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Don't forget that digitalis, strophanthus, strychnine and caffeine are the most effective heart stimulants, and that nearly everything in the line of heart stimulation can be accomplished by them if they are correctly exhibited.

Don't use nitroglycerin in cardiovascular disease to reduce blood pressure if the kidneys are much sclerosed, but do not fail to use it freely if coronary sclerosis is present.

Don't forget that individual susceptibility to strychnine varies greatly, and that it is not generally safe to begin with a larger dose than one-sixtieth of


a grain every four hours; and that the maximum dose in diseases of the heart is generally not more than one-thirtieth of a grain every four hours.

Don't prescribe passive movements as part of the treatment without watching very carefully to see that they are not given too vigorously.

Don't expect to get compensation in a bad case too soon; be satisfied if the patient shows slight improvement immediately; permanent improvement must be slow if it comes at all; and attempts to hurry it unduly may prematurely exhaust the heart.


In the present campaign in getting back to first principles in medicine and pharmacy, we hear much of the fraudulent nature of many secret specialties and nostrums.

While there has been much exaggeration in these charges, and while some of the reformers are rather guilty of a lack of discrimination in putting the good, worthy proprietaries in one bunch with the bad ones, still physicians have been humbugged by the claims of some nostrum manufacturers in the endeavor to foist their specialties upon the medical profession.

And the destruction of worthless specialties, which many physicians have been prescribing, calls for some constructive effort on the part of the medical press, and it is the intention of the MEDICAL REVIEW OF REVIEWS, each month, to bring to the attention of its readers the virtues of two ethical and official preparations of the United States Pharmacopoeia and the National Formulary, our two legal standards.

These two legal standards contain some 1500 official drugs and preparations, which are practically sufficient to meet every physiological condition that the human body may present in disease. These official standards constitute the physician's most effective armamentarium.

This month we will consider the Elixir of Salicylic Acid, N. F., and the Compound Syrup of Senna, N. F.

ELIXIR ACIDI SALICYLICI, N. F. Elixir of Salicylic Acid, N. F., contains in each teaspoonful dose, 5 grains of Salicylic Acid and 7 grains of Potassium Citrate, in a vehicle of Aromatic Elixir and Glycerin. It contains. 50 per cent. of Glycerin and 9 per cent. of Alcohol. It is made fresh upon prescription needs. The dose is 4 Cc. (1 fluidram), after meals and well diluted.

Physicians are cautioned never to use Salicylic Acid in pill, powder or capsule form, as it is very irritating to mucuous surfaces. Its action, which

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The average dose is 8 Cc. (2 fluidrams), preferably administered upon retiring, and full doses are recommended. This syrup is a most excellent example of rational medication, the compound being a fine blend of three efficient laxatives in palatable form. The addition of some simple bitter, as Gentian or Colombo, increases its activity.

Fluidextracti Gelsemii

Fluidextracti Cimcifugae Elixir Acidi Salicylic ad. Dose, one teaspoonful as per indications. SYRUPUS SENNAE COMPOSITUS, N.F.

The Compound Syrup of Senna, N.F., represents, in each average dose, the virtues of 16 grains of deodorized Senna and 4 grains each of Rhubarb and Frangula (Buckthorn). It contains 60 per cent of Sugar and the Alcohol content is 17 per cent. It is flavored with Oil of Gaultheria.

This Syrup is an active, safe and pleasant cathartic, free from griping, and has also feeble hepatic stimulant powers. The secretions of the stomach and intestinal tract are increased

by its use, and the peristaltic movetion to the size of the dose. ments are stimulated in direct propor

The three chief ingredients of this syrup, Senna, Rhubarb and Frangula, contain emodin, chrysarobin and chrysophanic acid, all glucosides. The cathartic effect is not produced by these, but by their decomposition product "oxymethyl-anthraquinon" produced. by hydrolysis, or by oxygenation in alkaline solution.

