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MEDICAL MEMORANDA. Just as Good.- Please send me one-half dozen pounds of Abbott's saline laxative as soon as possible. I use it all the time, I have tried others claimed to be "just as good," but they do not ‘fill the bill."-Dr. D. S. Bradford, Janesville, Ia. My wife has been a sufferer with chronic eczema for the past twelve years.

It first appeared on one side of her face and gradually extended over her body. I tried every remedy that I could find recommended in medical literature and by eminent authorities without any permanent results, but with about two months treatment with resinol ointment I have obtained an effectual cure.-W.R. Hinkle, M.D., Holland, Ark.

Diseases of the Liver.-Carabana, by stimulating biliary circulation, prevents the stagnation of the toxic and irritant poisons resulting from the last stages of intestinal digestion. Also acting as an antiseptic where the deficient biliary secretion cannot be rendered normal. Then, too, it modifies catarrhal conditions of the biliary apparatus. It is consequently of great benefit in hypertrophy of the liver, inflammation of the bile ducts, congestion and in many chronic liver lesions usually considered incurable.

Vitogen.-It is now some years since vitogen was first presented to the profession and the claim made that it should prove the ideal surgical dressing, it being strongly antiseptic, odorless, non-irritating, non-poisonous and at the same time stimulating while its oily character, a feature unusual to powders of its class, made it a decided protection to wound surfaces. It is safe to say that no phys cian who has given it a thorough trial has failed to verify to his entire satisfaction that these claims were founded justly and this explain the tremendous popularity of this agent with the profession. It is easily one of the most important of the G. F. Harvey Co's. specialties and one which should be well known to every progressive physician.

Cactus as a Heart Tonic.-Cactus admits of more general application than digitalis. It is especially useful in cases of cardiac weakness associated with defective nutrition and consequent extreme irregularity or aggravation of the action of the heart, but it should be avoided if such action is due to temporary nervous excitement ; in such cases gelsemium soothes the excitement and allows the heart to regain its normal condition. Cactus acts as a cardiac sedative and lowers the temperature in fever associated with cardiac depression or when collapse is threatened. When, however, the temperature is subnormal cactus restores it more rapidly than strychnine.—Nouveaux Remedier Abstract in Lancet.

Typhoid Fever-Report of a Case.—(By J. F. Crouthamel, M. D., Souderton, Pa.). -In June, 1903, Prof. R. S, who resides in a distant Pennsylvania city, came to the home of his parents for a vacation, and in a few days was stricken with typhoid fever. The case, which proved rather severe, was treated in the usual manner with intestinal antiseptics, etc. On account of the spread of the intestinal inflammation, as shown by marked tympanites, I applied a thick dressing of antiphlogistine to the entire belly wall. Wiihin a few hours after the application the temperature commenced to drop and experience soon taught me that by putting on a fresh dressing every twenty-four hours, it apparently exercised considerable control over the temperature. The treatment, external and internal, was persisted in, and the patient made an uneventful recovery. I am certain the action of antiphlogistine was responsible to a considerable degree for the decline in temperature, and that it also reduced the blood pressure on the heart.—The Bloodless Phlebotomist.

The Children's Laxative-Cascarenna a Sweet and Pleasantly Flavored Preparation -Exactly what the Practitioner Needs.-In his perplexity of choosing just the laxative or purgative he wants for a child, particularly for an infant, the physician will find that cascarenna affords a most satisfactory solution of the question. Cascarenna has several commendable properties that other laxative compounds do not possess. It is agreeable to children, being sweet and pleasantly flavored. There is no difficulty in getting them to take it, a point that mothers and nurses appreciate thoroughly. It is a happy combination of well trier laxatives and gentle purgatives; hence it is not an experiment to prescribe cascarenna for the first time. It does not gripe or derange the digestive system; and owing to the presence of cascara sagrada it has a tonic laxative action that imparts to it double value in the treatment of the constipation of infancy and childhood. Finally, cascarenna is a thoroughly efficient and reliable therapeutic agent, from which the practitioner may confidently expect the most satisfactory results. Each fluidounce of carsarenna represents: Cascara sagrada, 40 grains; senna, 120 grains; potassium and sodium tartrate, 24 grains; chenopodium, 8 grains; pumpkın seed, 8 grains; sodium bicarbonate. 4 grains. Agreeably flavored with aromatics. The dose for a very young infant is 5 to 10 drops; a child one year old may take 10 to 20 drops; older children 20 drops to one teaspoonful, according to circumstances. Cascarenna is prepared by the well-known house of Parke, Davis & Co., which is a guarantee of its reliability.

