Progress of Medicine. THERAPEUTICS AND PHARMACOLOGY. UNTOWARD EFFECTS OF DUBOISINE -Dr. H. F. Hansell reports the case ("Philadelphia Poly.") of a 19-year-old girl who had hyperopia and astigmatism. A prescription of dubosia sulphate gr. ij to the ounce was given, according to the routine practice when paralysis of accommodation is essential to an accurate estimate of the refractive error. There was no disease of the media or fundus. The following day, by request, the patient returned, but the contemplated test of refraction could not be made, because the lias of both eyes, but especially the right, were nearly closed by acute inflammation of the skin and infiltration of the underlying connective tissue of the lids and adjacent parts. The skin was discolored but not painful, and only slightly sensitive to pressure. The subjective sensations were burning and itching. The swelling had developed within a short time after the first instillation of the dubosia solution. Desirous of testing whether this acute cellular tissue inflammation were really the result of the use of the drug and not a coincidence, the patient was requested to continue with it. During the next twenty-four hours she instilled it three times, and upon her return presented a ludicrous and somewhat startling appearance. Both eyes were almost entirely covered by the tense, red and swollen lids. The conjunctivæ were not chemosed, the corneæ were clear, the pupils widely dilated and accommodation paralyzed. Dr. Blomer had been treating her "for a month for pemphigus, which had affected the inner surfaces of the toes, heels and fingers, corners of the mouth, and, in fact, all the moist surfaces of the body." Dr. Hansell dropped a few drops of the solution of dubosia used, into the conjunctival sacs of three other patients without producing other than the usual effect, and thus eliminated the question of an impure solution. Under simple treatment the inflammation subsided in a few days. He remarks that the cause of this unusual action of dubosia may be either a peculiar manifestation of a belladonna idiosyncrasy or an irritative local action upon an individual whose blood was disordered. PIPERAZIN IN LITHÆMIA.-Under lithæmia, the gouty habit, are comprised a large variety of pathological conditions, having their origin in the accumulation of uric acid within the system. Owing to the insolubility of uric acid and the sodium urate in fluids having an acid reaction, any diminution in the alkalinity of the blood and other secretions will lead to the deposition of these substances in the various tissues of the body. This takes place especially in the joints and kidneys, giving rise to attacks of gout, and to renal lithiasis and the so-called gouty or cirrhotic kidney. Many efforts have been made to discover remedies, which, when taken up into the system, will not only keep the uric acid and urates in a soluble form so as to prevent their deposition, but will also dissolve existing concretions in the tissues. The alkalines, especially the salts of lithium and mineral waters containing them, have been largely employed for this purpose. Since the introduction of piperazin (Bayer) the practitioner has been able to treat cases with greater success. Results of clinical experience with this remedy may be briefly summarized: In the "gouty habit" piperazin favors the elimination of uric acid from the system and thereby prevents its deposition in the tissues. It dissolves the concretions in gouty joints and relieves the pain, stiffness, and other discomforts. In rheumatoid and rheumatic arthritis, it is equally serviceable. In uro-lithiasis, stone in the kidney, gravel, etc., piperazin has cured cases where operative treatment appeared the only resource. It dissolves not only the uric acid layers of the calculus, but also the albuminous nucleus, thus effecting its complete disintegration. In diabetes mellitus piperazin arrests excretion of sugar and improves the general condition of the patient. As the list of effective remedies in this disease is exceedingly small it deserves a careful trial. Piperazin (Bayer) may be obtained in one-half and one-ounce vials and in tubes of ten tablets, each tablet containing sixteen grains, which represent the average daily dose. UNTOWARD EFFECTS OF QUININE.-Dr. J. Schenck of Carmel, Ill., cites ("Jour. Amer Med. Assoc.") instances in which quinine produces a herpetic eruption on the lip, ear, cheek, or prepuce. He also reports a case where five grains produce acute coryza. In an elderly woman ten grains during half a day will produce large, reddish-purple blotches on the ulnar margin of the left hand, and another, about the size of a half dollar, on the upper po:tion of the left concha; the eruption is accompanied by a hot tingling sensation, and disappears during the following twenty-four hours after the remedy has been given; the same train of symptoms invariably occur after quinine. In another case twenty grains, given in four-grain doses two hours apart invariably produces a similarly colored condition of the skin, on the back of the left thumb, between the first and second joints. The burning sensation is very severe, the epidermis is raised into a blister and afterwards shed. In another patient twenty grains will cause the mucous membrane covering the glans penis to change to a dark purple color, accompanied by intense itching, followed by the shedding of the epithelial layer in the course of the following week. In a fourth case four grains will cause a most annoying itching of the glans penis in from thirty to sixty minutes after it has been taken. If taken