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The Infantile Diarrhea of Summer.At a recent meeting of the New York Academy of Medicine (Med. Record, May 25, 1878), Dr. J. LEWIS SMITH contributed a very interesting paper on this subject. As regards its treatment, he said he believed that there were but very few remedies from which it was necessary to select, and for his own part he scarcely ever employed more than two, viz., opium and bismuth, before the hydrocephaloid stage was reached, and these he considered better than all others. The administration of the large doses of bismuth now employed is of but recent origin, but has been followed by the best results. In ordinary cases it should be given in doses of ten or twelve grains, and it may be advantageously combined with the compound powder of chalk with opium (which contains one grain of opium in forty), or else with ordinary Dover's powder. For general use, however, it is perhaps better to give the bismuth in suspension, and the following prescription will be found a very admirable one :R. Tinct. opii deodoratæ
gtt. xvj. Bismuth, subnitratis
3ij. Syrupi .
f3iss. M. Dose, a teaspoonful for a child of one year.
Dr. Smith said that he had been much more successful since he had employed opium and bismuth in this way than before, when he would often try a long list of remedies in succession, and not find good results from any. Such a combination as the above is retained on the stomach, and has the effect of both an antiseptic and an astringent. No preparatory treatment is necessary, unless it is found that some irritating article of food has been taken ; but most of the cases are considerably advanced when the physician is called in, and any such source of trouble has long since been gotten rid of.
Almost all cases of entero-colitis need stimulus, and brandy is the best form in which it can be given. Of course, the amount should vary according to the age, and Dr. Smith is in the habit NO. LXXIII.
of giving three drops for every month of the child's age (when under one year) every two or three hours.
When the hydrocephaloid stage of the disease is reached, the opium should be withdrawn or given very cautiously ; but the bismuth may be continued as before. At this period, however, we must depend principally on tonics and astringents, and one of the most useful agents that can be employed is the liquor ferri nitratis. The following prescription will prove of great service: R. Tinct. calumbæ
f3 ij. Liq. ferri nitratis.
gtt. xviij. Syrupi .
fzij. M. Dose, a teaspoonful. At the same time the stimulus should be kept up as before.
Finally, the kind of diet used is of the utmost importance. If the child is under one year old it should at once be removed to the country, or a wet-nurse should be provided for it, as no artificial food is reliable. If both of these are impossible, the best cow's milk should be prepared in such a way as to resemble healthy human milk as much as possible. The milk should be allowed to stand for some time, and then only the upper third of it employed. In this way the larger part of the sugar and butter will be obtained, while the indigestible casein (which settles to the bottom) will be avoided. As regards farinaceous preparations for children under six months old, Dr. Smith prefers Mellin's Liebig's food, which also has the endorsement of such authorities as Eustace Smith and Tanner. Its taste is quite sweet from the dextrine and glucose which it contains, while it is almost entirely free from starch. When added to cow's milk, it makes as good a substitute for mother's milk as has as yet been obtained. After the age of six months infants can digest a certain amount of starchy food, and then Robinson's prepared barley may be used with advantage, if it is sufficiently boiled. As a rule, however, Dr. Smith prefers Ridge's food, which is highly recommended by Steiner, of Germany. Dr. Smith formerly used to employ Nestlé's food, but has been obliged to give it up, when the bowels are affected, on account of its laxative effect. In cases of habitual constipation in young infants, which is often a very perplexing condition to the practitioner, he has found it of very great service. — Monthly Abstract.
Surgical Treatment of Bronchocele.Professor Bilroth has found that the injection of iodine is not as dangerous as was supposed. In some individuals a violent reaction occurs, in others, there is none. His method is as follows: He injects first from one-third to one-half of the socalled Pravaz syringeful of undiluted tincture of iodine, and, if this is well borne, in five or six days he makes a second injec tion of one half or a whole syringeful, repeating this twice a week. If the patient becomes thin, the treatment should be immediately stopped, as the emaciation may go on to an important degree. It should also be stopped if hæmoptysis appears. In general, the injections are well borne, and exert remarkable influence. They may be tried when suffocative symptoms have appeared, if the patient is kept under constant inspection ; and even in cases about to be operated upon, their employment has been followed by recovery. It is essential that the iodine be injected well into the substance of the bronchocele, which may be done rapidly, the pain at the most continuing for five or ten minutes, and requiring cold applications, while in many cases it is entirely absent.
