Medical Progress.

Under this head we endeavor to present a condensed summary of practical medicine, drawn from the best and most reliable sources, thus saving our readers much labor in winnowing out from the chaff medical grains of real value.

Leucorrhea.

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This is such a common affection among all women at some time in their lives that some dismiss it with hardly a thought. It is a condition which demands prompt treatment, and it is a trouble should never be allowed to run on. Dr. John G. Reed, in the Cincinnati LancetClinic, in going over his cases of leucorrhea, says that women should be educated to understand that the "whites" is not a trivial condition, but that it may be very serious, and it is our duty always to examine every woman who comes to us with a history of the "whites."-Md. Med. Jour.

The Medical Treatment of Epilepsy.

While the bromides still occupy the foremost place in the treatment of epilepsy, attention has been called during recent years to the value of Trional in this class of cases. This drug was first successfully employed for this purpose in Prof. Weir Mitchell's clinic in Philadelphia.

In a recent article (Cleveland Med. Jour., October, 1898), Dr. Henry S. Upson, professor of diseases of the nervous system in the Western Reserve Medical School, states that, aside from the bromides, Trional is the best of the few drugs which deserve mention. If for any reason bromides cannot be given, Trional may be given in three or four grain doses, three or four times daily, the amount being reduced if the patient becomes too sleepy. He has seen attacks stopped altogether under its use for many months, and has never noted any bad symptoms during its continued employment. It has great advantages in not disturbing the stomach and causing no eruption. The author considers it possible that in still larger doses it may be more efficacious. It may be combined with the bromides, especially

A large per cent. of children go without treatment unless some threatening complication like approaching deafness arises.

The profession is not entirely to blame because the people will not appreciate the danger of neglect in such cases. It is to blame, in a great measure, for the impression, which is so general, that relief of nasal catarrh is a hopeless undertaking. Even where there is beginning deafness a great deal of benefit can be given these patients.

If there be occlusion of one or both nostrils, obstruction should be removed. If the function be damaged by hypertrophic rhinitis, this condition should be systematically treated with confidence as to results. In atrophic rhinitis little hope of ultimate cure can stimulate us, but we can, at least, give the patient comfort by keeping the membranes well covered with some bland oil, thus mitigating, to some extent, the effect upon the ear.-Kansas Med. Jour.

Relief of Suffering in Pneumonia.

In an article on the treatment of acute lobar pneumonia, Dr. Morris Manges, visiting physician to Mount Sinai Hospital, New York (N. Y. Med. Jour., January, 1899), states that the most striking indication for the relief of suffering in pneumonia is the alleviation of the pleuritic stitches and the distressing coughs, which wear out the patients and rob them of their much needed sleep.

For this purpose he recommends the hypodermic injection of morphine, the use of the Paquelin cautery, which often acts magically in quieting pleuritic irritations, and the ice bag, which is also very favorable, but acts less promptly. Quite recently he has been using a new drug, Heroin, as a sedative for these thoracic

symptoms, and, so far as his present experience permits him to judge, he believes that this remedy will be found a valuable aid in quieting distressing coughs. It has acted well in some cases which were not relieved by codeine. As regards its mode of administration, it is given in tablet triturates or powders, in doses of 1-12 to 1-6 of a grain every four hours.

The Urine as a Diagnostic Factor.

Dr. Kernode, in the Tri-State Med. Jour., concludes an article with the following succinct rules, first formulated by Dr. Formad and verified by many investigators:

1. Sediment in the urine has no significance unless deposited within 24 hours.

2. Albumen in the urine does not indicate kidney disease unless accompanied by tube-casts. The most fatal form of Bright's disease-contracted kidney-has little or no albumen.

3. Every white crystal in urine, regardless of shape, is a phosphate, except the oxalate-of-lime crystal, which has its own peculiar form; urine alkaline.

4. Every yellow crystal is uric acid if the urine is acid, or a urate if the urine is alkaline

5. Mucus casts, pus and epithelium signify disease of the bladder (cystitis) or other parts of the urinary tract, as determined by variety of epithelium.

