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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. Within 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 tried 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 fluid ounce of carsarenna represents: Cascara sagrada, 40 grains; senna, 120 grains; potassium and sodium tartrate, 24 grains: chenopodium, 8 grains; pumpkin 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.

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 physician 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 pregnancy 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 meats, 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 materially 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, the 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 confessedly greater than those of any other form of iron. Then, too, pepto-mangan (Gude) is more readily absorbed and more completely assimil ated 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, pepto-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 no doubt, for at birth they present unmistakable evidences of physical robustness and seem well fortified against those illnesses which are peculiar to infanthood. 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.

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Vol. XXX

ST. LOUIS, NOVEMBER 25, 1906.

Papers for the original department must be contributed exclusively to th's magazine, and should be in hand at least one month in advance. French and German articles will be translated free of charge, if accepted.

A liberal number of extra copies will be furnished authors, and reprints may be obtained at cost, if request accompanies the proof.

Engravings from photographs or pen drawings will be furnished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

COLLABORATORS.

ALBERT ABRAMS, M. D., San Francisco.
M. V. BALL, M. D., Warren, Pa.
FRANK BILLINGS, M. D., Chicago, Ill.
CHARLES W. BURR, M. D., Philadelphia.
C. G. CHADDOCK, M. D., St. Louis, Mo.
S. SOLIS COHEN, M. D., Philadelphia, Pa.
ARCHIBALD CHURCH, M. D., Chicago.
N. S. DAVIS, M. D., Chicago.

ARTHUR R EDWARDS, M. D., Chicago, Ill.
FRANK R. FRY, M. D., St. Louis.

Mr. REGINALD HARRISON, London, England.
RICHARD T. HEWLETT, M. D., London, England.
J. N. HALL, M. D., Denver.

HOBART A. HARE, M. D., Philadelphia.

CHARLES JEWETT, M. D., Brooklyn.

THOMAS LINN, M. D., Nice, France.

FRANKLIN H. MARTIN, M. D., Chicago.

E. E. MONTGOMERY, M. D., Philadelphia.
NICHOLAS SENN, M. D., Chicago.

FERD C. VALENTINE, M. D., New York.
EDWIN WALKER, M. D., Evansville, Ind.
REYNOLD WEBB WILCOX, M. D., LL. D., New York
H. M. WHELPLEY, M. D., St. Louis.
WM. H. WILDER, M. D., Chicago, Ill.

LEADING ARTICLES

INTERESTING PROBLEMS IN EAR, NOSE AND THROAT PRACTICE.

ROBERT BARCLAY, A. M., M. D.

SAINT LOUIS,

Fellow of the American Otological Society; formerly Assistant Aural Surgeon, New York Eye and Ear Infirmary, New York; Aural Surgeon, Missouri Pacific Railway Hospital, St. Louis Baptist Hospital, M. K. & T. Railway Hospital (Sedalia, Mo.), Passavant Memorial Hospital (Jacksonville, Ill.); etc.

I. TO HEAL PERSISTENT PERFORATIONS OF THE DRUM-HEAD.

ALTHOUGH not frequent, as a rule, in general practice, the occasions are nevertheless urgent, where it becomes necessary for the physician to have at hand some simple, yet reliable method of healing perforations of the drum-head, persistent without attendant discharge of secretions. For, not only does he meet this condition shortly after the patient has sustained an injury, but, less frequently, perhaps, in cases where an active suppurative process has entirely ceased, leaving a persistent and dry perforation, the cure of which appears, practically, an exceedingly interest. ing clinical problem.

To deal with the former, in such a way as to induce healing rapidly, while averting the evils attending prolonged exposure of the

No. 9

middle-ear structures to the vicissitudes of the atmosphere, avoiding the tympanic suppuration that usually attends the ordinary methods of interference, in such cases; and to dispose of the latter in such a way that protection may be permanent for the tympanic contents, and the special function restored, with all the joy and advantage that attend the recovery of serviceable hearing;-these give the matter an importance that may arouse, on the part of the progressive readers of THE MEDICAL FORTNIGHTLY, quick interest in a brief description of a simple method of accomplishing these ends, if supplemented with a short demonstration of its efficiency in clinical experience.

