the water. If it turn gray or slate black iron is present. Second-Dissolve a little prussiate of potash, and if iron is present it will turn blue. For Lime.-Into a glass of water put two drops of oxalic acid. Blow upon it. If it gets milky, lime is present.

For Lead. Take sulphuretted gas and water in equal quantity. If it contains lead it will turn a blackish brown. Again-The same result will take place if sulphate of ammonia be used.

For Copper. If present it will turn polished steel a copper color.-Pacific Rec. of Med. and Surg.

Nutrition and Stimulation in Treating Diseases of Children.

In the N. E. Med. Monthly, Dr. Love, of St. Louis, presents an article containing the following conclusions:

"I. The most careful consideration of the diet of children from the day of birth should be given on the part of physicians and parents with a view to building up in the child the power of resistance against disease.

II. The majority of the diseases of children can better be treated dietically than medically, though medicine should not be despised.

III. Of course, in diphtheria and the exanthemata, and some other diseases, we have a specific germ which must never be lost sight of, but in all other diseases acute or chronic, elimination, tranquillization, stimulation and nutri tion are the "big four" combination upon which we can safely rely.

IV. In typhoid and other continued fevers a gently open condition of the vital sewerage system, a daily cleansed skin, proper sleep and quietude, mental and physical, a safe temperature (not permitted to go to high, or brought down to low) maintained, judicious stimulation and persistent feeding, feeding to the limit of the assimilative powers of the alimentary canal and the skin if need be, never losing sight of the necessity in the majority of cases of predigestion of all foods.

A persistent course of treatment such as this, will, I believe, accomplish the saving of nearly all cases, a record of ioo per cent. recoveries.'

Treatment of the Uric Acid Diathesis.

In the treatment of the uric acid diathesis, Dr. Henry Pickard advises the administration of water in large quantities, believing that it is of use in assisting mechanically in the expulsion of uric acid that may be deposited in the kidneys and in diluting that which may be contained in the blood. Water alone possesses such slight solvent effects upon uric acid that to

One ounce of this in three or four ounces of water makes an insipid solution that may be given even to children.

Some persons do not tolerate the alkaline carbonates well, and for such, the phosphate of sodium, administered in doses of from thirty grains to two drachms, is an efficient substitute.

The alkaline benzoates are also excellent solvents, and change the insoluble uric acid into the soluble hippuric. The benzoates of sodium and calcium are perhaps the best, and may be administered in solution or in pill form in doses of from three to thirty grains. Benzoic acid may also be used, the following being an excellent formula in which to administer it:

To Disinfect Feces.

PROF. UFFELMANN, (Berlin Klin. Wochenschrift) prefers the following process: Make a solution of two parts water to one part of either sulphuric acid or hydrochloric acid. To the infectious feces an equal quantity of the solution should be added. Let stand for two hours if sulphuric acid is used, or twelve hours if the hydrochloric acid is used. A 1 to 500 solution of corrosive sublimate may be used instead, or a five per cent. solution of carbolic acid.

THE fact that the bacillus of putrefaction is destructive to other forms of microbes, does away with the generally accepted theory that infection from the air and water of cemeteries

is to be dreaded. According to the National Druggist, Esmarck concludes after thorough examination, that no form of pathogenic microbe now known, survives for any length of time in the dead body, and the more active the putrefaction, the shorter the survival of the microbe. Amer. Pharm.

WHEN children are troubled with bedwetting, try a combination of bromides and belladonna, a full dose of each, according to age, at bed-time. If that be not successful, add a little tincture of the chloride of iron and tincture of nux vomica to the treatment.

THE USE OF TESTICULAR LIQUID IN WOMEN. -Prof. A. Mairet submitted two women at different times to injections of testicular liquid, and in both cases he obtained results entirely similar to those obtained in man.

Again, in these two patients, injections of ovarian liquid gave tesults much less marked; in one the results were nil.

This simply indicates, that the action of the testicular liquid has nothing specific, but should be attributed to its chemical composition, which contains substances, as phosphoric acid for example, which act on the nervous system, of which it forms part, and this in woman as in man.-Bulletin Medical.-Times and Register.

Uric Acid in Disease.

BY A. B. CONKLIN, M. D., ELK RAPIDS, MICH. (Continued from April number.)