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Battle & Co., of St. Louis, have just issued pamphlet No. 11 in their interesting series on " Intestinal Parasites,” a copy of which will be mailed to any pbysi. cian upon request.

Dr. Budd, of Frankford, Ky., says: Don't neglect local treatment in diphtheria. A fifty per cent solution of hydrogen peroxide sprayed into the throat every hour has proved a most satisfactory treatment in my hands.

His First Patient's Remains.—The small son of a doctor recently had another small boy staying with him. Contrary to all rules and regulations they betook themselves to the consulting room and began to play there. The small guest, opening a door, beheld with horror and shrank back from-a skeleton. "Cowardy, cowardy," said the doctor's son. 'Tisn't anything to be afraid of." But what is it?" the other gasped. “Oh, just old skellington. Papa's had it a long time. I fink it was his first patient.”

The Park Hotel.—This famous hostelry at Hot Springs, Arkansas, is now booking for the social season, with all the new appointments indicated by the demands of a discriminating public. “The Park," under the management of that prince of hotel men. Mr. J. R. Hayes (formerly of the Grand Hotel, Mackinac Island), has taken a place in the front rank of American hotels, and with its beautiful new grill rooms and cafe, amusement hall, gymnasium, dancing pavilion, observation tower, sun parlors, and roof garden, certainly leaves nothing to be desired by the traveller or pleasure seeker. “The Park” is operated upon both the American and European plans, and at most reasonable rates, considering the superb accommodations and excellent cuisine. Delegates to the Mississippi Valley Medical Society should reserve rooms at The Park" in advance to secure the best, and avoid confusion on arrival at the Springs. “The Park" is open all the year, and its guest list is composed of the best people who travel. For information write to J. R. Hayes, Hot Springs, Ark.

The Necessity of Iron to the Pregnant Woman.-It is universally conceded that the administration of iron in pregnaucy is now made expedient by the development of an anemia which is usually foreign to non-pregnant subjects, and which, at one time, was an uncommon occurrence even in the case of the child-bearing. During pregnancy, the appetite is invariably immoderately capricious and there is a disposition to gratify the palate by partaking of those foodstuffs which have been rendered fictitiously attractively to the partial, or by the complete, exclusion of the more simple and nutritious viands. While such indulgences must inevitably contribute to the development of anemia, it was not until the modern table supply, consisting almost wholly of such victuals as hot breads, highly spiced refrigerated moats, artificially colored canned goods and pastries, was made the rule with the masses as well as the classes, that anemia of pregnancy became the rule and not the exception. In addition to the inadequate food supply which is now current, the anemia of pregnancy is rendered more widespread by the style of dress imposed by society upon women in all the walks of life. Furthermore, the blood depletion of prospective mothers of the present day is materialiy increased through the abandonment of outdoor exercise on account of a false sense of modesty. In view of the fact that the health of a woman in the pregnant state, and the proper development of her unborn, is always directly dependent on a blood stream that is qualitatively and quanitatively sufficient for the exigencies of pregnancy, the administration of iron is made distinctly needful by the artificialities inseparably associated with modern life. In selecting the form of iron to be administered to pregnant women, tho utmost discrimination should be exercised. That form of the drug which is most easily assimilated and proves most acceptable to the palate is the one which should be employed. This injunction is made for the reason that the nausea which is incident to the pregnant state must not be increased, and for the further reason that constipation must not be induced by the drug. Again, the nutritive processes must be held at the proper standard,and this cannot be done in the absence of a painstaking selection of the iron to be administered. Pepto-Mangan (Gude) is the ideal form of iron for these cases This contention has the support of logic. The hemoglobin-imparting properties and the nutritive potency of the preparation are coufessedly greater than those of any other form of iron. Then, too, pepto-mangan (Gude) is more readily absorbed and more completely assimilated than any other preparation of iron. Still further, pepto-mangan (Gude ) produces no untoward effect upon the mucous surfaces of the alimentary tract, nor does it encourage constipation or increase nausea. In addition to overcoming the anemia and the deficiencies of nutrition, popto-mangan (Gude) adds tone to the blood vessels and reduces to a minimum the softening of the heart walls which always attends the pregnant state. Certainly one of the most gratifying effects of pepto-mangan (Gude ) is the increase of physical strength and buoyancy of spirits which the prospective mother derives from its administration. That the unborn participate in the benefits derivable from pepto-mangan (Gude), there can be po doubt, for at birth they present unmistakable evidences of pbysical robustness and seem well fortified against those illnesses wbich are peculiar to infantbood. It is also a matter of common observation that the roborant action of pepto-mangan (Gude ) enables the mother better to bear the strain of parturition.

