really have no etiological connection with it. For instance, permitting the patients to get up after seventeen or eighteen days does not predispose to hernia, and keeping them in bed for longer periods does not prove a prophylactic against its occurrence. The wearing or failure to wear a bandage after operation does not affect the liability to hernia either favorably or unfavorably. Pregnancy following immediately or remotely after operation plays no part in the production of hernia, despite preconceived notions to the contrary. It is evident then that the occurrence of ventral hernia after operation is mainly due to the method of closing the abdominal wound, despite all that has been said by certain gynecologists abroad as to the advantage to be derived in this matter from making the incision through the rectus muscle. Dr. Clark, from his experience at Johns Hopkins as well as his records of the subject decides in favor of the incision in the linea alba. Two things are necessary to lessen the tendency to hernia in closing the incision. First, the fascia, i. e., the aponeurosis of the recti muscles, must be carefully brought together so as to secure complete and firm continuous union along the line of section. The essential point in placing the sutures is to catch enough of the aponeurosis to firmly bring the borders of the fascia not only into complete coaptation, but also to slightly elevate them into a median ridge. The coaptation of the fascia must be especially exact at the lower end of the incision when the liability to hernia is greater, because the layers of fascia are fewer. The second requisite for a firm cicatrix is to secure healing per primam, and this is best secured by leaving no dead spaces in which blood or lymph may collect to become infected, and by allowing no penetrating cutaneous stitches through which microorganisms may penetrate from the surface despite the most careful precautions. On the whole, this subject of the avoidance of hernia by a careful technique in the close of the abdominal incision would seem to have reached a development that leaves very little to be desired, and it is evident that it is only in patients with especially relaxed tissues, or with natural tendencies to hernia that the operator may feel exempt from responsibility in future cases of this annoying sequela. Post-Febrile Insanities.-Hamilton (Med. Record, June 24, 1899,) defines post febrile insanity as a form of mental disturbance occurring at any stage of an acute infection, and that is caused by the bacterial infection. It should be distinguished from that caused by coarse destruction of brain substance, which occurs with encephalitis in scarlatina, small pox, etc. The insanity of typhoid usually occurs after the twenty-first day after the subsidence of the typhoid state, and is usually due to exhaustion and toxic absorption from the digestive tract. The post-febrile condition may develop often an initial delirium, and usually assumes the appearance of an ordinary acute mania. Delusions of identity are associated with those having an expansive character, and are often accompanied by destructiveness and impulsive attempts at suicide. In mild cases there may be periods of lucidity, but in the severe cases the asthenic confusion and feeble excitement are continuous. The dementia sometimes follows the light, confusional condition, deepening rapidly, or a stuperous state with katatonic rigidity lasting for several weeks. Pilgrim out of 6,000 patients found twenty-four cases of post-febrile insanity; thirteen of these followed typhoid fever; of these seven were melancholia, four mania and two dementia. In malarial poisoning mental disturbance sometimes follow the long existing states, especially of the quartan type. Insanity occasionally develops in malaria as a result of large doses of quinine. The author thinks from his large experience with insanity of influenza that there is no definite period of development of the mental symptoms. In some cases there is an initial rise of temperature, general pains, sense of fatigue, and within a few days mental depression, followed by excitement and confusion, and a train of hallucination and delusions. These are unsystematized and of a suspicious character; they are often visual and resemble those of alcoholic delirium. Loss of identity occurs early. The form may be either maniacal or melancholic; age has little influence; about 40 per cent are predisposed by heredity; about 75 per cent recover in a few months. The writer quotes two cases of post-febrile insanity of measles reported by Tinkelstein. Prognosis of post-febrile insanity is usually good. The author thinks that more than 50 per cent of the typhoid cases recover. There is a small per cent of recurrent and demented forms. Those of grippe recover in from three weeks to four months. The treatment consists of disinfection of the gastro-intestinal tract and hastening of elimination; naphthalion or salol with calomel and soda, or castor oil given in full doses. Milk and easily digested foods should be given. In stuperous states alcohol with strychnine, nitro-glycerine or morphine. In reduction of excitement and relief of insomnia ordinary treatment is employed; the coal tar products are not well taken. Entero-Colitis in Infants.