NOTES: AND ITEMS knowing how much in surgery depends on these, that we have little time and thought to spare for scientific prin ciples. We may, therefore, profitably remind ourselves that our art is better just in proportion as our science is broader; that for true progress the two must go tion. In the Charter of the Welsh University, (Med. The New Welsh University and Vivisecforward abreast; and that, though great things have been accomplished in our time, much more remains to be done. Times and Hosp. Gaz) which is now before the English Parliament, there is a clause expressly forbidding the practice of vivisection in the School of Medicine which it is proposed, under the Charter, to establish at Cardiff. This prohibition was demanded by the Marquis of Bute as an essential condition of his helping to endow the institution. The Marquis is one of the Vice Presidents of the Anti-Vivisection Society. A New Method for the Radical Cure of Varicose Veins.-Recognizing the deficiencies of these modes of treatment (Laplace, Jour. Am. Med. Ass), we proceeded to treat the condition in a manner Brown-Sequards's Elixir.-As this eminent that would remedy it at once. The two great channels physiologist is reasserting with great confidences the that drain the superficial venous circulation of the leg therapeutical efficacy of testicular and other glandular are the internal or long saphena and external or short preparations, it may be interseting to cite negative evisaphena veins. These and their tributaries are the dence on the subject. Lo Sperimentale (of Florence) vessels affected in the varicose condition. The lack of quotes from the Riforma Medica the results of a long support, or any other cause act simultaneously upon series of experiments with the "liquido testicolare di every branch of the vein. The long saphena vein Brown-Sequard," undertaken by S. Massalongo. He commences in a minute plexus on the dorsum of the foot; it ascends in front of the inner ankle and inner side of the leg, behind the inner margin of the tibia. It drains all the anterior surface of the leg and the whole circumference of the thigh. wholesale obliteration of all the varicose veins of a limb, hence the cure. concludes that the testicular liquid of young and healthy mammals, injected hypodermically, has not the slightest effect upon the human organism; that the trifling and transitory modifications of circulation, respiration, temperature, and musclar power are explicable by the excitement and tension of the subject's mind; that any rare and transient improvement observed n the treatment of various organic diseases by this method was due to suggestion and the influence of imagination, to which causes alone is to be attributed the cure of some cases of hysteria and neurasthenia.-Dublin Journ. of Med. Science. The external or short saphenous vein drains the posterior portion of the leg and empties into the popliteal vein between the two heads of the gastrocnemius muscle. This being the case it occurred to me that if obliteration of the varicose veins was the essential fac tor in the cure, it might be possible to obliterate all the surface venous circulation by ligating the long saphenous vein at the saphenous opening and the short saphenous The New Nerve Restorative-Kola.-Some vein between the heads of the gastrocnemius. Blood interesting information respecting the Kola plant has stasis must necessarily follow and a certain amount of recently been published in an official report by Mr C. edema. Elevation of the limb, and gentle compression F. Elliott on the botany of Sierra Leone (Med. Times with raw cotton and a flannel bandage soon overcomes and Hosp. Gaz.). The tree, Kola acuminata, Mr. Elthis. Rest in bed adds the final requirement to what liott says, grows freely everywhere, and is found from seemed to me a priori the ideal mode of obtaining a the sea level to fully 3,000 feet. It appears to thrive wherever planted, and is well able to hold its own in the original native bush. It begins to bear in seven years, and is in full bearing after eight or ten years. At present the nuts are chiefly used by the natives, but so much has been done of late years to bring their valuable properties before the public that it may be safely | said that the demand in Europe is sure to increase. The following are some of its properties: A nut, or even half a nut, will enable a man to go without food and support great fatigue for twenty-four hours or more. It is an excellent nerve tonic, and is especially good for keeping the brain clear and active at night. It, however, prevents sleep almost too thoroughly, and should not be taken less than four hours before bed. A property not understood is that of rapidly clearing foul water and improving beer. It is also said to remove immediately and thoroughly the unsteadiness and stupidity due to drunkenness. Mr. Thomas Christy, of The advantages claimed for this method therefore are, first, it deals with the cases of varicose veins at wholesale; second, the operation if aseptic, is harmless, easy, and with the help of cocaine, painless; third, it achieves that principle which we know underlies the cure of all aneurismal or varicose conditions, viz; an ultimate obliteration of the impaired blood vessel. This is reached by coagulation of blood and gradual ab sorption of the coagulum, while sufficient white blood corpuscles have exuded during the period of distension to subsequently build fibrous tissue which will contract upon the obliterated vein; fourth, until now we are not aware of any relapse; fifth, a cure seems apparent in from two to three weeks. 