Our Responsibility for Quackery Gentlemen, in this war emergency, let us unite! Let us ask the Government to help us to unite in practical service If we do, we will give quackery as black an eye as we, with our Allies, are going to give Germany..............page 135 No. 2 Influenza (La Grippe)-a grate Influenza ful field of activity for ATOPHAN. (LA GRIPPE) and ATOPHAN Here it can broadly display its superior constitutional anti-inflammatory and pain-relieving properties. Seven and a half to fifteen grains, two or three times daily, help readily to check and alleviate the worst manifestations. The respiratory inflammation. The congestive headache. The pain and stiffness of limbs and back, etc. And ATOPHAN acts without cardiac depression, excessive diaphoresis, constipation or kidney irritation. Only when the fever is high and persistent, a more active antipyretic is needed to back up the good work of ATOPHAN. Distributed exclusively by Now Manufactured in U.S.A. You can buy with Confidence-See "Service Guarantee to Readers" on page 100 J. J. TAYLOR, M.D. FOUNDER THOS. S. BLAIR, M. D. EDITOR THE PHILADELPHIA 420 Walnut Street Published monthly - The Medical Council Co.; Mrs. J. J. Taylor, Publisher. FEBRUARY, 1918 VOL. XXIII Entered as second-class matter Feb. 13, 1896, at the post office at Philadelphia, Pa., under Act of March 3, 1879. Domiciliary Fever. The Coughs, Colds and Bronchitis of Winter. HE ANIMALS that "den up" during the winter hibernate; the ones that keep on the job live largely outdoors. Man is a strange animal that works all the year, does not give nature a chance to slow down by hibernation, but who yet wants a stuffy den for the winter heated to suffocation and rarely ventilated. The result is domiciliary fever, yes, the inevitable result. Furthermore, it is peculiarly an American disease, for Europe knows little of the hot apartments so common in the United States during our long winters. To our infinite discomfort, the shortage of coal on account of the war is introducing us to the European standard of house heating. While it is hard on old people and invalids who have learned the domiciliary habit, it is not hurting the robust nearly as much as they expected it would. After this dreadful war is over and the soldiers come back-those that do come back-they will teach us how to avoid the domiciliary disease. It is not a new lesson they will teach, but simply one we don't want to learn. But, ultimately, we will learn it. Why not now? There is about two square feet of mucous membrane above the neck and a whole lot more below the neck, and it is about the best culture ground in the whole body. Naturally it is a regular ventilating shaft with a back-and-forth play of hot and impure air to be vented from the body and an intake of whatever all outdoors has to offer, hot or cold according to season, but always pure and more or less moist. No wonder we pay a penalty when we impose upon this wonderful ventilating system in the way we do, a way too familiar to need description. A Simple Disease With Many Variations. Domiciliary fever may occur as acute nasal catarrh, and it is apt to become chronic; it may take any one of the many forms of laryngitis or pharyngitis, and it may ring the changes through a long winter; it may be manifest as one of the several bronchial involvements, and it may extend to the lungs and pleura. But whatever symptoms it may manifest, never No. 2 theless it is at base domiciliary fever the house disease. And a strange thing about this whole group, which does not include true pneumonia and epidemic influenza, or "grippe," is this: In whatever way it may manifest itself the one superior method of treatment alike applicable to all forms is to go to bed and stay there, or, in other words, hibernate for a while until nature establishes a balance. And, by the way, that is what a sick animal does; it hibernates, whether it is its fashion to do so or not. Verily a period of hibernation, the while subsisting on a light diet, is one of the best therapeutic resources we have. How We Should Build and Heat Houses. The square house with folding or sliding doors, so that the whole interior may be thrown into as nearly one apartment as possible, is the very best type for winter living. Then, if we have only one big register or heating flue in the center, a series of complex air currents keep circulating all through the whole interior and blend the air admirably. Of course many houses are so constructed that such a means of heating is not practicable; but, from the health standpoint, it is an admirable way to heat a small dwelling. That method nearly approaches the California bungalow, which also has another factor developed to perfection, abundance of windows, so that the house is light and readily ventilated. A well-lighted house with the sun pouring in actually seems several degrees warmer than the thermometer shows it to be. Note the greenhouse of the florist. Here the temperature is kept at 55 to 60 degrees, rarely higher unless the sun makes it so. Men work in these houses in their shirtsleeves in the coldest of winter. The secret of it all is floods of light, good