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2. The Water Supply of Towns and Cities. employed as frequently as local remedies in in3. The Water Supply of Philadelphia.

flammations of the mucous membranes as they 4. The Disposal of Slops, Garbage, Refuse, etc. deserve to be. They seem to us to be distinctly. 5. The Prevention of Communicable Diseases. sedative, and at the same time slightly astringent, 6. Influence of Clothing on Health.

and may be used freely in the most acute stages 7. Ventilation.

of mucous inflammation. Thus, in the beginning 8. The Drainage and Sewerage of Cities and of an acute nasal catarrh, bismuth may be blown Towns.

by means of a quill freely into the nostrils, often 9. The Drainage and Sewerage of Philadels with great relief. If five grains of the carbonate phia.

of sodium be added to two drachms of the bisto. The Influence on Diet on Health.

muth it will often be found serviceable. In gon11. The Relations of Christianity to Health. orrhea, during the most acute stage, injections 12. Mistakes in School Architecture.

containing twenty to forty grains of bismuth, sus13. Defective Vision in School Children: pended by means of some mucilage, and repeated Causes and Management.

every two or three hours, sometimes act most 14. The Necessities of Physical Education. advantageously.

15. Drainage and Sewerage in Country Dis- As is universally recognized, these salts of bistricts.

muth are of great value in all gastric or intestinal 16. Sanitary Science in Villages.

irritations. When the stomach itself is affected, 17. Municipal Sanitation.

the bismuth should be given just before or im18. Artificial Feeding of Infants.

mediately after the meal; the doses are not less 19. Condensed Milk.

than ten grains, the object being, of course, to have 20. Various artificial Baby Foods.

the bismuth retained in the stomach and brought 21. The Inheritance of Disease.

in contact with the mucous membrane of the 22. Hygiene of the Home.

stomach as thoroughly as possible. In many 23. Sanitary Plumbing and Drainage.

cases it would be better to give the bismuth a 24. Test for Impurities in Water: The Use of half-hour before the meal. When it is desired Filters.

to influence the mucous membranes of the intes. 25. Germicides.

tines the bismuth must be given in much larger 26. Vaccination.

doses, twenty grains to a drachm; but especially 27. The Hygiene of Old Age.

is it desirable that it be administered about two 28. Cholera.

hours after eating, when the contents of the 29. City versus Country Life, from a Hygienic stomach are rapidly passing into the intestines, Point of View.

in order that the bismuth may be hurried through The public are cordially invited to take part in the stomach as rapidly as possible and reach the and help to make a success of this convention. intestines in an unaltered condition. At a later date, circular of details will be issued. The remarks which we have been making refer JOSEPH F. EDWARDS, M.D.,

to the insoluble preparations of bismuth-the subChairman of Committee on Arrangements, nitrate and the subcarbonate-which do not in 224 S. Sixteenth Street, Philadelphia, Pa. any way differ from one another in their relations BISMUTH PREPARATIONS.---The great difficulty

to the human organism. The soluble ammoniowhich in the past has attended the therapeutic cidedly irritant remedy which, in our practice,

citrate of bismuth is a very astringent and deuse of the salts of bismuth in large quantities has failed to prove itself of any special value, has been their proneness to contain arsenic. We

Therapeutic Gazette. well remember having produced severe arsenical poisoning by the administration of a preparation IDIOSYNCRASIES.—There are probably very of bismuth which had been made by one of the few physicians who have not from time to time largest and most reliable chemical establish- been seriously annoyed by the idiosyncrasies of ments in the United States. This liability to ar- people in regard to drugs. These idiosyncrasies senical contamination grew out of the fact that are without reason that can be discovered, and the only bismuth ores formerly in use were those cannot be allowed for by any a priori judgment. of Central Europe, all of which contain arsenic Perhaps one of the most serious is the case of susin abundance. Since the discovery of ores of ceptibility to the action of mercurials which some bismuth in South America, which are free from people possess. We have seen a fraction of a arsenic, the practitioner need not fear to use this grain of calomel cause a most frightful and really drug in very large doses.

serious salivation. A very curious circumstance There are one or two therapeutic points in re which we have noticed in one or two such cases gard to the salts of bismuth which it has seemed is that blue mass was tolerated when the sysworth while to call attention to. In the first place tem exhibited the most violent reaction against we hardly think that the bismuth preparations are calomel.

