stating that the patient was as well as ever. weeks after the accident. This is nine PULTACEOUS ANGINA. By WILLIAM F. WAUGH, M. D., Chicago. Under the name of pultaceous angina (Angine pultacée) the French describe the following affection: It appears frequently in young soldiers, gymnasts, firemen, and in all those who are called upon to make at any given time rapid marches, violent efforts, to sustain excessive fatigue, or sudden changes in the weather. It frequently attacks school children who play beyond reason, becoming overheated and then resort to damp places to cool off quickly. The attack begins with fever, which may run up to 105° F., intense congestion of the face, the cheeks showing characteristic patches of reddish brown. The patient is heavy, nerveless, complains of the head, but very little of the throat, which leads the careless observer to overlook the local disease. But an examination reveals an intense inflammation of the pharynx and tonsils, with white points, more or less confluent, on one or both tonsils. These soon unite, forming a great patch, soft, little resistant, easily detached by washing or pencil. The first indication is to subdue the fever. For this Toussaint recommends the use of strychnine arseniate gr. 1-134, digitalis germanic gr. 1-67, and amorphous aconitine gr. 1-134, to be given together every quarter hour till the temperature falls or the pulse approaches normal. For children he advises frucine gr. 1-134, aconitine and veratrine gr. 1-134, given together every half hour. The bowels should be flushed with saline laxatives, and if there is pronounced gastric irritation, a full emetic dose of emetin should be given. For an adult one grain of emetin suffices, in a glass of warm water. The amorphous emetin is free from cephaeline, the acrid irritant of ipecacuanha, and acts certainly and with a minimum of distress. However, if it be desirable to evacuate the stomach without nausea, this may be accomplished by administering a seidlitz powder, letting the patient drink first the alkaline solution and then the acid. The throat should be painted frequently with glycerite of tannin, or, which I prefer, be treated to a teaspoonful of nascent chlorine solution, made as follows: Put into a four-ounce vial a dram of powdered potassium chlorate, add a dram of strong hydrochloric acid, as soon as fumes of chlorine are evolved fill the vial up with water; cork well and keep in a cold, dark place. When the green tint of chlorine has faded, throw away what is left and prepare a fresh supply. Of this a teaspoonful may be given, undiluted at first, every hour. Under its use the greater danger is obviated, that diphtheria may seize the opportunity to attack the weakened tissues of the throat. To further guard against this and other infections, and to prevent suppuration in the tonsils, give calcium sulphide and sodium benzoate gr. 1-6 each, every hour (Toussaint). In adults these doses may be increased to one or two grains each. The more one studies the throat, the more he becomes impressed with its possibilities as a portal for infection. The tonsillar tissues are deficient in resistance, while every morsel of food and of drink, every breath we draw, carries with it the possibilities of a microbic invasion. It is surprising how often a passing "hyperemia" of the throat tissues precedes the outbreak of fibrile disease, rheumatism, etc., or of those indeterminate maladies for which the doctor may not be called. If this initial sore throat is inquired after it will be found in remarkable frequency. The household use of such a remedy as the chlorine mixture described, with a few of the "circulation equalizers," would fend off very many hours of indisposition and some serious illnesses. Mackinac Island, July 31, 1903. Suprarenal Solution. Every doctor is interested in the Suprarenal Substance. It is the most valuable of all the articles added to the materia medica during recent years. Suprarenalin Solution supplies the active-constituent of the Suprarenal Capsule in a uniform, permanent and non-irritating medium. The Suprarenalin Solution takes the place of all the preparations of the suprarenal glands as it may be employed locally or internally. Suprarenalin Solution is made by Armour & Company, and is furnished to the trade in one ounce glass-stoppered amber bottles. Sections. MEDICINE. Under charge of H. D'ARCY POWER, L. S. A. Eng., L. R. C. P. Ire. Professor of Principles and Practice of Medicine, College of Physicians and Surgeons, San Francisco. Diabetes-New Studies of Glycosuria.- In practical medicine few subjects are of more împortance than diabetes mellitus, and few are less satisfactory in their pathogenic and therapeutical aspects. In many diseases experience has provided empirical treatments of more or less value, but not so in diabetes; and the hope of patient and physician rests on the physiological laboratory for the means of combatting a disease of increasing prevalence. For these reasons the work of Drs. Pavy, T. G. Brodie and R. L. Siaw, reported in the Journal of Physiology, are of great interest. It has long been known that when phloridzin was administered to an animal a glycosuria resulted that differed from other forms of this condition in that the amount of sugar in the blood was not increased. This was explained by the discoverer, Dr. Von Mering, by crediting the kidneys with an abnormal permeability to sugar. This theory has been practically investigated by the above-named workers with the result of showing the untenability of Von Mering's hypothesis, and that the sugar is the product of the kidney itself, which under these circumstances becomes a sugar-secreting organ. The authors sum up as follows: 1. In confirmation of Kuntz, injection of phloridzin into the renal artery of one kidney produces glycosuria from that kidney prior to and to a greater extent than from the other. 