flow through the needle. There are no means of determining with certainty the presence or absence of adhesions in a given case; pain, tenderness and oedema over the seat of the liver suggest the presence of adhesions, but are by no means certain proof of their existence. Even the up-and-down movement during respiration of a needle inserted into the liver is not a conclusive proof that adhesions do not exist. Of the symptoms and signs of hepatic abscess, pain, tenderness and swelling in the hepatic region are by far the most important. Fever is present in a large proportion of cases, is intermittent in character, and except in pyæmic cases rarely rises above 102.5° or 103°. Jaundice and ascites nearly always denote the presence of dense adhesions or gall-stones. Dyspnoea and cough are frequently present. It is doubtful whether absorption of the contents of an hepatic abscess ever occurs; bursting is of frequent occurrence, the most usual direction being into a bronchus or the pleural cavity. Under expectant treatment death occurs in a large proportion of cases before bursting. With respect to treatment, free incision and drainage give far better results than any other mode. The results of aspiration are rarely satisfactory, nor is aspiration itself entirely free from danger.

GASTROSTOMY.-Dr. N. Senn, in a paper read before the British Medical Association, concludes: Gastrostomy is indicated in all cases of cicatricial and malignant stenosis of the esophagus and cardiac orifice of the stomach as soon as a sufficient quantity of food cannot be introduced into the stomach by simpler measures per viam naturalis. Gastrostomy for malignant obstruction on the proximal side of the stomach, if performed at a time when the patient is sufficiently strong to survive the immediate effects of the operation, is a comparatively safe procedure, and adds from a few weeks to six or eight months to the patient's life. In treatment of impermeable cicatricial stenosis of the esophagus gastrostomy not only furnishes a new inlet for the introduction of food into the stomach, and thus prevents death from starvation, but it often proves a curative measure in such cases, as the gastric fistula can be utilized for another purpose successful retrograde dilatation of the stricture. The upper central part of the left rectus and the eighth intercostal space between the cartilages of the ribs are the most desirable points for the formation of the gastric fistula. If the patient's strength warrants it, the operation should be done a deux temps, as it is safer

to postpone opening the stomach until firm adhesions have been formed between stomach and the circumference of the external incision, than to establish the gastric fistula at once. Fixation of the projecting cone of the anterior wall of the stomach in the abdominal wound is best secured by two long needles passed through the serous and mucous coats only, and suturing of the surface to the circumference of the wound. Leakage from the fistula can be prevented most effectually by making the opening in the stomach small, by the use of an inflatable double rubber bulb through which the feeding tube reaches the stomach, or by making an oblique tunnel in the anterior wall of the stomach as devised and practiced with success by Witzel. Solid food should first be subjected to thorough mastication and insalivation, when it is transferred by the patient from the mouth to a small funnel connected with the distal end of the feeding tube, from where, by blowing it through the tube, or, finally, it is aspirated into the stomach by the patient's sudden expiratory efforts. Mastication of food, as a preliminary step to introduction into the stomach, satisfies, at least in part, the sense of hunger, not always accomplished by liberal exclusive gastric feeding through fistula.

It

UTERUS TAKEN FOR A LYMPHATIC GLAND. -Dr. Poole removed ("New York Med. Jour.") a uterus from a child of 12 years, who had been admitted to the hospital on December 15, 1889, having then an oblong swelling over the left external abdominal ring. It had not been painful and had given the patient no inconvenience. had been diagnosticated as an enlarged lymphatic gland. January 13, 1892, the child had been etherized and the tumor cut down upon. There had been found a white, glistening tumor, firmly attached by its pedicle to the inguinal canal and the external ring, which had subsequently been recognized as the uterus and its appendages. The entire uterus, with the tubes and the broad ligaments, had been entirely without the external ring. The tubes and the ligaments had not been developed. The tumor had been tied off close to the external ring, and the wound closed. Vaginal examination had shown the vagina to end in a cul-de-sac about an inch behind the hymen. The patient was discharged recovered February 14, 1892.

TRANSPLANTATION OF AN EYELID.-The following case is reported by Douthwaite ("N. Y. Med. Jour."): A Corean official had lost part of the lower eyelid, and prevailed upon a slave for a consideration, to furnish his own eye

lid for transplantation. Both men were chloroformed and the margin of the official's eyelid was prepared first by scraping and then making a deep slit along its whole length. The lower lid of the slave was then seized and its margin slit off in a wedge-like piece, which was quickly inserted into the slit prepared for it in the other eyelid and adjusted by means of fine sutures. It was then washed with a 1-to-1,000 bichloride solution and a pad of antiseptic lint was applied. On the second day the circulation was fully established in the transplanted tissue and the eyelid looked natural. On the third day everything was doing as well as could be desired, but that night, while half asleep, his eye feeling somewhat uncomfortable, the patient gave it a vigorous rubbing with his hand, which completely ruined the work that had been done. Douthwaite believes that with the observation of greater care the operation would probably have proved successful.

