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THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

A MANUAL OF MATERIA MEDICA AND PHARMACOLOGY, COMPRISING ALL ORGANIC AND INORGANIC DRUGS WHICH ARE TO HAVE BEEN OFFICIAL IN THE U. S. PHARMACOPOEA. Together with Important Allied Species and Useful Synthetics. Especially Designed for Students of Pharmacy and Medicine, as well as for Druggists, Pharmacists and Physicians. By David R. M. Culberth, Ph.G., M.D., Prof. of Botany, Materia Medica and Pharmacology in the University of Maryland, Dental, Medical and Pharmaceutical Schools. Fourth edition, engraved and thoroughly revised, with 487 illustrations. Philadelphia and New York: Lea Brothers & Co., 1906.

The fourth edition of this book contains the changes of the last U. S. Pharmacopoia, and every subject has either been rewritten or decidedly modified. The numerous excellent illustrations of plants, animals, etc., affords the reader a good opportunity to become more familiar with them. The synonyms are given in the Latin, American, British, French and German language, thereby enhancing its value as a reference book particularly to the druggist or other reader who may be familiar with the substance in one language but not in another. The methods of manufacturing the various pharmaceutical preparations is also given in a clear and concise way. The microscope and its use in materia medica forms part VI, giving the reader the essentials of this subject. This book will be found a valuable addition to any one's library who may be interested in the subjects with which it deals.

SENATOR.-The

VON BERGMANN MADE noted surgeon, von Bergmann, was recently appointed by the Kaiser member of the upper house for life.

DISINFECTION IN TORONTO.-Hereafter all houses in which tuberculous patients have died, in the city of Toronto, will be disinfected by the local health officer.

NEW RULING. The Iowa State Board of Medical Examiners has made a ruling that after July of this year no diplomas will be recognized that are ganted by schools giving advanced standings for work done outside of medical schools. Minnesota has had such a rule for some months past.

"THE JEWS IN ROUMANIA" is the subject of a paper by Carmen Sylva (the Queen of Roumania) in the March Century. The Queen pleads that Roumania is not inhospitable, but so absolutely poverty-stricken that the soil cannot support foreigners; and she begs at least a hearing for the people of her "sorely afflicted country" before they are censured for considering first their own children and their necessities.

REPORTS ON PROGRESS Comprising the Regular Contributions of the Fortnightly Department Staff.

DISEASES OF THE NERVOUS SYSTEM.

FRANK P. NORBURY, A. M., M. D.

The Treatment of Cerebro-Spinal Meningitis. -(O. T. Osborne, M. A., M.D., N. Y. Med. Jour., Feb. 17, 1906.)-A rather optimistic paper, in which the author advocates "ice, ergot and morphine" as "the treatment that will save and has saved many patients from this disease." His treatment in brief is as follows: "The almost constantly beginning sore throat is treated with antiseptic, with antiseptic gargles and sprays. Conjunctivitis should be treated by sample boric acid drops. A calomel purge in the beginning. Painful joints are to be treated by being wrapped with cotton and kept warm.

Pain

in general by the use of morphine by mouth or hypodermically, and in sufficient doses to give relief. Food should be light, and when nausea and vomiting occur withdrawn until these symptoms subside. Nausea and severe vomiting may be relieved by injection of morphine. To quiet cerebral excitement and delirium and also pain, and to diminish the necessity for large doses of morphine, ergot is recommended. It contracts the blood vessels, is of value in cardiac weakness with soft pulse and dilated arteries, and is a decided sedative to the central nervous system, as it seems to relieve congestion in the cerebral and spinal vessels. A patient who does not sleep well with a large dose of morphine will be found to sleep well after a dose of ergot has been added. Immediate and best action of ergot is secured by hypodermic injection and preferable in the region of the deltoid muscle; the frequency of injections depending on the symptoms. An indication that too much ergot is being used is a high tension pulse and a too greatly slowed heart. Ice. The ice cap to the head and the spinal ice bag are necessary. The ice applications are more or less constant, depending on positive discomfort of the patient, and subnormal temperature. If the temperature is subnormal or the surface of the body is cold, bot applications are certainly of advantage. The general care of the patient should be the same as in typhoid fever-a light, airy room -the patient quiet, no talking, except such as is necessary. The bowels must move daily. The diet should be nutritious after the first few days. Avoid alcoholics, avoid strychnine and quinine. Massage and electricity during con valescence.

