pressure and pain. Neuralgia is an expression, therefore, of a localized neuritis and its treatment is the treatment of neuritis.

Myalgia may be cured or relieved by different methods. Very long applications of radiant light and heat from five hundred candle power lamps applied over the affected muscles is often effective. The method, however, par excellence is the static method referred to in the treatment of neuritis. Acute myalgia may be uniformly cured with one or two twenty-minute applications of the static wave current with a large metal electrode and long spark-gap followed by a thorough application of static sparks; thereby relieving the muscular spasm and producing elimination of the exudations which are filling the infiltrated tissues. The d'Arsonval current by the method described placing a large distributing electrode connected to one side of the d'Arsonval with the patient lying on the d'Arsonval couch will effectively relieve the trouble. In chronic cases of myalgia applications of static sparks and the static wave current will effectively improve the conditions. Dry hot air energetically used may also help.

The treatment of headache is a very complex subject. There are cases of gastric origin for which the only treatment is the correction of the alimentary conditions. There are cases which have their origin in pelvic conditions. Many of these may be corrected by correcting the pelvic trouble. Others may persist through the life of the individual, particularly during the menstrual periods. There are others which may be more or less due to spinal cord conditions, especially in the upper cervical regions. Many of these may be corrected by the systematic employment of mechanical vibration and other modalities which relieve local muscular spasms and congestion. Each case is a study in itself, and in many the conditions are so vague that it is impossible to locate the cause. On general principles everything should be done which tends to restore normal functional metabolism in every part and correct local causes.

The indications in such cases if for the treatment of visceral inflammation. If visceral inflammation is not of infectious origin the same principle of treatment obtains as for the treatment of inflammation elsewhere. The relief of infiltrated, non-malignant, non-infectious conditions calls for the restoration to normal of eirculation and metabolism, as in hypertrophy of the liver from cirrhosis, or splenic enlargement from malaria. The application of the static wave current will reduce enlarged viscera to normal in most early cases. In deep seated malignant tumors the Roentgen ray has remarkable affects in

controlling the pain and in sarcoma may still further inhibit the progress of the disease. The X-ray likewise is remarkably efficient in relieving other deep-seated pains and is particularly applicable to the treatment of pelvic inflammations. The pains of dysmenorrhea and the nervous suffering of subinvolution may be more effectively relieved or cured by the use of the static wave current applied directly to the uterus through the rectum. This method of treatment for dysmenorrhea is one of the most remarkable additions to the gynecological methods. We can report many more than one hundred cures in these patients in from one to two months.

The pains referred to here are probably more effectively relieved by the use of the X-ray and radium than by any other means, and the future of the treatment of these conditions must look to these measures as a part of the treatment of all cases with the assurance that with the combined use of the Roentgen ray and radium with surgery or other measures for removal, the prospect of not only removing the macroscopic but also of destroying the microscopic disease cells is often possible, thereby removing and alleviating the pain and suffering.

The time has passed for the general practitioner or specialist to rely upon opiates and anodynes for the relief of human suffering except in extreme cases of malignancy when other measures have utterly failed. The agents enumerated in answering the preceding questions require nothing like the technical skill that most men attribute to them, and yet a knowledge of the fact is necessary that pain can be relieved by these measures, and that conditions can be cured which are generally left to Nature which at best fails in most inflammatory conditions. These with the adoption of the rational life in point of diet and exercise as prophylactic measures and when conditions have gone wrong, as curative ones as well, will accomplish for human suffering what cannot be accomplished by surgery or drug methods alone.

"Could you do something for a poor old sailor?" asked the seedy looking wanderer at the gate.

"Poor old sailor?" echoed the lady at work at the tub.

"'Yes'm; I followed the wotter for sixteen years."

"Well," said the woman, after a critical look, "you certainly don't look as if you ever caught up with it!"

Then she resumed her labors.

Death from Ratlesnake Bite.-About four in the afternoon, says Crutcher in American Medicine, D. J., a bright, energetic boy, aged seven, residing near Kenna, New Mexico, was struck by an enormous rattlesnake (Crotalus adamanteus, most probably), both fangs entering the ulnar side of the right forearm about three inches above the wrist. The injured extremity was corded at once and the parts incised. The Hon. Arthur J. Evans, M. D., of Elida, was summoned, arriving at the bedside of the patient five and a half hours after the receipt of the injury. Dr. Evans found the patient delirious, pulse 108, temperature nearly normal, with persistent vomiting. The corded arm was greatly swollen, with many vesicles present. The parents of the boy had given him about half a pint of whiskey during the first hour after the accident. Dr. Evans administered strychnia grs. 1-30 hypodermically every four hours, and applied a strong solution of potassium permanganate to the wound. Some improvements followed these measures, but the patient sank gradually and died at 10:20 a. m. following the injury.