I remember of having read the report of a case in which the patient was a sufferer from migraine, and could prevent or bring on an attack at will by avoiding or indulging in meat for several consecutive meals. A similar case has come under my own observation, in which a free indulgence in meat would bring on an intense supraorbital pain, preceded by a colorless urine, which became high colored as the headache began to abate. An avoidance of meat almost entirely gave complete immunity, as long as this dietary was followed, a free indulgence at any time precipitating an attack. That tion, most fruitful in the production of uric a free indulgence in meat is a dietic indiscreacid excess, there can be no doubt. Secondly, portal congestion, which induces failure in the functional activity of the liver, tends also to this accumulation of lithates and lithic acid in the system.

Of hepatic inadequacy as a cause of gout and other forms of lithæmia, Fothergill says: "When kidneys first appeared in the animal kingdom the form of urinary excretion was uric acid. Uric acid belongs to animals with a three-chambered heart and a solid urine (reptiles and birds). The mammalia possess a fourchambered heart and a fluid urine, the form of excretion being the soluble urea. When the has a tendency to form primitive urinary dehuman liver becomes depraved or degraded it posits. To the question, What is gout? the answer is: Gout is hepatic reversion, when primitive urine is formed by a mammalian liver. When the urine of an animal possessing a fourchambered heart and a fluid urine deposits on cooling a quantity of urates-the form of urinary excretion belonging to animals with a three-chambered heart and a solid urine-depend upon it, the kidneys will suffer sooner or later for this reversion on the part of the liver. Human kidneys were not made to excrete the comparatively insoluble urates, and if they have to do so for a continuous time they become injured. If the urates are formed in large or considerable quantity, one of two things must occur: (1) The kidneys are injured, or (2) the urates are retained in the system as gout. The first gives Bright's disease; the second, gout in some form. Often the condition is a blend of

the two."

As a third cause for the accumulation of uric acid and urates in the system, may be mentioned sedentary habits. Such a mode of life tends to bring about an inactive condition of body, with a partial arrest of function in all

the glandular organs. Sedentary habits also furnish an insufficient amount of oxygen to admit of the perfect oxidation of proteids. As Dujardin-Beaumetz says: "It is enough for me to remind you, that the production of uric acid, whatever view we may take of its origin, is in direct relation with a slowing of nutrition in general, and this is combatted by exercise, which has an opposite effect.

Too little water taken into the system to hold the solid constituents of the urine in solution, and so admit of their elmination, may be mentioned as a fourth cause for their accumulation. I find this a common cause, especially among women. Just in proportion as the solid constituents of the urine increase, excretion becomes difficult. Physiology teaches us that a healthy adult excretes daily about fourteen ounces of water through the lungs, twenty-six ounces through the skin, and fifty ounces through the kidneys. As only fifteen or twenty ounces are taken in during the same period with solid food, it becomes necessary, therefore, to maintain normal excretion, at the difthference, or from seventy to seventy-five ounces of fluid, be taken as drink, and nothing fills the bill so well as pure water. If you will take the trouble to question your patients upon this point (and you ought to do so), you will be surprised to see how many people there are in this world who do not take so much as an ordinary glassful of water, as drink, in a day, and many there are who take none at all, their only drink being a little tea or coffee at meal times. There is a belief among feminine aristocracy that an indulgence in water begets obesity, and it is avoided. A very unfortunate belief, indeed.

I recall many cases among lady patients, most of them sufferers from headaches, who have told me that they would go for days without taking a single drink of water, and when they did it was a mere sip. As might be expected their æsthetic natures were not troubled with a copious flow of urine.

Dr. Meigs, of Philadelphia, says: "In a great majority of cases where children worry without any apparent reason, the origin of their distress is a lack of water to wash away the products of tissue change."

George B. Fowler, M.D., a very prominent physician of New York, says: "A lack of sufficient water in dietary is the cause of onefourth of the cases of indigestion in fashionable life."

Animals and men will survive longer upon it than upon any other one alimentary principle, while the system robbed of it becomes a mummifying wreck, or, as some one has put it, "He who stints himself in drinking water is dirty inside."

As a fifth and last cause for the accumulation of uric acid in the system, I would mention an indulgence in alcoholic beverages. They give rise to gastric and intestinal irritation, and catarrh of the lining membranes, with indigestion; hepatic engorgement with loss of function, and renal irritation with arrest of excretion follow. Alcohol when introduced into the syshas the direct effect, through its strong affinity for oxygen, to check the natural processes of oxidation, whereby alone nitrogenous matter is fitted for excretion.

