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geal, tracheal, pulmonary, gastric, mediastinal,
or pleural.

The nervous cough is very common. It oc-
curs as the result of a tickling sensation in
the larynx, and does not depend upon any or-
ganic cause. It may be treated by suggestion,
for example, in the course of sanatorium treat-
ment. The patient educates himself by his
own will. If this treatment is not enough, re-
course must be had to the following: Swabbing
the throat with a 30 per cent, solution of potas-
sium bromide, or taking 1 g. (gr. xv) of that
salt in water.

The pharyngeal cough should be treated in
the following way (the patient uses this gargle
warm) : —

5 B-Naphthol gr.iij.

Sodii Perboratis 5ss.

Aquae Menth© Piperitse 3vij.

Aqu» ad. 5xxxv.

Mlsce. Fiat ga**garisma.

If any inflammatory condition is present, the
pharynx should be swabbed with the follow-
ing:—

5 Cocain» gr. Ij.

Resorcini gr. xv.

Glycerini 5j.

Mlsce. Fiat collutorium.

In the case of pharyngeal irritation, the fol-
lowing gargle should be used: —

5 Sodii Salicylatis 3vj.

Phenazoni 3j.

Aquse LAurocerasi,

Aquffi Aurantii Florum. .ana 5s8.

Glycerini Jiiss.

Aquam Destillatam ad Jxxxv.

Mlsce. Fiat gs.-garisma.

The laryngeal cough calls for the attention
of the specialist. In the meantime, applica-
tions may be made of the following: — Ortho-
form powder, a solution of balsam of Peru,
gomenol-water as a spray, or a solution of cocoa
leaves with carbonate of potash.



^Journal des Practiciens, Nov. 1912.

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125



The followliig draught may be ordered: —

5t Tlnctur® Bryonlae Mx.

Tinctune Aconiti Mxx.

Tincturse Belladonns Mx.

Syrupl Opli 51.

Aquse Jlv.

Mlsce. Fiat linctus.
"One teaspoonful to be taken every two hours."

The tracheal cough requires expectorants, and
at the same time the tenacious sputum must
be rendered more liquid. A useful mixture Is
one composed of infusion of senega, and of
ground-ivy with Canada balsam, sweetened.

of,

5 Terplnl Hydratls,

Pulveris Ipecacuanhse Comp., ana gr. IJ.
Mlsce. Fiat pulvis.
"To be taken in a cachet two or three times a
day."

Or,

5 Antlmonii Oxldi gr. xv.-xxx.

Tincturse Aconiti Mxx.

Aquae Laurocerasl 311J.

Syrupl Opli 3vlJ.

Syrupl Ipecacuanhse 311j.

Aquae jlv.

Mlsce. Fiat mlstura.
"Four, five, or six tablespoonfuls to be taken
in the twenty-four hours."

For the ffostric cough, the following should
be used: —

Ten minutes before each meal, 2 drops of
Sydenham's laudanum (Tlnct Opli Crocata), or
%th of a grain of codeine, or, during the meal,
make a few inhalations of oxygen.

In the case of the hronchitic cough, or of the
cough due to compression, these pills should be
ordered: —

5 Bxtractl Opli gr. %.

Elxtractl Stramonll gr. V^.

Mlsce. Flat pilula.
"Three of these pills to be taken at bedtime,
two to be taken during the night, and from
three to five during the day."

Or, dlonlne may be given in pills, gr. % to %.
in the twenty-four hours.

For the cough of pleurisy, a counter-irritant
is the most effective; iodine, the point of a
cautery, or a blister.



Chronk Gastritis.^— The first essential in
considering treatment, says Barclay, naturally
is to determine the etiological factor or factors
and as f^r as possible to correct them. To this
end the attention must be directed to a few
common points of general hygiene.

*Harold Barclay, Med, Times, Dec. 1912.



I mention them briefly as follows:

1. Prohibition of alcohol.

2. Limitation of tobacco.

3. Appropriate treatment of diseased gums
and teeth by a dentist.

4. Exercise regulated to the Individual re-
quirements.

5. Sufficient maatlcation.

6. Regular hours.

No hard and fast rules can be made as re-
gards diet for each case will be Influenced by
the condition of the gastric secretion and motil-
ity. In general it should be said that food
should be good, nutritious, as bland and non-
irritating as possible and of sufficient variety
not to become Irksome. Cannon has shown
that coarse foodstuffs are notably retarded in
their exit from the stomach, and consequently
act as irritants. When marked glandular ac-
tivity exists as in the hyperacid stage, a diet
rich in proteids, in spite of its high combining
power with hydrochloric acid tends to further
increase this activity.

