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action of remedies. This has been ascertained will admit of an accuracy of application of mainly througb the medium of physiologio which we now see only the possibilities. experiment; and this is of necessity contined The great need is for clinical workers, who to the definite, uniformly acting principles, will apply these agents and make careful obbecause certainties can not be deduced from servations as to their effects. For instance, uncertainties and the experimenters were there are two new remedies for epilepsy-verdriven perforce to these agents. It results benin and solanine. Each has won nore that we have concerning them a wealth of in- than popular repute. Verbenin has proved formation, reaching down to the minutest de curative in a series of cases studied by Prof. tails, that enables us to prescribe them with French, of Carbondale, who believes it acts full knowledge of the effects to be expected. upon intestinal parasites. Solanine is the
active principle of the bull or horse nettle, of The active principles are not substitutes
bittersweet, and of several other plants that for the tinctures and extracts, but each has
have proved useful in this malady. How, why, a therapeutics of its own. We offer them on
what its action and the limits of its effectheir own merits. They may resemble the
tiveness, are yet to be determined. We have orude drugs, but this is incidental. Study
gathered these facts; and we ask the profesthe alkaloid for itself, without refereuce to
sion to ascertain further facts by clinical the parent plant. Of what possible conse
trials; but they ask us for information inquence is it to us whether byoscine comes
stead. We proffer brotherhood, they insist from ben bane or from scopolia ? Or what
on foroing us into an undesired leadership. these plants were used for in the earlier day?
I have recently traveled from the Atlantio We give hyoscine for its own powers, as to the Pacific, addressing many medical socie. shown by scientifio experiment.
ties, in the endeavor to arouse an interest in In the Text-book of Alkaloidal Therapen. purely scientifio, purely ethical, non-secret, tics there are 155 remedies described; but non-monopolistic, therapeutics. The alkathese are far too few. Many alkaloids are loids form a very important part of this, but known to the chemist but not yet tested for by no means all. Many synthetics and sera the physician. There is a whole group of are as striotly scientifio as they. The results tetanizants of which strychnine is the type, hare proved highly satisfactory. The profesembracing brucive, thebaine, laudanine, sion shows signs of waking up to the importgelsemine, calabarine, curarine, all having ance of this morement—the need of reform in similar effects—but not identical necessarily. therapeutics is universally admitted. The They have not been studied yet, except that scope of our work is being better comprewe know bruoine is a local anesthetio, and hended. The cry of commercialism" is si. that thebaine has shown powers in certain lenced. It is an absolute necessity that there cases of paralysis superior to those exerted by should be a source of standard supply for strychnine. We are convinced that a thorough these delicate instruments, or the propaganda study of this group would show valuable di. would be emasculated. Of what possible use versities in the powers of the different mem- would it be for us to recommend strophanbers that could be fitted to like diversities thin, and send the physician out for it into in the symptoms of diseases. For a market where the supplies vary in strength instance, at present the writer is struggling from one to ninety9 But when a non-secret, with a case of so-called asthma. The vas. non-monopolized remedy is advocated, which cular tract of the lungs becomes dilated, al. every druggist, every physician, may prepare lowing congestion, with strenuous cough and and dispense if he chooses, the cry of interfollowed by dyspnea. The indicated remedy ested motives becomes triling. The only op. is one that will increase the tonicity of the position now manifested against the alkaloids vessels walls in the pulmonary tract with comes from men who supply ready-niade preout affecting those of the general circulation, scriptions to physicians and who find their which are in a spastic state already. What sales decreasing under our advice for physi. is this remedy? Hydrastine does this ex- cians to study their cases, and do their own actly for the uterine tract. Adrenalin does prescribing with drugs they know all aboutit for the general circulation, for exactly the and of suob opposition we are rather proud part we do not need it in. That there is such than fearful. a remedy as we need we cannot doubt; but as We are not contending for the alkaloids long as the profession is satisfied with crude but for drug-therapeutics, based on agents drugs there is no incentive to add to our list worthy of trust, because their effects are sure, by the careful and painstaking investigations uniform, perfectly well known; drugs neither necessary to establish tbe place of new alka- secret normonopolized, with no commercial loids. When this has been done we will have backing as such, but depending for popular. a collection of finely selected remedies that ity on their effectiveness and nothing more. And on this basis we ask from the profession tuberculous or have a strong predisposition a renewal of confidence in such drugs, and to tubercular infection. a trial of the therapeutic methods based on The importance of tubercular disease of the them; promising in return a renewal of that neck is made apparent by recalling that in optismitic faith that moves away mountains - 14% of cases of tubercular disease in other of disease.
