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boiled rice or farina and zwieback. In three to four weeks a carefullyselected mixed diet is well borne; the dose of bismuth subnitrate is reduced after ten days and iron and arsenic substituted for it. As compared with the milk cure, this albumin dieting shows less frequent hæmorrhages, less gastric pain and more rapid general improvement.

F. CRAVEN MOORE.

BRUGSCH (THEODOR). The Action of Salicylates on the Kidney. Die Therapie der Gegenwart, 1904, p. 59.

THE result is given of three hundred experiments with sodium salicylate and aspirin in rheumatic affections, made to test the maximum dose without any deleterious action on the kidney. It was found that 75 grains of either salt given daily in divided doses had no harmful effect, but that this amount given as one dose caused a temporary nephritis lasting from two to four days; if repeated on the second day the inflammation lasted about six days. On the other hand, 45 grains in one dose did no damage even when given for three weeks. With fever and in old persons with degenerated arteries the kidney is irritated by still smaller doses. The irritation is showed by albuminuria and the presence of granular and hyaline casts with some red corpuscles. As the result of these experiments the writer advises that in chronic and subacute cases 45 grains should be given daily; in acute cases 75 or even 100 grains should be tried in small frequent doses on the first day and that this should be diminished to 45 grains on the next few days, and later to 15 grains.

E. B. LEECH.

URSTEIN (M.). Isopral, a New Hypnotic. Die Therapie der Gegenwart, Feb., 1904, p. 64.

AFTER an apology for still another hypnotic, the writer goes on to say that in his asylum practice he has found this drug twice as active as chloral and with less toxic effect on the heart, as powerful as veronal and distinctly better than trional and paraldehyde. It is easily soluble in water, and is rapidly absorbed from the stomach, so that it can be detected in the blood within five minutes. The dose is about 10 grains in ordinary cases, but as much as 30 grains were given where excitement is great. Drowsiness should commence after a quarter to half an hour, but with maniacal excitement sleep may be delayed for two hours or longer. In the worst cases the drug may fail to act. Frequent use does not necessitate increased dose. After effects are distinctly less than with most hypnotics. After large doses headache may be present on the day following. Isopral is tri-chlor-iso-propylalcohol; it is excreted in the urine as glycuronic acid.

E. B. LEECH.

RENAUT (M. J.).

Therapeutic Value of Kidney Extract. Bull. Gén.

de Thérapeutique, 1904. Vol. cxlvii., pp. 3, 37.

THE writer strongly recommends the treatment of renal insufficiency of all types by means of watery extract of kidney. He takes two or three absolutely fresh pigs' kidneys, and removes the capsule and part of the medulla. The cortex is then chopped up and pounded with 450cc. of 7 per cent. saline solution. The preparation is then allowed to stand four hours in the cold, ice being necessary in summer, and the fluid is then decanted off. About 400cc. of extract are thus prepared; this amount should be taken daily in three or four doses. The appearance of the preparation is improved by a mixture with a clear soup, but the temperature must not pass 38°C. Pigs' kidneys are chosen owing to the omnivorous habits of that animal, which in this respect resembles man. It is best to continue treatment for periods of ten consecutive days separated by intervals of five days. Otherwise, if the treatment is too prolonged, the patient may suffer from sweats, smelling of urine, papular and miliary eruptions, nettle-rash and vomiting. By this treatment albumen diminishes rapidly; the fluid excreted surpasses or equals that ingested; the kidney has apparently an opportunity of recovering from overwork caused by diseased tubules. Notes are given of four patients treated in the way described. All were first treated with only partial success by the drugs usually given in kidney disease and heart failure. One suffered from a mixed nephritis, two from interstitial nephritis, the fourth had a degenerated heart with cardiac kidneys following influenza. All had uræmic symptoms. Relief was in all cases immediate, and now, about twelve months after the commencement of the treatment, all are in a good state of health. Occasional doses of the extract are given, regular treatment being unnecessary.

