BOOKS RECEIVED. A Manual of Dietetics. By J. Milner Fothergill, M. D., Edin., Physician to the City of London Hospital for Diseases of the Chest (Victoria Park), Hon. M. D. Rush Medical College, Chicago, Ill., Foreign Associate Fellow of the College of Physicians, Philadelphia. 8vo, extra muslin. 255 pages. Price, $2.50. New York, William Wood & Company. NOTES AND ITEMS. "A chiel's amang you takin' notes, P. -It is not only republics that are ungrateful. The poor mad king, Leopold, of Bavaria, who threw his own worthless carcass into the lake and was drowned, received the extravagant and loving homage of his subjects until his remains were put under the sod, while the eminent man of science and hero, Dr. von Gudden, who sacrificed his life in his efforts to save his patient, was quietly forgotten. So do fools ever reverence worthless and imbecile royalty rather than noble and self-sacrificing heroism. -One of our most attractive and valuable exchanges is the "Alienist and Neurologist," conducted by our collaborator, Dr. C. H. Hughes. We find but one fault with it-it does not appear often enough. It is practical and full of information for the general practitioner, as well as for the specialist. -We do not think it right that a Chicago medical college should procure its anatomical material from the St. Louis "Potters' field." -We notice that several of our exchanges are not careful always to give credit when quoting. If their type runs out, we may supply the deficiency. -We observe in the "N. Y. Medical Record" a reference to a case of "Delusions caused by Intestinal Accumulations," reported by Dr. A. E. Bridger, in the "British Medical Journal." descending colon, which it took several days of herculean effort, with spoon handles, injections of glycerine, oil, warm soap suds, and aperients to remove. After the removal of the accumulation, the patient improved in every way-delusions soon vanished and perfect recovery ensued. Possibly some of the delusions and hallucinations with which the "Record" has been afflicted for a year or two past, might be traced to a similar cause. --Dr. S. W. Marshall, of Sparta, was elected president of the Southern Illinois Medical Society, an exalted office, worthily filled. -Another new journal with the name "The Alabama Medical and Surgical Journal," comes to our table. It has an attractive appearance, and upon close inspection, the first good impression is strengthened. It is under the editorial management of Drs. J. D. S. and W. E. B. Davis, of Birmingham, Alabama, and is the first and only It occumedical journal published in the state. pies a splendid field, and with the merits and attractions it presents on every page, it can but succeed. -In a case of profound, a. may arrive when the ? may well be made regarding the necessity of emptying the :. Unless the conditions be grave the physician should not be expected nor * his reputation by making an abdominal ?. -It may not be mal apropos, in view of the present agitation in industrial circles, to call attention to the fact that Moses was the original boy-cutter. The operation was, however, attended by none of the serious impediments to labor which characterize the present excitement.-"Medical Age." Rather the reverse; for since the days of Moses we know that the tribe of Israel has been more prolific than any other, and of course the nights of labor have had much to do with the fact. -Speaking of Knights of Labor, reminds me that the orderlies, or nurses, in Bellevue Hospital, led by an ex-street car driver, formed themselves into a Knights of Labor Assembly, and demanded more pay, sirloin steak for breakfast instead of the round, pie for dinner, jelly or prunes for supper, shorter hours and no obligatory clean linen. All this is funny, of course. The only point about the story that calls for criticism is the practical surrender of the Commissioners of Charities and Correction to the Knights. The precious lot ought to have been turned out of the However, we The patient, a lady of fifty, gradually lost appetite and flesh, skin became harsh, dry and yellowish, digestion greatly impaired, hallucinations of sense and smell, and many mental delusions began to show themselves. Bowels were said to be reg-hospital without any ceremony. ular; urine thick, abundant lithates, no albumen or sugar. Thorough examination revealed an immense collection of hardened feces in transverse and fear their grievance against clean linen was a just one. The idea that one should be kept clean nolens volens is outrageous in this land of freedom. THE WEEKLY MEDICAL REVIEW. VOL. XIV. No. 2. ST. LOUÍS, JULY 10, 1886. TERMS: $3.50 A YEAR. is not altered, although its character is slightly changed; the arterial tension is elevated, and the pulse-beat becomes more abrupt and sharp." On taking forty-five grains, the same symptoms persist to a slightly more exaggerated degree." Our own experience with the remedy in