parts of the body show these glands infected. This may to many readers be a many times The conclusion cannot be escaped that to ar. told tale; but it is one that has traveled far rest the disease in the neck we would reduce and met no serious attempt at controversion. tuberoular disease by just so much. It is a Many of the foremost men of our day have very familiar sight, I dare say, to every one assured me that we are right; and that the present to see persons in his practice, cbild. only trouble has been that the world required ren, adolescents and aged ones with these time to catch up with us. But we who are tuberculous lymph nodes. advocating tbis reform are painfully conscious It is no reproach to the profession of that it is a thing far bigger than the men now course, but at this day of general awakening in it and that at the best we may hope in of both profession and laity against tubercutime to be known as “forerunners,” but no lar disease, and especially along the line of more.
prophylaxis it is our duty to deteot and remove The way is opening, the medical mind is these nidi. in travail, the result is not hard to foretell. It would be begging the question to say
this condition is secondary to and depeudent on primary foci in the mouth of upper air
passages, and that to correct these should be TUBERCULAR ADENITIS OF THE NECK.* the aim of treatment I am thoroughly assured
that no modern physician would hold this ROBERT J. CHRISTIE, JR., M. D.
view; it would be a striking parallel to the
assertion that because the Chicago drainage QUINCY, ILL.
canal pollutes the stream, those living on its In presenting this topic for your discuss. banks at Peoria, Alton and St. Louis sbould ion it is well to consider the frequency with not filter the water that is carried to their which the condition is met, and the usually every home. unsatisfactory course of the disease. I say The answer to the query, why is 90% of disease; it is not entitled to be set aside as a glandular tuberculosis shown to be in the special disease, but the peouliar features pre neck? is found in the fact of the abundant sented by tuberoular adenitis when located in lymphatic supply of this region, and the the cervical region justifies its study great exposure of the mouth and upper air apart from general tuberculosis or tuberculo. passages to the lodgment of germs. sis of lymph glands in other localities of When you reflect that 95% of all tuberouthe body. It differs in no essential from lar disease becomes infected by way of the tuberculous glands in any portion of the mouth or nose, and that these cavities are anatomy.
constantly invaded by living germs, is it any The frequenoy with which glandular dis wonder that the lymphatio chains of the ease is met in the first decade of life is neck, these faithful sentinels, ever on watch striking. Owing to it being the time of for the enemy, should sometimes suffer de. second dentition and to the predilection for feat? Greater is the wonder that they should the exanthemata tbis is the period of the achieve such numberless victories against greatest susceptibility to glandular disease. the arob enemy of the human body, so insid. It has been shown that about 85% of child. ious and so relentless. ren in this period are affected. These are It is needless for our purpose to discuss largely simple infections of non-pyogenic or the numerous infections that may disturb the ganisms, and remain without producing any glands of the neck. It is sufficient to say symptoms indefinitely. The number of these that any oonsiderable enlargement of them, that are already tuberculous, and the number occurring in the second and third decades of which may at a later time become so cannot life, that are not lympho-sarcoma or pseudo. be expressed in numbers. But coming to leukemia, or syphilitio, or that does not the second and third decades of life we find rapidly progress to suppuration or resolution, 76% of cases of the affection, and that a large is in all probability tubercular and at once a per cent of these give a history of glandular surgioal disease. disease in childhood. So we know that a
I think we are forever divorced from the large per cent of those in the first decade are sorofulous disease of the older writers as
meaning other than tubercular disease. I do Read before the Western District Medical Society of Mlinois, at Alton, October 21, 1905.
