MT

III

ILK in its natural state and eggs not absolutely fresh are quite fresh are quite often contraindicated in the diet of patients suffering from atonic dyspepsia because of the flatulence which they provoke. I have often seen this in the victims of an ovolactic diet, as well as among those who take mineral waters as their exclusive drink. I counsel regular repasts well chewed.

"We have thirty-two teeth," said Andrew Clark, "which is the reason why every mouthful should get thirty-two bites with the teeth. I also advise that the interval between the three meals should be five hours. As drink I permit the atonic patient, if he or she is not too nervous, a quart of old red Bordeaux thinned with three quarts of weak hot tea. Hot drinks stimulate the act of digestion, diminish the sense of heaviness, favor the activity of the ferments and the molecular dissociation of the fats.

The bread should be either stale or toasted or replaced with zwieback (bread sliced and browned in the oven). There is no harm in introducing in small quantities the following articles into the diet of the atonic individual: lean oysters, smoked ham, lemons, old wine, vinegar, parsley, thyme, laurel, truffles, cinnamon, vanilla, cloves, and diffusable antispasmodics and stimulants. As soups the best would be fat-free bouillon as a base, into which chopped vegetables may be introduced, then thickened with rice flour or barley or dough. Meats should be tender and well cooked; gelatinous meats, brains, calves' sweetbreads, young turkey, fresh partridge,

quail and lark may make up the menu, without fat or piquant sauces, and without ragouts or fried things. All vegetables should be mashed with butter. The most digestible vegetables are salsify, chicory, crosnes, [crosne, Japanese labiate plant with an edible tuber. It is a winter vegetable."Dictionnaire Petit Larousse"], cardoons, carrots, peas, greens, and lentils.

He that eats and swallows quickly digests slowly. The tachyphage becomes a dyspeptic. But, on the other hand, slow eating (bradyphagia) is quite often the provoking cause of habitual air swallowing (aerophagy). The longer one masticates, the greater chance he has of swallowing air. In medio virtus. In almost all nervous dyspeptics there is need of reeducating the appetite and the digestion. These patients have the deplorable habit of depriving themselves gradually of all aliments, which they regard one after another with suspicion, as hurting them. The anorexia is at first voluntary and elective but gets to be quite morbid and general. Among these dreaders of food (sitiophobics) we find those of perverted taste, who are a prey of irrational desires (pica, malacia) and the syrmiacs [Greek syrmos, vomiting, and syrmaie, an Egyptian emetopurgative made of the juice of a certain radish mixed with salt water.-GLEANER], who like the old Romans make themselves vomit whenever they feel the least heaviness after a meal. All cases of that condition are quite amenable to psychotherapy.

Gastralgia has often occurred in consequence of some mental and moral shock preoccupying the mind. In the young, gastralgia is often the sign of anemia. It

follows readily the grip and prolonged wetnursing of infants. Here too is the neuropsychic treatment of far greater importance than eupeptic medicaments and restricted diet. To sum up the matter, we should say that we have here a hyperesthesia of the solar plexus. This diagnosis is frequently impossible to be made except by exclusion, i. e., when we have ascertained that the pains in the walls of the stomach and the intermittent cramps, which come more frequently than usual while it is empty, do not depend on the presence of either a round ulcer, nor on a stenosis of the pylorus, nor on hyperchlorhydric troubles, nor on any lesion of the liver, nor on a congestion of the appendix.

At the time of a painful attack I counsel giving simultaneously a granule of Gregory's salt, a granule of atropine, and one of cannabin, which medication should be repeated in case of persistance of the pain. If the attacks continue we order tepid douches, with interrupted jet, on the spine, during ten or fifteen days, one minute every day. If this fails then a fly blister at the epigastrium, left on for four days, constitutes a most favorable revulsive. Internally the medicament that served best was sodium chloride in solution of 10 percent, two or three tablespoonfuls in twentyfour hours. I explain the sedative power of this salt by its topical action on the gastric mucosa, which must be affected at times with herpetic epithelial desquamation.