Exophthalmic Goitre and Its Treatment.Geo. R. Murray (British Medical Journal, Nov. 11, 1905, the Bradshaw lecture.) In a very complete lecture Murray, who by the way is one of the foremost workers in this field of medicine, suggests the systematic application of the faradio current after the manner proposed by Sir Victor Horsley, as the most satisfactory treatment. Two flexible electrodes, 2x4 inches, covered with flannel or wash leather are moistened with a warm salt solution, and one is applied over the goitre in front and other at the back of the neck. The electrodes may be held in position by straps. The secondary circuit of a dry cell battery is used and a water rheostat used to control the current, which should be strong enough to produce a prickling sensation to the skin. The treatments should be for one hour twice a day, and in some cases three or four hours in a day. The patient can learn to apply the current and should recognize the importance of continuous day after day treatment. Steady improvement and recovery has resulted in many cases treated in this manner. The drug treatment is advisable, but the limitations of drug treatment are recognized. Arsenic is the most useful for daily routine treatment. A useful method is to order four or five minims of the liquor arsenicalis, three times a day, excepting one week each month or during the menstrual period.

This should be continued from six to twelve

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months. To reduce the pulse rate the tincture of convallaria from ten to fifteen minims with the arsenic. If extreme nervousness is in evidence, then the bromide of potassium in ten grain doses, may be added. donna is useful in cases presenting excessive perspiration, but not for prolonged treatment. Iodide of potassium is unsuitable and only in many cases aggravates the condition. Thyroid extract also is not desirable as it aggravates the condition. Suprarenal and thymus tablets have been of service in some cases. The red iodide of mercury applied locally has also been of service in some cases. For the special symptoms special measures are needed, thus in diarrhea, rest, liquid diet and a mixture containing laudanum and dilute sulphuric acid will be of service. Persistent vomiting, frequently uncontrollable and may produce death, is best relieved by hypodermic injection of morphine. The serum treatment is slowly meeting with favorable results, especially in the cases presenting acute mental symptoms, Schultes reported such a case. Thyroidectin, Moebeus's serum, etc., have not been used sufficiently to report their full therapeutic value. The risks of surgical treatment are unfortunately so great that Murray hesitates to recommend

it.

He concludes this very excellent lecture by saying, "We must on the whole conclude that at the present time in the great majority of cases the best results are obtained by general hygienic treatment combined with the use of electricity and certain drugs, and that as yet no serum. or other animal product can be considered to give better results than these older methods of treatment."

The Underlying Principles of Treatment of Epilepsy.-W. P. Spratling, M.D. (Annual essential in the treatment of epilepsy is the Report of Craig Colony, 1905, p.3.) The first treatment of the individual. To ignore the person and treat only the symptoms is not a cause that invites best results. At Sonyea (Craig Colony) the first efforts are devoted to the individual in toto. By doing this it is. possible to overcome seemingly fundamental defects that on exclusive method of combating could even rectify, and while this is the first factor it is far from being all of it. No claim is laid to originality in its use, except to apply it in the treatment of epilepsy. The same course has been used in treatment of

pulmonary tuberculosis. When epilepsy is as rationally treated as is tuberculosis the percentage of cures in epilepsy will be as high as they are in insanity, 25% to 30% or more. tuberculosis and epilepsy; the two diseases No argument is made for the similarity of are widely dissimilar in every respect. only argument is that the epileptic is a victim of a deep-seated condition, the eradication of which cannot be accomplished by a single narrow line of treatment.

