ers.

MEDICAL MISCELLANY

THE "VENAL" MEDICAL PRESS. What is all this ado about the sinfulness of publishing advertisements of proprietary medicines? My Faith! to read the late issue of the California State Medical Journal one would think the medical editors were nothing but a pack of mercenary knaves. It is "venal" we are and "subsidized," sunk, indeed, in the lowest depths. And the J. A. M. A., too, has been pounding along in the same lines and roundly denouncing all prescribers of those nefarious concoctions. But mark you, the smell of fire is pretty strong on their own garments, for their advertising pages tell their own tale. Proprietary medicines, which no doubt are very good, are there advertised and their formulae, too, are given, but in a more or less indefinite way, a way that would be confusing to a compounder and certainly so to the majority of prescribThe publishing of these formulae makes the articles none the less proprietary nor does it detract from or add to their efficacy and, if there be a sin in publishing these advertisements, we fail to see how the giving of these quite indefinite formulae removes the curse. But, according to this pricker of consciences and rattler of dry bones it is sinful, it is "venal" to publish these advertisements. Further, by pursuing our "venal" ways we are upholding the Arch Enemy in his works to undoing and the lasting disgrace of the profession. Perhaps we are, but we can not believe the men who give character to the majority of the medical journals of this country, Canada and Great Britain are "venal," are "subsidized" and debauched by the manufacturers of proprietary medicines. We do not believe that the California State Journal really means what it says or is mortifying itself to any great extent for its own sins. Neither do we believe that it is wrong to carry advertisements of these articles of merit, for, such many of them are; nor do we consider it an unpardonable sin to prescribe a proprietary remedy when it will do what we want of it, and is more convenient and palatable than anything we could have compounded, prescribed we ever so beautifully. While we like the old drugs to which we have grown accustomed to, there are times when the newer preparations, even though proprietary, are as a haven of refuge, "a rock in a thirsty land." It is then we have prescribed them, have gotten desired results and have felt grateful to the journal whose pages informed us of the remedy. Yes, we have prescribed proprietary medicines and expect that we may do likewise in the future, that too, with a clean conscience and, "Tell it not in Gath," we have even prescribed "peptomangan" and gotten results when the tincture of the chloride of iron could not be tolerated, useful as that time-honored remedy is and, worse, if possible, we have given "Fig Syrup" to babies and nervous women when officinal preparations for one reason or another have not given satisfaction. We do not believe in habitually prescribing proprietary remedies, as it encourages slip shod methods of thinking and prescribing just as surely as does the prescribing or dispensing of ready-made tablets or mixtures, excellent though they may be, but there are times when they "fill the bill" to a nicety and it is then we believe it our duty to the patient to prescribe them. This we know will bring down disapproval from many and honest disapproval, too, from some, but it will all be honest or do people forget their shortcomings? It is not very long ago that we listened to a paper by a distinguished gentleman anent the subject of proprietary preparations. In this, he took occasion to roundly denounce all physicians by inference who would prescribe, for example, any preparation in a long list which he read. We were, as he proceeded down the line, feeling very small indeed, for we had been guilty, until a certain preparation was mentioned, then our spirits rose, we were sure he did not mean all he said or else he had suddenly reformed, for it was only a short time previous that we had the privilege of reading a prescription written by the essayist which called for this same preparation. The gentleman had honestly prescribed this

preparation and the patient averred that it had greatly benefited him, why, then, should he have been so sweeping in his condemnation unless he had forgotten? And why should our western brother be so unmerciful and uncharitable when he himself is likewise at fault if fault there be? We are free to confess that these sweeping charges of "venality" and "subsidization" sound very strangely in our ears, we fail to grasp their full import. We have thought no evil and can not believe that such evil exists. We believe in publishing good, clean advertisements even though proprietary; we do so with good conscience, not knowing that we are "venal" by so doing and knowing we are not "subsidized."-Milwaukee Medical Journal.

SURGICAL SUGGESTIONS

(American Journal of Surgery)

Before excluding glycosuria examine both morning and evening specimens of the urine.

When operating upon the ureter for calculus or stricture, avoid undue manipulation; it is important to prevent detachment of the ureter from its bed if possible.

Attacks of abdominal pain associated only with intestinal symptoms, may nevertheless be due to a renal or urethral calculus, even though, in addition, a tender area may be palpated at a point more or less remote from the kidney regions.

In a very acid urine red blood cells may be disintegrated and appear under the microscope as an amorphous material. When it is important to determine the presence or absence of blood in the urine it is sometimes necessary, therefore, to resort to a chemical test, e.g., that with guaiac resin.

A radiographic shadow simulating that of a urinary calculus may be produced by an atheromatous plaque, as, for example, in the internal iliac artery, by a phlebolith, or by a calcareous gland.

If a cystic swelling in the scrotum is opaque when examined by the well-known transillumination test, especially if a history of traumatism is elicited, it may still be a hydrocele. Admixture of blood in the hydrocele destroys its translucency.