several cases of pneumonia has been quite satisfactory. Recently, in an acute case of double pneumonia, when the temperature registered 105° F., we succeeded in reducing the heat 34° in two hours, after the administration per rectum of three doses of fifteen grains each at intervals of one hour. The temperature was held for several days in succession at 102° F. by the administration of ten grain doses every ten or twelve hours. The patient bore the remedy well, arterial tension was increased, and the heart's action correspondingly strengthened. Dr. Frankenberg says that the drug is eliminated through the skin and urine chiefly. It makes its appearance in the urine very soon. after administration, and reaches its maximum in the course of one or two hours, and gradually disappears after twelve hours, which seems to indicate, as it happens, the length of time during which it exerts its physiolog In the Med. Rec. for May, Doctor J. H. Frankenberg publishes a very interesting and valuable article upon the relative merits and therapeutic properties of antipyrine as an antithermic. He says the remedy is a derivative of chinoline by synthetic chemistry. He claims for it a wide field of trial both in Germany and all over Europe, as well as in this country. As an antifebrile remedy it will cope with, and, in his judgment, surpass any other antipyretic means that we possess at the present day. The doctor says that it is apical effects. Speaking of its effects in displicable to almost all cases with febrile movement, that it acts with safety and certainty, and that its effects can be graduated approximately, and prognosticated according to the amount administered." He says also that the reduction of temperature is lasting, and accompanied by few or really no, objec tionable features. In this statement we can fully concur, as our experience with the remedy in a number of cases of late amply justifies us in so doing. The author further says that if thirty grains are taken, the temperature is reduced about one-half degree; the pulse rate ease, he states, "that if thirty grains be given to a patient with febrile movement, in about twenty minutes the skin becomes somewhat reddened and moist, the superficial veins present a congested appearance and a profuse perspiration is set up. In one case that was weighed, the loss of bodily weight amounted to over one and a quarter pounds in the course of two hours after the first administraof thirty grains. Accompanying this derivation of the blood from the interior to the circumference, there is a corresponding reduction of the internal temperature. In several cases we recall a discrepancy of over 2° F. between the rectal and axillary temperature. The rapidity of the pulse is diminished during the administration of antipyrine, but comparatively less than the temperature. The ratio existing between the temperature and pulse before and after the exhibition of the drug is not the same. It has a more decided effect on reducing the temperature than on the pulse. If given to a patient with a dicrotic pulse, the dicrotism, that is the secondary wave, disappears entirely, or nearly so." This the doctor has verified with the sphygmograph in a number of cases of typhoid fever. The remedy is soluble in warm water or alcohol, and can be administered by the mouth, rectum, or hypodermatically. Given by the latter method it acts quickly and efficiently and with less dose. To avoid all To avoid all gastric disturbances, the hypodermatic or rectal method should be employed. Of course antipyrine should not be used indiscriminately, for in extremely enfeebled conditions, or where certain ataxo-adynamic symptoms supervene, it is best to withhold it, but in all other states it is as safe and far more efficient than quinine sulphate or the cold bath. The doctor further adds that in a series of experiments on the urine of a patient taking antipyrine, he found that the amount of nitrogen, which is an exponent of the amount of urea, was considerably diminished." Contrasting these results with those of Sassitzky, who made similar experiments on the urine of patients taking quinine, salicylic acid and cold baths, he concluded that the elimination of nitrogen through the urine was most reduced when antipyrine was exhibited. This proves says the doctor, a priori, that antipyrine has a greater influence upon reducing the chemico-vital changes than either of the other antipyretic measures." The remedy has been used in typhoid fever, scarlatina, pneumonia, puerperal fever, acute articular rheumatism, erysipelas, and chronic phthisis, intermittent fever, peritonitis, meningitis and insolation. In some of these patients as high a temperature as 108.6° F. prevailed, and in all of these cases the tempera ture was safely reduced at least two degrees, and in some six to seven degrees, on the average from four to five degrees. Antipyrine in its effect varies largely with the severity