There is a very well-known practitioner in | Other language I fail to find which can adePhiladelphia who is most violently affected by quately describe the condition assumed by Batthe odor of hyacinths. We have known a single tey's ardent disciples. We hear Dr. Imlach sprig of hyacinth, put in his room without his opening his paper upon pyosalpynx with the reknowledge, to cause in a few moments sick mark “ that every Monday, at two o'clock, I see stomach, followed by violent, repeated retching, out-patients at the hospital for women. If unable and great general depression, amounting almost to attend, I were to tell the nurse to send into the to syncope. It would appear as though, if he hospital those women who suffered most and had were shut up in the room with a single hyacinth been the longest ill, out of ten sent in, seven or bulb in full bloom, it would cause his death. A eight would have some chronic inflammatory curious feature of this case is, that the emana- disease of the uterine appendages, and most of tions will produce so much disturbance of his them would prove incurable without surgical system without his perceiving the odor.

treatment." And further on: “I have removed Another very curious idiosyncrasy that has the uterine appendages one hundred and twentycome u nder our notice is in a lady who is thrown six times,” all of which he considered in a disinto fainting fits by eating the smallest piece of eased condition; on the other hand, we hear an aubutter. We have known her tried by those who thority like Dr. Grimsdale declare that the ovaries thought her condition was purely imaginative by which he saw on one occasion removed by Dr. placing a small piece of butter in a dish of mashed Imlach were perfectly healthy, and this was, I potatoes and giving her a tablespoonful, after understood, the only time that he (the consultant telling her that there was no butter in it. In a of the institution) got the chance of being present. very few minutes she fell off her chair in a con- We also had the evidence of Dr. Alexander, who dition of swooning.

declared that out of the large number of postSome years ago, one of the residents of the mortems which he made at the Liverpool WorkPennsylvania Hospital was forced to resign, be- house, he very rarely found traces of this disease, cause the moment he went to work in the surgi- although he had paid particular attention to the cal wards he became afflicted with a crop of boils examination of the uterine appendages. Under which would have disrupted the heart of job these circumstances, does it not seem time to with envy. It was only years afterwards that the do something to stay the destroyer's hand, unfortunate doctor discovered that the boils were

as even the removal of one set of healthy parts produced by the emanations of turpentine, which would, in the minds of honest men, counterwas, at that time, used in the wards for cleaning balance all the supposed good of the remaining off the skin of patients to which the adhesive one hundred and twenty-five operations, at which plaster had remained.

neither Dr. Grimsdale or any other man of equal Not long since there came into our office a

erudition was present; had they been, possibly a gentleman to whom morphine was given for the few more healthy organs might have been dis

covered. Poor Baker-Brown in his day was purpose of relieving pain. Contrary to all expectations, a violent diarrhoea was produced quite as eminent a man as either of the gentleby the alkaloid ; indeed, so excessive was the

men referred to; but alas! he fell for performing flux that it was stopped with difficulty.

an operation trivial in its consequences compared

In this case the idiosyncrasy appears to have been in to spaying. Dr. Tait and Dr. Imlach have atas the father of the patient was accus

tempted to draw conclusions from the results of tomed to use habitually paregoric as a laxative their practice by comparison with those of two a teaspoonful of this Auid taken at night would general hospitals; was this fair or generous on always produce soft evacuations in the morning. Thornton ward diseased organs alone are inter

their part? I think not, as, I believe, at the As already stated, there is no way of foreseeing fered with ; whereas, if I may again quote Dr. these peculiarities. It ought, therefore, to be the Grimsdale, healthy ones have (at least once) been habitual practice on the part of the physician, removed in Shaw Street, so that if the same difwhen prescribing for a patient with whom he has ference of practice exists in Birmingham, it may not before been acquainted, to ask as to the existence of any such peculiarities, and to pay at

somewhat account for the disparity of death-rate, tention to the answers received.— Therapeutic

operative measures upon diseased subjects being necessarily more fatal than those performed upon

perfectly healthy ones. If we dare make use of The LAPAROTOMY EPIDEMIC.—No more mo- the analogy of the sow-gelder, he seldom loses a mento us question has been ventilated in our pro- healthy pig, but has large mortality among disfession, nor one requiring greater coolness and eased ones. otherwise of those engaged in wholesale spaying, public that women are being unsexed (castrated)

seems, rightly or wrongly, to have become in batches, such as described by Dr. Imlach, and the fashionable craze of certain gynæcologists. the exit of its authors (in this country) from the




