is more than a mere cathartic; it is a physiologic "toner" of intestinal function-positive, rational, etfective. It does more than "move the bowels"-it

restores normality.

CONSTIPATION IN PREGNANCY

As you know, at least half the cases are subject to constipation, due to pressure of the uterus and loss of tonicity of the abdominal walls. Consequent straining at stool leads to hemorrhoids. Lesions accompanying eclampsia, vomiting in pregnancy and acute yellow atrophy of the liver are all influenced by bowel conditions. Furthermore, toxins from constipation put an additional strain upon the kidneys. The health of both mother and child are jeopardized by the indiscriminate use of cathartics. Saline cathartics deplete the system of body fluids and are particularly harmful in pregnancy. Cathartics which act through initiating peristalsis may even lead to abortion. A lubricant is the best peristaltic regulator during pregnancy, according to a prominent gastro-enterologist. It does not upset digestion and acts both locally and generally in the intestine. Nujol, the ideal lubricant, is the therapeutic common denominator of all types of constipation. Microscopic examination shows that too high a viscosity fails to permeate hardened scybala; too low a viscosity tends to produce seepage. Exhaustive clinical tests show the viscosity of Nujol to be physiologically correct and in accord with the opinion of leading medical authorities.

A TRUE TONIC

According to Thacker, Cactina Pillets make an ideal heart tonic, always safe, quick and efficient. For a weak heart one to two Pillets should be given 3 or 4 times a day.

W

A WARNING

We agree with the Doctor fully, and warn the physician who is about to use such a potent remedy to have his patient under as accurate control as must be had in controlling diabetes mellitus with diet and insulin. The blood-pressure readings must be taken continuously, at least every half hour for the first three hours following injection, and adrenalin must be at hand to take care of any undue depression of arterial tension.

We are pleased to announce that, pending the preparation of this solution in sufficient quantities for general commercial distribution, we shall be happy to forward, without charge, to any interested physician, enough of this solution to make a complete test.-The Harrower Laboratory, Inc., Glendale, California.

CYSTITIS

While the essential cause of cystitis is bacterial contamination, as gonococcus, staphyloccus, streptococcus, pneumococcus, typhoid bacillus and tubercle bacillus, predisposing factors are highly irritating urine due to an excess of acid or alkaline constituent, or to the presence in the urine of certain chemical substances in excess, such as turpentine, copaiba, cubebs, cantharidese, or to an overindulgence in alcoholic beverages. It may also result from an extension of inflammation of the posterior urethra. In the general treatment, whether of the acute or chronic form, the anodyne and soothing preparation Sanmetto holds first rank. It very markedly helps to reduce inflammation and materially assists in overcoming vesical spasm. A well-rounded treatment for cystitis will include Sanmetto.

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A SAFE SEDATIVE The need for a safe and efficient sedative has been filled by Neonal, the new hypnotic and analgesic agent.

other

Neonal is butyl ethyl barbituric acid, which combines high hypnotic efficiency with low toxicity and freedom from undesirable side effects. Neonal is hypnotic, sedative and analgesic-a combination of desirable properties not possessed by any hypnotic substance. The sedative action of Neonal is unique and valuable in a wide variety of disorders, including nervous cases, obsession, psychoses, neuroses, alcoholism, etc. The analgesic action of Neonal is marked and is particularly desirable, as the frequent cause of insomnia is pain.

Neonal is not habit forming, and is ordinarily free from side and after effects. It produces no gastric disturbances, and is quickly eliminated; it has no depressant action on the heart and no effect upon the blood pressure or respiration; the "headiness" or dullness upon awakening, so frequently noted with many hypnotics, is absent with Neonal. Clinical reports on the use of Neonal have been received from many physicians who have used this drug successfully in various conditions, ranging from acute alcoholism to whooping cough. The results in insomnia were very satisfactory. Good results were also reported in cases of epilepsy, neuritis, neuralgia and psycho-neuroses.

Literature and samples of Neonal may be obtained by writing to the Abbott Laboratories, North Chicago, Ill.

MERCURY AS A SPIROCHETICIDE

It has long been the unique distinction of the arsphenamines (606 and its successors) that in nontoxic doses they were capable of acting as spirocheticides, whereas mercury has always been given in subcurative doses because of its comparative toxicity. Now the claim is made that the organic mercury compound, Mercurosal, is spirocheticidal in nontoxic doses. Based on animal tests in cases of syphilis artificially induced, the spirocheticidal dose of Mercurosal for a luetic patient has been fixed at 3.5 miligrams per kilo of body-weight, the injections (intravenous) being repeated at intervals of three days until ten are given. A 70-kilo patient would therefore receive 245 milligram (0.25 gram) at a dose; but it is advised that smaller doses be given at first to test the patient's sensitiveness toward mercury. The manufacturers, Parke, Davis & Co., put out an intravenous dose of 0.1 gram, and in addition a 50-cc rubber-diaphragmed bottle containing in each cubic centimeter 0.025 gram of Mercurosal, or 0.25 gram in 10 cc. It is claimed that, with caution, the dose can be built up by degrees to this figure, or, if doses of 0.2 gram or less are preferred, the injections can be given at two-day intervals. Mercurosal is said to be harmless to the vein; and this being so, the intravenous method of administration is, of course, the ideal one. See Parke, Davis & Co.'s advertisement on Mercurosal in this issue.

