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and Shelby County Medical Society, we unwittingly stated that the combined dues of the state and county were five dollars, when we should have said four dollars, the annual dues for each being two dollars. We still hold to our original contention that if the combined dues of the two were made lower, it would be much more satisfactory to the general membership and prospective members.-EDITOR.

Editor Memphis Medical Monthly :

Inclosed find check for one dollar, which is the twentieth year for me. My subscription began in January, 1885, which is nearly twenty years. The late Dr. Sim was editor at that time. The leading article in that number was one written by Dr. Smith, of Dyersburg, at that time, and I believe now of Paducah, Ky. His subject was "Malarial Fever," and it was a very able article. I am glad to see that you keep up the standard of the MONTHLY, as I prize it very highly. Hoping you a prosperous year, I am, Yours truly,

Ripley, Tenn., Nov. 11, 1903.

J. W. SANFORD.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.
Visiting Physician St. Joseph's Hospital.

Treatment of Angina Pectoris.

Prof. Huchard, the acknowledged authority on cardiac disease, speaking on the treatment of angina pectoris (Paris Cor. Med. Press & Cir., vol. 77, no. 3384), says that it is necessary at the outset to distinguish between the false and the true angina. The former gets well by suppressing the cause that provoked it-hysteria, neurasthenia, gastric troubles, overindulgence in tobacco; but in true angina pectoris it is of little use to treat the causal affection-gout, diabetes, syphilis, malaria-for the result is always nil. To successfully treat the malady, it is not the pathological cause that should receive attention, but the anatomical cause-disease of the coronary

arteries. Hence a double medication is necessary, one addressed to the inflammation of the arteries, the other to the possible and ever threatening risk of syncope. The first indication is met with iodide of sodium, or, rather, iodide of potassium, which is more active if well borne (iodide of potassium, one drachm; water, ten ounces; a tablespoonful three times a day). Against the danger of syncope, the result of myocardiac ischemia, vaso-dilators should be prescribed. But before commencing the medical treatment, attention should be paid to the diet, which should be lacto-vegetarian and without salt as much as possible. As to remedies he prescribes along with the iodides theobromin, as being one of the best diuretics; it eliminates the chloride of sodium, the toxins, and the vasoconstrictive substances from the organism. Ten grains are given twice a day for fifteen days. The other fifteen days of the month he divides between two vaso-dilator agents-trinitrine and tetranitrol. The trinitrine is given in solution, in tablets, or in hypodermic solutions.

Sol. of trinitrine (1 per cent.) 60 minims.

Water, 10 ounces. Two to four tablespoonfuls a day. Sometimes this drug is not well borne; it provokes violent headaches. In such cases the dose should be diminished, but not too quickly, so as not to give a dose too weak to be of any benefit. The same precautions should be observed in regard to tetranitrol, which is in one way superior to trinitrine by the fact that the effect lasts longer (one to two hours). Being insoluble in water, tetranitrol is employed in the form of tabloids (1, 2, 5, 10 milligrammes). An average dose (5 milligrammes) to commence with should be given twice or three times a day, and diminished if headaches are produced. As a substitute for the above two agents, M. Huchard frequently prescribes nitrate of soda associated with diuretics :

Nitrite of soda, grs. 15; nitrate of potash, 3ij; bicarb. of potash, 3iv; water, 3vi. A tablespoonful each morning.

It frequently happens that patients get tired and impatient of the same treatment, consequently it is well to vary it. The extract of cactus grandiflora, in one-grain pills three times a day, is an excellent cardiac tonic.

When the heart shows signs of weakness, M. Huchard gives

small doses of digitalin (10 drops of the solution of crystallized digitalin, 1-1000) once a day for five days. Sulphate of spartein is also a cardiac tonic, but not always trustworthy.

When the patient is seized with an attack of angina pectoris, nitrite of amyl is the life-saving agent.

As to the general treatment, the patient is warned against violent exercise, constipation, long walks against the wind or after meals. He should be enjoined to take a rest of one hour after each meal.

Valvular Disease of the Heart and Its Treatment.

