Testa preparat

gr.

gr. gr. j

Sig. Give every two hours until the stools improve.

Bartholo suggests Fowler's solution, to drop with to 1 drop of laudanum, for mucous stools streaked with blood. He also recommends pecac for greenish stools with blood and mucus, and gives a teaspoonful of the spirit of camphor in four ounces of milk as a stimulant. For diarrhea continuing after the reaction is established, he gives inc oxid, bismuth and pepsin for the stomach, and copper sulfate for the bowels If there is nervous irritation or cerebral congestion he prescribes potassium bromid.

Brunton favors carbolic acid and bis

muth, and E. Smith pronounces a morphin hypodermic of from to o gr. with five drops of ether, the best treatment.

M. L. Brown has used potassium bromid with great satisfaction in this disease, and considers the drug a specific or physiologic antidote to the toxins that operate as a

cause.

Other authorities advocate the use of copper, arsenite, salol, resorcin, and the naphthols.

ACUTE ENTERO-COLITIS.

This is an inflammatory process of the ileum and colon, of a greater severity than that of dyspeptic enteritis, and chiefly affects the lymph follicles. It is a disease of the hot months and of teething, altho not strictly confined to the former, and is produced by the same causes operative for dyspeptic diarrhea.

4.

Acute entero-colitis has a temperature between that of dyspeptic diarrhea and cholera infantum, and is characterized by the presence of quantities of mucus in the stools, and by absence of vomiting, of colliquative diarrhea, and of collapse.

The prognosis is doubtful, much depending upon the strength of the child and upon whether the surroundings be hygienic.

Treatment should embrace the general dietetic and hygienic precautions advocated for the other forms of intestinal inflammation. Anodynes are necessary. The rectum should be chiefly used for the administration of drugs, particularly for opium when used.

Tyson prescribes solutions of nitrate of silver, one grain to the ounce, or tannic acid, five grains to the ounce, to be given as rectal injections. The mouth should be examined and the gums lanced so often as may be necessary for the coming teeth.

It should be enjoined upon the doctor that he carefully differentiate the form of disease, since the treatment varies in the different cases. Not all cases of infantile summer diarrhea are cholera infantum, and the treatment for cholera infantum would be far from apposite for diarrhea of the acute dyspeptic type. The differential diagnosis is clear and should be closely

made.

It is difficult to secure the retention of the stimulants which are so necessary to tide over the period of collapse. Iced champagne may be given in small doses, often repeated, and brandy in cool water will be of benefit. If liquids are rejected, do not be discouraged from repeating their administration.

The matter of the microbial origin of infection in the diarrheal diseases of chil- /: dren has been thoroly investigated by Dr. Charles G. Cumston, who concludes:

(1) The bacterium coli communis appears to be the pathogenic agent in the greater number of cases.

(2) This organism is frequently associated with the streptococcus pyogenes.

(3) The virulence, more considerable than in the intestine of a healthy child, is almost always in direct relation to the condition of the patient at the time the

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culture is taken, and does not appear proportional to the ulterior gravity of the

case.

(4) The motility of the bacterium coli is generally proportional to its virulence. The "jumping" movement, nevertheless, does not correspond to an exalted virulence in comparison with the cases in which the motility was very considerable without exhibiting these jumping movements.

(5) The virulence of the bacterium coli found in the blood and other organs is identical to that of the bacterium coli taken from the intestine of the same individual.

CHOLERA MORBUS.

This is sometimes called sporadic cholera, and is an acute gastro-intestinal catarrh, characterized by profuse vomiting, purging and painful cramp. The disease is self-limiting, and is characterized by a brief course. The prognosis is generally favorable, altho fatal cases sometimes occur in persons suffering from chronic kidney affections or heart disease, or in the very old or very young.

It is supposed to be of microbic origin, altho this has not been definitely proved. TheFinkler and Prior" bacillus is found in the discharges with considerable constancy, and this closely resembles the comma bacillus of true cholera. Hence it has by some been considered the exciting cause. Exposure to cold and wet and improper food are often the immediate occasion for the attack.