Vol. XXX

St. Louis, NOVEMBER 25, 1906.

No. 9

Papers for the original department must be contributed ex- middle-ear structures to the vicissitudes of clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans- the atmosphere, avoiding the tympanic suplated free of charge, if accepted.

puration that usually attends the ordinary A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the methods of interference, in such cases; and proof.

Engravings from photographs or pen drawings will be fur. to dispose of the latter in such a way that nished when necessary to elucidate the text. Rejected manu

protection may be permanent for the tympanio script will be returned if stamps are enclosed for this purpose.

contents, and the special function restored, COLLABORATORS.

with all the joy and advantage that attend the ALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

recovery of serviceable hearing ;—these give FRANK BILLINGS, M. D., Chicago, Ill.

the matter an importance that may arouse, on CHARLES W. BURR, M. D., Philadelphia. C. G. CHADDOCK, M. D., St. Louis, Mo.

the part of the progressive readers of The S. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

MEDICAL FORTNIGHTLY, quick interest in a N. S. DAVIS, M. D., Chicago.

brief description of a simple method of acARTHUR R EDWARDS, M. D., Chicago, Ill. FRANK R. FRY, M. D., St. Louis.

complishing these ends, if supplemented Mr. REGINALD HARRISON, London, England. RICHARD T. HEWLETT, M. D., London, England.

with a short demonstration of its efficiency J. N. HALL, M. D., Denver.

in clinical experience.
HOBART A. HARE, M. D., Philadelphia.
CHARLES JEWETT, M. D., Brooklyn.

Although not new, the method which we are
THOMAS LINN, M. D., Nice, France.
FRANKLIN H. MARTIN, M. D., Chicago.

about to consider is one, not generally familiar E. E. MONTGOMERY, M. D., Philadelphia.

to physioians; and, even amongst specialists, NICHOLAS SENN, M. D., Chicago. FERD C. VALENTINE, M. D., New York.

it seems to have failed of due appreciation. It
EDWIN WALKER, M. D., Evansville, Ind.
REYNOLD WEBB WILCOX, M. D., LL.D., New York was first publicly suggested to the medical
H. M. WHELPLEY, M. D., St. Louis.

profession by Dr. Clarence J. Blake of BosWM. H. WILDER, M. D., Chicago, Ill.

ton, Mass., at the First Congress of the In-

ternational Otological Suciety, which met in LEADING ARTICLES

the City of New York in 1876. You will find á description of the method, made at

that time, in the Transactions of that Society, INTERESTING PROBLEMS IN EAR, NOSE published, in 1877, by D. Appleton & Co., AND THROAT PRACTICE.

of New York; and a more recent and exhaust

ive treatment of the subject, in the conjoined ROBERT BARCLAY, A. M., M. D.

treatise of Dr. Blake and Dr. Reik, just issued by the same publishers, under the title of

"OPERATIVE OTOLOGY, SURGICAL PATHOLOGY, Fellow of the American Otological Society; formerly Assistant Aural Surgeon, New York Eye and Ear Infirmary,

AND TREATMENT OF DISEASES OF THE EAR." New York; Aural Surgeon, Missouri Pacific Railway I beg to remark, in passing, that this work Hospital, St. Louis Baptist Hospital, M. K. & T. Railway Hospital (Sedalia, Mo.), Passavant

specifies several additional indications for the Memorial Hospital (Jacksonville, III.); etc.

application cf this method other than that for I. TO HEAL PERSISTENT PERFORATIONS OF

the bealing of perforations of the drum-head, THE DRUM-HEAD.