OPERATIONS ON THE NOSE.-Dr. Clarence

C. Rice concludes ("Post-Graduate") the only way to become skillful with instruments of examination and expert in diagnosis is to personally examine the upper respiratory tract of as many patients as possible. Cases for operation on the nose should be selected only after careful deliberation, and the relation in size between the obstruction and the total capacity of the nostril should be considered. When in doubt about the necessity for operation, try for a time treatment by topical application. There are many cases of so-called "hypertrophic rhinitis" where the apparent hypertrophies are nothing more than erectile tissues distended by blood or serum, and many of these do not require the application of any destructive agent. The effect of a weak solution of cocaine upon these will aid in their diagnosis. We do not find advanced hypertrophic changes in young people. The soft tissues are usually nearly normal, so it is not wise to injure physiological tissues by operative procedure. Deformities of the nasal septum are usually the first pathological condition to appear, and are the cause of the later changes in the soft structures of the nose. The removal of this septal lesion should first claim the attention of the operator. Do not produce by operative measures large ulcerations on the septum, if they can be avoided, as there may be present in the case some constitutional vice, and therefore the ulcerations will be healed with difficulty. Nothing is more efficacious in their treatment than the use of antiseptic washes and covering.

121

ABDOMEN GUNSHOT WOUNDS.-Dr. Lippincott concludes ("Univ. Med. Mag.") that in about 90 per cent of penetrating abdomen wounds the viscera are involved. In most abdomen gunshot wounds the intestinal lesions are multiple. When the viscera are wounded, fæces and gas or finding the ball in the fæces are the only pathognomonic symptoms. Complete repair may occur naturally in viscera wounds by prolapse of mucous membrane, plastic lymph exudation bringing a healthy surface over the intestinal rent and finally cicatrization. Statistics do not show better mortality by operative procedures than by conservative treatment. Stomach and small intestine wounds are graver than large intestine. Shock per se is not an internal hæmɔrrhage symptom. Gunshot intestine wounds usually cause death by septic peritonitis, albeit death by shock and hæmorrhage is not rare. The hydrogen gas test is not infallible. Statistics do not justify laparotomy, except in well-selected cases particularly where there is pronounced hæmorrhage. Laparotomy has increased the mortality from abdomen gunshot wounds. Localized peritonitis must occur to attach wounded gut to healthy peritoneal surface. The indications for treatment are to promote reaction, control hæmorrhage, stimulate hypodermically (nothing by mouth) and feed by rectum till perfect adhesions have formed.

ANDROLOGY AND DERMATOLOGY. CARDIAC SYPHILIS.-Semmola ("La Trib. Med.") states that independently of the cardiopathies, secondary to arteritis or arterial scleroses of luetic origin, there occur primitive cardiopathies which develop in old luetics and may produce the gravest cardiac disorder. He had under observation a cardiac case whose symptoms were such as defied all treatment and whose origin was uncertain. The patient was given mercury bichloride subcutaneously and large doses of sodium iodide internally. In four weeks all cardiac symptoms vanished. Several cases of this type have occurred varying from simple arhythmia to decided cardiac symptoms. Cardiac symptoms in old luetics, Semmola claims, should be subjected to antisyphilitic

treatment.

GENERAL MEDICINE.

FIBROID PHTHISIS.-Sir Andrew Clark insists that fibroid phthisis can occur independently of bacilli. In three cases of non-bacillary fibroid phthisis selected by him examinations by bacteriologists failed to demonstrate bacilli.

SAJOUS' ANNUAL.

[To the Editor]: The Annual of the Universal Medical Sciences sent by the F. A. Davis Company, will probably have reached you by this time. I am much pleased to say that it has appeared somewhat earlier this year than usual. Had it not been for an unexpected obstacle, we should have been able to do even better. Difficulties, as they arise, are gradually being removed, and I sincerely hope that the time will come when none need be feared.

Some contemporaries have stated with truth that I was to be absent in Europe for three years. The true motive of this absence has been kept in darkness to avoid counteracting influences. As you know, the contributions of American physicians do not receive the recognition to which they are fairly entitled on the continent. This is not due to willful disregard of the work done in this country, but mainly to the fact that the English language is not read as easily as French or German. The plan of the "Annual" naturally brings within a limited scope a great number of American writers, but few of whom are quoted, abroad, and I hope, by presenting an edition of the work in the French language, soon to obtain for our conferrees the recognition due them.