It was most unfortunate that skilled assistance could not be obtained until after a delay of several hours, and the administration of such a quantity of alcohol by the parents was doubtless greatly against a favorable outcome.

In cases of this sort I believe that the prompt administration of a full dose of morphin would prove of great value in mitigating the effects of mental shock, which must certainly be a decisive factor in many instances. I have now under my care a girl of 15 who was stung ten years ago by a copperhead (Agkistrodon contorrix). Both fang marks are perfectly distinct. The local symptoms at that time were trivial, but I am told by the girl's mother that grave symptoms of shock nearly proved fatal and that life was saved only by the most energetic efforts on the part of skilled physicians.

A New Saline Solution.-Schiassi (Semaine Medicale) has, he thinks, improved upon the commonly used physiological salt solution, the use

of which for some time may cause progressive adynamia. He wishes to secure the tonic effect of calcium, and therefore submits a combination which is alleged to be very useful:

In the first place he lessens the quantity of sodium chloride to 650 in place of 750 to the 1000, and adds a definite quantity of potassium and of calcium. This is not only tonic, but increases the coagulability of the blood. Moreover, since surgical operations are peculiarly prone to develop the initial phenomena of an acidosis, he adds bicarbonate of soda and finally glucose because of its diuretic, tonic, and cardiotonic properties, which are peculiarly inherent in this substance. His formula for intravenous injection is as follows:

Chemically pure chloride of sodium, 6.50;
Chloride of potassium, 0.30;
Chloride of calcium, fused, 1.00;
Bicarbonate of soda, 0.50;

Glucose, 1.50;

Distilled water, 1000.00.

If the solution is for the purpose of rectal instillation, the quantity of glucose is increased from 11⁄2 to 50 grammes and pure ethyl alcohol is added in the proportion of 15 grammes. Schiassi distinctly prefers the rectal method of injection because substances being absorbed by the portal circulation undergo a proper transformation in the liver. Moreover, a greater quantity of liquid cannot be introduced by this route than is actually called for by the needs of the general circulation.

Treatment of Heroin Addiction.-Many cases of heroin addiction are being reported, and this drug is said to be second only to cocaine in its harmful effects. However, it can be cured according to T. D. Crothers, who, writing in the Medical Council, declares that in the treatment sulphate of magnesia in 10- or 15-grain doses three or four times a day, unless the bowels become very irritable, is probably the best drug.

Humulus is another drug which can be given with great satisfaction in an infusion. This will produce a mild sedative action without complicating or producing any possible addictions. If

humulus does not act promptly, valerian is a safe sedative which can be used particularly at night. Hydropathic measures in the form of baths every day are very essential.

The rule should be to withdraw the heroin at once and depend on valerian and sumbul or asafetida compound to quiet the nervous irritation and care should be taken not to give any form of opium or spirits. Infusion of quassia is a very valuable tonic, and often takes the place of heroin in its stimulating qualities.

A heroin addiction is not a difficult thing to treat if the patient will come under the exact care of the physician and follow his directions implicitly.

There is a mental weakness that must be recognized, and the patient must be profoundly impressed with the danger of his condition, and the need of exact means and measures extending over several months. I have seen several cases of heroin addiction, but they have been complicated with cocaine and spirits, and, of course, present a complex mass of symptoms that require considerable discernment and skill to meet and overcome.

There is no danger from the sudden withdrawal of either cocaine or heroin. There is more danger in the attempted slow reduction. It is always wise to avoid in these cases tinctures of any description, and give liquid drugs only of the watery infusion class.

Heroin is a dangerous drug to a neurotic, and if given to such an one for any particular purpose should be concealed and withdrawn at the very first opportunity, or replaced by sumbul or others of the milder narcotic class.

