MEDICINE.

THE MODERN CONCEPTION OF COLDS.-John Zahorsky (N. Y. Med. Jour.) shows what a misnomer the term "cold" is, since the condition so named is not due to cold at all but depends upon the activity of pathogenic microorganisms. "Colds" are more frequent in winter because of the more intimate commingling of people in closed apartments in which the air is stagnant. He epitomizes the modern concept of "colds" as follows:

1. Colds run a more or less definite course. If colds were merely reflex congestions, these should terminate soon after the excitant ceased. As a

matter of fact, colds last from three to seven days in spite of our therapy.

2. The inflammation begins at one point and spreads up and down the respiratory tract. This is a common observation, and very much resembles the dermatitides of infectious origin; e. g., erysipelas.

3. Colds are accompanied by fever and general symptoms. This is especially true among infants. These general symptoms are usually proportional to the extent of the local inflammation.

4. Microscopically, as well as macroscopically, inflammatory changes are found in the mucous membrane.

5. The ordinary secretion of the mucous membrane is soon replaced by a discharge more or less purulent.

6. Specific microorganisms have been isolated from these secretions. Among these, the Bacillus influenzae, Diplococcus lanceolatus, Friedländer's bacillus, streptococcus, etc., have been demonstrated.

7. The varying clinical picture of colds speaks for a variety in the virulence and character of the bacteria.

8. Colds are contagious. It is hard to conceive how this clinical fact, so easily demonstrable, has received so little attention in the literature of the past. In schools, asylums and hospitals this fact is very clearly shown almost annually. In family. practice, too, the development of one case after another in spite of care is a very common observation.

9. A relative immunity follows each attack. Were colds merely reflex congestions, these congestions should appear after each exposure. But after an attack the individual will be free from & cold for some time.

ACTINOMYCOSIS HOMINIS IN AMERICA. -W. G. Erving (Bull. Johns Hop. Hosp.) has collected the cases of this disease which have been reported in America, since the first in this country were described by J. B. Murphy in 1885. Ruhröh collected 58 cases in 1899. Since then others have raised the total number to 100, this including six new cases reported by the author in this paper, seen in the Johns Hopkins Hospital and the Union Protestant Infirmary of Baltimore. Of these

cases the disease was primary in the cervico-facial region in one, in the thoracic region in the second and in the abdominal region in the remaining three. They were treated by operation, locally with antiseptics and potassium iodid, and potassium iodid internally. Two died. The author's conclusions from a study of the 100 cases reported are interesting. He finds them pretty well distributed over the country, New York leading with 22 cases, then Illinois with 15. Only 20 per cent are from southern states. About three-fourths The infection is due to the ray are males. fungus and the disease is usually contracted from cattle suffering from "lumpy jaw," or from chewing straw or grain; therefore 53 per cent were The symptoms are clearly described. In all his six cases the author noted a leucocytosis, varying from 8,000 to 36,200. In the thoracic form the first symptoms are those of a bronchitis or pleurisy; the abdominal form often resembles appendicitis. The diagnosis depends upon the recognition of the organism. In man all three elements are found, but the long-branching threads and coccus-like bodies are more often seen. The organism is anaerobic. As regards potassium iodid Dr. Erving thinks it has no specific influence, but it may be used in connection with the surgical measures. Its action probably depends upon its bringing about solution of the cellular infiltration, promoting discharge of the fungi.

cervico-facial cases.

gtt. 4 . Cc. 4

Ether (ordinary). . Emulsionize strongly; this assists in the separation of a precipitate which rises very rapidly to the upper part of the liquid.

3. Redissolve the precipitate with an excess of concentrated solution of soda. Shake violently after having added an excess of ether. Let the mixture stand. There now rapidly forms a ring at the surface of separation of the liquid and ether. In this ring are found nearly all the tubercle bacilli contained in the fluid. This ring, however thick at first, grows rapidly thinner until it becomes a very thin pellicle. It is easy, after the ether has evaporated, or even before, to lift off a portion of this pellicle for microscopic examination after coloration by Ziehl's method.

