the blood-vessels remain contracted only as long as they are in contact with the drug. On the coagulability of the blood the latter has no influence. Hemorrhages from a small artery are more likely to be controlled by the suprarenal extract than a capillary oozing from a hyperemic mucous membrane. Whether the drug would prove useful in typhoid fever hemorrhage is uncertain, as we cannot know whether it would reach the site of the ulcer in an efficient form. The author has had no personal experience with the drug in this condition. In hemorrhage from the rectum the drug has proved most satisfactory; the method of using it is by dissolving two or three tablets in a few ounces of water and injecting into the rectum. It is also useful as an irrigation in hemorrhage from the bladder, and in post-mortem hemorrhage it may be used as a uterine douche. In hemophilia the author does not think the remedy would prove useful, because the condition is most probably due to a congenital hypoplasia of the walls of the blood-vessels. As the liquid preparations are quickly spoiled, the author prefers the tablet form. COMPARATIVE VALUE OF CURETTAGE OF AND LOCAL APPLICATIONS TO THE ENDOMETRIUM The value of curettage as compared with local treatment of the endometrium is discussed by Prof. Henry T. Byford. In the author's hands curettage has proved disappointing; if the infection of the mucous membrane is recent, curetting is very liable to open up new channels of infection, carrying the inflammation to deeper parts; if, on the contrary, the infection is an old one, the deepest portions of the endometrium have probably become affected, and those layers curettage could not remove without destroying the entire membrane. In cases of septic and of acute puerperal infection, curettage is, therefore, useful only for the purpose of removing foreign material, retained and adherent débris, etc. There is another kind of endometritis which is not due to infection, but to a kind of hyperplasia; it is usually characterized by hemorrhages or by an abundant thin, mucous discharge. In these cases the author uses curettage to remove the redundant tissue, and then applies antiphlogistics and astringents to limit vascular development. Curettage alone is rarely sufficient, because the vascularity of the tissues may extend too deep to be reached by the curette. The local application that gave the au 1 Wisconsin Med. Recorder, III, No. 11. thor the best results is a 25-per-cent. solution of ichthyol in glycerin. The author has cured many cases by keeping the cervix dilated by means of sounds and applying the ichthyol-glycerin solution to the endometrium. The following case is given as an illustration. A patient who had contracted gonorrhea from her husband presented herself with a left pyosalpingitis. The author dilated the cervix gradually, until he was able to pass a sound the size of a lead-pencil. This was done twice weekly, and a 25-per-cent. solution of ichthyol in glycerin was each time applied to the endometrium. After a few weeks the left Fallopian tube, which was full of thick pus, and the left suppurating ovary were removed. Following the operation, the cervix was kept dilated with sounds and the endometrium disinfected with the ichthyol solution. In less than a year the patient became pregnant and gave birth to a healthy child. She has remained healthy since. The author, in conclusion, says that the method that has cured the most cases in his hands has been: Dilation of the cervix with sounds twice weekly, application of the ichthyol solution to the corporeal endometrium, and painting the vaginal portion of the cervix and lower half or lower two-thirds of the cervical cavity with iodized phenol (glycerin, I part; liquefied carbolic acid, 2 parts; iodine, I part). This treatment, in conjunction with glycerin tampons, is also useful in chronic affections of the adnexa. No strong applications should be made to the endometrium, when there is any perimetritis present. THERAPEUTIC USE OF IODIPIN Dr. Sessous' gives his experiences with iodipin at the Halle Clinic. He gives it both subcutaneously and by the mouth. For internal administration he used a preparation containing 10 per cent. of iodine; 1⁄2 fluid dram caused iodine to appear in the nasal secretion in from ten to fifteen minutes, the action persisting for three or four days. For hypodermic use a 25-per-cent. iodine preparation is to be preferred, the action of which is much slower but more prolonged. By injecting 200 Cc. (72 fl. oz.) in divided doses in the course of ten days a store of 50 Grams (121⁄2 dr.) of iodine is accumulated in the body, which is gradually and slowly given off, and the organism is kept under the action of iodine for a long time. This prolonged action is useful in bronchial asthma and emphysema. The chief use of iodipin is in late syphilis. 