Indol and Indican.-From the excellent review given by Austin in the Boston Medical & Surgical Journal we extract the following:

In a careful investigation of patients suffering from gastro-intestinal symptoms, Frankel and Franko have found that when blood is poured into the digestive tract, even in the minutest quantities, indican is markedly increased in the urine; this is particularly true of blood from a gastric ulcer. As the ingestion of meat, and particularly of fibrin, may produce the same increase in indican, similar precautions must be observed, as in the search for occult blood in the feces, i. e., freedom from the ingestion of meat. The dependence of the amount of indol and indican formed on the character of the food has been studied by von Morazewski and Herzfeld, who found both increased upon a fat, vegetable and gelatine diet in healthy individuals, but a marked diminution occurs upon a starch or sugar diet. When on a starch and sugar diet a change to pro

tein caused an increase and while on a fat diet a change to protein caused a diminution in both substances. A close connection exists between the fecal indol and the urinary indican in that they both increase and diminish conjointly. When an idicanuria exists two factors must be considered as its cause, first the absorptive power of the intestine, and secondly the power to destroy indol before its pairing on the part of the organism. The former tedious method of isolating indol from feces by distillation, extraction with ether, and its quantitive determination by weighing has been much simplified by Herzfeld and Bauer, who proceed as follows: 10 grams of feces are suspended in 1,000 c.c. of water and 5-600 c.c. of this distilled off, the distillate shaken out with xylol, the latter allowed to evaporate, a definite amount of water added to the residue dependent on the amount of the control used, and Ehrlich's reagent (dimethylaminobenzaldehyde, 2.0, and acid hydrochloric conc., 100.0) added, until the most intense color is producer, when it is compared with a standard indol solution of known strength, to which some of the reagent has also been added. A colorimeter may be employed but is not necessary. Quantities as small as 1:10,000,000 can be estimated in this way.

Calcium Salts in Skin Diseases.-Some years ago Almroth Wright advised the use of the calcium salts in sick headache, purpura, and urticaria, on account of their effect upon the coagulability of the blood. Charles J. White has employed this class of remedies for several years and reported some of his results at the last meeting of the American Dermatological Association, as reported in the Medical Record.

He had prescribed calcium in many different conditions, but by elimination of the unsatisfactory tests the final trials had been limited to the following diseases and conditions: Hyperidrosis, pernio, herpes simplex, erythema multiforme, urticaria, livedo, purpura, and angioneurotic edema. In addition to the calcium salts, patients had been asked to partake as freely as possible of food rich in calcium, and had been urged to avoid raw fruits and all acid foods, for it had seemed to him that many people suffering from the suspected diseases had been large consumers of these articles of diet. External treatment had been prescribed in all cases, a factor which vitiated the scientific value of the whole work, but it must be borne in mind that most of these patients were referred to the writer by general practitioners who had been unsuccessful in the previous treatment of these individuals, and, furthermore, that these men and women were mostly wage-earners who deserved as

speedy restoration to health as was possible. Also the work was necessarily hampered by the fact that all these patients were ambulants, who obeyed or broke laws as the spirit moved them. The cases of urticaria had done well; statistics showed twelve with great improvement; two some improvement, and nine others, not reported, none whatever. Cold figures were not always our only means of judg ment in medicine, but from personal contact with these patients it had seemed that the ingestion of calcium had been followed by improvement in the majority. In the cases of erythemia multiforme, seven of the group showed decided improvement and six exhibited what one might call the normal, although perhaps quickened, evolution of the disease following the ingestion of the calcium. The pernio group showed that six patients were practically cured in a short space of time; three were decidedly benefited, while three only were not helped at all. This seems a good showing, considering the frequent intractability of the disease. In hyperidrosis cases four patients to all intents and purposes were cured, and one decidedly benefited -which seemed very satisfactory considering the frequent obstinacy of the condition, and in this particular group several of the patients had suffered for a number of years very severely. The cases of purpura rheumatica, livedo, sick headache, and erythema toxicum were too small in number to be of any scientific value, and yet the degree of success attending their treatment was striking and worthy of remembrance in the future. In summing up his experiments Dr. White thought it seemed fair to state that calcium was certainly not a specific for any of the diseases in any sense of the word, but it was a drug which might render distinct and most welcome service in any one of them, and a drug which should always be tried in obstinate examples of the conditions above cited.

Does an Insect Transmit Cancer?-Dr. John R. Littlefield, who writes upon this subject in the Virginia Medical Semi-Monthly, is inclined to charge the bedbug with responsibility. After examining the problem at some length he arrives at the following conclusions:

"1. Our present theories as to the cause of carcinomata and sarcomata are untenable.

"2. Until proven to the contrary, the protozoan organisms should be looked upon as the cause of these growths.

"3. The fact that the bedbug has been the constant companion of civilized man, following him wherever he has gone, and that cancer has always made its appearance in cancer free savage tribes following their contact with civilization and the

introduction of the bedbug, would lead us to the definite conclusion that the bedbug is the carrier.

"4. In the light of our present knowledge, until it is proven that cancer is not an insect bornedisease, we should exercise a greater caution in protecting our bodies from all biting insects.