6. The urine from females can often be differentiated from the urine of males by finding in it the tesselated epithelium of the vagina.

7. Hyaline casts (narrow), blood and epithelial casts signify acute catarrhal nephritis. There is much albumen in this condition.

8. Broad hyaline casts and epithelial dark green granules and oil casts signify chronic catarrhal nephritis. At first, much albumen; later, less.

9. Hyaline and pale granular casts, and little or no albumen, signifiy interstititial nephritis.

10. Broad casts are worse than narrow casts, for the former signify a chronic disease.

II. The urine should be fresh for microscopical examination, as the micrococci

will change hyaline casts into granular casts, or devour them entirely in a short time.

12. Uric acid may, in Trommer's test for sugar, form a peroxide of copper, this often misleading the examiner into the belief that he has discovered sugar. Thus when urine shows only sugar, other methods of examination must be usedpreferably the lead test.

13. The microscope gives us better ideas of the exact condition of affairs in examination of urine than the various chemical tests.

Treatment of Neurasthenia.

In an article on this subject by Dr. Arthur E. Mink, of St. Louis, Mo., and published in a late issue of the Medical Bulletin, the author states:

"All of the various symptoms of neurasthenia, be they sensory or motor, psychic or somatic, slowly but surely yield to general systemic and tonic treatment, and disappear, pari passu, with the restoration of the nervous system to its normal condition.

"In combating the insomnia usually present in aggravated cases, I use drugs only as a last resort, for a properly regulated time for meals and attention to the diet usually suffices. Sometimes I have found it absolutely necessary, however, to temporize, and one of the most valuable agents for this purpose, in my opinion, is a first class preparation of cannabis indica. I use a fluid extract, giving 10 to 15 minims on sugar, and repeat as the urgency of circumstances requires. It is not only a valuable hypnotic, but it also relieves the mental depression, the general restlessness and paræsthesias and paralgias of this neurosis. Constipation can be relieved by gentle massage and a regular hour of going to the stool daily. It is absolutely wrong to give the patients cathartics, especially those in the form of pills, for the pill habit is soon formed and they soon become a pray to the various advertised nostrums so often seen in our street cars and on the highway. It should be our aim to suggest to the patients, for obvious reasons, the mildest laxatives. The

calibre of the lower bowel should be maintained at all hazards and all those preparations which produce a mushy stool avoided.

"The gastro-intestinal disturbances of neurasthenia are to be combated by strict attention to diet. The use of the various digestive ferments may be of use in combating any gastro-duodenal indigestion present. We should not loose sight of the fact that such symptomatic treatment is merely transitory. The cause must be removed. For this purpose the use of systemic tonics, and those which affect the cells and are especially nutrient to the nerve centers are to be recommended.

"It was my custom formerly to prescribe the various forms of iron, but an extensive experience has induced me to abandon them entirely. The relief obtained from their use was palliative and transitory. In the treatment of neurasthenia I have a decided preference for the compounds of arsenic and gold. The preparation which suits me best, and which I have been prescribing extensively for the last few years, is the liquid of bromide of gold and arsenicArsenauro. It is not only very valuable as a systemic and nerve tonic, but at the same time seems to have a peculiar and beneficial sedative effect, due doubtless to the bromide present in its composition. Hence it not only allays the tremors and restlessness in these cases, but it is also of great benefit in sexual neurasthenia in calming the morbid irritability of the genito-spinal centers. We must use it persistently throughout the entire course of treatment, and bear in mind always that the neurasthenic can stand very much larger doses than they would care to admit-20 to 30 drops, largely diluted with water, after each meal.

"It is impossible to carry out the Weir Mitchell rest treatment, as a rule, so I merely urge the patient to take as much rest as possible.

The Obstetric Binder.