The onset of the disease is often sudden, beginning with severe vomiting of the last food ingested, then of bile, and lastly of watery fluid. Simultaneously discharges from the bowels will begin, and these will finally assume the "rice water"

appearance of true cholera. Following each spasm of vomiting and purging will be severe cramping pains, at first of the abdomen, later extending to the general muscular system, especially to the calves of the legs. This is due to the sudden abstraction of liquids from the system. There is also intense thirst, and generally fever, characterized by a higher internal than external temperature.

Since the symptoms caused by poisoning by arsenic, antimony and toadstools are

similar, care must be taken to exclude these. In fact, it has been stated by a high medical authority that three-fourths of the deaths reported as due to cholera morbus are instead cases of arsenical poisoning.

In treatment the diet must be rigorously restricted, predigested foods having the preference when it is necessary to supply nourishment. Opium is almost essential to the successful treatment, but this is best given hypodermically in the form of its alkaloids. Larger doses than usual should be employed, nothing less than at least grain being of much use for an adult, and even and grains being well borne. It is best to begin with the smaller dose and gradually increase until the maximum is reached. Mustard plasters should be applied over the abdomen until the skin shows redness, and then should be followed by linseed poultices to be worn constantly. Absolute rest should be enjoined. If a cold stage supervenes, use the hot bath.

If the immediate cause is the ingestion of irritating substances, it is sometimes well to clear the intestinal tract by a prompt but mild laxative. For the nausea, thirst and weakness, give brandy sprinkled upon chipped ice. If obtainable, the use of champagne will often bring about the happiest results.

If collapse begins, inject whisky and ether under the skin. The injection of large quantities of water into the bowels is advocated to supply the loss of water from the system. If absorption from the bowel is not sufficiently rapid, the normal saline solution may be injected in amounts varying from one-half pint to one quart per day.

Waugh advocates the administration of five drops of chloroform in a little water every five minutes until the pain is controlled, and says that hot applications to the epigastrium or over the right pneumogastric nerve in the neck are valuable adjuvants. He gives this prescription :

Sig. Tablespoonful every two hours.

A woolen bandage should be worn after recovery and the after-diet should be particularly bland and unirritating.

Ringer prescribes camphor, gives veratrum album for vomiting and in the earlier stages gives lead acetate.

Da Costa prescribes the usual eliminative and anodyne treatment with the addition of chloral, one part, to five of soap liniment, rubbed on the abdomen for cramps.

Bartholow claims that chloral by enema is the best treatment, but says that carbolic acid with bismuth is very efficient. He gives morphin hypodermically in very full doses and iced brandy for the vomiting.

Other remedies recommended are; ipecac by Waring, (who does not believe in the use of stimulants,) and columbo as an antiemetic by Phillips who also thinks sumbul and oil of cajeput excellent remedies. For heart failure Phillips gives a mustard emetic.

HAY FEVER, "JUNE COLD" OR "ROSE COLD."

This is a catarrhal inflammation of the

upper air passages, occurring thru the summer months, and is associated with asthmatic dyspnea. It is most intractable to medical treatment, and seems little benefited by anything short of change of

scene.

Occasionally operative treatment on the nasal cavities, such as correcting deviations, removal of hypertrophic processes by the knife, or actual cautery, have produced total cures. Palliative treatment is most uncertain.

Irrigating the nasal passages with a weak quinin solution has sometimes proved very beneficial. Internally quinin and Fowler's solution seem to give the most beneficial results; but the administration of chloral in small doses (24 grains), frequently repeated, has many advocates.

The above covers the field of the diseases

especially likely to be encountered during June, and is a summary of the best thoughts of the leading authors in this country and abroad. Still, it is possible that sometimes cases may occur which are not typical in their course, and yet require immediate attention and the promptest treatment. In such event it is almost always safe to assume that cases of intestinal inflammation are due to the presence of irritating substances, and whether such are merely articles of food or are some specific microbe, it is well to adopt an antiseptic mode of treatment for the general indications, and to prescribe anodynes for the attendant pain. Stimulants are always necessary for symptoms of collapse.

