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Early Diagnosis and Operation of Empyema

of the Mastoid Process in Acute Sup-

purative Otitis Media .........................

131

Ear Affections in Scarlet Fever ............

391
Etiology of Disturbances of the Auditory

Nerve Apparatus Appearing Suddenly..... 392
Inflation of Air in Acute Otitis Media Pur-

ulenta, on Account of Complicated Mas-
toiditis ............................................

202
Labyrinth Suppuration ....

658

Leukemia Hemorrhage in the Inner Ear

with Special Reference to the Pathologic-

Anatomic Examination of the Temporal

Bone ......

201

Late Hereditary Syphilis of Both Laby-

rinths of the Ear ......

391

Middle Ear Suppuration in Diabetes...... 79

Making a Chromic Acid Bead ..

Operative Treatment of Acute Otitis Media

Operative Treatment of Tormenting Sub-

Pathological Anatomy of the Inner Ear and

the Question of Primary Brain Abscess..

jective Noises ....

515

Relation Between Diseases of the Ear and

Those of the Face ......

628

Rare Case of Deaf-Mutism Following Pur-

pura Hemorrhagica ......

629

Recent Reports on Otosclerosis ......

474

Scopolamin Narcosis in Ear Surgery

79

Stricture of the Eustachian Tube ....

345

Some New Local Anesthetics .....

345

Surgical Interference in Tuberculosis of
the Meninges and the Brain .....

344

The Movement of the Ossicles and the Part

They Play in Hearing ....

19

The Exudative and Plastic Processes in the

Middle Ear .............................

20

Treatment of Suppurative Middle Ear Dis-

eases by Bier's Method of Hyperemic
Engorgement ..

629

Two Cases of Deaf-Mutism Due to Ptomaine

Poisoning .......

391

Toxic Action of Aspirin ...........

545

Three Cases of Objective Ear Noises

545

Thiosinamin in Tinnitus Aurium ...

THERAPEUTICS

W. T. Hirschi, M. D.

Absorption of Fat in Pancreatic Diseases 572

Acute Eczema

480
Application for Painful and Bleeding Hem-
orrhoids ...

502
Aristol Therapy of Hay Fever...

344
Abdominal Arteriosclerosis
Chloasma ....,

480
Cure of the Whisky Habit ..

479
Cholera Infantum ....

479
Diarrhea of Children ....

480
Diarrhea in Infancy ......

502

Dietetic Treatment of Basedow's Disease... 573

Diet in Tuberculosis

477

Diet in Nephritis ........

Diarrhea of Children ...

479

Diet for Gastric Ulcer ..

135

Digitalis Therapy .....

135

Ethyl Chlorid as a General Anesthetic..... 573

Edema of the Feet and Legs as a Result

of the Excessive Use of Sodium Chloride 107

Effect of Various Substances on Artificial

GastricDigestion .......

199

First Aid and Artificial Respiration

199

Floating Kidney in Women

199

Hay Fever .........

479

Heatstroke ..........

479

Importance of Anesthetics in Inflammatory

Processes ......

477

Is It Possible to Prevent Salicylic Nephritis

by Administering an Alkali?......

343

""""""""""

Internal Treatment of Appendicitis ..... 199

Lumbar Puncture ........

135

My Experience with Antituberculosis Serum 476

Nausea and vomiting After Narcosis.

49

Nervous Liver Colic .....

573

Pharmacologic Action of Digitalis, Squills
and Strophanthus on the Heart .....

343
Present View of Cancer Research .....

344

Prevention of Vomiting in the Use o

thelmintics .......

106

Prickly Heat ........

480

Present Methods of Treating Fractures....

Ovoferrin ...........

106

Rhus Poisoning ...

480

Remarks about Orthostatic Albuminuria. 106

Rest and Treatment ............................

Significance of Spinal Analgesia for the

Diagnosis and Treatment of Rectal and

Anal Diseases .......