The

The Nervous Manifestations of Rheumatism. -Poynton and Paine (London Lancet, Dec. 16, 1905) first discuss the etiology of rheumatism, saying it is a definite infectious diseases, due to the diplococcus rheumaticus. In support of this view they explain the coincidence of this bacterium as found associated with arthritis, endocarditis, pericarditis, subcutaneous, nodules, pleurisy, pneumonia, peritonitis and nephritis, and that they are able to produce similar lesions in animals. They summarize in the clinical part of the paper, as follows, realizing their belief that rheumatic chorea is a local infection of the nervous system, and that most of its symptoms are the result of a slight meningio-encephalitis and possibly meningo-myelitis, viz: 1. They have isolated and cultivated the diplococcus from the cerebro-spinal fluid in four cases of fatal rheumatism, in three of which there was chorea at the time of death. 2. They have produced twitching movements, arthritis, endocarditis and pericarditis by intravenous injections of the diplococcus

into rabbits. 3. They have demonstrated the presence of diplococcus three times in the cerebral pia mater, and once in the brain from cases of chorea. 4. Also in the brain and pia mater of the rabbit that has shown twitching movements. In the third section of their paper they discuss rheumatic meningitis, basing this upon a case fully reported in which was found a meningitis, basic in distribution and spinal meningitis general in type. Minute diplococci were found in pus from the cerebro-spinal fluid and cultures, yielded a pure growth of the diplococcus. Two rabbits were inoculated and died in twenty-four hours. The diplococcus was isolated from the blood, injected into a rabbit and was followed by arthritis. The diplococcus was found in the affected joints. The authors believe this to be diplococcus rheumaticus. The authors place rheumatic meningitis midway between the slight rheumatic lesions which exist in chorea and acute fatal rheumatic hyperpyrexia, which they regard as an acute rheumatic toxemia.

The Value of the Bromids in Epilepsy.One of the better methods of treatment of

epilepsy of late years is the reduction of the amounts of bromids given.

The

The use of this drug is well nigh universal; a household remedy; hence its abuse. Many epileptics respond well to the suppressive efforts of bromid, but suppression is not cure. bromids have a limited value in holding epileptic attacks in abeyance, while other forms of treatment aim at the removal of the cause have a chance for action. Not more than onehalf the cases treated at Craig Colony are given bromid in any form. Its unlimited use is disastrous. The dose as generally given is too large. It is seldom necessary to give over 12, 15 or 20 grains three times a day as a routine treatment for any length of time, while 8 to 10 grains is sufficient under guarded administration. Emergency doses to check "serial attacks" or "status epilepticus' may be much larger.

OTOLOGY.

ALBERT F. KOETTER, M. D.

Bilateral Suppurative Otitis Media, Due to Scarlet Fever, with Mastoiditis and Rupture into the Corticalis, Complete Deafness, Recovery and Restoration of Hearing without Operation.-Suné Molist, Barcelona Académie of Medicine.)-Girl of twelve, eight days after inception of scarlet fever, was taken with severe earache and discharge from both ears, complete deafness. After ten days region of mastoid painful, red and edematous,

fluotuation. Whereas from some sources operation was advised, author decided to wait simply making an incision back of the ear. The wound healed nicely. On the twentieth day, the watch, which had not been heard. either through the air or bone conduction was heard 1 cm. distance, six days later 10 cm. Discharge continuous. Two months later, after treatment with natrium sulphophenolicum, recovery, both perforations closed. Watch heard 60 cm., whispered voice 2 meters. After one year complete recovery, hearing normal. Based on the result

of this case author considers it advisable to operate on children, only under the following conditions: 1. When the pain over mastoid process is very severe and does not yield to treatment. 2. When the retro-auricular abscess is not very painful. 3. When after opening the abscess a bone fistula is found. 4. When the bone fistula is not closed after one month's local treatment. 5. When cere

bral symptoms appear. Complete deafness appearing early in the disease may not necessarily be permanent in children. Perforation in lower half of membrane indicates chain of ossicles intact, consequently after healing of perforation hearing will again be normal. When perforation is found in upper half, the exudate in the attic usually leads to ankylosis, synechia, etc., with consequet deafness. The favorable result of the case reported by the location of the perforation. is no doubt due to the good drainage favored

