not so fast, however, that he can not drop it when something better is available.

The possessor of "Modern Treatment" will have a reliable guide along a none too easily traveled road. Volume I contains chapters on modern pharmacology and its bearing upon practical therapeutics; untoward effects of drugs; prescription writing; treatment of disease by nonmedicinal methods (climatic therapeutics, hydrotherapy, electrotherapy, rest-cure, serum therapy, glandular therapy, opsonins, vaccine-therapy, etc.), and an important discussion of tuberculin as a diagnostic and therapeutic agent. The treatment of the infectious diseases is also considered in this volume. Volume II deals with the treatment of parasitic, circulatory, digestive, and respiratory diseases, and diseases of diathesis. Special articles of the most practical character also cover diseases of the nervous and genitourinary systems, the skin, eye, nose, and throat.

Each volume contains more than 800 pages, while illustrations are used freely wherever their presentation aids a clear understanding of the text. No matter how many recent works the doctor may possess, "Modern Treatment" should be upon his table for instant reference, and the more hours he can devote to the study of its contents, the greater his success in the sickroom will be.

G. H. CANDLER.

who may or may not be intellectually capacitated for the task.

Dealing with the legal history, the book carefully reviews, analyzes and distinguishes the principal leading adjudication upon the subject. The author, in logical vein, covers and instructs upon the constitutional provisions regarding free speech and freedom of the press of many states.

The book is cleanly written, interesting, and worth the time of every interested person to read and learn. The subject is and will continue to demand more and more attention from the scholars of the day. Read, learn, and foster the desired purity to be obtained. The book is not for sale through bookdealers.

MORSE'S "PEDIATRICS"

Case Histories in Pediatrics. A collection of histories of actual patients, selected to illustrate the diagnosis, prognosis and treatment of the most important diseases of infancy and childhood. By John Lovett Morse, A. M., M. D. Boston: W. M. Leonard. 1911. Octavo, 320 pages. Price, cloth, $3.00.

Dr. Morse's book comprises one hundred actual histories selected to present, in the author's opinion, as thoroughly as possible, for physicians, a postgraduate clinical course in diseases of children.

Much attention is given to diagnosis, which is thoroughly discussed by naming.

Obscene Literature and Constitutional Law: A Forensic Defense of Freedom of the Press. By Theodore Schroeder, legal counsellor to the Medico-Legal Society of New York, and compiler of free-press anthology. Privately printed for forensic uses. New York, 1911.

"Obscene Literature and Constitutional Law" is the handiwork of Mr. Theodore Schroeder of the Boston Bar. Carefully and with painstaking energy and sincerity of purpose has this volume of some four hundred pages been prepared. It is an appeal to the medicolegal profession, to effect an enactment of law upon the subjects which are now tabooed by underlings

be made, and eliminating each in turn by careful reference to clinical signs and symptoms, the final diagnosis being that which cannot be set aside and which all symptoms support. However, treatment has received most attention. Both diagnosis and treatment have in each case been verified by subsequent history and so are considered to be correct.

The book is original and thorough, and the most interesting as well as the most valuable in this department for the general practician. A very complete index adds to its usefulness.

We understand that Dr. Morse's book forms the first volume of a series of casehistories to be published. Dr. Mumford's

"Case Histories in Surgery," according to advance advice received from the publishers, should be out by this time. The third book, Dr. Taylor's "Neurology," is said to be on the press, and Dr. Cabot's "Medicine," the second edition, will follow immediately after.

It has been found that books constructed on this plan have been, not only interesting to the reader, because presenting concrete examples of problems that constantly confront the physician, but have been found of the highest practical value and benefit. In studying definite cases from all viewpoints, such as they are taught by the very efficient staff of teachers of Harvard University Medical School, the tedium of mere theoretical reading is relieved, and the physician will constantly be reminded of similar cases he has encountered and made conscious of things he might have done, while he will also be confirmed in the management of those cases which he carried to a successful termination.

ones.

