being attached to the last, although many kinds in the market contain quantities of starch varying in amount from 30 to 40 per cent, and yet potatoes contain only 15 per cent, and Jerusalem artichokes 16 per cent. Fruit, which is so valuable an addition to a diabetic dietary, is usually totally excluded, although apples and sour oranges contain not more than about 10 per cent of carbohydrate, while rhubarb, green gooseberries, cranberries, bilberries, and currants range under 4 per cent. In a recent paper by Dr. F. Kraus, jr., of Karlsbad, he has shown that cooking still further deprives many fruits and vegetables of their carbohydrate components. A raw apple containing 11.7 per cent of carbohydrate after once stewing contained 7.3 per cent; after twice, 6.1 per cent; peaches contained 9.5 per cent before cooking, and 1.8 per cent after. He recommends that the water in which the fruit is stewed should be thrown away and a little flavoring added, such as cinnamon, cloves, or vanilla, as well as saccharin. In this way really palatable preserves are in Germany made for the use of diabetics, containing very little carbohydrate.

Vegetables may be made to take up a large amount of fat so as to form a very valuable addition to the diet, without becoming disagreeably greasy, as in salad (oil), or puree (butter), or by frying them in oil or fat. Dr. Kraus illustrates the futility of trusting to the general run of commercial articles sold as diabetic bread by a table showing the carbohydrate contents of most of those used in Germany. Of the nineteen specimens enumerated, only five contain less than 30 per cent of carbohydrate, four are between 30 and 40 per cent, four between 40 and 50 per cent, two between 50 and 60 per per cent, and four over 60 per cent, as against ordinary white wheaten bread, which contains 60 per cent. He quotes a case mentioned by Professor von Noorden, which was sent to him as a severe case of diabetes because on the strictest diet the sugar had gone up. This "strictest diet" consisted of meat soup, coffee, tea, eggs, meat, green vegetables, bacon, butter, and "conglutin bread," of which last 300 grams were taken daily. This conglutin bread contained thirty-eight per cent of starch, and was equal to 200 grams of white bread. On proper diet the sugar disappeared in two days, and the case proved to be really a mild one. We could produce parallel examples of English diabetic bread and flour in every respect as bad as those made in Germany. It is not uncommon in England to meet with patients who are on what they believe to be strict diet; if they are asked whether they eat bread, they promptly answer, "No, only toast," of which they take as much as they please. It is extraordinary that any virtue can be supposed to exist in toast, but it is a not uncommon delusion, as all consultants must be aware. Only a few weeks ago a letter was sent to the British Medical Journal by a correspondent who wished to impart his experience of what he called "strict diabetic diet" of this kind. Toast is useful for diabetics who can assimilate bread in any form, because it can be weighed accurately, and because it is less tempting to the appetite than fresh bread, but, unless it is burnt to carbon, it must contain as much carbohydrate.

Milk contains only four or five per cent of milk sugar, and in limited quantities of half a pint to half a liter can generally be taken with safety, but a diabetic milk may be made by previously diluting the milk and then passing it through a separator so as to get nearly all the fat, and half or less than half of the other solids in one portion. It can then be sterilized and sold in bottles. It would diminish the objection felt by many to this very valuable article of diet if such diabetic milk were prepared for sale in this country.

To sum up the lesson we desire to teach: (1) It is much better to allow a definite quantity-for example, two to four ounces of potato or toast, than to allow an unlimited amount of "diabetic bread" of unknown composition; (2) in many cases such definite quantities of natural foods are safer than even limited amounts of the less palatable and more expensive specially prepared articles; (3) when it is desired to place a patient upon strict diet, care should be exercised to see that he obtains his bread substitutes from a really trustworthy maker; (4) lastly, many fruits, especially if well cooked, may be added to the diabetic dietary.-British Medical Journal.

BELLADONNA POISONING SIMULATING PUERPERAL INSANITY.-Mrs. G., 26 years old, was delivered last January of an anacephalous male child. Labor was short and natural. Two days after, to prevent the secretion of milk with the consequent painful distension of the breasts, a belladonna plaster was applied to each gland in addition to the usual bandage compression. The nipples were not covered by the plasters. In about twelve hours I was hurriedly called to my patient, and found her condition as follows: Flushed face, pulse 100 and good; temperature 100.5° and quite actively delirious. She sang, whistled, laughed, cried, and made futile attempts to get out of bed and house. Finding no appreciable cause for the combined disturbance of body and mind, puerperal insanity suggested itself as the most probable diagnosis.

The second visit was made sixteen hours after the first; the woman's condition was found to be much worse, namely: Her delirium was intensely maniacal in spite of the fact that she received large and frequent doses of chloral and bromid. However, at this visit new features were added to the old clinical picture which at once removed the diagnosis of insanity and established one of belladonna poisoning. The patient's lips, tongue, mouth, and throat were dry, the pupils fully dilated, and the secretion, as urine, was almost totally suppressed.

The belladonna plasters were quickly removed and the breasts washed with soap and water. The breasts were examined for a scratch or an abrasion which could serve as an avenue for absorption, but as none was found, the drug evidently found its way into the system through the unbroken skin.

All the symptoms disappeared within ten hours of the removal of the cause excepting the pupillary dilatation, which lasted thirty-six hours.

