fluids which have been successfully used in such cases, by the writer as well as others, are the strong tincture of iodine; a strong solution of nitrate of silver, say one drachm of the salt to one ounce of distilled water, and the following: Acidi carbolici, gr. xxv; glycerin, 3ij; aquæ distillat, ziv. A number of other escharotic solutions will suggest themselves to practitioners generally.

I have successfully treated quite a number of cases of simple and superficial anal and rectal fistulæ, in which there existed one or more straight or slightly curved fistulous tracks, by means of probes of silver or copper, eight inches long, and of different sizes. the silver probe may be coated with the nitrate of silver, by dipping it several times in the fused salt and introducing the whole length to the tract; or the copper probe may be coated with the nitrate of copper by dipping it in nitric acid and introduced like the former. A choice can thus be had between the nitrate of silver and the nitrate of copper; I have had most success with the latter. The former was the suggestion of Sir Benjamin C. Brodie, and the latter of Mr. Evans, of London. When a silver and a copper probe are dipped in nitric acid and introduced together into a festulous passage, the caustic effect is greatly increased, and if suffered to remain in too long would destroy the tissues with which they were in contact. This is the effect of the Galvanic action set up by the contact of the copper and silver probes with the acid acting upon them.-Bodenhamer, Medical Record.

A CASE OF POISONING BY ANTIPYRINE.-Biggs reports a case of antipyrine. poisoning, interesting chiefly because of the prominence of the renal symptoms. A moderately robust middle-aged man, accustomed to use antipyrine for headache, took sixty grains in divided doses in thirty hours. This produced urine of rather high specific gravity, having the

dark, olive-green color of carbolic acid poisoning, with a small amount of albumen, many red blood corpuscles and numerous small hyaline casts. This continued with a scanty secretion for fortyeight hours, then gradually disappeared. No renal disease existed previously, and after the attack the urine became normal again.

In this relation the writer cites Eloy's conclusions that antipyrine should not be given in antipyretic doses to fever patients because of its interference with the action of the kidneys, and that it is contraindicated in acute febrile conditions associated with nephritis. Reported cases are cited of uræmia, retention of urine and fatty degeneration of the kidneys and liver following the use of antipyrine.-N. Y. Med. Jour.

THE ACTION OF YEAST.-According to Edward Boinet, yeast injected into the veins, subcutaneous tissue, or taken by the stomach in the rabbit, produces no inflammatory phenomena. Added to a culture of typhoid bacillus, yeast attenuates its virulence. The employment of yeast has given advantageous results in the treatment of typhoid fever, thrush and diphtheria.

Heer has used it with success in an epidemic of the latter disease. Internally it was administered in dessertspoonful doses every hour, and as a gargle one part to five of water. Its innocuousness and the attenuation that it exercises on a series of pathogenic microbes will warrant the multiplying of the therapeutic trials of yeast.-Bull. gen de Therap.

COMPOUND TINCTURE OF CINCHONA IN RHEUMATIC FEVER.-C. C. P. Clark reports three cases of rheumatic fever treated with Huxham's tincture of cinchona, in which the happiest results were obtained after other measures had failed. One of the cases was that of a

boy, 14 years of age; the other two were adults. All recovered entirely in less than a week.

The medicine was given in half-ounce doses every four hours. The author states that he has cured a dozen more patients with almost exclusively the same treatment; and further remarks that the locality of his practice is free from malaria. The effects observed in the disease referred to are attributable solely to the action of the cinchora tincture.-Thera. Gazette.

This fact seems to have been confirmed by clinical experience and actual experimentation. Ferguson, therefore, acting on the strength of such a fact, has subjected his epileptics to a strict vegetable diet, and has even dispensed with the use of drugs. This method has given, in his hands, excellent results, especially in well-marked cases of status epilipticus. In these cases a non-nitrogenous vegetable diet alone has rendered better service than the bromides, without restriction in diet.-Therap. Gazette.

THE PRELIMINARY TRAINING OF RAILWAY EMPLOYEES.-In view of the very large number of accidents, resulting either fatally, or in the maiming of the unfortunate ones for life, it is proposed to establish schools of training at favorable railway points. In the aggregate the number-2,000 killed, and 20,000 injured in 1890-of sufferers is great, and the utmost means of prevention should be taken. It is true that carelessness is responsible for a goodly proportion of the accidents, and it is this very factor which will be largely overcome by a proper drilling, and a due presentation of consequences. Jour. Amer. Med. Ass'n,

