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sorbent cotton. If there is a pigmentation of the new skin, this should cause no alarm, as it will fade out in from six to eight weeks. "Tincture of iodine has been used for the same purpose, as well as its mixture with carbolic acid. Resublimed resorcin is also advocated, but the resultant peeling will not prove thick enough to give a satisfactory result. If, for any reason, the effect obtained is not as desired, the patient should wait for several weeks and have the treatment repeated. "It is hardly necessary to say that the application used should not get into the eyes. The upper eyelids should not be treated, since no benefit arises from it. If there is a redundancy of tissue, it should be removed surgically, as elsewhere described."

In the atrophic, or depressed, type of scars, electrolysis, according to McIntosh, ("Medical Electricity") is "the best treatment, the object being to remove the superficial layer of epithelium, and thus by means of dressings to bring up the granulating tissue to the normal level. Being a tedious process, however, it is not well suited for multiple smallpox pits." This method is described, although briefly, by Lanphear, in his "Surgical Therapeutics," from which we quote:

"When operation is not possible or not desired, treatment by electricity may be tried. In some cases the scars have softened, the discolorations have disappeared, the surface taking on more nearly the appearance of normal skin. The application is made with two large electrodes moistened with a 10-percent solution. The negative electrode, which is applied to the sacrum, has an area of 30 square inches. This is connected with the positive pole of the induction coil, and this electrode has a surface of about 16 square inches. The apparatus should have a commutator that will enable the operator to use either the galvanic or faradic current alone or the two combined, the strength of the constant current employed to be only from 3 to 4 milliamperes. The induction current should be sufficiently intense to provoke appreciable contraction of the muscles. Each treatment should last from fifteen to twenty minutes.'

Nowadays, of course, a good physician will not permit disfiguring "pox pits" to occur in his patients' faces, since the prevention of such scars is a comparatively simple matter, by following the procedure as described in Candler's "Everyday Diseases of Children," page 243.

QUERY 5738.-"Constant Use of the Sulphocarbolates and Strychnine." J. A., Cuba, writes as follows: "(1) Is the daily use of the sulphocarbolates injurious? (2) I have read somewhere that to take sulphate of magnesium constantly weakens the organism, and predisposes to tuberculosis. That the intestinal mucous membrane suffers and its functions are modified until atony or paralysis is set up. (3) Is the daily use of strychnine, as Burggraeve recommends, advisable?"

It is not advisable to take any preparation of magnesium sulphate every day unless the conditions present in the individual demand such medication. It is perfectly proper to exhibit magnesium sulphate each day for a limited number of days when it is desired to cleanse the intestinal tract thoroughly. There is a difference, moreover, between purified preparations of magnesium sulphate and the crude commercial epsom salt; as a matter of fact, thousands of individuals have used a saline laxative daily for months and even years without being injured in any way. Still, the fact remains that the prolonged use of magnesium sulphate is generally not advisable.

The daily use of small doses of strychnine arsenate prove beneficial in a great many cases. The aged may advantageously take this drug for prolonged periods.

The habitual use of the sulphocarbolates has never been recommended, and it is not only unnecessary but unadvisable to continue the exhibition unless indicated by an abnormal condition of the digestive tract. If an underlying acidemia or autotoxemia exists, and examination of the feces and urine (or a definite clinical picture) reveals putrefaction of the intestinal contents, the sulphocarbolates should be given until the pathologic condition is overcome. The stools under such medication will first

become black or extremely dark, then normal in color and odor. The symptoms produced by the intestinal conditions will disappear. To make assurance doubly sure, it might be well in such cases to give a very small dose of the indicated sulphocarbolate two or three times daily for a few days, yet we can conceive of but few conditions which would call for the continued daily use of any intestinal antiseptic.

QUERY 5739.-"Nuclein in Pernicious Anemia." A. M. F., Michigan, asks what, in our opinion, might be expected of nuclein in a presumptive case of progressive anemia. "The nature of the final outcome of pernicious anemia," he remarks, "of course is recognized, but might it not be advisable to give nuclein a fair and square trial."

