CATARRH OF THE AIR PASSAGE.

By W. L. CAPELL, M.D.

Catarrh of the air passage is the most frequent of all the diseases of the human family. Almost every individual has at some period of his life had more or less catarrhal condition involving some part of the air passages. The literature on this subject is so voluminous that it would seem that nothing more of interest could be said, but it seems that the fact that the volume is so large proves that the treatment is still lacking. Without attempting to cover all of the tract, which would make this article too long, it will be confined to the nasal fossa. The nasal fossa embraces that part of the tract from the anterior to the posterior nares, and consists of two large, irregular cavities with very uneven walls, pierced at different places by openings that lead into other small cavities. The mucous membrane lining these cavities seems in some respects to differ from the mucous membrane found in other parts of the body, being much thicker in places and folded in such a manner as to wholly or partially close the orifices to the other cavities. The physiological connection between the small and large one is not wholly understood, but no doubt they assist in warming and purifying the air before its passage into the lungs. The great thick

ness

of this membrane permits a still greater thickness on account of inflammation, and the opening to the smaller cavities may be entirely closed during the existence of the inflammation. Hence, whatever physiological function they are to perform must be interfered with. As the vascular and nerve supply to this membrane are abundant, interference with its functions is likely to make a more or less profound impress on the whole system. As a part of

the functions of the Schneiderian membrane is the warming and purifying the air before entering the lungs, environment must play an important role in producing catarrhal conditions of the nasal fossa. Gas and gaseous emanations from chemicals; the effluvium from decaying vegetable and animal matter; dust and pollen are probably all exciting causes. What part bacteria play as an exciting cause is problematical. There is no doubt about the part they play as accessories after the fact and is one of the most formidable obstacles encountered in the treatment. The resume of the past and present treatment of rhinitis the foregoing anatomical facts should be borne in mind. In no disease has a greater number of different remedies been tried, in fact, almost everything embraced in the Pharmacopoeia. Many and varied have been the theories of treatment, all of which were more or less successful. Owing to the fact that it is a question whether simple rhinitis isn't more a physiological than a pathological condition that will in certain cases subside without any treatment. If the functions of the Schneiderian membrane is the extraction of the poisonous matter from the passing air as it reverberates through the cavity, the destruction of this poisonous matter may entail some hardships on it, increasing its physiological action and the resultant hyperemia and copious discharge be a purely physiological process, and the good results of treatment was in spite and not the result of it.

Unfortunately, but few cases are purely simple; bacteria of some kind find ingress into the finely cultivated field, and the case becomes purely pathological. If the anatomical construction of the cavities are kept in mind with their several small openings into other cavities, the unusual thickness and many folds of the lining membrane, it will be readily seen how easy it is

for bacteria to find hiding places where there is great difficulty in dislodging them. Washing the cavities may leave much of the diseased surface undisturbed, for aqueous solutions will not flow through the small

Capell's Iodine Fumigator

openings and is not wholly devoid of danger. Powders are objectionable for the same reason. Spraying was an improvement because of the finer division and covered more surface, but lacked penetration. Oleaginous spray made an impervious covering for the membrane, interfering with its physiological action, the warming and purifying of the air as breathing goes on regularly, even a few minutes, may suffice to allow the slipping past of dangerous bac

teria or poisonous gas. To anesthetize the membrane with cocaine or other anesthetics paralizes at least for a short time, impairing its functions and may lead to a vicious habit. The treatment demanded is one that can be completely air-borne; that is, it will go wherever the air goes, thus being carried into all these small cavities. It should be highly destructive of germ life. It should be very penetrating. It should be healing to the inflamed membrane. It should be non-injurious should it pass beyond the nasal fossa. It should be rapidly absorbed, not to remain on the exterior of the membrane so as to interfere with 1.3 functions. It should be non-toxic so that no ill effects may follow its use. It should possess analgesic properties to allay the nervous excitement, and something that can be repeatedly used without injury. No one so nearly fills all these requirements as will iodine, especially when applied in the form of fumes. The fumes are quickly generated, easily applied, producing only a slight smarting, which can be easily overcome with a small amount of menthol. The technique is simple, requiring no especial skill or expensive paraphenalia.

The device that I use is simple. The crystals of iodine are vaporized by heat in a cylinder opening on opposite side. As the air is forced in one side the fumes flow out on the other through a rubber hose, whereby they can be carried to the anterior nares, and by squeezing the bulb, made to flow out at the time of inspiration, and the inflowing air carries them into the nasal fossa, and by the process of sublimation, the iodine is evenly and thinly spread over the wall of the cavity and is almost instantly absorbed, passing through the membrane into the blood stream below, there to produce the alterative effect of the drug, which is so essentially beneficial in chronic and acute rhinitis.

Omaha, Neb.

Goose oil is said to be the most readily absorbed of any fats or emollients. Next come lard and olive oil. Vaseline has the lowest absorptive properties of any.

Do not heat a mustard plaster, as the essential oil will be destroyed.

RECTAL DISEASES.

BY GEO. J. MONROE, M.D.

