READING NOTICES. ABOUT ONE YEAR AGO I was called to see a gentleman of this city who for fourteen years had been suffering from frequent (at least weekly) epileptic fits, sometimes severe, sometimes light. I exhausted all the ordinary remedies upon him with but little benefit. Six months since I commenced the use of Peacock's Bromides, and am pleased to say that from the very first day of its use he has not had a single paroxysm, and now feels himself entirely cured. J. STINSON HARRISON, M.D. 1225 F. St., N. W., Washington, D. C. PEPSIN CORDIAL.-The extraordinary delicacy of the digestive ferments causes their administration to be attended with some difficulty. Unless thoroughly familiar with the peculiar conditions under which they operate, and their behavior toward other medicaments used in the treatment of indigestion, there is danger of their being destroyed. This applies with particular force to pepsin, and it is safe to say that 90 per cent. of the elixirs, wines and essences of this medicament as now supplied to the trade, are either absolutely inert or will become so with the lapse of time-a statement which experience will amply confirm. Messrs. Parke, Davis & Co. have long aimed to prepare a satisfactory liquid vehicle for the presentation of pepsin, but until recently their efforts were not more successful than those of other manufacturers. Now. however, they have prepared in Pepsin Cordial a product which is at once therapeutically active, and absolutely permanent, at the same time elegant in flavor. It is possessed of all the properties peculiar to pepsin; will dissolve egg-albumen or other proteid matter, and curdle milk. It is onethird the strength of saccharated pepsin, and an average dose of the ferment is therefore contained in a comparatively small bulk. A sufficient proportion of aromatics has been added to make it a grateful stimulant to the peptic glands, thus exciting a natural secretion of gastric juice. One fluidrachm will dissolve 1,000 grains of albumen under the conditions specified in Parke, Davis & Co.'s modification of the official test for dtermining the value of pepsin. Pepsin cordial is essentially an artificial gastric juice containing all the elements which are essential to gastric digestion. By W. F. FAISON, M.D., and C. D. HILL, M.D., Jersey City Hospital. Eminent authorities all agree that, as a rule, the practice of closing, that is, hermetically sealing, penetrating wounds of the chest, other than clean-cut wounds, should never be resorted to. But are there not some cases in which the surgeon is justifiable in closing such wounds to relieve the urgent symptoms, such as dyspnoea, etc.? The following is a report of a case in which the wound was closed "hermetically," with most gratifying results: Matthew Burke, æt. 31, Irishman, of strong build, was admitted to the Hospital December 6th, 1889. While engaged in blowing up an old boiler with dynamite, a fragment of iron, the dimensions of which could not be ascertained, was hurled about an hundred yards, striking him in the back, inflicting a wound, located about one inch above the inferior angle of the left scapula and three inches from the median line of the back. which would admit the tip of the little finger. There had been considerable hemorrhage, both external and internal, probably from wounding one of the intercostal arteries; but which had been controlled by the application of a temporary compress, applied before his admission. When we saw the patient he was suffering from most agonizing dyspnea, air, rushing in and out of the wound on inspiration and expiration (traumatopnœa), made a whistling noise which greatly alarmed the patient. Hæmoptysis was not very profuse, though large moist râles could be heard in the throat, from his inability to expectorate the blood. Emphysema was marked on either side, in front, behind and laterally, from the root of the neck to the lumbar region. Shock was not so pronounced as might have been expected, the patient was talking and said: "I would be all right if I could only get my breath." The pulse was exceedingly rapid and thready. On palpation, percussion and auscultation there was every evidence of pneumo-hæmothorax. The lung must have been punctured, for we have the three cardinal symptoms-dyspnea, emphysema and hæmoptysis, along with considerable ecchymosis of blood in the loins, this latter being a sign considered almost pathognomonic by Valentine of effusion into the pleural cavity. The Something had to be done, and that speedily. Although we are warned not to close penetrating wounds of the chest, yet in this case so urgent were the dyspnoea and every evidence of impending dissolution that we determined to close the wound at once. nature of the wound and the time involved in such proceeding would not admit of paring the edges and converting the external opening into an incised wound, and drawing it together with sutures; consequently a thorough antiseptic dressing was applied; over this strips of adhesive plaster were placed in a imbricated