In Barclay's experience the best results were
obtained by restricting or cutting out the coarse
fibred meats, as beef, and prohibiting the use
of such scratchy articles as cabbage, raw celery,
graham bread, raw fruits, etc. Where atony is
present water should not be allowed with meals
or its amount limited as the extra bulk acts as
a mechanical hindrance to the peristaltic action
of the stomach.

In the mechanical treatment lavage is a most
useful adjunct. It not only removes the mucus,
but in the expansion and contraction of the
stomach wall stimulates the unstripped muscle
fibrea In the milder degree of gastritis where
mucus is not a continuous secretion, washing
after a night's fast fails to reveal its presence.
In these cases if it is practiced say four hours
after an ordinary meal it can usually be de-
monstrated. The author has never seen that
medicated lavage possesses any advantage over
plain warm water. The presence of mucus Is
best shown by splashing a hook around in the
washings and if it is present it can be drawn up
in white glairy strings. Mere inspection as a
rule falls to show its presence, as it is of the
same color and held in solution by the water.

A vast host of drugs has been advocated, but
the majority of them are useless. In the well
nourished cases, with normal or higher acidity
use the alkaline saline waters, as Carls-
bad in the form of Imported salts. What their
action is authorities seem to differ, but the
general consensus of opinion is that they do
exert a beneficial influence on the gastric mu-
cosa by stimulating the secretion of bile, the
motor functioti, dissolving mucus and reducing
the acidity. In those cases of less robust con-
stitution Vichy salts may be substituted in place
of Carlsbad, as its prolonged use is less de-
bilitating. Where hyperacidity exists, the use
of alkalies is Indicated as soda bicarb, or mag-
nesia oxide.

In the subacid cases Kissengen salts have
been advocated and as far as my experience
goes, they have proven of benefit, but their use
has rested largely on an empirical basis. Re-



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J Fbbbuart^ 1913.

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cently Van Norden and Dapper have endeavored
to determine thel- true physiological value.
Their observations were carried out on a large
number of gastric conditions, and one very in-
teresting conclusion was that in many cases of
gastric disorder, especially chronic gastritis, the
use of saline waters leads to an active increase
in the hydrochloric acid secretion. Again, that
In case of hyperacidity a moderate use of the
salines tends to decrease the hydrochloric acid
secretion. This certainly sounds paradoxical,
but the high standing of these clinicians leaves
no room for scepticism. When constipation is
present, the temperature of the saline should
be reduced, as the cooler the water, the more
laxative is the effect; where a tendency to
diarrhea is present they should be given as hot
as possible, slipping .them preferably through
a tube.

Those cases where there is no free hydro-
chloric and a total acidity of 20 or under; hy-
drochloric by itself or in combination with re-
sorcln, especially where atony is present, is
of decided benefit. The Klssengen salts should
be given a half hour before meals and the hy-
drochloric not earlier than half an hour after
meals. In those cases where overwork and
worry are prominent factors, a trip to some
of the EiUropean or American spas will often
prove of great benefit, not so much on account
of the waters, as the regular life, simple diet
and the freedom from care.



is very apt to occur if the pernicious practice
of plugging the posterior nares with lint
soaked in a strong solution of perchlorlde of
iron is followed.



Treatment of Epistaxis.^ — ^Let the patient
always sit up before an open window — ^never lie
down — so as to keep the head higher than the
trunk. Ice may be used locally and to the
back of the neck. The lower extremities
should be Immersed in hot water up to the
knees, or the lower limbs bound with hot
cloths, and small doses of digitalis with ergot
may be given every three hours. The best
method of using powerful astringents is to il-
luminate the nose by a good light and spec-
ulum, and attempt to detect the spot from
which the blood flows. Then apply such
remedies as adrenalin, turpentine, sulphate of
iron, hazeline, and other astringents directly
to the bleeding point, a probe being tipped
with sponge for the purpose. This is a better
practice than blindly swabbing the whole of
the nasal cavity and membranes with caustic
agents. It is sometimes necessary to plug the
nares, which must be plugged posteriorly with
a piece of lint, fastened with silk through the
nose. The silk may first be passed with a
T'ellocq's sound, or, better, a soft gum catheter.
These plugs should always be soaked in anti-
septic solutions and covered with boracic acid,
or they soon become foul. They should always
be removed within twenty-four hours. A
serious objection to their use is the setting up
of acute Inflammation of the middle ear, which

*Dr. J. L. Morse, Am. Jour. Med. Sciences,
Nov., 1912.