PREVENTION OF TYPHOID Fever.With reference to a circular recently issued by the Kentucky State Board of Health, in which attention is called to the increasing prevalence of typhoid fever, and the advice given to boil all suspected water before using it, or to guard against contamination by using properly stored cistern water, we point out the immunity from this disease enjoyed by the citizens of New Orleans. The people of New Orleans of course use cistern water, not from choice but from necessity. As typhoid fever is mainly disseminated by drinking water, we can feel confident that this horrible disease will never become a fruitful source of deaths here as long as we adhere to our

good and much-abused method of storing drinking water. It is not denied, however, that the water supply of New Orleans contains much organic matter and myriads of algae. Having made a virtue of necessity in using open drains instead of sewers, and thereby escaping from the dangers of sewer gases within doors, New Orleans has at last awakened to the idea that it is as good a city (for a large city) to live in as any in the Union, provided that the plainest laws of hygiene be observed.-Exchange.

EMMENAGOGUES AND PREGNANCY.Dr. L. Atthill finds that, in his own experience, some of the so-called emmenagogues are practically devoid of special action upon the uterus. For many years he has made a practice of administering ergot to patients threatened with abortion, hæmorrhage being present but uterine action not having been excited. He finds that it checks hæmorrhage without exciting undue uterine contraction, and accordingly he does not hesitate to give it to pregnant women if for any reason it seems to be indicated. He has often administered ergot before labor in cases where there is a predisposition to post partum hæmorrhage. In none of these cases has labor set in earlier than was expected, while in two or three cases it has been delayed. From personal experience he believes that iron, quinine and strychnine can be administered to pregnant women in ordinary doses with perfect safety.-Brit. Med. Journal.

THE WAY THEY DO AT VIENNA.Late correspondence rehearses the details of a sudden death upon the operating table-from the occurrence of an air thrombus, as was shown by the autopsy -following the operation for the removal of a goitre. It was at Billroth's public clinic, and the absence of measures which aid resuscitation was notable,

however impossible of success their application might have been. Yet it was the events following, more than the "shadows before," which are unique, as will be illustrated by the following quotation: "A most unpleasant impression was made on all the foreigners present by this tragic spectacle, and one could not but be struck by the unshaken coolness with which the surgeon, after the dead body of his patient had been carried out, proceeded immediately to perform a goitre extirpation on a second case- —this time with a happier result." -Pharm. Record.

INFLUENCE OF FOOD ON PHYSICAL CHARACTER. Dr. Oliver Wendell Holmes is quoted as offering the following sentiments regarding this topic:

Most assuredly I do believe that body and mind are influenced by the kind of food habitually depended upon. I am persuaded that a too exclusively porcine diet gives a bristly character to the beard and hair, which is borrowed from the animal whose tissues these stiffbearded compatriots of ours have too largely assimilated. I can never stray among the village people of our windy capes, without now and then coming upon a human being who looks as if he had been split, salted and dried, like the fish which has built up his arid organism. If the body is modified by the food which nourishes it, the mind and character very certainly will be modified by it also. We know enough of their close connection to be sure of that, without statistical observations to prove it. -Medical Age.

THE SURGICAL TREATMENT OF ACUTE INTESTINAL OBSTRUCTION.-J. Greig Smith, in a recent paper on this important subject, makes a plea for the early transfer of these cases to the surgeon. While the causes of obstruction are varied and numerous, clinically we need

simply consider the condition of the patient and his capacity to bear operation, and the special state of the intestinal tract and its power of self-recuperation. Frequently the typical operation must give way to modified procedure, and patients who are too collapsed to stand a grave operation may be first saved from death and then brought back to health by successive small operations. The cases thus met with are usually of three kinds:

(1.) Patients on whom an ideal operation can be performed. The obstruction is of short duration; there is vigorous and free vomiting; intestinal contractions may be seen through the parietes; abdominal distension is not sufficient to prevent deep respirations, these being 20 to the minute; the pulse is not over 110. While the expression is anxious, the features are not drawn and sunken, and the skin, although moist, is not cold and clammy. The abdomen is generally resonant, and intermittent gurgling can be heard, which is most marked at one point; there is little or no tenderness, and palpitation and rectal examination give negative results. An enema containing brandy is given, and the patient thoroughly anaesthetized. A two-inch incision is first made in the linea alba below the umbilicus. Through this the intestines are inspected and the coil selected that is most distended and congested. This is followed in the direction of increasing distension and congestion and will usually lead to the point of obstruction. The cause of the obstruction is then treated according to well understood principles, and, when removed, a rush of gas from the distended into the empty bowel takes place, and there remains nothing further to do but close the abdominal wound.

