cent. alcoholic solution of carbolic or salicylic acid as a lotion for the itching.

Treatment of Acute Peritonitis.—Maurice Richardson uses salines at the beginning of the attack to secure free watery evacuations. Calomel, one-fifth grain every hour, will at times produce satisfactory discharges. Opium should be given only when indispensable for unbearable pain. The surgical treatment consists in removal of any special cause, and incision, irrigation, cleansing and drainage.

Sexual Sterilization.-Castratio mulieris uterina by atmocausis is advocated by L. Pincus (Practical Medicine Series) in married women who suffer from hemophilia or from any incurable disease, such as phthisis or nephritis. The procedure consists simply in the obliteration of the uterine cavity by passing in live steam for a minute or less. Two applications are generally required.

Treatment of Erysipelas.-Stelwagon gives a purge, followed by tincture of chloride of iron and quinine, with stimulants if needed. Benedict recommends a five per cent. solution of menthol in petroleol. Stevens prescribes one part of ichthyol to four parts of vaselin, spread thickly on lint and applied to the affected parts. Seneca Powell uses the local application of strong carbolic acid, leaving it on for a few moments till the skin whitens, then neutralizing with alcohol.

Treatment of Erythema Simplex.-Van Harlingen recommends calamine lotion, made with one-half ounce each of calamine, zinc oxide, starch and glycerin in a half pint of water. Stelwagon emphasizes removal of the cause, such as cold, heat, sunshine, trauma, irritants, indigestion, or ingestion of certain drugs. Intestinal antiseptics are sometimes useful. Local treatment, including dusting powders and mild, cooling, astringent lotions, is rarely needed.

Dermatitis Exfoliativa.-This disease, also known as erythema desquamative scarlatiniforme, from its resemblance to scarlet fever, is marked by bright scarlet, uniform spreading patches of macules or punctiform papules, followed by profuse scaling. It is often accompanied by malaise, rigors, sharp fever and angina. Stelwagon advises general treatment based upon the special indications, and external soothing applications, such as are employed in acute and subacute eczema.

Occipito-Posterior Positions.—When recognized at the brim before rupture of the membranes and deep engagement, say Grandin and Jarman, use manual rectification under anesthesia, turning first the body then the head of the fetus. If there is disproportion between the fetus and the pelvis, version is preferable. If the head is already engaged by its greater segment and the membranes are ruptured, watch in hope of anterior rotation-if mother or fetus show signs of exhaustion, apply forceps and deliver.

Treatment of Measles.-John Abercrombie says: Keep the patient in bed. Give a liquid diet while the fever lasts; diaphoretics may be useful. If diarrhea is very severe and persistent, apply cold compresses to the abdomen, and give bismuth and astringents internally. For the skin, inunctions of lard or vaseline with a little carbolic acid are useful. Use quinine and packing or cold baths if the temperature is very high. Cough and hoarseness are often relieved by wet compresses to front of the throat, and by painting the fauces with glycerin and borax.

The Blood Pressure in Health and in Disease.-According to H. S. Carter (International Medical Annual) the average normal mean pressure in males is 116 mm.; in females, 113 mm. In acute primary nephritis the pressure varies in general with the amount of albumin in the urine. In chronic nephritis the pressure averages about 62 mm. higher than in the acute form. In anemia and in aortic regurgitation pressure is low. Sodium nitrite is the best vaso-dilator, acting in about 26 minutes. It reduces the pressure by ten to fifteen mm., the effect lasting threequarters of an hour.

Face Presentation.-Hirst states that a posterior position of the chin demands active treatment, taking care not to rupture the membranes. Try to convert into vertex presentation by external or external and internal manipulations. These failing, try version if the face is not impacted in the pelvis. When the presenting part is impacted, hasten anterior rotation of the chin by two fingers or a single blade of the forceps pressing on the posterior cheek and chin. This failing, try to compel rotation with straight forceps. Never use traction when the chin is pointing backward. Craniotomy is a last resort.

Death of Fetus in Utero.-Unless labor sets in within two or three weeks after death of fetus, says Lusk, we should induce

labor except that a living twin is present. Dilate the os with a hot-water douche and with Barnes' dilators filled with hot water or hot air. Anesthetize and empty the uterus as speedily as possible, then flush with hot water. If the patient is septic or the fetus decomposed, pack the uterus moderately with iodoform gauze, leaving only a single piece to protrude from the cervix. Remove the gauze in twenty-four hours, and use a hot bichloride vaginal douche 1:10,000 twice a day.

Treatment of Acute Appendicitis.-Maurice H. Richardson thinks it is best to ease patient, if possible, through the acute attack and remove the appendix in the healthy interval. When the infection is successfully localized by the end of the second, third or fourth day, the case may be watched if the constitutional symptoms are not severe or are improving, and when local symptoms are not conspicuous. If there is a marked tumor, evacuate immediately. When both local and constitutional symptoms are severe, exploration is always demanded. A high pulse alone is a much more reliable guide for operation than high temperature alone. In case of doubt it is safer to operate than to delay.