not concede that there is such a condition or entity, certainly not from a practical point of menacing condition? I would lay the blame view, as simple chronic hyperplastic adenitis. equally on the patient or his parents, on This classification is based on the character the doctor and on the patent medicine man istic long period of involvement, the inactiv. and his congeners; the doctor in many in. ity and the sometimes spontaneous oure by stances for not insisting on an early operaabsorption.
tion; the patient for following the mislead. This I maintain is illogical. These glands ing claims of the uneducated or vicious, will in the great majority of cases prove and the patent medicine man for his crime themselves to be tuberculous, and will surely of hypocrisy against the credulity and fixed go on to caseation and suppuration. Not to superstitions of the average wan. What so consider them would compare well with should be the rule in the treatment of these the argument that says, let the appendix conditions? First, excise every tuberculous alone until it suppurates. It can only be gland found, and do it at the earliest stage if said for taking this chance course that it possible. may be justified by results. It is poor argu. It would follow as a rational principle that ment, as the evolution in the treatment of the source of infection should be sought out, appendicitis plainly shows, and the analogy and if possible corrected, whether it be the is so true that it must carry conviction. Why tonsil, post adenoids, caries of the teeth or not remove the doubt along with the disease ? abrasions of the mouth, nose or pharynx. If
I would, therefore, make a plea for the early the case is not presented at this early and extirpation of these glands. What do we favorable period, but belongs to the second, gain by an early operation, and what may we excision should still be the rule. not suffer by delay? These are pertinent Do not temporize with iodoform injections questions, and their correot answers should or bichloride injections or iodine injections; determine the course of all toward an early you may get results, but the chances are operation.
against you, so do a clean excision, and do What do we gain? In the first place we not be satisfied with the removal of one casesave from more extensive and widespread tu- ated gland; remember that there are always berculosis 14% of patients. Secondly, we three or more involved at this stage. I am treat a simple uncomplicated surgical disease im pelled to speak rather strongly on this of the neck and we get an ideal and perfect point. In my own cases, at least, those recovery. These things accomplished for the that have done badly were those that bad patient and humanity are not to be despised. been treated expectantly in the first stage If any plan of treatment could reduce the and by injections in the second, and have mortality of pulmonary tuberculosis 14% it reached the third by progressive gradation. would be hailed as a dispensation from What is the rule for this third stage of the heaven. This is what early and complete disease? Excision! excision! broad, bold operation does if statistics are true, and my and deep if there is any possibility of entirely premises, and conolusions are correct. What removing the masses. The excision should do we suffer by a delayed operation? We include all tissues involved in the disease, cannot escape the suppurating abscesses of skin, fascia, muscle, and if need be vesicles the neck and the hazard they carry to life and and nerves, excluding of course, the carotids, happiness.
and the pneumogastric, the cervical, symTubercular disease of the lymph glands of pathetic and recurrent laryngeal nerves. It the neck considered as a surgical disease may should be remembered that the structures be classified in tbree divisions. Tubercular mentioned can in most instances be avoided infiltration, which is the early stage of all and protected. The carotid sheath by some tuberculous glands; caseation and softening fortunate principle of immunity is seldom is the second division, and is the next step in involved. the progress of the disease, and third the It is not within the province of this paper periadenitis when the disease is no longer to discuss surgical technique, this is fully condined within the capsule of the gland, and treated by all modern works on surgery. bas penetrated into the contiguous tissue, After a rather extensive experience I am and we have those large indurated masses convinced that the principles herein set involving all the tissues whose center is a forth, and sought to be made impressive suppurating chain of glands connected by are correct, and I may add that they are not sinuses and discharging purulent matter. my dictum, they are the doctrines enunciated This third division is, unfortunately for the by all surgical authorities, and if I have patient, and also for the complacence of the made them forceful and effective for some doctor, the one he is most often called hesitating and vacillating brother, then my upon to treat. Now who is blameless or plea has not been in vain and his grateful most to be blamed for this distressing and soul will answer to his satisfied conscience what he has gained by an early operation, by osmosis into these channels and into the and what he and his patient have escaped by pelvis of the kidney, where it is carried by not waiting for late one.
the ureters to the bladder.
