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MEDICAL MEMORANDA.

Have used and prescribed resinol ointment and soap with very satisfactory results. Last case was one of eczema on face and shoulders, and of several years standing. The trouble has entirely disappeared with the use of one jar of ointment and one cake of soap.-Chas. Hubley, M. D., New York City.

Never Without Calcidin.—I have the highest regard and praise for calcium iodized —calcidin (Abbott) having in my own simple way no doubt saved the life of a child twenty months of age (one of twins)—croup complicated with congestion of lungs. The condition was grave: temperature 105.6; one convulsion after the other. The condition, as it was found, had been existing only six hours before my arrival. I ordered calcidin every ten minutes for two hours, then every thirty minutes with calomel, gr. 1-10, every thirty minutes; hot foot bath, in fact above hips; cold applica. tions to head and neck, I expected the child to die, so did the parents when they called me. I returned in six hours. Temperature 101.8 and breathing very good indeed. In one week the child was well. Two years before I had a case exactly like this one, I have particulars, and the child died eight hours after I saw her. I think I am safe in saying I was the means, with the aid of calcidin and Nature, in bringing back the life that was fast coming to a close. I shall always use it. I am never without the drug a minute.-Dr. Frank S. Myers, Youngstown, Ohio.

THE A B C OF COCA.
A stands for Andes, the mountains so high.
B for the breezes which blow through the sky;
C stands for Coca-both Co and the Ca-
D“Divine Plant"-it was named by Inca.
E is the earth 'neath the clouds, far below,
F for the forests near where the shrubs grow;
G the gray rocks over which the mule packs
Huge bundles of Coca done up in sacks.
I for the Indian, without food or drink,
Jogging, untired, 'round high mountain's brink.
K is for Koller, with drop in the eye,
Learning new uses for Coca to try.
M. Mariani first made Cuca wine.
Niemann's the chemist who found cocaine:
O for the ore, and some other things, too,
Plentifully found in the land of Peru.
Q is the Quichua Indian race,
Round as to limb but of angular face:
S for the strength of this plodding man, who
Travels all day with but Coca to chew.
U stands for you, if you will but admit
Vin Mariani has made a great hit,
Wine make with Coca--a tonic unique-
Xcellent both for the well and the weak.
You'll find it endorsed full fifty years through;
Zealously hold then, that found to be true.

- The Coca Leaf, September, 1905.

The Treatment of Cough.-Cough, regardless of its exciting cause, is a condition that every physician experiences more or less difficulty in relieving. While the agents designed for its relief are numberless, it is a matter of common knowledge that but few of them are of general utility for the reason that although they may be capable of effecting relief, and in doing so they either derange the stomach, induce constipation, or cause some other undesirable by-effect. The ideal cough cure must combine sedative and expectorant properties without exhibiting the slightest systemdepressant, gastric-disturbing, constipation-inducing or palate-offending action. Nor should it contain any ingredient the prolonged use of which would cause a drughabit. Then too, it must be of sufficient potency to produce the desired effect with the utmost promptness, for, in many instances the patient has indulged in self-drugging to a certain extent before consulting the physician; hence, it is directly to the interest of the practitioner to demonstrate his skill by immediately relieving the disturbing condition. It is now universally conceded that glyco-heroin (Smith) is the ideal cure for coughs of all varieties. This product embraces the most active sedatives and expectorant agents in the exact proportions in which they exhibit their greatest remedial potency. It matters not what the exciting cause may be, the effect of this preparation is always immediate, pronounced and extremely agreeable. The cough is almost instantly suppressed, the expulsion of the accumulated secretions is stimulated, respiration is rendered free and painless and the inflammation of the lining of the air-passages is speedily allayed by its use. Glyco-Heroin (Smith) may be administered for an indefinite length of time without any depreciation in its curative properties and without the induction of a drug-habit. It is of especial value in the treatment of pulmonary phthisis. It is pre-eminently superior to all preparations containing codeine or morphine.

