An examination of the buccal mucous membrane on both sides of the teeth shows that considerable ulceration has taken place, and on the right side there is a large ulcer almost as big as a quarter of a dollar, which is so broad and deep that the induration underlying it extends to the skin of the cheek, so that the cheek of the child feels as if a large foreign body had been introduced into it. As a result, palpation reveals a great deal of brawniness of the skin, and this makes us fear that should the ulceration persist a perforating ulcer of the cheek may develop, and the child may suffer from what is known as noma, which is an exceedingly grave condition, rarely, if ever, seen except in children suffering from profound impairment of nutrition, and which is nearly always fatal, both because of the severity of the lesion itself and because the general condition of the child is so bad that it can not withstand the severe suppuration of the ulcerative process. You will also notice that on the margins of the tongue, and that on the gums around the teeth and on lower lip on its inner surface, are to be found a number of small ulcers which are quite deep and surrounded by an indurated area; and also there is a considerable flow of saliva from the mouth, which is produced by the irritation. We have before us, therefore, a case of severe ulcerative stomatitis, which will require active interference in the way of local treatment. At the same time, the greatest possible care is needed in the treatment of the child's general system.

You will meet with many cases of simple catarrhal stomatitis in practice, but unless you are connected with some institution to which many children in a depraved state of health are admitted you will rarely see such a case as this. The child, like many other children who have been forced to depend upon themselves to a large extent, is older than one would expect from a statement of her years, and I feel convinced that she is sufficiently intelligent to be able to use a mouth-wash. I have, therefore, given her a prescription which contains:

This is to be diluted one half with water, and used as a mouth-wash. If on examination of her urine we find that it is normal, and that the kidneys are not irritated, I shall direct that half a dram of this mixture shall be given to the child internally every six hours, since the chlorate of potassium is eliminated by the salivary glands, and will continually bathe the inflamed mucous membrane.

Some of these ulcers may also be advantageously affected by touching them with a solid stick of nitrate of silver, and the pain of this application may, to a large extent, be decreased by applying cocaine beforehand. Care must be taken that much cocaine is not employed, since if it is swallowed or absorbed it may produce disagreeable symptoms; and, furthermore, by dilation of the capillaries in the healthy mucous membrane, may disturb the local nutrition of the mucous membrane of the mouth.-Dr. H. A. Hare in Medical News.

THE AMERICAN PRACTITIONER AND NEWS

Vol. 29.

"NEC TENUI PENNÂ.”

FEBRUARY 1, 1900.

H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors.

No. 3.

A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid.

This Journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors.

Books for reviews, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER and NEWS, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky.

BUBONIC PLAGUE.

The bubonic plague was brought into New York harbor on November 18, 1899, by the steamship J. W. Taylor, which sailed direct from Santos, Brazil, to New York.

When it is remembered that this is one of the most fatal diseases with which mankind can be afflicted, the mortality being more than 98 per cent in some instances, it would seem useless to call the attention of the profession to the necessity of using every effort to prevent its ingress into this country. No greater calamity could befall America than to have her larger cities invaded by this terrible disease. The intercourse between our great commercial centers is so frequent and the transit so rapid that it would be well-nigh impossible to prevent its spread. Our great hope lies in our ability to prevent its admission into this country. The precautions taken by the United States Government through its Marine Hospital service have unquestionably been the means, so far, of keeping it restricted to the degree it now holds.

Every sanitary officer in the United States should be an active, energetic man; no "old fogies" should be permitted to hold offices of trust in times like these.

THE Hospital College of Medicine and the Kentucky School of Medicine have unusually large classes this session.

THE University of Louisville and the Louisville Medical College will have larger graduating classes this year than last.

Notes and Queries.

UROTROPIN IN CHRONIC INFLAMMATION OF THE SEMINAL VESICLES.— Dr. J. M. Thompson (Boston Medical and Surgical Journal, November 16th) says that thus far in his experience urotropin has had the most noticeable and salutary effect in this affection. As a rule, when first seen these patients call one's attention to the urine, which is nearly always abnormal in color, high in specific gravity, and more or less turbid. A deranged nervous system is not uncommon, while the neurotic element frequently betrays itself. Such patients, too, are likely to suffer from either periodical or persistent phosphaturia, which urotropin dissipates as if by magic. The turbidity so common in these cases, whether due to the path, ological deposit which escapes backward from the vesicles or to involvement of the prostate (what is known as "prostatorrhea "), to a catarrhal condition of the deep urethra or to the presence of bacteria, disappears after the administration of urotropin.

It is not uncommon to find among those who have suffered from the pangs and discomforts which only the gonococcus causes that after all symptoms have ceased for a time the discharge returns copious and freeyet unaccompanied by the other symptoms characteristic of the first stage. Naturally such patients are likely to be extremely debilitated and nervous; their urine is either neutral or alkaline. Upon questioning them, one will discover that the treatment which they have followed included the daily use of an antacid, like sodium bicarbonate, which for the first few days contributes to the patient's relief, but when continued beyond the acute stage, or rather beyond the time when such treatment is indicated, by prolonging an abnormal (alkaline) reaction of the urine keeps such normal constituents as phosphates, carbonates, etc., in a state of precipitation, a condition that must in time act as a mechanical irritant to the urethral mucous membrane and provoke what may be termed a "phosphatic urethritis." If urotropin is ordered in seven and a half grain doses morning and evening a most happy effect will be noticed in about forty-eight hours, and, unlike the effect produced by a mineral acid, of a permanent character.