S. S. Burt (Medical News, vol. 84, no. 12) says: Judicious treatment of a patient with valvular disease of the heart presupposes a knowledge of the distinction, and an ability to discriminate clinically, between adequate and inadequate compensation; possibility is one thing, probability is another, and finality quite another in the prognosis of these affections; although not always feasible, it is nevertheless desirable frankly to explain the situation, where dilatation from valvular defects is balanced by hypertrophy, in order to forestall a fortuitous disturbance of equilibrium; ordinary occupations and recreations not too strenuous need not necessarily be abandoned; systematic outdoor exercise, preferably walking, is not only permissible, but, to maintain the integrity of the heart muscles, actually indispensable; violent exertion, exciting emotions, and excessive eating and drinking are positively injurious; temperateness in all things pertaining to daily existence should be the watchword; with failing compensation absolute rest is of paramount importance, and, not infrequently, all that is necessary for rehabilitation; digitalis in this condition irrespective of the valve affected when drugs are required is the sole remedy that cannot be dispensed with; large doses may be given for a short time and small doses for a long time or indefinitely; strophanthus is one of the most reliable substitutes for digitalis; nitroglycerin, calomel, aconite, iron, arsenic, magnesium sulphate, and strychnin are valuable adjuvants; maximum doses of strychnin should not be continued for extended periods without intermission; finally, ruptured compensation is the beginning of the end, however long deferred by intelligent management.

On the Late Effects of Typhoid Fever on the Heart and Vessels. W. S. Thayer (Amer. Jour. Med. Sci., vol. 12, no. 3) says: A study of the condition of the heart and vessels in 183 individuals who have passed through typhoid fever at the Johns Hopkins Hospital within the last thirteen years has revealed the following facts:

1. The average systolic blood pressure in these old typhoids was appreciably higher than in control observations upon healthy individvals.

2. The higher average of the blood pressure was constant in every decade.

3. In many instances among the old typhoids the blood pressure exceeded appreciably the limits of what is usually regarded as normal.

4. The radial arteries in the old typhoids were palpable in a proportion nearly three times as great as that found in control observations upon supposedly healthy individuals who had never had the disease.

5. The average size of the heart was greater among the old typhoids than in the same cases at the time of admission to the hospital. The difference held good also when the cases were classed according to age by decades.

6. Cardiac murmurs were heard with considerably greater frequency among the old typhoids and in the same cases during

the attacks.

7. In eight cases where, on discharge from the hospital, the heart was considered normal, subsequent examination revealed hypertrophy, with mitral insufficiency. One case showed a possible mitral stenosis; one an aortic insufficiency; one a striking general arteriosclerosis, with hyper-tension.

8. In one case an aortic diastolic murmur was present four months after discharge, but had disappeared five months later.

9. Those patients whose pulse during the disease was remarkably rapid or irregular, showed, in general, on later examination, a blood pressure above the common average for the old typhoids. In other respects, however, their condition differed. but little from the general run of cases.

10. Those cases in which a systolic murmur at the apex of the heart was observed during the attack showed later an

increase in the blood pressure and in the size of the heart, as compared both with the mean of the observations made upon the same cases on admission to the hospital and with the general average for the old typhoids. Nearly one quarter of those cases in which during the attack, systolic apical murmurs were detected, showed, on later examination, evidences of organic heart disease. Indeed, the majority of all the cases of organic cardiac lesions among the 183 old typhoids came from this small group of 31 cases.

SURGERY.

UNDER CHARGE OF W. B. ROGERS, M.D.

Professor of the Principles and Practice of Surgery and Clinical Surgery,
Memphis Hospital Medical College.

Anesthesia in Abdominal Surgery.

J.J. G. Williams (Amer. Jour. Obs. etc., vol. 49, no. 315) gives the following reasons for his choice of ether as an anesthetic. in abdominal operations:

1. It is always or nearly always possible to procure a fresh supply. This is not so with chloroform, as that made for anesthesia is not kept by all druggists, a prescription for this drug being filled by the commercial article which, of course, is totally unfit for anesthesia. Only a day or two ago I heard of a patient who was operated upon after being put under the influence of spirits of chloroform.

2. So far as statistics go ether is the safer, about one death occurring in ten thousand cases; chloroform one in two thousand. The educated public know this and frequently request that chloroform shall not be used. Personally, I do not think that this gives the relative safety in competent hands.

3. The patient can be placed under ether nearly and in a good number of cases, quite as easily, quickly and quietly as with chloroform. In point of fact, I have etherized a patient in exactly ten seconds, he taking only five inspirations. This was a strong, robust young man who was to be operated upon for hernia. The anesthetic was administered by fitting over the nose and mouth a rubber mask connected to the ether bottle by a tube, the bottle being plunged into boiling water

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