Mucous Plaques : Prophylaxis and Treatment.-(By Edward H. Skinner, M. D.' Kansas City, Mo.) The proper care of the mouth is a matter of importance in the control of the secondary symptoms of oral syphilis, especially in view of the fact that the average leutic patient has all too little regard for any hygienic measures. In anticipation of the early onset of the secondary oral patches it should be the duty of the physician to instruct his patients as to the proper prophylactic measures to be · adopted that the severity of these symptoms may be ameliorated. The first thorough examination of the new leutic case should include the careful examination of the mouth and teeth. If we feel incompetent to judge of the conditions of the teeth we should refer the patient to the dentist. The roughened edge of a tooth, or an unfilled cavity, may serve as an irritant in establishing a mucous patch. The dentist will instruct the patient as to the proper care of the teeth. The cleaning of the teeth after meals, to avoid the accumulation of debris, should be impressively taught, We should also realize that the salivation may best be avoided by the attention to the condition of the teeth and gums. Anticipating the secondary symptoms we usu. ally attempt to promote the general health of the individual by tonics and bodily hygiene. We should also try to increase the cellular resistance of the buccal membrane by local measures. It may be well to consider means to this end at this time. Bartholow considers a number of drugs to be used locally. Hydrastis canadensis is recommended as a stimulant to mucous membranes. It also has a valuable astringent quality and promotes the salivary secretions. Hamamelis virginica is also valuable in advancing the prophylactic powers of the mucous membranes. Thymol and menthol have valuable properties, influencing fermentation and putrefaction, and also serving as antiseptics. They allay the sensibility of the mucous membranes and arrest the retraction of the gums. Boric acid has decided antiseptic and deodorant properties. This acid was an important factor in the original Lister antiseptic method. Being very mild, it may be used in varying strengths without danger. Glycerine has a beneficial effect on all mucous membranes, inasmuch as it dehydrates and soothes any tissues it may touch. Combinations of the above remedies may be made that will serve not only as valuable prophylactics, but also as curative agents in any inflammation of the mucous membrane. But we should remember that the application will avail little if the patient does not assist their action by the careful cleansing of the mouth and teeth at frequent intervals, not being afraid to use the greatest remedy of all-pure water. When once the mucous patch has asserted itself we should try to avoid the ulcerating and sloughing process that accompanies the oral syphilide. It is at this time that our prophylactic measures show their true worth. The mucous patch rarely spreads in the clean mouth. Foul secretions and decomposing food stuff favor the ulceration of the patches. The best local application for a patch is the silver nitrate pencil. One application a day will usually suffice. An antiseptic mouth-wash should be used by the patient about every three hours during the day. Among the various combinations on the market today one will find that katharmon offers advantages. The internal administration of mercury should be pushed. If we find that the patches persist in spite of the above treatment we should try a short regime of the iodides. Very frequently the stubbornness of the oral features of syphilis may be due to the mercury treatment. It is in these cases that the withdrawal of the metal and the substitution of the iodide, with the use of remedies to cure the ptyalitic symptoms, will afford relief.

Substitution in Medicine. In a recent case of death from poisoning, the druggist who gave the wrong medicine offered as an excuse that he had merely substi. tuted one article for another on the supposition that it was of equal strength and much cheaper. The prescriber, in testifying on the trial, stated that the practice was a very dangerous and very frequent one, and was apparently past remedy. While the latter may or may not be the case, it is quite certain that with many who claim to be reputable and competent pharmacists the practico of substitution is very common. The number of protests made from time to time in medical journals have reference to only a small percentage of offenders, inasmuch as the larger number of such do not happen to be discovered. The question of prevention, however, is a very serious one from every point of view. The physician, in his direct and responsible connection with the trustful patient is the one most concerned, although drug manufacturers also have a right to claim fair play regarding the guarauteed qualities of their products. With both parties it should be the real thing or nothing. From the business point of view it is a fraud on the producer, and, from the ethical view, a danger to the consumer. Both parties in the compact have thus a common cause against the middle-man who surreptitiously plays the part of thimble-rigger and steerer. The temptation to substitution is always strongest with the most expensive medicaments, and in the case of such as have a known quality of efficacy. An inferior, and oftentimes inert, article is almost invariably used when substitution is practiced. Thus the manufacturer and the prescriber are always placed in a false light with the patient, who expects certain promised results. Generally speaking, the physician is the one to suffer most, as his disappointed client is apt to leave him for another. How many lost patients can be accounted for in this way it would be difficult to imagine. The too trustful pbysician is in a very bad way between the prescribing druggist on the one hand and the ever-roady substitutor on tbe other. Must he be compelled to turn dispenser himself in sheer defense ? Certainly, in some cases, the crime has in tbis way met its penalty. But when we look about for a remedy against the evil we butt against the bulwark of general depravity and the impossibility of applying ordinary missionary efforts. The only thing is to discover and then to punish. The man who substitutes will do so again. He has no conscience to begin with and nothing, in fact, to which an appeal can be made. The whole question then parrows itself down to that of mutual trust and the dispensing of original unbroken packages.-Medical Record.

Vol. XXX

ST. LOUIS, NOVEMBER 26, 1906.

