Under the above caption the Medical Review speaks of the over-use of the thermometer. The writer states that it would be a brave physician who when called to an acute case did not take the temperature. Furthermore, the thermometer habit seems 111 a measure to encourage laziness and lack of acuteness in observing other clinical signs and symptoms; in other words, the doctor feels that his duty is pretty well done in the matter of diagnosis when he has read the patient's temperature.

Another thing this writer points out is that we have no rational means of combatting an abnormal temperature so far as drug medication is concerned. Aside from hydrotherapy no method of combatting a fever directly has general sanction, yet the majority of doctors in the majority of cases give a high temperature a decided swat with some coal-tar or near-coal-tar preparation. By so doing the fever is at once sent on the downward trend and it is perhaps seldom that the patient suffers in any way from the medication. Still, such treatment must be applied judiciously or grave harm may follow.

We believe the clinical thermometer is a valuable instrument, especially as an aid in the diagnosis of tuberculosis in its incipiency. The excessive use of the thermometer, particularly by the laity, has a tendency to make too much of fever. It is incorrect to think of fever per se as a pathologic condition. The temperature should always point to the elements of causation. The laity should be taught that fever is usually conservative and is simply nature's method of pointing out a condition that is abnormal. It is an intense oxygenation at work endeavoring to burn up deleterious elements. No, we would not brand the thermometer as "useless," although there is no use of having our patients everlastingly sucking a thermometer to the extent of making it a hobby.

ORAL AND DENTAL HYGIENE.

In another editorial we have emphasized the value of early and persistent attention to children's teeth. It is equally true that much ill health and much suffering comes to the adult because of neglect of mouth and teeth. Doctors can do much good by preaching the gospel of clean teeth and clean mouths. It is a psychological fact that a person who forms the habit of brushing the teeth and lavaging the mouth regularly learns to enjoy it, and is actually uncomfortable when he can not perform these ablutions after having eaten or mussed up his mouth.

Decay of teeth, pyorrhea, gingivitis and many other untoward conditions get a hard jolt if a systematic hygiene is carried out. Any mild antiseptic may be used a part of the time. It need not necessarily be a strong solution. Boric acid, peroxide, listerine, lysol, any of these in proper strength are useful. We have found the ready-prepared tooth pastes to be good.

If the teeth are smudged with tartar it would be well to have the teeth cleaned by the dentist. Appropriate attention will then prevent its formation and incidentally prevent tooth decay and pyorrhea. Do not use regularly any tooth paste or lotion containing a gritty substance, as this will act like a file and injure the enamel. If the individual prefers to remove tartar from the teeth himself, this may be done by wrapping a wisp of cotton on a probe, moistening it with peroxide of hydrogen and dipping it in pumice stone. This rubbed over the spots removes tartar. Finely triturated charcoal may be employed in the same way. These remedies should not be overdone. Neither should peroxide be used too freely, and carbolic acid employed for toothache has no salutary effect upon the teeth. The tooth wash on the whole should be mildly alkaline. Tender gums and pyorrhea are relieved by astringents and antiseptics, as witch hazel, alcohol, etc. The systemic condition should be looked into in stubborn cases. A deranged stomach with the eructation of gases may keep the mouth in a state of infection which reacts unkindly upon the teeth and gums.

EXCESSIVE VOMITING IN PREGNANCY.

Hyperemesis gravidarium or the distressing and dangerous disturbance of the stomach during the early weeks of gestation is a matter that always deserves careful and conscientious scrutiny on the part of the family physician. The authors describe three types of severe vomiting, known as toxic, reflex and neurotic. To assign a given case to any of these three categories is sometimes a difficult matter. In fact it is likely to partake in a measure of all of them. It is especially hard to disassociate the toxic and neurotic. It is probable that when the trouble exists as a so-called neurosis there are underlying tangible factors of causation if we but find them. The renal and hepatic functions are usually a storm center. Constipation with its attendant autoinfection from this source must bereckoned with. It is evidently true that the psychic element has much to do with this type of vomiting, and this is compromising to life and strength if it is so extreme as to permit nutrition to slip below par.

