nephrin, apocynum and nitroglycerin. He rarely uses convallaria, cactus or sparteine, and never finds use for ammonia.

Caffeine is the best heart tonic for children, because it is easily administered and the dosage is easily controlled; in fact, he considers it the best all-around heart stimulant. It is quickly absorbed and eliminated and there are fewer side or untoward effects.

Strychnine is also used in children, mainly to deepen respiration, thereby stimulating the heart, as well as by direct effect on the heart. He uses it more continuously than he does caffeine.

Strophanthus is the best remedy for aged persons, because in these cases myocarditis is usually present, or some degree of arteriosclerosis, in which condition digitalis is contra-indicated.

Strychnine is never used as a heart tonic per se, but rather as a respiratory stimulant. Deep respiration seems to have a stimulating action on the heart. The doctor uses it in pneumonia, asphyxia or in conditions where the breathing is shallow.

He has had little experience with sparteine and is not prepared to speak with certainty as to its action. Cactus he finds useful in paroxysmal tachycardia or other functional disturbances, usually combining it with other remedies, like the bromides or hyoscyamus. As to its action, he feels uncertain, although his results are uniformly good.

He also uses morphine in cardiac dyspnea. Aside from its sedative action, it seems to slow the beat and make the contractions of the heart stronger.

Caffeine is used in cardiac weakness due to toxic action where powerful stimulation of the heart is required without materially raising the blood pressure, and to overcome any inhibitory effects on the vaso-motor centers; to stimulate the respiratory centers to produce diuresis and overcome periods of depression, providing other indications for a heart tonic are present.

Dr. W. C. Wolverton, Linton, N. Dak., prefers as heart stimulants the remedies which follow in the order named: (1) Nitroglycerin, (2) strychnine, (3) sparteine sulphate, (4) Germanic digitalin, and (5) cocaine, which is used occasionally in emergencies. Alcohol is resorted to occasionally as a heart stimulant and is given for this purpose to (a) adults habituated to alcohol, and (b) to infants and young children in protracted and exhausting diseases like bronchial pneumonia, cholera infantum, and the like.

Since beginning the use if sparteine sulphate, Dr. Wolverton has found but little use for digitalis, although it is indicated in all forms of heart disease except when compensatory hypertrophy is present. Sparteine, he declares, is more satisfactory as a heart tonic than any other drug. In his practice it has practically displaced digitalis and its preparations. Dr. Wolverton declares that it has all the advantages and none of the disadvantages of digitalis. Digitalis when used is given in the following forms: (a) soluble digitoxin (Cloetta), (b) Germanic digitalin, and (c) tincture digitalis. The doctor has never used the infusion, regarding its action as too uncertain and the preparation as too irritant to the gastric mucosa.

The contraindications to the use of digitalis are (1) arteriosclerosis; (2) infancy or childhood, at which age sparteine is immeasurably preferable, the same being true in old age; (3) in the presence of compensatory hypertrophy before dilatation supervenes; and (4) in the presence of gastric irritation.

The galenic preparations of strophanthus have been found entirely unreliable and crystalline strophanthin Dr. Wolverton has never used, although his old teacher, Professor C. S. Chase, of the University of Iowa, declares that when it is given intravenously its action is prompt, sure and almost miraculous.

The heart tonics preferred in the treatment of children are sparteine and strychnine. Children's stomachs are very easily upset by digitalis and they do not tolerate the drug well. In old people sparteine is preferred for general use. It does not raise the blood pressure but otherwise has a digitalis-like action. Strychnine is also valuable, and nitroglycerin may be given to lower high vascular tension, and morphine to promote sleep during arteriosclerosis. Strychnine is a fine heart tonic. "It takes up the slack." Dr. Wolverton uses it (1) in functional heart disorders, (2) at or folllowing the crisis of pneumonia, but not before the crisis, and (3) in cardiac disorders attending tobacco and drug addictions. Cactus he has used to a limited extent in functional cardiac disorders, but not enough to draw conclusions. Morphine is employed only when insomnia is a troublesome sympton as in arteriosclerosis of the aged. Caffeine he does not give at all.

