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MEDICAL MEMORANDA. I have prescribed resinol ointment for four cases of pruritus ani recently, and have obtained relief. I have completely cured one case of eczema with the ointment, and I have a number of families who keep it on hand as a family medicine. -G. W. Smith, M. D., Ft. Smith, Ark.

A Matter of Spelling.–A trolley collided with a milk wagon and sent the milk splashing on the pavement. Soon a crowd gathered. "Goodness!" exclaimed a

“What an awful waste!” A very stout lady turned and glared at him. "Just mind your own business," she snapped.-October Lippincott.

A Fair Test of Calcalith.-From Dr. Toland down in Texas, comes the statement: “ There's nothing surpasses calcalith (Abbott). I gave it a fair test two weeks ago in a patient who had cystitis, prostatitis, urethritis and gonorrheal rheuma. tism and was passing "matter" (pus and blood) with his urine. He surely was in a bad condition, but calcalith with other alkaloidal remedies (calcium sulphide and tonics) soon brought him around all right.”

Constipation.—As a rule the habitual use of purgative waters causes a constipated condition which may become chronic. This does not occur with carabana, which is tonic in its effects. It is consequently very useful for preventing not only the diseases directly attributable to constipation, but also for alleviating the remote reflex or sympathetic disturbances. It effects this result by removing the fecal matter, which not only acts as a local irritant and by its pressure interferes with the venous circulation, but also causes auto-infection by the elaboration of toxic alkaloids.

Fothergill, one of the highest English authorities on medicine, says that no treat. ment of respiratory affections is complete without appropriate tonic treatment. This explains why Gray's glycerine tonic comp. is so uniformly effective in both acute and chronic forms of bronchitis and laryngitis. It relieves the symptoms because of its local antiphlogistic properties and eradicates the disease because it antagonizes the ever-present element of systemic depression. The unique therapeutic value of Gray's glycerine tonic comp. can be best proven by a trial in those cases of general debility that have resisted all other tonic and reconstructive medication.

Coca Bases.-W. H. R., Chicago, Ill., writes to the editor of the Coca Leaf: "In the analysis of Vin Mariani I notice 'Coca bases.' If this means the alkaloid cocaine, why not say so plainly?” Coca bases means precisely what it designates, i.e., alkaloidal bases of the coca leaf, of which cocaine is but one among many. The several coca bases, while chemically analogous,differ markedly from each other in physiological action. Thus, while cocaine acts chiefly upon the central nervous system, other coca alkaloids, as ecgonine, benzoyl ecognine, hygrine, cinnamyl-cocaine, etc., act directly to stimulate muscle fibre while having little if any anesthetic action, direct or remote. The alkaloidal yield of coca varies with the quality as well as with the variety of leaf used. The large Bolivian leaf being rich in cocaine to the exclusion of the other alkaloids, is employed by chemists for the extraction of cocaine, while the small leaf varieties inversely being low in cocaine and rich in aromatic bodies and those alkaloids which act upon muscle, are employed medicinally for such physiological properties. A blending of these latter varieties of aromatic coca is employed in the preparation of Vin Mariani. It is the refinement of selection of appropriate coca from long years of experience, and skill in its preservation and manufacture, to which this unique tonic owes its restorative properties.—The Coca Leaf, March,1905.

The Use of Glyco-Thymoline in Obstetrics.-(By Geo. H. Shelton, M. D., Detroit, Mich.)-I am so gratified and pleased with the action of glyco-thymoline in the various conditions in which it is indicated, and especially so in obstetrics, that I can not endorse it too highly. I have used glyco-thymoline in obstetrical practice wherever sepsis is present or threatened, and can say candidly that I have yet to meet with disappointment. The result in every instance has been simply charming. Did not time forbid I could recount numerous cases in which the happy climax was attributable to the use of glyco-thymoline. But for the purpose of this paper the report of two cases in obstetrics will illustrate typically its wide field of usefulness in this branch of practice. Case 1.-Mrs. J., age 28. Multipara, was delivered at full term of a still-born child. It had been dead about ten days and was foully decomposed. Condition of mother was very critical. Temperature 102.5 degrees. Pulse 120. All symptoms of septicemia present. Two tablespoonfuls of glyco-thymoline to one pint of hot water as a douche three times daily, brought about a wonderful recovery in a remarkably short space of time. Case 2.—Mrs. S., age 19. Primipara. Premature labor, followed by puerperal fever. In this case the septic condition was such as to be truly alarming, but glyco-thymoline, two tablespoonfuls to one pint of hot water, to be used as a douche three times daily, produced a rapid recovery. In conclusion, wish to state that I find such general use for glyco-thymoline in obstetrics that I would not consider that I was fully prepared for any and all emergencies which might arise while attending a case of labor unless I had a supply of the above mentioned remedy on band.