These glucosides and especially the two last mentioned, are entirely too irritant to be available as cathartics in their pure form; but in their natural state of combination in the drug, this irritant action is tempered by the presence of colloid extractive. Thus the decomposition goes on slowly and action never progresses to inflammation. This fact makes this preparation therefore especially valuable when a purgative is to be taken habitually.

It may be advisable to acquaint the patient with the fact that this preparation will color the urine yellowish brown, or reddish or violet; yellowishbrown if the urine is acid, and reddish

or violet when it is alkaline.


The Ophthalmo-Reaction in Typhoid Fever.

The Ophthalmo-Reaction in Typhoid four cases of typhoid fever in the febFever is the title of an article by Charles R. Austrian, M.D., appearing in the January number of the Bulletin of The Johns Hopkins Hospital. The writer outlines the method of Chantemesse, who was the first to realize that a reaction in typhoid similar to the tuberculin ophthalmo-reaction would be of immense diagnostic importance. The process of sterilizing, drying, and pulverizing the typhoid bacilli and of making the ultimate solution is similar to that used in making the tuberculin preparation. Chantemesse obtained positive reactions in all of the seventy cases of typhoid fever examined; and negative reactions in forty-nine of fifty control cases. The one control case which gave positive reaction was a tuberculous subject "who probably had typhoid two years before." The typical reaction appeared within two or three hours as a reddening of the conjunctiva which rapidly spread to the caruncle, followed, after a short interval, by the appearance of lachrimation. and a fibrinous exudate. The injection lasts for at least twenty-four hours, and occasionally as long as six days. In none of Chantemesse's series did dangerous local symptoms develop.

A few months after the publication of the findings in this initial series, other investigators added confirmation, criticism and modification modification to the method. Still later Malisch contributed much to our knowledge of the subject. Using the technic of Chantemesse he made observations on fifty

rile stage of the disease and obtained positive reactions in all of them. Of sixty-six patients, febrile or convalescent, 66% showed positive reactions. Of sixty patients with diseases other and of fifty normal persons, only three than typhoid, 10% reacted positively showed a "slight, very transitory conjunctival reddening."

He found further that of thirteen. cases of typhoid fever, seven gave a positive reaction when an extract of Bacillus paratyphosus was used as the antigen, and that of eleven typhoid fever patients, all showed the marked conjunctival inflammation when an extract of the colon bacillus was applied to the eye. He stated that altho the reaction is not absolutely specific the response in patients infected with the Bacillus typhosus is more constantly present, is more marked and persists for a longer time than it does in other conditions.

At the Johns Hopkins Hospital the typhoid antigen is prepared according to a method worked out in that institution. It has been used as a test in seventy-five cases of typhoid fever; and was negative in five of these cases. It has been used in 190 cases other than typhoid and was negative in all these. Some of the conclusions drawn from these series are as follows:

The results of the typical ophthalmoreaction are in close agreement with those of the blood culture, and in establishing a diagnosis early in the disease the eye test is apparently of greater as

its simplicity, the fact that it can be applied and interpreted by the physician, the rapidity with which it becomes manifest, and the absence of any discomfort to the patient.


Some Observations in Relation to the Treponema Pallidum, and the Laboratory Diagnosis of Syphilis.

sistance than is the Widal reaction. The reaction is relatively specific and can be differentiated from the response produced in other diseases and in health. The advantages of the test are

Hideyo Noguchi in the January issue of the Journal of Experimental Medicine describes three distinct types of spirochaetae, found in the normal oral cavity of man and animal. One is known as the Spirochaeta buccalis. For the other two Noguchi suggests the names Treponema microdentum and Treponema macrodentum. In general characteristics they fall within the group to which the Treponema pallidum belongs. A perusal of this and other articles along the same line may lead one to reflect upon the fact that the diagnosis of syphilis by the demonstration of the Treponema pallidum has never attained very general use. The identifications of the Treponema pallidum antedates the Wassermann reaction by several years. We breathed a sigh of contentment and relaxation when the tense hunt for the organism of syphilis ended in its capture. There was an expectant flurry of excitement as we began to diagnose syphilis thru the demonstration of the etiologic organism in luetic lesions. Such examinations are still made and are of unquestionable value; but it cannot be gainsaid that they have never even approximately attained the general confidence of the general practitioners. That comparatively late-comer, the Wassermann reaction has in a brief space of time made a well recognized and widely important place for itself in our diagnostic armamentarium.