I, sometimes, become tired from writing upon "rectal diseases." Although in the last ten or twelve years much has been written relative to diseases of the rectum, which are very prevalent and the cause of many other diseases, also, pain and suffering locally, yet the medical profession apparently is paying very little attention. to them. I cannot understand why this should be. When we take into consideration how annoying and harmful rectal diseases are, I am surprised that so little attention is given to them. For a time, a great deal was written about rectal diseases and many valuable books were published in relation to them, but to-day we see no new publications concerning the aforesaid diseases and we find but very few articles in medical journals treating and referring to them. As stated above, this is a surprise to me, for in my practice, which is restricted almost entirely to diseases of the rectum, I find just as many, if not more, cases of these diseases than I did ten or fifteen years ago. The only way that I can account for this negligence in the publication of articles on rectal diseases in the medical journals is that perhaps the medical profession has reached the point where they are much more able to cope with these diseases than they formerly were.

This, no doubt, is true, yet I am finding just as many uncured cases as I did ten, fifteen or twenty years ago; in fact, the cases which come to me to-day are much harder to cure than I found them to be when they were much less treated by the medical profession. The general practitioner, as a rule, is not competent to treat diseases of the rectum, still he tries, and as a rule, leaves the case in a worse condition than existed before his treatment. My experience has taught me that much knowledge and experience is necessary in order to treat rectal diseases successfully, and I would much rather treat a rectal disease that had not been meddled with by the general practitioner. There are very few rectal diseases incurable, if they are treated rightly, and I find that a physician cannot have too much experiences or knowl

edge to enable him to treat successfully rectal diseases-"Tom, Dick and Harry" cannot treat them successfully.

How many people there are who pass through life having some rectal disease, which could be very easily cured. Not long ago, a lady asked me if it was safe to cure piles or hemorrhoids. I told her it was entirely safe. She said she had been taught by her family and her physician never to have her piles cured, because if she did the disease would go to the lungs. I then told her, on the same principle, that if there was anything the matter with her lungs, she should not have them treated, for fear the disease would go to the rectum-one is just as reasonable as the other. I have never known the cure of a rectal disease producing a disease anywhere else; in many instances of chronic lung disease we have abscess and fistula of the rectum and in many cases of fistula of the rectum we have tuberculosis, but I do not believe the cure of the one is in any way detrimental to the other; in fact, I believe the cure of a rectal fistula in a consumptive patient is beneficial, because in curing the fistula we shut off a great drain upon the system.

I find it essential in all, or nearly all cases of fistula of the rectum and anus, that the general tone of the general system should be maintained. In fistula of these parts, the general system, as a rule, is much debilitated, especially if there is much discharge of pus from the fistula-curing the fistula stops this discharge, hence the cure acts as a tonic to the system. My advice is to cure all cases of fistula, if we can, for in doing so we conserve the general system.

The idea, which at one time so generally prevailed, not to cure a rectal fistula for fear of affecting some other part of the system, I think has exploded. I am satisfied from actual experience, that there is nothing in it. I now cure, or attempt to cure, all cases of fistula of the anus that come to me, and I advise all rectal specialists, or those who treat rectal diseases to do the same; if we can stop the discharge from a rectal fistula we are certainly adding to the patient's comfort, as well as stopping a deleterious drain upon the system.

I am frequently asked if all fistula can be cured. As a rule, I think they can, however, if a fistula results from an epithelioma

or other cancerous condition of the anus or rectum, our treatment, I believe, is futile and of no effect; in fact, I think it is deleterious and bad practice, and I seldom perform any surgical operation any more for the cure of cancer of the rectum, for no operation or removal of the cancer does any good, but I really believe, does a great deal of harm. What shall we do, then, for a patient who has cancer of the rectum? I reply, as above stated, no cutting operation, for it will do no good. Of course, with cancer of the rectum there comes a time when the pain is almost unbearable, and in this class of cases I resort to the administration of the sulphate of morphine. I aim to keep my patient as comfortable as I can during the remainder of his life, and nothing, according to my experience, will do this better than an opiate, so I invariably use the sulphate of morphine, as stated above.

cancer.

Now, in reference to the radium treatment, as I am not a millionaire, I have been unable to try it in any way, but I have decided from my reading of cases where it has been used, that it is of no use whatI have yet to ever, in cancerous cases. learn where it has done a particle of good in I believe that arsenic in some form is to some extent beneficial in treating cancer; I have not had enough cases of cancer to determine just how useful arsenic is, but in the few cases where I have used it, I think I have derived benefits from it. I use the Fowler solution of arsenic, and I carry it to the full extent that a patient can stand. I think I can say that marked benefits have resulted-that it will cure cancer is doubtful, but so far I believe it is the best remedy we can use in cancerous diseases. I wish that it might be carried in its use for cancer to the very limit that a patient can stand. Try it.

618 The Paul Jones, Louisville, Ky.

For gastric flatulence try aromatic spirit of ammonia, 25 minims; spirit of chloroform, 15 minims; spirit of peppermint, 12 minims; spirit of cajeput, 8 minims. Take a teaspoonful of this mixture in a wineglassful of water whenever necessary.Medical Standard.