(2.) Patients who can bear a complete operation, but with certain precautions and additions. The obstruction has lasted for a week or more; vomiting is less vigorous and less frequent; the distension is greater but the walls are lax

and intestinal contractions are no longer visible; the face is drawn and pinched and the skin cold and clammy; the pulse is 120 or more, and small and wiry. Anesthesia is full of risk, not only increasing shock, but because it tends to induce vomiting. The stomach tube should hence first be used, and anæsthesia kept up no longer than is necessary. The cause of the obstruction is relieved as in the former class, but it should be remembered that as the intestines are distended with fluid the loop nearest the obstruction will sink down and not present at the opening. After the cause of obstruction is removed the intestinal contents do not move on as the over-distended bowel is paralyzed and cannot contract; besides the distended bowel is kinked at its numerous acute flexures. The contents must be evacuated thoroughly and the intestine enabled to contract. The anesthesia is stopped and the patient enveloped in warm blankets; a distended but inflamed loop of bowel is brought out and fastened to adhesive strips by two quill sutures on each side; an inch apart, Infection of the abdomen is prevented by smearing the junction of bowel and parietes with an antiseptic ointment. The outer coats of the intestines are incised and an aspirating needle pushed into the bowel. By patiently kneading for an hour or two the abdomen will become quite flat. The intestine is then closed, disinfected and replaced, and the sutures, previously inserted, and the abdominal wound tied.

(3.) Patients in a hopeless condition. Any severe operation and even the anæsthetic will kill. A small opening is made and the bowel attached by quill sutures, opened and thoroughly emptied as above.- Brit. Med. Jour.

TREATMENT OF ALOPECIA AREATA.With regard to the treatment, I rely mostly on blistering the early patches, painting on the liquor epispasticus in three coats, allowing each to dry before

the other is applied. At a later stage those parasiticides, which are also powerful stimulants, give the best results in my hands. It is true that such applications fit either theory, but they are none the worse for that. The loose hair round the patches should first be pulled out, and, when practicable, from half to one drachm of chrysarobin to the ounce of lanolin and oil, is one of the best applications; but owing to the erythema it is liable to excite, the indelible staining of linen and the discoloration of the hair, it can only be used in a small proportion of cases. A cleaner and universally applicable remedy, even for the face, if two to five grains of perchloride of mercury, one drachm of rectified spirit of wine, to seven drachms of oil of turpentine. The smaller proportion of perchloride of mercury should first be tried, and the strength increased as the patient can bear it. Of course it produces some burning and stinging of the skin, but this is inevitable in all really efficacious remedies. It should be rubbed in with the finger, not only on, but round the patch, night and morning. Internal medication is not of any use, except in the late stage when the disease is not spreading, but only the dormant vitality of the injured hair follicles requires awakening; then I think pilocarpine may be given with advantage, internally, in the proportion of one-sixth to a quarter of a grain at bed-time, and I find it acts most surely when given in solution.

Where circumstances permit, hypodermatic injection of pilocarpine is still more efficacious. One-tenth to onesixth of a grain may be given, It is not wise, however, to administer it except at the patient's house, as in some subjects it produces vomiting and faintness. Of course, if I find any defect in the patient's health, I endeavor to rectify it, but I do not think it exercises any influence on the course of the affection.

Let me, in conclusion, sum up what I have said in the following proposition.

At least four classes of cases are recognizable under the term "alopecia areata:" In the first are universal cases, usually of rapid development, and not necessarily in patches. In the second those with one or more patches in the course of a nerve, or on the site of an injury. In the third those with small atrophically depressed patches, which Neumann called "alopecia circumscripta." In the fourth those of the common type in patches or bands of irregular distribution, and with characteristic (!) hairs at the borders of spreading patches.

The first three classes are undoubtedly of tropho-neurotic origin, and the fourth is parasitic, and forms the largest proportion of the cases. With regard to the fourth class, the preceding facts show: 1. That this form is to a limited extent contagious, and that from time to time limited outbreaks have occurred in small communities. 2. That not only children, but adults who have been in contact with tinea tonsurans, sometimes develope bald patches indistinguishable from alopecia areata. 3. That in tinea tonsurans, commencing in the typical way, the typical crooked stumps may both spontaneously, and under treatment disappear, and the patches develope into an alopecia areata condition with (!) hairs. 4 4. That in those countries where tinea tonsurans is most common, alopecia arata is also most frequent. 5. Hence we must conclude that a large proportion of cases in adults which are termed alopecia areata are cases of bad tinea tonsurans, which is acknowledged to exist among children, and that the old authors, from Bateman onwards, were justified in calling it porrigo or tinea decalvans. 6. Finally, I believe that a parasite indistinguishable from the trichophyton tonsurans fungus may be demonstrated in recent cases, and the treatment most efficacious is inunction of powerful and stimulating parasiticides.- Crocker, Lancet.