tion showed no plasmodii, but excess of leucocytes. Calomel in small doses and quinine were given internally.-St. Joseph B. Graham, M.D., of Savannah, Ga., in Virginia Medical SemiMonthly.

TREATMENT OF STRICTURES.-Howland (Medical News, April 9) writes on "Gradual Dilation Versus Cutting in the Treatment of Urethral Structures." He says: The best genito-urinary surgeons are now decrying the practice of using the knife at the first sign of a stricture of the urethra. This is good surgery and should be even more generally practiced. Dilation is always advisable and more often successful than surgeons generally believe. The length of period necessary to effect a cure depends largely on the patient and on the stricture, the length of time it has existed, and its location in the urethra, varying from three to twelve months. Many patients prefer the cutting operation to this long treatment, until they understand that with such operations the cure is not as permanent and sounds have to be passed at regular intervals. I have observed the best results from gradual dilation up to and not exceeding 32 French, and if a urethra thus treated can be maintained at a calibre of 28 or 26 French, it is all that will be required. The dilation should be conducted slowly and with great care, and an advancement of more than two sizes at one sitting not attempted. At the slightest sign of blood oozing the treatment must cease and the irritated membrane treated by instillation or irrigation with some astringent preparation. I have used plain water at 105 to 110 degrees F., one quart at a sitting, with encouraging results. Never allow a patient to pass sounds upon himself. The writer does not believe that all strictures can be cured by gradual dilation, but he does believe that a great number can be.American Medical Compend.

THE POSSIBILITIES OF ANTITOXIN.-A statement was made by one of the speakers at the recent Sanitary Convention in Detroit that the use of antitoxine has established an expectancy of from 13-14 per cent. as a death rate in diphtheria instead of

the old time rate of 30 per cent. and over without its use. This statement calls for a criticism from Dr. George Suttie, who in the Louisville Medical Monthly of recent date recites his experience in the Contagious Department of Harper Hospital, of Detroit, where he has watched its administration from the beginning. In the early months a serum of foreign make was used, 44 cases being treated with a majority of 4. Afterward the American product, manufactured by Parke, Davis & Co., was used and proved more satisfactory than the former. With this 24 cases were treated, 4 requiring tracheotomy, with a mortality of only 1. After this free distribution of antitoxine was made by the Board of Health to those who were not able to pay for it, and to the various hospitals where patients were sent by the Board of Health. The number of patients treated for the year ending February, 1897, were 374 with antitoxin, the death rate being 12.56 per cent.; and 467 without antitoxin, the death rate being 34.90 per cent. From March 1st to December, 1897 there were treated with antitoxin 305 cases, with 32 deaths; and 632 cases without antitoxin with 192 deaths, representing 10.49 and 30.39 per cent, respectively. The Board of Health used the preparation of Messrs. Parke, Davis & Co., entirely. Continued experience goes to show that with the advantage of the early use of antitoxin being recognized both by the public and the profession there is a steady improvement in the results obtained.North Carolina Medical Journal.

COLD SPONGING VERSUS COLD BATH.-Dr. H. A. Hare (Therapeutic Gazette, March 15th) affirms that he has used cold sponging in his hospital practice and rarely the bath, with the most satisfactory results. He suggests the following rules of treatment: 1. In early typhoid, with constipation or moderate diarrhoea, gave a full dose of calomel in divided doses, in order to stimulate the liver and antisepticise the bowel with bile. 2. Control the fever when it reaches 102° F. by sponging. The patient being stripped and laid on a rubber sheet or blanket over a sheet, he is to be sponged with water adapted in its temperature to his needs, and it is to be remembered that the rapid application of a low temperature is more refreshing than the prolonged

application of a higher temperature (Baruch). The chief advantage of the cold sponge lies in the shock and reaction. This is better obtained by the use of ice sponging than by the bath. The patient's surface is always red in ice sponging, often blue in the bath, and that the fever is not the chief danger in the case renders the fact that as great a reduction from the sponge is not reached as from the bath of little importance except in hyperpyrexia. Shattuck tells us that he has found no marked or constant difference in the antipyretic value of cold sponging at 60° F. for twenty minutes, the cold pack at 60 F. for sixty minutes, or the cold bath at 70° F. for ten or fifteen minutes. Finally, if this does not bring the temperature down to 100.5° or 101° F. in twenty minutes, resort should be had to the tub. It is essential when the sponging is used that more water be applied to the back than to the trunk of the body, for at the back the great muscles and thick skin retain the heat as a reservoir, and are not cooled if only the front of the body is sponged. Further, the posterior surfaces are the ones apt to be congested and sore, from the dorsal decubitus, and therefore need the stimulating effect of the bath, as do the kidneys and other deeply situated organs. That this treatment is of value is shown by the marked redness of the skin, the improvement of the circulation and respiration, and the cleared mind. 3. It is advisable not only to use friction in a light form, but to use mod. erately active massage, with the same objects in view as when the rest cure is undertaken, for the proper treatment of typhoid is a modified rest cure. The writer is firmly convinced that by this means bedsores, local congestions and effusions, cedematous swellings, peripheral nerve pains, and muscular feebleness will be largely decreased, and Pospischl has shown that mechanical irritation of the skin is capable of increasing heat loss ninety-five per cent. 4. In nearly all cases give more nourishment than the average typhoid patient in the past has usually had. With the exception of broths and meats, almost any article easy of digestion should be allowed-as one or two or more lightly boiled eggs, corn starch, arrowroot, etc. 5. Use stimulants in carefully graduated doses whenever the circulation needs them, particularly alcohol. Even the cold-bath enthusiasts give whisky to overcome the depression they often produce.-Medical Record.