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scene will, I think, be as rapid and decisive as | tion has almost always failed to produce scarlawas that of the clitoridectomist. Before it is too tina. The common rule of isolating scarlet. fever late let them adopt the motto, if they may so patients for six weeks, is considered a safe one ; apply it, Appetitus rationi pareats.—DR. JAMES yet, if convalescence be retarded, it may be well M. BENNETT, London Medical Press.

to extend the period to nine weeks. Stress is laid THE CAUSATION AND TREATMENT OF SCARLA upon three points: (1) The poison from the mild. TINA.—A valuable contribution to the literature

est case may produce the most deadly form. (2) of this subject is made by Dr. Whitla in the Dublin In no disease is the part played by individual Journal of Medical Sciences, in which the writer susceptibility so striking. (3) This susceptibility

runs in families, and is often noticed in the most summarizes pretty carefully the present state of

robust members. The period of incubation is our knowledge. The investigations of Pohl-Pin

believed to be shorter than is generally supposed. cus, Klein, Eklund, and Octerlony are discussed, but the conclusion reached that, as yet, the living

The writer is of the opinion that the rule is three organism of scarlatina has not been demonstrated

or four days; numerous cases are referred to in or isolated. Much still is known regarding its

which it was only one or two days. To prevent nature. It is the most tenacious of all contagions.

the patient from spreading the disease, rigid and It will survive heat up to near the boiling point,

immediate isolation, disinfection of everything

which has come in contact with his person, and a freezing temperature does not destroy it. In England its virus is always more active in anointing the body with some disinfecting ointautumn.

How does it enter the system? The ment, scrupulous cleansing of the body with tepid writer cites cases where a lancet has carried baths, or sponging with a solution of Condy's the disease, but thinks in the great majority of Auid, are all things to be insisted on in every cases the route of contagion is the pulmonary the disease by destroying the virus at its point of

The writer has no faith in cutting short tract and the throat, first taking effect in the fauces. The ingestion of articles of food which it is compared to the excision of a chancre to

entrance, the throat, during the preliminary stage. have stood in the sick room appears, in some cases, to have caused the disease, so that it may bolate of soda are believed to do great good by

prevent syphilis. Quinine and the sulpho-car. possibly be absorbed by the stomach. The evi. dence that the disease may be communicated

reducing temperature, but do not shorten the through the medium of a third party, the writer

disease. The reckless dosing with chlorate of states is overwhelming. The carrying of the dis- also the too free use of carbolic acid internally

potash is often productive of great harm, as is ease by clothing, toys, letters, flowers, and even locks of hair from the sick room are mentioned, and about the patient; both are believed to inDomestic animals are another medium.

crease the liability to renal complications. Great

Regarding contagion by means of milk, the writer

success is claimed for free and fearless purgation states that these cases have been found to be by croton oil and the use of the hot pack in treating from the existence of the disease in the man who uræmic convulsions. A dozen cases are mendelivered the milk, the person who milked the

tioned as having been so treated successfully.cow, or, more often than either, the presence of

The Physician and Surgeon. scarlatina in the house where the milk was THE REQUIREMENTS OF THE SICK-ROOM.-J. strained, mixed, or allowed to stand. No authen- Varnum Mott, M.D., Boston, Mass., in speaking ticated cases of disease in the cow were found. of food, says:

We are called on from the very The author denies that scarlatina is even a drain hour of birth to furnish appropriate food for nourdisease, in the sense that the poison may be gen-ishment, and when sickness occurs the twofold erated there de novo. There is not, even to his importance of this task is justly appreciated. mind, satisfactory evidence that the general ill | Whilst, as a rule, each disease requires a special effects of bad sewerage render a patient more | diet, dependent on several physiological indicaliable to the disease, or render the attack more tions, it will not be possible for us to consider virulent. The disease has continued to deepen more than very generally this subject. Milk in extent and gravity in the face of all modern ranks among the first articles ever known for improvements in sewage management. Em- sustaining life, and is generally liberally supplied phasis is laid on the fact that it is the pulmonary by the natural laws; and when a woman fails to and cutaneous exhalations which are the active be able to supply her offspring with this essential agents in spreading the disease, and not the epi- cominodity, there is something radically wrong. thelial scales of desquamation. There is no The beasts of the fields are thus enabled to nurdoubt that the disease is highly contagious as ture their young, and the first instinct developed soon as the rash appears, and analogy would is to seek that nourishment at the maternal fount. render it at least probable that it may be con- Hence milk is known to possess very valuable veyed during the period of incubation. Inocu- properties, and yet a milk diet is not to be dilation of animals with the scales of desquama- I rected for an adult without very careful consider