48

Sweating of Feet ...

479

Spinal Analgesia ...

106

Treatment of Albuminuria and Eclampsia

Occurring in Pregnacy ..........

49

Treatment of Bronchial Asthma ............ 572

Tuberculin in the Treatment of Tubercu

sis, with Report of 167 Cases ......

573

Treatment of Hyperacidity .........

476

Treatment of Incarcerated Hernia ...

106

Treatment of Goitre .................

133

Treatment of Obstinate Cases of Sciatica

with Perineural Infiltration ......

344

Treatment of Pneumonia ..........

135

Thiosinamin in Scar-Contractions ....

107

Treatment of Gastric Ulcers an d Gastric

Hyperacidity ......

............ 107

('se of Carbohydrates in Diabetes Mellitus.. 476

Vioform-Its Use in Otology ..................

500

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PATHOLOGY AND BACTERIOLOGY.

P. B. H. Gradwohl, M. D.

Aneurism of the Right Sinus Valsalve of

the Aorta and its Relationship to the

Upper Ventricular Septum .............

17

Bacteriological Examination of the Blood

of Cadavers .....................................

Histology of Callus .........

390

Intestinal Origin of Pulmonary Tuberculo-

sis ..........

45

Pathologic Histology of Hereditary Syph-

ilis, with Especial Reference to the Spiro-

chaeta Pallida ..........

198

Pulmonary Lesion of Tuberculosis.

45

**

Phlebitis Migrans (Non-syphilitica) .......

17

SURGERY

John McHale Dean, M. D.

Antiseptic Action of Bromine .............

16

Action of Roentgen Rays on the Blood .... 17

Acute Postoperative Dilatation of the

Stomach, with Report of Case Follow-

ing Nephropexy ....

196

Common Duct Cholelithiasis .....

195

Cartilage Plates from the Scapula of the

Calf for Liver and Spleen Suture

16

Excision of Neck Cancer ...

680

Effects of Osmic Acid Injections.....

133

Early Operation in Traumatie Intracranial

Hemorrhage ................

Foreign Bodies in the Esophagus ........

Fracture of the Patella .......

Local Effects of Peritoneal Drainage .... 15

New Technic for Breast Amputation... 195

Plea for the International Study of Car-

cinoma ..............

269

Surgical Treatment of Goiter, based upon

Three Hundred Operations .....

680

Serum Therapy of Tetanus ......

627

Surgery of the Biliary Tract ....

627

Surgical Treatment of Cancer of the Stom-

ach .....

269

Three Years' Experience with Pyloroplasty 133

The Injection of Air into the Circulatory

15

System of Animals ......

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REVIEWER'S TABLE
A Compend of Medical Chemistry. Inor-

ganic and Organic, including Urinary

Analysis-Leffmann .....................
Abbott's Alkaloidal Digest ....
Cleft Palate and Hare-lip-Arbuthnot ...
Czar's "Human Side" ..
Compend of Materia Medica Therapeutics

and Prescription Writing. with Especial
Reference to the Physiological Action of

Drugs-Potter ...

Case Teaching in Medicine ....

Cushny's Pharmacology ........

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Harden Rulean and Disa est Diet

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Clinical Treatise on the Pathology and

Colds Are Contagious .....

629

Therapy of Disorders of Metabolism and

Coeducation Condemned .....

613

Nutrition ...

71

Death of Dr. Max Hemple ....

629

Chemistry: General, Medical and Pharma-

Conditions of Female and Child Labor..... 618

ceutical, Including the Chemistry of the

Cardiac Diseases in Doctors

515

U. S Pharmacopeia-Attfield .......

541 Constipation ..

574

Disorders of Metabolism and Nutrition;

Calcium Sulphid for Cough,

546

Diabetes Mellitus-Von Noorden ....

44 Chinese Foods and the Pure Food Law,... 454

Doctor's Recreation Series, Vol. IV-Jeaf-

Chicago's Health and Drainage Canal .... 454

freson .........