These cases demand careful watching. The woman may exaggerate her nausea in the presence of the physician; she may take nourishment when alone. Subjective symptcms should be taken for their actual worth. If the case does not yield to treatment the uterus should be emptied after the concurrence of two other physicians has been obtained. A few of the symptoms which augur for a termination of the preg. rancy are, increasing weakness and emaciation, rapid pulse, tendency toward collapse and the persistent ejection of both food and water. Before radical measures are determined upon the woman should rest in bed a reasonable length of time and all food and drink taken in a recumbent position. High bowel flushings should be employed until the intestinal canal is thoroughly emptied, and these followed by a quantity of normal saline solution slowly introduced into the bowels. A few full doses of calomel will do no harm. One or two of the five hundred remedies for vomiting of pregnancy might also be tried.

The best way to prevent blindness is to prevent gonorrhea.

THE SALINE SOLUTION.

The value of the saline solution when the patient is depleted from blood loss is too often overlooked or neglected. The general practitioner meets cases of labor and abortion quite frequently in which there is a measure of exsanguination and consequent grave weakness. In such conditions the "boost" of a little salt water is almost magical. It gives immediate improvement of the untoward symptoms as well as greatiy promoting ultimate recovery by shortening the period of convalescence. If you have not at hand an outfit for throwing the solution into the subcutaneous tissues or into a vein, a very good alternative is to administer it as a high enema. Attach a large-sized soft rubber catheter to any kind of syringe and put a pint of the solution into the rectum. This should be done very slowly in order to allow absorption and not too much solution employed at once in order that its expulsion may be avoided. If the water is expelled the operation should be repeated and persisted in until absorption takes place.

SUGAR AS AN ANTISEPTIC.

The application of sugar to wounds of all kinds has been practiced since goodness knows when. An old remedy for burns with the laity is an application of molasses. More recently sugar has been employed in intraperitoneal surgery and in other locations in which harmless antiseptics are indicated. Those who have investigated the action of sugar state that it has a disinfectant and antiputrefactive effect, dissolves fibrin, and incites secretory activity through decided osmotic action. In other words, it seems to be the opinion that sugar is a harmless, cheap and apparently sterile medicament for routine wound treatment.

Some physicians laud apomorphine in dry, explosive, irritative coughs. Most of my experience with it has been hypodermically. A physician should never be without a supply of hypodermic tablets of this medicine in his hypodermic case. When you need this you need it "quick and bad.”— Dr. Mitchell in Eclectic Med. Jour.

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RADIO-ACTIVE MEDICINES.

BY JOHN A. WELSCH, M.D., M.E., Ph.G.

Formerly Professor of Electro-Therapeutics, Minor Surgery and Anasthesia in St. Louis College of Physicians and Surgeons, and Prof. ElectroTherapeutics and Neurology in Hippocratean College of Medicine, St. Louis. Member of Eclec. Med. Soc., Mo., and National Eclec. Med. Asso., Amer. Cancer Research Soc.

Some two years ago my attention was called to this form of medication in an article in some medical publication, and afterward seeing such remedies advertised, I selected the one known as dioradin, marketed in this country by the Dioradin Company, of New York.

This remedy contains about 1/20000 milligram of radium chloride to the dose, in a fixed oil containing fractional quantities of iodoform, menthol and ether; each dose is enclosed in an amber glass ampoule, and is recommended that it be administered intra-muscularly.

I was induced to try this remedy in tubercular conditions having failed to find anything satisfactory along other lines of recommended treatment. I have also found it useful in other conditions, as the following case history will show:

Case 1.-Mrs. T., age 26, mother of one child five years old, had been in poor health and taking treatment from first one then another for two years; during the three months previous to consulting me, cough had developed with morning expectoration, night sweats, loss of flesh, evening elevation of temperature and weakness, together with pain in the chest. The microscope showed abundant tubercle bacilli in the sputum while fluoroscopic examination showed infiltration in the apex of both lungs.