of the illness. When the disease is moderate in degree, the time elapsing between the minimum and maximum temperatures, after its administration, varies from three to six hours. But in severe cases, where the temperature is persistent, it is found that a short intermission or only a remission will occur. The experience of Dr. Frankenberg with the drug has been extensive for the length of time that the remedy has been in use, and his experiments have all been carefully and honestly made and fully corroborated by such men as Fruitnight and Draper, as well as other skilful and careful experimenters. These experiments serve to illustrate the wonderful power and efficacy that this remedy posseses in controlling excessive heat elevation. So far antipyrine has no equal, and it stands unrivalled in this, that in most all conditions it can be safely employed without materially depressing the system, and at the same time giving increased vigor to the heart's action. It is the remedy par excellence in chronic fevers of a tuberculous type. We distinctly remember its effects in a case we treated several mouths since, when a daily variation of temperature of from 1° to 2° F. between morning and evening occurred, attended by cough, expectoration, hectic flush, night sweats and rapid tissue waste that was greatly benefited and relieved by antipyrine after quinine, digitalis, iron and the hypophosphites had been given persistently and failed. do not claim for it specific properties, and hence do not rely upon it as antiperiodic or as an antirheumatic, for with neither quinine nor salicylic acid can it cope in antidoting the peculiar poisons of malaria or rheumatism. ON THE TREATMENT OF ERYSIPELAS. We By Dr. G. Kuehnast, Freiburg (Centbl. f. Chirg. 1886, No. 9).-The acceptance of the view that erysipelas is an infectious disease, brings with it the demand for suitable antiseptic treatment. Hueter's plan of local hypodermic injections of phenol does not give very satisfactory results, not only from its imperfect destruction of the germs but from its failure to effect drainage. Kraske (1880) reported excellent results in phlegmonous septic processes from multiple incisions and scarification.. It seems that Dobson had employed scarification in erysipelas as long ago as 1828. Two of Kraske's later cases successfully treated by the above method are mentioned. His assistant here describes its further application in three cases of erysipelas. He makes fifteen to twenty incisions to the square inch, some punctiform others up to one cm. long. Most of these only penetrate the superficial layer of the corium, but about one to the square cm. passes through the entire cutis. These are made all over the erysipelatous tract, but of course thickest along and just beyond its edge. At first a bloody-serous fluid exudes, later abundant pure blood. Then the skin is raised in folds, and, under a current of five-per-cent carbolic, as much fluid is squeezed from the tissues as possible, the carbolic being finally rubbed in with the flat of the hand. His cases are: 1. Erysipelas of leg and thigh, starting from an ulcus cruris. By the next morning all symptoms of the trouble had disappeared. 2. Erysipelas of arm, from a burn. Likewise disappearance of the symptoms by the next day. 3. Erysipelas starting from a nearly healed rectal abscess. Next morning the trouble seemed to have been aborted, but it soon reappeared a little to one side. Scarifications afresh-without carbolic treatment, owing to the effect of the first on the urine. Dry sublimate dressing. Again temporary improvement and relapse. This time it in volved the scrotum, which naturally could not be subjected to this procedure. On its progressing to the thigh, however, the treatment was renewed-this time with lasting effect. In each of these cases the temperature rose directly after the operation, then sank to the normal in a few hours. In light cases, and where exposed portions of the body are attacked, this method is, of course, not advisable. In children, old and infirm patients, care must be had as to the antiseptic chosen. In comment, Dr. W. W. Van Arsdale says: "If it is desired to employ local antiseptics in erysipelas, a much simpler, more widely applicable and very satisfactory method is available. Burman, Practitioner, May, 1884, reported some very favorable experience with the local use of iodoform collodium. Dr. Lyttle, of New York, (vide report in Boston Medical and Surgical Journal, Jan. 1, 1885, p. 14), also speaks well of the same. We can corroborate this. Especially instructive was a case of erysipelas from a slight wound in the thigh. Wherever the coating was well over the neighboring apparently free skin, the process was checked; where this had not been done, the process extended, but was stopped by a fresh properly extensive coating. This application, moreover, alleviates the burning and discomfort immediately.