-Dr. M. A. Clark (Atlanta Med. and Surg. Jour.) recommends the following: B Tannigen... Pulv. peptenzyme. Aquæ q. s..... M. Sig.: One teaspoonful every three or four hours. 20 grains 30 grains 4 drachms 2 ounces Paraform for Warts (Dermatologisches Centralblatt, April, 1899).—C. Mense mentions that paraform has already been recommended by Unna as a caustic, and he praises it for the treatmeut of warts, because its action extends deeply into the skin. He has used it extensively in papular syphilides, and it is especially useful in psoriasis palmaris, and in papules on the face. The best form in which to use it is the following: B Paraform... 3 parts 27 parts To be painted on three times a day. Generally after two to four days the epidermis peels off, and the part has a healthy appearance.-Treatment. Orthoform as a Local Anesthetic, Analgesic and Antiseptc.-Dr. Jno. North in a recent number of the American Medical Compend gives the result of his investigations with this new derivative of the complex cocaine group. Experiments have shown that the toxic and anesthetic elements can be separated. Einhorn and Heinz submitted the entire class of compounds to examination, and prepared nearly forty compounds, which they submitted to physiological tests, and made the discovery that the esters of the aromatic oxy-amido acids possessed greater anæsthetic action than their benzoyl compounds. The one having the most active local anesthetic effect was the methyl ester of the para-amido-meta oxy-benzoic acid. The name of orthoform has been given to this compound. Orthoform occurs in a white, voluminous crystalline powder, without odor or taste. It is very slightly soluble in water. This is one of its great advantages. It is so slightly and slowly disolved that only small portions and absorbed. Its anæsthetic action continues for hours. Orthoform has no effect when applied to unbroken skin. When applied to healthy mucous membrane it only produces slight anæsthesia after considerable time. But when applied to the exposed nerve it produces complete anæsthesia in a short time, and its action is prolonged. As orthoform is almost insoluble it must be applied in the form of dry powder, or as an ointment. It does not produce anæsthesia beyond the surface on which it is applied. It takes from five to twenty minutes to produce complete anæsthesia. It never produces any constitutional symptoms, no difference how much is applied, or over how large a surface. Orthoform is absolutely non-poisonous. From 30 to 60 grains have been given to rabbits for several days in succession and dogs given doses of 45 to 90 grains without giving rise to any symptoms; 45 grains introduced under the skin of a dog gave rise to no toxic symptoms. Orthoform is also strongly antiseptic. His first clinical experience was in a case of laryngeal tuberculoses. Orthofrom was applied to the inflamed and ulcerated surface of both larynx and pharynx in a few moments the patient was free from pain, a condition she had not experienced for months and drank a glass of milk without the least pain. The anesthesia lasted for several hours. The nurse was instructed to use the orthoform upon the return of pain. This was kept up and the patient experienced no more pain in her throat, and had no difficulty or pain in swallowing. After this he adopted orthoform in all forms and varieties of ulcerations and inflammations in the nose, mouth, pharynx or larynx obtaining absolute freedom from pain, the effect lasting from several hours to several days. It is so thoroughly antiseptic that ulcerations heal much more rapidly when orthoform is used then when it is not used. It is also the ideal anesthetic in dental work. In this connection it is well to mention orthoform "new," which has recently been placed on the market by the Farbwerke Hoechst, which is chemically m-amido-p-oxy-benzoic acid methyl ester. While orthoform "new" is fully equal in therapeutic effect to the original orthoform, the former possesses the following advantages. Ist. The powder is of a pure white color. 2d. It is more finely grained and amorphous, and does not cake or lump as does the original orthoform. 3d. Orthoform "new" is considerably less expensive. PRACTICAL THERAPEUTICS INFLAMMATORY DIARRHOEA IN INFANTS.-In the insidious beginning of the disorder, when large, pasty stools are being passed, the child, if an infant, should be fed with weak veal broth and barley water in equal proportions; whey with cream; the yolk of one egg beaten up with broth or whey, and Mellin's Food mixed with whey or barley water. The meals should be frequently varied during the day, and the quantity allowed must be strictly proportioned to the infant's powers of digestion. For medicine he may take a powder of rhubarb (gr. ij-iij) and aromatic chalk (gr. 1j-v) every night for three nights; and in the day, a mixture composed of half a drop of laudanum with four or five grains of the bicarbonate of soda in some aromatic water.-From "Diseases in Children," by Eustace Smith, M. D. LARGE FIELD OF USEFULNESS.