at bedtime the itching will continue until morning. The party is about 50 years old, and during the last eight or ten years of his life this effect has invariably followed the use of quinine, while previous to that time this effect was not noticed, although he has taken quinine frequently since early childhood. Surg. Jour.") concerning parachlorophenol that: The drug does not possess anæsthetic properties of pure phenol. Besides it has nasty smell and taste, which mightily interfere with its use, more especially in cases of laryngeal or pharyngeal disease. Parachlorophenol destroys the epithelial lining of mucous membranes and "almost immediately gives rise to a powerful local reaction;" frequently it causes local suppuration, while repeated paintings lead to shrinkage and distortion of hypertrophied tissues. In laryngeal tuberculosis the drug produces edematous swelling of the part treated, as well as long, lasting and intense pain with loss of appetite and general nervous irritability. On the whole, in non-tuberculous cases, parachlorophenol proves to be much inferior to chromic acid or galvano-cautery, while in the treatment of laryngeal phthisis it is nearly useless, and at all events is much inferior to lactic or carbolic acid, or menthol. ELECAMPANE, according to the "Medical Age," is one of the most valuable of modern antiseptic remedies, one that, aside from its powerful effect, has the great advantage of being free from odor. It is aromatic, stimulant, expectorant, emmenagogue, diaphoretic, and tonic to mucous membrane. It has been found of especial use in malaria, tuberculosis, catarrhal diseases, whooping-cough, and chronic bronchitis. One grain of the inulin added to 10,000 of urine will prevent the latter from decomposition. With this evidence it would seem as if it would prove a true bactericide in wasting diseases. Elecampane in the early forties en disuse until the revival of the old contagious views of that disease. COAL OIL IN GONORRHEA.-Dr. R. W. Glendenning of Portland, Ore., reports ("Medical Sentinel") the case of an Italian who consulted a druggist for gonorrhoea. The treatment was not entirely satisfactory, and the organ involved began to swell. He was now instructed to apply cold water. Not understanding En-joyed much reputation in phthisis but fell into glish very well, he went home and injected coal oil into his urethra. Following up the treatment a few times set up a very active lymphangitis, and the penis, scrotum, perineum and lower hypogastric region became very oedematous. The penis was swollen to an enormous size and suppuration set in, extending over the whole region. Dr. Glendenning made three incisions in the penis, two in the hypogastrium and one in the perineum-being rewarded by a liberal flow of pus from all. A large slough separated from the side of the penis a few days later. The patient had considerable fever for a few days and symptoms of septicemia, but finally threw them off. There was no anuria or dysuria at any time present. PARACHLOROPHENOL IN LARYNGOLOGY -Dr. Szmurlo concludes ("St. Louis Med. and PHENACETIN, according to Peabody ("Med. Bull."), is less likely to cause collapse than antifebrin, and has a soothing effect. It is very good for neuralgia, migraine, and frontal headache of acute catarrh; in sciatica it is very useful; in locomotor ataxia, not so good, although in some cases it is excellent. In chronic neuritis it relieves pain, and in rheumatism it is as good as antipyrin, but it is of no use whatsoever in gonorrhoeal rheumatism. Relapse is as frequent after phenacetin as other drugs. It has been found to relieve pain in epithelioma of tongue when used locally. In polyuria it has diminished urine, and obstinate singultus has been stopped by 15 grains in one dose for eight to ten hours; then repeat. It is often hypnotic. PROGRESS OF MEDICINE. ADONIS ÆSTIVALIS IN LIPOMATOSIS.-The "American Medico-Surgical Bulletin" states that tr. adonis æstivalis has been found of value in lipomatosis in ten drop doses thrice daily. THERMODIN, according to Schmitt ("Sem. Med."), is a mild, safe, efficient antipyretic in 15grain doses. OBSTETRICS, GYNIATRICS, AND PÆDIATRICS. PAIN IN THE BACK.-Erben states ("Amer. Medico.-Surg. Bull.") that pain in the back may be due to a great variety of causes, is of different intensity, and may be localized in different places. The first step in making a diagnosis should be in determining other symptoms of disease. First, see whether herpes zoster or spondylitis is present; if not, take the temperature, because the fever present in infectious diseases or inflammation of any organ is apt to be accompanied by pain in the back and extremities. At the same time it must not be forgotten that severe pain in the back is one of the most constant symptoms of the commencement of variola. The next step should be an examination of all the organs of the chest and abdominal cavities; in this manner a commencing pneumonia, or pleurisy, or pneumothorax, or tuberculosis can be discovered. If, besides pain in the interscapular region, a difficulty in swallowing be 89 present, a pathological process may exist in the posterior mediastinum, such as aneurism, or carcinoma of the œsophagus. Frequently affections of the stomach and intestines, liver and spleen, are accompanied by pain in the back, which in these cases is usually confined to the region between the fifth and ninth dorsal vertebræ, and is not, as a general rule, very severe. One of the most frequent causes of this dorso-intercostal neuralgia is constipation, which should always be inquired into. In chronic catarrh of the stomach, in