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reaction of the blood begins to become more alkaline. The uric acid is taken up, gets back into the blood again, and, by free diuresis and diaphoresis, it is washed out of the system.

The treatment of these cases is of much interest Drugs will do much to assist, but will not cure. The gouty diathesis is a food diathesis, and can be cured only by regulating the diet. The diet should be largely a nonnitrogenous one. Milk should take the place of meat to a great extent. A vegetable diet, which raises the alkalinity of the blood, is to be advocated. All in dulgene in ales, beers, wines, etc., which lower the alka linity of the blood, and consequently favor retention within the system of the uric acid compounds, should be prohibited, From what has been said the raison d'etre for the water cure, the hot springs cure, the grape cure for chronic rheumatism and gout, will readily be seen.

If a person has a large amount of uric acid stored up in the system and begins the use of alkalies, and puts himself on a vegetable diet, the acid is dissolved and comes into free circulation in the blood. The effect of this is to make the person feel very ill. A large amount of uric acid in the blood deranges the circulation seriously, and gives rise to severe headache and mental depression. This accounts for the violent headaches that so many experience in connection with a uric acid wave. The arterioles are contracted, and the circulation through the brain is decidedly deranged. Certain The action of drugs would require too much time for drugs and acid drinks will throw down the uric acid this paper. One thing I may urge, namely, that the out of the blood, but at the expense of a recurrence of sodium salts are not so good as the potassium salts, for the rheumatic pains in the joints. the sodium compounds with uric acid are not so soluble Prof. Lange has given a great deal of study to the as the potassium compounds with the same agent. important fact that suicides prevail in the hot months. Further, it may be mentioned that lithium salts are Indeed, July has been called the month of suicides. almost valueless in the treatment of the uric acid This can to a great extent, be explained by the fact diathesis. Potassium salicylate is better than sodium that the blood at this season of the year is in the con- salicylate. The views that rheumatism is due to some dition of uric acidemia. The arterioles are contracted, nervous condition, to a germ, or to lactic acid, may be and the cerebral circulation not free. Mental depression dismissed at once, and the treatment consequently difollows. In these facts we have an explanation for the rected in proper channels. fact that suicides are more frequent during the hot months than at any other season of the year.

In various papers during the past four years I have The Necessity of a Pure Water Supply in the Conduct of Hospitals and Public

shown the relationship existing between uric acid in the
blood and epilepsy, migraine neuralgia, uremic con.
vulsions, and some allied conditions.
These papers
have appeared at different times in the Medical News,
Therapeutic Gazette, and Alienist and Neurologist. So
far as these observations go, they all tend to confirm
the ground so ably maintained by Haig

Institutions.

In determining the location of hospitals, asylums, re formatories, and penal institutions, the most essential requirement is an adequate supply of clear, pure water (Dr. T. W. Huntington in Occidental Medical Times). This is a matter that is paramount to all others. Unfortunate climatic conditions or topographical faults can be met or obviated in most instances by scientific

to such enterprises, if the water supply be known to be deficient in quantity or in any manner contaminated or subject to contamination.

It is a well-known fact that during fasting the alkalinity of the blood falls very considerably. Any uric acid in the blood would tend to be precipitated. This measures; but no locality can be regarded as adapted fact was especially emphasized by Sir W. Roberts a short time ago. He made it clear that, to those who are subject to renal calculi, the greatest period of danger is toward morning, when the acid wave sets in. To guard The general subject of the relation of the water against this acid wave and the formation of renal cal- supply to public health, and its bearing upon endemic culi, he urges that the person should live on a nongouty and epidemic outbreaks of disease, has been often and diet, should take some digestible nourishment a short thoroughly canvassed. Recent investigations have time before retiring, and some alkali at bed time. For proven beyond doubt that an isolated case of typhoid this purpose he recommends a good dose of citrate of potash in a glass of water. All this is thoroughly scientific. The alkali, in these cases, may do good or may do no good, just as it is given at the right time or

not.

Those cases of dead hands, where the circulation is almost arrested in the fingers, due to contraction of the arterioles, are due to the uric acid diathesis. This distressing condition is an ally of gout. The great majority of those intense headaches of the migrainous type are nothing other than one of the protean forms of the same condition.

fever or cholera has, by impregnation of watercourses, imperilled the lives of communities. Hence in institutions devoted to the wellbeing of large numbers of inmates, all subject to the same conditions and exposures it is apparent that the utmost caution should be exercised in securing absolute immunity from any disease breeding element.