manner, rendering the wound impervious to air, and around this a roller bandage. Traumatopnea ceased, the dyspnoea diminished, and the patient was very much relieved. The following morning temperature was 101.8° F., but the patient's general condition was much more favorable. The breathing was much better, but confined almost entirely to the sound side, the wounded lung being compressed by the effusion of blood in the pleural cavity, as shown by a marked bulging in the intercostal spaces, dulness on percussion, etc. On December 8th, two days later, the temperature had risen to 103° F. (in rectum), and he complained of "feeling cold," but there had not been a distinct rigor. Now was the trying moment! What should be done? Was the pyrexia an inflammatory fever, due to the absorption of fibrin, a traumatic pleurisy or pneumonia, or was it due to septic infection? If the fever were due to the former causes, then antipyretics were indicated; but if to septic infection-a trouble of a far more formidable nature-then antipyretics plus thorough drainage, which would necessitate opening the wound and inserting a tube. The former mode was adopted and the dressing allowed to remain, with the gratifying result of seeing the temperature gradually decline under the administration of sulphate of quinine in 10-grain doses, repeated every three hours. On the third day the dressing was removed under a constant stream of bichloride of mercury (1-2000). The wound showed no evidences of a septic trouble, and the opening was completely sealed up. The patient's condition was still favorable-no hæmopysis, emphysema rapidly disappearing, and the temperature slightly above normal. Another antiseptic dressing was put on, which was allowed to remain for two days. Healthy granulations were now springing up in the wound. From this time onward it was treated as an ordinary granulating surface. Nothing but the most favorable symptoms were manifest until December 24th-some three weeks later-when the patient's temperature suddenly rose to 105° F., accompanied with profuse sweats and a dry hacking cough. But there was no chill. This last rise of temperature at first occasioned grave apprehensions, but, from the fact that "La Grippe " was prevailing in the wards at the time and that the temperature fell, it probably had this for its origin, this being one of the symptoms of certain forms of this peculiar epidemic. From this onward the patient steadily improved, normal resonance returned, except slight dulness at the base of the lung, the effusion into the pleural cavity being absorbed. The patient was discharged cured February 13th, 1890. As a further evidence to show that our treatment in this case was rational, we will cite two other cases of severe injuries to the chest, involving the lung, but without any external opening. Case 2.-George Schaffer, æt. 33, an American of magnificent physical development, was admitted to the Hospital January 11th, 1890, about one-half hour after having been run over by a truck weighing 3,500 pounds. Several of the middle ribs were broken on either side, but no external injuries more than slight contusions. The patient was suffering from shock-that "erethistic" form spoken of by Travers as "prostration with excitement." It required several attendants to hold him in bed, notwithstanding the fact that the pulse was almost imperceptible at the wrist, the extremities cold and the skin bathed in a profuse clammy perspiration. Emphysema was marked over the whole of one side. No hæmoptysis, but agonizing pain with marked dyspnea. The lung was very probably punctured on one side by the broken ribs, as emphysema was confined to one side, showing that the air had not escaped from the mediastinum, in which case the emphysema would have made its appearance first at the root of the neck or in the epigastric region, with equal liability to affect both sides. With hypodermics of morphia and whiskey the urgent symptoms were abridged, and eight days afterwards the patient had sufficiently recovered to be taken home in a coach. Case 3.-Joseph Schum, æt. 34, German, of fine physique, was admitted to the Hospital November 1, 1889. The wheel of a large beer truck, weighing 8,500 pounds, had passed obliquely across the left chest and clavicle, grazing the side of the neck. The patient was in profound shock, and death seemed imminent. On examining the chest the whole left side, on slightest pressure, caved in. There was a tumor in the axillary region of the size of a large orange, due to extravasation of blood; also considerable ecchymosis extending down to the lumbar region, with hæmoptysis, emphysema and dyspnea, again showing injury of the lung. Stimulants were given, and rest in the recumbent posture was all that could be done. Very much to our surprise reaction soon set in, and the patient made a rapid recovery, being discharged in twenty-six days apparently as well as ever. In these three cases, above reported, we had every reason to suspect lung injuries, but in the last two, although the injuries per se |