1 Lime Street, E. C., has been very active in introduciug the Kola fruit to the notice of medical men in this country. The President's Health.-It seems a confirmed weakness of the secular press in dealing with the affairs of men prominent in public life, to announce them more or less incapacitated by illness--the habit of political opponents; or else suffering from an excess of good health -the habit of political supporters. So general is this cus tom of exaggeration that the public put little faith in reports on the subject. There is always a disposition on the part of friends to deny all rumors of sickness. This was notably so when Garfield was dying; also when Sheridan and Blaine were upon their death beds. The more prominent the man, the more he suffers from press reports, so that when actually sick or threatened by impending death, the true knowledge of the matter comes like a shock to the public. That it is fortunate the public is not generally aware of the truth is well illustrated in the present case of President Cleveland. The existing financial stringency, the commercial interests of the country and other questions of vital importance to the nation, have brought about a condition of affairs that alarm for the chief magistrate's health would make "confusion worse confounded," Sensational reports of President Cleveland's physical condition, together with some actions apparently inex plicable, have of late filled the secular press. The reports of ill health have been regarded in the same light as the reports of cowardice in meeting political emergencies. But it now seems that there was some foundation for the former reports, as it is asserted on what appears to be good authority, that not only was the President's health impaired seriously, but that he has submitted to an operation for immediate relief; and in hope of the ultimate cure of a serious condition. It is stated that Mr. Cleveland has been suffering for some time from a morbid growth "in the bones of the left upper jaw and nose," the nature of which could only be determined by microscopical examination; the infer ence being that the growth was malignant. The dis eased portion of the bone was thoroughly removed with out an external incision and the immediate recovery was complete. The operation was performed under nitrous oxide anesthesia, while the Precident was on board of a friend's yacht on the first of July last. None but the most intimate friends of the President were cognizant of his condition or of the performance of the operation at the time. Epilepsy and Chorea. Dios Chemical Co., St. Louis, Mo.-I find your Neurosine a valuable nerve tonic. I also find it the best remedy for epilepsy I have ever tried, and in chorea, I look upon it as the best. A. F. WATKINS, M.D., Potosi, Mo. Elixir Nutrans. Elixir Nutrans, although known to the profession but a short time, is always used again wherever tried. This tonic and stimulant has been successfully used by our most prominent physicians. In depression and melancholy its worth can not be over-estimated. Send to Allaire, Woodward & Company, Peoria, Ill., for literature on the subject from prominent physicians. Dysmenorrhea, Surprising Results!! Dios Chemical Co., St. Louis, Mo.-The Dioviburnia you sent me has proved itself a friend indeed. I used it in a case of dysmenorrhea with surprising results. I recommend its trial to all who are willing to trust to its efficacy, knowing well that it will give satisfaction. P. W. PEARSALL, M.D., Grand Lodge, Mich. Compound Talcum Baby Powder. Dr. Julius Fehr's Compound Talcum Baby Powder, the "Hygienic Dermal Powder" for infants and adults is advertised in this journal. It is a superior article and we recommend it especially for infants, but its antiseptic, antizymotic, aud disinfectant properties indicate its usefulness in all affections of the skin in adults as well as children. It is also used as a general sprinkling powder. Sennine in Eczema and Venereal Ulcers. EUREKA SPRINGS, ARK., Oct. 9, 1893. Dios Chemical Co., St. Louis, Mo. GENTLEMEN-The sample of Sennine you sent me came safely to hand, and I happened to have some cases that visited my office daily for treatment. In two cases of eczema covering the inner side of thigh I applied the Sennine just as I received it from you, that is, full strength, dry, and I I applied Sennine to venereal ulcer and must say that it did all any one could ask. I look upon Sennine as the antiseptic of all others and shall continue its use in my practice. W. R. HARDESTY. M.D. am happy to say it acted like a charm in both cases. Again Febricide Pills in Malarial Troubles. In malarial troubles we have a multitude of depressing symptoms which keep the system in a low condition. We find many similar symptoms in neurasthenia. Are not many cases of malaria (so-called) eally caused by a deficient action of nerve force from the cerebre-spinal system? If this is the case then we require a stimulating tonic to elevate these forces during this period of inaction, and by the elevation of these