2. Perfusion of a surviving kidney with blood containing phloridzin produces a diuresis, accompanied with the presence in the urine of a notable amount of sugar, which is not to be accounted for by the disappearance of sugar that occurs from the blood. 3. Intravenous injection of phloridzin produces glycosuria after ablation of the abdominal viscera (necessarily the kidneys excepted) and the elimination of sugar persists after the blood sugar has fallen to the lowest level that is noticed to occur. 4. The sugar excreted under these circumstances may far exceed that existing in the circulating blood. 5. The fall in blood sugar observable after simple ablation of the viscera undergoes no variation with the supplemented administration of phloridzin notwithstanding the associated glycosuria. 6. The hitherto proposed theories of phloridzin action fail to meet the requirements of the conditions existing. 7. Under the view propounded by us, the glycosuric effect of phloridzin is attributable to a specific action exerted upon the cells of the renal tubules by which they acquire the power of producing sugar. We consider that under the influence of the presence of phloridzin these cells exert a katabolizing upon something reaching them from the blood, resulting in the liberation of dextrose in a manner comparable to that by which lactose is set free by cells of the mammary gland. GYNECOLOGY AND ABDOMINAL SURGERY. In charge of SOPHIE B. KOBICKE, M.D., Adjunct to the Chair of Gynecology and Abdominal Surgery, College of Fowler's Position in Abdominal Surgery.-Van Buren Knott, of Sioux City, Iowa, in a paper published in American Medicine, strongly advocates Fowler's position in cases of diffuse septic peritonitis. He considers it a curative agent in these conditions. The position is very simple, and consists in elevating the head of the bed from 24 to 30 inches, and maintaining it thus for 24 hours. It is easily accomplished by placing under the bed a small table, a chair with stout arms, or a box. This elevation of the head and trunk drains the high and more dangerous area into the lower which is less sensitive, thus lessening the danger of rapid absorption. Fowler has reported twelve consecutive successful cases. The author gives brief histories of five successful cases but not consecutive. He later adds three consecutive cases of diffuse septic peritonitis due to perforative appendicitis, successfully operated upon. Knott also finds this position of great benefit in general abdominal work, and has employed it in 326 cases, covering the past two years. The majority of patients escape the discomforts and danger of post-operative nausea and vomiting, colic is diminished, and flatus passes much earlier and more freely. No ill effects have thus far been observed. Intestinal Anastomosis by the Elastic Ligature. -Theodore A. McGraw, of Detroit, Mich., in American Gynecology, gives impartially the principles which should govern the surgeon in his work in intestinal anastomosis, and then describes his own method of applying the elastic ligature as a means of producing an intestinal anastomosis. The two viscera are brought together, and the surgeon connects them with a single line of Lembert sutures a little longer than the desired opening. The rubber is then, by means of a large needle, passed through the walls of first one and then of the other bowel and tied firmly in a single knot. Before tying it, however, a silk thread is laid under the knot, and, after the knot has been firmly tied with the rubber stretched to its utmost, the silk thread is made to fasten it in place. Both threads are then cut short and the Lembert suture is now completed so as to form a ring inclosing the rubber. In passing the rubber through the gut it should be put upon the stretch in order to lessen the size, and drawn slowly and carefully through in order not to tear the gut. It is not necessary to say that the rubber should be first-class and fresh, for old rubber is apt to break. The advantages of this procedure are: First, its simplicity, and quickness of application. Second, its aseptic quality, for the rubber fills the openings through which it passes so completely that no extravasation is possible. Third, the delay in opening the passage until the intestines have become well glued together; and Fourth, the ability to make with it a communication of any desired length. If we compare it with the incision and suture it is more easy and quicker of performance, much more aseptic, and is accompanied with much less hemorrhage. Compared with the Murphy button it is less liable to meet disaster from faulty technique, causes no loss of blood, is more aseptic, and it leaves no foreign body in the bowel. |