Other measures used in the treatment of heart diseases to tone up the organ are: hydrotherapy, and moderate exercise of the Nauheim Schott order.

Petrolatum as a Substitute for Beck's Paste in Treating Fistula.-P. B. Salatich (New Orleans Medical and Surgical Journal) calls attention to the dangers and disadvantages of bismuth paste, which not infrequently has proven highly toxic. He uses yellow vaseline, which is easier to handle and can be purchased in flexible tubes, already sterilized. He proceeds as follows:

Sterilize the amount necessary in an open vessel, set in sterilizer or water bath, then draw into one or more ordinary glass syringes and use partly warm or cool, as we do Beck's paste. In the most foul and freely suppurating cavities, after one injection and without any other treatment, all odor and suppuration diminish. Abdominal wounds, that suppurate either form infection or contaminated catgut, often show very foul pus. After making an incision-only a small one is necessary when vaseline is used-all the pus is pressed out; the cavity is then filled with vaseline, and the wound needs no dressing for two or three days, at the end of which time very little odor and pus remain. The procedure is then repeated, and the dressings can remain for a longer period, only wiping the abdomen with alcohol being necessary. It is marvelous, says Salatich, how rapidly cases heal where the entire wound above the fascial layers suppurate, and with less danger of hernia resulting.

In all acute and subacute sinases it is best to wait until little serum or sero-pus exudes before injecting the vaseline, especially if there is any fear of dead bone at the bottom, which must be removed, or the patient will be made worse, for the vaseline stops drainage and the pus must find some other means of exit.

of relief, its advocacy, based on certainty of cure and assurance of nonrecurrence, is not borne out by results. 2. The main object of treatment is the relief of the infection and inflammatory changes, and not merely the removal of the gallstones. So long as there is no recurrence of the inflammatory attacks, there will be no attacks of gall-stones. 3. Recovery not infrequently occurs under nonoperative treatment, especially in early and mild cases, and particularly after first attacks, before serious local damage has been produced by the infection. 4. Medical treatment should be given a fair trial in all cases where the patient's physical condition does not warrant operation, and with the numerous patients who refuse operation. In many such cases he has seen complete and permanent recovery from all symptoms of the disease. 5. Medical treatment is indicated in many cases as a preliminary to operation, and in order to allow the acute infection to subside as far as possible. 6. Medical treatment is indicated in all cases after operation to allow of complete subsidence of the infection and, if possible, to prevent reinfection and recurrence.

The Treatment of Wounds.-A. E. Hoag (N. Y. Med. Jour.) says that all incised wounds should be painted with a 7 per cent tincture of iodine and then the parts shaved dry, as the tincture will not act in the presence of water. Then iodine is again applied both in the wound and around it. After tying all bleeding points, and sponging out all foreign material with dry sterile wipes of gauze, and suturing nerves and tendons which may have been divided, the wound may then be closed without drainage. A dry sterile dressing is then applied over the wound. No wet dressing is ever applied to this class of wounds under the above mentioned treatment with the one exception of alcohol. The reason for this is that alcohol helps to dissolve the iodine and will not prevent the evaporation of it and thereby cause blistering.

Suture material that may be used varies with the individual operator, the author preferring sterile horse hair or subcutaneous catgut sutures on the face, as these leave little or no scars. On other

Treatment of Gunshot Wounds.-Under no circumstances, in any ordinary gunshot wound, should the doctor "probe" for the bullet, which has already done its harm, says A. E. Hoag, in the New York Medical Journal.

