. One of the best descriptions we have seen is that given in The Practise of Obstetrics by American Authors, as follows:

"It is well known that the sacrum, especially in the later months of pregnancy, is capable of a slight nutatory motion on a transverse axis passing thru its second vertebra. Walcher, in 1889, called attention to the importance of utilizing the mobility of the sacroiliac joints in difficult labor. The sacral promontory lies in a plane above the axis of rotation and in front of it. The promontory, therefore, moves forward and backward, according to the changing inclination of the pelvis in different postures of the body, and the tip of the sacrum, of course, moves in a reverse direction. When the woman lies in the lithotomy position, the thighs being strongly flext on the abdomen, the conjugate diameter of the pelvis is shortened; when placed in the dorsal position with the hips close to the edge of the table and the lower extremities hanging, that diameter is lengthened. The latter posture is known as Walcher's position. The gain in the conjugate in changing from the lithotomy to the Walcher position is variously estimated at from 5 mm. to 13 mm. In a series of observations made by the writer the increment was, in the cadaver of the non-puerperal subject, 3 mm., and in the living woman, within two weeks after labor, from 5 mm. to 7 mm. This gain may be used to advantage in moderate disproportion between the head and pelvis. In difficult extraction the patient should be placed with the thighs in full extension till the largest circumference of the head has passed the brim. On the other hand, the dorsal recumbent posture, with the thighs moderately flext and knees held apart, and especially the extreme lithotomy position, is the best during the extraction of the head thru the outlet of the bony pelvis."

Flexing the thighs and bending the knees in the lateral position, gives the same increase at the outlet of the pelvis by lengthening the sacropubic diameter just as in the lithotomy position. We call attention to this fact be

cause this position is generally selected in England for the closing scene of delivery of the head, and many in this country prefer it for convenience sake.

The ordinary bed being much lower than a table, the bed could be raised by placing blocks under the posts.

We hope that the remembrance of these facts will save many a woman much needless suffering, and will let the practician "get home earlier."

Gastralgia.

Gastralgia is a definit disease. It may or may not be associated with gastro-intestinal catarrh. Its diagnosis is an important one in many ways. The tendency of the practician is to err in supposing ulcer or cancer to exist. Sawyer wisely says: "Do not diagnose ulcer of the stomach if you have not evidence of bleeding from the stomach, either in hematemesis or in melena, or in both of them.” "It is not safe to diagnose cancer of the stomach until you can, to speak colloquially, feel the cancer." No clinician is justified in making a careless diagnosis when gastralgia, ulcer, and cancer may be confused; and it would be doubly unpardonable to ignorantly or negligently maintain such an erroneous premise. Leube considered that gastralgia is limited to the sensitiv area of the gastric nerves, and that it was a true neurosis; but such a theory is impossible of positiv demonstration. Romberg made laborious researches along the lines of the etiology of this malady and attempted to distinguish two forms: gastrodynia neuralgia, which he claimed was a hyperesthesia of the gastric branches of the pneumogastric nerve, and celiaca, which he held was a hyperesthesia of the solar plexus. While we give him honor for his work, and while it may be based upon a correct theoretical and anatomical basis, like Henoch, we do not deem it of any value as a therapeutic guide. Gastralgia is variously designated as cardialgia, gastrodynia, neuralgia of the stomach, a painful symptom of indigestion due to the formation of gas from fermentation, and, popularly, as "cramps," and "bellyache." When a clear diagnosis is made, curativ therapy is easy; but slipshod methods will not bring satisfactory results. Gastralgia manifests itself as a "drawing" pain suddenly appearing just below the sternum, prone to occur periodically regardless of whether the stomach is full or empty, and is generally relieved by pressure. It is more common in women than men, and is oftenest noted in those of neurotic temperament. It is generally lookt upon as a symp tom of "indigestion," and is commonly and ignorantly treated by a rigid diet, pepsin,

acids or alkalies, purgativs, gentian, nux vomica, etc. Such a course generally leads from bad to worse. An ample, judiciously advised diet will often in itself go far toward a

cure.

When such a case presents itself for a diagnosis (1) Exclude both cancer and ulcer by the well known methods. (2) Treat your gastralgia rationally. (We admit that the earlier stages of cancer are often impossible of diagnosis; but, commonly, when a patient consults you for chronic indigestion, you should be ready to exclude or to diagnose cancer.) Gastralgia occurs in those who declare that they digest perfectly, and when you have ascertained that they do, and that rigid diet, and lavage, and hyper-medication, are all futil, then think of gastralgia before you refer them to a specialist. Try such a case on tender beef or mutton, fowl or fish, cookt vegetables, toast or crackers, cocoa or weak tea or coffee, and some well cookt starches like roasted potato. Place them on heroic dosage of arsenic of a grain of arsenious acid three times daily between meals is none too much. Mild cases yield like magic. Severer and more chronic cases may require counter-irritation over the superficial gastric area, by diluted croton oil, fly blisters, etc. Such a course, continued but a few weeks, will cure the most obstinate cases of gastralgia, and win fame for the practician.

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The Treatment of Broncho-Pneumonia in Children as Given by Late Book Authorities.

Koplik (Diseases of Infancy and Childhood, publisht by Lea Bros. & Co., Philadelphia)

says:

In the treatment of broncho-pneumonia in infants and children it should be borne in mind that the disease is a self-limited, acute, infectious one, and that there is no remedy which can abort it or prevent complications. As in lobar pneumonia, the ill-effects of the disease must be counteracted as much as possible and the strength of the patient supported. Since the patients are of very tender age, remedies which are powerful in their ultimate effects are to be carefully avoided. The indications in the treatment are to counteract the effects of the temperature and to support the heart.

The temperature in the most fatal forms of this disease in newborn infants is below normal at times, and rarely reaches a very high point. In other cases of broncho-pneumonia in older infants and children it remains persistently above 103.5° F. In these cases, as in lobar pneumonia, the various forms of hydrotherapy are utilized. Of all methods the cold compress seems to me to be the most efficient when applied to the chest. Compresses lower than 70° F. are not applied. The applications may be renewed every hour if the patient bears them well. It sometimes happens that a compress wrung out in water at 70° F. will depress the patient, causing cyanosis, without reaction. In such cases, as in the lobar cases, I have found the warm bath 105° F. to 107° F. of the greatest utility in relieving the nervous symptoms, such as restlessness and convulsiv twitchings. Infants, as a rule, will not bear baths below 80° F. I, therefore, do not utilize the cold