If the demonstration of the Treponema pallidum holds a place of secondary value or importance it cannot be without reason. Either the process is too involved or the results are not dependable. The first cannot be the fault for present methods of staining and examining are simple. Are the results dependable? We believe that in a restricted sense they are; that in the research laboratories and in some others, the identification of the Treponema pallidum is scientifically accurate. We believe that in a general sense the results are not dependable. By this is meant that the endeavor of clinical laboratories thruout the country to employ this method has led to innumerable errors of omission and of commission. Either the organism has not been found when present; or on the other hand, some other spirocheta or treponema has been mistaken. for it. While the technic of preparation is far simpler than that required by the Wassermann reaction, it is far more difficult to get a working knowledge of the distinguishing points of difference between the pallidum and similar treponema and spirochaetae, than it is to get a practical ability to make correct Wassermann readings. Herein lies the reason that the more recent Wassermann reaction has taken precedence over the demonstration of the treponema pallidum in diagnostic importance.

Noguchi within the past few months has brought before the medical profession an improved and successful method for cultivating the Treponema pallidum. This method has enabled him to prepare a vaccine which is employed in a way similar to the Von Pirquet tuberculin reaction. A characteristic cutaneous reaction results in a large percentage of syphilitic conditions, the reaction being especially uniform and valuable in the tertiary stage of the disease. In this respect it difIn this respect it differs markedly from the Wassermann test. This cutaneous reaction has not

been weighed in the balance of extensive clinical application. It may be found wanting in some respects but it bids fair to hold an important place, either alone or in conjunction with the older tests that are still under consider




Urriola of Panama City (Interstate Med. Jour., Jan., 1912, Vol. XIX, No. 1) believes that the presence of blood pigment in the plasma and urine is of as true pathognomonic significance as is the parasite in the pernicious attacks of the disease or of malarial cachexia. He claims that these hematic pigmented elements are parasitic in origin and that the kidneys are the principal emunctory organs in the living subject. He found the pigment in the blood plasma and in the centrifuged urine in four forms: (1), very fine granules in considerable numbers; (2), somewhat larger granules; (3), large polymorphous masses of varying sizes; (4); granules enclosed in hyaline plaques, or in leucocytes. In color, he states the black pigment is most abund

ant with few blue and occasional ochre granules present. He believes these to be present in all malarial subjects no matter what form the disease may HAMILTON.



Albert and Mendenhall (American Journal of the Medical Sciences, Vol. 143, No. 2, Feb., 1912) made a series of typhoid bacillus vaccinations on ten medical students with the object of determining the reactions and blood changes thereby induced with special reference to the change in the number and proportion of leucocytes.

Each student was vaccinated three times at ten day intervals; the first being with five hundred million and the

other two of one billion each. Their vaccines were prepared at the Army Medical School, Washington, D. C., from an 18 hour agar culture of nonvirulent typhoid bacillus from which a suspension of the growth was made in sterile salt solution and diluted so that each cubic centimetre contained one billion bacilli. This was sterilized 56 deg. C., for one hour and its sterility tested by aerobic and anaerobic cultivation and by animal inoculation. After the addition of 0.25% solution of tricresol as a preservative the vaccine was placed in sealed sterile glass ampules.

The vaccinations were given subcutaneously in the arm. The local reaction at the seat of injection began three to four hours later. It subsided. in from three to five days. The systemic reaction is noted in Table I and is associated with a temperature of 102° to 103° F., which disappears in about forty-eight hours.

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