Again, alcohol has a strong affinity for water and robs the system of it, as shown by the extreme thirst after a night's debauch or a single drink of high-proof liquor. It has been shown that a pound of lean beef immersed in alcohol loses in weight, through the abstraction of water, four ounces and three drachms.

So also, by shrinking the red blood corpuscles, alcohol incapacitates them as carriers of oxygen.

Thus it is, by impairing functional glandular activity, robbing the system of its oxygen, so necessary for the conversion of proteids into urea, and also of water, equally as essential in carrying out the worn-out material from the system, that alcoholic drinks tend to the production of uric acid troubles.

In proscribing alcoholic beverages in these cases, let it be remembered that those containing a relatively small per centage of alcohol are quite as pernicious in their effects as high-proof liquor; indeed, common lager beer seems the worst of any of them, while a pure article of whiskey or brandy, well diluted, may do but little harm. I remember having read, not long since, a physician's report of his own experience in the use of white wine. Upon several occasions an indulgence in a single glass gave rise in a short time to symptoms of renal colic, which were each time followed by an elmination of so much uric acid as to cause a copious sediment of its gritty crystals.

The only condition worth considering, which interferes with the elimination of uric acid and its salts, is the one above-mentioned-a partial failure in the uric acid excreting function of the kidney.

A man may eat and drink and live in a manner to occasion a large formation of uric acid and the urates, and may go on with little inconvenience so long as the output equals the formation, but let the uric acid excreting function of the kidney fail, and he soon becomes a fit subject for a doctor.

While a restricted dietary, total abstinence from alcoholic drinks, and an avoidance of sedentary habits, will be found sufficient treatment in many of the milder cases of lithæmia,

192

yet the inability to effectually carry out this line of treatment, and its failure to relieve in more severe cases, make the application of therapeutic agents a part of the physician's work in managing lithæmics. Lithæmics should not be meat eaters as a rule. Animal food adds to lithæmia. On the other hand, too much dependence should not be placed in carbo-hydrates, for an exclusive diet of fat, sugar and starch will very soon lead to acetic fermentation in the stomach and bowels, with gaseous accumulation, followed by indigestion and a general aggravation of the symptoms already existing. A mixed diet is best suited to the needs of the lithæmic.

While the flesh of animals does not contain so large a percentage of nitrogenous matter as some other articles of diet, yet it seems more difficult for the system to take care of it, and I believe it a very judicious restriction to limit the meat-eater to a very small amount, many times forbidding its use entirely.

Original Communications.

Short articles on the treatment of diseases and experience with new remedies are solicited from the profession for this department; also difficult cases for diagnosis and treatment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them, Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

Pages from a Physician's Life.

CHAPTER VII.

(This serial article was begun in November, 1889.) WHEN called to a case of rheumatism, after my preliminary experience of failures, and the period of solitary study and research following, I made it a rule to investigate thoroughly for the probable causes of the attack, if acute, or the diathesis, if chronic. If there was much fever, inflammation, pain and swelling (rheumatic fever), I gave either pilocarpus or Dover's powder, with aconite, alternating with another prescription containing salicylate of sodium, bromide of lithium and benzoate of lithium. The bowels should be looked after with a combination of cascara and colchicum. This looks like pretty severe treatment, but these cases are also pretty severe, with constant danger to the heart, and should be abruptly broken up without being allowed to run the classical "course." The case must be closely watched, and, as soon as the more active symptoms go down, gradually withdraw the aconite, Dover's powder, bromide, salicylate and colchicum, and substi tute iodide of ammonium to cause resorption of the inflammatory products with quinine and strychnine as tonics. Ice cold compresses to

following dandruff pomade:

B. Acid. salicylic.,...

M.

Sodii borat.,.

Balsam Peru.,.

Olei anisi,..

Olei bergamot.,.. Vaselin.,

Coll. and Clin. Rec.

IN renal diseases, the albumen in the urine is generally increased by digitalis, strophanthus, caffeine, and other heart-tonics; and also by the various preparations of iron. It is nearly always diminished by nitro-glycerine.

the speedy cure if your will can sufficiently override the prejudice of meddlesome friends as to secure their efficient and continued application. It took me some time to work out this combination of treatment, but the success it finally brought me, more than justified the effort. Sweet milk salted, and if necessary, peptonized, with fruits and vegetables, form an excellent basis for the diet, with buttermilk and lemonade for drink. Meat, malt and spirituous liquors, tea and coffee must be avoided. Wool must be worn next the skin. My growing success in acute inflammatory rheumatism soon brought me some of the old chronic cases that had been

The

hanging on in the neighborhood for years. first difficulty I found with them was to determine which were true rheumatism and which were not so. They all insisted on it that they had rheumatism.