thus enlarging its field of usefulness in the

hands of those familiar with all advantages. ALTHOUGH not frequent, as a rule, in gen- The method of Blake consists essentially in eral practice, the occasions are nevertheless applying to the perforation, a moistened disc urgent, where it becomes necessary for the of sized writing-paper, a trifle larger than the physician to have at hand some simple, yet perforation. This is effected by cutting out reliable method of healing perforations of the

the of such paper, a disc sufficiently large to overdrum-head, persistent without attendant dis. Tap the entire edge of the perforation; moischarge of secretions. For, not only does he tening it upon both sides with sterilized water meet this condition shortly after the patient or normal saline solution; carrying it to the has sustained an injury, but, less frequently, perforation, upon the tip of a wet cotton wool. perhaps, in cases where an active suppurative brush; applying it to the perforation, conprocess has entirely ceased, leaving a persist. centrically; pressing it snugly into apposient and dry perforation, the cure of which tion with a broad, flat, dry cotton wool brush; ,

, appears, practically, an exceedingly interest. and having the patient abstain from tympanic ing clinical problem.

inflation of any kind or degree, for from To deal with the former, in such a way as twenty-four to forty-eight hours afterwards. to induce healing rapidly, while averting the Amongst the principal advantages of Dr. evils attending prolonged exposure of the Blake's method, may be mentioned: that it

SAINT LOUIS.

closes the perforation in such a way that the allowed to remain until it had passed clear drum-head is at once perfected as a sound. outward to the inner edge of the wall of the sail; the tympanum is kept filled normally auditory canal, just at its junction with the with warm, moist air; the growth of new imaginary line marking the division of the membrane is stimulated, at the edge of the upper and lower posterior quadrants of the perforation; a splint, or plane, correspond. drum-bead; the perforation having bealed ing with the circumference of the perforation, over during its passage. This was now tbe is supplied, upon which, without the other thirty-seventh day since the disc had been wise unavoidable variable stress or flapping, originally applied. It was forthwith removed the growth of new membrane across the per- from the canal wall with a Jack's stapedeoforation, takes place steadily, and upon the tomy-book; and there is now no evidence normal plane of the drum-bead; and the discs whatever to indicate the site of the original serves also as a local stimulant, support, and perforation.

a tightener, in like manner, to loose or flapping parts of the drum-head, even where no perfor- CASE II.- Drum-head ruptured by blow ation of the structure exists.

of a sand-bag. L. L. K., aged 39 years, was As evidence of the wide range of its appli, struck a severe blow, upon the left side of cation, in cases of perforated drum-head, I his face and head, with a sand-bag, in the would state, in passing, that this method has hands of an enraged discharged employe. availed me, to secure union by first intention, Six days later, on examination, a dried, cir. in a case where the entire antero-superior cular perforation of the left drum-bead, one. quadrant had been detached by a blow of the eighth an inch in diameter, was found, close fist upon the ear. After replacing the detached to and bebind the umbo, or lower extremity flap, it was held in place by a Blake-disc; of the handle of the malleus. and after healing, thus, and subsequent re- A forty-eight-inch watch could be heard moval of the diso, no evidence whatsoever of with this left ear at a distance of but five previous injury to the parts was recognizable. inches; bis own watoh, at eight. The lower

I have employed this method, also, much to tone-limit for the tuning-fork was sixty-four the astonishment of a brother-practitioner, in vibrations a second, an elevation of one octave healing a perforation of his own drom-head, from the normal. Hearing by bone-conducwhich had previously persisted for fully tion was better than that by air-conduction, thirty-five years.

from the fork of thirty-two, to that of twoThe advantages of this ready method are thousand-and-forty-eight vibrations a second beautifully illustrated in the following cases: -the entire normal tuning-fork range.

After the application of the Blake-paperCASE I. - Drum-head ruptured while diso, of circular form, three-sixteenths of an wrestling. G. S. R., aged 22 years, while inch in diameter, the forty-eight-inch watch wrestling, had his head suddenly and tightly was audible, with this ear, at eighteen inches compressed, from side to side, between the arm distance-showing increased hearing power, and body of his antagonist, attempting a for this watch-tick, -over one-thousand perstrangle-hold. After the bout, his left ear felt cent greater than before. He could now hear numb and deaf; and besides a constant bis own watch at twenty-four inches distance ringing in it, be heard an unnatural echo of showing an increase of over eight-hundred his own voice upon that side.