On the Early Diagnosis and Operation of Empyema of the Mastoid Process in Acute Suppurative Otitis Media. (Arthur of Forselles, Helsingfors, 1905 )-Author describes in detail the progress made in indications for opening the mastoid, since Schwartz's first dissertation on this subject, and reports thirty-five cases operated on, with his observations and opinion as to the indications for opening the mastoid. Besides the usual symptoms, swelling, fever, etc., finds in the consistency of the pus a very important adjuvant for the location of the pus, whilst the sticky, cell impoverished pus is usually found in the tympanio cavity the thick, creamy pus rich in cells is found in the antrum and mastoid cells. According to the experience of the author the consistency of the pus is determined by measuring the specific gravity according to Hammerschlag's method: One drop of pus is added to a mixture of chloroform and benzine having a specific gravity of 1020, and then chloroforin or benzine added until the drop of pus floats in the solution, then determine specific gravity of fluid by areometer, this will also be specific gravity of pus. In these examinations the

specific gravity of the pus is much higher in mastoiditis than otherwise, fourteen cases (adults) were examined and in all cases the specific gravity was 1045, .shortly before the operation, whereas the specific gravity in uncomplicated cases 1044. Author believes that cases with specific gravity of 1045 are suspicious of empyema and when 1046-1047 the diagnosis is certain and operation indicated. In five cases where no symptoms of empyema were present, after this indication, namely, high specific gravity, operation was performed and justified. In children the condition is different, two operative cases and several uncomplicated point to the fact that the specific gravity in children is lower. On the other hand, we must not forget that the presence of blood increases the specific gravity of the exudate. Author does not mention the fact that cases occur in which the empyema of the mastoid process, may become incapsulated so that no connection exists with the tympanic cavity, in these cases we would not be able to observe an increase in the specific cavity.

Collection of Illustrative Cases Contributing to the Question of Deafness and Deaf-mutism as a Result of Syphilis Hereditaria Tarda. -Hopmann (Zeitschrift fuer Ohrenheilkunde) reports seven cases in which the patient besides other hereditary syphilitic stigmata, retarded development, deformities of the skull and nose, scars of the skin and mu

cous

membranes, articular inflammation, Hutchinson's teeth, parenchymatous keratitis, a disturbance of the hearing was recognized, this is one of the Hutchinson trio of symptoms. As with other observers, so with. bim the female preponderates in proportion of five to two. The deafness usually appeared

in the first or in the first half of the second decennium, the eyes usually being involved before his time. It is characterized as a nervous deafness, with bone conduction entirely gone to greatly reduced, appears suddenly and always bilateral. Vertigo and tinnitis often trouble. accompany this Pathologic-anatomical conclusions are missing. Therapeutically the energetic mercury treatment should be instituted. The complete schmier cure should not only be used once, but is to be repeated several times in the course of two to three years.

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cially mentioned in surgical interference. Exposure of dura mater in the middle and posterior cranial fossa which cannot always be avoided in cases where there is a descent of the cranial fossa respectively, the protrusion of the sinus, is without danger, especially injury to the dura. Injury to the facial nerve and external semicircular canal oan avoided if caution is exercised, the latter is more often injured than the former by the beginner, and may lead to labyrinth infection. Sometimes injury to the facial cannot be avoided, namely, where infectious process extends inward from the nerve. Variations in the after-treatment: Temporary paresis of the facial, as it sometimes occurs two or three days after the operation usually heals in a few weeks. Delay in healing or continuance of the suppuration are usually due to insufficient removal of diseased surface or mistakes in the plastic operation. Optio neuritis often exists for months. Symptoms of disease of the inner ear or the brain as they occur in extensive inflammation of petrous portion of the temporal bone disappear after operation, but not in those cases in which these parts are actully involved. Final result: In careful execution of the radical operation permanent recovery occurs unless we have to do with malignant tumor or tuberculosis, but even then complete recovery takes place in the latter cases, and in the former we have at least considerable relief, recurrence in about 10%, usually at the tegmen, marasmus in children, may cause marantic thrombus of the longitudinal sinus, after operation. The restoration of the hearing is of secondary consideration and depends on the condition of the parts surrounding the windows. The prognosis is better in acute cases, and also when the disease is limited to the mastoid process. Choice of cases for operation: all chronic suppurative cases should be treated In a case which by the radical operation. was operated after six weeks suppuration the radical operation is safer than if done during acute stage.