Subiodide of bismuth promptly stops the bleeding. growth of epithelium.

dusted on an oozing granulating wound It is also an excellent stimulant to the

Collodion, commonly used to seal a puncture wound, as after aspiration, will not adhere if the spot is wet or bleeding. To obviate this, pinch up the skin, wipe it dry, apply the collodion and continue the compression or so until the collodion has begun to contract.

Enlargement of the veins at the sides of the abdomen is indicative of obstruction to the flow of blood in the inferior vena cava; distension of veins about the umbilicus suggests obstruction in the portal circulation. The former may be associated with varices of the lower extremities, the latter with hemorrhoids.

If the cause of pain in the feet is not otherwise clear, examine them in the dependent position. This may develop the presence of erythromelalgia.

The twisting of the pedicle of a small ovarian cyst may simulate both the symptoms and the signs of attacks of appendicitis.

Severe and repeated headaches may be due to the unsuspected presence of otitis media, with or without mastoiditis.

MEDICAL MEMORANDA.

For Sale.-First-class surgical chair and fine improved nebulizer. Both will be sold cheap if taken at once. Address" Removed," care Medical Fortnightly, St. Louis, Mo.

I prescribe resinol ointment almost daily, and will say that it is the finest preparation for what it is intended. I have used it in my practice of twenty-one years Seven years general.and fourteen years eye, ear, nose and throat practice. I assure you that I shall continue using it as nothing yet can fill its place, and am always sure of results.-G. A. Weirick, M.D., Hastings, Neb.

Treatment of Cervical Catarrh.-Under this heading, the St. Louis Medical Era of July, publishes the following editorial of interest: "Very many of the inflammatory attacks of the os and cervix are due to neglect of personal hygiene, and violation of the laws of health. Deranged functions of organs gradually induce morbid conditions in those parts which are the most vulnerable and the most abused. Constipation, deranged nutrition, neurotic vagaries, and irregular blood supply with abdominal and pelvic congestions, constitute a group of pathological conditions which will rarely fail to provoke womb disease. I believe we as physicians are too apt to view diseases in the abstract. A female complains of a leucorrheal discharge. We introduce the speculum and discover a cervical catarrh, and address our attention to that special lesion without sufficient regard to the disordered life which caused it. Abatement and cure of a local disease depend more upon the conduct of the patient than the use of special remedies. By giving a patient rest, restoring normal healthy action to deranged organs, and keeping the cervical and vaginal canal in an aseptic condition, a complicated case becomes a simple case in which a mild topical treatment will complete the cure. The treatment which I find most successful is first to get the general mechanism in good shape, keep the patient quiet, especially her genital organs. Prescribe what she shall eat and drink. Keep her bowels open with mild laxatives. Give her an antiseptic alkaline douche consisting of one part of glycothymoline to two parts of warm water, then apply tinct. of iodine to the os and cervical canal, if the discharge is purulent. A few hours later apply to the os a tampon of cotton wool saturated with one part of glyco-thymoline to two parts of glycerine. In twelve hours this tampon is removed and the above douche is repeated morning and night. Twice a week, as long as the discharge lasts, apply the iodine and follow with the tampon. This treatment usually affects a cure in a short timc. Of course, conditions may arise which would require some change in the details of treatment, but as a general rule harsh procedures should be avoided."

"Sheet Anchor."-In neurosine we offer no herbs or drugs of doubtful utility, but we present in permanent and palatable form an elegant and efficient combination of well-known and long-tried remedies, concerning whose virtues in the diseases and conditions indicated there is absolute unanimity of expression among all observers and authors upon the subject.

FORMULA OF NEUROSINE-Each fluid-drachm represents five grains of the C. P. bromides of potassium, sodium and ammonium: one-eighth grain bromide of zinc; one-sixtyfourth grain of pure extracts belladonna, honbane and cannabis indica; four grains extract lupuli; five minims fluid extract cascara sagrada, with aromatic elixirs. EPILEPSY.-Since Brown-Sequard formulated his celebrated mixture of the bromides they have everywhere been regarded as the "sheet anchor" in the treatment of epilepsy, and whatever progress has been made has only been in the line of additions to these efficient remedies. Hammond ("Diseases of the Nervous System") says: "The treatment of epilepsy rests solely on experience. Among medical remedies the bromides stand pre-eminent and should be thoroughly tried in every case." He adds: "Herpin, several years ago, called attention to the salts of zinc in the treatment of epilepsy. I have used the lactate, and still more recently, the bromide, with very definitely beneficial results" (pages 714-716). Lauder Brunton says of the bromide of potassium: "It is especially beneficial in epilepsy and by its use the convulsions can almost always be lessened if not entirely stopped" (Therapeutics, etc., p. 531). Allen McLane Hamilton says in the treatment of epilepsy: "No general remedies have been of so much service as the bromides, especially those of sodium, ammonium and potassium, and since their introduction, about twenty years ago, the number of cures have greatly increased and the prognosis improved, as our knowledge, derived from experimental therapeutics has broadened" (Reference Hand-Book, Vol: II, p. 708). The literature upon this subject is so vast that volumes might be filled with quotations from standard authorities only, but our desire is to make the briefest reference to these with a view of calling attention to our neurosine, an elegant preparation of the usual bromides, together with bromides of zinc and the pure and reliable extracts of cannabis indica and belladonna. Since Trousseau announced the great efficacy of belladonna in the "Petit Mal"" it has held high rank as a valuable addition to the bromides. Of cannabis indica it is well said, "In morbid states of the system it has been found to cause sleep, allay spasms, compose nervous disquietude and relieve pain. In this respect it resembles opium, but it differs from that narcotic, in not diminishing the appetite, checking the secretions, or constipating the bowels" (U. S. Disp., p. 351).