-Practitioner and News. SULPHATE OF SODIUM. Especially in our country, whenever a neutral salt seems indicated as a purgative, Epsom salt-sulphate of magnesia-is usually the remedy employed, while sulphate of sodium-Glauber salt-is neglected. One reason for this may be found in the fact that Glauber salts are very cheap, and that it is used mainly in horses. Not long ago we advised a patient to take Glauber salt, but when the patient asked his apothecary for it, the latter ridiculed the idea, and said that this salt was used for horses only. Epsom salt cannot be administered to young children, because its action on the delicate mucous membrane of the alimentary canal of the young, is too harsh; but Glauber salt can be given with immunity. This fact alone should convince everybody that in most cases sulphate of sodium is preferable to sulphate of magnesia. will prove more satisfactory to the reader to send for the report, for it is of the treatment that we desire to specially speak as the prac tical feature in this interesting paper. professor distinctly avers that while salicylic Nothnagel, a year or two ago, investigated the action of neutral salts on the intestines. He found that sulphate of sodium-Glauber salt-was the mildest of all; that it first caused a very slight redness, and later induced depletion by emptying the congested capilla-acid may be of benefit "in gout uncomplicated ries and producing a slightly watery stool. In the inflammatory intestinal disorders of childhood, as for instance in cholera infantum, if administered early in moderate doses, it acts almost as a specific, while sulphate of magnesia induces a severe congestion of the intestinal mucous membrane, and generally destroys the epithelial lining. Experience has proved this observation to be correct, for, generally, whenever especially a larger dose of Epsom salt has been given, the patient will suffer from constipation, or at least from sluggishness of the bowels, for several days afterward. The action of Glauber salt is so certain and at the same time so much a true laxative-not causing congestion and not injuring the epithelial lining-that a much smaller dose is generally needed than in the case of the magnesia sulphate. In most cases, from one-half to a teaspoonful, if administered to an adult, largely diluted with water-as all neutral salts should be if the intention is purgation-one hour before breakfast, will induce one or two motions of the bowels about a half an hour after the meal, and this result will be brought about without the least griping and without any after-effect, as constipation, so often observed as a consequence of the magnesia salt. Med. and Surg. Reporter. DR. LATHAM ON THE TREATMENT OF GOUT AND RHEUMATISM. An interesting summary of the views of Professor Latham, of Cambridge, upon the treatment and pathology of gout, rheumatism and diabetes is given in the Maryland Medical Journal for May. Dr. L., after discussing the chemistry of the pathological changes, arrives at the conclusion after all, that "uric acid and lactic acid are the essential causes of these affections." As to the various steps explanatory of the origin of uric and lactic acid, it The with contracted kidney or albuminuria,” that it is in acute rheumatism that its agency and specific power is exerted. These views will be endorsed and corroborated by every physician who has given this remedy a satisfactory trial. The conditions, therefore, necessary to success in the use of the remedy are based upon the following directions: 1. "The true salicylic acid obtained from the vegetable kingdom must alone be employed. 2. Give the acid without any alkali or base. A very good form is to mix 100 grains with fifteen grains acacia powder and a little muscilage. Allow the mass to stand and harden, and then divide into thirty pills. 3. Place the patient fully under the influence of the drug, that is, let him have sufficient to produce central disturbance. * * * four To an adult I generally administer three doses of twenty grains (six pills) at intervals of an hour, and if the head remained unaffected, a fourth dose at the end of another hour; and repeat the twenty grains every hours until the physiological effect of the remedy shows itself. In the majority of cases from 80 to 100 grains are enough. Afterwards about eighty grains a day are sufficient, and as the temperature declines, smaller quantities will develop their physiological effects. *** It is a very striking illustration of the difference between the therapeutic effect of a remedy and its physiological action. 4. Give the patient from forty to eighty grains daily for ten days after all pain and pyrexia have passed away. 5. Let the patient's diet consist entirely of milk and farinaceous food for at least a week after the evening temperature has been normal. No meat or soup. 6. Take care to maintain a daily and complete action of bowels. Calomel followed by a saline purge. |