Transplantatioii of Bone In Treatment of
Fractores.^ — Dr. Murphy has demonstrated be-
yond a doubt that transplantation of bone, if
done in a certain class of cases, and under cer-
tain conditions, is perfectly feasible; and a
most satisfactory method of dealing with un-
united fractures, or fractures where there is
loss of much bone tissue, and especially in
cases where malignancy or traumatism has
caused the loss of a considerable section of a
long bone.

The following rules must, however, be ob-
served: First, the bone must be taken from
the same individual, preferably from the spine
of the tibia of the well leg; second, that there
must be direct contact of both ends of the
graft with the bone, and preferably the graft
should be driven snugly into the rimmed out
medullary canal at each end. Nails may be
driven in to prevent undue shortening and to
make the contact more accurate if there has
been much loss of bone substance.

The site of reception of the transplant must
be free from infection or disease of any kind,
and must not have sustained a recent trauma.
After placing the transplant, the wound must
be closed so as to exclude the air. Reasonable
fixation of the limb must be maintained, and
the usual treatment for simple fracture be
instituted. The size of the transplant should
be as large as can be taken conveniently from
the tibia, provided the same is not larger than
the place to be filled.

In chiseling the slip from the tibia it is his
custom to leave the periosteum attached to one
side of the transplant, but he is not at all cer-
tain that this is necessary. He is certain that
he has demonstrated that bone regenerates
from bone and not entirely from the perios-
teum.

He is not yet certain whether the transplant
simply acts as a stimulant to the osteogenic
process, the Haversian canals with their lacu-
nae, canaliculi, lamellae and Haversian spaces,
serving as carriers of the osteoblasts and osteo-
clasts, the compact tissue eventually being en-
tirely absorbed, its place being taken by new
bone; or whether It remains after complete
regeneration has taken place simply as a part
of the new bon*..

It will be remembered that both osteoblasts
and giant cells are found In great abundance
on the walls of the medullary canal, also
that the canal does not exist in early fetal
life. To what extent It reforms later in these
cases is still unknown. This, however. Is not
a matter of great importance from a clinical
standpoint.

*C. P. Thomas, M. D., 8o. Cal. Practitioner,
Los Angeles, Cal., Nov.. 1912.



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Mixed Narcosis.^ — ^Embley in his useful pa-
per states that the purposes of administering
morphine in conjunction with ether or chloro-
form in general anesthetics are:

(1) To diminish the quantity of chloro-
form or ether necessary to maintain surgical
anesthesia, thereby lessening the liability to
overdosage and the severity of after effects.

(2) To cut out as far as possible the lia-
bility to reflex syncope and to diminish shock
in prolonged operations.

(3) To diminish "psychic shock."

(4) To diminish the secretions of the
mouth and airway in ether narcosis.

llie addition of atropine to morphine in
mixed narcosis was made for the following
reasons:

(1) To further diminish the secretions of
the mouth and the airway in ether narcosis.

(2) To cut out the cardio-inhibitory func-
tion of the vagi, and thus to prevent ssmcope,
especially in chloroform narcosis.

(3) To compensate the defective lung ven-
tilation due to morphine.

The addition of scopolamine to the morphine
in mixed narcosis was made for the following
reasons:

(1) To further diminish the secretions of
the mouth and airway in ether narcosis.

(2) To further diminish the amount of
ether or chloroform necessary to maintain
surgical anesthesia, by summing its own anes-
thetic effect with that of ether and morphine
or chloroform and morphine.

(3) To compensate the defective lung ven-
tilation, due to morphine. His conclusions,
which should be read in connection with the
remarks in the *'Univ. Med. Record,** Septem-
ber, 1912, No. 697, and October, p. 335, are
that:

(1) The use of morphine, atropine, and
scopolamine in mixed narcosis appears to be
justified; with the exception of the employ-
ment of atropine and scopolamine to compen-
sate the respiratory depression caused by mor-
phine.

(2) Neither atropine nor scopolamine com-
pensates the respiratory depression caused by
morphine. In the severe form of depression
they are incompetent, whilst in the milder
forms the augmentation is of too short duration
to be of service in clinical usage.