A feature of importance in the next "Annual" will be the insertion, when possible, of the address of each author quoted. You can readily appreciate the value of this new step. John Smith of Lebanon, Pa., can be distinguished from hundreds of the same name practicing in this country and England. The individual is properly recognized-so is his country. Were each journal to give the address of its contributors, this improvement could easily be effected. CHAS. E. SAJOUS, M. D.,

16,2 CHESTNUT ST., PHILADELPHIA,

LYCOPUS.-Bugle weed (Lycopus Virginicus) according to Dr. Felter ("Eclectic Med. Jour.") is of great value in acute pulmonary complaints, and of still greater utility in chronic lung troubles. It acts as a gentle sedative and tonic. It reduces the frequency and force of the heart's action, and is indicated in pulmonary lesions with irritation and cough, with tendency to hæmorrhage. It is particularly valuable in chronic cases with copious secretion of mucus or muco-pus. It lessens irritation, allays the distressing cough, so frequently encountered in

chronic bronchitis, pneumonia, and consumption. By its action as a nervine it gives rest and quiets pain. By its control over the circulatory apparatus it slows the pulse and brings down the temperature. Tumultuous action of the heart and consequent increase of circulation through the lungs are controlled by it. It may be employed in acute cases to control fever and inflammation. Here it gives rest, alleviates the pain, quiets the vascular excitement, besides allaying the irritative cough. It is an excellent remedy for homoptysis, especially in those cases where the bleeding is small in amount yet frequent, or it may be administered to prevent the tendency to hoemorrhage in phthisis. In consumption it serves to relieve the distressing symptoms, and may be administered in drop doses every hour. It is valuable in acute as well as chronic pneumonia. In ordinary acute catarrh it may be administered with aconite, eupatorium, and other indicated agents.

It is indicated by chronic cough, mucous or muco-purulent expectoration, frequent pulse, high temperature, tubercular deposits, albuminuria, with vascular excitement.

DIURETIN IN CHILDHOOD.-Dr. Demme has given ("Jour. Amer. Med. Assoc.") this substance to eleven children suffering from various forms of dropsy. He finds diuretin applicable in childhood from the end of the first year, a valuable diuretic and tree from injurious action. The diuretic effect appears to be due to its action on the epithelium of the kidneys. The at times excessive dropsy of scarlet fever nephritis appears, after the expiration of the first acute stage of the nephritis, to be more quickly overcome by diuretin than by any other treatment. Dropsy from mitral insufficiency can generally, after compensation of the latter by digitalis, be quickly cured. The daily dose for a child two to five years old is 0.5-1.5 grams, from six to ten, 1.5-3.0 grams of diuretin best taken in 100 grams of water with the addition of ten drops of cognac and 2.5 grams of sugar. No cumulative action has been observed nor weakening of the therapeutic effect after several weeks' use.

SALOLATED RETINOL IN CYSTITIS.-Desnos ("Rev. de Clin. et de Therap.") has had excellent results from irrigation of the bladder in sub-acute cystites with salolated retinol. The quantity used varied between five and thirty grams.

A. Spaulding has relocated at 318 W. Franklin avenue. Dr. W. O. Stephens died September 8. MISSOURI St. Louis.-Drs. J. M. Hoffman, H. C. Duke, and St. J. Bradley of the Female Hospital have resigned their assistantships.

NEBRASKA. Dr. E. F. McClelland has located at Alliance.

NEW HAMPSHIRE.-Dr. W. Wilkins, of Man chester, died recently at the age of 63.-Dr. H. F. Adams, of Peterborough, died recently.

NEW JERSEY.-Dr. O. W. Budlong, of Washington, D. C., has located at Atlantic Highlands. -Dr. J. F. Duncker, of Newark, died recently at the age of 83 -Dr. J. J. Broderick, of Jersey City, recently married Miss Carlin, Dr. Jas. Green, of Elizabeth, Miss Fisher, and Dr. E. L. Riegel, of Bloomsburg, Miss Farrow.

