THE CINCINNAT1 Tancet-Clinic A Weekly Journal of Medicine and Surgery. ESSENCE OF PEPSINE (FAIRCHILD) Ingredient of the GASTRIC JUICE. Extracted Directly from the Peptic Glands of the Stomach. of the Essential Organic A VALUABLE AGENT. APOLLINARIS, "The Queen of Table Waters." "Light, sparkling, and easy of digestion." FORDYCE BARKER, M.D., Professor of Clinical Midwifery and Diseases of Women in Bellevue Hospital Medical College: Surgeon of the New York State Woman's Hospital, New York, etc. "Can recommend it in the strongest terms." Professor of Orthopedic Surgery in Bellevue Hospital Medical Healthful as well as agreeable." "Well suited for Dyspeptics." AUSTIN FLINT, M.D., Professor of the Principles and Practice of Medicine and Clinical Medierne in Bellevue Hospital Medical College; Visiting Physician to Bellevue Hospital, New York, etc. "Every case of TYPHOID FEVER is a case of WATER POISONING. This is a useful item for the public to keep in mind." N. Y. MEDICAL RECORD., January 9th, 1892. "THE PURITY OF APOLLINARIS OFFERS THE BEST SECURITY AGAINST THE DANGERS WHICH ARE COMMON TO MOST OF THE ORDINARY DRINKING WATERS." LONDON MEDICAL RECORD.,, From In Essential to the Perfect Pill. rom Time Immemorial up to the day when advanced pharmacy gave us improved preparations, physicians complained of the imperfect nature of their medicaments. "To-day inert and to-morrow toxic," said an eminent therapeutist, "how are we to depend upon these drugs when promptness and certainty of action are pre-requisite?" The speaker referred to inexact preparations, made without testing their strength and soundness. in Previous Notes we have characterized, as follows, the requisites of a wellmade pill: PURITY of medicaments and excipients. PRECISION as to weight and division. PERFECT UNIFORMITY as to activity and identity. PERMANENCE as to conservation. PALATABILITY; and ELEGANCE of appearance. Perfect Uniformity as to activity and identity is largely dependent upon the two points in the above list-purity and precision—which immediately precede our present theme, and to them we have referred in other notices. Purity aids in securing uniformity as to activity, for unsound materials are subject to progressive chemical changes which give rise to wide variations in strength. Uniformity as to weight is to be obtained only by using the greatest care in mixing and dividing the pill mass. Stability is so important a factor, not only in securing uniformity, but for still more obvious reasons, that we will refer to it in a future note. Meanw eanwhile we ask attention to the following preparations, which, with many others in our list, will be found to realize the conditions we have described. Among the pills here cited are some useful preparations for this season: PIL. QUINIÆ, Ferri et Zinci VAL- PIL. TINCT. WARBURGI, "W. H.S. ERIANAT, "W. H. S. & Co." PIL. PHENACETINE ET CAFFIE CIT- Prescribed in all forms of Nervous Headache. Prescribed in the Dermatoses. It has been successfully used in Eczema, Acne, Furn culus, etc., is highly beneficial in Psoriasis. (Pills of 1-100 gr., 1-50 gr. and 1-30 gr.) W. H. Schieffelin & Co., New York. THE the investigation of the cause of the trouble; we must carefully study the general condition of the patient, and endeavor to recognize the pathological condition of any organ which may prohibit the use of drugs that might seem to be rationally indicated. Of course, A Paper read before the Academy of Medicine, every chronic case of disease must have May 24, 1892, BY JAMES M. FRENCH, M.D., CINCINNATI. I wish to lay before the Academy this evening an analysis of the successful treatment of three cases of chronic sciatic neuralgia, and I think that this may be more interesting than a dissertation on sciatic neuralgia in its acute stage, because we have all of us, most likely, met with acute cases that have terminated favorably, though perhaps the treatments employed may differ widely. I have met with such cases, and have come to the conclusion that they would frequently get well if the only medicine administered was sugar of milk; nature herself, aided by rest, expelling the poisons that give rise to the pain from the system. In several such cases I have found that the patients had a fondness for gratifying their palates at the expense of prudence, with articles of diet made tempting by the cook's art, but which were of small nutritive power, and were doubly undesirable, because they stimulated the appetite to an extent beyond the proportionate powers of the digestive apparatus. There is small art or science required in the treatment of this variety of neuralgia, but when we find a pain that is almost always present in varying intensity, and which is not attributable to any such hurtful selfgratification, we must, go further in its origin, except, indeed, it be congenital, and have not been