Nor is it alone from the standpoint of drinking and cooking water that this source of possible danger should be carefully scrutinized. The risks to human life may be in plumbing choked by gradual deposits of filth in discharge pipes, in the implantation of germs in the

crevices of floors, in bedding ond clothing, and exposure in bathing.

ABSTRACTS

Upon no class of persons are the exactions for absolutely pure water more imperative than the modern surgeon in the treatment of open wounds. Asepticity, What are the Indications for Abdominal which means the highest possible standard of cleanli- Section in Intra-Pelvic Hemorrage.-M. ness, is the first and most positive requirement in deal- Rosenwasser, M.D., Cleveland, O. (Amer. Gynecol. ing with this class of work, and to bring in contact with Journ.) says: Sufficient clinical evidence has now exposed tissues a fluid that is known to contain a accumulated to demonstrate that a differential diagnosis certain proportion of organic matter, is little short of between extra and intra peritoneal hematocele cannot be criminal. While it is true that by careful manipulation made. It is therefore suggested to divide intra-pelvic impure water may be rendered inoccuous, yet how hemorrhage into free and circumscribed. We control much more perfect immunity from danger there is in the former by abdominal section, how shall we manage absence of pollution in the original material.

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the latter? Ruptured tubal pregnancy has, in most cases, been found to be the cause of both vaireties; hence the tendency of those entertaining advanced views to treat all intra-pelvic hemorrhages alike-by section-as the shortest and safest way out of a serions dilemma. The fact that circumscribed pelvic hemorrhage is quite common, and that cases often recover without operation, and that it is quite possible to distinguish and separate cases requiring operation from those likely to get well by rest alone, makes the author doubt the propriety of promiscuously throwing all into one group, subject to abdominal section. Only cases giving evidence of infection, or of continued growth of tumor, or of interferense of vital functions by pressure, or of secondary rupture, are properly subject to operative treatment.

A table of sixteen consecutive cases of circumscribed pelvic hemorrhage is submitted and analyzed to substan. tiate the views expressed. There was a definite indication for operative treatment in but six cases. Of the remainder, nine recovered by rest, and one was operated at her own urgent request. Her recovery was unevent

4. Diuretin acts chiefly on the renal epithelium. 5. Contrary to what has been pointed out by Schro-ful, but she now has a ventral hernia. Guided by his der, diuretin acts as a poison on warm-blooded animals, and, above all, on the nervous system. In no matter what doses given, it excites the brain.

6. Under the influence of diuretin, the heart beats become more frequent, and in the larger doses the beats became irregular. Death takes place through its action on the heart and respiratory organs.

7. The fatal dose of diuretin is seventy centigrams per kilo. of animal's weight. Of course, there are individual idiosyncrasies.

8. Non-toxic doses of diuretin produce a temporary rise of temperature; a toxic doses produces a marked rise of temperature that persists until death.

9. Diuretin has undoubtly an effect on the muscular system of both warm and cold-blooded animals.

own experience, the writer would advocate vigilant delay, until the operation is definitely indicated.

The so called advantages of early section lose all value when operation is unnecessary.

First,as to control of hemorrhage.-Section is uncalled for when hemorrhage has ceased and the mass is shrinking. Final absorption is effected by rest in bed. Secondary rupture is rare, and the dauger arising therefrom is offest by the danger incident to unnecessary operation.

fully disposes of the debris in at least sixty per cent of these cases, only the minority will require operation in the event of suppuration or of pressure symptoms.

Second, as to removal of debris.-As nature success

Third, as to the removal of ruptured tube.-The appendages, in cases recovering without operation, and in

10. In large doses, diuretin brings on vomiting and those treated by vaginal inision, are not touched, and frequent liquid stools.

11. Diuretin has a sialagogue action.

12. Diuretin is not cumulative.

even in cases treated by abdominal section, they are left undisturded-no harm following.

Fourth, as to safe and speedy recovery.-Though the 13. Diuretin has an action on cardiac muscle analo- risk of death by operation be but a fraction, the danger gous to the action of the accelerator nerve. of chronic invalidism from ventral hernia, intestinal ad

14. In all doses, diuretin diminishes arterial pressure. hesions, and, rarely, from fecal fistula, ought to be suffic-Revue Chirur; Can. Prac. ient to deter one from operating for the sake of speedy

recovery. The writer offers the following conclusions: at the end of 10 minutes, giving it by the rectum. Here

1. Intra-pelvic hemorrhage may be free into the peritoneal cavity, or primarily or secondarily circumscribed by true false membranes.

2. Though nearly always due to ruptured ectopic pregnancy, the same surgical principles underlying the treatment of other hemorrhage are applicable in intrapelvic hemorrhage.