Dioradin was administered hypodermically under strict aseptic precautions in the deltoid and intra-scapular regions daily

until ten doses were administered, then every other day until forty-three doses had been given. There was improvement noted in the cough and expectoration after the fifth dose, and the temperature remained normal after the fifteenth dose, all symptoms disappearing by the time the thirty-fifth dose was reached, and one week after the forty-third dose was given the patient was in perfect health and had gained twenty-three pounds, no tubercle bacilli in sputum, and lungs were clear under fluoroscope. It has been one year since treatment was discontinued and patient remains in perfect health. She is pregnant at this time.

Case 2.-Mrs. H., age 43, mother of six children, had been confined to her bed for four months, was being treated for pneumonia at the time I was called. She was having night sweats, almost continuous cough with copious expectoration, much emaciation, afternoon temperature as high as 103 deg. F., constant pains in the chest, marked lesions in both lungs. I advised the use of dioradin, explaining that the case was so far advanced that I had little hope of benefitting.

No microscopic or X-ray examination was made. Dioradin was administered the same as in case I-only twelve daily doses were given when the temperature record and pains began to show improvement, the temperature never getting beyond 100% deg. after the twelfth dose. The remedy was continued every other day and patient was up and around the house and yard by the time the twentieth dose was reached, and took the thirteenth dose in my office. Thirtyeight doses in all were given, and two weeks after the thirty-eighth dose patient had gained twenty-four pounds and was entirely free from symptoms and feeling well. It has been fourteen months since treatment was discontinued and patient has remained

free from symptoms and held her increased weight and strength, doing all of her housework. The only possible symptom has been occasional pains in chest of short duration during extremely cold weather.

Case 3-Mrs. S., age 24, mother of one child six years old. Symptoms, weakness, cough, expectoration, night sweats, loss of flesh; microscopic examination of sputum showed abundant tubercle bacilli, fluoroscopic examination of chest revealed marked lesions in apex of left lung. Dioradin administered hypodermically in deltoid and interscapular region daily for ten days, then every other day until forty doses were given; patient gained five pounds the first ten days, cough, pains in chest and other symptoms completely disappeared by the time the thirtieth dose was reached, and by the time the fortieth dose was reached patient had gained eighteen and one-half pounds, and declared she felt better than she had ever felt in her life. No tubercle bacilli in sputum and lungs clear under fluoroscope. It is eleven months since the treatment was discontinued and patient has retained weight and strength.

Case 4-Mrs. O., age 24, had a cough since childhood, had been treated much with little or no benefit. Fluoroscope showed lungs comparatively clear. No tubercle baccilli in sputum, much cough and expectoration and had been losing in weight for three months before consulting me.

Dioradin was administered in connection with other treatment, such as laxatives and the usual remedies for catarrh and chronic bronchitis, in the way previously described, daily for ten doses, interval of four days, then daily for from four to six doses with from four to six day intervals. This method of administration was made necessary on account of the inability of the patient to remain in the city for longer intervals regularly. A total of forty-four doses of the dioradin was administered, cough entirely gone, no expectoration, gain in weight eight pounds. It is eight months since treatment was discontinued and patient has had no return of symptoms of any kind.

In cases 1 and 3 no other medicines of any kind were administered; in case 2 laxatives were necessary and a few doses of codein grain were given in the begin

ning to relieve pain and cough; in case 4, the regular treatment for bronchial catarrh was administered in connection with the dioradin.

I have also administered this remedy in other cases where the results were equally as good, and in two well advanced cases where the results so far as a cure was concerned were negative, but the cough, pain and temperature were always modified and the sufferers made more comfortable.

The last case in which I have used it was a case of persistent cough following la grippe, man, aged 45, very weak, had been under treatment for several weeks without benefit. I gave the indicated medical treatment with an ampoule or dioradin in the deltoid region every other day, together with the static positive headbreeze; after eight doses, covering a period of sixtecn days, cough was gone, appetite and strength returning, the patient has been working at his occupation of stationary engineer daily since treatment was discontinued, some two months ago.

As the case histories point to the results, I shall limit my comment and only say that it is recommended to use the remedy intramuscularly; having tried it thus as well as hypodermically I have been unable to discover any advantages over the ordinary subcutaneous injection, and if strict aseptic precautions are used there will be no local irritation.