In true pernicious anemia you could hardly expect much benefit from the exhibition of nuclein, but in a progressive secondary anemia its use would be distinctly indicated, and the results might be very satisfactory. As a matter of fact, nearly all anemias are more or less progressive, and the earlier the underlying pathologic condition (the causa causans) is discovered, the better chance we have of putting a stop to the blood deterioration.

In a true progressive pernicious anemia there is a persistent tendency from bad to worse. The disease almost invariably ends fatally and treatment is of little or no avail. We can, of course, maintain elimination, strive to improve nutrition, and place the patient in the most favorable condition to resist the malady.

It is well to remember that there are three distinct categories into which cases of pernicious anemia may be grouped: (1) Those in which no discoverable cause for the hemolysis is ascertained, either ante or post mortem; (2) those in which the real cause is discovered on autopsy only; (3) those that are plainly attributable to some primary cause or condition. In many obscure cases of idiopathic anemia, the writer believes, the hemolysis originates in the gastrointestinal capillaries and is due to the generation of toxins formed in and absorbed from that tract. Apparently causeless cases have been found, at autopsy,

to have been due to an obscure malignant disease, the presence of parasites, etc.

We suggest, doctor, that you make a thorough examination of your patient and report findings in detail, sending at the same time a specimen of blood to our pathologist. We shall then be in a position to make more intelligent comments.

QUERY 5740.-"Uses of Thuja and of Echinacea." B. O. L., Louisiana, asks information regarding the therapeutic uses of echinacea and of thuja and the best preparations to use. He has read a great deal about these drugs in the different journals but possesses no textbook that treats of them.

We have taken pleasure in mailing a reprint of Dr. Candler's article on echinacea, a drug that is being more extensively used each day, and is undoubtedly one of the most potent systemic alteratives at our disposal. In septic conditions or wherever a depraved condition of the body-fluids obtains, it acts promptly and positively. Boils, phlegmons, carbuncles, abscesses, and even gangrene are benefited by its freer use. Tablets containing 1-2 grain of

the concentration are now available and prove effective.

Thuja (arbor vitæ, white cedar) has been used extensively in the treatment of cancer, epithelioma, condylomata, chronic skin diseases, open sores, sloughing wounds, phagedena, gangrene, bedsores; and vegetations of all kinds, especially those upon mucous surfaces, yield to it readily. Hydrocele has been cured by injections of thuja. Howe used this agent exclusively.

Internally, thuja may be given advantageously in various urinary disorders, nocturnal incontinence, senile enuresis, relaxed conditions of the bladder, spermatorrhea, etc. When spermatorrhea is the result of overindulgence or masturbation, this agent is almost a specific. In treating conditions involving blood changes (especially where there is a cancerous condition), the beginning doses should be small and the drug administered three times daily. The amount may be increased, if necessary, to 1 dram every two or three hours. large doses are called for only in malignant

Such

cases. Warts, excrescences, and many minor dermatoses disappear in a short time when 5 minims of thuja are exhibited twice daily.

Applied externally, thuja produces at first a sensation of smarting or tingling, and it is usually best to dilute it with one to three parts of water.

Lloyd's are unquestionably excellent fluid preparations. Besides specific thuja, a nonalcoholic extract (Long's thuja) is prepared, and it proves extremely serviceable. For internal use you will find echinacea and thuja thoroughly satisfactory.

QUERY 5741. "Desquamative Preparations." F. B. W., California, desires the formula of a good preparation causing superficial peeling of the skin.

An excellent preparation to produce a dermatitis to be followed by peeling off of the skin is a 20- to 30-percent solution of resorcin. It must be remembered, however, that weak solutions of resorcin promote cornification, while strong ones macerate the skin.