No. 10

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Papers for the original dopartment must be contributed ox- this proprietary remedy, and failing in this, olusively to this magasine, and should be in hand at loast ono month in advance. French and German articles will be trans I hope to interest others in investigating this lated free of charge, if accepted. A liberal number of extra copies will be furnishod authors, and

subject. Therefore, I will in this contribureprints may be obtained at cost, if request accompanies the tion succinctly summarize the results of my proof.

Engravings from photographs or pen drawings will be fur observations. The arrest of an asthmatio nished when necessary to elucidate the text. Rejected manusoript will be returned if stamps are enclosed for this purpose.

paroxysm by means of a nasal spray pos

sesses a distinot advantage over the inhala. COLLABORATORS. ALBERT ABRAMS. M. D., San Francisco.

tion of the smoke of various antispasmodic M. V. BALL, M. D., Warren, Pa.

agents. The inbalation of the latter per. FRANK BILLINGS, M. D., Chicago, nu. CHARLES W. BURR, M. D., Philadelphia.

mits of tbe entrance into the bronchial 0. G. CHADDOCK, M. D., St. Louis, Mo.

tree of adventitious substances which main. 8. SOLIS COHEN, M. D., Philadelphia, Pa. ARCHIBALD CHURCH, 'M. D., Chicago.

tain what I am pleased to call a “foreign N. 8. DAVIS, M. D., Chicago. ARTHUR R EDWARDS, M. D., Chicago, Ill.

body bronchitis." I bave seen many in. FRANK R. FRY, M. D., St. Louis..

tractable oases of bronchitis associated with
Mr. REGINALD HARRISON, London, England.
RICHARD T. HEWLETT, M. D., London, England. asthma which have evanesced after the dis-
J. N. HALL, M. D., Denver.
HOBART A. HARÉ, M. D., Philadelphia.

use of smoking antispasmodics, and it is CHARLES JEWETT, M. B., Brooklyn.

quite evident to me, that in many instances THOMAS LINN, M. D., Nice, France. FRANKLIN H. MARTIN, M. D., Chicago.

where bronohitis survived the oured asthma, E. E. MONTGOMERY, M. D., Philadelphia. NICHOLAS SENN, M. D., Chicago.

the former was originally provoked by the FERD C. VALENTINE, M. D., New York.

jnbalation of antispasmodio remedies. An.
EDWIN WALKER, M. D., Evansville, Ind.
REYNOLD WEBB WILCOX, M. D., LL.D., New York alyses bave repeatedly been made of the pro-
H. M. WHELPLEY, M. D., St. Louis.
WY. H. WILDER. M. D., Chicago, Ill.

prietary remedy in question. An old analy-
sis by Aufrecht, demonstrated the presence

of the following: LEADING ARTICLES

Cocaine mur.................

Kalii nitrio............
INHIBITION OF THE ASTHMATIC PAR-

Glycerin .................
OXYSM.

Water ......

... 25%

Plant extracts (stramonium). 4%
ALBERT ABRAMS, A. M., M. D.

A more recent analysis by Bertram (Medi-
BAN FRANCISCO.

zin, Klinik, April 9, 1905), shows it to con. THERE are many asthmatics who obtain

sist of an aqueous glycerine solution of naalmost immediate relief from a certain Amer.

trium nitride 4%, atropin sulphate (about ican proprietary remedy employed as a nasal

1%) and a not determined plant extract. spray. I have never prescribed a remedy,

From the analyses thus far made, there is the ingredients of which were unknown to

always an hiatus, the mythical something me, bence my acquaintance with this partic

which is stigmatized as a plant extract. Ber. ular spray, bas been achieved by contact with

tram suggests the following cheaper substiasthmatics, who employed it to the exclusion

tute for the proprietary remedy: of everything else. I sought to dissuade

Atropin sulphat..... 0.15 them from using it, knowing fully well that

Natrii nitrosi........ 0.6 it contained cocain, and that its employment

Glycerin............ 2.0 would engender a habit. My efforts in this

Aq. destill..........15.0 direction, however, proved unavailing. They

M. S. Atomize for three minutes in each argued, that its continuous use provoked no,

o nostril and inspire deeply. babit, for the reason, that notwithstanding its persistent use, no augmentation of dos. The use of the latter formula in my experi. age was necessary to seoure relief. It was once has been found disappointing and is in quite evident, that unless I could substi. no wise fitted to supplant the proprietary tute a legitimate agent for the one in ques. remedy. tion, all my admonitions would pass for Having concluded that the analyses thus naught to the suffering mortal, who reason. far published must be erroneous, for the ably declined to have ache charmed with air reason that their employment was without apand agony with words. It has been my preciable results, I approached a solution of constant endeavor to fathom the nature of the problem in another direction, viz., the de.