nervous dyspepsia, atony of the stomacy, ulcer of the stomach with consecutive formation of scars, and in cancer of the stomach, dorsal pain may be one of the most pronounced symptoms. Affections of the urinary apparatus, and of the female genital tract, are often accompanied by pain in the back. Should, after an examination of all these organs, a diagnosis still not have been made, there should be determined, especially if the pain has lasted for a long time, whether a constitutional disturbance, such as chlorosis, anæmia, or osteomalacia is not present. Other If all these conditions have been excluded, either a muscle or a nerve-process must be present, although even here there is quite a variety of pathological disturbances. symptoms, pointing either to myelitis, myelomeningitis, pachymeningitis, cervicalis hypertrophica, or commencing tabes may be present. Pain in the back (rachialgia) is also a frequent symptom of hysteria. If besides this pain there are other nervous symptoms, such as pain in the head, face, or limbs, fear, sleeplessness, cold hands, copious perspiration, palpitation of the heart, colic, frequent urination, etc., the diagnosis of spinal irritation is made. In cases of accidents, also, pain in the back plays an important rôle. Finally, if no other symptom whatever besides the pain be present, the conclusion that there is a mere local trouble must be reached; in this case, the pain is the disease, and not the symptom. In many cases, the trouble is then due to a dorso-intercostal neuralgia; in others, it is simply a muscular rheumatism. In neuralgia, the left half of the body is mostly affected; the pain is usually of short duration, and easily yields to treatment, although, in rare cases, it is the commencement of sciatica. It is noncontinuous, and in that way differs from that of muscular rheumatism, which is constant. BACTERIOLOGICAL DIAGNOSIS OF DIPHTHERIA [To the Editor:] The ability to differentiate cases of diphtheria quickly and certainly by means of cultures of bacteria, prepared from the throat, renders it important that such a method should be used as far as possible by the profession. Certain difficulties, however, prevent the general practitioner from carrying out detailed examination himself. In view of this the Chicago Department of Health offers the method as an aid to the profession at large. The bacteriological diagnosis of diphtheria cases involves the following: (1) Preparation of the proper culture medium, and its distribution to doctors. (2) Inoculation of tubes from patients and return when so inoculated to the department. (3) Cultivation and examination of the tubes in the laboratory. (4) The rendering of reports of the results of the inoculation of the cultured tubes. The department has prepared wooden boxes containing tubes of culture material, throat swabs, and the necessary blanks. These boxes may be obtained from the department clerk, room 4, city hall. The following are the directions for the use of cultures in the diagnosis of diphtheria: The wooden cases containing culture tubes and throat swabs may be obtained at any time by a physician, or upon his order from the department clerk, room 4, city hall. The blank form is to be filled out down to the double lines, and always returned with the case. When making an inoculation the throat should be first well gargled with plain water to remove mucus and antiseptics. Remove the sterile swab from its tube, and, without contact with other objects, rub it firmly against the suspicious area in the throat. Remove the cotton plug from the other tube, and rub the swab over the surface of the culture medium. Replace the swab in its own tube, and replace the cotton plugs. Send the outfit to the department at once. Cultures from diphtheria cases should be made as early as possible, as the bacillus sometimes disappears from the throat before the membrane. In all cases when the outfit is not used, it is to be returned to the department. The examination of cultures obtained and demonstrations as to the presence or absence of the diphtheria bacillus is a part of the work of the laboratory of the health department. Here the tubes will be incubated and examined when colonies appear. From here, also, the reports will be returned to the physicians. The culture medium used in this work is Loeffler's bloodserum mixture, and also the urineagar mixture of Schloeffer, upon which the diphtheria bacillus grows almost as readily, and gives as characteristic results as upon the blood-serum. The bacillus will grow within twenty to twenty-four hours, that is, before any of the pus or any other bacteria that may be present in the throat grow to any extent. In that way a growth of the diphtheria bacillus, preceding other growths, is obtained and a diagnosis is made. In general, reports may be returned by the noon of the day following delivery of the inoculated tubes. CHICAGO. A. GEHRMANN, M. D. SEXUAL PERVERSION IN THE FEMALE.