CUSHNY'S "PHARMACOLOGY”

A Textbook of Pharmacology and Therapeutics; or the Action of Drugs in Health and Disease. By Arthur R. Cushny. Fifth Edition, thoroughly revised; with 61 illustrations. Philadelphia and New York: Lea and Febiger. 1910. Price $3.75. I have found the new edition of Cushny's work a notable advance on the previous It is a reference book more for the scientific student than the busy practician, for the latter will not find the information sought in the generally desired tabloid form. Rather, he must hunt for it, and this chase usually will end by his sitting down to study the volume from beginning to end. This latter procedure is necessary in order to get the newer arrangement and ways of looking on the subjects discussed. The old clinical index is replaced by a scant five pages of a "Classification of Drugs According to Their Therapeutic Use;" which, however, contains the gist of the matter in compact form.

The author disdains to bother with crudities, and as a rule scarcely mentions these when an active principle fairly repre

sents the plant, as in the case of aconitine, atropine, quinine, cantharidin, jalapin, colocynthin, santonin, strychnine, picrotoxin, hydrastine, caffeine, coniine, gelseminine, sparteine, nicotine, lobeline, agaricin, cocaine, yohimbine, pilocarpine, muscarine, physostigmine, veratrine, emetine, colchicine, saponin, sapotoxin, and solanine; all of which appear in the table of contents instead of in connection with the parent plants, and are discussed at length, the respective plants receiving but cursory mention. This, surely, because the therapeutic investigators are driven to the active principles to secure definite results from their experiments, and which may be of true scientific value.

The tendency to extract the clean alkaloids and then to throw them back into the dirt for medicinal use is rapidly subsiding, as may be seen by examining such modern treatises as this one.

Cushny's work requires study, and merits study. The enormous advances that of late years have been made in this department may be appreciated only by such study of such works.

W. F. WAUGH.

REED'S "DISEASES OF THE STOMACH"

Diseases of the Stomach and Intestines. By Boardman Reed, M. D. Third edition, thoroughly revised and largely rewritten. New York: E. B. Treat & Co. 1911. Price $5.00.

The third edition of Reed's well-known work on diseases of the stomach represents practically a new book, in so far as a very considerable portion has been rewritten. Like its predecessors, the present edition is essentially a practical working guide for the practitioner and does not enter unnecessarily into abstruse or involved discussions. About the text, it may be sufficient to say that it is even better than former editions. In addition to the description of gastrointestinal disorders from the physician's point of view it also offers interesting discussions of the surgical affections of these organs, which will prove of material benefit to the physician. The book is well printed and freely illustrated.

QUERY 5721.-"Chronic Mucous Gastritis." W. G. D., Illinois, sends the stomach-contents of C. F., taken one hour after eating the Boas-Ewald test breakfast. Only 3 1-2 ounces were obtained, the stomach-contents being so thick they would not flow through the tube. The patient is a man of thirty-three, single, weighs 130 pounds-about 10 pounds less than he has weighed before. Height, 5 feet, 9 inches; occupation, farming and real-estate dealer. Family history is negative, except that several brothers and sisters are more or less neurotic. He has had no venereal disease. Has always had more or less trouble with digestion. No other diseases. The present trouble began ten or twelve years ago and has continued, with remissions and exacerbations, ever since. Pain is felt in the epigastrium about one hour after eating. Often, upon eating a full meal, he will feel quite comfortable for an hour or so, after which the sensation of boring, burning and fulness begins in the epigastrium, followed by belching of gas and a sour and burning feeling; no fluid comes up. There never is vomiting, but occasionally there is nausea at the beginning of a meal. Large quantities of water ease the burning sensation. The bowels are constipated; has no appetite; sleeps poorly the fore part of night, awakening in the morning depressed and without ambition. He has almost continuous dull, dizzy headache; complains of a sense of weakness and exhaustion.

The urine seems normal; heart and chest also. There is tenderness over the epigastrium. There is no spitting of blood or hematemesis. General appearance is bright and active; complexion normal. Genital

organs are normal, except that he has had an operation for variocele and always wears a suspensory bandage. The pulse is 76, soft and regular. Tongue is coated. Mucous membranes look pale. A tentative diagnosis of ulcer of the stomach has been made.