Although not new, the method which we are about to consider is one, not generally familiar to physicians; and, even amongst specialists, it seems to have failed of due appreciation. It. was first publicly suggested to the medical profession by Dr. Clarence J. Blake of Boston, Mass., at the First Congress of the International Otological Society, which met in the City of New York in 1876. You will find a description of the method, made at that time, in the Transactions of that Society, published, in 1877, by D. Appleton & Co., of New York; and a more recent and exhaustive treatment of the subject, in the conjoined treatise of Dr. Blake and Dr. Reik, just issued by the same publishers, under the title of "OPERATIVE OTOLOGY, SURGICAL PATHOLOGY, AND TREATMENT OF DISEASES OF THE EAR. I beg to remark, in passing, that this work specifies several additional indications for the application of this method other than that for the healing of perforations of the drum-head, thus enlarging its field of usefulness in the hands of those familiar with all advantages.

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The method of Blake consists essentially in applying to the perforation, a moistened discof sized writing-paper, a trifle larger than the perforation. This is effected by cutting out lap the entire edge of the perforation; moisof such paper, a disc sufficiently large to overtening it upon both sides with sterilized water or normal saline solution; carrying it to the brush; applying it to the perforation, conperforation, upon the tip of a wet cotton-wool centrically; pressing it snugly into apposition with a broad, flat, dry cotton-wool brush; and having the patient abstain from tympanic inflation of any kind or degree, for from twenty-four to forty-eight hours afterwards.

Amongst the principal advantages of Dr. Blake's method, may be mentioned: that it

closes the perforation in such a way that the drum-head is at once perfected as a soundsail; the tympanum is kept filled normally with warm, moist air; the growth of new membrane is stimulated, at the edge of the perforation; a splint, or plane, correspond. ing with the circumference of the perforation, is supplied, upon which, without the otherwise unavoidable variable stress or flapping, the growth of new membrane across the perforation, takes place steadily, and upon the normal plane of the drum-head; and the discs serves also as a local stimulant, support, and tightener, in like manner, to loose or flapping parts of the drum-head, even where no perforation of the structure exists.

As evidence of the wide range of its application, in cases of perforated drum-head, I would state, in passing, that this method has availed me, to secure union by first intention, in a case where the entire antero-superior quadrant had been detached by a blow of the fist upon the ear. After replacing the detached flap, it was held in place by a Blake-disc; and after healing, thus, and subsequent removal of the disc, no evidence whatsoever of previous injury to the parts was recognizable.

I have employed this method, also, much to the astonishment of a brother-practitioner, in healing a perforation of his own drum-head, which had previously persisted for fully thirty-five years.

The advantages of this ready method are beautifully illustrated in the following cases:

CASE 1. Drum-head ruptured while wrestling. G. S. R., aged 22 years, while wrestling, had his head suddenly and tightly compressed, from side to side, between the arm and body of his antagonist, attempting a strangle-hold. After the bout, his left ear felt numb and deaf; and besides a constant ringing in it, he heard an unnatural echo of his own voice upon that side.

Nine days later, on examination, a small crust, elliptical in shape, about one-eighth of an inch in its longest diameter, was found upon the left drum-head, just behind and below the umbo, or lower extremity of the handle of the malleus. This was carefully removed; and, near it, was found, a small, dry, slit-like perforation, about one-sixteenth of an inch in its longest diameter. This, examined with the utmost care, and with magnifying-glasses, proved to be prefectly dry and quiescent, and presumably persistent. No further abnormal feature could be noted in the affected drum-head.

The Blake-paper-disc was then applied; and its progress from the site of its original application toward the periphery of the drumhead was noted, from time to time.

It was

allowed to remain until it had passed clear outward to the inner edge of the wall of the auditory canal, just at its junction with the imaginary line marking the division of the upper and lower pcsterior quadrants of the drum-head; the perforation having healed over during its passage. This was now the thirty-seventh day since the disc had been originally applied. It was forthwith removed from the canal wall with a Jack's stapedectomy-hook; and there is now no evidence whatever to indicate the site of the original perforation.

CASE II.-Drum-head ruptured by blow of a sand-bag. L. L. K., aged 39 years, was struck a severe blow, upon the left side of his face and head, with a sand-bag, in the hands of an enraged discharged employe.