3. Such treatment must, therefore vary according to the conditions, dependent primarily on the hemorrhage, and secondarily on the original cause of the hemorrhage; hence

we must observe that the rectal administration of iodide of potash is extremely painful, and the subject of exper iment is almost at once forced to expel the suppository. Accordingly, less than one gramme (the adopted dose) was absorded by the rectum.

Methylene blue imparted a coloration to the urine. within forty minutes after oral administration, and at the end of an hour and fifteen minutes when given per rectum.

Salol, taken by the the stomach, manifested itself at the end of thirty minutes; taken by the rectum alone, 4. To prevent free intra-pelvic hemorrhage, abdomi- after the lapse of four hours. This was to be antici nal section is indicated in all cases of presumably recog-pated, taking it for granted that the salol does not split nized, unruptured tubal pregnancy, either as prophylac-up in the digestive tube, save under the alkaline influtic, or for the purpose of removing pathological condi- ence of the pancreatic juice. tions not otherwise curable.

5. In all cases of free intra-pelvic hemorrhage, from whatever cause, early and immediate section is the only safe means of averting a fatal termination.

6. In circumscrbed intra-pelvic hemorrhage, section is indicated for removal of increasing blood clots and debris, whether due to recurring bleeding or continued growth of fetus.

7. In circumscribed intra-pelvic hemorrhage, section is necessary whenever the symptoms indicate decomposition of the blood-clot.

8. Section is also indicated whenever the pressure of the circumscribed blood-mass produces obstruction of the bowel.

As for the terebinthine, it required forty five minutes to communicate the odor of violets to the urine when administered by the stomach. Given by the rectum it never gave evidence of its characteristic odor.

"One of us," adds M. Main, "had attempted some time previously the employment of suppositories of santal. This product was not absorbed, and produced only an intense rectitis."

From these experiments it follows that all substances may in general be administered by the rectum. products, however, such as the terebinthine and the santal, would not be absorbed.

The speaker added that amongst the products directly soluble, which had been tested, the greater number pass into the circulation more quickly by the rectum than by the mouth. This is a new confirmation of the researches of Demarquay.

In the discussion which followed, M. Patein observed that salol decomposes, not only under the influence of the pancreatic juice, but also in the circulation.

M. Main: We simply wished to emphasize the fact that the decomposition of the salol in the rectum must proceed less rapidly, the secretions not being alkaline at the lower end of the digestive tube.

Experimental Researches on the Comparative Absorbing Powers of Stomach and Rectum.-At a recent meeting of the Societe de Therapeutique, reported in the Bulletin General, M. Main presented, on behalf of himself and M. Lemanski, the result of comparative investigations made, under M. Dujardin-Beaumetz, on the absorption of certain medicaments by the stomach and by the rectum. "One of us," he states, "being pressed for time, we instituted our experiments only with salicylate of sodium, salol, anti pyrin, iodide of potassium, terebinthine, and methylene blue. After having determined the integrity of the subjects under observation, we first administered by the mouth a quantity of the medicament, the dose being adjusted with great precision. Two or three days after question-I was led to look into this phenomenon, and every trace of the medicament had disappeared from the urine, we placed in the rectum of the same subject a hollow Kugler suppository containing the same dose of the product."

Taken by the mouth, the salicylate of soda manifested itself in the urine at the end of thirty-five minutes; and at the end of twenty-five minutes when taken by the rectum.

We were enabled to determine the passage of antipyrin forty minutes after stomachal indigestion, and thirty minutes after rectal absorption.

We found iodide of potash in the saliva at the end of 15 minutes, giving the medicament by the mouth; and

M. Catillon: This question of the alkalinity or acidity of the rectum has been controverted. In the course of investigations which I made at the laboratory of Vul pian on alimentation per rectum- investigations which have been here discussed and which have solved this

very often I found an acid reaction in the rectum.

M. Constantin Paul: I believe the physiological rectum should be alkaline, but I have often determined its acidity in children suffering from green diarrhea.Med. Age.