These arterioles have the muscular coat discarded when they enter the kidneys, but
their fibrous coat furnishes the connective CHRONIC NEPHRITIS IN THE AGED.*
tissue stroma of the kidney.
When the blood absorbs irritant proteid fer. J. PALMER MATTHEWS, M. D.
ments from the alimentary canal and filters
them through the kidneys there is produced CARLINVILLE, ILL.
a diapedesis of white blood cells through the In the examination of the old soldiers who irritated capillaries and a new formation of come before the pension board I frequently connective tissue in the fibrous coat. This find three marked symptoms of degeneration process continues all over the body with whioh when taken together are diagncstio of hardening of the tissues of the liver, brain, chronic interstitial nephritis.
kidneys and all organs well supplied with The hardened arteries, hypertrophied heart, arterioles; altered blood supply produces and insufficiency of the kidneys, are sequelae
amaurosis and congestions with loss of funcin a chain of symptoms which start from a tions to these vital organs. faulty metabolism of animal proteids in the
The heart hypertrophies to compensate for process of digestion, causing the formation
the resistance increasing in the narrowed of poisonous leucomaines, and the absorption
brittle arterioles. The strong, full pulse of into the blood of unoxidized nitrogenous by.
a sclerosed artery is a diagnostic sign. If products.
tbe condition is not remedied by glenoin, The arterioles become spasmodically con
aconite or other arterial sedatives, apoplexy tracted, causing resistance in the circulation
may suddenly end all, or the heart will weaken to the aotion of the heart which becomes by.
and cause blood stasis and general apasarca. pertrophied to compensate for the added work.
These proteid substances bave the same Diagnosis.- Differential between intersti. formula of N,H.CO urea, except that they tial and parenchymatous becomes clear when are unoxidized. They are urio acid N414 we see by the microscope that in the latter C.0, from nuclein cells and creatin NH, there is a proliferation of the epithelial cells C.0,+H2O from muscle. The formula of of the uriniferous tubules, plugging them up nuclein is C2,8401,022P3.
with epithelial casts, causing soanty urine In the process of digestion of meats the And large, wbite kidney from thickening of nuclein of the animal cells is oxidized into the uriniferous tubules in the parenchyma urea for excretion from the blood by the of the kidney. In the former, interstitial kidneys. The liver and small intestines are connective tissue from the outer coat of the the places where this oxidation takes place. blood vessels, does not stop the secretion of If they are inactive the poisonous by-products water, but shrinks up the malphigian blood are retained to the detriment of the whole tufts from which is secreted the solid con. conomy, and are not properly eliminated as stituents of the urine. So we have copious urea, but circulate as forms of uric acid and flow of urine with retention of solids in the creatin.
blood; and a contracted kidney with adherent Aoute dysentery or a lithemic attack may capsule from fibrous inflammatior. be the beginning of the absorption of pro. The presence of casts in the urine of par. ducts of putrefaction and progressive inflam- epobymatous nephritis is diagnostio of the mation of the liver and kidneys, causing cir. chronic or acute stage. When the casts are rhosis and interstitial nephritis.
epithelial they indicate an acute proliferation The symptoms are persistent headache, diz. of cells in the uriniferous tubules. When the ziness, dull memory, nervous ilusbes and casts are hyaline they indicate a chronic degeneral uremic symptoms with a copious flow generative process wbich follows the subsi. of pale, urine of low specifio gravity and dence of the acute stage. strong, slow pulse.
The presence of albumen in the urine of The histology of the kidney shows us mal. interstitial nephritis indicates a progressive pighian tufts of blood vessels from which is inflammation with diapedesis of white blood secreted the solid constituents of the urine. corpuscles through the diseased capillary A large supply of blood passes through arteri. walls to form new connective tissue from the oles, which are in contact with the urinifer- fibrous coats of the arteries. ous tubules. The water of the blood passes When the albumen is diminished or absent
the inflammatory process is in abeyance and * Read before the Western District Medical Society at
the disease is chronic.
Alton, October 27. 1905.
THOS. A. HOPKINS.