In cystic bronchocele he usually injects half an ounce of tincture of iodine, after having allowed the cyst to empty itself through a canula. The puncture is sealed up, and on the third day there is great swelling and accumulation of gas; from this moment absorption begins slowly, lasting about a year. In thirty-four cases treated in this way he had twenty-nine recoveries. The iodine is supposed to exert an alterative action upon the cells lining the cyst, and thus prevents further secretion. He has also tried incision with drainage, and stitching the wall of the sac to the skin. Three out of twelve treated in this way died however, Of thirty-seven cases of extirpation, twenty-four recovered. He finds the cartilages of the trachea so thinned by pressure that they become easily compressible, and hence several sudden deaths have taken place from swelling of the parts, giving rise to suffocation. The mortality in a series of ninety-four cases was eighteen, or about nineteen per cent. A case of goitre successfully treated by one subcutaneous injection of ergot was reported at the recent meeting of the American Medical Association. -Boston Medical and Surgical Journal.
Aneurism of Subclavian and Axillary Artery-Treated by Rest and Restricted Diet.-At a late meeting of the Clinical Society of London (Lancet, March 16, 1878), Mr. HULKE read the notes of such a case. The patient, a French-polisher, aged thirty-six, but much older in appearance, addicted to drink, after suffering from pains in the left shoulder and arm, supposed to be rheumatic, during two months, became aware of a swelling at the root of his neck on the left side, for which he went into King's College Hospital. Dissatisfied with what was there done for him, he left that hospital, and five months after the beginning of his illness entered the Middlesex Hospital, 28th March, 1877. At this time he had a large aneurismal tumour filling the axilla and implicating also the third, second, and presumably, to some extent, also the first part of the left subclavian artery; and he suffered great pain down the arm and over the shoulder-blade. He was kept in bed, and enjoined to keep perfectly still—not even to sit up or to move off the bed for any purpose, and he was put on a very limited non-stimulating diet. This was followed by rapid mitigation of the pain, by decrease of the aneurism and its obstruction by clot. He was discharged for disorderly conduct in June, at which time the axillary portion of the sac had shrunken to the size of an acorn, and was quite impervious, and the cervical part was very small, and felt very firm. It was thought that a slight pulsation of this part might be communicated. He afterwards entered Charing-cross Hospital, where, Mr. Hulke learned, doubts were entertained of the nature of the affection. This
Mr. Hulke took to be confirmatory of the permanence of the consolidation and occurrence of a cure. The encouragement the case afforded for the trial of a modified Valsalva's method in aneurism, where the ordinary direct surgical methods were not applicable, induced Mr. Hulke to submit the case to the consideration of the Clinical Society.—Monthly Abstract.
Cerebral Localization and Amputation of Extremities. A case of amputation of the right thigh at the age of nineteen, followed by atrophy of the fold passing from the second left frontal convolution to the anterior marginal one, is reported by Drs. Le Double and Violet, of Tours. The patient died of tubercular pleurisy thirty-one years after the operation. The general appearance of the brain upon autopsy, was found to be symmetrical with equal lobes, with exception of a very evident depression of the membranes in front of the anterior marginal convolution, which became more apparent on the removal of these envelopes. The left anterior marginal convolution had the same volume as the right, but the fold passing from it to the second convolution presented all the usual phenomena of atrophy. As the case was one bearing upon the disputed issue of cerebral localization, the reporters took the trouble to locate analogous cases, of which they found seven on record. In the first, amputation of the left arm had been followed, in the course of five years, by atrophy of the superior portion of the ascending convolution of the paracental lobule. In the second, amputation of the thigh had involved atrophy of a cerebral lobe and corresponding marginal convolutions, in the course of thirty years. In the third, amputation of the thigh having been performed, the patient died nine months later of purulent infection, and no atrophy had yet taken place. M. Luys reported three cases of his own to the Academy of Medicine, France, in October, 1877, in which amputation of the leg had been followed by atrophy of an ascending frontal convolution. The seventh case was one of arrested development of the leg, reported by M. Laudouze, in which the atrophy involved the superior part of the ascending