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MEDICAL MEMORANDA. Syrup of Figs and Elixir of Senna.-With a view to making a name of this excellent laxative more expressive, the manufacturers of “Syrup of Figs” have decided upon the above title. In speaking of the subject, Mr. Queen says; “In order to make the name of this laxative more fully descriptive of it, the California Fig Syrup Company has made an addition to the name, as you will see by the new advertise. ment, and in future, the full name, which will be printed on the wrappers and labels of every bottle, will be “Syrup of Figs and Elixir of Senna," which is what the remedy really is; its special excellence being due to the original method of obtaining the laxative properties of the plant. The original method of the working formula is known to the California Fig Syrup Co. only. We think that the new name will be more acceptable to physicians, as it describes the laxative more fully than the shorter name of Syrup of Figs."

The sample of resinol ointment which came into my hands to-day jogged my memory in regard to your preparations, and reminded me that I have been intending to write you for some time. During the past six months I have twice found it very efficacious. A young lady patient of mine had a very troublesome and unsightly eruption on the back of her neck extending up behind the ears on both sides. She informed me that she had been receiving treatment for it to no effect for over a month and I advised her to use resinol ointment. The result was a cure in a very few weeks, and three months have passed with no recurrence.

Several months ago I extracted some teeth for some boys and their father, and in a couple of days their mouths and chins were covered with eruptions, much to my discomfiture. Prescribed resinol and resinol soap and the recovery was remarkably prompt. I could not account for causes in these cases for I did the work in an antiseptic manner, but will say that I regard resinol ointment as an exceptionally valuable preparation.—A. S. Wolff, D. D. S., 2100 N. 11th St., St. Louis, Mo.

The Card System for Keeping Records and Accounts.—The keeping of records and accounts is a most irksome duty to the active practitioner. No matter how busy or

exhausting the day, they still remain to be attended to. Sooner or later they are slighted, and slipshod methods and confusion follow. The "Card System" revolutionizes this state of affairs. It

eliminates all the disadvantages of 但萬萬圍

books, and makes each record so comprehensible and easy of reference as to give it a new value. In lieu of the

physician's memorandum book, case BA 图图 history book, cash book, ledger, and

what-not, the card system substitutes two cards—case history card and ledger card. One card is used for each pa. tient. Impressed with the worth and practicability of these cases, the Angier Chemical Company has developed a complete case, designed especially for physicians, and so arranged as to take

care, in the best possible manner and with the least tr uble, of his records and accounts. The first of January is the most convenient time to change from books to the card system, and as the Angier Chemical Company (Allston District, Boston, Massachusetts) is making a special advertising offer and low price for these history and ledger card outħts, we advise our readers to write them ( mentioning this journal) for sample cards and details regarding their attractive offer.

Hemorrhoids.—(By Elmore Palmer, M.D., Buffalo, N. Y., Ex-President of the Western New York Medical Society.)— Without any comment on the nature, causes, varieties or pathological conditions found existing in rectal ailments, I will transcribe from my records two cases of hemorrhoidal troubles that I have treated within the last two years with glyco-thymoline: Case 1. Mr. B. O. H., age 29, had been ailing several years with what he called piles. A careful examination revealed the follow ing condition: On the margin of the anus were three strangulated tumors about the size and color of a Concord grape. On contin ued pressure the tumors would empty themselves almost entirely but refill again in the course of an hour. Several similar tumors about the size of a pea were found just inside sphincter. Anal moisture and pruritus vere very troublesome, but singularly enough little pain was complained of. The bowels were somewhat constipated. Regulated the diet and secretions, gave an enema of two ounces of a fifty per cent solution of glyco-thymoline every night and morning quite warm, held in until absorbed, and applied gauze to anus on lamb's wool during the night and as much of the daytime as he could spare from his office. A decided improvement was noted in a week, and three weeks later he was cured. That was nearly two years ago and there has been no trouble since. Case 2. Mrs. R., consulted me regarding "bleeding piles," which had been gradually growing worse for three or four years. At every stool she would bleed two or three tablespoonfuls. She had become quite anemic. No external tumors. A corroding ulcer as large as a

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nickle was diagnosed just inside of the internal sphincter. Washed out the rectum three times a day at first with a warm solution of boric acid and then gave an enema of one ounce of glyco-thymoline full strength hot, held in until absorbed. After four doses only two enemas a day were used as no blood was passed. At the end of two weeks time a careful examination of the rectum showed it to be perfectly normal. She was cured. No return after eight months.

