The Employment of Kryofine in the Eruptive Fevers.

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BY ROBERT C. KENNER, A. M., M. D.,

LOUISVILLE, KY.

HILE speaking of kryofine, and before detailing its applicability in the eruptive fevers, let me call attention to some errors which exist in the minds of some physicians in regard to coal-tar derivatives. Prof. Thompson, as a representative of this class, declares that the coal-tar antipyretics are "one and all muscle paralyzers." I maintain that the results of clinical experience do not prove this statement. Kryofine, in my opinion, is the best of the synthetical antipyretic and analgesic remedies, exerts no depressing action on the heart, but conversely improves the circulationagain, not only is there no cardiac depression following its exhibition-there is no mental disturbance or irritability of the heart. In no case have I ever seen it produce blueness of the skin. In cases attended with fever, rapid pulse, and increasing delirium, the action of kryofine is to bring the temperature to normal, bring the pulse from riotous beating of from 120 to 140 to normal-the mind becomes clear; the patient who has usually been wakeful, most generally falls into a peaceful natural sleep. Kryofine exerts an action on the stomach which is kindly-making it a remedy different from many other agents of this character, which irritate the stomach. In gastric irritability, and acute gastritis, its action is most happy, it is soothing; hence the great applicability of this agent in fevers, in nearly all of which there is more or less gastric irritability.

Unlike many of the coal-tar products, kryofine does not alter the chemical constituents of the blood, and in this quality it recommends itself as superior to other agents.

Unhappy experience with coal-tar derivatives, I believe, has been the result of using inferior agents, and due to the fact that these agents are not given judiciously. If any antipyretic be given in an irrational manner, nothing but harm can result from it. I esteem it irrational to give kryofine, or any other antipyretic, according to any other rule as regards the size of the doze, or the hours of administration, than the demands of the case in hand seem to make necessary. The dose of kryofine for an adult I generally consider to be 8 grains, but I may give more or less, as the condition of the patient seems to warrant. It may be given every three hours, or every six or eight hours, as the conditions present in the individual case seem to warrant. The only rule is consistency with the case in hand, and the physician's judgment must direct him in the employment of kryofine as well as other drugs-never letting empiricism lead him from the path of true reason. Two cases are cited as illustrations, taken from quite a series of these diseases.

Scarlet Fever.-M. H., aged 12 years, was taken ill on the 1st of October. She had a very sore throat, and strawberry tongue; in a few days the characteristic scarlet rash was well expressed. This patient had the anginose type. Her temperature on the third day ran up to 106 F., her carotids pulsated violently; she was delirious, and the early supervention

of convulsions was greatly feared, all the symptoms of the case had assumed a more violent and threatening front. I had been giving the usual remedies employed in scarlet fever, and in addition had given her bromide of potassium, to counteract the symptoms of congestion of the brain which had seemed to be threatening the patient when I saw her last. I found the patient was tossing from one side of the bed to the other, and her mother said that she not only could not sleep, but that it was often with force only that she kept her in bed. My experience in the treatment of other fevers led me to believe that I could make but little headway against the growing dangers of the increasing cerebral congestion, as long as the patient was allowed to have such a high temperature. I accordingly gave kryofine; I gave the nurse a clinical thermometer, and told her to give the patient another dose of kryofine whenever she discovered the child's temperature rose above 100 F. In about forty minutes the pulse became appreciably less bounding, the violent headache and delirium began to assume a more tractable appearance, and she soon had a normal temperature, a moist skin, and sleep came to the hitherto restless patient. This patient, after the addition of kryofine to the treatment, in the manner 1 have outlined, went along to an uneventful recovery. This case is one which, I think, shows well the value of an antipyretic. Without it, I think the cerebral congestion must have gone on, and with the supervention of convulsions there is little telling what might have been the outcome of this

case.

Measles.-M. L., aged 10 years, was taken ill September 20th. Several of the children in the family had been ill of measles, and they all made a speedy recovery, and were given only simple diaphoretic and quieting remedies. This boy had, when I was called, a temperature of 105° F., was delirious, with rapid pulse, and extremely active. The boy had had convulsions before, and the mother dreaded the coming on of others. The rash had not come out well; his breast was well broken out, but his extremities showed no eruption, and I thought before examining his lungs that I had in this patient one having catarrhal pneumonia, as it is common for the patients in whom pneumonia develops as a complication to lack a full expression of the eruption. Often the eruption is coming out well and will suddenly disappear-in these cases pneumonia is generally found to coexist. In this particular case, however, I could not find upon the closest physical examination anything in the chest beyond the usual signs found in measles. Acting on my past experience, I put this patient at once on kryofine, and directed the nurse to give it whenever the temperature rose above 100 F. The patient became quiet after the first dose of kryofine, and its regular administration (according to the principle already laid down) after that kept all these symptoms which were so menacing, in subjection, and the patient soon recovered his former state of health. The beauty of the treatment of this case lay in the fact that the patient under the action of this agent ceased altogether to have wakefulness, delirium, rapid pulse, and went into a peaceful slumber.

I might go on detailing clinical histories of cases of scarlet fever and measles, in which I have used kryofine with uniform benefit, but I shall let

the two I have detailed above suffice. An examination of my report will recall to all practitioners the sad picture which these cases present, and I am sure all practitioners like me will hail the introduction of an agent which will rob these diseases of such of their terrors as have in the past made the mortality of eruptive fevers so great. When I study my notes on cases of eruptive fevers treated before the introduction of antipyretics, I find that many cases which were hitherto intractable, would now be amenable to treatment.