(3) During employment of the closed
method of mixed narcosis, respiratory depres-
sion does not occur. When marked depression
occurs in the open ether method of mixed
narcosis, the closed method should be substi-
tuted. Should marked depression be found to
continue after the operation and to cause anx-
iety. CO, should be administered, much diluted
in the inspired air.

(4) If the dosage be confined to the lowest
useful limit — say % to % grain of morphine
for adults and 1/100 to 1/150 grain of atropine
or scopolamine — ^and the anesthesia by open
ether be not carried to too deep a level,

*C. P. Embley, M. D., AustraUMian Med.
Jour., Aug. 17, 1912.



marked respiratory depression will rarely oc-
cur.

(5) In the small minority of cases. in which
morphine causes marked respiratory depres-
sion, it is due to abnormal innervation of the
respiratory mechanism, when even the small-
est serviceable quantity of morphine will bring
it about.

(6) Omnopon appears to offer a way of ob-
taining the advantages of mcrphine in mixed
narcosis with a diminished risk of respiratory
depression.

(7) In the mixed narcosis of chloroform,
respiratory depression Is apt to be absolute
and persistent in cases of abnormal innerva-
tion. Such cases are not necessarily danger-
ous, providing that artificial respiration be
maintained till autonomic breathing returns.
The administration of CO, during artificial
respiration is the best treatment. The CO, of
course, should be used so that some approxi-
mation to 5 per cent, be inspired inter-
mittently.

(8) Clinical experience of omnopon, scopo-
lamine, nitrous oxide and oxygen, with ether,
favorably impresses. The after effects are
much less and the patient lees unhappy on
recovery. Much less ether is used than by
other methods.



Treatment of Erysipelas by Tinctare of
Iodine.^ — Binet reports the results of a series
of cases of erysipelas treated by swabbing over
the affected area with tincture of iodine. He
points out that the disease is a dermatitis, and
consequently that if the streptococci, which
swarm in the compact meshes of the skin, are
to be destroyed, it is necessary to use an anti-
septic which can be absorbed. Iodine answers
this want, but its absorption varies consider-
ably, according to the conditions under which
the swabbing is made. Faults of technique are
responsible for the most part of the failures
o^ this method. It is absolutely necessary to
follow up the application of the antiseptic with
a dressing composed of sterile compresses or of
simple sheets of wool. The tincture of iodine
dries up and forms a pellicle on the surface of
the epidermis. It is, therefore, necessary also,
when a fresh swabbing is required, to begin
by removing this iodic pellicle, and clean the
epidermis with either a little absolute alcohol
or glycerine. The skin must be quite dry be-
fore the iodine is applied.

To avoid excessive concentration, Binet di-
lutes the tincture of iodine with alcohol, and
adds a small quantity of guaiacol.

5 Guaiacol gr. xlv.

Tincture lodi,

Alcohol Absolut aa Ji.

Misce.

The guaiacol is absorbent, analgesic, and
antithermic. The first swabbing with iodine is
made freely over the whole surface of the
erysipelatous area, even going beyond its bor-
ders to prevent serpiginous invasion of the in-



^ Revue MedioaJe.



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Fbbbuart^ 1918.
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fection, and an Impermeable dressing is ap-
plied. The next day but one, and each sub-
sequent day, the swabbing is repeated. After
the second or third day a very apparent change
is produced in the affected area. Instead of
edematous tissues, tight and shining, is found,
on the contrary, a skin which has passed into
a condition of subsidence. The epidermis
seems shrivelled and dried up; sometimes it
has cracked, laying bare in narrow fissures
the underlying dermis. Towards the fifth or
sixth day peeling occurs, and then the swab-
bing must be stopped, otherwise the caustic
action of the iodine will produce scars. With
the improvement in the local condition, the
general condition recovers.



HYGIENE AND DIETETICS.

Eating and Overeating.*— The majority of
people eat too much. It is safe to say that the
average man eats four times the quantity neces-
sary to sustain life, or to keep him in good
health. He eats, not because he is hungry, but
for fear that he may be hungry before the next
meal — even indulging in a hearty meal when
in an exhausted condition. At such times the
digestive organs are unfit to digest an immoder-
ate quantity of hearty food. Oftentimer gastric
irritability, resulting from physical or mental
exhaustion, is mistaken for hunger. Genuine
hunger is one of the most delightful sensations
experienced by man. When a person is very
tired, instead of sitting down to a hearty meal,
it is better to take a little hot soup or milk,
when in the course of ten or fifteen minutes, he
may with safety begin to eat slowly, masticat-
ing thoroughly, and should stop eating before
he experiences a feeling of satiety. Such a
course will result in a return of gastric vigor,
and if this practice be religiously followed one
will rarely suffer from indigestion or "dyspep-
sia." Our appetites are difficult to master, but
when once under perfect control a long stride
has been made in the matter of self-discipline.