The treatment should be the application of iodine to the wound, and if a large vessel or nerve has been injured, which can be readily told by the amount of bleeding or paralysis present, there is no other treatment than to make an incision, find and tie the bleeding vessel, or suture the nerve. After this is completed, close the wound without drainage. If there has been no large vessel or nerve injured the only treatment needed is the application of iodine and an alcohol dressing. After the wound has healed a search for the bullet may be made under aseptic precautions, after having an X-ray taken and stereoscopic pictures made which will give the exact location of the bullet. The author thinks it is unwise to make a search for a bullet that is causing no trouble. It is also a very safe rule to give tetanus antitoxin in all these cases.

深深

The Emmenagogue Oils. In the olden times, says the Therapeutic Gazette, the oils of tansy, pennyroyal, and savin had considerable reputation as emmenagogues or abortifacients, notably pennyroyal. More recently apiol, derived from parsley, has been largely used as a substitute for these oils. It has been recognized for a long time that these substances cannot be used as abortifacients with success unless the dose which is given is so large as to produce abortion by means of the general poisoning which ensues. In the Journal of Pharmacology and Experimental Therapeutics for July, 1913, Macht has studied the influence of pennyroyal, savin, tansy, rue, thyme, turpentine and

apiol upon the uterus of the cat, pregnant and virgin. The results which he obtained show that all these substances, even in large amounts, exerted absolutely no stimulating action on the uterus; on the contrary, they caused it to relax, and even paralyzed it, and the tracings which accompany. Macht's papers certainly show that his interpretation of his result is correct. We, therefore, have experimental evidence confirming the decision heretofore reached by clinicians and already mentioned that the "emmenagogue" and abortifacient action of these oils is entirely due to gastro-intestinal irritation or general constitutional poisoning and not to any specific influence upon the uterus. 惺惺惺

Lobelia in Spasmodic Diseases.-C. W. Jester (Med. World) declares that he injected 30 minims of tincture lobelia into the arm of a 16-month-old babe suffering from membranous croup, and it gave relief in less than thirty minutes. He has used it in spasmodic croup, giving from 30 to as high as 90 minims to children; only last week he gave a 6-year-old boy 90 minims in spasmodic croup and he was relaxed and asleep in thirty minutes. The doctor has also used it to relax a stubborn os uteri in confinements; to relieve headaches and migraine when former treatments had been the hypodermic use of morphine; it will relieve asthma more quickly than any known drug. He uses it with confidence in eclampsia, infantile convulsions, spasms, hysteria, diphtheria, tetanus, apoplexy and ptomaine poisoning.

Dr. Jester first used the fluidextract (alcoholic), but of late years has used only the aqueous preparation known as "subculoyd." The dose is from 20 minims to 2 drams and the medium dose may be repeated every thirty minutes to one hour until effective. Volumes have been written in the last few years regarding this drug when used hypodermically, and the many uses and efficiency of the remedy seem like the fairy tales told by some patent medicine fakir, but it is a dependable remedy for all the conditions above named.

炭烤

An Efficient Dressing for Burns.-W. M. Gregory writes as follows to the Medical Council: Calendula has, in my hands, proven a wonderfully effective dressing in burns; it relieves pain, promotes rapid healing and is an antiseptic which prevents pus formation, thus inducing aseptic healing.

The proper preparation to use is the non-alcoholic extract, or fluid extract, of calendula officinalis, or marigold. There is a tincture prepared for internal use, but for all antiseptic and surgical purposes this concentrated preparation is the necessary one. The succus calendula is not ef

fective, but this thick, non-alcoholic extract, when properly made, is of great value; it is non-proprietary and is made for the regular trade channels for drugs and procurable by them.

When dressed with the old carron oil, burns are often covered with pus in a day or two, but with calendula they remain absolutely aseptic and clean, healing rapidly. The same holds good with wounds which are bruised or lacerated, as I have verified in many cases. It is superior to ichthyol, especially in the relief of pain.

I add two ounces of reliable calendula, as described above, to fourteen ounces of saturated boric acid solution, and apply on gauze or absorbent cotton.