Oxygen and Alcohol for Septicemia.-At the last meeting of the American Gynecological Society, Dr. Currier of New York, read a paper in which he ad vanced the idea that septicemia is an acute toxit myco sis of the blood, resulting from the decomposition of substances in the intestines and the absorption of the toxic products, the absorption of decomposed material

from the genital canal after labor, or the absorption treat a chronic case of constant and pernicious hemor. of toxic substances through the serous surfaces after an rhage from the uterus due to debility of this organ. It operation on the abdominal or pelvic organ. If recovery had continually resisted treatment by several other occurs, it is obtained by means of phagocytosis which physicians, but responded to "Dioviburnia" in twenty. disposes of the germs, and by the oxidation and elimi- four hours. The hemorrhage stopped at once and she nation of the toxic products. The author recommends proceeded to immediately recover, and has never had giving highly concentrated liquid food and alcohol and a return of it. She had taken fluid extract of ergot unthe administering of oxygen. til she became so weak from its depressing action on the heart that she was hardly able to walk. She had also been treated locally with electricity until the mucous membrane of the uterus had been cauterized and nearly destroyed. This is but one case out of many which I have successfully treated with "Dioviburnia.” When I told her former physician the remedy I had used he would not believe me and insisted that I had used something else in connection with this product. The main trouble in their treatment of the case was the mistake of diagnosing the cause of the hemorrhage. Some physicians would not be guilty of using a semi-proprie. tary preparation deeming it beneath their professional dignity to do so. Well they are losing cases every day, while many of my professional brethren are up to the time and are using anything new that is better than the old are gaining new patients and increasing reputa tion. I am satisfied that "Dioviburnia" is the best

which it is indicated. I have always got the best and most uniform results from its use.-Exchange.

No fault can be found with the doctor's theory con cerning the nature of the disease, nor the importance of sustaining the patient by easily assimilated food, and his suggestion respecting the use of oxygen is especially valuable. We have used this remedy in cases of septicemia with wonderful effect. The cyanotic appearances observed in case of intense systemic poisoning, we have seen disappear as if by magic as the result of the inhalation of oxygen by means of a mask placed on the face, the oxygen being received from a large distended rubber bag. It is impossible to understand, however, by what theory, consistent with the result of modern physiological investigation. Doctor Currier administers alcohol along with oxygen. It is well known that alcohol di minishes the power of the red corpuscles to transmit oxygen to the tissues, since it has a powerful affinity for hemoglobin, combining with it as soon as it enters the blood and destroying its ability to absorb oxygen. We preparation on the market for the class of cases for most heartily recommend oxygen in septicemia and other allied conditions having demonstrated its value by personal experience; but we must with equal emphasis con demn the use of alcohol in such cases. This drug itself a toxic agent, and not a food, as is supposed. Attention was called to this fact by Dr. Hart, the eminent ed. itor of the Brit. Med. Journ., in his recent address on cholera at Milwaukee. His suggestion was that alcohol should never be used in cholera, since it s a toxic product, and closely allied to the ptomaines with which the system is struggling, and hence could be only a detrim ent. The use of alcohol in cases of toxemia can be Their curative action is often wonderful, and can condemned only in the light of our modern knowledge usually be implicitly relied upon when the drugs are respecting the relation of toxic substances to the human given in accordance with the recognized clinical manibody. Oxygen if nature's sovereign remedy for these festations of the disease. In their preventive action, cases. It is only through its agency that recovery is however, they are less satisfactory. This action is feeble, possible. But nothing could be more inconsistent, and we superficial, and transitory, since outbreaks of the disease can scarcely think of anything more detrimental to the seem to be prevented not at all by the prophylactic patient, than the use of alcohol, since the drug not only treatment. There is only one condition under which introduces additional poison requiring oxidation into a this preventive action has proven satisfactory—that is, system already loaded with such poisons, but lessens the power of the body to absorb and distribute the only agent by which the oxidation and destruction of the poison can be effected.

In a discussion during the late meeting of the Amer ican Med Asso. at Milwaukee, it was observed that many physicians who have had a scientific training are convin ced that alcohol is of no service in many maladies in which it has been supposed to be indispensable.-Mod. Med.

Pernicious Uterus Hemorrhage. -E. A. Wood, M.D., of Syracuse, N. Y., says: I was called to

The Curative and Preventive Action of Mercury and Iodide of Potassium-Mauriac (Journ. de Med. et de C. Prat.) holds that the two drugs most powerful in tho treatment of syphilis do not realize the conditions essential to entitle them to be named as specifics though they are incontestibly superior to all other remedies which have been employed against syphilis.

when administration of the specifice prevents hereditary transmission of the disease from the husband or wife free from apparent manifestations. Daily experience demonstrates that mercury neutralizes the latent infection of the spermatozoa of the sperm, the ovule, and the blood which occasions hereditary syphilis. This, again, however, seems to be transitory, since after treatment and apparent cure hereditary transmission may appear latent and the parents themselves may be attacked by recurrences. It cannot be doubted that there is a tendency towards spontaneous cure in syphilis. Since welldirected treatmeat cannot injure the system, since it powerfully aids this tendency to spontaneous evolution,