forces we restore the functions of life to a normal condition. Neuralgia caused by nervous depression must be corrected on a basis of common sense. If we administer anodynes the effect is only temporary. If the trouble is due to loss of nerve force we must raise that force to accomplish permanent relief. This is a practical manner of considering disease, and its scientific treatment. In the treatment of malarial troubles, neurasthenia and neuralgia, the profession will find Febricide Pills worthy of their consideration, as it is a combination of remedies which merits their confidence President Cleveland's wonderful self.control and en durance, and his intense devotion to the duties of his position have excited the admiration and respect of all, even his political opponents. The hope that the growth will prove benign, or if not, that the operation was entirely radical will be universal. Doubtless the profes- and which has proved most valuable in my experience with sion will soon be aware of the actual nature of the disease.-Med. and Surg. Rep. it. ELIAS WILDMAN, M.D., D.D.S., Ph.G., Jenkintown, Pa. Regular Weekly Issue, 10,000 Average Monthly 43,333 VOL. XXVIII. A WEEKLY JOURNAL OF MEDICINE AND SURGERY. ST. LOUIS, OCTOBER 28, 1893. ORIGINAL ARTICLES Mastitis-Its Treatment. BY M. R. MITCHELL M.D., Professor of Obstetrics, Kansas Medical College. Read before the Section of Gynecology and Obstetrics, at a Meeting of the Kansas State Medical Society, Topeka, May 12, 1893. NO. 18 prominence of gland, great pain, high temperature, no redness and often attended with chill. The third variety, the most common form, is parenchymatous, located in the body of the breast, commonly involving both the glandular and the interglandular connective tissue. Its special symptoms are circumscribed prominence and redness with the other usual indications of local inflammation and suppuration. Mastitis may occur in any case, and at any time during lactation, or even non lactation, but it is most apt to occur in the primipara, and in the first three or four weeks of lactation. In the primipara these rudimentary organs are at first severely exercised. Imperfect development or deThe sorrows of maternity do not end with bringing pression of the nipples intensify the effort to secure forth children. When the babe is first wrapped in swaddling clothes, the responsibilities of the obstetrician are but fairly begun. By derangements of the breasts great suffering is often experienced, the mothers convalescence much complicated, and the child's welfare sorely tried. One of the most common of these derangements is suppurative mastitis. The general indications are swelling, hardness of some part, or, it may be of the whole of the mammary gland, with tenderness, pain, lymphangitis evidenced by the appearance of red lines on the surface of the gland and in the axillary region, with more or less rise of temperature and pulse, and sometimes pronounced rigors. It is easily diagnosed from tuberculosis of the mammary gland by the indications of acute inflammation. The disease presents itself in varied degrees of intensity. From the tender lump to the multilocular abscess which occupies the whole of the gland filled with pus and broken down connective tissue, incurring weeks or months of intense suffering and exhaustion, with permanent impairment of function of the gland. For clinical study of the pathology and treatment experience perhaps justifies the usually classified varieties. Thus, first, superficial or subareolar, shown by soreness, redness, swelling at a point on the surface near the nipple, which soon suppurates. lactation, resulting in the wounding or removal of the epithelium. This mechanical irritation, with a want of cleanliness, produce excoriated or fissured conditions of the nipple which are the most frequent predisposing causes of the disease. The opinion has been quite prevalent that abscess of the breast may follow as a direct and necessary consequence of engorgement, caused by imperfect flow of milk, by drafts of cold air, blows and bruises. But this view is hardly consistent with the accepted theory of parasitic causation of suppuration. Such condicions can reasonably be regarded as only producing a susceptibility to abscess, the ultimate consequence of the entrance of microbes through the wounded epithelium of the nipple, or it may be rarely auto genetic, from the general septic character of the blood of the mother. In calling attention to the treatment I wish to emphasize the responsibility of the obstetrician as to the preventive attention. The primary care of the breasts should not be left to the patient and nurse, but shonld have at least the personal direction of the obstetrician himself. Necessary precautions to prevent excoriation of the nipples should be minutely directed, and particularly as to thorough cleanliness and protection of the nipples from irritation. A good rule from the first, after each nursing, is to cleanse the nipple with a saturated solution of boracic acid, also the child's mouth with the same solution. Endeavor to guard against over-distension and conSecond, It is submammary, deeply seated in the con- gestion of the breast by suitable compression and supnective tissue between the gland and the pectoral port. If excoriation or cracks of the nipples