......... 195 Concerning the Diagnosis...............

383

Diseases of the Skin-Jackson ................

72 Colombia's Industrial Opportunities

276

Diseases of Infancy and Childhood-Koplik 654 Canada Associaton Meeting ....

519

Examination of the Function of the Intes-

Denver Clinical and Pathological Society.. 618

tines by Means of the Test Diet ............

340 Dr. Harrison Convicted ...

510

Food in Health and Disease-Williams...... 100 Diagnosis of Renal Calculus ..

302

Golden Rules of Surgery-Bernays ..... 267 Diameters of the Normal and the Phthisical

Hare's Therapeutics ........

44

Chest .....................

80

Health and Care of the Baby-Fischer ..... 471 Denaturized Alcohol ...

624

Individualism versus Socialism ...

195 Diet in Arthritis Deformans .....

440

International Clinics ....

340 Diet as a Cause of Appendicitis.

95

Lectures on Autointoxication in Disease or

Diagnosis of Gallstones

519

Self-Poisoning of the Individual-Bouchard 71

Ether Day .............

618

Laboratory Manual of Physiological Chem-

piepsy ...............................

624

istry-Rockwood ....

470

French Scale for American Catheters ......

............

547

Manual of Materia Medica and Pharmacol-

Fifteenth International Medical Congress..

Feeding of Infants During Hot Weather...

ogy, Comprising all Organic or Inorganic

425

Drugs which are to Have Been Official

Effect of Proprietary Literature on Med-

130

ical Men ........

in the U. S. Pharmacopeia-Culberth.....

.. 316

Man and His PoisonsAbrams ...........

Fresh-Air Homes and Medical Work in Con-

267

267 nection with Them ....

Manual of Operative Surgery-Binnie ....

Fighting the Mosquito ........

Morris' Anatomy Under American Edito

446

471 Formic Acid is the Latest Rejuvenator...

ship ...............................................

72 Floating Hospital of St. John's Guild .....

New United States Pharmacopoeia....

547

Government Model Farms ......

Non-Surgical Treatise of Diseases of the

652

493 General Fatal Infection with Gonococcus

Prostate and Adnexa-Overall .....

and Staphylococcus ..........

Practitioner's Library-Carr .................

400

418

Hepatic Dyspepsia ......

Poker Jim-Lydston ....................

95

Health of the Americans in the Canal Zone

Physical Examination of Infants and Young

655

340 Hospital Saturday and Sunday Collections..

Children ............................

679

340 Hospital for Acute Alcoholism ...

Progressive Medicine ..

248

Health Pamphlet Issued by the Illinois

Progressive Medicine-Hare ....

State Board

Physical Diagnosis, including Diseases of

437

Idaho Will Have Health Laws

the Thoracic and Abominal Organs-Le-

652

India's Death-Rate From Wild Beasts......

72

Fevre ...........

530

516

Leprosy Hospital in the Hawaiian Islands

Progressive MedicineHare and Landis....

534

Massachusetts Admits the Homeopaths.....

Pathogenic Micro-organisms, including Bac-

683

teria and Protozoa-Park ........

Medicinal Use of Eggs

44

558

Medical Forgeries ....

Quiz Compends-St. Clair .......

Mortality from Homicide and Violence ....

Saline Therapy-Von Noorden ...

501

Simon's Manual of Chemistry .....

Munificent Bequest to the Lloyd Library of

100

416

Surgical Suggestions—Brickner ..

Cincinnati ........

547

Thornton's Pocket Medical Formulary..... 72

New York City's Tuberculosis Hospital .... 629

New Method of Libeling

The Training of the Negro

547

World's Anatomists-Kemper ...

493

New Building for Insane Hospital Opened.. 437

New Members of the St. Louis Medical

Zoroastrianism Today ............

Society .....

656

Nature's Best Tonic ........