bare lungon wall of the anifested conditios first

termination of the physiologic action of the of cocain. The formula tbus constituted is proprietary remedy in question.

the nearest approach in my opinion to the Primarily, one must study the nasal mu. proprietary remedy in question. I contend cosa as a center for the discbarge of re. that the theory of asthma must not be based flexes. Some years ago in an article on alone on a spasm of the circular fibres of the "Heretofore Undescribed Neuroses of the bronchi, but on an inability of the weaker, Lungs" (New York Medical Journal, June longitudinal fibres of the bronchi being un. 13,1896), I stated the premises upon wbiob able to expel residual air imprisoned by the my conolusions were formulated. The first circular fibres. The effect of the proprietary proposition was, tbat there are conditions of remedy, like other efficient antispasmodics in nasal reflex genesis manifested by dilatation arresting the asthmatic attack, is caused in and contraction of the lungs. The second my opinion, by the contraction of the longi. proposition was that the pulmonary neurosis tudinal fibres of the bronchial musculature of lung dilatation can be invoked in every which are no longer antagonized by the circu. healthy individual by any irritation of the lar fibres. The action has its analogue in the nasal mucosa. At that time I maintained bladder musculature when, in consequence of that the vagus contained fibres whioh could a spasm of the sphincter vesicae, the weak dilate or contract the bronchi. Auld of detensor vesicae, cannot expel the urine and London, England (Lancet, October 17, 1903), ischuria spastica results. Everytbing speaks referring to the epoch-making researches of for the correctness of this theory. Thus, in Dixon and Brodie, says, “It undoubtedly asthmatics, owing to the feeble development belongs to the credit of Abrams, to bave of the longitudinal bronchial muscular fi bres, proved at least seven years since by a sim. or to the excessive development of the circu. ple olinical observation, that the pagus must lar ones, it is impossible to elicit the long recontain bronoho-dilator as well as broncho. flex of contraction, or at any rate, it is but constrictor fibres.” Now, when the proprie feebly expressed. My tracheal traction test tary remedy is sponged into the nose even is praotically lung contraction induced by of a normal individual, it will be noted, that vagus stimulation when the head is thrown after a few minutes the normal lung reson forcibly backward, during wbich time per. ance on percussion will be supplanted by cussion of the obest is executed. It will be dullness and, in some chest regions, a flat found that in health this test is positive, i.e., percussion note is elioited (Abrams' lung re. when the head is thrown back or forcibly to flex of oontraotion). The same reflex phe. the right or left, percussion over the manu. nomenon was observed in asthmatics. It brium sterni and lungs contiguous thereto, may be noted parenthetically, that bypoder will yield a dull or flat percussion sound, mic injections of adrenalin possess the same which is rather felt than beard (palpatory peraction in translating lung resonance into cussion). dulness or Aatness. Adrenalin subcutane. This test is positive in health and in all ously only, is perhaps one of the most effi. cardio-pulmonary affections, but it is not oacious remedies for arresting a paroxysm present in all instances of idiopatbic asthma. of asthma. I employ the adrenalin chloride I have already shown that inbalations of solution (1 in 1000) of Parke, Davis & Co., amyl nitrit (American Medicine, January 3, of which 8 to 15 minims are injected. It is 1903), which often suoceed in arresting astb. rarely necessary to repeat the dose. I have matio paroxysms, induce the lung reflex of found it equally serviceable in many forms contraction. This remedy recently so bigbly of dyspnea even when morpbin was without vaunted for the arrest of hemoptysis, owes effect. It remains to be seen how far experi. its effioacy in my opinion, not to any alteramental adrenalin atheroma will influence the tion in blood pressure, but to the production clinical employment of the drug. We owe of a veritable lung reflex of contraction. the hypodermio use of adrenalin chloride to Amyl nitrit in hemoptysis may justly be reBullowa and Kaplan (Medical News, Octo garded as a specifio. In individuals who ber 24, 1903).

