The writer also gives the patient the elixir of gentian and chloride of iron, to be taken after meals. After a few days the patient can go to work, though suffering from severe tobacco heart. He has no trouble in giving up tobacco. In all cases the best plan is to stop the use of tobacco at once. Nine times out of ten the patient will not miss the tobacco after several days of abstention. The diet should be regulated, and any local trouble, such as nasal or post-nasal catarrh, dyspepsia and tobacco heart, should be treated with appropriate remedies. The following is one of the best tonics to give the patient: R Gold and sodium chloride, gr. 4; strychnine nitrate, gr. ; nitroglycerin, gr. ; atropine, gr. ; tr. digitalis, min.iii; oleoresin capsicum, min. 3. M. A tablet. Sig: One tablet four times a day four hours apart. The elixir of iron, quinine and strychnine, or the aloin, strychnine, belladonna and ipecac pill may be indicated in some cases. In all cases where the craving of tobacco proves troublesome, or where there are symptoms of nervous derangement, or where the will power is deficient, or where the heart is functionally deranged, or where the patient thinks he ought to take a nervine to help him quit the narcotic, give him the bromide of sodium, cactus, pulsatilla and passiflora, as already prescribed.—Alienist and Neurologist. Transplantation of a Strip of Skin into the Intermarginal Space of the Lids. Dr. H. Knapp: In severe cases of entropion and trichiasis, good results can be obtained by an implantation of skin into the intermarginal space of the lid. The steps of the operation are as follows: 1. Ordinary canthoplasty. 2. Incision of the intermarginal space, according to Jaesche-Arlt. 3. Curved incision of the skin to four mm. above the ciliary border; removal of a small strip of muscle along this incision. 4. Grooving of the tarsus according to Streatfield. 5. Passing sutures through the lower lip of the wound, the upper edge of the tarsus, and the skin of the upper lip. 6. Detaching from the upper lip of the wound, with a straight pair of scissors, a strip of skin two mm. broad and as long as the incision in the itermarginal space, and implanting it into the gaping and cleansed incision. Sutures may be used, but are not essential. 7. Tying these sutures, four or five in number. The threads may be cut short, or stretched and fastened to the skin above the brow by collodin (Panas) or strips of plaster (Born), if the free edge of the lid is not sufficiently everted. 8. Dressing with bichloride gauze, greased with a salve, or leaving the eye uncovered. 9. Cutting the sutures in from three to five days; cleansing the eye every day gently, so as not to disturb the implanted. flap, which in almost every case unites in its whole extent. This plan of operation is to be simplified or modified, according to the condition of the case.-Annales d'Oculistique. Mob Violence Against Sanitation. Violence, with murder, has been, it is believed, the indirect result of the efforts of Europeans to apply modern methods of sanitation against cholera in Asia. The riot took place at Jeddah, on the Red Sea, and the rioters are supposed to be Bedouins. In the course of the outbreak, the new cholera hospital was destroyed. It is highly probable that the outbreak was a kind of reaction, or protest, against the new sanitary regulations adopted at Jeddah to prevent the spread of cholera. Jeddah is a port on the Red Sea, about half way between Aden and Suez, sixty-five miles from Mecca, the birth place of Mohammed. The pilgrims to Mecca usually embark there, and at this season of the year there are often 100,000 of them in the city. These pilgrimages have often been the starting point of a rapid spread of the disease. The Paris Sanitary Conference arrived at the unanimous conclusion that a great source of danger was to be found in the filthy condition of the wells and water tanks around Mecca and along the shores of the Red Sea. These reservoirs are open to all pilgrims, and the tanks serve as bathing places, as well as for the supply of drinking water. The wells have been deepened and covered over, regular bathing places have been provided, and no one is allowed to bathe in the tanks from which the drinking water is supplied. The pilgrims, who had been accustomed to lower their filthy skin bottles into the wells, have this year had pure water measured out to them, and have not been allowed to draw for themselves. As the wells are accounted holy, some dissatisfaction was to be expected, and the late outbreak is doubtless due to it. The pilgrims regarded as an unwarrantable restriction of their liberty, the salutary regulations designed to save their lives and the lives of thousands to whom they might communicate the disease.