After Operations. After an operation, be it simple or severe, it is always good practice to reinforce a patient's vitality. Gray's glycerine tonic compound is eminently useful for this purpose.

John Drew on Drawing Power.—A fellow actor was the subject of discussion at The Þlayers Club not long ago;

He is perfectly devoted to that blonde"-so Mr. Drew was informed. "His family think it a case of hypnotism."

"Seems more like chemical attraction," said the great actor thoughtfully.-November Lippincott's.

Just How to Manage Otorrhea.-(By F. E. Burgevin, M. D., of Spiro, I. T.)Otorrhea, from the purulent middle-ear catarrh, the "running ears" of the laity, was at first my bete noire. I used the classic treatment of Pomeroy and others-syringing, insufflations of powdered boric acid, etc., sometimes with benefit, sometimes the reverse, but never by any chance curing any of them, until I dreaded to see a patient with cotton in his ears come into the office. Now I cure them in a few days .or weeks without difficulty, and really prefer this class of cases to any other. When I was at the Manhattan Ěye and Ear Hospital in 1890, Dr. Pomeroy said that one case had been under treatment nearly ten months and was slightly improved. He said that it required one or two years to cure this disease, and then it generally returned. My method of treatment is as simple as it is effectual, and any

doctor after reading my description attentively can use it as well as I can and cure every case. Once daily I fill the ear with a warm solution of some good peroxide of hydrogen, beginning with a 35 per cent solution, and increasing the strength every day until the pure drug is used. Hydrozone is the same, only twice as strong, and I use it when I can get it simply from motives of economy. After cleansing the ear thoroughly, which at first may require twenty minutes to two hours, according to the foulness of the auditory canal, I then instill a few drops of glycozone (warmed) and close the canal securely with a bit of absorbent cotton. This is allowed to remain in situ until next treatment. The first cleansing should be very thorough, the peroxide being repeatedly instilled until all foaming ceases. In some cases it may require two, three or more treatments to cleanse the ear properly, especially if the lumen be occluded by a furuncle, or by swelling, or inspissated discharge. Do not be discouraged by any little difficulty like this, keep right on and you will finally succeed in getting the ear clean. After that it is plain sailing. Thenceforth the daily treatment need not consume more than ten to twenty minutes. It is better to treat the case every day, but I have had good success with patients who could not come oftener than once a week. Do not give the patient medicine to use at home and expect to cure him; and never tell him what you are using. In children who dread the procedure, I do not attempt much the first time or two, but strive to win their confidence, which is not ordinarily difficult, as the treatment is not at all painful and is always followed by a certain sense of relief, so that children who were in mortal terror of me at first will, after a few treatments, come to me of their own accord. Even babies of one or two years who would not suffer me to touch them at first, after experiencing the grateful relief afforded, will place the head on the chair in the proper position and gladly submit to the treatment.

When the diseased ear has once been thoroughly cleansed I consider my work as half done. Thenceforth improvement is usually very rapid, even old inveterate cases yielding in few weeks. Relapses occur, but are easily managed, and I have seldom had a second relapse. Of course, mastoid disease, necrosis, polyps, etc., must receive appropriate treatment; but I have no hesitation in saying that all simple, uncomplicated cases (which include the vast majority of all cases under one year's duration) may be cured by this treatment if it is properly and thoroughly carried out. Care must be taken to have the medicaments warm and not too hot100 F. is about right-and to always stop up the ear with a bit of aseptic cotton before permitting the patient to leave the office. Be careful to use a piece of cotton of just the right size to securely close up the meatus; if too large it will work out, allowing the solution to escape and leaving the ear unprotected; if too small it will slip back into the canal and so fail of its effect. Never syringe the ears in otorrhea; it is risky and useless. I usually drop a little warm solution of sodium borate-5 per cent-in the ear to prevent a slight stinging which sometimes ensues when active steps are taken. I also dry out the canal with cotton on an applicator, but this should be carefully done with speculum, and the canal well lighted. These points are non-essentials, merely refinements which render the treatment a trifle more pleasant, perhaps, that is about all. The general health will probably require overhaul. ing, indications being met as they arise. It is a good idea to regulate and antisepticise the bowels as a routine measure, using salines and intestinal antiseptics-e. g., the sulphocarbolates are needed. In the South especially, malarial and other miasmatic affections will often need looking after; also any other existing disease may require attention, but it is presumed that the practician will know how to handle these. We all ought to try to help each other; not one of us has much to learn; and in these brief talks it is my principal aim to set an example for the rest, hoping my little crumbs may some day come back to me in the shape of seasonable aid from some brother who has a few pointers himself and, like me, is willing to "whack up.”—Kansas City Med. Record.