appear, the muscles. The symptoms are general swelling and above cleansing should be kept up, also boracic acid ointment, or the Co. tr. benzoin may be applied with great benefit, and the breasts kept carefully covered with dry absorbent cotton. Too frequent or prolonged nursing must be avoided. If the fissures become deep, nursing must be suspended for a time. In case of a circular fissure at the base of the nipple a few applications of collodion with a little cotton may render such protection as will secure healing of the fissure. Great benefit is sometimes rendered by touching these fissures with the pointed stick of nitrate of silver. In many of these cases of excoriation and fissures of the nipple, a suitable shield may often be effectually used, the process of nursing continued with little pain and the restoration of injured nipple attained much more readily. But if nursing is attended with considerable pain, and there appears any indication of threatened inflam mation and suppuration of the breast, nursing should certainly be suspended, strict antiseptic care pursued, engorgement relieved by compression and support of breast bandage, a skillful and intelligent application of massage with some emollient, an occasional bathing of the gland with solution of acetate of lead and opium, repeated doses of a saline laxative, which by its deriv ative effect assists in draining the lymphatic channels of the mother, should be given. The chief points to be observed then are prompt prophylactic attention, especially to the nipple. If abscess is imminent, or does already exist, take the baby from the breast, secure rest to the organ, immediately evacu ate the pus. Thorough cleanliness and antisepsis all the way through should be rigidly employed. If the whole technique of attention embracing the above as the principal points, are strictly carried out, under the personal supervision of the obstetrician, childbearing will be deprived of at least some of its horrors. Alumnol in Rhinolaryngology.—For the investigation of the value of the new soluble preparation of alumnol, designated by the above name, in affections of the upper respiratory tract, we are indebted to Dr. Albert Spengler, Assistant Physician to the Heidelberg Out-Patient Clinic for pharyngeal, laryngeal and nasal diseases. The cases (twenty in number) were chiefly various forms of acute and chronic inflammation of the mucous membrane and the remedy used was in one-half, one, two, five and ten per cent aqueous solution. The duration of the treatment in acute cases, varied from a few days to two weeks, and in chronic cases, from one to two months. In two acute cases of pharyngitis, cure was effected in from four to eight days, and in two of the chronic form, in two to four weeks, by painting with five per cent alumnol solution, in four cases of chronic pharyngitis, decided objective and subjective improvement was obtained. Such troublesome symp. toms as feelings of dryness, stinging pain sometimes shooting to the ear, slight loss of voice, disappeared, while at the same time the mucous membrane assumed a more normal appearance, and the volume of the secre tion was reduced. When suppuration becomes inevitable or has already set in, the question of lactation is an important one. If there is a reasonable hope of an early termination of the disease without serious involvement of the gland and a safe preservation of the function it should be done. When the abscess is superficial, or involves but a small portion of the gland we may expect to suspend the babe's nursing only temporarily, but in all aggra vated forms we should promptly decide to suspend it entirely. Whenever pus is formed it should be immediately sicca, became moister, and the secretion changed from evacuated by a free opening. In the submammary or parenchymatous varieties, where the pus is located deep in the organ the incision should be made only through the skin and subcutaneous tissue, then a grooved director should be forced into the pus cavity, along which may be passed a pair of scissors or spreadors, by which the opening may be enlarged so as to introduce the finger to break down the diseased tissues and open up additional cavities. Where the pus cavities are deeply seated, there should be free drainage and washing out with boiled water. In old cases when the pus has been decomposed, some antiseptic wash is indicated followed by an antiseptic gauze dressing. As a rule in these operations an anesthetic should be given. In all cases poulticing should be rigidly discarded, but absorbent cotton should be used as a dressing. In some instances hot fomentations may be temporarily applied where there is severe pain. After daily clearing out the pharynx with five per cent alumnol solution for only two or three weeks, the mucous membrane lost its dull dryness in pharyngitis thick tenaceous blackish brown masses, to a thin yellowish liquid of small volume. The five per ceht solution was eventually exclusively used, as weaker solutions proved inactive, and stronger were very irritating. In three cases of slight laryngitis acuta, cure was ef fected in four to eight days after treatment with twenty per cent alumnol solution, but in four cases of laryngitis acuta gravis, daily paintings with six per cent alumnol solution for a few days only, brought about a