349

SOCIETY PROCEEDINGS

Neuritis Due to Ptomains ....

95

Nervous Dyspepsia of Middle-Aged People 95

Dedication of the St. Louis Medical Society's

New Woman in Sweden ..............

Auditorium

515

...................................

517

Over One Million Immigrants in One Year.. 454

Georgia Independent Society .....

Obstructing the Work at Panama ....... 80

Medical Society of the New York Polyclinic

Public Health Defense League ..........

683

Medical School and Hosp. 52, 107. 168. 427. 3

Physicians and Proprietary Remedies..... 425

Medical Society of City Hospital Alumni

Professor Perkin's Discovery of Coal-Tar..

619

546

....191, 233, 328, 364, 384, 417. 441. 464. 5

Pittsburgh's Water Supply

Mississippi Valley Medical Association..... 520

446

Pneumonia .....

95

Medical Society of the Missouri Valley...

Pain and the Blood

95

........................................ 138, 4'

Price of Radium ....

349

St. Louis Medical Society ....

.....427. 395

Pharmacopeial or Proprietary Preparations,

Tri-State (Alabama, Georgia, Tennessee)

Which? Caution.....

Medical Society ......

520

534

Quick Cure Treatment for Gonorrhea ... 264

Toronto Meeting of the British Medical

Rest Cure ...

615

Association ...

... 448, 498

Rachitic Teeth ..

95

Reflex Light from Africa

268

Rabies Prevalent ......

MEDICAL MISCELLANY

646

Reason for "Patents"..

383

American Medical Editors' Association..... 425 Recently Enacted Pure Food Bill ...

574

A Rare Form of Intestinal Stenosis .......

Relation of the Medical Profession to the

Social Evil ..................

Aneurism of the Posterior Wall of the Left

425

A Dying Profession.

Rapid School Inspection ................

683

519

Ventricle .........

Suit for Certifying to Gonorrhea ....

682

534

Alcohol in Diabetes

Stomach Douche and its Application .... 363

A Plan for Saving Infant Life ......

679 Some Observations on Prostatectomy .. 426

Accidents of the Foot-Ball Season

647 Suture of Heart Wounds ...

110

Alexian Brothers' Hospital .....

656 Sea Voyages for Invalids .....

362

Absurdity of Fretting ....

652 St. Louis Pharmacists and the Liquor

Austrian Country Doctors Strike ..

629

License ................

349

Anal Fissures in Infants

575 Safe Local Anesthetic.

400

Appendicitis Remedies ..

440 Subinvolution of the Uterus: How is it Best

Asthma

533 Prevented ......

547

Boston Session of the American Medical System of Venereal Prophylaxis that is

Association .....

316

Producing Results ...

........................... 349

349

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W. T. CORLETT. M. D.. Cleveland.

REYNOLD W. WILCOX, M. D., N ew York.

Papers for the original department must be contributed ex symptomatio neurasthenia. While neurasclusively to th's magazine, and should be in hand at least one month in advance. French and German articles will be trans thenia is not as common an affection as many lated free of charge, if accepted.

A liberal number of extra copies will be furnished authors, and suppose, it is a distinct clinical entity whose reprints may be obtained at cost, if request accompanies the cause is overfunctioning or undue expendi. proof.

Engravings from photographs or pen drawings will be fur ture of nervous energy, and whose manifestanished when necessary to elucidate the text. Rejected manuscript will be returned if stamps are enclosed for this purpose.

tions are symptoms and signs wbich indicate

nervous weakness and nervous irritability. It COLLABORATORS.

is true fatigue neurosis and the expression ALBERT ABRAMS. M. D., San Francisco. M. V. BALL, M. D., Warren, Pa.

"'irritable weakness,” often used, is one FRANK BILLINGS, M. D., Chicago, Ill. CHARLES W. BURR, M. D., Philadelphia.

fairly descriptive of its chief characteristics. C. G. CHADDOCK, M. D., St. Louis, Mo.