1 Edinburgh Med. Jour., VIII, No. 5, p. 467. where potassium iodide causes gastric disturbances or proves useless. Sometimes it acts very quickly. Most authors recommend small doses of from 2 to 3 fl. dr. daily, but Radestock gives up to 10 or 12 dr. daily without ill effect, the drug being better borne than corresponding doses of the potassium salt. Iodipin is a fatty combination, which passes through the stomach unchanged, and from which, after absorption, iodine is only slowly liberated; hence, in several cases in which potassium iodide caused iodism, iodipin could be readily taken. In the Halle Clinic the drug was chiefly used in those syphilitic cases in which, for some reason or other, potassium iodide was contraindicated. Most patients took it readily-the oily character can, if necessary, be concealed in milk or coffee. Sessous gives a number of cases illustrative of its advantages. In one case potassium iodide in every form, even as enema, caused vomiting, while iodipin was readily taken and quickly healed a chronic gummatous condition. In a case of cerebral syphilis potassium iodide made the headache unbearable, while iodipin relieved it. Other cases are given in which potassium iodide had no effect, but which improved or healed under iodipin. In one case a distinct increase of weight was noted, a fact already mentioned by various observers. In conclusion, Sessous claims that, where other preparations fail or cannot be borne, iodipin must be tried; that it has proved as good an antisyphilitic remedy as potassium iodide, while there is little danger of causing iodism, and it is more easily taken. Lastly, it has the great advantage that it can be given hypodermically, which is a new method of administering iodine. MEDICINAL TREATMENT IN TYPHOID FEVER Dr. William Ewart' highly recommends. the following combination in typhoid fever: Solut. Mercuric Chloride (B. P.) 20 min. Syrup Orange or Lemon. This dose is to be administered every six hours throughout the attack, and for ten days after defervescence to guard against a relapse. [The liquor hydrargyri perchloridi of the British Pharmacopoeia contains 1/16 grn. of corrosive sublimate to each dram; 20 minims, therefore, correspond to 1/48 grn.ED.1 The author says that while this combination will not avail against a fatal issue in 1 Lancet, Dec. 8, 1900, p. 1644. the very worst attacks, it has, so far as he has been able to judge, mitigated the severity of the great majority of cases, has almost always brought about a rapid amelioration of symptoms, such as disappearance of sordes, cleansing of the tongue, clearing of the complexion, and, above all, a return of the appetite. Diarrhea, if present, is quickly stopped by this combination, while should constipation ensue it is easily remedied by daily injections of glycerin. The results of this treatment have been so satisfactory that alcohol has hardly ever been called for. Port wine, though, is invariably given during convalescence. Though a very large series of cases have been treated in this way, salivation has never been observed. The treatment is always well tolerated, provided it is administered at an interval from the milk meals. As to the rationale of the treatment, the author thinks that the mercury and the iron are equally valuable. The iron acts as a local application to the ulcers and tends to constrict the bowel and its blood-vessels against the risk of hemorrhage. The mercury exerts its action upon the hepatic, lymphatic, and mucous systems and it is not unreasonable to suppose that it exerts a disinfectant action on the alimentary canal. ENOPHTHALMIN Dr. A. G. Cipriani1 has found enophthalmin very valuable in a number of cases in which he used it. The mydriatic effect of the drug manifests itself in twenty to thirty minutes, and lasts from three to six hours; the intraocular pressure remains unchanged. With the employment of a 2 to 5 per cent. solution no disagreeable effects were noticed, nor was there any special disturbance of accommodation. According to the author the drug seems especially useful in the various forms of iritis. [Enophthalmin is the hydrochlorate of oxytoluylmethylvinyldiacetonalkamin, a substance closely related to eucaine.-ED.] THE TREATMENT OF INCIPIENT TUBERCULOSIS IN DISPENSARY PATIENTS After considering the general hygiene and diet of the phthisical patient. Dr. Henry L. Shively, physician to the Presbyterian Hospital Dispensary, New York City, says that as regards drugs the best routine treatment in the poorer classes is the administration of creosote or some of its derivatives, with cod-liver oil and some preparation of malt. During the hot sum 1 Wien. med. Woch., 1900, No. 46. Phila. Med. Jour., Dec. 1, 1900, p. 1035. mer months the hypophosphites may be substituted for cod-liver oil, but nothing can replace it permanently as a fat and tissue food, nor are any of its numerous commercial derivatives or so-called active principles to be considered as representing it. When the oil is well borne it should be given in the pure state. Children frequently acquire a fondness for it. The amount of creosote given daily ranges between 24 and 60 minims, and the author prefers to give it in the form of salol or keratin-coated pills, which become dissolved only on reaching the intestines, thus avoiding gastric