ventilation and adequate humidity. And here plants that ordinarly hybernate thrive through the winter as well as the summer-a lesson for man in his house-building. Medicinal Treatment. Of course drugs are useful in the treatment of domiciliary fever if they are used discreetly; but the main thing for us to learn is the actual nature of this protean affection, its prevention, and its rational cure. DE Treatment of Progressive Deafness. EAFNESS was investigated fifty years ago by Meyer and Tonbyee; and Politzer, Lucae and others further elaborated what they taught. But so little has been done since that most physicians feel like the late Prof. Wood, who said to his class: "Gentlemen, the case of deafness you can treat with a syringe you can cure; but only the Almighty can cure the ones the syringe won't reach." Nevertheless, progressive deafness from chronic secretory otitis media has been shown to have, in nearly every case, a primary focus, and the hearing varies from day to day in such cases. Therefore, the best hearing of such an individual may be attained by reaching that focus and draining it, whether the focus be in one of the sinuses, tonsil or other auditory adnexa. Of course hearing may not become normal, but it may be much improved by such attention. We have learned that inflating the tubes and middle ear is almost always harmful, since there is more a lack of tone than of obstruction. Get rid of or drain the infection, and hearing will almost certainly improve. Some cases are kept up by atmospheric conditions unfavorable to the individual. Eustachian deafness is common among people from the United States who remain for long in the Panama Canal Zone, owing to the high humidity there; and there are other cases aggravated or even caused by contaminated air in factory districts. Local Treatment. The current idea that middle-ear deafness is almost universally due to "catarrh" is largely untrue; hence, the multitudinous applications are inefficient. Yet many of them give a certain relief if not repeated too often. Emerson, of Harvard, contends that applications to the tube should not be strong enough to excite reaction, an exceedingly difficult thing to control. Dr. Edward J. Brown, of Minneapolis, in a paper in The Laryngoscope, March, 1917, advocated calomel vapor. His suggestion has been exceedingly well received. He vaporizes the calomel in a special device described in Medical Record, Oct. 6, 1917, using 2 or 3 grains of calomel for a treatment and passing the vapor through the nares by means of the pressure from compressed air and having the patient swallow every few seconds. The calomel may also be applied directly through the Eustachian catheter, using very little air pres sure. Radiant light and heat from a 50 c. p. stereopticon carbon filament incandescent lamp with a reflector directing the rays parallel is strongly advocated for purulent otitis media, with its accompany ing deafness. Apply for 30 to 60 minutes morning and evening. Nerve Deafness. Otologists are on the defensive as regards nerve deafness. Emerson, writing in Boston Med. and Surg. Jour., Oct. 25, 1917, claims that most of these cases are due to toxemia from some definite focus. Yes, we can do much for deafness if we can find what causes it, or where the focus of low-grade infection is located. The relief is largely surgical, though vaccines have given brilliant success in a few cases. Usually vaccines fail. There is a vast deal of ineffective medication and applications directed to the relief and cure of progressive deafness, even by specialists in ear diseases. There is need for intensive investigation into the many problems involved, for there certainly must be a way to meet these cases more effectively. E' Cardiac Decompensation. XHAUSTION of the reserve force of the heart which overcomes certain impediments tending to abnormal action brings about decompensation, a condition of imbalance that may be likened to a steam engine having a sudden stress of work thrown upon it when steam-pressure is sufficient only to carry the normal or the minimum load. The first symptom of decompensation is dyspnea, which is followed by edema in the lower limbs, enlargement of the liver, gastric irritability, constipation, a sense of constriction in the chest, irregular heart action, exhaustion under stress, cardiac asthma and altered blood-pressure. Treatment. Restore the reserve force and the patient may live in comfort for years, dependent of course on how he lives. So put the sufferer from decompensation to bed and keep him there, where he will have both physical and mental rest, each of equal importance. The whole effort is to restore the exhausted heart muscle, not to cure the valvular lesion. Let him assume whatever posture is most comfortable. Place on, a diet largely of milk but with little other fluid. Rice and vegetables seem to agree with most cases. Diuretics may be used along the lines outlined in the leading editorial in November and the one on "The Treatment of Cardiac Dropsy" in January; but the xanthine derivatives are exceedingly useful in decompensation if there is no complicating nephritis. Osler has well said: "Broken compensation is the signal for digitalis." Add to this rest and then more REST, with the further fact that it is often advisable to change from one drug of the digitalis group to another one, and we have the whole formula in a few words. After compensation is recovered, a calmn, placid and temperate life is imperative-one with no stress or strain and yet with a fair amount of exercise. As Cross well said: "It is the wise patient who knows his own heart." Such patients will do well, after recovering compensation; but the one who won't take advice, desiring to depend wholly on medicine, will disappoint both his physician and himself. Is Drug CA Therapy Worth While in Treating Pulmonary Hemorrage? AREFUL general management, with the patient in bed in a cool room, does so much for the relief of the various forms of pulmonary hemorrhage that most cases do not need drugs. However, they are not to be wholly dismissed. Until after the anatomists and physiologists determine if there is or is not a pulmonary vasomotor supply, we will be unable to dogmatize upon the use of certain drugs in hemorrhage from the lungs. It is rather generally agreed that the calcium salts, given for a short time, increase blood coagulability; but calcium acts too slowly to serve in an emergency, though worth while in cases liable to recurrence. Much the same must be said of gelatin, for used subcutaneously it gives rise to many disagreeable symptoms and sometimes dangerous ones; but used as a food it possesses some value. The injection of fresh horse serum has its advocates, but it also has its dangers, especially anaphylactic shock. Pituitary and adrenal extract have been very well tried out by us in numerous cases of pulmonary hemorrhage, with very disappointing results; nor has emetin done much better, being markedly inferior to ipecac itself, or the combination of ipecac and hydrastis. Ipecac and cotarnine has been combined with good results, the ipecac for the pulmonary congestion more especially and the cotarnine for capillary hemorrhage. From some results in severe cases, we have come to regard most favorably the hypodermic use of atropin and nitroglycerin, separately or in combination. Their use seems to be rational, at least. Except in an occasional case, morphin is unnecessary, full dosage of bromides doing better and, like the old salt method which was far from inefficient, rapidly increasing the coagulability of the blood, the sodium salt being preferable to the potassium bromide. Yes, drugs are useful in the treatment of pulmonary hemorrhage; but they should be regarded as auxiliary to general management and local measures, such as strapping, the application of cold, etc. W Erosive Balanitis. Have We Mastered "The Fourth Venereal Disease”? E PUBLISHED, in our issue for May, 1915, an article on erosive balanitis by Dr. N. E. Aronstam, who described it very accurately and gave it a period of four or five weeks to run. He commended cleanliness and "a masterly inactivity" as the proper treatment. The term, erosive balanitis, was then a new one in medicine, with most practitioners. In The Jour. of Lab. and Clin. Med., Sept., 1917, Owen and Martin gave a clear discription of this condition, first recognized by Bataille and Berdal, in 1889. Scherber and Müller, in 1904, identified the causative organisms, which are anaerobic and of vibrio and spirochete type; they readily stain with dilute carbol-fuchsin. They may exist in the mouth, and coitus per os, or wetting the penis with saliva, is a frequent cause, the organisms proliferating under the foreskin. Owen and Martin recommend frequent mechanical cleansing followed by applications of gauze soaked in hydrogen peroxide and covered with oiled silk. The treatment seems to be specific. Our Own Cases. After reading the paper of Dr. Aronstam, and receiving a reprint by Dr. B. C. Corbus, who was the first American writer on the subject, we had two cases we diagnosed as erosive balanitis. One recovered in due time, although the pus had a most foul odor, but the other became gangrenous and was most serious. As it happened, the second patient had syphilis also, and after long urging he consented to have salvarsan administered, which promptly cured the gangrenous balanitis. However, we have a most unpleasant recollection of both cases and did not wish to encounter others. Soon after the paper of Owen and Martin appeared, another case presented. There were several coalesced lesions somewhat resmbling soft chancres but with very free exudate of very foul odor. There was some lymphatic involvement. A smear stained with dilute carbol-fuchsin was diagnostic. The second case was similar but with very marked phimosis with very tender lymph glands which did not suppurate. Both cases were promptly cured entirely by the peroxide treatment within a very few days. The results were certainly most striking in both cases. Some Conclusions. After our experience we looked up the papers of Corbus (J. A. M. A., 1908, lii, 1474; ibid. 1913, lx, 1769), and they show the disease to be relatively infrequent in private practice but common in certain dispensaries. Looking back in our own practice, |