Many preparations of calendula are little more than colored water, and much of the crude drug is practically worthless. A good non-alcoholic extract is so concentrated as to be almost a syrup.

The First Thousand. The editor of the Medical Council gives some excellent advice to his readers on saving, as follows:

"Go tell Aunt Sallie her old gray goose is dead; the one she was saving to make a feather bed," is the first financial tragedy we are taught in childhood. Later in life we hear of others just like it; for most savings are to make feather beds in which we hope to rest, and we pick all the feathers off our goose, or kill it to get its golden eggs, all at once. The doctor's first thousand dollars is usually this goose, and he loses it. Some one has said the best thing a man can do with his first thousand is to lose it and gain the financial wisdom necessary to teach him to handle his next thousand more wisely. Perhaps this may be true; who knows? It is the only comfort the loser has.

Don't adopt the feather-bed idea of the early savings, but put them away as a working capital in the form of a gilt-edge bond bearing interest to be spent in the business of practicing medicine. Don't sell the bond to buy a static machine or an automobile; use the next thousand for such purposes if you really must do so. But use the interest to buy appliances experience, not an agent, prove you actually need. Needs and imagined ones are two vastly different things. Every business needs a reserve; and a thousand dollars is none too much in the business of any doctor. An automobile practice should be grown up to; it is like a mileage book expiring in a year, needed if you have to ride that far.

Until well established in a community, it is not, as a rule, a good thing to use the first thousand dollars in making first payment upon a property with a big mortgage as a liability. Such men usually buy in the wrong place and become

"property poor," one of the most galling kinds of poverty. Until practice is established, no doctor knows just where he should live. If you must buy property, purchase a small place and rent it to good tenants. It is better to own outright a thousand-dollar property and get twelve dollars a month rent for it, than to pay out half you earn in interest and taxes upon a place too valuable for the business you are doing in it.

Make it an inflexible rule never to expect more than six per cent interest upon the first thousand you save. This is the only safe plan. Don't crow over your first thousand; invest it in a bond and forget it until it is time to cut a coupon. Then look upon the next thousand in the same way, just as though it were the first thousand. Keep this up and you will "arrive" before you know it. Never invest anything in speculative stocks and bonds. Few indeed are the speculators who "arrive."

A Study in Human Nutrition.-In The Bulletin of the Manila Medical Society, Drs. A. O. Shaklee and Daniel de la Paz have a preliminary report on a study in human nutrition, in which they relate their experience with a very low diet persisted in for a considerable time. The authors found that after periods of low diet an increased intake of food always brought the individual to much better physical and mental condition than he possessed before beginning the experiment. He was always heavier, stronger, brighter, and happier than before, but after a few months a retrogression took place and eventually the subject was in as poor condition as at the start.

The paper relates several personal experiences of the senior author commencing many years back, when he was put on very low diets through force of circumstances or when he voluntarily chose to subject himself to exceedingly low amounts of food for prolonged periods. After these periods of semifasting the increased amount of food always produced a rapid gain in weight and decided improvement in the general condition, suggesting the idea that one road to good physical condition is through a preliminary low diet.

These preliminary experiments of the authors, however, are not sufficiently conclusive to permit any inferences to be drawn, and we shall look for their later report with interest.

Treatment of Tetanus.-O. L. Rudersdorf, M. D. (Bennett, 1912), Internist, writes: A German boy, aged 7 years, smashed his thumb. Ten days later tetanus set in severely. The family had lost another child in Germany from this malady. They brought this one to St. Francis'

Hospital, Evanston, Illinois, to the clinic of Dr. Webb. Antitetanic serum was given in doses of 3,000 units three times a day for two days, then discontinued as unavailing. Magnesium sulphate solution (25 per cent) was then injected intramuscularly twice a day, the dose being 2 drams of the solution. Some chloral and bromide were also administered. The injections were continued for twenty days, when the child was discharged cured. A febrile reaction from 12 to 1 degree followed each injection in about half an hour.