disturbances. It may also be given with glycerin and whiskey, in emulsion, or shaken up with milk. Guaiacol or creosote carbonate, or thiocol, which latter is freely soluble in water, are better borne by the stomach, but they are too expensive for general dispensary use. In one case, complicated with tubercular infiltration of the pelvic floor, ichthyol was used locally with good results, and the author, being favorably impressed by the drug, tried it in a series of sixty cases. He gave the ichthyol in doses of 10 minims, every four hours. "Of these 60 cases, 29 reported regularly for treatment, and of this number 25 (over 86 per cent.) were much improved, gaining in weight and the temperature diminishing, with a corresponding improvement in all subjective. symptoms." In 5 cases the author found it necessary to discontinue the drug on account of the eructations and nausea. Where the disease is progressing rapidly opium in small doses acts very nicely; not only does it act favorably on the cough and the hemoptysis, but it seems to exert a general tonic and encouraging effect; especially valuable is the Niemeyer pill, consisting of opium, quinine, and digitalis. For neuralgic pains the author advises a small cantharidal blister and rubbing the chest with the following liniment: the fever is better controlled by baths and other treatment. When there is an irritating, nagging cough, unaccompanied by expectoration, heroin in 1/12 to 1/ grn. doses is useful; ammonium carbonate, senega, dilute hydrocyanic acid, codeine, and hydrobromic acid have been found useful palliatives. Syrupy mixtures, though, as a rule, should be avoided, on account of their bad effect on the stomach. In cases of mixed infection, when streptococci swarm in the sputum, the author has seen occasional improvement from Marmorek's antistreptococcus serum, as prepared at the Pasteur Institute of Paris. In one case, after three injections of 20 Cc. each, the streptococci disappeared entirely from the sputum, the chills and sweats ceased, the temperature diminished, and there was a marked improvement in the appetite and general condition. In other cases no improvement was observed. vulsions being very violent and the urine. practically solid with albumin, forcible delivery was not practiced; the treatment was with hypodermic injections of morphine and atropine, with solution of ammonium acetate and cathartics. All three cases recovered. A point of great interest in one case was that the child, a male, when born, was quite black, and after taking two or three breaths had a severe convulsion. He was put into a warm bath and given castor oil; for four days he took no food, his lips being moistened with milk and water. During this time he had thirtynine convulsions in all; on the fifth day they ceased and the boy is now perfectly healthy. The author's personal experience leads him to the conclusion that to induce labor in eclampsia, however severe the convulsions, is a great mistake; that morphine is the drug par excellence in that condition, it being free from the heart-depressing effect exerted by chloral and chloroform. The old notion that it had a bad effect in cases of kidney trouble appears to have no foundation in fact. THIOCOL IN LARYNGEAL TUBERCULOSIS re Potassium guaiacol-sulphonate, or thiocol, in laryngeal tuberculosis, is ported by Prof. Ad. Fasano,1 of Naples, as having been used by him during the past year in fourteen cases, three primary and eleven secondary, and from the results obtained he is led to confirm fully the favorable statements made by others on the use of this remedy. The author believes that thiocol is a remedy which is capable of effecting a complete cure of tuberculosis in the early, and sometimes even in the secondary, stages, while in the more advanced stages it hinders the rapid development of the phthisical processes, and decidedly improves the patient's condition. Two of the primary cases treated exhibited tuberculous infiltrations of the arytenoid spaces, and were treated with small doses of thiocol internally, and externally the following insufflation was used: tered. This case was also completely cured. The eleven remaining secondary cases comprised tuberculous infiltrations and ulcerations. These cases also were treated with scraping and insufflation, thiocol being given internally at the same time. In seven of these cases the tuberculous laryngeal lesions healed perfectly, and the other four were very much improved. These results, the author states, led him to conclude that thiocol is the best antiseptic which has yet been introduced for tuberculosis. Bacteriological experiments prove its destructive action on the tubercle bacilli; clinical tests show that as it specifically combats the tuberculous process, it relieves the biological vitality of the tissues and trophic conditions. The author is convinced that thiocol has a great future not only in pulmonary tuberculosis, but also in laryngeal tuberculosis, used either alone or in conjunction with scraping. The local application must be supported by internal