F. P. NORBURY, Nervous and Mental Diseases.
Interstitial nepbritis is a degeneration frequently found in the aged, or those prematurely aged from disease. The treatment of these symptoms of func
Issued Tenth and Twenty-Fifth of Every Month. tional impairment of organs so vital is rest.
Under the Editorial Direction of The insufficiency of the liver and kidneys
FRANK PARSONS NORBURY, should be relieved by careful regulation of
CARL E. BLACK. the diet and exclusion of the proteids of the
With the following staff of Department Editors animal kingdom. These are known to form - 0. E. LADEMANN, Internal Medicine. poisons when not sufficiently oxidized by
JOHN MCHALE DEAN, Surgery.
R. B. H. GRADWOHL, Pathology and Bacteriology. the liver,
W. H. VOGT, Obstetrics and Gynecology.
WALDEMAR FISCHER, Ophthalmology. The eminent soientist, Mechkinott, of the
A. LEVY, Pediatrics. Pasteur Institute, Paris, France, has found
W. T. HIRSCHI, Therapeutics.
A. F. KOETTER, Otology. a cure for old age. He says man is as old as HERMAN STOLTE, Laryngology and Rhinology. his arteries. He recognized that the absorption of products of proteid metabolism, de
ROBERT H. DAVIS, Dermatology. composed in the alimentary canal was the cause of the degeneration of his arteries when circulating in the blood. He has found lac
EDITORIAL tic acid to be an efficient destroyer of pathogenio germs By a process of yeast fermenta. tion be prepares milk in the form of kumiss
It is imperative in this day of concerted ef. to predigest the proteid of casein sufficient fort in almost every line of business activity. for his bodily nourishment. The lactio acid
for medical men to keeps the alimentary canal free from ptomain The
pause and consider the poisons.
Independent tendency of the times in Professor Neiswanger of the Chicago Medical Press. their own individual School of Electro-Therapeutics, has made the
field, which while strict. happy experiment of placing bis nephritic ly and essentially professional, must necespatients on an insulated chair and giving sarily have in it some consideration of the them an electric batb from a statio machine. commercial. Under this treatment the blood pressure sub. In this prelude we refer to medical joursides, and the albumen disappears from the nalism, which in its varied phases, presents urine.
ope at this time, which we believe is not to When we recognize high blood-pressure
nize high blood pressure the best interests of the profession as a whole. with slow, full pulse and exaggerated second We refer to the tendency in certain quarters sound of an bypertrophied heart, with other to give to those medical journals, the propevidences of uremio poisoning in our patients erty of State or National organizations, a recwho are advanced in age we should warn them ognition beyond that of the independent med. in time. Stop their meat and coffee, and call ical press. their attention to the proteid foods of the Medical journalism should be democratio: vegetable kingdom, which are so scientifi. should be governed only by the broud prin. cally prepared, such as toasted wheat flakes ciples of democracy and not hampered or of the Battle Creek Sanitarium.
circumscribed by "expedienoy” or “the fear of consequences.”
Every editor should be broad enough, and AFTER removal of the appendix symptoms
80 full of the desire to approach the ideal of appendicitis sometimes persist, leading the
of truth, that he oun serve the interests of patient to believe that the organ bad not
the profession as a whole, and consequently been extirpated. These are generally due
without prejudice or partiality. to a colitis, which must be treated by high
There is a place for such an editor, whether
he edit a small journal, or one of larger cali. irrigations, diet, eto.
ber, and in him should be vested the eternal TREATMENT OF BUBO.–Orville Horwitz di. rights of liberty and the pursuit of happi. rects to shave and sterilize the overlying ness, for the profession which he represents. skin; punoture and evacuate pus with a bis. No one editor knows all of the needs of the toury; irrigate cavity with hydrogen peroxide profession; he of the larger journal is cosmo. till wasbings are clear, then with 1:5000 bi. politan in all of his aims, and perhaps he of chloride solution. Next 6ll cavity with ten the small journal is more or less provincial, per cent iodofura in vaseline, apply a piece but both should aim only at truth-live up of ice over the part till the vaseline is hard to it, fight for it, and convince his respective ened, and dress with a firm compress of gauze. readers that it is only right living, right