Hannibal, Missouri.

TREATMENT OF TYPHOID FEVER.

By D. W. REED, M.D.

Do people ride hobbies? Yes; I ride a hobby, and that hobby is the treatment of typhoid fever. But I think I have a right to that hobby, because I have treated typhoid twenty-four years, and have never lost a case. True, some of them have been very sick, but they have been the exception and not the general rule.

Would you like to know how I have treated them in order to avoid death in twentyfour years? That is just what I want to tell you, so that if you have lost some cases in the past I may give you at least one helpful idea that may enable you to

save some victim of the disease that would otherwise be lost.

First then I wish to say that I do not fold my hands and do nothing till I can get a positive laboratory test, but get to busi

ness at once.

The most important item concerning the treatment of typhoid fever is the correct diet.

During the first two or three days the diet should be acidulated water. No other food is necessary. The physician's attention should be given chiefly to cleaning out the alimentary canal as thoroughly as possible. The chief abode of the typhoid germs is the alimentary canal, hence if that is thoroughly cleansed the great majority of the germs are expelled.

The next point of importance is to make the alimentary canal so unfavorable a place for the multiplication of germs that what do remain there will not thrive and multiply, but will shrivel up and die.

The drinking water of the patient should be acidulated with hydrochloric acid, "C.P." a drop or two in each glass of water. Why acidulate it? Because the typhoid germs do not like an acid medium in which to grow. They prefer a medium that is neutral or slightly alkaline. When the patient has been thoroughly cleaned out and expresses a desire for food, acid fruit may be given in addition to the acidulated water mentioned above; and he need not be confined to one kind of acid fruit, either. Any kind of acid fruit may be given if stewed and made semi-liquid by passing through a sieve or colander. The acid that the germs dislike most is found in the juice of black grapes. Fortunately, that is the acid that the patient likes best and is most nourishing and refrigerating. Hence we would give him all he wishes of it. Also stewed apples, cranberries and any fruit, stewed and passed through a colander. It is better to leave out sugar. The above is the secret of my success in treating typhoid fever.

The other item in the treatment is hydrotherapy. I do not recommend the Brand method of "tubbing," as it gives too great a shock to the nervous system, and if the above ideas in regard to diet are carried out the Brand method is not necessary. If it is convenient to place the patient in a bath

tub it should he done when the fever be-gins to ascend. The water should not be more than two or three degrees below the temperature of the patient's body. The cold water tap may be turned on while the attendant stirs the water and rubs the patient till the temperature is as low as desirable-80° to 70° F. Time of bath, 15 to 20 minutes. The patient should then be put in bed between sheets and the moisture allowed to evaporate. This may be repeated as often as the temperature goes up to 102° F. If no bath tub is convenient, equally good results may be obtained by giving patient baths with the bare hands or with mits made of turkish toweling on the hands. If the patient shivers and dislikes cold baths, hot ones will accomplish the same result-the reducing of the fever. If the fever persists, as it sometimes will in spite of the above treatment, the patient may be placed in a wet sheet pack, with a cotton blanket over the wet sheet. The evaporation process continues for several hours in the pack and the patient may get much refreshing sleep. A cold wet compress should be kept on the head and throat. The above treatment does not exclude any medical treatment that may be necessary. I usually add sulphocarbolates or salol and occasionally resort to stimulants of some kind, but the cases requiring stimulation will be very rare if the diet and baths are given as above. I forgot to say that the hand or mit baths should be given every hour when the temperature is above 102° F. and a cool compress kept on the body of the patient from chin to thighs constantly between the baths, and changed as often as they get warm.

With this method you need have no anxiety about the nourishment of the patient, as he will be ill only a few days, and may then eat what he wishes. I do not give sweet milk or meat broths, simply because the germs multiply rapidly in them, and that is the very thing we wish to avoid. If we would use a little more "horse sense" in treating this disease we would have fewer cases to turn over to the undertaker. Greeley, Colo.

Do not forget that a persistent cough may be due to uterine reflex irritation.