Necessarily in such sharp attacks there will not be time to report your cases to THE WORLD Symposium for consultation in time to receive any material assistance; yet, the next case may benefit by suggestions thus gained. After all, the typical cases are not the terror of the general practitioner. It is those which seem to indicate mixed infection, which are in some way abnormal in their course, and which veer around the medical horizon like a

needle when disturbed by a magnet, that In such, as in all pertry men's souls. plexing cases, let us have your difficulties, and see what can be done toward solving them.

*

In July issue we will present such a summary as the above on the various forms of sun stroke, or heat stroke, with treatments for the same. Send communications on this subject, giving your experience, in time for July issue.

ORIGINAL COMMUNICATIONS

Short stories on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treat

ment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN. COMPARE. RECORD.

READ.

REFLECT.

Summer Complaint and Antiseptics. Editor MEDICAL WORLD:-A correspondent writes that he has noticed my recommendation of calcium sulfocarbolate as an intestinal antiseptic in cases of tuberculosis, and says that he cannot find this salt in any work on therapeutics; hence he concludes I meant the sulfocarbolate of zinc. Now I have a habit of saying exactly what I mean, and tho the typesetter occasionally edits my mss. to the detriment of my reputation, on the whole I have very little cause of complaint. In this case he was right, for I meant just what I said. The calcium sulfocarbolate is furnished in excellent quality by Rosengarten, and is so useful a drug that its exclusion from any work on therapeutics speaks strongly against the value of the work. This salt is neither astringent nor irritant. It is efficient as an intestinal antiseptic, and is specially indicated in tubercular and scrofulous cases, in all persons who show a deficiency of lime in their tissues.

The three sulfocarbolates, of zinc, lime and soda, practically fill all requirements, and tho I have also the salts of potassium and ammonium, I only give these when I am combining other salts of these bases in the same mixture. 1

In the summer diseases of children there is abundant room for the employment of all three. My instructions to mothers at the opening of the summer season are simple and uniform. The house and surroundings are inspected. I never delegate this duty to any one else, but do it myself. It is amazing that people who know all about hygiene will neglect the most important rules of that science, and leave filth under their noses that can be removed with little trouble. For there is rarely to be found matters so serious that a day's cleaning up will not remedy. And yet the lives of the

little ones lie in those heaps of decomposing organic refuse. A man with a shovel and wheelbarrow to remove muck, a match and can of benzine to disinfect, can in a few hours prevent the development of cholera infantum.

It would be the saving of many lives if American mothers could be taught the truth about milk. Excellent as is that ideal food when in ideally perfect condition, it is beset with dangers at every step, from its formation in the mammary glands of the cow. She may be tuberculous, or otherwise unhealthy, ill fed and kept, dirty; she may be milked by dirty hands, into dirty pails, set to cool in a spring house in water that has passed thru the family privy, diluted with water from the barn-yard pump, the receptacle for surface drainage, sent to market in dirty cans, dispensed by dirty milkmen, or from little shops in which diphtheria, cholera infantum or other infectious diseases are found. And when the milk has passed safely thru all these perils, the mother puts it in a clean vessel and places it in a refrigerator, whence it is removed as needed, warmed, diluted with pure water, and administered at proper intervals, in suitable doses. in that refrigerator a bit of meat or fish has fallen down into an out-of-the-way corner and decomposed. Milk is remarkable in the facility with which it takes up the odor and the noxious qualities of any decomposition, or the micro-organisms of any infectious disease, with which it comes in contact, or even which exists in its near neighborhood. Typhoid fever has been imparted by milk, when the crocks were set in water running from an infected privy.

But

And even more: For if the milk has escaped all these dangers, it is liable to decomposition from causes arising in itself, without any extraneous causation.

Get this exclusive milk diet fetish out of your patients' minds. Let them learn to utilize properly the farinaceous articles that are suitable for young children, such as well-cooked rice, tapioca, sago, toasted bread or crackers, flour-ball, zwieback, pretzels, browned flour, arrow-root, farina, corn-starch, etc., preferably eaten with salt and butter, or meat-gravy, rather than sugar and milk, but always with the addition of a portion of some form of diastase or malt-extract.

Milk must be replaced by other albumenoids, selecting those that can be had of undoubted wholesomeness and of easiest