Errors of diet are most harmful for gastralgic patients, yet we may permit them a sufficiently large diet on condition that they exclude all crude and irritating aliments, such as acids, spices, condiments and stimulants, articles rich in tannin (as tea or red wines), ice, beer of poor quality (very rich in dextrin), and medicaments that are hurtful to the gastric mucosa, those namely that are mostly of the purgative kind. The gastralgic patients may have mucilaginous pottages, fresh eggs, gelatinous meats, and thickened barley gruels as drink. We must not forget that this evil is almost always a reflex or sympathetic. Thus it is that we must consequently closely observe and treat all ptoses, all hernias, hemorrhoids

and uterine deviations. We have to counsel warm clothing, and females should replace their rigid corsets with girdle corsets of elastic tissue.

Gastralgia requires habitual general treatment of neuroarthritism, living in the open air, exemption from fatigue, especially of the mundane kind, exemption from intellectual work and overwork, giving up the use of tobacco and of aperients, and all drinks after meals. Presclerotic persons (inclined to sclerosis) and persons of an exaggerated disposition (préscléreux et les hypertendus) are subject to a variety of gastralgia which is accompanied by cardiac arrhythmia and at times by tachycardia. In these cases use should be made of the high-frequency current and the current and sparks applied at the epigastrium locally by the aid of Oudin's resonator.

Under a pretext of debility, and during an attack of sudden boulimic appetite, the gastralgic patient may be led to use and too often abuse strong wines, prepared meats, highly seasoned dishes and condiments. Then it does not take long for him to superadd to his purely nervous malady a dyspeptic gastropathia of a more or less grave character. The sedative granules of codeine, cocaine, cannabin and hyoscyamine, moderately employed, act very well against the false hunger and against the impulsion to use excitants. [These granules are also valuable for dipsomaniacs.] If there is also an associated chloranemia we should add quinine hydroferrocyanide, which is perhaps the only iron preparation that is tolerated by gastralgic patients, but we must always begin with small doses. [We must warn against the use of cocaine internally. This is a dangerous drug, lending itself too readily to habit formation.-ED.]

In young hysteric females gastralgia is altogether a special disease. It readily becomes complicated with a rebellious anorexia and an uncontrollable emesis. As soon as the diagnosis is made certain the physician should begin a course of therapeutic intimidation; he should speak loudly of direct cauterization, of electric shocks, of esophageal sounds and bougies, and even of surgical operations. If these

moral means fail then he should not hesitate to prescribe absolute isolation, permitting neither the receiving of letters nor visitors. This mental diet becomes indispensably necessary in order to make effective the useful suggestions and to reeducate the unsteady will. In recent times I have thus intervened in saving from death some young hysterical patients who, after adopting a diet of inanition, have brought on vomiting which eventuated in progressive cachexia. Such are those hysterical gastralgias which are engendered by those lean and long silhouettic females, by that absurd fashion which is reigning at the present time.

We ought not to believe that all vomiting of hysterical females is without any organic trouble. A certain number of these cases is connected with stomach lesions, especially when there is gastrorrhagia, even menstrual, for there can be no bleeding unless there be erosion, though there may be no ulcer. Usually it is pain felt on palpation of the epigastrium which betokens the development of the hematemesis in the paroxysms of the nervous patients. The pure nervous attacks are moreover recognizable by their sudden invasions succeeding some emotion. and they are more frequent when the stomach is empty. They terminate with a convulsive attack, more or less characteristic, in which suffocation and repeated sighing and air-swallowing and abundance of tears are predominating features.DR. E. MONIN in La Dosimetrie, June, 1911.

THE ALKALOIDS

The discovery of the alkaloids, said Dr. Debout, of the last century, was one of the most important ones made at the commencement of that century, and it saved the medicinal flora from the shipwreck in which modern skepticism threatened to engulf it. The energetic action of most of these organic bases no longer made it possible to contest the properties of a goodly number of medicinal plants whose therapeautic value had been called in doubt. Moreover the fixity of the composition of these new products entitled them to the same rank with the most active and con

stant principles in the mineral kingdom. It is enough to name in this respect quinine, digitalin, aconitine and hyoscyamine to make evident at once that the vegetable principles can furnish practical medicine with resources not less energetic than iron, mercury and arsenic.-Repertoir Universel de Médecine Dosimetrique, Vol. XII, p. 191, 1884.

[THE GLEANER places this paragraph here, at this late date, merely as an item for the medical historian, who will find further valuable material in the article by Dr. Forran, from which this paragraph is taken.]