remedied by developmental changes, in which case. we may say that the patient could never be looked upon as physically perfect at any time; he is a degenerate specimen of humanity. But to come to the subject under consideration: I have reason to think that most cases of neuralgia of a chronic variety originated in a pain which was not of that severe character which demands relief, or else, as it is sometimes said, our patients will go frantic; but rather was bearable without any great effort, although it made one conscious of its presence continually, gradually increasing in severity, and, developing in almost every case a paroxysmal character, it finally compels the sufferer to seek relief, however unwilling he may be to take medicine and to pay doctors' bills. Such cases are generally by no means easy of cure, and the recovery is usually notably slow, its tediousness being usually proportionate to length of time that has elapsed from its commencement until the beginning of treatment. The anatomy of the nerves themselves is almost wholly of physiological importance; we must necessarily encounter them in general dissection, and of course we must, to practice medicine intelligently, know where to look for any nerve that is usually found in the economy; but their regional anatomy is not of that character that invites the They attention of the busy general practi- | due to an overtaxing of the mental tioner so readily in the arteries, muscles powers, I may mention a case that I and bones, because a traumatism of any once saw of the most distressing and nerve usually involves some of the inveterate character, where the globes structures I have just enumerated. So of the eyes and the orbital regions were that I will not deal with the description involved. It occurred in a young girl of the anatomy of the nerves, but pass of about nineteen, and was due to on to the consideration of the general hereditary syphilis. We sent the case pathology of the cases I am about to early on to Mr. Jonathan Hutchinson, quote, first glancing at the etiology of who gave quite a grave prognosis, neuralgia-that is, its cause. although he tried a remedy. The girl was then employed as a domestic in a family who made some exactions upon her in regard to her manners and personal appearance, and then she suffered quite frequently and severely. were very kind to her, but after a time she left them, saying that she needed rest; she went home to her people, and seemed to be quite content to remain in a state of poverty and obscurity, being well satisfied with the poor remuneration she gained by picking hops and such simple employment. She seemed literally to be of such feeble physical and cerebral calibre as to be capable only of the lowest order of productive exertion. On her return to this sphere of life her neuralgia disappeared. This condition may be the cause of chronic neuralgia in a young person, and also in those who are in the decline of power caused by advancing years. It is only of value as regards prognosis. First of all, I should mention the possibility of mechanical irritation, either at the site of the pain or at a point remote from it; such might be caused by the pressure upon a nerve trunk of some foreign body retained beneath the integument, by an aneurism, by the growth caused by syphilis from the bony structure, by an indurated gland, painless in itself but pressing upon a nerve in its vicinity, or by an intra-cranial tumor or a gummatous product within the brain. A case has been put upon record in which a lady applied to a surgeon of eminence with a view to having a part of a nerve in her arm, I think, exsected; she had been referred to him by a provincial practitioner, who had tried to relieve her in vain. The surgeon removed the fragment of a splinter from over a knuckle of one hand; it had entered years before the lady remembering it perfectly, and had been almost wholly extracted, but a fragment had remained and caused all this severe pain. Only a week or two ago a man told me that he had removed from his leg a splinter of an inch length that had been there for some years without giving him any uneasiness, except when he pressed upon the spot, when it would prick him indistinctly; ultimately a very slight suppuration occurred, and he removed the splinter. So that the pressure of such an irritant beneath the integument without exciting a great amount of attention to itself may be quite possible. its most serio Assuming that anæmia causes neuralgia, one may ask, how does it cause it? I believe by lowering the blood pressure and causing a pathological condition in the sustaining and eliminative organs of the system. Anæmia causative of neuralgia is generally gradua: in its advance, and is usually due to sol me disease which may produce us results by the anæmia it induces. Al diseases that run a long