SURGERY.

JOHN MCHALE DEAN, M. D.

Three Years Experience with Pyloroplasty. -Finney in an article in Journal of Surgery, Gynecology and Obstetrics gives briefly an account of his experience with his pyloroplosty operation in benign stenosis of the pylorus. He reports a series of thirty-three cases operated on with three deaths. The deaths were not due to the operation per se. He claims pyloroplasty offers more advan. tages tages than gastroenterostomy in benign

cases. Mayo has had bile regurgitation after one of his pyloroplasty, but the author has no such experience. The popular opinion is that in dense cicatrical ulcerations it is difficult to perform is strongly denied by the author, who claims that such cases are not only more easily remedied in this way, but that the repair of the ulcer itself promptly follows. The author believes the interrupted suture more expedient in its performance than the continuous.

Foreign Bodies in the Esophagus. In Journal of Surgery, Gynecology and Obstetrics, Stuart McGuire reports two cases of foreign bodies in the esophagus removed by him at Richmond hospital. The one lodged in the esophagus opposite the cricard cartilage proved to be a glass stopper. Esophagotomy was performed and the foreign body removed. In the other case an open safety pin with a sharp point directed upward was lodged in the esophagus just opposite the heart. In this case the author performed gastrotomy and with esophageal bougie pushed the pin in reach of his finger through the cardiac orifice of the stomach. Both patients recovered promptly. The author advises in all cases of foreign body low in the esophagus it is best prior to operating to force or push the foreign body into the stomach on account of the danger of undue manipulation to the heart actions during anesthesia. Diagnosis of foreign bodies in the esophagus is easily made from history in ability to swallow or painful deglutition together with the employment of the X-ray.

Effects of Osmic Acid Injections. In Jour. A. M. A. Eastman reviews the literature of osimc acid injections in nerve trunks for the relief of neuralgia. He appends eleven cases of his own in which the treatment was adopted. The author injects ten drops of a 2 per cent solution of osmic acid in the nerve trunk after the trunk has been exposed by incision. He claims much benefit from this procedure in neuralgias and in some cases permanent cure has resulted. In some cases the acid was injected subcutaneously, but with not as much success as in the open operation. Some cases received injections in the terminal branches with good results. The conclusions of the author seems so lucid that the reviewer thinks best to add same in his own words:

1. The injection of 10 drops of osmic acid in 2 per cent solution into sensory nerve trunks is safe. The likelihood of irritation of the kidney, however, should not be forgotten in cases exhibiting kidney lesions. It is not probable that the death from cerebral hemorrhage three months after injection of

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5. In the case of small nerves, it will be found exceedingly difficult to inject directly into the nerve trunk, that is, the needle eye will pass to the distal side of the threadlike nerve or perhaps not enter the nerve substance at all. Or, notwithstanding the utmost. care, the fibers may be so teased apart by the needle point that the fluid will simply be spilt about the nerve. In such a case, in order to bring the acid in contact with all of the fibers, it is wise to clip the nerve so that the end may be bathed in the fluid.

6. The effect of manipulation of the nerve, as by stretching, has not as yet been eliminated as a possible aid to the chemical action of the osmio acid; therefore, a general anesthetic should be administered so that neureotasy or section of the nerve may be done if desired.

7. My experiments have shown no changes in the nerve tissues as the result of injections of osmic acid other than the disintegration. of fat and oil globules in the perineurial space and in the white matter of Schwann, such white matter of Schwann being simply fatty matter in a fluid state insulating and protecting the essential part of the nerve. The degenerations appearing in the nerve itself are only as may be fairly attributed to nutritional changes and exposure, the indirect result of the selective action of osmic acid of destroying fat. There is no reason why this fat should not be restored and the nerve again become capable of transmitting sensation, that is, theoretically, the neuralgia may return after injections of osmic acid.

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