per-cent in hearing power, for this sound; Nine days later, on examination, a small and he could hear a low whisper at thirteen crust, elliptical in shape, about one-eighth of feet distance,--the limit of capacity of the an inch in its longest diameter, was found testing-room. upon the left drum-head, just behind and be- The diso remaining in situ until the sixth low the umbo, or lower extremity of the day, he was permitted to absent himself from handle of the malleus. This was carefully observation for a considerable period of time. removed; and, near it, was found, a small, On the twenty-sixth day after the diso bad dry, slit-like perforation, about one-sixteenth been applied to the perforation, it was found of an inch in its longest diameter. This, ex- at the junction of the drum-head with the amined with the utmost care, and with mag- oanal-wall, at the level of the imaginary line nifying-glasses, proved to be prefectly diy of demarcation between the postero-superior and quiescent, and presumably persistent. and postero.inferior quadrants of the drumNo further abnormal feature could be noted bead. From this point, it was readily rein the affected drum-bead.

moved with a Jaok's stapedectomy-hook, and The Blake-paper-disc was then applied; a Dench-Mokay forceps. and its progress from the site of its original No trace whatever of the perforation was application toward the periphery of the drum- now visible; and the hearing was found nor. head was noted, from time to time. It was mal; whereupon, he was discharged cured;

tbe ear.

CHICAGO, ILL.

and there has since been no evidence what. METABOLIC ASPECTS OF OVER-FEEDING ever that any injury had ever been done to

AND OF UNDER-FEEDING,*

RALPH W. WEBSTER, M. D., PH. D. CASE III. – One druni-head ruptured while "sliding to base;" the other, by former inflammation of middle-ear. W.E.W., aged

In these days, in which we have so much 26 years, while "sliding for Third," in a to do with the various disorders arising, di. base-ball game, struck bis left ear against rectly or indirectly, from the use and abuse the opposing base-man's knee. Immediately of our diet, it seems fitting to ask ourselves afterward, and up to the time of consulting whether we are justified in ordering a certain me, be found this ear practically deafened; diet in one case and a definite diet in an. he had a continuous buzzing in it, and an other. It is not my intention, in this paper, annoying echo whenever he used his voice. to outline what, to my mind, seems the proper The night following the accident, he suffered dietary in various ailments and diseases with from frontal head-ache.

which we are all confronted, but, rather, to Three days later, on my first examination, discuss, briefly, certain phases of the subject a dried, circular perforation of the left drum. of over-feeding and of under-feeding. head, three-thirty-seconds of an inch in diam. eter, was found, half way between the umbo, or lower extremity of the handle of the malleus, and the postero-inferior edge of the membrane. No signs of activity were recog. nizable about it.

A large perforation of the antero.inferior quadrant of the right drum-bead, five thirty seconds of an inch in diameter was found; around which, and in the cul-de-sac of the canal, was found some muco-purulent secretion.

The patient stated, that he used to have discharge from the right ear for years; and that this right ear was 'now' his "bad ear.

A Blake-paper-disc was applied to the left perforation at once; and behaved as usual in such cases. As soon as the right ear seemed to have become quieted, and no discharge bad been noted for several days, a Blake-disc was applied tentatively; but this had to be removed, a couple of days later, on account of excess of discharge within the tympanum,

RALPH W. WEBSTER, M. D. which oozed out beneath the edge of the disc. After the diso had been removed, it was no

NORMAL STANDARDS. ticed, that the edge of the perforation had be. come raw; and the perforation had begun to

Before proceeding with such a discussion heal. Treatment was then instituted, to place just what we are to regard as the normal die

it is imperative that we fix clearly in mind the tympanic contents in a more healthy condition; when the Blake-paper-disc was once

tary standard for a person in good health and

physioal condition. At the outset we must more applied.

remember that certain factors, such as age, Eighteen days after the application of the Blake-diso to the perforation of the left drum

sex, ocou pation, climate, external surroundhead, it was removed with a Jack's stapedec. ings, etc.,

have a great influence in determin. tomy-hook, the perforation having healed, ing the amount of food necessary to maintain with normal bearing; and no trace or sign of

one in a condition of healthy equilibrium. the perforation remains to mark its former

Hence, in speaking of a normal standard site.

diet, I will refer, later, to the diet of a After a brief period of time, not accurately healthy adult male doing a moderate amount

of work, recorded, the disc was removed, in the usual

As we all know the standard diet of Carl manner, from the right drum-head also; the old perforation having finally healed.

Voit has long been accepted, more or less

generally, as representing the needs of the (To be continued.)

• Read before the Mississippi Valley Medical Association, 3894 Washington Boulevard.

Hot Springs, Ark., November 7, 1906.

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