Albumosuria.-Hugounenq (International Medical Annual) says there are two forms of albumosuria: One in which the urine yields a precipitate on heating, which dissolves on boiling and reappears again on cooling; and a second variety in which no precipitate results from heating, but is produced with hydrochloric acid, alcohol or ammonium sulphate. He thinks that the first type is especially connected with myelopathy, and the second more common ("peptonuria") is frequently present in nephritis, transitory disorders of nutrition, scarlet fever, pregnancy and occasionally insanity.

Calcium Salts in Uric Acid Nephrolithiasis.—A. C. Croftan (Journal of the American Medical Association) concludes that, since the uric acid of the urine is held in solution by disodic phosphate and is precipitated by the monosodic phosphate, the decrease of the latter is a desideratum, which is best attained by decreasing the phosphoric acid of the urine. Calcium salts produce this effect by binding the preformed phosphates of the food, preventing their absorption. He gives calcium carbonate in the dose of fifteen to twenty grains three times a day in large bulk of pure water. The diet should also be regulated with reference to its contents of purin bodies.

Spermatic Colic.-This form of colic occurs at the moment of ejaculation during coitus or nocturnal emission. The pain, says Keyes, is very sharp and nauseating, and is centralized about an inch up the rectum or at the neck of the bladder, radiating up the posterior pelvic wall or to the testicles. The pain is caused by the impaction of a concretion or a mass of inspissated semen in the duct, causing the emission to be deficient or absent. Keyes has found the hot rectal douche an excellent remedy to relieve the pain and shorten the attack. Many persons obtain relief in mild cases by pressing upon the offending organ with a finger in the rectum. If the attack has been severe, after it has passed away massage of the protate and vesicle against a full-sized sound in the urethra should be employed.

Mercury and Iodides.-Gowers (quoted in Philadelphia Medical Journal) thinks it is not wise to give mercury and the iodides together in full doses, except when the life of the patient is threatened. He believes that the iodides promote the elimination of mercury and so hinder the retention of enough of that substance to act upon the disease. Inunctions are much facilitated by the use of mercury oleate. He thinks that specific treatment should be energetic, brief and renewed, but not continuous. It should stop at the end of eight weeks or so, and be renewed in from two to six months. The patient should have three or four weeks' treatment with iodine during the first year after the disappearance of true specific symptoms, and every six months for the next three or four years.

Meningismus.-This term, says the editor of the St. Louis Courier of Medicine, has received a firm place in nosology. It denotes the appearance of a group of symptoms which resemble those resulting from inflammation of the coverings of the brain, such as somnolence, stupor, irregular pulse, sluggish respiration, unequal pupils, strabismus, rigidity of the neck and other muscles. These symptoms may persist for several days or even weeks. They are often due to gastrointestinal infection, occasionally to uremia, but most frequently they accompany certain infectious diseases, as pneumonia. The diagnosis is often impossible, though in infants the fontanels may give a clue, and usually one is compelled to resort to lumbar puncture to determine the presence or absence of meningeal infection.

Sajous on the Respiration.-I. The adrenals secrete a chromogen-a colloid, hyaline fluid-which leaves the organs through the suprarenal veins, and is mixed with the plasma of the venous blood in the inferior vena cava.

2. When the venous blood reaches the pulmonary alveoli, the marked affinity of the adrenalized plasma for oxygen causes it to absorb this gas from the alveolar air.

3. The carbonic dioxide in the blood is thus forcibly replaced by oxygen, and expelled with corresponding vigor.

4. The red corpuscles, after this operation, bathe in an oxygen-laden medium, and their hemoglobin becomes reconverted into oxyhemoglobin. Furthermore: 1. When the secretion of the adrenals reaches the pulmonary alveoli, it absorbs oxygen from the air and forms with the latter a compound, or "oxidizing substance."

2. A part of this oxidizing substance is absorbed by the hemoglobin of the corpuscles and the balance remains in the blood-plasma.

3. This oxidizing substance is the reagent to which the oxidation processes that occur in the blood-stream are due.,

BAYARD HOLMES' ADAGES IN THE TREATMENT OF SCALP WOUNDS.

1. Shave three inches about every scalp wound.

2.

Make every scalp wound into a large incised scalp wound, so that it may be explored with the finger.

3. Use no probe except the index finger.

4. Trim with the scissors the edges of a scalp wound; the razor and the brush are not effective.

5. Scrape out an old wound with a sharp spoon as a part of the mechanical removal of infection.

6. Sew up clean and bloodless scalp wounds without drainage, inserting the stitches half an inch or more from the edges of the wound, and tying on one side.

7. Remove the stitches at the end of 48 hours, being careful to cut the stitches near the skin so that none of the exposed and infected silk will be drawn through the scalp.