Suggestions in the Treatment of Diseases of the Respiratory Tract.—(J. F. T. Jenkins, Ph. G., M. S., M. D., Los Angeles, California.)— marked advanced in therapeutics has taken place in the last few years and many new remedies have been introduced which after careful clinical tests have been found to be vastly superior to former methods of treatment. A drug which has attracted considerable attention is the new morphine derivative heroin It has been brought before the profession for the purpose of allaying cough and to take the place of codeine as a more efficient substitute. Its action in relieving cough and dyspnea is much more prompt and decided, and the frequent deleterious after-effects of codeine and morphine-nausea, vomiting, headache, constipation, gastric pains, tinnitus, and visual hallucinationshave never been observed during its administration. Results are equally as good with children as with adults, and it has now taken a permanent place in the armamentarium of the physician. Some time after the introduction of heroin, while I was acting assistant surgeon in temporary command of the station for the United States Marine Hospital Service, I had a number of government patients, sailors of the merchant marine, at the Los Angeles Infirmary (Sister's Hospital) under my professional care. In one case of persistent cough, which was extremely distressing to the patient and harrassing to his friends, I tried everything I had heretofore used, without obtaining even partial relief. The then resident physician, Dr. M. M. Kannon, urged me to try a new combination of heroin with other drugs, known as glycoheroin (Smith), made by Martin H. Smith Company, of New York. Acting upon upon this suggestion, I gave a prescription for a few ounces of this preparation to be given in teaspoonful doses every for to six hours until relieved. The good effect was immediate and pronounced, and from that time to the present I have had positive results in relieving cough that I had failed to obtain in my previous experience of a quarter of a century in the active practice of the medical profession. Before giving it in the case mentioned I was inclined to be sceptical, notwithstanding the frequency of favorable reports in regard to it by respectable medical journals and leading professional men. I had tried without satisfactory results the usual mixtures, heroin comp.," of which there are so many without merit, failing entirely to accomplish all that heroin can shown to do in using the preparation indicated. To satisfy myself still further and to remove a doubt in my mind that this might be an exceptional case or a mere coincidence, I was induced to give it a trial in a series of selected cases of a similar character. The result was so satisfactory that I feel constrained to add my testimony to that of others. Glyco-Heroin (Smith) is a true solution of heroin in glycerine; each teaspoonful represents one-sixteenth of a grain of heroin, with ammonium hypophosphite, hyoscyamus, white pine bark, balsam of tolu, with glycerine and aromatics. A glance at this formula shows a happy selecticn of drugs adding to the palliative effect of the heroin and each possessing decided curative properties of its own. It gives the physician an elegant pharmaceutical preparation, strictly ethical in character, a trial of which will satisfy him that it excels any single drug or combination of drugs in the materia medica. Limitation of space prevents an exhaustive consideration of the individual therapeutic virtues of the ingredients mentioned. With the exception of heroin, all are so well known that a very minute detail of their virtues is not necessary. It is important, however, to notice that the value of each seems to be increased tenfold, and the special sedative action intensified in the uniformly exact proportions adhered to by Martin H. Smith Company in its manufacture. So much for heroin, with a great deal left unsaid which might be justly stated in its favor. The ammonia hypophosphite and hyoscyamus each speak for itself. The peculiar virtues of white pine bark in checking night sweats and in allaying all inflammatory conditions of the bronchial mucous membrare, need only to be mentioned to be appreciated. That pleasant and palatable aromatic stimulant, balsam of tolu, together with glycerine, completes the prescription known as glyco-heroin (Smith), now so well established by the evidence of experience.

The striking and surprisingly good results so uniformly obtained in the administration of this remedy can be fully verified by an unprejudiced trial in which it is tested. Such a trial may be made without hesitation, for notwithstanding its therapeutic advantages it possesses the virtue of absolute harmlessness. When physicians of the professional standing of Francis W. Campbell, M. A., M.D., D.C.L., L.R.C.P., London, Dean and Professor of Medicine, University of Bishop's College, Montreal and Dr. J. Leffingwell Hatch,late Professor of Laryngology in the New York Clinical School of Medicine, Pathologist to the Philadelphia Hospital and formerly Sanitary Inspector in the Marine Hospital Service, give this preparation their unqualified endorsement, their opinions founded on the actual treatment of a large number of cases, it is apparent that these positive, unlimited, and clear results must gain for this remedy a still fuller recognition, and lead ultimately to its universal acknowledgement as the best remedy of its class for the purposes indicated in these reports and in clinical reports of prominent medical men in England and her colonies, in addition to the favorable testimony of many American physicians from Canada to Mexico and from Maine to California.