-Dr. Samuel J. Hall, 615 Market street, Louisville, Ky., thus reports five interesting cases in which he has successfully employed Unguentine. Case 1. Burn or Foot: Applied Unguentine thick over the burn once each day. Healed in seven or eight days. No scar. (2.) Ulcerated Gum: Applied Unguentine on cotton and pressed between lips and gum. Had this applied fresh three or four times a day. Healed in five days. (3.) Fissured Nipples: Used Unguentine which healed them without trouble. Had the nipples washed and wiped dry after each nursing. (4.) Circumcision: I used Unguentine as a dressing in a case of circumcision in a child two years. old. My idea was that the oil nature of the Unguentine would protect the margin of the incision from urine coming in contact with it which would cause more irritation. It acted well in that case. "I shall continue to use Unguentine in all cases where it is indicated and have no trouble in getting it or prescribing it as most of the druggists in this locality keep it." AN IMPORTANT OBSERVATION.-Prof. Burney Yeo of London states in his latest work on Clinical Therapeutics that many of the common forms of diarrhoea are accompanied by excessive acidity of the intestinal contents, and that they may be promptly cured by antacid remedies without the use of astringents. These forms of diarrhoea are associated with the growth and multiplication of micro-organisms which induce intestinal fermentation and consequent local irritation from decomposing food products. The therapeutic indications in these cases are clear, viz: check intestinal fermentation, neutralize acidity, and overcome the existing atonicity and catarrhal inflammation of the intestinal mucous membrane. Lauder Brunton speaks highly of the value of glycerine as an intestinal antiseptic. In combination with digestive tonic alternatives and antacids, as is in Gray's Glycerine Tonic Com., it fulfills all the existing indications and moreover promotes the digestion and assimilation of food so that the normal nutritive processes are speedily re-established. It is of particular value in diarrhoea occurring in people of impaired vitality as it not only cures the intestinal disturbances but it also restores tone to the enfeebled system. A USEFUL PRESENT.-W. R. Warner & Co., of Philadelphia, New York and Chicago, are distributing free to doctors and druggists, a very complete list of drugs, giving apothecary and metric doses. They are arranged in convenient columns and printed on coated linen cloth size 22x14 for hanging at the prescription counter or in the doctor's office for ready reference. It will be sent to any doctor or druggist upon request. Drop them a postal for it. ARE YOU USING PROTONUCLEIN? It is indicated as a prophylactic, as an antitoxin, as a restorative and as a tissue builder. As a prophylactic it increases the resistance to disease as an antitoxin it destroys disease germs, as a restorative it promotes glandular secretion and restores tone to the system, and as a tissue builder it stimulates the nutritive processes. In diphtheria, it is to be preferred to antitoxin, and in typhoid and yellow fever to antiseptic treatment. It promotes and stimulates cell life throughout the organism, and thus cures diseased conditions and restores perfect health. Put up in tablets, powder and special powder. MALTINE WITH CREOSOTE.-The Maltine Company has added another combination to its popular list, and one which will meet with hearty reception at the hands of the profession. Among the more recent remedies Creosote has proven of the utmost value in the treatment of tuberculosis in its various forms, especially pulmonary, and in septic conditions of the alimentary canal as exhibited in different forms of diarrhoea. By its antiseptic properties it counteracts the toxic influence of tubercle bacilli, destroys bacilli of a less virulent type, and increases nutrition, by stimulating metabolic activity. Its combination with Maltine has proved exceptionally serviceable in supplying a highly nutritious element, disguising the disagreeable taste, and completely removing the tendency of creosote to produce gastric irritation; in fact, pure creosote, such as is used in this combination, causes little or no irritation in the alimentary canal even when taken alone. Each fluid ounce contains four minims of pure creosote. "VIN MARIANI" is essentially the brain and nerve tonic of those who have talent and genius. These it is who compose the great army of intellectual workers, and the ravages made upon their nervous systems by the demands made upon them are at times truly appalling. This damage and consequent drain yield to nothing more quickly than to "Vin Mariani." The most noted European physicians, literateurs, musicians, singers, artists and diplomats have sent the most flattering letters to M. Mariani extolling his product. Not only these, but crowned heads as well have been mentally invigorated and rejuvenated by "Vin Mariani" and never tire of speaking words. of praise. It must be acknowledged that unsolicited testimonials, couched in such glowing terms, from such sources, are the best evidence possible that can be offered for the merits of the preparation. When "Vin Mariani" becomes as well known in this country as it is in Europe it will be adopted as one of the indispensable remedies in the household.-St. Louis Medical and Surgical Journal. |