Vol. XXX

St. Louis, DECEMBER 10, 1906.

No. 11

Papers for the original department must be contributed ex- tion of gastrio juice, food undergoes fermenclusively to this magazine, and should be in band at least one month in advance. French and German articles will be trans- tation or putrefaction, and an undigested lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

mass is emptied into the duodenum. The reprints may be obtained at cost, if request accompanies the mucous membrane of the duodenum unaccusproof.

Engravings from photographs or pen drawings will be fur- tomed to receive a decomposed mass is irri. nished when necessary to elucidate the text. Rejected manusoript will be returned if stamps are enclosed for this purpose.

tated and this produces diarrhea.

It is not always clear why intestinal disCOLLABORATORS.

turbances frequently mask severe stomach ALBERT ABRAMS, M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

trouble. The attacks of diarrhea are dependFRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.

ent upon the digestive strength and the re. C. G. CHADDOCK, M. D., St. Louis, Mo.

sisting power of the intestine. In gastro8. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

genio diarrhea there is an insufficiency of the N. 8. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.

preparation of the food in the stomach. Pa. FRANK R. FRY, M. D., St. Louis. Mr. REGINALD HARRISON, London, England.

tients may have stomach trouble for years, RICHARD T. HEWLETT, M. D., London, England. but not severe enough to induce them to conJ. N. HALL, M, D., Denver. HOBART A. HARE, M. D., Philadelphia.

sult a physician until they are suddenly CHARLES JEWETT, M. D., Brooklyn.

taken with a diarrbea. When the stomach THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.

does not do its work properly too much is E. E. MONTGOMERY, M. D., Philadelphia. NICHOLAS SENN, M. D., Chicago.

demanded of the intestine. The intestine FERD C. VALENTINE, M. D., New York.

may do the work of the stomach for years EDWIN WALKER, M. D., Evansville, Ind. REYNOLD WEBB WILCOX, M. D., LL. D., New York without any apparent difficulty. The inH. M. WHELPLEY, M. D., St. Louis. WM. H. WILDER, M. D., Chicago, Ill.

testine carries on this increased work under unfavorable condition, being subjected to ab

normal irritation by the food that has not LEADING ARTICLES

been properly prepared by the stomach. In consequence of abnormal fermentation the

mucous membrane is irritated which induces GASTROGENIC DIARRHEA.*


The reaction of the food in the stomach in. CHARLES D. AARON, M. D.

fuences the contraction and relaxation of the

pylorio spbincter. Free hydrochloric acid Professor of Diseases of the Stomach and Intestines in the

in the stomach opens the pylorus. The acid Detroit Post-Graduate School of Medicine; Clinical Pro- chyme acting on the intestinal mucosa refessor of Gastroenterology in the Detroit College of Medicine; Consulting Gastroenterologist to Har

flexly closes the pylorus. As the pylorus per Hospital, etc.

closes, the pancreatio juice and bile gradu. DIARRHEA is a symptom of a disease that ally neutralize the acid chyme, and this allows induces abnormal frequency and liquidity of

the free acid in the stomach to again open the fecal discharges. Gastrogenic diarrhea is a pylorus and a new supply of the stomach concondition in which a perversity in the secre

tent enters the duodenum. On account of tion or the motility of the stomach is the this great acidity the intestine is never overetiologio factor. Many cases of stomach dis

burdened with too much food at one time. order manifest themselves by symptoms sug.

As soon as a certain amount of the acid stom. gesting intestinal disease.

This has been

ach content enters the duodenum the pylorus frequently shown during the last ten years, oloses to prevent any more from passing by an examination of the stomach content, through until the pancreatio juice has bad showing abnormal secretion

an inter- time to act upon the food in the intestine. ference with motility. We

may have

Proteids take up a great deal of hydrooblorio all degrees of decreased secretion of gas- acid and require a longer time to give a tric juice or the direct opposite may be the reaction for free bydrooholrio acid than the case showing a hyperchlorhydria. Both con- carbohydrates. For this reason the pylorus ditions may or may not be associated with opens sooner after a carbohydrate diet than a atony and interference with motility. An ex- proteid diet. In cases in which hydrochlorio amination of the feces after a test-diet sbows aicd is secreted in insufficient quantities the that the food stuff is inadequately digested. pylorus relaxes and allows the stomach conOn account of some perversity in the secre- tent to empty itself into the duodenuni when Read before the Michigan State Medical Society, at

there is not enough acid in the duodenum to Jackson, Mich., May 24. 1906.