ation, and its use must be very strongly indicated. on the contrary, he should be encouraged to rely Many are unable to properly digest milk unless on a small amount often repeated. Care should diluted with lime water, and hence it is, although be taken that it be prepared in a manner calcuwe recognize it as being very valuable, still it is lated to tempt the appetite. Coaxing should, of capable of giving rise to certain functional dis- course, be indulged in when necessary. The apturbances which it is our duty as medical men to proximate amount of food and the time adminisguard against. Beef tea will always very justly tered should be carefully tabulated. Absolute have its advocates, and for adults it is to be pre- cleanliness should be observed in each detail, ferred to milk. Beef extracts, meat juice, etc., and each article should be prepared with great are favored by the profession, and are used as care, ever having it in view that it is for the paexperience dictates. The very best preparation tient. Fruit is indispensable to the sick room, and that I have extensively used is known as · Valen- many there are who would thrive in every way tine's Meat Juice.' It possesses the great advan- on what might be termed a fruit diet. There are tage of always being ready for use ; it serves best very few conditions that would of necessity prowhen taken cold, and I have yet to meet a case hibit the use of at least some kind of fruit, and where the stomach will refuse to retain it, pro- generally this will prove more grateful and acviding it be administered diluted (one teaspoon- ceptable than anything else. In the present cenful to a wineglass of cold water), and fed to the tury we are enabled at no very great expense to patient by a teaspoonful at intervals of every two avail ourselves of imported fruits during our or three minutes until the above is given, when a winter months, so a very decided advantage is small piece of ice may be allowed. There are thus held over our ancestors, who, per force of numerous medicinal foods that are much vaunted, circumstances, were unable to obtain any save and all have their adherents. The Imperial native fruits. When broths are to be given let Granum.' in my hands, has seemed to meet with them be sufficiently hot, although not absolutely all that is claimed for it, and experience has boiling, and have them carefully seasoned. brought me to rely on its use where its special When, on the contrary, cold drinks are ordered, properties are indicated. In infantile diseases it care should be taken to insure their being reasonhas proved very efficacious, and I always direct ably cold. Nothing is so apt to discourage a its use when a child is being weaned. Koumyss nervous patient as bringing to his attention unhas within the past few years been added to our palatable food or drink; and in this we cannot list, and in some cases of gastric disturbances it exercise too much care, for we must remember has proved very valuable. Cocoa has been the patient is fully supported in his objections and largely prescribed during the past few months, contempt at such edibles by the instructions given and, whilst it undoubtedly is a valuable tonic, in Revelations iii. 16: · Because thou art lukestill it should not be expected to take the place warm, and neither hot nor cold, I will spew thee of food. Alcohol and various drugs are capable out of my mouth.'”— The Microcosm, New York, of exerting a stimulating effect, but should be February, 1886. used with great care, for there are many who today are addicted to its abuse who first indulged

The Cause of ELEVATED the order of their physician. So in dealing In an article in the New Orleans Medical and with alcohol and opium there is a moral aspect Surgical Journal, Dr. John B. Elliott, Professor that should enter into the consideration, and, if of the Theory and Practice of Medicine, Tulane possible, I consider it much better policy to dis- University of Louisiana, says:guise its character when obliged by certain symp

From the nature of the forced change involved toms to employ it. Water is not very generally when chemical energy transforms to tissue-build. considered as food, but it certainly is under cer-ing force, we are entitled to regard it as the most tain circumstances, and often can be retained important of all the physiological processes of the when meat and everything else is rejected, and body. In it energy becomes constructive, while it serves the purpose of temporarily quenching in all other processes it is destructive. Its conthe thirst in a case of fever. Eggs raw, or slightly trol and regulation must, therefore, be conboiled, are valuable adjuncts, and are very largely sidered the highest function of the automatic employed throughout the land, combined with centres. milk.