This reference to neurasthenia as a psycho. S. SOLIS COHEN, M. D., Philadelphia, Pa.

sis and a symptom of disease outside of the ARCHIBALD CHURCH, M. D., Chicago. N. S. DAVIS, M. D., Chicago.

nervous system suggests a word or two at the ARTHUR R EDWARDS, M. D., Chicago, Ill.

outset about the treatment. While it is true FRANK R. FRY, M. D., St. Louis. Mr. REGINALD HARRISON, London, England.. that the insane may be neurasthenic or the RICHARD T. HEWLETT, M. D., London, England. J. N. HALL, M. D., Denver.

neurasthenio become insane, the terms neuHOBART A. HARE, M. D., Philadelphia.

rasthenia and psychosis are not interchangeaCHARLES JEWETT, M. D., Brooklyn. THOMAS LINN, M, D., Nice, France.

ble; nevertheless a psycbio element which FRANKLIN H. MARTIN, M. D., Chicago. E. E. MONTGOMERY, M. D., Philadelphia.

has its underlying cause in heredity is present NICHOLAS SENN, M. D, Chicago.

in most cases of true neurasthenia. FERD C. VALENTINE, M. D., New York.

From EDWIN WALKER, M. D., Evansville, Ind.

first to last the body as well as the mind of H. M. WHELPLEY, M. D.; St. Louis.

the neurasthenic should be treated, suggesWM, H. WILDER, M. D., Chicago, Ill.

tion and encouragement, which is continuing suggestion, being potent factors in the suc

cessful management of the disorder. Another LEADING ARTICLES fact which has some bearing upon the ques.

tion of the existence of genuine, uncompli.

cated neurasthenia is that in symptomatic THE TREATMENT OF NEURASTHENIA.* neurasthenia, unless the neurasthenio ele

ment is recognized in the therapeutio measCHAS. K. MILLS, M. D.

ures adopted, the treatment instituted with

only the primary causal conditions in mind, PHILADELPHIA, PA.

will probably meet with little success. The Professor of Neurology in the University of Pennsylvania. proper method of treatment in symptomatio

It is necessary in order that my views with neurasthenia is one which takes into consid. regard to the therapeutics of neurasthenia eration both the neurasthenic and the undershould be clearly presented, to say a few words lying non-nervous disease. Whatever is done about its definition and nature. Recently for heart, stomach, liver, kidneys or blood, some tendency has been shown to return to the patient needs also mental and physical the views which prevailed before Beard, in rest and the inspiration of well-directed sug1880, impressed the profession and the com. gestion. munity with the idea that neurasthenia or

A single illustrative case may be of value nervous exhaustion de served separate recog.

in this connection. A young married man nition in our nosology. Dana, for instance,

caine to me from a distance to be treated for in a paper significantly entitled “The Pass. neurasthenia. He had gradually become more ing of Neurasthenia," would relegate the ma.

and more nervous, irritable and depressed. jority of cases so diagnosticated to the psy. He occupied an important commercial posichoses, and of the cases left he believes that tion, but not one sufficiently calling upon his many should be regarded as illustrations of energies to entirely account for his breaknervous disorder dependent upon the disease down. He suffered from an annoying vitre. of non-nervous organs. I do not, however, ous opacity and an old orchitic trouble; also accord with the view that all cases, or nearly from a congenital, partial arrest of developall cases, come either under tbe psychiatric

ment of one lower extremity. His mind bad pale or are to be regarded as instances of

become concentrated on the symptoms and

conditions which were not in themselves suffi. *Read before the Philadelphia Neurological Society, No

cient to cause any serious apprehensions. He

Tember 8, 19.5.