COCA ERYTHROXYLON.- We need not enter into a full description of the history of the Erythroxylon Coca, as we believe that most medical men are fully acquainted with the principal facts concerning the plant. We may, however, recall to mind that the leaf is the only part of the plant used. Very much depends, therefore, upon the plucking of the leaf, and the time at which it is plucked; the subsequent care of the leaf being matter of considerable importance, and affecting very materially the preparations made from it. M. Mariani was the first in Europe who took up the study of the plant, and over thirty years ago commenced manufacturing for the medical profession the various specialties associated with his name, viz., Vin Mariani," "Elixir Mariani, "Pate Mariani," "The Mariani," "Pastilles Mariani," etc., preparations which are known all over the world, and which have acquired their well-known reputation by their purity and efficacy. The stimulating and strengthening property of the leaf in its natural state has been tested by experienced travelers and botanists during several centuries, and it is this invigorating property which the physician wishes to bring into. use, and which he is enabled to do in a palatable form by means of "Vin Mariani," this wine being indicated where there is great depression, long continued exhaustion, and where a special stimulative action is desired. "Vin Mariani" is agreeable, palatable, imparting by its diffusibility an agreeable warmth over the whole body, and exciting functional activity of the cerebro-spinal nerve centres. We have frequently prescribed this wine, and we can, from practical experience, recommend it. -The Provincial Medical Journal, London, Eng.

GOLDEN RULES.-The following suggestions in abdominal surgery are said to have come from a celebrated London surgeon: Always avoid purgatives in treating a patient who has swallowed a foreign body. Give opium and constipating food-boiled eggs, cheese, puddings, potatoes, etc. Never close any wound of the abdominal wall till all hemorrhage bas ceased. Never, under any circumstances, apply pressure to a wound of the abdominal wall to arrest hemorrhage. Never mind increasing a superficial wound of the abdomen in order to remove a foreign

body or to secure a bleeding point. Never probe any wound in the abdominal wall. Never forget that all abcesses of the abdominal wall should be opened freely and at once. Never hesitate or delay to open and drain an abscess in the loin due to rupture or injury to the kidney. Never procrastinate in strangulated hernia. It is not usually the operation which will prove unsuccessful in herniotomy; the danger lies in your allowing the bowel to become irrecoverable. Never be deceived by an opiate masking the acute symptoms of hernia, obstruction, peritonitis. Never tap a suspected renal tumor through the peritoneum. Always relax the adominal wall after suturing. Never ligate en masse in cutting off omentum; do it piecemeal; the constricted edge of the apron of omentum may unravel, and fatal hemorrhage result. In protrusion of the viscera never neglect to pass your finger fairly through the wound to make sure that the reduction has been complete. And be careful never to push the bowel into an interstice between the muscle or into subperitoneal tissue.-Medical Record.

GASTRIC ULCER.-In the Medical Brief Dr. William Murrell, of London, Eng., says: "We all know that when an ulcer of the leg is indolent, and refuses to heal, the best plan is to touch it up with lunar caustic or sulphate of copper. This mode of treatment is, with certain modifications, equally applicable to an ulcer of the stomach. What I do is to paint it with iodine. There is not the slightest difficulty; I order the patient five drops of iodine (U. S. P.) three times a day, in a wineglass of water. It produces no pain and no inconvenience, and the condition of the mucous membrane of the stomach rapidly improves, until in a few days the ulcer is completely healed and the digestive powers are restored to their pristine condition. I have done this over and over again, and I have never known iodism or any inconvenience result from the treatment. In the early stages it will often effect a cure without limitation of diet or confinement to bed. Should the patient object to the pungency of the tincture of iodine I add half a drachm of glycerin to each dose. This I believe to be the best plan of curing gastric ulcer," Medical Belletin,