Vol. XXX


No. 12

Papers for the original department must be contributed ex- above a whisper. At my examination I clusively to this magazine, and should be in hand at least one month in advance. French and German articles will be trans- noted stridor in breathing, hoarse cough, lated free of charge, if accepted. A liberal number of extra copies will be furnished authors, and

apbonia, and slight temperature elevation. reprints may be obtained at cost, if request accompanies the With the laryngoscope, the obstruction was proof.

Engravings from photographs or pon drawings will be fur- easily recognized lodged between tbe true and nished when necessary to elucidate the text. Rejected manu

false vocal cords, and extending transversely soript will be returned if stamps are enclosed for this purpose.

across the glottis. After the use of a spray COLLABORATORS. ALBERT ABRAMS. M. D., San Francisco.

containing cocaine, several attempts were M. V. BALL, M. D., Warren, Pa.

made at extraction with forceps, but without FRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.

success. A long bent probe was then hooked C. G. CHADDOCK, M. D., St. Louis, Mo.

from behind forward under the obstruction, B. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, M. D., Chicago.

and by sudden traction, it was readily N. 8. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Iu.

brought up into the mouth, and thence exFRANK R. FRY, M. D., St. Louis. Mr. REGINALD HARRISON, London, England.

tracted by the patient. The boy returned to RICHARD T. HEWLETT, M. D., London, England. his home the same day, and a later report J. N. HALL, M. D., Donvor. HOBART A. HARE, M. D., Philadelphia.

from his family physician stated complete CHARLES JEWETT, M. D., Brooklyn. THOMAS LINN, M. D., Nice, France.

voice recovery in five to six days. The piece FRANKLIN H. MARTIN, M. D., Chicago.

of wood measured 15 millimeters in length E. E. MONTGOMERY, M. D., Philadelphia.

and 9 millimeters in width.
NICHOLAS SENN, M. D., Chicago.
EDWIN WALKER, M. D., Evansville, Ind.

CASE II. – Agnes, the eight-year-old
H. M. WHELPLEY, M, D., St. Louis.

daughter of Mr. A. E., of Owensville, IndiWM. H. WILDER, M. D., Chicago, IU.

ana, while at school October 11th, 1904, and

eating an apple during recess, bit off a large LEADING ARTICLES

piece which in hurriedly attempting to swal

low found its way into the wind-pipe. FOREIGN BODIES IN THE LARYNX AND

Alarming symptoms of suffocation at once TRACHEO-BRONCHIAL TRACT.*

followed, and Dr. M. Montgomery was immediately sent for. By the time the doctor

reached the patient the suffocative attack in L. D. BROSE, M, D., PH. D.

a measure had been recovered from. Acting upon the advice of the physician the obild

was brought to my office by its father. With The entrance of a foreign body into the air passage, is an exceedingly grave acoident

the laryngoscope, the piece of apple was

readily seen lodged in the upper part of the and usually productive of a symptomatology,

trachea, just below the true vocal cords. It distressing to the patient and highly alarm

was deemed inadvisable to attempt its reing to his family. I cannot better enter

moval by instruments introduced through the upon this subject than through the relation of the three following cases, two of them

mouth, for fear of its becoming displaced and

perhaps lodging deeper in the air passage illustrating the gratifying result of successful operative interference, the other an

and causing death ere the trachea could be un

opened externally, so the child was sent to St. successful operative interference with subse

Mary's Hospital, where with the assistance of quent coughing up of the foreign particle,

Dr. P. Y. McCoy, preliminary tracheotomy after the patient had been dismissed from

was made, a tube inserted and the patient retreatment:

turned to its bed without making an attempt CASE I.--J. F. W., aged eleven years, was

at removing the obstruction until the follow. sent to me June 21st by Dr. E. G. Luke- ing day, when chloroform was again adminis. meyer, of Huntingburg, Indiana. The his- tered through the tracheotomy tube, and then tory obtained, was that wbile whittling a by use of a probe passed from below upwards, trigger on a piece of wood four days previ- it was sought to bring the particle of apple ous, the severed partiole of wood was drawn into the pharynx. Not succeeding in this, a into the wind-pipe, calling forth a severe at. small intubation tube was passed from above taok of strangulation. After regaining his

in the usual way, and the portion of apple breath he found himself unable to speak

pushed down and removed through the

opened trachea. The external wouud was at • Read before the Ohio Valley Medical Association, November 15, 1906.