It may be interesting to add that the very same condition was produced in the same patient four days later by the application of one plaster only, and the removal of which resulted in the removal of the trouble.

The points of interest in this report appear to be these: (1) The remarkable suspectibility of this woman to the influence of belladonna. (2) The minimum amount of the drug which produced the symptoms of poisoning. (3) The possibility of mistaking that condition for acute insanity when it occurred in the puerperium. (4) The caution to be observed in prescribing belladonna plaster or ointment—an old warning, but one that can bear repetition. Journal American Medical Association.

THE PREVENTION OF TUBERCULOSIS.-We are glad to see that the Daily Telegraph is lending its powerful support to the movement recently started by Sir Wm. Broadbent, Mr. Malcolm Morris, and a considerable number of leading members of the medical profession in London to take steps to check the continued prevalence of tuberculous disease in this country. The question is eminently one upon which an enlightened public opinion ought to be formed. The public mind must be aroused to the fact that consumption and other forms of tubercle are preventable diseases. "If preventable, why not prevented?" as the Prince of Wales said on a memorable occasion. We understand that His Royal Highness has already shown a warm interest in the movement, and has promised to preside over a public meeting which will be held after the autumn holidays, probably early in October. At this meeting the formation of an Association for the Prevention of Tuberculosis on lines similar to those of the associations which are doing such good work in France and Belgium will be proposed, and other means will be concerted for placing sufferers from pulmonary consumption in its early stages under the most favorable conditions for recovery.-British Medical Journal.

TARDY ABSCESS OF THE LIVER FOLLOWING DYSENTERY IN A TEMPERATE CLIMATE.-At the Fourth French Congress of Internal Medicine (Gazette hebdomadaire de medecine et de chirurgie, April 24) Boinet, of Marseilles, reported four new cases in which, within a few months or a year after a mild attack of dysentery, a large abscess had formed in the liver. In such abscesses occurring in temperate regions, he says, adhesions are exceptional, although they are frequent in the tropics.-New York Medical Journal.

ATHEROMATA ON THE FLEXOR TENDONS OF THE FINGERS.-Trnka, of Prague (Centralblatt fur Chirurgie, 1898, No. 6; Wiener klinische Wochenschrift, May 12th), reports that he has observed six cases in which globular atheromata as large as a hazelnut and of cartilaginous hardness were situated between the skin and the flexor tendons of the fingers. Although firmly attached to the sheath of a tendon, they could always be smoothly dissected away without injury to the sheath.-Ibid.

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THE MORPHINE HABIT AND ITS TREATMENT BY BROMIDES.

The increase in the number of opium habitues from year to year is a menace to the body politic, and must soon become appalling if the medical profession can not devise some effective method of holding it in check. So far all drugs which have been used against it have proved vain; the "cure," if effected at all, being the result of gentle restraint, and moral suasion on the part of the physician, and the exercise of extraordinary will-power on the part of the patient. This and nothing more is what is done in the numberless sanitariums for the relief of drug addiction, and we fear that time will add no new resource to the measures in vogue.

The results are too well known to call for statement, and are melancholy indeed. The victim of the insane appetite returns to common life, and, being set free from the healthful restraint of the sanitarium, is too weak to withstand temptation, and, like the "dog" and the "sow" of the Scripture, turns again to the "vomit" and the "wallowing in the mire."

Now, if the unfortunate could be put and kept for a season upon a drug not itself enslaving until the cravings for opium had died out of his system, the problem of the cure of opium addiction might be solved to the relief of a multitude of helpless and hopeless wretches, and the unburdening of society of a load that may become insupportable. If

the problem is ever solved, it must be worked out upon some such line as the following interesting case-report suggests. Dr. C. H. Humphreys, of Dayton, Ohio, writes thus in the New York Medical Record, 24th ult.:

I was asked recently to see a physician who had unfortunately acquired the morphine habit, and who, after many ineffectual efforts to stop the use of the drug by "tapering off," saw an account by Dr. MacLeod, in the British Medical Journal, of the cure of the morphine habit by bromism, and determined to give it a trial. He had taken about three ounces of the salt when his family grew alarmed at the mental disturbances produced, and requested me to see him. I found him deeply under the influence of the bromide, and, learning the true state of affairs, had him removed to the hospital, the better to conduct the treatment. Not being satisfied with his statement that he had been taking on an average twelve grains of morphine a day, I cut the injection down to half a grain three or four times a day, and then gradually reduced it to one fourth of a grain twice daily, until on the fifteenth day of his hospital treatment he, of his own accord, refused further injections of the morphine, although it entailed considerable suffering. The cessation of the drug was followed by the usual digestive and nervous disturbances for several days. At the end of the third week the patient returned to his practice, freed from all desire for morphine, he firmly declares.

As a result of the bromism and the withdrawal of the morphine there were great muscular relaxation and general lassitude, which were relieved by hypodermic injections of strychnine.

The patient is of the opinion that the morphine should have been entirely withdrawn while he was under the full effect of the bromide, as the continuance of it, even in small doses, after the effect of the bromide had passed off, only fed the old flame and in a measure converted the treatment into the gradual-withdrawal plan, with its attendant suffering.