This method is considered valuable by the author in doubtful cases of pulmonary tubercu

OBSTETRICS AND PEDIATRICS. TUBERCULAR PERITONITIS IN CHILDREN.-M. Comby, in the last number of the Archives de Médicine des Enfants, studies the medical treatment of this affection and shows that it can be cured without surgical intervention. In the first place absolute rest in bed is indispensible. The child should remain in this position for several weeks-several months if necessary. This horizontal position will favor the reabsorption of exudates, keep the parts from injury and spare the dependent organs. Rest must not exclude air and sun. The windows of the patient's room should always be open, and if possible, the room should open to the south. During pleasant weather the air cure can be taken out of doors, on a portable bed or a special carriage. Whenever possible, he should be sent to the seashore or country. At the same time the patient should be fed as liberally as his appetite will permit. One may give milk, eggs, vegetable purées, meat, raw meat or meat juice. Medicinally one may employ according to indications and tolerance, cod liver oil, pure or with creosote, glycerophosphate of lime, lecithin, local application of creosoted oil, iodin to the abdomen, collodion, compresses to the stomach, frictions of black soap, etc. But all this is but accessory. The principal thing is to place the child in the best hygienic condition-one which will not prevent the natural regression of the tuberculous products, their fibrous transformation and reabsorption.

PROGNOSIS OF TUBERCULOUS PERITONITIS IN CHILDREN.-G. A. Sutherland (Arch. of Pediatrics) bases a study of the prognosis of this disease upon an experience with 41 cases treated in the Paddington Green Green Children's Hospital. Among these cases 29, or 70.7 per cent, recovered; one was unrelieved, and 11, or 26.8 per cent, died. Of those treated medically (27 cases), 22 recovered; of those treated surgically (14), 7 recovered. The author admits the possibility of recurrence in some of the cases reported as recovered. His conclusions concerning the factors involved in the prognosis are as follows:

1. In uncomplicated tuberculous peritonitis the prognosis is good.

2. When tuberculous pleurisy is present, the prognosis is still favorable.

3. The prognosis is rendered less favorable in the case of (a) a strong family history of tuberculosis; (b) an infancy passed under bad hygienic and dietetic conditions; (c) a constitution of feeble resistant power, or (d) a history of severe infective illness in early life.

4. The prognosis is rendered less favorable in the presence of one or more of the following symptoms: Continuous pyrexia, rapid wasting, persistent diarrhea, rapid pulse, or recurrent acute exacerbations.

5. The prognosis is rendered less favorable in the presence of one or more of the following local complications: (a) tuberculous ulceration of the bowel; (b) extensive caseation of the mesenteric lymph nodes, or of tuberculous masses; (c) localized suppuration from infection through lymph nodes, or the intestine; (d) obstructive symptoms from bands or matting of the intestine.

6. The prognosis is bad in the case of the following complications: (a) the rupture of a suppurating lymph node, or the perforation of an intestinal ulcer into the peritoneal cavity; (b) pulmonary tuberculosis; (c) tuberculous meningitis; (d) general miliary tuberculosis.

7. In tuberculous peritonitis the prognosis is not appreciably affected by simple laparotomy.

TAMPONADE FOR POST-PARTUM HEMORRHAGE. -J. B. De Lee (Chicago Med. Recorder) follows the following routine treatment in post-partum hemorrhage from atony: (1) brisk uterine massage; (2) ergot; (3) a short, but hot (125° to 130° F.), uterine douche; (4) bimanual compression of the uterus in anteflexion; (5) uterovaginal tamponade.

He also occasionally practices compression of the aorta, drawing down the cervix with volsella, packing the vagina, and bimanual compression of the uterus through the tampon, external massage over the balled fist in the uterus, electricity, etc. The tamponade in his hands has proven so simple and so safe that he uses it prophylactically, in cases where the bleeding is not great. After an operative delivery, where often the patient has been in labor for many hours, and it is desirable to get her off the table and warm in bed as soon as possible, he finds it a very grateful procedure to remove the placenta quickly, and, if a little oozing persists, or the uterus shows a tendency to fill with clots, to tampon the whole tract. The patient then may be safely put to bed. Hemorrhage sometimes comes from the lower uterine segment, especially in cases of low placental insertion; again, from small lacerations here, that cannot be reached by suture. The tampon is indicated in these cases. After Cesarean section, it may be necessary to tampon the uterus because of atony. Where the appearance of the blood suggests some abnormality of its constituents, and where one tamponade has proven inefficient, the uterovaginal tract should be repacked with gauze saturated with a ten per cent solution of gelatin. In two instances of the writer's, this procedure stopped at once obstinate hemorrhage.