LET US TALK IT OVER.

BY OLD DOCK.

Hello, boys, how do you find yourselves! Just hold on till I answer the phone, and we'll talk it over. Let's see, what do you

know about the new disease that has come to this country and brought its trunk? The name of this disease is pellagra, and it is supposed to have originated in Europe. Well, boys, there is being so much said about the disease by Tom, Dick and Harry, it seems useless for me to have anything to say on the subject. But I am going to say a few mouthfuls anyhow. Boys, I'll Johnedfround if pellagra isn't a strange disease; nobody seems to know much about it. Some say the cause is one thing and some another. From my own personal experience with the disease I am inclined to the opinion that the cause of pellagra is a toxic poison in the digestive tract, and the food we eat has a great deal to do with its combustion. And how is it diagnosed? By an eruption on back of hands, feet, face, neck, with salivation, stomatitis, loss of strength in lower extremities, either diarrhea or constipation. What of the prognosis? Well, nobody who has sense enough to catch a rabbit will deny that pellagra is a serious disease. But I do believe a large per cent. of cases, if taken in time, can be cured. Well, what about the treatment, boys? I have no certain treatment for pellagra or any other disease. I meet indications as they arise. Any form of treatment for pellagra to be successful must be kept up for months or years. I speak only from experience. In my opinion, diet is the most important part of the treatment. And now, boys, I am going to tell you in my opinion if you do not diet your pellagra patients you may just as well tell them to order their wooden suit and tell Nancy goodby. As to diet, I prescribe boiled sweet milk with lime water, malted milk, butter-milk, butter, raw eggs, soft-boiled eggs, lean meat, Graham bread, vegetables, if there is no diarrhea. I have my patients take a vapor bath every third night, add four drops of oil of mustard to bath, keep them in bath 15 to 20 minutes, then have them sponged with carbolized magnesia (sulph, magnesia, 3i; carbolic acid gtt.xx;

water I pint. M. Ft. et lotion). Sponge entire body with it. This is to put the skin in the best condition for elimination of waste. Boys, I believe in the clean out, clean up and keep clean plan of treatment, and for this purpose I give, if bowels are constipated, liver inactive, one alophine pill before meals, 1⁄2 gr. protoiodide of mercury after meals until bowels are thoroughly cleaned out, which usually takes five to six days. Then I gr. double sulphide calcium every hour for twelve hours, or until the system is thoroughly saturated. Then I gr. before meals and the following prescription after meals:

R Fld, ext. hydrastis,

Fld, ext. chelidonium,

M. Sig.-Apply. For the nervousness often complained of by the patient, such as creeping, crawling, burny sensation, with twitching of the muscles, etc. The following prescription has served me well in such cases: R Specific tinct. gelsemium,

Specific tinct. cimicifuga..ãā 3ss.
Neurilla ....
.q.s. Zij.

M. Sig.-Teaspoonful every two or three hours. If syphilis is a complication I give 914 every two or three months until cured. With the above treatment I have succeeded in curing a large per cent. of my pellagra patients.

Boys, I must protest against the opinion often expressed that pellagra is incurable. We as doctors profess to be able to heal the sick and we have got to prove to the public that we are able to do it, or throw up the sponge. Bless your souls, boys, the world loves a man who can do things, but

has no use for one who folds his hands and says it can't be done.

Now, if the editor thinks this article is worth printing, all right; if not just throw it over into the waste basket. Boys, excuse me, I'll have to answer the phone again. So long.

THE MOST IMPORTANT APPARATUS FOR GENERAL OFFICE PRACTICE.

BY J. A. BURNETT, M.D.

There are various apparatuses that are of value in general office practice. If the non-drugless methods were more generally known there would be far less drugs used and no occasion for the various so-called drugless healers to become so numerous. In my opinion there should be more attention devoted to office practice. I am inclined to believe that general office practice or general chronic diseases should be considered a specialty. At least the physiotherapeutic methods should be considered a specialty, and in order to practice such, a physician must have an equipment and do mostly office practice, as such apparatuses are, as a rule, not portable. In making a selection of apparatus one will generally think of the following:

light

1. Galvanic battery; 2. Faradic battery; 3. High frequency apparatus; 4. Sinusoidal apparatus; 5. Static machine; 6. X-ray machine. After this there are various apparatuses that can be selected, such as the following: 7. Vibrator; 8. Vibrating chair; 9. Therapeutic lamp; 10. Electric bath cabinet; II. Hot air apparatus; 12. Inhalatorium; 13. Dr. Abram's reflex set; 14. Electric concussor; 15. Bennett's magnetones; 16. Stetching table; 17. Apparatus for using carbonic acid gas in the various ways; 18. Apparatus for using oxygen in the various ways; 19. Abdominal supporters or belts, or abdominal strapping, as treated in Rose and Kemp's book Atonica Gastrica; 20. Goosman carbon dioxide apparatus; 21. Operating table or chair in which a patient can be placed in any position; 22. Cheatham's obstetrical support and leg holder; 23. Scales, so a patient can be weighed at regular intervals; 24. Kelly cushion; 25. Stomach tube; 26. Return flow