Those with the dyspeptic form were generally well treated with a good draught of a hot solution of phosphate of soda (ten to twenty grains to a teacupful of hot water) half an hour before breakfast, and a small dose of nitromuriatic acid after each meal for a couple of weeks, together with needed remedies at the time of any acute attacks. Those complicated with malaria received, in addition, treatment especially for the malaria, besides also, a dose of chloride of ammonia and nitrate of potassium at bed-time. All were advised to dress exclusively in wool. Many of the cases of pure muscular rheumatism recovered well by the use of five to ten grains of Epsom salts four times a day. Many cases presented decided symptoms of the uric acid diathesis-highly colored urine, brick-dust deposit in the chamber, fits of headache, neuralgia, corns and bunions and melancholy, worse in wet weather, obscure sore throat, with wandering, shifting pains. These were generally well treated by regulating their diet as above indicated, salt baths and woolen clothing, and chloride of ammonium and benzoate of lithium or sodium, keeping the kidneys, bowels and skin acting normally all the time. The practice of full, deep breathing always proved to be a valuable adjunct to the treatment. Lately I have used with some success cascara sagrada in such cases, and also minute doses (one-half to one drop thrice daily), of the fluid extract of rhus toxicodendron.

As my practice grew I found that all this special study during my "days of waiting" was most valuable to me. My rule was to make one case a nucleus for continued study until I had completely gone over the available literature on that subject. I also learned how much absolute trash finds its way into medical literature along with that which is really valuable. I shall take pleasure in outlining my views on diarrheas and cholera of infants in my

next letter.

(TO BE CONTINUED.)

Pregnancy and Lactation.

EDITOR MEDICAL WORLD:-Physicians are frequently consulted in regard to the necessity for, or the propriety of, weaning babies, because the mother is actually or presumably in the "family way." It seems to be a prevailing opinion that it is harmful for the mother to continue nursing after again becoming pregnant. For no other assignable reason, the milk of the mother is condemned and assumed to be inju

rious to the child. Physicians give a quasi assent to this idea, even though they may not formally endorse it. It is far easier to move smoothly with this current of opinion than to attempt to stem it.

Is there a general law that pregnancy impairs lactation? It is not so accepted in regard to domestic animals. The great bulk of our daily supply of milk is obtained from cows that are "with calf." We may assume that cows are always milked during the early months of pregnancy.

In women, there are special cases that show marked systemic derangement, almost from the moment of conception. The sympathetic phenomena of anorexia, craving, nausea, salivation and other recognized disturbances may be so exceedingly severe that it may be fairly assumed that the lacteal function may suffer likewise. These, however, should be considered exceptional cases. But in a normal healthy pregnancy, I see no good reason to believe that the milk is so seriously affected as to call for the immediate weaning of the child.

The point under consideraticn may be illustrated by a case. In August, '81, I attended, in her first confinement, Mrs. Y., then 25 years of age, born in N. S. Wales, but of Irish extraction. She nursed the child until her next confinement, a little more than a year later, after which, for some months, she nursed the two children. She has had six children, and in each instance has nursed the last until the birth of the next, and then for some months has nursed the two. Her latest confinement was ineptember last. The child then born she is now nursing, and also the preceding one --and, by way of parenthesis, it may be stated that she expects to be again confined in the early autumn.

Although this woman has been nursing continuously for eight and one-half years, bearing milk and babies with generous profusion, she has nevertheless grown stout and robust, and is to-day a fine picture of a comely matron. As for the children, they are fat, healthy and strong, and would easily carry off the premium offered for a round half-dozen of prize babies.

That the nursing has been no mere formality may be judged from the fact that the fifth child, now about 19 months old, and still sharing the maternal font with his younger sister, derives his sustenance wholly from the mother, refusing to take any other food.

While this case deserves to go on record on account of its somewhat exceptional features, it serves at the same time to forcibly illustrate the main fact that pregnancy and lactation are not necessarily and always incompatible.

Brooklyn, N. Y. BENJ. EDSON, M. D.