reflexly close the pylorus, and thus the duo.



denum is over-burdened and the intestinal neotive tissue, need not necessarily be al. mucosa irritated, which leads to a condition tered; the connective tissue can permeate that superinduces gastrogenic diarrhea. feces that are otherwise normal. More often

The acid chyme poured into the duodenum the feces are not normal in other respects, stimulates the flow of pancreatio juice. If being soft and mushy to a liquid or oontainthe secretion of hydrooblorio acid in the ing mucus and showing signs of decomposi. stomach is in any way inhibited there is a iton. Similarly results of stomach affections reduction in the secretion of the pancreas. on the intestine are not uniform; they can The secretion of the pancreatio juice is vary from the slightest funotional deviations brought about by a substance called secre- to the severest catarrhs, according to the tin. The hydrochloric acid from the stom- duration of the condition, the sensibility of ach produces this secretin in the intestine the intestine, the care which the patient gives from some unknown substance, and after himself, eto. When pronounced intestinal being absorbed has the power of increasing affections are present, the symptoms may bethe secretion of pancreatio juice.

We can

come so prominent as to determine completely readily see how an anomaly in the secretion the appearance of the disease, wbile achylia, of hydrochloric acid in the stomach would which is well known, frequently occurs withinhibit the secretion of pancreatio juice and out any symptoms suggesting disturbances tbus set up diarrhea.

on the part of the stomach. In the fact that Scbmidt (1) has proved this by giving a the conneotive tissue test in these instances test-diet and then examining the feoes.

He at once leads us on to the right path, lies its found tbat raw connective tissue was norm- value. It has, however, a greater advantage, ally digested in the stomach and that the in that it reveals the danger threatening the pancreatic juice had no effeot upon such con. intestines when nothing else indicates it, nective tissue. He says, "That these obser- when only now and then subjective symptoms vations are not isolated, and that gastrogenic or rapidlly subsiding intestinal irritations apintestinal disturbances are extremely fre- pear, which, without this test, would be quent, and therefore bave a great practical overlooked entirely." significance, must be obvious to any one who Sahli has given us a simple test of the has systematically employed my functional chemistry of the stomach in cases of gastroexamination. The appearance of macroscop- genic diarrhea without inflicting on the paically recognizable remains of connective tis. tient the discomfort of the stomach tube. sue in the feces after the test-diet is a simple The patient is to swallow a little iodoform or as well as a reliable sign of this disturbance methylene blue wrapped in a small square of and it indicates that the stomach in the par. rubber tissue tied with a piece of raw catgut. ticular case is unable to perform the work If the chemic funotions of the stomach are which must be expected of it. In iny fecal normal, the catgut is soon dissolved in the investigation I myself have come upon undi- gastrio secretions, and the appearance of the gested connective tissue remains so often that blue in the urine or the iodin in the urine I do not hesitate to declare the stomach to be and saliva testifies to the normal digesting frequently the point of origin of the most power of the stomach juices. The little bag varied intestinal disturbances. I purposely

I purposely is swallowed after a meal and the absence of say the most varied, for, as already pointed any reaction is proof that the bag was either out above, remains of connective tissue are passed along before the gastric juice acted on found not only in cases of diminished hydro- it or that the secretory functions of the stomchloric acid secretion-although undoubtedly ach are defective. they occur here most frequently, one might It was at first believed that the cause of say constantly, but also under the opposite gastrogenic diarrhea was to be looked for in circumstances. How the failure to digest the absence of the antiseptic action of the the connective tissue is to be explained in all hydrochlorio acid in the stomach. But bythese cases, is not yet determined. It is at drochloric acid is not the all determining faconce intelligible in achylia, but in cases of tor in preventing processes of decomposition hyperacidty it is a deficient pepsin secretion, in the intestine, as can be seen from the many which we kuow can occasionally happen in patients with achylia who do not get intestspite of increased hydrochloric acid secre. inal disturbances; and besides, we see fretion. Where the motility is reduced pro- quently strong decomposition in the stomcesses of decomposition may be involved, ach itself where hydrochloric acid is pres. etc. The work of the intestine, if we ent. There is no doubt that the origin of disregard the presence of undigested con- these fermentations in the stomach is due to

disturbances of the motor activity, and is of (1) Adolf Schmidt, the examination of the functions of the intestine by means of the test-diet, its application in greater significance than disturbances of the medical practice and its diagnostic and therapeutic value. F. A. Davis Co. Philadelphia.

chemic processes. Gastrogenio diarrhea with


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