This is very sustaining and highly nutri- It remains further to insist, in this connection, tious, and in most cases should be taken without upon the strict quantitative relation existing beany alcoholic addition. It is the duty of the tween chemical energy which undergoes transnurse, as we have already observed, to attend formation in the body and the modes of force the wants of the patient, but nourishment comes into which it is changed. This may be illustrated directly under the directions of the physician, and numerically by the following : Suppose an amount the nurse is looked to for their being properly of chemical energy, represented by the number carried out. We must never permit a patient to 12, to undergo transforination into work, heat, take a large quantity of food at any one time, but,' and tissue-building force; then the value of the work, heat, and tissue-building force in their sum, | in a state of unstable equilibrium. In almost can never vary from twelve.

equal balance, destructive forces and construcFurthermore, if we suppose in this case that tive forces are playing about them. In the natuthe amount of energy expended in automatic ral order of events they are destined after their muscular work=3; the amount contributed to brief life is run to fall to pieces and go into disintenormal body heat=3; and the amount devoted gration as the last link in their functioning lives. to tissue-building=6, then any change in the But the nerve energy which supports them quantity of one of these forms must compel answer through this period is the only power which ining changes in the others. As the work (=3) is sures them their natural term of life. Take away usually a fixed quantity, we may neglect it for this support and death and disintegration begin our present purpose and confine our attention to before their time. the other two. Let us suppose, then, that the Thus, more results from the loss of nerve-power transformation of chemical energy into the high-than the simple checking of tissue-building. Arest form (tissue-building force) falls, through rested growth in developing cells means also prefailure of the nervous system, from 6 to 4, then mature death and more rapid disintegration in from the law of the conservation of energy, the the mature cells. This last accident is likewise value of the lowest (heat) must rise from 3 to 5; hastened by the increased heat which results for tissue-building is a vital constructive process, when tissue-building ceases. Sensitive as are all sustained by nerve energy, and can cease im- delicate tissues to elevation of temperature, they mediately if that supporting power be withdrawn, become far more so when the nerve power which while combustion is a chemical process and will sustains them is withdrawn. Their death and not cease until the matter at its disposal shall be disintegration is thus doubly hastened by the consumed. Anything, therefore, that arrests tissue- same nerve failure which checks tissue-building. building must elevate temperature; or, anything In what has been already said, our theory of that prevents chemical energy from passing into elevated temperature has already found expresits highest transformation, tissue-building force, sion. It only remains to sum up the propositions compels it to appear in its lowest form, heat. discussed, and from them to formulate our theory.

In considering thus the mode of disintegration These propositions are :of the cell with which we began, we have prac- Ist. Fever is not the expression of a disturbing tically reached an explanation of fever-heat. Yet agent, but of a thing disturbed. before explicitly stating the theory we will better 2d. This "thing disturbed" is the nervous prepare for it by glancing at the mode of growth centre (or centres) controlling the distribution of of our cell.

the chemical energy within the human body. Every cell is an area of nervous influence. 3d. This chemical energy within the body is As the development of each cell begins from its distributed into the forms of heat, automatic work, parent cell, it too is born into and grows within and tissue-building force of which heat is the the same influence. From the pabulum which lowest, and tissue-building force (since it is concomes to it food is selected through this influence structive) the highest form. both in kind and quantity, and of the chemical 4th. Depression of the centre controlling these force which is being transformed about it this transformations causes it to fail in its highest nervous control determines the amount which it function, tissue-building. is to appropriate, and the form it shall assume. 5th. As combustion goes on though tissueIts whole life history is an unbroken play of forces building ceases, the energy which was destined as they build up the matter of its form under the for tissue-building force has now to appear as the control of nervous influence. The most import- lower form of heat. ant fact in its history is the lifting up of pabulum 6th. The same nerve failure which arrests tis. into the substance of its tissue molecules. As sue construction and gives rise to heat favors also long as its healthy growth continues, the trans- the breaking down of the tissue already formed, formation of chemical energy into normal heat, this latter process being likewise hastened by the and into tissue-building force, goes on under the elevated temperature. even control of the nervous system. But let From these our definition may be drawn as some disaster befall the controlling centres, and follows:the tissue-building receives a check. The en- Fever results from a depression of that nerergy it was absorbing fails to reach its higher vous centre which controls the distribution of destination and appears as additional heat. energy within the body, on account of which de.

The remoter effect of this loss of nervous force, pression tissue-building ceases, and the energy and the direct effect of the additional heat thus destined to perform that act passes off into the liberated, need some attention. The same ner- lower form of heat. From this same failure of vous energy which sustains the development of nerve-power, and from the heat resulting, tissuea growing cell sustains also the integrity of the destruction in the body is usually increased.maturer cells about it. These perfected cells are ' Gaillard's Med. Journal.

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