In dermatitis exfoliativa, alkaline lotions should be used in the early stages. In the later stages, apply oxide of zinc ointment; or urophen, 2 grains to 1 ounce of vaseline; or, also, urophen, 2 grains; compound tincture of benzoin, 10 drops; lanum, 1-2 ounce; vaseline, 1-2 ounce. Antiseptic oil and olive oil, equal parts, make another excellent application. As an alkaline application, nothing equals one of the menthol compound tablets dissolved in 8 to 10 ounces of water, to which 2 drams of glycerin may advantageously be added.

Salicylic acid will, of course, produce superficial exfoliation. Mercury bichloride may also be used. A lotion of corrosive sublimate, 1: 1000 or 1:2000, may be brushed on the affected area once or twice a day until desquamation commences; or the following ointment may be used: Mercury protoiodide, 10 grains; ammoniated mercury, 10 grains; simple ointment, 1 ounce. The following paste is an excellent preparation: Betanaphthol, 10 parts; precipitated sulphur, 50 parts; vaseline, 25 parts; green soap, 25 parts. Spread

upon the skin to the thickness of a dime. Leave in situ for fifteen or twenty minutes, then remove with a soft cloth and dust in with simple or borated talcum. The skin becomes inflamed, turns brown and peels off. Repeat the application daily until sufficient exfoliation has been secured. Desquamation can be hastened by adding 2 parts of salicylic acid.

Personally, we prefer a 20-percent solution of resorcin, allowing the dermatitis. (which follows the application of the fluid two or three times a day for a few days) to subside under cold cream or resin ointment, 1 part; carbenzol ointment, 1 part; vaseline, 2 parts. If necessary, the resorcin solution may be applied again.

QUERY 5742.-"Senile Pruritus." J. E. G.. Maryland, is treating a man over 86 years of age who suffers very intensely from an itching which seems to be located just under the skin, no lesion being perceptible to the eye. It is worse after the least mental excitement. Calcium sulphide, the arsenic and other preparations have been tried with little or no results.

Senile pruritus is a condition which often proves rebellious to treatment. In every case it is essential to discover the underlying disorder of the body-chemistry. In the present instance we suspect an acidemia. Send a specimen of urine to some good laboratory. Examine the sphincter ani, which may need dilation. Keep the bowels active, the mouth clean. A good mouthwash should be employed. A bran bath, made by adding five pints of bran to half a tubful of water is very soothing, while an epsom-salt sponge-bath (carbolated) is even more efficacious. To 2 quarts of water add 4 ounces of epsom salt and 20 minims of carbolic acid or creolin. Sponge the body from head to foot each night on retiring. In some cases the solution should be used hot. Do not rub the surface of the body afterward; just "dab" it dry with a soft cloth, and dust with borated talcum. Small doses of pilocarpine (one granule night and morning) often proves beneficial. However, as has already been pointed out, the cause must in every case be discovered and removed.

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NOVEMBER, 1911

Are Diseases

HERE can be no question that the prevalence of certain diseases has increased during the last half-century. Conspicuous among these are diabetes and nervous diseases, these being due largely to the mental stress of a harder struggle for existence.

The increased consumption of alcohol and the free use of narcotics are also responsible for many morbid conditions unknown to our hardier forebears. But, in comparing the present prevalence of diseases with that of the past, there are several factors for which due allowance is often not made.

One of these factors responsible is that our forefathers died, as a rule, at a considerably younger age than their descendents; if they did not perish by the sword, they were mowed down from time to time by the plague or various devastating epidemics. In this way they escaped many of the diseases, not only of old age, but of advanced middle life. Again, it must not be forgotten that each generation represented to a much larger extent than is now the case the survival of the fittest. Many of the weaklings died in childhood.

The triumph of modern hygiene is that it has preserved a large proportion of these lives; on this we may fairly pride ourselves

Increasing?

No. 11

from the humanitarian point of view; but we must not forget that it has the serious drawback of lowering the general standard of health and of sapping the vigor of the race.

Another factor that must be taken into account in estimating the prevalence of disease is our vastly greater power of recognizing its presence, whatever the form. What, then, is the cause of the multiplication of disease?