NEW YORK.-Dr. Neville has located at 6 Crosby street, Jamestown.-Dr. F. D. Foster of Union, W. F. Duncan of Williamsbridge, and A. C. Taylor of Malone, died recently.--Dr. J. A. Knapp of Mt. Vernon recently married Miss E. Scheack.-Dr. Geo. Saxe of Madison has been appointed first assistant physician at Dr. Strong's sanitarium, Saratoga.-Dr. G. W. Peterson has located at Waterloo.-Brooklyn.-Dr. S. J. Brady died September 8.-Dr. C. S. Perry has resigned his Kings county insane hospital assistantship.— Dr. R. H. Folger died recently in his ninety-first year.-New York City.-The "Circle of Willis" is the title of a local physicians' club.-A death under ether occurred in a sixteen year-old boy while undergoing finger amputation at the Chamber Street Hospital.-Dr. Douglass has under care a female who insists she cannot obtain work except in male attire.-A patient was admitted to Charity Hospital with an eruption closely simulating tuberculoid leprosy. The case proved to be one of phosphorous poisoning and jaw necrosis set in requiring exsection. Dr. Cushing injected into a forty-twoyear-old man two drams of a 4 per cent solution of cocaine to deaden the pain of an operation. The patient was almost immediately thrown into convulsions, and died within five minutes.

The autopsy

showed the heart, lungs, brain, kidneys, liver and spleen greatly congested.

NORTH CAROLINA.-Drs. Sumner McBee, of Lincoln, and C. Duffy, of Berne, died recently.

OHIO.-Dr. W. H. Halliday, of Cleveland, has been sued for alleged malpractice. Dr. J. W. White, of Upper Sandusky, died recently.-Dr. Coleman recently married Miss K. Hatch.-The state insane hospital is to be located at Massillon. -Dr. G. W. Bushnell, of Hartford, died September 14, at the age of 92.-Dr. Berechner has been appointed state medical inspector at Youngstown. -Dr. L. Lewis, of Springfield, died September 10. OREGON -Dr. C. H. Wheeler has been appointed Portland city physician.-Dr. R. D. Page

has located in Roseburg. -Dr. Bowen Porter, of Gold Hill, died recently.-Dr. J. A. Low, of Portland, died September 11.

PENNSYLVANIA.-Dr. W. S. Brentzholty, of Hughesville, has located at Columbia.-Dr. J. W. Lowry has been appointed superintendent of the Lackawanna Hospital, Scranton.-There has been a very fatal dysentery epidemic in the Norristown insane-hospital female department. -Dr. A. McNamorce has located at Susquehanna.—Pittsburg. -Dr. J. S. Dickson died September 4.-Dr. H. J. Powers recently married Miss A. Lewis.-Dr. G. Grove, of Carlisle, died September 14 at the age of 82. Dr. C. A. Williams has located at Union City. -Dr. F. A. Koch, of Hanover, died September 1. Dr. G. C. Burnley has located at Lockhaven.Dr. L. Sutton, of West Newton, died September 13.-Dr. J. M. Deaver, of Buck, died recently.— Philadelphia.-Dr. J. J. Reese, the toxicologist, died September 4.-Dr. E. O. Shakespere succeeds Dr. Leffmann, resigned, as port physician.-Dr. C. F. Wittig died September 13 at the age of 85, after sixty years' practice.-Dr. T. S. Bruce died September 14.-Dr. A. P. Seligman has located at Pottsville.

WISCONSIN.-Dr. T. C. Dodge succeeds Dr. Hanner resigned as Northern insane-hospital assistant physician.-Dr. O. D. Colman, of Pardeeville, died September 20, at the age of 71.-Drs. A. W. Trewitt, and Margaret Trewitt, of Wausau, have removed to LaCrosse and Dr. C. M. Gould, of River Falls, to W. Superior.

BRAIN EXHAUSTION.-In the busy struggle for existence the battle of life is no longer fought with the hands, but by the brain. The demands made by the efforts of the brain-worker upon the nervous system are excessive. No matter what powers of endurance the body may possess, the restless tenant exhausts them. Especially is this true of those slightly built persons with well-vaulted foreheads and small viscera. Their restless energy brings about a break down; the assimilative organs cannot supply the nutritive pabulum of the nervous system in sufficient quantity, the store becomes exhausted, and then the brain power gives way; the work that once could be accomplished with ease becomes a grievous task, and a little later on the capacity to discharge it is no longer present. The patient is sent away for rest. After a long rest and appropriate food the nervous system is once more for a time equal to the demands likely to be made upon it.

The treatment of mental overwork is absolute As rest, with a generous diet that will make at. the nervous substance is largely made up of fat with phosphoric acid (lecithin), its nutrition must be maintained by PROTEINOL. Proteinol is composed of the entire egg, digestible fat, brandy and maltose. One tablespoonful Proteinol should be given every two hours.