Dr. W. J. Wilson, in the Canadian Jour. of Med. and Surg., says that a binder to fit nicely should be thin, preferably one ply; one that will stretch so as to adapt

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itself to the contour of the body. It should be drawn down below the great trochanters; drawn tightly to prevent slipping upward. It should be just tight enough to give the needed support and be comfortable at all points. A well applied binder gives a needed support to the abdominal organs and adds much to the comfort of the patient. The emptying of the uterus lessens the intra-abdominal pressure and allows a filling of the large venous trunks in the abdomen and pelvis and consequent lowering of arterial tension. The binder drives this venous blood out, lessens venous stasis, and thereby increases arterial tension. The abdominal relaxation following labor lessens the support to the abdominal organs and favors the occurrence of entroptosis. It requires about six or eight weeks for the uterus to regain its non-pregnant dimensions. During this time it is heavy, its support from below often weakened, the uterine ligaments are at the same time recovering from their elongation, and this with the upright position favors the descent of the uterus. If the binder can be used so as to support the intestines from below, and thus remove some weight from the uterus, the woman is given a material aid towards her final recovery.

Tribromphenol-Bismuth.

Dr. Somers' method in the treatment of chronic suppurative otitis media is to thoroughly cleanse the external canal and middle ear with hydrogen peroxide, applied on a cotton-tipped applicator, all granulation tissue having previously been removed. Then he lightly dusts Tribromphenol-Bismuth over the secreting surfaces and inserts a gauze drain, which reaches from the tympanic margin to the concha, fitting into the concha, and over the external canal he places a pad of sterile absorbent cotton and allows this to remain for one or two days, according to the amount of discharge. In cases in which the use of this treatment, after other methods and remedies had been tried, they were all apparently cured, and he has treated more than 100 cases.

It does not stain the parts as does pyoktanin, nor does it cake like boric

acid, and it not only lessens but changes the character of the discharges from the middle ear. Being slowly decomposed in the ear, its action is of considerable duration, thus keeping the mucous surfaces antiseptic for a longer peroid than any other remedy. He especially emphasizes a thorough cleansing of the canal and tympanic cavity before applying any of the powder, as it has little or no influence unless brought into immediate contact with the pus-producing surface. Through its sedative action pruritis is also allayed, permitting more rapid repair. Am. Med. Asso. Jour.

Arsenical Caustic Treatment of Cutaneous Cancer.

Dr. William S. Gottheil, in an article under the above caption says:

1. The arsenious acid caustic treatment of skin cancers does not contemplate or depend upon the actual destruction of the new growth by the caustic.

2. The method is based upon the fact that newly formed tissue of all kinds has less resisting power than the normal structure when exposed to an irritation and its consequent inflammation. Hence the former breaks down under an "insult" which the latter successfully resists.

3. If, therefore, the whole affected area can be subjected to the influence of an irritant of just sufficient strength to cause a reactive inflammation intense enough to destroy the vitality of the new cells, the older normal cells will survive.

4. Arsenious acid of properly mitigated strength is such an agent, and its application causes an inflammation of the required intensity.

5. It therefore exercises a selective influence upon the tissues to which it is applied, and causes the death of the cancer cells in localities outside the apparent limits of the new growth, where there is as yet no evidence of disease.

6. It is superior, in suitable cases, to any method, knife or cautery, which requires the exercise of the surgeon's judgment as to the extent to which it is to be carried. That that judgment is often wrong, and necessarily so, is shown by the frequency of recurrence under these methods even in the best hands.

7. It is applicable to all cutaneous carcinomata in which the deeper structures are involved, and which do not extend far unto the mucous membranes.

8. It is easy of application; it is safe; it is only moderately painful; its results compare favorably with those obtained with other metheds.

Apomorphine in Hysteria.