had worried himself into a state of extreme work are full of unrest. Of two business men neurasthenia because of affections easily who have equal amounts of work to do, and cured, or at least relieved. The first thing are practically equal in physical strength and necessary to do in this case as in so many mental capacity, one goes about his tasks others, was to remove the patient from his with a steadiness and system that do not environment and to put bim on as complete wear either upon himself or those with whom rest as possible, and to forcibly impress him he comes in contact; the other with such with the idea that all his annoying symptoms restlessness and unnecessary output as to were transient, or at least could be remedied, keep himself in a half exhausted state and and that no reason existed why he should not those around him disturbed and disquieted. in a short time be in as good health as be had Perhaps bis unrest is shown in the unnecbeen one or two years before. Proper atten. essary steps that be takes, or the unnecestion was given to his eyes, to his somewbat sary rapidity with which he takes them; in crippled limb, to his genitalia, but at the talking too long or too excitedly; in driv. same time he was placed upon a thorough ing when leading would do better;-in brief, rest treatment, at first pearly complete and in expending more energy tban is necessary later made partial. Isolation, massage, elec- even for the full accomplishident of the work tricity, hydrotherapy and other measures, in hand. The feelings of those compelled by bereafter to be referred to, were used, and as fate to keep oompany with these useful but they were gradually withdrawn, systematized irritating mortals is best expressed by the exercises and increasing occupation were sub- slang expression, “Give us a rest;”, but as stituted. The man made a good recovery in a rule they neither rest themselves or let less than three months.

anyone about them rest. One man does bis Before taking up special measures for the work with smoothness and with only that treatment of neurasthenia, a few words should loss of vitality which is easily repaired by be said about its prophylaxis, and it would his daily food and sleep, the other is always be time saving to include in these remarks giving out more than can thus be supplied. suggestions regarding not only the methods One saves his forces at the same time that he of preventing its occurrence, but also of its uses them, the other is wasting much that he recurrence after recovery through time or might easily save. One physician is worn treatment. The age is strenuous. Notwith out before his hours of work are half expired; standing the pace whiob is set in almost all the other goes evenly and quietly through walks of life, however, many succeed in pass. the hard day's work. The work that nags and ing to middle life and later, and then suo. harrasses one man scarcely ruffles the other. cumb not to neurasthenia, but to arterioscler. Probably no one thing is more important osis or some other degenerative disease. The in the prophylaxis and treatment of neuras. predisposd neurasthenio who tends to early thenia than the avoidance or prevention of exhaustion of bis nervous system may, in worry. . Genuine neurasthenia seldom occurs spite of his neuropathic heredity, have within in one with a healthy inheritance, simply him great possibilities in sone directions, through persistent and severe mental work. and it is well worth while to conserve and The biographies of scholars, technologists, develop his powers. The physical and men and professional men who have obtained tal endowments and limitations of the child celebrity afford ample evidence of the truth should receive the close attention of the par- of this statement. On the other hand, it is a ent and the educator. The seeds of neuras. matter not only of bistory, but of common thenia may be sown in the preparatory school experience, that anxiety and worry, whether or in the college, and especially in the latter, caused by domestic disturbances or embarwhere so often a false standard, or at least one rassments and purplexities in business and that is not suited to the average members of professional life, are fruitful sources of the a class, is set. After the general education exhaustion and irritability which are the sign or training of the youth is completed, another manual of neurasthenia. Probably no one greut step towards the prevention of neuras. factor is more important in the production of thenia is that which is taken when care is the neurasthenic state than the worries of do. exercised, both by the individual and his mestio life. Res angustoe domi. The stuadvisers, in the choice of an oucupation dent of mathematics, of law, of medicine, or which is suited to his inherited endow- of any vocation requiring intellectual capacments.

ity and presistent labor may continue his Passing now to the question of the preven work through long hours for many weeks or tion of neurasthenia in those engaged in ac- months with no more visible result than nortive pursuits, it should be remarked that not mal mental and physical fatiguo. But add to a few of those who suffer from nervous or this an embarrassing or nagging doinestic other breakdown do so because their lives and life, and neurasthenia is one of the most fre.

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