Cystogen-Lithia Tablets.-This effervescent tablet is of interest to physicians as it affords the means of employing the uric acid solvent and genito-urinary antiseptic properties of cystogen augumented by the alkaline and solvent action of the lithia salt. The value possessed by the salts of lithia as uric acid solvent, diuretic and ant-acid are available in this preparation. It is a most happy combination, displaying all of the desirable effects of both cystogen and lithia. The effervescence brings about a quick solution in water, producing a perfectly tasteless solution. Water that is too cold retards the effervescence. It may therefore be conveniently taken at meal time in a glass of water. In cases where this method of administration is contra-indicated, it may be taken between meals, always dissolved in considerable water. Samples supplied to physicians on request to the Cystogen Chemical Company, St. Louis, Missouri.

The Role of Iron in the Nutritrive Process.—It is an established custom of physicians to administer iron whenever a patient with pale, waxy, or sallow complexion complains of extreme exhaustion, muscular feebleness, easily accelerated pulse, aphasia, anorexia and the several symptoms which constitute the characteristic issues of a qualitative or quantitative reduction of the corpuscular elements of the blood. Such symptoms are unerring indications of anemia, and iron is beyond dispute a cure for that disorder. But while the chief therapeutic property of iron is that of an anti-anemic, the subordinate, or collateral, effects of the drug are manifold, and are worthy of far more consideration than they usually receive. As a hemoglobin-contributor and multiplier of red blood corpuscles, iron wlll doubtless forever stand supreme, but its utility is by no means restricted to anemic conditions, for one of the chief effects of iron-one quite often lost sight of is its influence upon nutrition. The primary effect or iron is a stimulation of the blood supply. This results from invigoration of the blood vessels. As a consequence of a more active blood stream, the digestive capacity is increased and the nutritive processes are correspondingly improved. Subsequently, iron increases the amount of hemoglobin contained in the red corpuscles. This imported hemoglobin converts the systemic oxygen into ozone, and thus wise oxidation, upon which nutrition directly depends, is restored to its proper standard. It is impossible to emphasize the fact too strongly that it is necessary to do more than increase the appetite to correct nutritive disturbances. A voracious appetite does not necessarily imply an extensive appropriation of nutriment. On the contrary, it is commonly observed that individuals who eat ravenously suffer, the while, a progressive loss in physical weight and strength, even in the absence of all exertions that might account for such losses. And while it is obviously needful to relieve the existing anorexia in order to arrest a loss in weight, it is likewise essential that the capacity to properly digest food be fully restored before the nutritive processes can proceed in befitting order. The manner in which iron begets an increase in appetite has only recently been perfectly understood. The earlier observers entertained the belief that an increase in appetite resulted from the mechanical effect of iron, and that this mechanical effect never manifested itself unless the drug was administered in some acid form. Later investigators advanced the theory that this mechanical effect could be secured by rendering the drug either strongly acid or alkaline. Recent observations have completely disproved the accuracy of both of those theories by inviting our attention to the indisputable fact that a neutral preparation of iron will relieve anorexia with greater celerity than will either an acid or an alkaline one. From the information gained from these observations, we are impelled to admit that the increase in appetite attending the employment of iron is due solely to the increased oxidation induced by its entrance into the blood stream. Accepting this as being true, we can readily understand the manner in which iron exerts its happy effect upon the nutritive processes. The aforestated facts compel the admission that that preparation of iron which enters most rapidly into the blood stream is the one capable of producing the best results in all disturbances of nutrition. Acid preparations of iron diminish the alkalinity of the blood, thus depressing the distribution of nutriment, and alkaline preparations of the drug offend the mucous lining of the alimentary tract. For these reasons it is consistent with logic to extend preferment to that preparation of iron which is neutral in action. That preparation is the depto-mangan (Gude). Pepto-Mangan (Gude) is unquestionably the form of iron most closly resembling that which is native to the economy, and the striking affinity for it displayed by the circulating fluid causes us to concede that it possesses desirable attributes not common to any other preparation of the drug. Whence we take it that it is the precise form in which to administer iron when a correction of nutritive deficiences is the end to be achieved. In those condition of weakened digestive power where the function is unable properly to take care of the food supply; when to administer the ordinary forms of iron would be but to increase the digestive disturbance, pepto-mangan (Gude) may be prescribed without apprehension, as the preparation is tolerated by the weakest stomach. Being practically predigested, pepto-mangan is immediately absorbed by the mucous membrane and taken up by the blood without the necessity of the weakened function being called upon to prepare it for assimilation, and therefore the entire system, including the digestive function, is strengthened and reconstructed. As a nutrient tonic in digestive disorders pepto-mangan (Gude) has no equal.