WE CAN SERVE YOU BETTER The W. A. Rosenthal X-Ray Co., located at 412-414 East Tenth St., Kansas City, Mo., have recently leased additional quarters at 416 East Tenth and have opened up a display room for the sale of used X-Ray and Physiotherapy equipment. They have also enlarged their shop facilities and are prepared to render service and make repairs on practically any make of X-Ray and Physiotherapy equipment. Physicians and Institutions requiring service on their equipment will appreciate the advantages of dealing with this organization. This department now being under the direction of Mr. E. A. Monroe.

BROMIDE OF SODA ADMINISTERED INTRAVENOUSLY LESS TOXIC THAN

IODIDE OR CHLORIDE

Another U. S. P. remedy has been added to those already adopted for intravenous administration. Repeated reference in the literature to the advantageous employment of a 10 per cent solution of Sodium Bromide intravenously in diseases of the skin, coupled with requests for a properly prepared, safe and standardized solution, have prompted Loeser to undertake the usual studies for the adaptability of standard remedies for injection into the bloodstream. Thorough toxicity studies, establishing the minimum lethal dose, have just been published in the Journal of Intravenous Therapy for January, 1926. These studies also show that, contrary to popular belief, Sodium Bromide is less toxic than either Sodium Chloride or Sodium Iodide. Copy of complete article and literature may be had by addressing the New York Intravenous Laboratory, 100 West 21 Street, New York.

Vol. XLV

Original Contributions

(EXCLUSIVELY FOR THE MEDICAL HERALD)

TYPES OF TACHYCARDIAS ARTHUR L. SMITH, A.B., M. D., F.A.C.P. Lincoln, Nebr.

TH

HE usually accepted idea of a tachycardia is an increase in the rate of the pulse. However, in recent years, we have learned through the employment of instruments of precision, as the polygraph and the electrocardiograph, there may be a great increase in the rate of one part of the heart and this not be manifested in another cardiac area or in the pulse. It is not so long ago there was no division of tachycardias but all were just considered an acceleration of the heart and of one type. At present we know there are many different types and sub-types which are manifested in many different manners. Tachycardias can be divided into two principal groups; those which are discovered by palpation of the radial artery or auscultation of the heart, and those which show no acceleration of the pulse or the ventricle.

Tachycardias Manifested in the Pulse The tachycardias which are noted by palpitation of the pulse or auscultation of the heart

are:

1. Conducted simple sinus tachycardia. 2. Ventricular paroxysmal tachycardia. 3. Conducted auricular or junctional tissue paroxysmal tachycardia.

4. Conducted auricular flutter.

5. Conducted auricular fibrillation.

At times auscultation may reveal an acceleration of the ventricle but so many of the arterial impulses do not reach the pulse that palpation of the radial artery reveals no tachycardia. Accelerated pulsus alternans or extrasystoles arising in the ventricle as a pulsus bigeminus may be of this type, when the weaker beats fail to reach the pulse.

Read before the Medical Society of Missouri Valley at St. Joseph, Mo., October 1, 1925.

No. 3

Tachycardias Not Revealed in the Pulse Tachycardias that are not revealed by palpitation of the pulse or auscultation of the heart are:

1. Partially blocked sinus tachycardia. 2. Partially blocked auricular or junctional tissue paroxysmal tachycardia.

3. Auricular flutter partially or completely blocked. Auricular fibrillation completely

blocked.

5. Multiple extrasystoles in the auricle or junctional tissues partially blocked.

In complete block no clinical method will show the rate of the auricle, whether it be fast or slow, therefore any type of auricular tachycardia in complete block is undiscoverable clinically.

I have seen one case of complete heart block in which, after exercise the ventricular rate increased from 38 to 74 per minute, so clinically a diagnosis of partial block was made. However, the showed the acceleration to be due to ventricuelectrocardiogram lar extrasystoles. The patient was a foundryman and worked at hard labor.

Clinical Tests for Identifying Tachycardias Tachycardias involving the ventricle or that may be transmitted to it after exercise may in a general way be recognized clinically. Exercise often differentiates many types of tachycardias, and rest is often of value in recognizing the general type.

In sinus tachycardia exercise accelerates the pulse in proportion to the amount of work done, while complete rest decreases proportionately the rate of the pulse.

In paroxysmal tachycardia the rate is usually uninfluenced by exercise or rest.

Auricular flutter, after exercise, shows a sudden increase in the rate from 2 to 4 times the original or it may develop into an auricular fibrillation and be grossly irregular. After rest the rate is suddenly reduced to half or one-fourth the exercise rate. This depends, however, upon the functional activity of the auricular-ventricular bundle.