once closed by four deep interrupted sutures,


and the patient made a rapid recovery, not. time or another found entrance into the withstanding a tedious tracheotomy, due to its larynx, are too numerous to mention, and being performed at night with the child in a general way may be classed under both struggling violently against the anestbetic, solids and liquids. The latter, such as and becoming early semi-asphyxiated, 60 blood, or pus evacuated through bursting of that it had to be placed in a sitting post. & peritonsillar abscess, will not be farther ure, partially revived and the wind-pipe

and the wind-pipe considered, since the fluid is either coughed opened with the trachea violently rising out or produces death before the arrival of and falling with each respiratory act. The the medical practitioner. Foreign bodies piece of apple removed was nine-sixteenths may enter the air passages through the nose of an inch long and five-sixteenths of an and mouth, from the stomach during vomit. inch wide, of firm and solid consistency. ing, or through wounds or fistulous opening

in the neck, chest wall, or bronchial tract. CASE III.—The five.year-old daughter of In most cases, however, the accident occurs Mr. H. J. was brought to my office January during unconscious, thoughtless, surprised 23, 1906, by Dr. W. G. Hopkins, of Fi. or frightened forcible inspiratory effort, in Bianch, Indiana, with the statement that on conjunction with a reflex swallowing impulse. the previous afternoon while playing with Loss of sensibility of the laryngeal mucous a bean in the mouth, she had a sudden at. membrane, wbich attends bulbar and diph. tack of violent coughing and strangling. theritic paralysis, favors the entrance of After a time, the breathing became easier foreign bodies into the laryox. a ,

Foreign and as soon as the child was able to talk bodies in the air tract are much more freit informed the mother that it had swal- quently met with during child life, than dur. lowed a bean. An examination of the ing adult life. The symptoms that follow larynx with a throat mirror proved negative. depend somewhat on the size, consistency, It was noted by inspection that the breath. shape and place of arrest of the body, and ing was labored, and upon auscultation dry may be designated primary and those which sonorous rales were beard with very feeble develop subsequently. Of the former reflex respiratory murmur over the right lung. cough and spasm of the larynx are at once Vesicular murmur clearly heard over the left manifested. The spasmi may be severe and lung, and the normal pulmonary area, either cause death in a few moments or pass off and side of the chest, was without dulness any- be succeeded by hoarseness dry oough and where upon percussion. Patient was sent to pain. Excitement and distressed feeling is St. Mary's Hospital, where an examination shown save when the acoident occurs dur. of the thorax by the Roentgen ray was made, ing the unconscious state or when the but the foreign body was not detected. Never. person is deeply intoxicated. Small round theless, it was decided to attempt recovery of bodies may lodge in one of the ventricles of the bean through an external opening in the the larynx and occassion very mild or no tranbea, and with Dr. J. N. Jerome adminis. symptoms. Should the body be of large size tering the anesthetic, a low tracheotomy was and sufficiently occlude the air passage un. made, but all our efforts at extraction or ex- less speedy relief is given death early occurs. pulsion with instruments, or through ever- Sharp or pointed bodies may perforate the bion and succussion of the body, failed to re- walls of the air tube and then injure an im. cover it. The tracheal incision was stitched portant blood vessel and through hemorrhage to the skin, and on the two succeeding days occasion death. After a time the parts acrenewed attempts were made to recover the quire more or less tolerance for the foreign bean, but resulted in failure. Purulent bron body and the primary symptoms in part or chitis, fever, with circumscribed pneumonic wholly subside.

wholly subside. Where the foreign body reconsolidation ensued, and only the use of by- mains movable and alters its position with podermio injections of strychnia, apparently the respiratory act or the body suffocative on several occasions sufficed to keep the attacks are apt to recur at irregular intervals. child alive. February 5th, at the earnest The subsequent symptoms are largely of an solicitation of the parents, permission was inflammatory nature laryngo-bronchitis degranted to remove the patient to their home veloping with fever expectoration of blood or in a neighboring county. The purulent pus, fetor of the breath perichondritis, pleurbronchitis and expectoration continued, with isy, pneumonia, abscess formation and gan. remiseions and exacerbations, until some grene. Pulmonary emphysema may result two months later during a violent parox. through bronchial obstinction and inability ysm of coughing, the bean was expelled by to expel confine air when coughing. the mouth, after which gradual recovery en- Diagnosis-This is easy when we get a sued.