-Jour. Amer. Med. Asso. Bilateral Dacryoadenitis of Tonsillar Origin. Dr. Panas (Semaine Medicale, 1895, No. 5, p. 37): The patient was a man 25 years old, and had an enormous symmetrical swelling of the lids, affecting more especially the external portion of the upper lid. This infectious condition was the result of a tonsillitis in the course of recovery. The tonsillitis had commenced on November 1 from a cold, while the first symptoms of ocular disturbance-lachrymation in both eyesmade its appearance November 25. On the next day, the 26th, the patient felt a slight smarting in the external angle of each eye, and twenty-four hours afterward his lids were red and swollen. Now, the patient has a swollen face, a pronounced coryza, and extensive ganglionic engorgement. In the external part of the upper lids is a slight projection, painful on pressure, hard, mobile, lobulated, irregular, and with its longest axis transverse. This feeling of glandular engorgement is very distinct on the left side, but is difficult to perceive on the right. On raising the lid the conjunctiva is seen to be slightly injected, and projects regularly into the external portion of the upper cul-de-sac, and under the bulbar conjunctiva are seen several ecchymoses. The lachrymal secretion is exaggerated and accompanied with muco-purulent secretion; the pre-auricular ganglion on each side is swollen; the movements of the eyes are somewhat painful and diminished in extent, without strabismus; there is no exophthalmus; vision is perfect in the right eye; the left eye has been amblyopic for a long time. The tonsils are also engorged, and covered with a purulent exudate, which is easily removed; the sub-maxillary gangliæ are swollen; there is also an abundant coryza, with muco-purulent discharge. The patient, in the last few days, has had repeated epistaxes. Bacteriological examination reveals the presence of a great number of virulent streptococci and a few staphylococci in the secretions from the throat and nose. There is, then, a lesion in both lachrymal glands, involving, as is shown by palpation, the cellular and lymphatic elements of this gland, converting it into a sort of oedematous paste. Dr. Panas lays particular stress on the multiple etiology of dacryoadenitis. He reviews cases of unilateral dacryoadenitis of palpebral origin due to direct infections arising from the conjunctival cul-de-sac, and places them in relation with the acute simultaneous, or almost simultaneous, inflammation of the two glands, causing an internal infection, appearing or existing with parotid inflammation. With mumps must be mentioned measles, influenza and urethral blennorrhoea. The chronic form of bilateral dacryoadenitis is gradually being distinguished from the symptomatology of oedematous tumors of the gland. It may follow the acute form, or develop in the course of a chronic infectious disease, such as tuberculosis, leucemia or syphilis.—Annales d'Oculistique. Evisceration of the Eyeball. Dr. L. Webster Fox (Philadelphia): Evisceration consists in excising the cornea and thoroughly removing the contents of the globe, and replacing them with a glass globe. In operating, the eye is thoroughly irrigated with an antiseptic lotion; the conjunctiva is dissected back to the equator. the muscles remaining intact; then the cornea is excised, and the contents of the globe removed with a scoop, great care being taken to remove the ciliary bodies, choroid, and head of the optic nerve; the cavity is then packed with cotton, which is removed after a few minutes, after which the scleral shell is again irrigated; the glass globe is then introduced by a specially devised instrument, the sclera split vertically, and drawn over the glass ball by sutures of catgut. When the operation is done under strict antiseptic precaution, very little or no reaction follows. The method being equally as safe as enucleation, it has the advantage of affording support for an artificial eye.-Annales d'Oculistique. VOL. XV-30 Memphis Medical Monthly Subscription Per Annum, One Dollar in Advance. The MONTHLY will be mailed on or about the first of the month. 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THE following digest of the proceedings of the recent meeting of the British Medical Association in regard to the antitoxin treatment of diphtheria is taken from the editorial columus of the British Medical Journal, and will, we believe, prove interesting to our readers: It was evident from the extraordinary interest that was taken in the work of the various Sections at the recent meeting of the association when antitoxins and antivenenes formed the subject of discussion, that all who have had extended experince of the use of these therapeutic agents, especially in connection with the treatment of diphtheria, have come to the conclusion that, from the clinical point of view at any rate, these substances possess considerable value. Although this has undoubtedly been the general experience, it is only on an occasion such as that afforded by the meetings of the association that comparisons of results, clinical and experimental, can be brought before, and discussed by, any large numbers of the profession. The Section of Medicine set an exceedingly good example in obtaining as the foundation of their discussion a most interesting experimental paper by Dr. Sydney Martin, whose previous work on the question was a sufficient guarantee that the subject would be ably and scientifically dealt with, and those who were present could not but be struck first of all by |