Whatever be the degree, form, tendency, or age of was necessary to obtain the serum proteids in a pure syphilis, it should always receive specific treatment. condition, and then to restore the activity and germiThis is especially so when the disease is in its active cidal property to those proteid substances which had state; medication should be directed not only against been rendered inert by chemical processes,such as precip manifestations of the disease, but against the diathe- itation, drying, etc.

sis. Under these circumstances (the absence of symp. "From a priori considerations this wonld appear an toms), medication must be conducted somewhat by impossible task; but the authors are satisfied with the guess-work. Admitting that the syphilitic diathesis result of their experiment showing that this difficulty may be present, and admitting the value of the admin has been overcome. In the first set of experiments istration of specifics against this diathesis, the logical serum was precipitated and then dissolved in water, In deduction would be to administer specifics during the the second set the serum-albumen was precipitated with entire period of life after syphilis is once acquired. This, alcohol, and dissolved in 4 to 5 per cent potash solution. however, is an unnecessary extreme, abandoned by its In the third set the serum-albumen-potash solution was one-time most enthusiastic advocates. heated to 60°-63° C. They conclude from the results of these expriments that the microbicidal property of blood serum is not a vital phenomenon but is merely a chemical process.

Mauriac belives that the best preventive results from the specifics are to be obtained by pushing their cura tive action as far as possible each time manifestations appear. The indications under these circumstences are clear and correct, and the dosing should always be full. In the intervals, when no external signs of syphilis are to be found, the mercury can be suspended until new developments require its administration. Mauriac believes that during the periods of latency the administra tion of a specifice is without good effect, excepting as a means of preventing hereditary syphilis. Here mercury is incontestably the strongest guarantee against the chance of transmission of the disease.-Therapeutic decreased by acidity, a position very similar to that taken Gazette.

Bactericidal Influence of the Blood.-Experiments in this line by Mr. Kionka, published in the Centralblatt f. Bakteriol. u. Parasitenk., xii, and quoted by the journal of the Royal Microscopical Society, cov ers the ground of those of Christmas in Paris, and are intended to demonstrate that the result obtained by the latter experimentalists may be interpreted in a different manner than he has done. The first experiments made with anthrax and bacilli of typhoid fever demonstrated that sudden changes from one medium to another did not abolish the bactericidal influence. In the second set, anthrax and typhoid bacilli and staphylococcus pyogenus aureus were cultivated in body juices (pleuritic exudate and hydrocele fluid), exposed to the influence of CO, after the cultivation media had been heated 55°C., after which the body juices lose their bactericidal influence. The author failed to discover that CO, had any power to inhibit the growth of micro-organisms. The 3rd series was made with typhoid bacilli (a), fresh from the human body, and (b) cultivations from artificial media. These two kinds of cultivations were made in various

media of human blood serum, in peritoneal and plural exudations, but little difference in the growths was noticed.

"In the coures of their remarks the authors point out that on occasions in the series where they were dealing with the alkalinized serum heated up to 60°, the number of bacilli was obviously diminished. This is the strong. est proof they bring sgainst the position of Buchner, who attributed the bactericidal power of serum to some inherent (vital) property, since heated to 55° this power was lost. That it is due to alkalinity they think is shown by the action being increased by alkalinity and being

up by Von Fodor some years ago. Von Fodor showed that by augmenting the alkalinity of the blood the bac tericidal power was ncreased."-Mod. Med.

Microbes and Carnivorous Plants.-Dr.J. N. Tichoutkine made a series of experiments in Prof. Botaline's laboratory at St. Petersburg, and came to the following conclusions:

1. The modifications of albuminoid substances in the juice of carnivorous plants are the result of the vital action of microbes, notably of bacteria.

2. There exists always in the juice of full-grown carnivorous plants microbes which have the property of dissolving albuminoid substances.

3. The commencement of the modification of the albuminoid substances does not coincide with the time of secretion of the juice. The modification commences only when a sufficient number of microbes have devel. oped in the juice.

4. It is through the air that the microbes get to the leaves of the carnivorous plants-not, of course, to the exclusion of other ways.

5. We are to understand by the term carnivorous plant as being a plant that absorbs products elaborated by micro organisms.

6. The part of the process belonging to the plant is the secretion of the juice; this juice then forms a favor. able medium for the growth and function of the microbes.-Revue Chirur.; Can. Prac.

"Is the bactericidal property of blood serum a vital phenomenon, or merely a chemical process? Such is the question propounded by Prof. R. Emmerich, Prof. J. Tsubio, Dr. Steinmetz, and Dr. O. Low, and their experiments were directed toward the nature of the microbicidal proteids of serum. To solve the problem, it REVIEW. |

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