The report of our pathologist upon specimen of the stomach-contents shows that your patient suffers from chronic mucous gastritis. We question the existence of ulcer, although, as you are aware, ulcers not infrequently complicate chronic gastric catarrh. It is rather a difficult matter to outline a definite treatment, for the reason that conditions vary from time to time with the individual, and the successful therapeutist modifies his medication to meet the requirements.

The basal indications may be epitomized as follows: Prevent further irritation of the already inflamed mucosa. Raise nutrition by administering food the feeble gastric juices are capable of digesting. Combat food stagnation; prevent autotoxemia; secure vascular equilibrium. No hard and fast rules can be laid down regarding the diet. Each patient requires individual treatment.

Very hot or cold foods or drinks are contraindicated, as are alcohol, tea, coffee, pickles, spices, condiments. Foods containing mechanical irritants (whole-wheat bread-containing bran-for example) are undesirable. Foods rich in sugar are prohibited, these undergoing fermenta tive changes. You must remember that hydrochloric acid is naturally an antiferment, but is present in only very small proportions. Food should not be allowed. which cannot be thoroughly masticated, i. e., oatmeal, new bread, fried meats,

etc.

Food saturated with oil is impervious to hydrochloric acid. The meals should be small and frequent, usually five a day. It is often desirable to begin with milk or cream, with or without raw eggs. Purees of vegetables are nutritious; soups and bouillons may be allowed. Cereals thoroughly cooked and finely divided are desirable. Pure meat juice is especially valuable.

Sanguiferrin or some similar preparation of bovine blood may be used; or the following: finely chopped, lean meat, mixed with a little salt, is placed in a double boiler, in the lower part of which warm water is kept at 120° F., for four hours. The juice is then expressed with a potato masher. As the digestive capacity increases, soft eggs, zwieback, finely minced rare meat, ripe fruits and a variety of cereals may be allowed. Give your patient enough food and a diet in which there is a proper balance of proteids, carbohydrates and fat. Very little fluid should be given with meals. Barley water, oatmeal water, grape juice, buttermilk, and light sour wines may be taken between meals. All food must be masticated thoroughly.

Instruct your patient to breathe deeply, * and to take plenty of exercise in the open air. The skin should be stimulated by a cool salt sponge-bath upon rising, followed by vigorous friction. The extremities and abdomen must be kept warm, silk or wool being worn next to the skin. Massage of the abdomen is indicated.

Lavage of the stomach is indicated in practically every case. Wash out the stomach with hydrogen dioxide solution every day for one week, then every other day. Night or morning is the best time; never flush the stomach for some hours after eating, i. e., before digestion should be completed. After drawing off the hydrogen dioxide solution, wash the stomach with a weak solution of resorcin or a 1: 2000 silver-nitrate solution.

One hour before the expected meal have the patient drink a pint of hot water and to take 1-3 grain of juglandin and 1-6 grain of hydrastin. Give, with the food, 10 minims of dilute hydrochloric acid in

water. Papayotin or pancreatin with charcoal, an hour after food, will prove useful. Keep the bowels open. Try this treatment for a time, say thirty days, and then report conditions.

QUERY 5722.-"Chronic Alcoholism with Cirrhosis." R. R. L., Oklahoma, has been treating, for alcoholism, a laborer, age 54. Height, six feet; normal weight, about 240 pounds. Previous health good. Father died with ascites-cause not known. Patient has mitral regurgitation of about three years' standing. Ascites, about a year and a half; beginning in lower extremities, but is now confined to abdomen. Dyspnea and cough, especially on exertion. Very marked cyanosis. Compelled to take whisky on rising in the morning because of dyspnea. Urine contains albumen and sugar. Unable to palpate liver, owing to ascites.

Patient has been given tincture of digitalis in 20-minim doses; purged freely with jalap and calomel. Small doses of spirit of nitroglycerin also were given. Under this treatment, the patient lost nine pounds in six days. At the end of that time improvement ceased. He was then purged freely with elaterium, the drug producing copious watery, green-colored stools. The doctor kept up the digitalis throughout, but no relief followed; instead, great gastric disturbance resulted, so that all further treatment was necessarily discontinued for a time.

The patient gradually regained his weight and soon became almost as before treatment. He would not remain at rest during treatment and as soon as improvement began persisted in overexerting himself. Suggestions are requested.