Is this multiplicity merely apparent, being due, first, to the progress of the natural sciences, and, next, to the new knowledge we have obtained with reference to pathology?

While the fact of this new knowledge is indisputable, this later hypothesis is insufficient to explain the absolute silence maintained by the most distinguished physicians of past years with reference to a great many of the diseases of our epoch. While biological science has made immense strides in recent years, we cannot deny to the physicians of ancient times a profound spirit of observation. Yet we look in vain for the least mention of diseases such as locomotor ataxia, progressive muscular atrophy, Parkinson's disease, Basedow's disease, general paralysis of the insane, and the different sort of cerebrospinal scleroses, all of which are frequent today.

It is, however, by no means safe to infer, because no mention is to be found in old writers of diseases of obscure and perplexing symptomatology, that they did not exist. They undoubtedly existed but were not recognized.

Where progress has been made, is in the prevention of acute infectious and preventable diseases, so that the average age at death has been greatly extended.

We can prevent to a great extent the diseases incident to middle and 'advanced life. What is needed, is to teach the people how to live, and by judicious early treatment arrest disease at its inception.

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In an exchange of homeopathic proclivities, I find this curious case:

"A man reports that he has been an invalid since childhood; he is now 56 years of age, has tried at least one hundred remedies for his ills, with less benefit than he has just secured from physostigma. Thinks it must have struck the cause, but just what, unless it is spinal disease, he can not understand. He says: 'I feel stronger and more self-poised, with a wonderful lessening of nearly all aches, pains, and disabilities, than I have for years.'"

Commenting on the case, the homeopathic editor takes a page and a half to say that he does not know why the drug did the man good. Physostigma's provings would require nearly sixteen pages to detail. Looking through an unabridged materia medica, an inexperienced man would think that nearly every drug covers the whole range of human ills.

Nevertheless, there is, in the brief account given, material for a close approximation to a diagnosis. The man had suffered, from childhood, a great variety of symptoms-this includes most diseases that would have gotten well or killed him long since. Constipation and fecal toxemia occurs as the most likely cause of his sufferings, and since physostigmine stimulates

intestinal peristalsis, the raison d'être of the relief is apparent.

Why go round Robin Hood's barn in search for an explanation when the obvious one is right under your feet to be stumbled over? The trouble is, that constipation is a too common everyday affair to be thus easily accepted. Disease and remedy must be things far distant, occult, mysterious, or the crowd will not gape in awe at the doctor's wonderful learning. Our confrère mentions, in discussing the case, tetanus from injuries, chorea, general emaciation, paralysis agitans, congestion of the spinal cord, spasms, myopia, pain after using the eyes, congestion of the eyes, and spasmodic action of the heart, as favorably influenced by the drug; but these are only conditions, and their ultimate cause may be anything from worms to spinal disease. Not one of these, seems to fit the case. Chronic "constipation" covers a multitude of sins!

"I could name lots of conscientious physicians in the small towns, and even at the cross-roads, who are today doing scientific work that is not appreciated at its full worth by the community in which they live. But I hope some day to see the people wake up to a realization of their duty to the country doctor-God bless his soul." -Dr. V. Berry, in The Oklahoma Medical News-Journal.

"CONSISTENCY”—ERGOT

There are some people who would like to see us sacrifice truth to appearances, utility to rule. Because we advocate the alkaloids, they expect us to favor nothing. else. Since we believe that it is usually best to separate the single active principles and use them, they want us to advocate this idea as to all plants. But this we can not do, for the reason that some plants do not permit of it. We have, therefore, urged that the best means of securing the beneficial effects of cannabis, for instance, is to use a good extract of that plant; of rhubarb, the powder; of ergot, the aqueous extract. Until the chemists have given us pure active principles that afford the action we require, we must content ourselves with using the preparations named, and similar ones, with all their recognized disadvantages.

In Merck's Archives, Livingstone gives us another of his pa pers on ergot. Hi

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