Six days later, on examination, a dried, circular perforation of the left drum-head, oneeighth an inch in diameter, was found, close to and behind the umbo, or lower extremity of the handle of the malleus.

A forty-eight-inch watch could be heard with this left ear at a distance of but five inches; his own watch, at eight. The lower tone-limit for the tuning-fork was sixty-four vibrations a second, an elevation of one octave from the normal. Hearing by bone-conduction was better than that by air-conduction, from the fork of thirty-two, to that of twothousand-and-forty-eight vibrations a second -the entire normal tuning-fork range.

After the application of the Blake-paperdisc, of circular form, three-sixteenths of an inch in diameter, the forty-eight-inch watch was audible, with this ear, at eighteen inches distance-showing increased hearing power, for this watch-tick,-over one-thousand percent greater than before. He could now hear his own watch at twenty-four inches distance

showing an increase of over eight-hundred per-cent in hearing power, for this sound; and he could hear a low whisper at thirteen feet distance, the limit of capacity of the testing-room.

The disc remaining in situ until the sixth day, he was permitted to absent himself from observation for a considerable period of time.

On the twenty-sixth day after the disc had been applied to the perforation, it was found at the junction of the drum-head with the canal-wall, at the level of the imaginary line of demarcation between the postero-superior and postero-inferior quadrants of the drumhead. From this point, it was readily removed with a Jack's stapedectomy-hook, and a Dench-McKay forceps.

No trace whatever of the perforation was now visible; and the hearing was found normal; whereupon, he was discharged cured;

and there has since been no evidence whatever that any injury had ever been done to the ear.

CASE III. One drum-head ruptured while "sliding to base;" the other, by former inflammation of middle-ear. W.E. W., aged 26 years, while "sliding for Third," in a base-ball game, struck his left ear against the opposing base-man's knee. Immediately afterward, and up to the time of consulting me, he found this ear practically deafened; he had a continuous buzzing in it, and an annoying echo whenever he used his voice. The night following the accident, he suffered from frontal head-ache.

Three days later, on my first examination, a dried, circular perforation of the left drumhead, three-thirty-seconds of an inch in diameter, 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 recognizable about it.

A large perforation of the antero-inferior quadrant of the right drum-head, 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.

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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 had 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, which oozed out beneath the edge of the disc. After the disc had been removed, it was noticed, that the edge of the perforation had become raw; and the perforation had begun to heal. Treatment was then instituted, to place the tympanic contents in a more healthy condition; when the Blake-paper-disc was once more applied.

Eighteen days after the application of the Blake-disc to the perforation of the left drumhead, it was removed with a Jack's stapedectomy-hook, the perforation having healed, with normal hearing; and no trace or sign of the perforation remains to mark its former the perforation remains to mark its former

site.

After a brief period of time, not accurately

recorded, the disc was removed, in the usual manner, from the right drum-head also; the old perforation having finally healed.

(To be continued.)

3894 Washington Boulevard.

METABOLIC ASPECTS OF OVER-FEEDING
AND OF UNDER-FEEDING.*

RALPH W. WEBSTER, M. D., PH. D.
CHICAGO, ILL.

IN these days, in which we have so much to do with the various disorders arising, directly or indirectly, from the use and abuse of our diet, it seems fitting to ask ourselves whether we are justified in ordering a certain diet in one case and a definite diet in another. It is not my intention, in this paper, to outline what, to my mind, seems the proper dietary in various ailments and diseases with which we are all confronted, but, rather, to discuss, briefly, certain phases of the subject of over-feeding and of under-feeding.

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Before proceeding with such a discussion. just what we are to regard as the normal dieit is imperative that we fix clearly in mind tary standard for a person in good health and physical condition. At the outset we must remember that certain factors, such as age, ings, etc., have a great influence in determinsex, occupation, climate, external surrounding the amount of food necessary to maintain one in a condition of healthy equilibrium. Hence, in speaking of a normal standard diet, I will refer, later, to the diet of a healthy adult male doing a moderate amount

of work.

As we all know the standard diet of Carl Voit has long been accepted, more or less generally, as representing the needs of the

*Read before the Mississippi Valley Medical Association, Hot Springs, Ark., November 7, 1906.

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