EFFECTS OF TIGHT DIAPERS.-A. C. Cotton (Arch. of Pediatrics) thinks that the ordinary diaper of unyielding material, pinned tightly about the plastic pelvis of an infant, in which the ossification of the bones is not yet completed, may be responsible for pronounced deformities. The contracted pelvis, the most frequent cause of dystocia in America, he thinks may be due in a considerable measure to the compression of the American diaper. The practice also of wadding a large amount of inelastic material tightly between the thighs is plainly responsible for deformities of the femora. There is little doubt in the mind of the author that many cases of genu volgum have their beginning in this cause. To obviate these defects Dr. Cotton advocates the use of light diapers and no more material than is absolutely necessary for the absorption of discharges. Absorbent cotton, either loose or in pads, preferably the latter, retained by a T bandage or triangle of some flexible material, such as cheese cloth, secured by safety pins to the shirt, before and behind, has been found to meet all the requirements.

MATERIA MEDICA AND THERAPEUTICS.

INFLUENCE OF Drugs on BLOOD PRESSURE.—J. B. Briggs (Johns Hop. Hosp. Bulletin) records a long series of observations made on blood pressure in cardiac diseases, as measured by a modified Riva-Rocci instrument. He found that in patients unaccustomed to the use of alcohol the ingestion of 1⁄2 to 1 ounce of whiskey will usually produce a temporary rise of blood pressure, never lasting more than thirty minutes, and followed by a fall below the usual level. The total effect of alcohol an the vaso-motor system, therefore, is one of depression. It was observed that the ingestion of 10 to 15 drops of tincture of capsicum caused a rise in blood pressure equal to or even greater than 4 to 6 drams of whiskey and its use was followed by no depression. Strychnia hypodermically in moderate doses was found to cause a rise in pressure somewhat delayed as compared with that after alcohol, but continuing with far more steadiness, and persisting for from one to three hours. A similar rise in blood pressure, with more rapid onset and somewhat less permanent, was found to follow the administration of digitalin. The blood pressure raising effect of these drugs was not followed by any phase of depression, as in the case of alcohol. During the routine administration of these stimulants, especially with strychnin given over long periods, the blood pressure response to any single dose may be apparently absent, and in any case will be less marked than that following the first few doses given to the patient, but in these circumstances if the routine order be suspended for one or two periods, the blood pressure will be seen to fall in the absence of the stimulant, to return to its former level when the drug is resumed. This constant blood pressure level, as maintained by the use of strychnin and digitalin at regular intervals, represents the ideal to be sought after in the stimulant treatment of the toxic conditions, as illustrated especially in the severe cases of typhoid fever. In this class of cases alcohol, not being a true cardio-vascular stimulant, does not contribute to the maintenance of the "stimulation level" of the blood pressure curve, and the rational basis, for its use must be sought in some alteration of metabolism, and not in any assumed improvement of the force of the pulse. Subcutaneous infusions of normal saline solutions, contrary to general opinion, have no stimulant action on the pulse.

INHALATION OF FORMALDEHYD IN TUBERCULOSIS.-W. G. Shallcross (Phila. Med. Jour.) has devised a simple inhaler for the administration of formaldehyd. It consists of an ordinary widemouthed bottle holding about one pint, closed with a tightly-fitting cork, perforated with two holes through which glass tubes are passed, one reaching to the bottom of the bottle, the other one short and bent outside the bottle to attach to a piece of rubber tubing connected with a mouthpiece. A piece of wire mosquito-netting is covered with gauze and rolled up so it can be put in the bottle. When unrolled a little it presents a large surface for the reception of the liquid. The mouth-piece can be made by cutting off one

end of an ordinary rubber bulb from an atomizer. The fluid which has given the most general satisfaction consists of equal parts of forty per cent commercial formaldehyd and ninety-five per cent alcohol. Chloroform, creosote, oil of gaultheria, guaiacol, etc., may be added to this when desired. About 50 Cc. or twelve drams are sufficient to moisten the gauze and leave an excess. This will last for two or three months without the necessity of renewing. This apparatus is cheap, requires no adjusting, permits free admixture with atmospheric air, and is readily portable. The benefit derived from its use in Dr. Shallcross's cases has been most decided.

THE THERAPY AND PATHOGENESIS OF ANGINA PECTORIS AND ALLIED CONDITIONS.-R. Breuer (Muenchner Mediz. Wochenschrift) has been using theobromin in the treatment of angina pectoris, and his results confirm the statements made some years ago by Askanazy. Theobromin, in addition to a very marked diuretic action, acts as an anodyne by arresting the severe and agonizing pain which is such a prominent subjective symptom in angina pectoris, cardiac asthma and allied conditions in which the pain is of arterial origin. Breuer cites a number of cases, going into the details, in which the pain was most severe in the heart and in the head, stomach, shoulder, intestines and kidney. The pain was invariably relieved by theobromin, from which he argues the common origin of the pain in the arteries. These radiating pains are often met with in arteriosclerosis and similar affections of the arteries, hence he believes that theobromin has a selective or specific action on the arteries. These pains are due either to distention caused by an increased blood pressure, or to a spasmodic contraction of the arteries, especially of the smaller arteries. These contractions are the result of exaggerated reflexes originating in the vessel wall, and they are set in motion by various causes which raise the blood Orpressure, emotions, muscular exertion, etc. gans which are the seat of a good vascular supply are especially liable to be the seat of these pains. The arterial hyperemia which always accompanies increased function starts the pain, and when the arteries react and contract a condition of arterial anemia is produced, which interferes with the function of the part. We have paresis and meteorism in the digestive tract; claudication in the extremities and paralysis of the heart, or, perhaps, only an insufficiency. In angina pectoris we know that the coronary arteries in particular are involved, and the pain is liable to radiate to remote regions. The very excruciating anginose pains are always due to the lodgment in the coronary arteries of a thrombus or embolus, and sudden death is very often the result. Breuer believes that theobromin has some action on the arterial spasm, or that it reduces the blood pressure, or that it diminishes the excitability of the reflexes. In either case its action is specific in so far that it promptly checks the intense pain. He gives it in the form of diuretin in one-half gram doses (grains) four or five times a day. In severe cases this dose may be increased to four grams a day, or one gram at each dose. Its high price is the only objection to its use.

ABORTIVE TREATMENT OF BUBOES.-A number of contributors to the N. Y. Medical Journal submit methods of treating buboes. They generally agree upon the necessity of careful antiseptic and cleansing treatment of the primary lesion, usually chancroid in the severe types of bubo. J. A. Nydegger thinks absolute rest of the greatest value and in conjunction with this applies the ice water coil or bag over the bubo every alternate half or three quarters of an hour. If this is not effective he employs liquor opii et plumbi subacetatis on gauze or cotton covered with rubber tissue, or 10 per cent solution of ichthyol or guaiacol in glycerin, applied twice daily. Restricted diet and laxatives are prescribed. E. S. Sherman gives laxatives and if the patient is seen before the suppurative stage orders the following ointment spread on lint, held in place with a compress and a firm spica bandage:

Ichthyol

oz. 12 Mercurial ointment (50 per cent) oz. 1⁄2 Comp. iodin ointment.. ..oz. 11⁄2

The rest and ice bag are also advised.

A similar ointment, used in the same way, is recommended by Chas. D. Luckett; it contains:

Mercurial ointment

Belladonna ointment

oz. 11⁄2

.oz. 12

.oz. 11⁄2 .oz. 11⁄2

J. N. Weller thinks highly of the cold applications and the local and opium lotion; but where there is much induration he advises:

This makes an excellent cleansing and stimulating wash for the hair. It may be supplemented in suitable cases by a good sulphur cream or ointment, such as that of Dr. Jackson, the formula of which appeared in the Standard for August, 1901.

SODIUM SULPHOCARBOLATE IN TONSILITIS.Geo. M. McBean (Clinique) extols sodium sulphocarbolate as a remedy in tonsilitis. Nine cases are reported in which the remedy was used, and in a number of these he succeeded in aborting the disease when other treatment had failed. Local treatment with hydrogen peroxid, potassium permanganate, boric acid solution, etc., was used in every case and usually the indicated homeopathic remedies were administered also. The dose employed was usually about 10 grains of the sulphocarbolate every two hours. It may be taken dry on the back of the tongue or dissolved in water

Ex

THE TELEPHONE AS AN AID TO HEARING.-D. B. St. John Roosa (Post-Graudate) suggests the practical utilization of the fact that some persons with impaired hearing can hear perfectly well through the telephone. He states that the condition which finds temporary relief in this way is one of disease of the middle ear. actly the same thing holds good with those people who can hear better in a noise. Dr. Roosa says that the improvement is probably due to increased action of the membrana tympani and the ossicles by the increased formation of sound waves. There is no reason why the principle of the telephone should not be utilized in devising an instrument for the relief of these people. somewhat after this plan is really now offered for sale under the name of the "Acouphone."

One

FOR TOOTHACHE.-The American Druggist suggests the following formula:

Mix and dissolve. Directions for using: Clean out the cavity, if possible and dry it by a pledget of absorbent cotton wrapped around a tooth-pick or sharpened match-end; then introduce a little wad of cotton saturated with the liquid intothe cavity. A thin strip of bibulous paper may sometimes be used for drying the cavity to better advantage than cotton.