THE SPREAD OF CHOLERA

At a recent meeting of the French Academy of Medicine, M. Chantemesse reported, for himself and for M. Borel, concerning the part which emigration plays in cholera. In the year 1910 cholera passed from east to west, and the winter of that year extinguished its focuses in Russia, in East Prussia, in three Ottoman localities, in Hungary and in Italy. Have the local struggling efforts put forth in all these focal centers been sufficient to protect us? We do not dare to hope that they have.

The inquiry instituted by M. Chantemesse yields some facts which show the formidable part which latent microbism and emigration play in the transportation of cholera.

Chantemesse cites many instances, and concludes as follows: The preceding facts establish examples of latent microbism: Individuals have left cholera-infected centers after 25 or 30 days, all their baggage has been disinfected, and sometimes several times, they themselves have been visited two or three times by physicians, and they have presented definitely most serious guarantees, from the point of view of maritime sanitary police, such as are defined in the international texts, and yet the infection of these individuals nevertheless withstands time and is not at all destroyed by the disinfection to which they have been subjected; despite all the medical examinations, it shows itself after all the precautions which have been exercised.

What protection against danger have those five days of observation imposed by the last international sanitary conference upon persons who come from countries contaminated with cholera?

If it is desired to make war against the transport of cholera by attacking latent microbism we cannot obtain that result to a greater or lesser extent except by severe regulations and active surveillance over emigration.

The preceding international sanitary conferences directed all their efforts to the danger of Mussulman pilgrimages. The next conference should occupy itself with the new facts growing out of the everincreasing extent of emigration, for inquiries show that for the exporting and spread of cholera the pilgrimage of misery is as dangerous as the one of religion. Gazette des Hopitaux, 1911, pp. 226-227.

[These facts are in accord with the discovery, in New York, of a number of

"cholera-carriers"-individuals who harbor the germs of the disease in their bowels, thus disseminating the disease itself, though they are themselves entirely well. How many of these "carriers" come in as immigrants is a vital problem, which our sanitarians are now trying to solve.-ED.]

THE PROTECTIVE EFFECT OF THE AIR

Our earth is hit every day, according to average calculation, by about four hundred millions of meteoric stones. Those rattling missiles from the universe about us would have a terrible effect were it not for the protective action of the atmosphere. But the friction of the meteors when passing through the air that covers the earth puts the smallest of them into a glowing heat, which burns them up and scatters them as dust before they arrive at our earth. Only few meteors reach the earth and these with greatly checked speed. The rain drops and the hailstones would bombard us with the speed and weight of the discharges from a gun were it not for the protection of the air. The same moderating protective effect is experienced by us in the change of temperature from day to night.

On the moon, which has no atmosphere surrounding it, the temperature changes between day and night, i. e., between its radiation [How I wish I were allowed to write "beradiate," like the German bestrahlen!-GLEANER] by the sun in the daytime and the absence of radiation at night are, according to calculation, from 100° C. above the freezing point to 200° C. below zero (212° F. to 148° F.), while with us on earth the change amounts to only a few degrees. This moderation is effected by the atmosphere which protects the earth.-Der Geisteskampf der Gegenwart, July, 1911, p. 270. TEMPERATURE DIFFERENCES IN THE AXILLAE OF THE TUBERCULOUS

Von Casali states, in Gazzeta Ospedale, (1910, 1041), that the temperature in the

axilla on the affected side of tuberculous

patients is almost constantly higher, the plus amounting to some tenths of a degree (centigrade) as compared with the healthy side. The difference is most pronounced in acute cases. Exceptionally an augmen

tation of temperature is met with in the axilla of the healthy side. The explanation of this latter phenomenon demands further

study.-Wien. Med. Wochenschr., 1911.

SKIN DISEASES TREATED WITH ETHEREAL EXTRACT OF MALE FERN

For many years Laner has been treating acute and chronic eczema, acne, sycosis and other skin diseases by brushing them over with ethereal extract of male fern exclusively. He has obtained some brilliant results with this remedy and in a short time. For acute cases the extract is mixed with two parts of ethereal tincture of valerian, and for subacute and chronic cases one or one and a half parts of the valerian is used. The remedy is applied at night and the affected place is washed and cleansed in the morning with soap and water and covered with a lead-glycerin ointment. In acute eczema, poultices are applied two or three days before the brushing with the male fern is begun. Crusts must always first be removed.-Pharmaz. Zentralhalle, 1911, p. 42.