One should not confine himself to a strictly
vegetable diet, neither should eat too much
meat "In older countries, the lower orders, as
a rule, have but a low vitality. It may be
truer to say that the vital volition is weak.
Let the learned settle the definition. The fact
is easily accounted for. During generations
the majority of European agricultural popula-
tions lived upon vegetable foods, like the
majority of Eastern Asiastics, and with the
same result. Hard labor produces hard muscles,
but vegetable food yields a low vital tension,
so to say. Soldiers know it well enough. The
pale-faced city clerk who eats meat twice a
day, will outfight, outlast and outstarve the
burly laborer, whose big thews and sinews are
mostly compounded of potatoes and water."
Man is an omnivorous animal, his teeth show
it, and he should recognize this fact and gov-
ern himself accordingly. Don't be like the

» Dietetic and Hyffienic (Gazette, Nov., 1912.



people David referred to, "Their soul ab-
horreth all manner of meat; and they draw
near unto the gates of death." Eat vegetables,
eat meat, but eat sparingly, especially as you
advance in years. As a man grows older, as
Dr. Love tersely put it, "he should eat lees,
drink less alcoholics, worry less, frivol less,
work less, but do better work, and eliminate
more waste matter." Moderation, then in meat
eating, with moderation in the consumption of
vegetables, other things being equal, should
make a man "healthy, happy, and wise."



How to Avoid taking Cold.**— "Everyone
catches cold — that means everyone at ir-
regular intervals suffers from a simple cold to
a severe pneumonia. A simple cold with acute
nasal congestion is an unmitigated nuisance,
while a severe pneumonia is one of the
tragedies of physical life.

**I believe," says Dr. Richard Ellis (Medical
Record), "I have found a way by which most
"colds" can be conquered if fought at their
birth. Some years ago a friend said to me,
'when I feel a strong draught blowing on my
bald head I always rub it hard — ^that brings
the blood back, and so I avoid taking cold.'
Later on I noticed that sneezing is always fol-
lowed by congestion of the face, especially in
those who sneeze heartily — ^that is 'Nature's
way of bringing the blood back,' said I, re-
membering my bald-headed friend. Acting on
this principle, I have experimented sufficiently
to know that 'bringing the blood back' does
drive away 'colds,' and that sneezing is
Nature's way of restoring (or trying to re-
store) the normal circulation when a surface
anemia has been caused by surface chilling.

Therefore, when the nasal mucous membrane
is first congested, and one feels he is 'taking
cold,' let him bend the body forward (as in
picking up a pin from the fioor) and 'strain'
gently till the face is red, then (in the erect
position) try to breathe through the partially
occluded nostrils; repeat this process till the
nostrils are freely open. Of course one should
exercise and take hot drinks till that chilly
feeling disappears, but that does not drive
away the nasal congestion which so often in-
troduces a severe cold.

This new method of avoiding 'colds* by
bringing on forced nasal hyperemia, and fol-
lowing this by patient nasal respiration till the
nostrils are freely open, 'sounds silly,' but
after three years of practical experience, I
have decided to publish this brief statement."



Birth Bate.— People thought that Germany
had but to sit tight and hold on and France,
in perhaps a couple of generations, would cease
to be a menace. The falling birth rate in
Prance was expected to take care of any dan-
ger from her.

But the official statistics of the medical de-
partment of the Prussian Ministry of the In-
terior that have Just been made public shed an
entirely new and alarming light on the mat-
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ter as far as Germany is concerned. So much
80 that the Government has decreed a thorough
investigation into the causes that are respon-
sible for the decline in the birth rate and the
methods by which it may be restored to normal-
ity.

The figures made public show that while in
1875 the births in the German Empire were
42.6 for every 1,000 of the population, in 1910
they had fallen to barely 31 per 1.000. That
the conditions were still worse in 1911 may be
inferred from the fact that in that year in the
Kingdom of Prussia there were 34,000 less
births than in 1910, 65,000 less than in 1909,
and 86,000 less than in 1908.



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