— Dr. J. G. Kiernan states ("Rev. of Nerv. and Ment. Dis.") that while the victim of congenital sexual inversion cannot be regarded as a lunatic, nor as criminally nor civilly irresponsible, still there exists a peculiar psychical state closely akin to that of the hysteric or sexual neurasthenic. It is in just such conditions that suggestion and other phases of psycho-therapy have been found of value. There is an undue exaltation of the "ego," together with abulic tendencies. There is a pretty prevalent tendency on the part of these anomalies to regard themselves as "interesting invalids" to whom sympathy is a duty. This notion, rather prevalent at present among them, is decidedly opposed to proper management. He cites the case of a 22-yearold girl who had a neurotic ancestry on the paternal side. Her face and cranium were symmetrical. The patient had always liked to play boys' games and to dress in male attire. She felt herself at certain times sexually attracted by some female friends with whom she indulged in mutual masturbation. These feelings came at regular periods, and were then powerfully excited by the sight of the female genitals. The patient in the interval manifested only repugnance to attentions from men. She had been struck with the fact that while her lascivious dreams and thoughts are excited by females, those of females with whom she has conversed are excited by males. She, therefore, regarded these feelings as morbid. At times she had imperative conceptions, such as that if she CORRESPONDENCE. turned her head around she would break her neck. To avoid this ideal danger she at times carried her head in a very constrained position. This patient was treated as if afflicted by nymphomania. The usual balneotherapic and other anaphrodisiac measures were employed, and at the same time a course of mental training was instituted. For a long time the patient was enabled to keep the feeling under control, and it was for some years quiescent. The patient later formed a friendship with a woman of like literary and musical tastes. This friendship became a perverted love, and the two were almost inseparable. To secure the companionship of her friend the patient was induced to marry the friend's brother. The union was not congenial to the patient, except that it secured the companionship of her friend. Sexual intercourse excited perverse images in which the husband (who resembled the sister) appeared as another sister. Under these images the patient endured and even enjoyed sexual intercourse, and conceived a languid liking for her husband, who was much attached to her and his sister, and chivalrous in his kindness to them. These relations lasted some years, the esteem and liking of the wife for the husband increasing, but paling before the deep, though perverted, affection for the sister. The sister died from an acute attack of pneumonia, devotedly nursed by both wife and husband. The marriage had been unfruitful, but less than a year after the sister's death a daughter was born who much resembled her. The wife's esteem passed through love of the sister, to intense maternal love of the daughter, as resembling the sister; through this to normal love of the husband as the father and brother. The congenital tendency to females is now entirely kept in check by this love. The denouement in this case and the mental phenomena indicate that there is entirely too much sympathy wasted on these patients, since sympathy to them is as poisonous as to the hysteric whose mental state is very similar. Insistence on the morbidity of the pervert ideas and prohibition of sexual literature as in the sexual neurasthenic, together with allied psychical therapy, and anaphrodisiac methods, cannot but benefit. These patients, like the hysteric, will not "will" to be cured while they are subjects of sympathy. 91 adult men. In one of the patients (a weaklymade and badly-nourished subject of thirty-three, a school-master by profession) the cardiac impulse was displaced to a point situated in the right third intercostal space, just above the nipple. The cardiac sounds were quite distinct and clear in the area and could be still faintly heard about the left edge of the sternum, beyond which line they ceased to be perceptible altogether. On the right side, the shoulder, clavicle and scapula were distinctly lowered, the supraclavicular, infraclavicular and suprascapular regions drawn in, and on percussion dull, and the respiratory movements diminished, while auscultation revealed moist rales and tubular breathing over the whole area of dullness. There was also present mucopurulent expectoration, but no tubercle bacilli could be found in the sputum. The patient stated that he had been suffering from cough, dyspnoea, fever and gradually increasing weakness for about five years. The left lung, liver and spleen proved to be sound. In view of all the facts, Dr. Berova came to the conclusion that she had to deal with a case of chronic interstitial inflammation of the right lung, with consecutive cirrhosis of the organ. According to her theory, "the lung gradually decreased in size, the right side of the chest as gradually collapsed, and the heart, being steadily dragged along by the shrinking lung, ultimately became displaced into the right thorax." A peasant had left-sided hydropneumo-thorax, of about three weeks' standing and obscure origin. The cardiac beat proved to be displaced to the right mammillary line of the level of the fourth interspace. The area of heart dullness commenced about the fourth rib and below blended with that of hepatic one, while its internal margin did not transgress the right edge of the sternum. HYSTERICAL JOINTS.-Dr. Miller ("St. Louis Med. and Surg. Jour.") reports a case of hysterical joint in a girl 12 years of age. Later on she had hysterical aphonia and regular epileptic seizures. A genuine case of hip joint disease occurred in the same house at the same time, and the symptoms of the two patients were so similar that consultants, who were called, could decide between them with difficulty. BUBOES FROM LOUSE-BITES.-Dr. R. Kraefting ("Jour. of Cut. and Genito-Ur. Dis.") reports the case of a man who presented bilateral inguinal buboes arising from lousebites. These had caused an eczematous state. |