A Ruptured Ectopic Gestation Sac.-From the report of a case of ectopic gestation, Dr. Frank W. Bradner says, in the New York Medical Journal for December 28, 1912, that pelvic examination cannot be relied upon, at least in general practice, to the extent commonly assumed by the textbooks and other treatises for the diagnosis of this condition, because bimanual examination cannot be performed satisfactorily on account of abdominal distention and tenderness or other anatomical characteristics peculiar to the individual.

Determining the presence of hemorrhage by internal palpation would likewise seem uncertain, since it requires the limitation of the process by adjacent structures or adhesions to the extent of forming an appreciable hematoma, or the lapse of sufficient time for firm clotting to take place, a condition greatly militating against its prospective value.

There is one point, however, which the writer observed in his case, and wishes particularly to emphasize, namely, whenever the uterus was locally disturbed, either with the finger or speculum, it was invariably accompanied by what the patient described as "that throbbing pain again," either aggravated if pain was present, or renewed if absent, and was so constant in occurrence, specific in character, and rational of explanation that it would require no personal hesitation in the future to regard its presence as highly indicative of a ruptured ectopic gestation sac.

Scarlatinal Measles.-In The British Medical Journal for December 21, James F. Blackett reports an instance of two children ill in the same bed, the boy having a well-marked scarlatinal rash on the body and the girl exhibiting a typical rash of measles, with blotchy face, injected conjunctiva, and so on. In the course of time the conditon of both children improved for a while, and then again became aggravated, the girl this time developing scarlet-fever, while the boy came down with measles. Dr. Blackett does not recall seeing any other case in which these two diseases have been so closely associated without any sacrifice of their individuality.

The present writer remembers an experience of a similar kind, which proved to be very harrowing. A woman and her three children-six, four, and two years of age, respectively-were sick at the same time. The mother complained of general malaise, fever, headache, and had a well-defined socalled scarlatinal sore throat. Her 2-yearold daughter showed scarlatinal sore throat and developed a characteristic rash of scarlet-fever on the chest, while the face and the body from the waist down was covered with a measles eruption. This little girl soon developed meningeal symptoms and died.

The same combination of symptoms was observed in the brother six years old, who died of meningitis after having been ill only twenty-four hours, and in spite of all treatment. Another daughter, four years old, showed, like her brother and sister, a characteristic eruption of scarlatina on the chest and in the throat, and an equally characteristic eruption of measles on the face and on the lower part of the body. Fortunately, in her case, the central nervous system did not become involved, and the writer was able to save her, as also the mother.

In a young man eighteen years old, a period of malaise was followed by intense fever and eruption characteristic of measles. For the next twenty-four hours his condition became rapidly aggravated, and on the second day after the eruption of measles had appeared the blotches on the body were interspersed with a typical scarlatinous eruption, which also showed in the very edematous pharynx. The young man's temperature was 104 degrees for several days; but he eventually recovered.

Table-Salt in Constipation. A solution of salt should be taken on an empty stomach, preferably before breakfast; in some cases it is desirable that the patient should also have omitted supper, says L. S. Hine, American Medical Association Journal, Oct. 5, 1912. A pint of sterilized water, hot as hot coffee, with the addition of a couple of teaspoonfuls of salt, constitutes the morning dose. Instruct the patient to sit down by the steaming bowl and sip the solution by the tablespoonful, to take time for it, not to be in a hurry, and to breathe deeply. This last is a stimulus to peristalsis. This dose is followed by an evacuation within a short time-from one-half to one hour. The passages are watery, but differ from those produced by saline catharties in that the common salt carries off seybalous matter and plugs of debris which the colon is so prone to retain. This method is effective not only with young people, but also with those of advanced years. It is also useful as an occasional laxative.