Recently the author tried urotropin in two cases, the patients aged sixtyfour and fifty-seven respectively, with enlarged prostate. Both had been

obliged to use a catheter for years, except at times when the symptoms abated sufficiently to enable them to void their urine naturally. At such times as the catheter was not a necessity the urine appeared normal, beyond the presence of small flocculi and common-shaped shreds; whenever the catheter was likely to be employed the urine took on a murky, cystitic look, and soon became alkaline and foul smelling. The usual subjective symptoms returned and life became a real burden. Both patients were under observation at this stage, when it was expected that the catheter might be required at any moment. In order to test the virtues of urotropin, each patient was put on seven and a half grains of the drug three times a day. The effect was most gratifying, for the urine cleared up rapidly, and the subjective symptoms disappeared gradually. The urine still remains in a satisfactory condition, and both patients report that urotropin has enabled them to enjoy the longest period of happiness that has fallen to their lot for years.

THE RELATION OF LEUCOCYTOSIS TO APPENDICULAR INFLAMMATION.Dr. Maurice Richardson (American Journal of the Medical Sciences, December) in a general paper on appendicitis says that from a hundred cases of appendicitis at the Massachusetts General Hospital Dr. R. B. Greenough has drawn the following conclusions in regard to the relation of leucocytosis to appendicitis. The paper is to be published later by Dr. Greenough: 1. Leucocytosis may be considered to be a fairly constant symptom of appendicitis. 2. The presence or absence of leucocytosis, or the degree of leucocytosis, without other data, is not sufficient to determine the local condition of the appendix and its surroundings. 3. In a series of cases the degree of leucocytosis corresponds roughly with the degree of temperature, but in individual cases great variations are found. 4. The degree of leucocytosis, when considered in connection with the duration of the attack, is of considerable assistance in the diagnosis of the local condition. 5. A high leucocytosis (above twenty thousand) on the first or second day of disease suggests general peritonitis. 6. A low blood count (below ten thousand) after the first week, if accompanied by severe symptoms, indicates general peritonitis, and is of grave prognostic significance; but if accompanied by mild symptoms, denotes a mild catarrhal process or well walledoff abscess which has become subacute in character. 7. A high leucocytosis (above twenty thousand) after the first week or ten days may be taken to indicate a local abscess.--New York Medical Journal.

EUPHTHALMINE: A NEW MYDRIATIC. Lyon Medical for November 26th attributes the following to Dr. Grandclement: A few drops of a collyrium containing three grains and three quarters of euphthalmine to one hundred and fifty grains of distilled water dilate the pupil at the end of from ten to twelve minutes, while accommodation is only disturbed for about an hour subsequently.

ENDOCARDITIS AND BACILLus Influenza.-Mabel F. Austin, in a preliminary report (Johns Hopkins Hospital Bulletin, October, 1899), amplifies our knowledge of the relationship existing between influenza and endocarditis. The occurrence of endocarditis during an attack of influenza as a clinical fact has been known for some time, but the presence of the microorganism, though demonstrated for other tissues of the body, has not before been reported in the endocardium. In this contribution an organism closely agreeing in its morphological features to the bacillus influenza is described as having been isolated from three fatal cases of influenza. Unfortunately, the investigator was unable to cultivate the bacillus, and hence the absolute proof of casual relationship is not obtained.-Medical News.

Methylene-blue as a HypnOTIC.-Vallon and Wahl (Le Progrès Medical, October 21, 1899) have tested the hypnotic properties of methyleneblue by administering it to six insane patients. The result in one instance was very satisfactory. No special results followed its administration to four patients, while the delirium of one patient was rendered much worse by it, the color of the urine which he passed leading him to suppose that he had been poisoned, and giving him other ideas of persecution. After such a brief test, however, the authors hesitate to deny the claims which have been made that methylene-blue is a hypnotic in the insomnia of insanity. The medicine was given in capsules containing about four grains.--Ibid.

ANNUAL REPORT OF BOARD OF MANAGERS OF CRAIG COLONY.-The annual report of the Board of Managers of the Craig Colony for Epileptics, of which Dr. Frederick Peterson, of New York City, is the President, has been submitted to the State Board of Charities. Since its opening, in the early part of 1896, 504 epileptics have been received, of whom 378 remain. When the new buildings now in course of construction are completed the capacity of the colony will be increased to a total of 720 beds. During the past year 95 new cases were admitted, 40 males and 55 females, and 35 were discharged. The death-rate for the year has been less than two per cent, and is the lowest in the history of the institution.-Boston Medical and Surgical Journal.

THE DUM DUM BULLET.-Prof. Bruns, at the German Congress, described these projectiles. He said that they were originally coated with nickel, but as it was found that the enemy's soldiers when wounded were not invariably disabled, the nickel coating was filed away from the top of the bullet. In fact, the nickel covering enabled the bullet to pass through the body, making only a relatively small wound, but when this covering was removed from the top the lead was flattened out as soon as it struck the body, by which flattening the remainder of the covering was burst open in an explosion-like way, inflicting wounds of an astonishingly severe character.