clear history of the disappearance in the The various substances that have at one air passage of a foreign body, followed by a sudden attack of oboking and cough. Treatment may be designated emergency, This, however, is not always obtainable, since or that directed toward saving life during imthe patient may be too young, insane, or his pending suffocation, and for this purpose im. statements unreliable, in case of intoxication. mediate tracheotomy is oftenest done, and Physical examination is valuable not alone measures undertaken for the purpose of exfor diagnosis, but in locating the position of pelling or extracting the foreign body. Exthe obstruction. By simple inspection with pectant treatment may be elective from the a strong light and the tongue depressor, the first, when the body is of small size, of extreme upper part of the larynx may be smooth surface, and harbored in a bronchus seen. Exploration with the finger or sound, with a possibility of sponaneous expulsion, may detect a hidden body, or one that was or from necessity after unsuccessful operative overlooked by other methods of examination. measure for its recovery. From the larynx The laryngoscope is of the greatest value, for our first attempt at extraction as a rule, witbit the interior of the larynx and trachea, should be made through the mouth with book and even part of the bronchial tract may be or forceps, after local anesthesia and under inspected. Unfortunately, just in the child, guidance of the laryngoscopic mirror. It may where we need it most, we encounter diffioul. happen that the body is impacted between ties in the use of the instrument, such as. the cords, or so embedded that its removal uncontrollableness and gagging, that robit from above is not feasible, in which case the often of most of its value. Profuse secretion knowledge derived through the throat mirror may so hide a semi-transparent body, as to may still materially assist us in the choice of make its detection with the laryngeal mirror external operative procedure. Inversion and difficult or impossible. When the patient succusion of the body may be employed, but is unruly and will not bold, a general anes- it is well always to prepare first for emergency thetic may be employed, and after uncon- opening of the wind pipe, since a partial ob. sciousness the mouth gag is inserted, the struction of the air tract may by these means tongue drawn forward with forceps, and the be suddenly converted into a more or less throat mirror introduced. An everbanging complete one through the offending substance epiglottis may be lifted with a slender book. altering its position. I have never seen the The recognition through auscultation of di. least good result

from the employment of minished respiratory murmur in the lower emetics. The Killian bronchoscope, is a lobe of the right or left lung, following upon useful instrument not only for the deteotion a history of foreign body in the air passages, of deep-seated foreign bodies, but likewise is strong evidence of obstruction in the cor. for their removal through the natural pasresponding bronchus, and according to sta. sages or through the trachea after an inferior tistics and for anatomical reasons, the lodg. tracheotomy. The acquisition of the necessment happens oftenest right-sided. When the ary skill for the successful use of the long obstructing body is movable, and changes its bronobioscope requires practice and patience position with the respiratory act, or upon and hence the superior operation must remain coughing, auscultation will almost certainly a procedure best executed by the specialist. deteot either a whistling sound, or flapping The inferior operation or that through the noise, or change in the area of diminished opened trachea is much easier of accomplishrespiratory murmur; should the offending ment and in children under six years of age body be of solid consistency and of some size, because of the smallness of the air tract it is the X-ray may be used in its detection and the procedure of election and in lieu of a more localization.

suitable instrument the ordinary oystoscope Prognosis is always doubtful so long as the may be employed. foreign body has not been expelled, and even During a visit to Professor Killian's clinic after expulsion death may still oocur in cases in Freiburg, Germany the past summer, I where grave secondary lesions have been set had an objeot lesson of the need of the anesup. The larger the body and the greater the thetic being in the hands of a skilled anesobstruction, the greater the danger from as- thetizer. The patient in question was one phyxia. Lodgment in a bronchus, offers a where I had been entrusted with the pulse, graver prognosis than when the offending and wbere sudden respiratory failure and col. body is arrested in the larynx. Also in the lapse oocurred during the midst of the operachild, our prognosis is more unfavorable than tion, and only the most active efforts at rein the adult, not only because operative in. suscitation saved the life of the patient. terference is undertaken with greater diffi. Whether superior or inferior tracheotomy, culty, but also because of the smaller size laryngotomy, or pharyngotomy is to be perof the lumen to be obstructed and the formed will depend upon the size, shape, nagreater liability to suffocation by spasmodic ture and position of the substance to be excontraction.

tracted, and after careful study and deduction

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