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Dr. F. J. Campbell, in an article on hysteria, in the Med. Record, says: "Apomorphine here is the remedy par excellence. It may almost be classed as a specific in the acute hysterical conditions. There are few clinical pictures which present such wonderful and sudden contrasts as that of a patient with teeth clinched, muscles rigid, with opisthotonus, or throwing herself and her anxious attendants about, transformed in three four minutes by 1-10 grain of apomorphine, hypodermically, into a docile, relaxed, limp and vomiting individual, her pride and alleged pains gone together, and a restful sleep in store for her after the emesis is over. I have never seen any unpleasant complication resulting from the use of this remedy, though I have depended almost solely on it for six years, and have used it in several cases in which pregnancy coexisted. Instead of a hypodermic, a dose of from 1-10 to 1-5 grain may be given by the mouth, and a satisfactory, though less prompt, result will be obtained. I regard apomorphine as by far the most prompt, reliable, and, both to the patient and to the physician, satisfactory drug in the treatment of this condition of which I have any knowledge."

Notes and Queries.

For this department we cordially invite questions, comments and criticisms on all topics of interest to the physician in his daily work for the relief of the sick, thus making the SUMMARY a valuable medium for intercommunication between the medical profession.

Correspondents will give their names and addresses, but ínitals only will be printed when desired. The QUERIES in this issue await the ANSWERS which our itelligent readers may be pleased to contribute for publication in our next.

Cerebral Hemorrhage....Query.

Editor Medical Summary:

Thursday, January 5, 1899, late in the evening, I was called nine miles in the country to see a boy seven years of age, and found the following conditions and history:

Two days prior to this, while at school, the boys were riding him on a ball bat and he fell off, striking the right side of his head on the frozen ground. He was taken into the school room and went to sleep, waking in a few minutes seeming none the worse for the fall, and walked home in the evening, a distance of a mile or more; complained some during the evening of headache. The next day about 1 o'clock he went into a spasm which lasted nearly four hours, after which he regained consciousness and called for water. At this time his parents noticed that his left side was completely paralyzed and the pupils contracted. When I arrived he was complaining of severe pain in the head; mind was clear; temperature one-half degree above normal; respiration irregular; pulse 150 and irregular; pupils rapidly contracting and dilating.

Applied cold compresses to head; gave ergot and digitalis every four hours and tr. opii deod. every two hours to control pain; moved bowels by enema. Returned Saturday morning and found temperature normal, some pain in head, pupils still irregular, but the paralysis had all disappeared. Gave calomel, 1⁄2 grain, every hour until bowels moved and continued treatment as at first.

The boy continued to improve and in a few days was able to walk about the house. January 14th, seven days from first attack, I was again called and found him unconscious; pulse fast and irregular;

Cheyne-Stokes' respiration; left side paralyzed and clonic spasm of the right half of the body involving the face, which lasted about three hours. During this time he looked as if he would die any minute. I gave atropine hypodermically and applied cold to head.

After he came out of the spasm his hands and feet cramped for 15 or 20 minutes and then he became quite easy, but still unconscious. I left expecting that he would die before the next day, but to my surprise he grew gradually better and in 12 hours regained consciousness, and with it a most ravenous appetite. The paralysis all disappeared, and in a few days he was able to walk some about the room, when he broke out with the measles, which were epidemic at the time. He made a rapid recovery from the measles, still has a strong appetite and seems to be doing well.

My diagnosis when first called was cerebral hemorrhage in right side. Was this correct?

Logan, Kan.

F. E. RICHMOND, M. D.

Gathered Fragments.

Editor Medical Summary:

All these years we have been faithfully gleaning, and wherever we have found anything worthy of preservation, whether original or from some other source, we have made use of the scissors and paste, and the result is that we have on our shelves some books of scraps that have been of much service to us. Here are some that have specially aided us.

Sometimes it is advisable to check bronchorrhea or profuse expectorationtr. strychnine, arsenic and calcium sulphide.

Some cases of asthma are readily relieved by glonoin. I have in my own case many times aborted the paroxysm with 1-250 grain dissolved on the tongue, by which systemic effects are produced in from 30 seconds to one minute. Try tr. glonoin, gr. 1-100; strychnine, gr. 1-60; morphine, gr. 1-20.

It may be a little old-fashioned, and I have seen it denounced as "buggy," but "carron oil"-equal parts of flaxseed oil