suffer from asthma of presumable nasal geneNext I ran the gamut of all the recognized sis, I have frequently found, that stuffing antispasmodics to determine their effect on both postrils with cotton will precipitate a lung resonance by nasal instillation. I oon typio asthmatic attack. Even though a par. cluded in brief, that employed alone, they oxysm may not be induced, one may bear on induced lung dilatation (Ābram’s Lung Re. lung ausoultation, after the cotton test, the flex of Dilatation) and only when combined rales peculiar to asthma. Two factors, psywitb cocain was it possible to obtain the same chic and reflex, operate in this test. A psy. percussional lung effects as from the proprie. ohio stimulus sets up directly an altered vistary remedy previously referred to. Hence ceral condition. Thus the firm impaction to the formula suggested by Bertram add 3% of cotton in the nasal cavities creates the con

cept of air hunger which is followed by the POSTMORTEM REPORT OF A CASE OF automatio employment of agencies wbiob tend RUPTURE OF THE STOMACH, DUE to combat it. The reflex factor is undoubtedly TO GASTROMALACIA.* predominant, insomuch as previous cocain. ization of the nasal mucosa, will with the oot

J. A. HARTMANN, M. D. ton test in most instances inhibit any tend. ency toward a paroxysm. In the employment

ST. LOUIS, MO. of agents by the nasal route for the arrest of The following case is of considerable inan asthmatio attack, I cannot deny the pos- terest because of its rarity, and because of its sibility of absorption. Thus in experiment. etiology whioh is upusual. I regret that the ing with various antispasmodics, I often in- records are far from complete; the examinaduced physiologio and even toxic action of tion was made under most unfavorable authe drugs in question. In several instances spices, in the home of the deceased, on the intractable emesis followed the insufflation of undertaker's cooling board, and with such apomorphin. These observations taught me limited facilities as were at hand. The stomthe very important fact, that the pasal mu. aob only was removed for demonstration to cosa is a suitable obannel for the introduction the coroner and for chemical analysis. of medicaments into the body. Thus with On July 22d, 1906, the case was reported apomorpbin, nausea and emesis in several to the coroner, and early in the day I was orinstances were induced by less of the drug dered to make a post-mortem, as death octbrough the nose than by the stomach. The curred suddenly and without medical attend. eventual mastery of asthma will be accom- ance, and the cause of death as given by plished along the lines of least resistance. It the family (heat-stroke), did not seem tena. will not be a subjugation of spasm, but of ble as the night previous had been but conditions which can aptagonize spasm. In moderately warm, and the death had occurred other words, spasm in the presence of cirou- in the early morning. The police evidently lar and longitudinal fibres is an expression of inclined to the theory of self-destruction, as enfeeblement contending with strength, and did the reporters for the daily press who to annihilate this anomaly, we must direct our were present. The residence was remote efforts toward toning up the longitudinal from my office, and I arrived at 5 p.m. and fibres of tbe bronchial musculature. This immediately proceeded with tbe examination. is not an impossible task, if we but appreciate The body was that of a young woman of 25 the fact, that the lung reflex of contraction years, Jewish, a native of Hungary, and for can be ovoked.

six years a resident of St. Louis. A very incomplete family history could be elicited; her mother died at the age of about 50 of

heart disease; ber father lived to the age of COEDUCATION was roundly condemned by 78, the cause of his death was said to have President G. Stanley Hall, of Clark Uni. been senile debility. Three brothers living, versity, in his paper recently read before all in good health; one dead, bis death at 37 the American Academy of Medicine, in having been due to brain fever. A brother Boston. From his profound studies of ado. stated that the deceased had never been really lescence, Dr. Hall is entitled to considera- siok in her life; she had had the hardy rosy tion and his opinions will have great weight cheeks, and suoh color as is the picture of in the present tendency to separate the sexes health and is found in many foreigners on in the public schools after 12 years of age their arrival in America. Her oocupation It is quite likely that the vast majority of the bad consisted in general housework and care medioal profession already agree with Dr. of her brothers' home. She first complained Hall though from different motives. His of indisposition three years ago, when she opinion is based upon the fact that the life attributed her trouble to her heart. She had role of men requires a set of mental charac- taken on flesh rapidly, a matter which disteristics, the opposite of those of women, and turbed her considerably, and which seemed a that to modify either sex by training it in the contributory cause for periods of depression atmosphere of the other, is to unfit it for its and melancholia, her imagination centered struggle for existence. A compromise of on tbe point that she was getting too stout. methods is unsuitable for either. Boys must This was aggravated by members of the fambe trained to greater manliness and girls to ily twitting her of being fat. To counteract greater womanliness, so that each will be this tendenoy to superfluous flesh, she had able to supplement the other. Coeducation begun at a time about two years previous to may nct produce long haired men and short her death, to limit her diet as closely as pos. baired women, but its tendency is that in that direction.-Am, Med.

*Read before the Macoupin County (Ill.) Medical Association at Carlinville, October 16, 1906.

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