"5. Cancer patients should be rigidly guarded from all insects."

惺惺惺

Fischer's Theory Regarding Nephritis. From the Journal of the Medical Society of New Jersey we gather the following explanation of the etiology of nephritis, as proposed by Martin H. Fischer, of Cincinnati. He thinks the symptoms. of this disease, all forms, are due to the production within the body, and especially in the kidney itself, of some form of acid. In other words, it is a direct result of acid intoxication.. The acids in the kidney act directly upon the protoplasmic colloid material of the cells, which under this influence absorb water, as a result of their increased hydration capacity. In other words, the cells become edematous.

The secondary effect upon the cell is, the precipitation within it of protein material, and thisleads to the condition which we know as cloudy swelling, the first stage in cellular degeneration..

Finally, the epithelial cells fall apart, stick together, and loosen en masse, as the cement substance dissolves, and this condition results in the formation of epithelial casts. By more prolonged action of the acids, the epithelial casts are converted into granular casts, and these still later into hyaline casts.

This, in general, is the pathogenic process occurring in nephritis, the parenchymatous form of the disease being taken as the general type. What we call chronic interstitial nephritis is a later resultant from the same process, connective tissue being formed to replace the crowdedout kidney-cells.

With this conception of the etiology of nephritis, the method of treatment devised by Doc-tor Fischer will be seen to rest upon a sound,. rational basis. Briefly, it consists, primarily, in. the administration of alkalis, in order to neutralize the acid present in abnormal amount in the kidney as well as in other edematous organs in the body. He also advises the use of salts. and of water. Salts are useful, because the various changes induced by acids in the renal colloids are counteracted by any salt, even & neutral one. Water is administered, in order to have more of this present in the body to saturate all of the body-colloids, in other words, to

provide the free water necessary for the secretion of urine.

Doctor Fischer also advises the administration of dextrose or other sugar, either by rectum or intravenously: first, because carbohydrate starvation is a very common and potent cause of acid formation, and, second, because sugar is a valuable agent for reducing excessive hydration of protein; or, to put this idea in more simple language, sugar withdraws water from swollen and edematous tissues.

With this conception of the etiology of nephritis, it is easy to understand how errors in diet -especially those associated with excessive ingestion of protein food and indican formation, which leads to high urinary acidity-may act as a factor in the generation of Bright's disease. Any cause, as a matter of fact, which gives rise to acidemia may also engender chronic disease of the kidney.

The methods of treatment so frequently advised in this journal for the care of the intestinal canal, in other words, the clean-out, clean-up and keep-clean method, together with alkalinization of the urine (as shown necessary by tests for urinary acidity), are of primary importance in the treatment of nephritis.

We have made use of the excellent abstract of Clinical Medicine in presenting this theory.

XXX

Intravenous Saline Injections in Hemoptysis. -H. Mueller, of Koeln, has been trying the intravenous use of salt solution (general 5 Cc. of a 10-per cent strength) in the hemorrhages of consumptives, and has published his observations (Beitr. z. Klin. d. Tuberk.), both in cases of dry and of ulcerative tuberculosis. These results were nearly alike for the two kinds, except that in the dry cases the bleedings are less liable to reappear. Altogether, the results were very gratifying in virtually all mild cases of hemoptysis; not quite so good in moderately severe bleeding; while out of three cases of intense attacks only one was beneficially influenced.

The Effects of Tuberculin Treatment.-Shalet (Journal of the American Medical Association) summarizes the net results of tuberculin treatment in 571 cases of pulmonary tuberculosis, as follows:

1. Those who were distinctly improved and apparently cured (clinically), 25 per cent.

2. The indifferent (60 per cent), who may be subdivided into (a) 40 per cent who respond indifferently while the tuberculin was continued, but on the cessation of which did distinctly

better than before tuberculin treatment, an indeterminate number of whom often come in later under 1, and (b) 20 per cent who remain indifferent.

3. Those who are apparently made worse (15 per cent); that is, under the use of the same dosage as the others in the class, but who do not only come in under 2, but some even under 1, if the tuberculin is given in doses attenuated enough to meet their hypersensitiveness.

4. Effect of tuberculin on localized visible tuberculosis such as fistulæ in ano, glands, etc., which is specific, particularly in the case of tuberculous glands in the neck, in which condition tuberculin is by far the treatment of choice.

While the number of the distinctly improved and apparently cured under sanatorium care and tuberculin does not appear to be any greater than under sanatorium care alone, the value of the former is in bringing up to the same percentage a type of case that under sanatorium care only would by no means fare so well, if clinical experience is worth anything.