You have to deal with a very intractable condition. A marked alcoholic cirrhosis of the liver unquestionably exists. We should like to examine a specimen of this patient's urine before prescribing. State also the pulse-rate, condition of tongue, location of apex-beat, character of pulse, nature of stools. Does the patient perspire readily or is the skin dry? Any icterus? How much whisky is the man taking? We should certainly forbid it.

Scillitin may advantageously be given in alternation with cactin, and small doses of strychnine nitrate may be added. We should give scillitin, gr. 2-67; strychnine nitrate, gr. 1-32, every three hours; cactin, gr. 2-67 or even 3-67, morning, noon, and night. Blue mass with soda, 1-2 grain; podophyllin, 1-12 grain; iridin, 1-6 grain half-hourly from 6 to 9 p. m. every third night. Apocynin, grain 1-3, with a mouthful of hot water, six times a day for two or three days. Rest two days and repeat.

At the end of a week give your patient a thorough sweating in the hot-pack. Inject a full dose of pilocarpine as the skin begins to moisten. Rub in daily, over the liver, 1 dram of ointment of potassium iodide. A granule of glonoin may be used, with, perchance, a granule or two of caffeine when the patient first rises or a few minutes before he leaves his bed. After an impression has been made, leptandrin before meals, chionanthin after food, and full doses of convallamarin will probably meet the conditions. These are basal directions only; upon receipt of specimen and clearer clinical data, it will give us pleasure to serve you to the extent of our therapeutic ability.

QUERY 5723.—"Whooping-Cough." J. L. W., Wisconsin, desires to know the dose for a child one year to five years old of a "whooping-cough" combination containing cicutine hydrobromide, gr. 1-134; lobelin, gr. 1-134; monobromated camphor, gr. 1-6; quinine hydroferrocyanide, gr. 1-67. He adds: "I have fifty-five cases of whooping-cough, two severe, with bronchopneumonia complicating, now in third week. Had one death in seven cases of this kind, an infant eight months old with whoopingcough eight weeks; the pneumonia lasted eleven days."

Once more we wish to urge upon our readers the undesirability of maximum and minimum dosage. The standard active-principle granule is, supposedly, the smallest known-to-be-effective dose for an adult. It would therefore be the average dose for a child under twelve. Most of the principles are presented in the sixths and the sixty-sevenths of a grain, or 1-67

and 1-134 of a grain, or even smaller quantities of the toxic alkaloids; the smaller dosage being, of course, indicated in pediatric work. We would, in this connection, call your attention to the answers to Queries No. 5558, March, 1910, and to No. 5680, March, 1911, issues of CLINICAL MEDICINE.

When dealing with single (and toxic) drugs (aconitine, atropine, strychnine, etc.) it is of course necessary to exercise care, but compound granules or tablets (i. e., "whooping-cough," "calmative for children," etc.) prepared especially for use in pediatric practice, usually represent one average dose for a child of one year or over. The only ingredient of the "whooping-cough" formula requiring care as to dosage is cicutine hydrobromide, and we should not hesitate to give 1-134 grain to a child one year old, and repeat the dose every hour or two until relief was secured or until the lobelin present in the formula (gr. 1-134) produced nausea or possibly vomiting. As you are aware, nausea in an infant is evidenced by whiteness about the mouth and nose and perspiration upon the forehead. As a matter of fact, the lobelin effect in this formula would manifest itself before any harm could possibly be done by the cicutine content.

For an infant five months old or less, make a solution with a little water, aromatic elixir, or glycerin and water. Give 1-4 to 1-2 a granule half-hourly or hourly; that quantity of the medication being contained in 15 to 20 minims of the solution.

Shaller's "aconitine rule" may be applied, if desired, to all toxic alkaloids. However, as you become familiar with the active principles, doctor, you will realize that the granule is in itself a small dose, and you will learn to give this quantity at intervals to effect, remedial or physiologic, selecting always the smallest dose for exhibition to children, unless urgent conditions demand the larger dosage.

Radue, in his "Diseases of Children," presents a very interesting and valuable dosage-table. For instance, in the giving of cicutine hydrobromide, the doctor recom

mends: