MEDICINE.

AN ANALYSIS OF SEVENTY CASES OF GASTROPTOSIS. Steele and Francine (Jour. Am. Med. Assn.) have made a careful study of 70 cases of gastroptosis, arriving at the following conclusions:

1. Gastroptosis is much more common than might be inferred from the meager reference made to it in a majority of the text-books on general medicine. In women showing symptoms of gastric atony its presence is almost constant. It is much less frequent in men.

2.

The occurrence of gastroptosis is not confined to any particular age or class of individuals. There are no causative factors common to all cases, and no explanation of its etiology heretofore given is broad enough to be wholly satisfactory, if we except the theory of congenital predisposition, which is entirely hypothetical.

3. The position assumed by the stomach in all of our cases was vertical or subvertical. Total descent was not observed and probably is extremely rare. Some dilatation of the pyloric extremity was always present. When this dilatation affects the pyloric end alone it may perhaps safely be assumed that the dilatation is secondary to the descent of the pylorus. In general dilatation and gastroptosis it is probable that the displacement is secondary to the dilatation. The data in regard to the position of the stomach were obtained in every case by inflation with air through the stomach. tube. The colon was inflated through the rectum.

4. The transverse colon invariably shared in the displacement, assumed the M or V shape, and when inflated by air was in close contact with the greater curvature of the stomach. The hepatic flexure may not be displaced or may sink to the level of the umbilicus. The splenic flexure lies behind the stomach and eludes demonstration.

5. The right kidney was movable in 60.9 per cent of the cases. The left kidney rarely showed abnormal movability and the spleen in but one case. The fact that the liver was observed to be unduly movable and sagging downward in three of six cases operated on suggests that ptosis of this organ may elude our methods of physical examination and be more frequent than is usually sup posed.

6. There is no condition of the gastric contents peculiar to gastroptosis. Absence or diminution of the free HCl is the rule. In a few cases the amount was normal. Hyperacidity was rare and usually occurred in cases where general dilatation existed, and when there was a strong neurotic taint.

7. There were no characteristic changes in the blood or urine.

8. The subjective symptoms were those of gastric motor insufficiency, and were of a mild grade in cases of primary ptosis, but more severe where general dilatation existed. Pain was present in the upper abdominal region in about half and in the lumbar region in a quarter of the cases. 9. The same causes that produce neurasthenia

Later he found cases in middle Alabama, southern Georgia and Florida. In the latter regions anemia is very common and is thought to be due to malaria, but his observations show that in almost every instance there are no malarial parasites in the blood, while eggs of the ankylostoma are constantly found in the feces. The writer is convinced that time will show that by far the greatest number of cases of anemia in Georgia, Alabama and Florida are due not to malaria but to the ankylostoma, and that this is the most common of all the serious diseases in this region. There can be no reasonable doubt that what is true as regards the states named likewise holds good for the entire south. He also quotes the discovery made by Stiles of the U. S. Bureau of Animal Industry that there is a distinctly American variety of hook-worm, which has been named the Uncinaria americana. Dr. Stiles examined the parasites from one of Dr. Harris's cases and pronounced it a member of the new species.

OBSTETRICS AND PEDIATRICS. ANTIPYRESIS IN CHILDREN.-E. W. Saunders (St. L. Cour. of Med.) places hydrotherapy in the first place among antipyretic measures in children; but he does not think it should be used to the exclusion of others. Often the combination of hydrotherapy with a drug is better than either alone. This is especially true when the temperature is high-above 105° F. Under this condition absorption of drugs from the alimentary canal is slow and their action uncertain. The best results are obtained by reducing the temperature several degrees with the bath and sustaining the effect with a suitable drug. Coal tar antipyretics are not to be used where the heart is likely to fail, as in diphtheria and pneumonia, but their use is justified in many conditions, such as the early stages of scarlatina and the exanthemata. In influenza they are indicated for the relief of pain, though a heart stimulant should be combined with them. Dr. Saunders has found the combination of phenacetin and camphor an excellent one. Pilocarpin is lauded as an eliminant, especially in scarlet fever and diphtheria. In pneumonia Dr. Saunders regards veratrum viride as the safest antipyretic. The external application of guaiacol as an antipyretic is also favorably mentioned by Saunders. As recommended by DaCosta, not more than thirty drops is to be painted on the abdomen. This method the author has found extremely valuable in young children when the stomach is irrit able and hydrotherapy inapplicable. In some cases one drop of the guaiacol will produce the desired effect; in others several drops are necessary.

CARE OF CHILDREN'S TEETH.-A. G. Friedrichs (N. O. Med. and Surg. Jour.) thinks that the preservation of the deciduous teeth is of more importance than that of the permanent ones, since any inflammatory condition may leave its mark upon their successors; moreover, mastication is interfered with, large boluses of food are taken. into stomach and various digestive and nervous disturbances are likely to arise. Dr. Friedrichs points out the necessity of furnishing proper food for the maintainance of the nutrition of the dental arch as well as for the body as a whole. Mother's milk is, of course, the ideal food. The

family physician should see to it that the mouth is kept clean. The new born infant should have its mouth washed after each feeding with boric acid solution. After the eruption of teeth a small, soft brush should be used and the teeth and mouth cleansed at least twice daily. The physician should examine the child's teeth once every six months. When caries attacks the upper or lower six teeth this usually takes place between the teeth; it may be checked by making a V-shaped opening between them, the knife removing a strip of enamel from the cutting edge down to the carious spot. Cavities in the molars may be checked by dropping in small crystals of nitrate of silver until the cavity turns black, protecting the mouth with absorbent cotton. Abscess cavities or the presence of pus around the roots should not be trifled with, since they are a dangerous source of infection. Remove them.

BUTTERMILK AS AN INFANT FOOD.-A. Baginsky (British Med. Jour.) gives his experience with buttermilk in the Emperor and Empress Hospital, Berlin. It was suggested by de Jager in 1895, who stated that it had long been used in Holland. Other pediatrists have since that time. reported excellent results with it. Baginsky commenced its use in July, 1901, at first sparingly, but more and more as it was found peculiarly adapted for the dyspeptic infant.

The buttermilk used by Baginsky is made from pure cream soured by bacteria. Thus obtained, to one liter of buttermilk 15 to 25 Gm. of wheat flour and 35 to 50 Gm. of cane sugar are added. The mixture is allowed to boil for two or three minutes, constantly stirring meanwhile, then poured into sterilized bottles, stoppered with cotton and placed in the ice-box until ready to use. This buttermilk mixture does not at all approximate either mother's milk or cow's milk. It contains only 0.35 per cent of fat as compared with 3.5 per cent in mother's milk, while there is 34 per cent of abumin as compared with 3 per cent in cow's milk; the percentage of sugar is about the same as in cow's milk; it is highly acid, due to the presence of lactic acid. The albumin is present in extremely fine particles, due to the flour present. The buttermilk is given undiluted.

The quantity prescribed is based upon the number of calories required for a normal child of the age of the patient, varying from 633 Gm. daily for a child of eight weeks to 1,137 Gm. for a child of 30 weeks. The results obtained with this food in the 300 cases treated were brilliant; 182 of these were in the medical wards under Baginsky's personal observation and in 150 of those the food proved successful. It was not given to normal children, only to the sick. It was found especially valuable in dyspepsia and acute diarrhea. In 77 cases it was taken with good results almost immediately after the attack; in 18 cases in which it was not successful there were other conditions to deal with, such as otitis media and bronchopneumonia. The same excellent results were attained in chronic enteritis, even when the patients were almost atrophic or marasmic. There were a few failures in patients who were in very poor condition-some almost moribund-when admitted. The author does not attempt to explain the good results from this food. The improvement is scen

first in the change in the consistency and odor of the stools and the gain in weight. The author considers it a "life-saving preparation" in chronic diarrhea and chronic enteritis, while it is well borne soon after acute attacks. He has never seen rickets or scurvy develop during its use.

MATERIA MEDICA AND THERAPEUTICS. TREATMENT OF ACNE.-F. H. Beadles (Va. Med. Semi-Monthly) bases the constitutional treatment of acne upon the cause, if it can be discovered. In a large percentage of cases a correction of the diet is of great importance. Reduction of the total quantity of foods, and especially of meats, is recommended. Milk, bread, fish, fruits and the lighter vegetables usually benefit these cases. Sponging the entire body, except the face, with cold water, and energetic friction are useful. Arsenic and calcium sulphid are not esteemed highly by Dr. Beadles. The local treatment of the face is as follows: First, the surface is rendered aseptic. A massering ball is then rotated freely over the surface, deep pressure being made over the affected region with the result of bringing into view groups of previously inconspicuous comedones, which are, in turn, removed with an extractor. A ring curette is next drawn over the lesions, expressing their contents and stimulating others to activity. The subsequent bleeding is encouraged by sponging with hot water. The patient is then directed to bathe the face thoroughly for ten minutes, just before retiring, with spirit of green soap and water as hot as can be borne; after which the face is wiped dry and some astringent lotion, which is allowed to evaporate on the surface, is applied. A lotion which Dr. Beadles has found highly beneficial is composed of the following:

Zinci sulphat

Potass. sulphuret Aquæ rosæ, q. s..

M.

..

.dr. 1 .dr. 1 .oz. 4

PROTECTIVES AGAINST EFFECTS OF X-RAYS.— W. A. Pusey (Interstate Med. Jour.) says there are two ways of protecting surrounding surfaces against the effects of X-Rays. The first is by surrounding the tube with an opaque covering so that the rays will have exit at only one point, as by Williams' box. The second is by covering the surface of skin itself with a protective. The second method is usually most convenient. Tin foil and sheet lead, in various shapes, are most used. Grubbe suggests a foil made of 95 per cent lead and 5 per cent tin. Dr. Pusey prefers lead, which he has experimentally proven to be almost impervious to the passage of the rays. He uses sheets one-thirty-second of an inch thick, such as can be obtained at any plumbers' supply house; these are covered on both sides with ordinary wrapping paper, which furnishes satisfactory insulation, is clean and easily washed off, so that the lead can be used again. The sheets are moulded into the desired form, a wooden model of the head and neck being useful for this purpose. For making vaginal exposures the ordinary Ferguson glass specula are used and the thighs, buttocks and perineum are covered with the lead sheets with a slit for the speculum. Caldwell's

tubes are the best means for making exposures in the mouth and vagina. Hard rubber is valueless as a shield. An ointment consisting of equal parts of vaseline and bismuth subnitrate makes a fairly good protective. Paraffin, alone, is useless for this purpose.

DIETETIC MANAGEMENT OF TYPHOID FEVER.F. X. Walls (Chicago Med. Recorder) objects to "milk alone" as an exclusive diet in typhoid fever. It is not so simple a food as it seems; it yields larger stools than milk or eggs, is not well tolerated, even in health, by many people, is a favorable soil for the multiplication of bacteria and the production of toxins, as shown by its action in the summer diarrheas of young children, and contains enormous amounts of filth, manure and bacteria. There is no such thing as a pure milk in Chicago, he thinks, and the same is undoubtedly true of other cities. Fifty specimens of milk, taken promiscuously, examined by the Chicago Health Department all contained bacteria-the least, 22,500 to the Cc. In New York and London similarly contaminated milk is the rule. In Berlin, each day the citizens consume 300 pounds of excrement in their milk. While painting a picture of the filthy condition of the average dairy the author calls attention to the fact that 6 per cent of cows are tubercular and that a large number have suppurating mammæ or infected udders.

The keynote of diet in typhoid is "individualization." Beside water, which should be given freely, the author suggests the use of well-cooked gruels, meat juices and broths, white of egg, jellies, milk variously modified, used cautiously, kumyss, buttermilk, junket and rarely the concentrated foods, such as somatose, plasmon, etc. Do not overfeed. Look out for gaseous distension and examine the stools for evidence of indigestion.

POISONING FROM PENNYROYAL.-G. W. Holland (Virg. Med. Semi-Monthly) reports the case of a healthy woman of 24 who took about 45 minims of oil of pennyroyal in three doses between 3 p. m. and 9 p. m. in order to bring on her menses, and presumably to induce abortion. After taking the last dose she went at once to bed. She soon dropped to sleep, and in about an hour roused and complained to her husband of great dizziness and nausea. In a few moments she vomited and began to complain of her extremities becoming stiff and cramped. By this time she had lost consciousness and was seized with a violent tonic contraction of all the muscles, opisthotonos being well marked. This spasm lasted only a few minutes and left the patient talking incoherently and tossing about the bed. The toxic symptoms now gradually began to subside and consciousness was regained in about half an hour, but she had no recollection of what had happened during the past hour. Upon the doctor's arrival she had regained consciousness, but complained of great weakness and cramps in the stomach, and slight desire to go to stool. The pulse was rapid (108) and feeble, respiration and pupils normal, and the toxic symptoms rapidly subsiding. It may be added that the pennyroyal failed to produce the desired effect.

THE TOWEL PACK.-Under the service of C. H. Hunter (Northwestern Lancet) there has been developed a therapeutic measure, used as a substitute for the Brand bath in typhoid fever. The latter measure is acknowledged to be the most effective means of combating this disease, but there are objections to its use in private practice. The

TOWEL PACK-FIRST STEP.

towel pack is an excellent substitute and it is preferred by patients to the ordinary sponge bath. The requisites are a rubber sheet, a common sheet and a blanket cover; a table for hot water bags and whiskey; a second table for bowls of ice and water, seven large, heavy bath towels without fringe. The steps are as follows:

TOWEL PACK-THIRD STEP.

First step.-Put the patient on the rubber sheet, covered by a blanket.

Second step.-Heat towel; blanket removed as wet towels (temperature 65°) go on chest, arms, abdomen, and legs.

Third step.-Packed; towels being wrung to replace first set, leaving no part uncovered for a moment.

Fourth step.-Replace the warmed towels with fresh cold ones.

Fifth step.-Front towels still clinging while the back is being covered; ice-rub over towels. Sixth step.-Towels removed; patient dried and uncovered.

Time.-Thirty minutes.

VERATRUM VIRIDE IN PNEUMONIA.-While the fashions change in therapeutics, as in everything else, there are some old remedies which hold their place in popular favor in spite of opposition. One

of these is veratrum viride. Its friends are enthusiastic in its praise, especially in pneumonia and puerperal eclampsia. V. D. Lockhart (Med. World) praises it for the first-named affection. He gives Norwood's tincture in 1 to 3 drop doses every hour or two until the pulse comes down to 70 or 75 a minute. Calomel, in moderate, repeated doses to produce catharsis, is given at the beginning of treatment. The editor of the Standard, talking with a prominent Chicago physician recently, elicited the opinion that veratrum will almost invariably cure pneumonia, provided the remedy reduces the rapidity of the pulse. This physician uses Norwood's tincture.

BREWERS' YEAST IN THERAPEUTICS.-Julius Ullman has an article (Am. Medicine) pointing out some of the therapeutic uses of brewers' yeast. This substance depends for its efficiency mainly upon the nuclein which it contains. Nucleinic acid is capable of inducing a leucocytosis, thereby increasing bodily resistance; the nucleins are also powerful germicides and the germicidal action of the blood is due to their presence. Yeast also

contains ferments which are believed to be useful in digestion and in metabolism, by the latter process probably having some action upon not only the breaking up of glucose, but its reconstruction within the body into glycogen, thus proving useful in diabetes. Many conditions are named in which brewers' yeast has been employed. Locally, it has value as a vaginal injection in leucorrhea. It is used internally in furunculosis, smallpox, diabetes, constipation and various digestive troubles, bronchitis, bronchopneumonia and especially in incipient pulmonary tuberculosis. The fresh brewers' yeast may be employed or one of the excellent derivatives now on the market.

Dover's powder, camphorated

Po. ex. belladonna

Po. aloin ....

Po. capsicum

Met ft. caps. No. 12.

.dr.

Sig. One every three hours after taking a glass of milk. Light diet and one 5-grain dose of calomel at beginning of treatment..

TREATMENT OF PNEUMONIA -A. T. Burkard (Med. World) epitomizes his treatment of pneumonia as follows: Calomel, 5 grs.; poultice with antiphlogistine; give an adult 10 to 20 drops of creosotal, or as many grains of duotal every 2 to 4 hours; strychnin, p. r. n. ; aconitin and strychnin, early, to abort if possible.

CASTOR OIL TREATMENT OF TYPHOID FEVER.C. C. Bass (Virg. Med. Semi-Monthly) bases his method of treatment upon the belief that the serious nervous and muscular symptoms of typhoid fever are due in a large measure to the absorption of toxins from the intestinal canal. The degree of tympanites may be taken as a measure of the intensity of the putrefactive or fermentative changes going on within the bowel. He thinks the indicated remedy is one which will eliminate the poisons from the bowel without spending the patient's strength. Castor oil does this. It cleanses the intestinal canal thoroughly; does not draw upon the system in its purgative action; does not charge the blood with abnormal substances; and has a protective, emollient action upon the inflamed areas of mucosa. His plan is to administer the castor oil every twelve hours, giving from one to four drams at a dose-enough to act in three to five hours and produce not more than two movements. He has used this treatment successfully in thirty-two cases of typhoid fever. The results are epitomized as follows: The temperature ranges lower; the tympanites and delirium do not occur, and if they are present, they soon subside; diarrhea and dysentery are prevented or checked if they already exist; the disease runs a milder course, and the patient does not lose flesh and strength so fast as they generally do under any other treatment. The last named result is its greatest advantage over any antiseptic treatment. The explanation is, that any antiseptic that is effective enough to prevent or materially retard fermentation and germ life will also prevent or generally retard digestion.

CHRONIC PROSTATITIS.-Louis Gross (Pacific Med. Jour.) places prostatic massage first in the treatment of this condition. It should be per

formed every two or three days, two or three minutes at a time. If on microscopic examination gonococci are found, urethra and bladder are irrigated with albargin, 1-1000 to 1-500 or protargol 1-400 to 1-50. If pus cells only are present urethra and bladder are irrigated with nitrate of silver or zinc sulphate in solution. Antiseptics like permanganate of potassium or oxycyanid of mercury may be used if germs are found in the prostatic portion. The author also recommends rectal enemata of hot water. Ichthyol is an excellent remedy, used in suppositories and gray salve may also be used in the same way. Finger recommends:

Potassium iodid

Iodin.

Ext. belladonna

M. et fr. suppos. No. 5.

0.5

0.05 0.07

Also by the urethra, sounds of the Beniqué curve, 20 to 30 French scale, may be employed or the psycrophore with warm water, or better still instillations of silver nitrate 1-3 per cent or copper sulphate 3-5 per cent. Internally urotropin, cystogen, salol, etc., may be used with a tonic. regime and regulated habits.

APOCYNUM CANNABINUM IN DROPSICAL CONDITIONS.-M. L. Hildreth (West. Med. Review) has used this remedy and found it particularly useful in the edema accompanying varicose conditions and especially in the varicose veins of elderly persons. Wherever there is a lack of vascular

tone, as in cardiac insufficiency, either from valve lesions, exhausting diseases, infections, etc., with capillary stasis, it has a very satisfactory action. It slows and steadies the action of the heart, stimulates the action of the kidneys, toning up the vaso-constrictors, thereby checking the tendency to transudation of serum. Dr. Hildreth uses Lloyd's tincture in 2 or 3 minim doses in water every three or four hours. In the discussion of this paper it was brought out that the only objectionable feature of this drug, its tendency to produce irritation of the stomach, could be obviated by giving very small and frequently repeated doses (one minim every hour or two).

BUTTER OF ANTIMONY IN SURGICAL TUBERCULOSIS.-L. F. Garrigues (Med. Record) points out the dangers of general infection to be feared in the local or surgical treatment of tuberculous disease in many localities. As a safe and effective method he recommends the use of butter of antimony which is official in the British Pharmacopeia. In tuberculous ulcers, for instance, he applies it to the surface of the ulcer and reapplies it when the slough separates, which takes about four days. This is continued until the granulations are a healthy cherry red color instead of the whitish, opalescent type characteristic of tuberculosis. The slough varies from the thickness of a piece of paper to one-half inch, according to the degree of tissue degeneration. The sloughs should not be pulled off, but should be allowed to separate. The same method may be employed in glandular and other forms of tuberculosis, in connection with appropriate surgical intervention, providing the whole suppurating or infected surface cannot be removed. removed. A tortuous, infected sinus, for instance, is to be slit up so it will be well under the eye be fore the antimony is applied.

TREATMENT OF URINARY INCONTINENCE IN CHILDREN.-A. M. Leonard (Med. Times) quotes from Kraus who recommends, in functional casesof urinary incontinence, removal of any local exciting cause, such as a tight foreskin, a sensitive clitoris, a narrow or irritable urethral opening or a

cystitis. In addition he advises the use of rhus aromatica with tonics to the weakened nervous system, as in the following:

Fl. ext. rhus aromatica.
Syr. iron iodid..
Elix. calisaya

.....

.dr. 5 .oz. 1 oz. 1

M. Sig. Half a teaspoonful four times a day. The use of electricity on the urethral sphincter for incontinence in children can be tried in the following manner: A sound is introduced having a metallic bulb, the urethral part being protected by a coat of Indian rubber. As soon as the bladder is reached withdraw the sound slightly so that the bulb rests in the sphincter; this makes the sound one pole of the battery, the other pole being applied to the pubes or perineum. A feeble current should be used, the intensity being gradually increased. Where the incontinence is undoubtedly due to loss of tone of the sphincter, as in women who have received some injury after parturition, and who are likely to pass urine on the slightest cause when laughing, going up-stairs, or riding horseback, electricity is good. In these cases one electrode (the positive) is placed over the peri

neum.