E. B. LEECH.

KING (D. B.). An Enquiry into the Value of X-Rays in Bronchiectasis. Practitioner, 1904.

THE writer records some investigations made in the hope that the X-rays might supply more information than the ordinary clinical methods as to the number and extent of cavities in the lung and also that they might help to clear up the diagnosis in some of those very early cases of bronchiectasis in which it is sometimes doubtful. Twenty cases are recorded. They are illustrated by charts and X-ray photographs. The following were the results of the investigation:The X-rays failed to reveal the presence of dilatation of the tubes; and they failed to reveal saccular or gangrenous cavities when their existence was strongly suspected by means of the ordinary clinical methods. The density of the shadow varied with the degree of the pulmonary fibrosis. The X-rays are of undoubted use in the detection of foreign bodies in the bronchi. The longer the foreign body has been in the bronchus the greater the difficulty of demonstrating it owing to the formation of fibrous tissue. In advanced cases with involvement of

the lower lobe the action of the diaphragm was much impaired; sometimes the diaphragm was altogether obscured. In most early cases there was improvement of its movement. "A diffuse mottling all over the lung seemed to point to tuberculous disease. The X-rays revealed less than the ordinary clinical methods, and are little or no use in the surgical treatment of bronchiectasis.

JOHN HAY.

SINKLER (W.).

Presidential Address to the National Association for the Study of Epilepsy and the Care and Treatment of Epileptics. Medicine, Feb., 1904, p. 87.

WHILE discussing recent progress in the study of epilepsy the writer says: "There is no doubt that the requirements of epileptics are best met in industrial colonies or farms. The most favourable results are obtained by giving epileptics ample opportunities for work, and at the same time affording to them proper scientific medical treatment and intelligent care and supervision. These requirements can only be obtained in the country. In the establishment of an industrial colony the first thing is to secure as large a tract of as fertile land as possible, and in a healthy region. . . . What is of the greatest importance is the providing of a separate building for children. Although, as a rule, the prognosis as to complete recovery in cases in which epilepsy begins at an early age is not good, at the same time, if judiciously treated and carefully trained, more can be done in childhood than at an advanced period. The neglect of the eduction of epileptic children, which is so common, is most regrettable."

ALAN MCDOUGALL.

SADGER. The Hydropathic Treatment of Epilepsy. Centralbl. f.d. ges. Therapie, Dec., 1903. Abstracted by KREBS (of Hanover) in the Referate und Besprechungen, p. 129.

SADGER recommends baths in conjunction with the bromide treatment. One bath of eight minutes' duration should be taken daily. The temperature of the water should be 30-27C. or 27-25Ɑ The patient should be douched, but not shampooed. The treatment is recommended on the following grounds: -(1) Bromides become more efficacious when hydropathy is employed; (2) bathing improves the general condition and the mental and physical strength of epileptics, and promotes nutrition and excretion; (3) it lessens the dangers and the sequelæ of the fits and produces health between the attacks.

ALAN MCDOUGALL.

DA COSTA (J. CHALMERS).

The Surgical Treatment of Epilepsy. Medicine, Feb., 1904, p. 96.