subjective and objective improvement. In one instance a very severe acute laryngitis with complete aphonia and manifest epithelial opacity on both vocal cords, improved with extraordinary rapidity on a daily applica tion of five per cent alumnol solution, so that within a week approximate cure was attained. The author in summing up points out that alumnol can do good service in various forms of laryngitis, especially pharyngitis sicca. Though not superior to a one or two per cent chlorides of zinc solution in theraThe general condition of the patient in many cases peutical effectiveness, it appears to be less unpleasant demands attention, such as support and rest. to the patient. Members of the profession who send us information of matters of general interest to our readers will be considered as doing them and us a favor, and we shall take pleasure in inserting the substance of such communications. Pfeiffer and Beck claim that it occurs in this fluid only in exceptional cases and that the bronchial tubes are the exclusive place of infection, Canon clings to his previ ously expressed view that the blood may be primarily infected. In Virchow's Archives, Volume 131, part 3, in an article: Die Influenzabacillen im lebenden Blute, he quotes a case in which he found influenza-bacilli in the blood of a patient who neither coughed nor expectorated anything during the whole attack, but, on the other hand, no bacilli were found in the blood of a few cases of influenza-pneumonia. Out of thirty-one cases twenty-two gave positive results with regard to the examination of the blood for the characteristic influenzabacilli, in the other nine the result was negative, but the cause of the latter result could be traced to either imperfect preparations or to the fact that the patients had passed the stage of fever, or were suffering only from some after-effects of influenza. In all positive cases the blood had been obtained at a time of the real attack of the disease. Based upon bacteriological ob. servations the possibilities of infection by influenza are thus formulated by Canon: 1. The influenza-bacilli enter the air passages and find a favorable soil for development; thence they enter the All communications for the editor, and all books for review, should blood-current but here development takes place only in be addressed to the editor, 914 Locust street. All letters containing business communications or referring to the publication, subscription, or advertising department of this REVIEW, should be addressed to 914 Locust Street, St. Louis. Entered at the St. Louis Postoffice as Second-class Matter. Department Editors of the "Review." We take occasion to draw attention to the fact that we have secured Dr. F. J. Lutz, Dr. W. B. Dorsett and Dr. E. C. Runge as Department Editors in General Surgery, Gynecology and Obstetrics, and General Medicine. This increase in the editorial management is quite an acquisition for the REVIEW, and will no doubt be welcomed by our readers. It will be our constant aim to furnish our patrons with the best possible information in the various branches of medicine, and hope that our friends will continue to help us in our effort to improve the usefulness of the REVIEW. Influenza. There is good reason to believe that the bacillus dis. covered by Pfeiffer and Canon is the cause of influenza. The bacilli are very small having, according to Sternberg, about the same diameter as the bacillus of mouse septicemia, but are only half as long. After they are stained they appear at first sight as diplococci, because the two ends of the bacilli are stained most intensely, but upon closer inspection a slightly stained middle piece will be noticed. According to Canon the bacilli a small degree. In this instance the catarrhal form of the disease is principally developed. 2. The influenza-bacilli develop in the air passages only to a small extent, but, finding a favorable soil in the blood, develop in large numbers. Then the clinical symptoms of a general infection are observed and the nervous form of the disease takes a place in the foreground, the catarrhal symptoms playing an inferior role or being entirely absent. 3. A conjoined intense infection of both, the bronchial tubes and the blood: The severe form with in tense catarrhal and general symptoms is the result. In our opinion these deductions appear exceedingly plausible and if the observations made by Canon are verified by other bacteriologists we would accept this explanation of the symptoms in the various forms of this disease as the correct one. Another interesting observation has been made in connection with this subject, namely, Canon has found objects in the blood of influenza patients which resemble those of the influenza-bacilli, but are but slightly stained. It is very probable that these are influenza-bacilli in a state of disintegration and since they have never been found in leucocytes this observation furnishes an additional argument for the bactericidal properties of blood-serum and that phagocytosis is not the only means which the animal organisma possesses to rid itself of an invasion of bacteria. The Etiology and Therapeutics of Lewis D. Mason, M.D., writes in the Brooklyn Medi occur in the blood of every influenza patient and, while cal Journal: The "alcohol habit," "drink craze," "thirst |