medication as well, because the latter combats the abnormal fermentative processes in the intestinal canal, increases nutrition, and hence renders the organism more resistant to the tuberculous process. SUPRARENAL IN DISEASES OF THE BRONCHI Dr. S. Floersheim, in a somewhat too strongly colored article, states that suprarenal powder is indicated in acute and chronic bronchitis, bronchiectasis, asthma, congestion, and edema of the lungs, hemoptysis, and in some cases of pulmonary tuberculosis, especially in those associated with hemoptysis. The author administered the suprarenal in the form of powder, in doses of 3 grains, ordering the powder to be chewed without water, and then to be swallowed. Seven cases of acute bronchitis are briefly reported, in which the action of the suprarenal powder seemed wellnigh marvelous. The following will serve as a sample of the reports: "Mrs. A. developed a severe attack of acute bronchitis; suprarenal powder within two minutes lessened the cough and expectoration, and the patient felt better. The suprarenal powder was administered every two to three hours, with benefit." In sixteen cases of hemoptysis, the author says, the suprarenal powder, chewed, stopped the bleeding from the lungs in less than half an hour; in six cases the hemorrhage stopped in five minutes. Similar statements are made as to the effect of the suprarenal in pulmonary tuberculosis, 1 Med. Record, LVIII, No. 20. congestion and edema of the lungs, bronchiectasis, etc. [It seems to us that the advocates of suprarenal therapy are going a little too far in their enthusiasm; such glowing reports are very apt to create skepticism in the minds of judicious and discriminating physicians.-ED.] 1 POISONING BY LYSOL A boy of fourteen, suffering with dysentery, was given a rectal injection of about 11⁄2 ounce of lysol, dissoved in a pint of water. About half an hour later he was found in bed quite unconscious, and remained so when the doctor, Wm. Hartigan, called to see him, about four hours afterwards. He was in a state of complete collapse, sweating profusely, with the legs drawn up, and with pinhole pupils; the pulse was almost uncountable, and the respiration forty per minute; temperature subnormal. Hypodermics of strychnine and ether produced some slight effect on the pulse, but after a short while a quantity of dark-brown, grumous blood was suddenly ejected from the mouth and nose, and exitus lethalis took place. No autopsy was made. The author says that he frequently, in similar cases, irrigated the lower bowel with a solution of 1⁄2 ounce of creolin in 3 pints of water, leaving some in the bowel, without the slightest ill-effect, and almost invariably with marked benefits. run up to sixteen, and then again reduced to ten or twelve. The author prefers ichthyol to creosote, because he says that ichthyol is borne better than creosote and can be used in large doses for a long time. Aristol, consisting of iodine and thymol, is considered a valuable adjuvant. Cantharidin is given in doses of 1/650 of a grain, two to six times a day. According to Buckner, Richet, and other authorities, cantharidin causes an exudate of serum around a tubercular lesion; consequently, if the system be saturated with antiseptic medicaments, these will come in direct contact with the tubercular focus. The cantharidin can usually be taken for long periods without any untoward effects, though occasionally it causes vesical tenesmus. These drugs, the author says in conclusion, if combined with plenty of fresh air and an abundant diet-which should include six to twelve yolks of eggs and about 31⁄2 ounces of cod-liver oil daily-constitute a most excellent plan of treatment. GIAOURDI This is a preparation of fermented milk, with which Dr. Achilles Rose1 became familiar while in Greece. It differs very materially from both kumyss and zoolak. It is prepared as follows: Milk is boiled for about an hour, under constant stirring, until it attains a certain thickness; it is then cooled down to 113° F. (if sheep's milk is used, it must be cooled to 122° F., while goat's milk is cooled to a temperature of 104°), and the ferment is added. The ferment is prepared by soaking a dry fig in 3 ounces of water over night, and adding to this 2 drops of lemon juice and a hardly perceptible quantity of rennet in the morning. It is important to have the milk of the proper temperature when the ferment is added, as the latter is destroyed at a higher temperature, while at a lower it does not exert its activity. It keeps ten days if stored in a cool place. According to the doctor, it forms a desirable addition to the diet of the sick. SODIUM GLYCOCHOLATE IN HEPATIC COLIC Dr. H. Richardson2 says that the only true cholagogue is ox-gall, but the objection to its use is that it contains all the impurities which it is the function of the bile to eliminate. Sodium glycocholate being the chief active principle of bile, he isolated it for purposes of experiment. One cholesterine gall-stone and one pigment stone 1 Post-Graduate, Dec., 1900. Virginia Med. Semi-Monthly, Dec. 7, 1900. |