OPERATING without conscience is not only ruin of the soul, it is often ruin of the patient, and it is always to the infinite disgrace of the medical profession. The confidence in the curative value of brain operations in epilepsy has very much diminished in recent years. The writer's conviction is that less than 5 per cent. are cured by operation. Any operation may for a time improve the manifestations of the epileptic condition. The administering of an anesthetic, the shock of an injury, the traumatism of an operation, just like a febrile seizure, may interrupt an epileptic habit and cause a patient to go for weeks or months without an attack. The subsequent history of such persons indicates that the attacks almost invariably return. A case should not be reported as cured until at least three years has elapsed since the operation was performed, and five years is probably a safer limit. A neurologist should, whenever possible, be associated with the surgeon in making the examination and in discussing the proper course of treatment. Uncomplicated cases of essential epilepsy should not be operated upon. If an epileptic suffers with persistent headache it is desirable to trephine, to open the dura, and to inspect the brain. Many cases of idiopathic epilepsy with focal symptoms begin within the first two years of life, and are due to unrecognised cerebral infantile palsy. If from the very start the convulsive attacks have had a local beginning, and if the surgeon has seen the case within two years of the first attack it is proper to trephine and to excise the irritated portion of the cortex. After the condition has persisted for two years operation offers practically no hope of cure, as the association fibres are by that time hopelessly degenerated. But even in an old case, if the attacks occur with such frequency as to threaten life, the excited cortical centre should be excised. The writer has long believed that the cases in which traumatism is said to have preceded generalised epilepsy show as large a proportion with a neurotic heredity as do those in which traumatism is not suspected. An injury may be followed by generalised epilepsy or by Jacksonian epilepsy. Traumatic Jacksonian epilepsy gives a better prognosis from operation than does any other form of the disease. In focal epilepsy with evidences of skull injury or depression, trephining is imperative and somewhat promising. The dura should invariably be opened. A dural scar should be extirpated. If nothing obvious is found on exploration and if the attacks have been distinctly focal in origin it is justifiable to extirpate the motor centre from which the discharge seems to originate. The treatment of Jacksonian epilepsy due to gross brain disease is that of the condition that causes it. In cases of epilepsy following infantile cerebral palsy operation is justifiable, but unpromising, in childhood; useless in adolescence. Operation is entirely valueless in the posthemiplegic epilepsy of adults. ALAN MCDOUGALL.

General.

Short Notes on Selected Papers.

By I. WALKER HALL, M.D.

Intoxication by Chloroform taken by the Mouth. Ernberg (H.). Nordisk. Med. Arkiv., Bd. 36, Heft 4, No. 20. A man drank a small flask of chloroform by mistake. After a short excitatory period, narcosis followed, and lasted for five hours. For some days later the patient was apparently quite well; then icterus and acute nephritis appeared, followed by mental symptoms, gradual rise of temperature, acute cardiac dilatation, pneumonia and death. The autopsy showed acute myocarditis and pericarditis, pulmonary edema, croupous pneumonia in the upper right lobe, broncho-pneumonia in the lower right lobe, hæmorrhagic nephritis, encephalomalacia, fatty liver, etc. The details of eight other cases are recorded. An experimental investigation upon rabbits yielded subnormal temperature, acute degenerative nephritis, fatty changes in the liver, etc. In addition to the usual treatment by removal of the stomach contents and the administration of stimulants, Ernberg suggests venesection and infusion of saline solution. Uric Acid Bacterium. Celso Ulpiani. Gazette, 1903, No. 33, p. 33. An organism has been isolated which is supposed to be responsible for the changes which occur in uric acid in standing. It is motile and stains by Gram's method. When the organism is added to an aqueous solution of uric acid, containing small quantities of mineral matter, the solution becomes turbid after 24 hours, and at the end of four days the murexide reaction cannot be obtained. The products of the action are carbon dioxide and carbamide.

Circulatory System.

Myomalacia Cordis, caused by a 4-centimetre long Thrombus in the Left Coronary Artery. Sievers (R.). Finska Läkaresäesp. Handl., Bd. 45, S. 32. The thrombus was situated about two centimetres from the aortic orifice, completely filled the lumen of the vessel, and was yellow white in colour, and distinctly fibrous.

Puncture of the Pericardium in Two Cases of Exudative Pericarditis. Boekelmann (W. A.). Nederlansch Tydschr. v. Genseskunde, 1904, No. 6. In the first case 170cc. of a bloodtinged fluid were removed. It rapidly coagulated. The serum had a sp. gr. of 1,024 and = -0.53°C. In the second case the fluid was clear, sp. gr. 1,020·7; =0−51°C.; NaCl, 0.7%; albumin, 4%; total nitrogen, 9-28gm. per litre.

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