In none of these cases-two hundred and eleven of scarlet fever and measles was there any cardiac depression-no excessive diaphoresis with children, as is the case with many, or nearly all, of the antipyretic drugs with which the market abounds. It seemed that kryofine regulates the heart and quiets the excessive nervousness-certainly something of this kind takes place, since patients not only become quiet, but also sleep of a kind resembling exactly natural sleep supervenes.

NEW YORK LETTER

Fracture of the Cervical Vertebra-Bassini Operation for Double Congenital Inguinal Hernia-Congenital Dislocation of Both Knee-joints—An Unique Theory-Prostatectomy-Sulphate of Copper vs. Carbolic Acid

[SPECIAL CORRESPONDENCE ]

At a recent meeting of the New York Surgical Society, Dr. Robert H. M. Dawbarn presented a case of fracture of the cervical vertebra, with paralysis of the eleventh nerve, occurring in a man who fell from a height of ten feet, striking on his head and shoulders. The patient's head assumed an abnormal position which was due probably to a paralysis of the sternocleidomastoid muscle, induced by a rupture of the eleventh or of the second or third cervical nerve. About the level of the fourth cervical verteba there was noted a depression; in the pharynx was noted too an abnormal bony prominence. The question of forcible reduction was brought up, but the majority of those present did not think it wise to resort to such a procedure so long after the receipt of the injury.

At the same meeting Dr. Alexander B. Johnson presented a case of double congenital inguinal hernia, upon whom a Bassini operation was preformed on both sides. This case was more or less of a surgical rarety. The details of this operation were published in the International Journal of Surgery, December number.

Dr. Charles N. Dowd presented a case of congenital dislocation of both. knee joints. As regards the causation, Dr.Dowd referred to Miller's ingenious theory that this condition occurs in those cases where there is a defici

ency in the liquor amnii, with extension of the legs: the inability to flex the legs on the thigh would cause complete luxation. This theory would hardly be sufficient to explain the concomitant abnormalities to which Dr. Abbe so appropriately applied the name of "walrus-fingers."

A paper on prostatectomy was recently read at the New York Academy of Medicine, by Dr. Parker Syms, who made the suggestion that in doing a perineal operation the prostate might be pushed downwards through an opening made in the peritoneal cavity. Dr. Briddon thought that by making a free dissection of the perineum, consisting of a median section and two cross-sections, so modifying the Zuckerkandi method, the prostate could be brought down by traction without any aid from above and without opening the peritoneal cavity. The consensus of opinion in New York seems to be that the operation of prostatectomy will be less performed in the future than it has been in the past. The fact should not be lost sight of that these patients are advanced in years and broken down in health, with an infected bladder and a complicating peri-nephritis, and they are in no condition to stand such a severe operation.

Dr. M. A. Veeder, Health Officer at Lyons, appeared before the Sanitary Club, Buffalo, and made the interesting statement that he preferred sulphate of copper as a disinfectant, rather than carbolic acid, because, unlike carbolic acid, on evaporation it is left behind. Then too it is diffused through the material so prolonging its effect, and even making it permanent if sufficient quantity is employed. Earth containing sulphate of copper thus diffused becomes a good disinfectant and may be used with confidence to cover typhoid or other infected material. He states that he had a large experience with its use, and had been many times surprised at the way in which even so small a quantity as a pound or two, diffused through several barrels of water, checks putrefaction and all signs of bacterial growth in foul drains and the like. In the absence of water it can be used dry with good effect, but a larger quantity is required. E. F. S.

The Western Ophthalmologic and Otolaryngologic Association will hold its fourth annual meeting in New Orleans, February 10 and II. Indications are that this will be a meeting of exceptional interest. The program promised is in every point a strong one. The matter of entertainment will include the Mardi Gras festival (February 13th and 14th), which, alone, would be sufficient reason for making the trip. The railroads are extending every courtesy to pilgrims on this occasion. The "Iron Mountain" will carry the delegation from St. Louis and the Missouri valley. While excursion rates have not yet been announced, it is certain that the trip can be made for one and one-third rate, and perhaps for less. Sleeper accommodations should be secured in advance, as travel southward is at this time especially heavy.

Reports on Progress.

COMPRISING THE REGULAR CONTRIBUTIONS OF THE FORTNIGHTLY DEPARTMENT STAFF.

A Report of Gynecological Cases Treated by Ovarian Substance.-(Dr. L. Seeligmann, Der Frauenartz.)- In the first cases the ovaries used were of pigs and sheep and obtained from the slaughter-houses, later Freund tablets were used and the English preparation of B. W. & Co. The cases treated may be divided into two groups:

Women whose ovaries had been removed by operation.

2. Women in whom symptoms appear, either at puberty or at the menopause, due to faulty, or an entire lack of, action of the ovaries. The cases of the first group are as follows:

1. Mrs. D., 38 years old. A difficult delivery with forceps 12 years previously, a second delivery 11 years previously was made by Caesarean section with removal of uterus and adnexa (sepsis). Status praesens; A wretchedly thin woman, with large vential hernia. She presented a typical appearance; restlessness, rush of blood to the head, sleeplessness, loss of sexual desire, beginning melancholy, alternating with great irritability; daily quarrels at home, that usually ended in a sound thrashing of the husband. After a short exhibition of the ovarian substance, later the tablets, an undoubted improvement began, so that peace returned to the household and the patient recovered her pleasure in living. The rush of blood to the head was lessened. The patient procured more of the remedy on her own responsibility and is now well pleased with her condition.

2. Mrs. B., a brakeman's wife, 42 years old. In '92 Dr. Seeligmann delivered her of her twelfth child by Porsos operation, an operation made necessary by marked osteomalacia. The osteomalacia is practically recovered from. She goes up and down stairs without pain and without a