or indefinite course, and some that run a rapid or definitecourse, induce anamia, and it in turn causes anatomical changes, which render r. the various parts of the body incapable, to a greater or less extent, of performing their func tions properly, adequately; I can not say perfectly, because ; perfectly After this I am inclined to think that in every case, except those due to a strain upon the mental faculties exceeding their capacity, neuralgia is due to anæmia caused by some circumstance healthy person in mind and body or element of disease. As to neuralgia always found. Some get on very | a is not Well by taking care of themselves, by hus- | tremens followed, and when he recovbanding their power and avoiding any ered from it and procured some employover-exertion, or if such must be made, ment that did not induce him to abuse by compensating for it as early and as beer, he became, like his brother, a man fully as possible. Yet, the man who of spare frame and symmetrical aspect. can do great deeds and yet remain Here the hypertrophy, sparing the more sound and well without displaying any important organs, had invaded the musof that cerebral irritability, or pecu- cles, the omentum, the subcutaneous liarity, so often concomitant with un- fat, the areolor tissue. The anæmia in usual achievements, is not of every-day this case was caused, of course, by the Occurrence. In this day, self-sacrifice, introduction into the system of materself-denial at the present for the benefit ials that formed in great abundance the of the future, has often to be practiced, uric acid and the urates-much more of and the body must often be subjugated them than could be eliminated through and subordinated to the intellect, by the proper channels-and when once which a reasonable and wholesome am- this condition was established it became bition can be gratified. The man of an integral part of his system, so that much and mighty strength is less sought it called for a replenishing of its volume, for than the man of quick wit and keen just as a healthy system calls for refreshenergy, of application and ready per- ment of a healthy and reasonable nature. ception. The man who is wise will always endeavor to preserve his health even though he has to sacrifice his wealth; but even though he strive ever so hard to do so he can not avoid certain imperfections which are the common lot of humanity. I return to the actual pathological effects of anæmia where it exists to such an extent as to be apparent, either through the sufferings of the patient, to himself, or when some slight, obscure symptom brings it before the practiced observation of the physician. They are: first, hypertrophy of some, rarely, if ever, of all the parts of the economy; this, if it be followed to the end, is succeeded by atrophy, or fatty degeneration, supposing the condition is not altered by judicious assistance. In a rapidly progressive anæmia, such as may be caused by acute malaria, the liver and spleen are most notably affected, and if they be so involved as to be rendered inoperative, of course a fatal result quickly ensues. In an anæ mia of slow progress they may be only slightly involved, the hypertrophy manifesting itself in other parts of the economy of less vital importance. As an instance of the latter type, I may cite the case of a man whom I treated for a crushed hand; he worked in a brew He was at that time a bloated nan of immense girth of arm, of thigh, and of abdomen. A severe delirium In the three cases I am about to relate I acted upon the theory that anæmia underlay the symptoms, both objective and subjective. Its progress was quite gradual, and did not appear to have affected any one organ in particular, although, of course, the most prominent symptom was the neuralgic pain, indicating disturbance in the nerve centers, from which the sciatic nerve drew its force. In such a case we may look closely into the patient's general condition, and treat a fellow-mortal and not a disease, and endeavor to ascertain the cause of the anæmia. In all of these the heart, liver, and the digestive tract seemed clearly to be involved. Of course, the heart derives its nourishment from the blood supplied to it by the coronary arteries, and is influenced by the altered condition of the blood in every case of anæmia. While in none of these cases was any symptom of discomfort of the heart expressed, yet I found evidences of irritation and of unsatisfactory, quickened action; let me say that it did not strike the chest wall with sufficient force, and it was easily excited and hurried in its movements. The rapid heart of course means the poorly nourished heart, one reason for it being that the venous blood is not assisted in its expulsion by the complete twisting and contracting movement that should be. Here we see the commencement of hypertrophy of |