The quinin destroys the invading germs, and by paralyzing the leucocytes, prevents their further accumulation, which compromises the transparency and vitality of the tissues. The quinin, therefore, is the beneficent mediator between the invaders and the defenders of the organism, and thus saves by arbitration, as it were the transparency in the cornea. Of course, when its task has been accomplished it should be replaced by the individual treatment needed. The instillations also relieve pain promptly and effectively, although they induce a slight transient exacerbation at first.

Ichthyol in the Treatment of Corneal Ulcers.

B. F. Travis (Med. Her., Nov. 9, '99) recommends ichthyol in a 30 per cent solution in the treatment of corneal ulcers, both idiopathic and of traumatic origin-this strength to be applied by the physician, and a weaker solution prescribed for home use. No danger is attached to its use, and it is highly beneficial in its results. The slight transitory pain accompanying its application may be temporized by a preliminary instillation of holocain, in a 1 per cent solution.

Bacteriology of Ophthalmia Neonatorum.

Groenouw, of Breslau, at a meeting of the Heidelberg Opthal. Soc., reported in the Opthal. Rev., Nov., '99. states that in forty cases examined, including simple catarrhal ophthalmia of infants, as well as purulent ophthalmia, he found the gonococcus fourteen times, but only once by itself. Staphylococcus albus was almost always present, also, xerosis bacillus rarely absent. Staphylococcus aureus was found in about half the cases, pneumococcus once, and bacterium coli six times, besides other undetermined bacilli. About one-third of the cases gave no typical bacteriological appearance.

Nasal and Aural Complications in Epidemic Influenza.

Snow (Jour. Am. Med. Asso., Nov. 25, '99) holds that practically all the headaches and cranial pains of la grippe are due to pressure in the nasal passage, or to pent-up secretions within the adjacent sinuses, the cutlets of which are blocked by the acutely congested membranes. The ethmoidal cavities are particularly susceptible to inflammation, and may, in some cases, be the only ones involved, but in others, one sinus after

another may be affected, a peculiarity being that these inflammations are likely to be confined to one-half of the head. We are hardly justifiable in calling the severe cranial pains that accompany epidemic influenza, neuralgias, and make no effort toward reducing the congestion of the membranes. The indications for treatment are to reduce the virulence of the poison and control nasal inflammation so as to promote a free drainage of sinuses, and thereby prevent the formation of pus. A mild alkaline solution, as Seiler's, snuffed or sprayed into the nostrils every two or three hours, followed with benzoinol plain, or in combination with menthol (grs. 3 to oz. 1) is of value in a majority of cases. A spray of a 2 per cent cocain solution followed by a light spray of iodol, menthol, and ether (Squibb's), one grain of each to the ounce is grateful to the patient, and gives the ethmoidal and frontal sinuses a better opportunity to unload their secretions. Serious middle-ear trouble can often be aborted by the use of leeches, followed by the aural icebag. Politizer inflation and hot water injections, one pint every hour, are advised. If the drum becomes bulged, a free incision into the posterior half should be made, carrying the knife well through, so as to cut the periosteum lining the middle-ear. Prompt, energetic, and persistent must be the measures instituted if the mastoid becomes involved. Either the ice bag or hot fomentations may be rationally used, but whichever is ordered must. be kept on continuously for hours.

Removal of Ear Wax.

W. Blair Stewart (Phil. Med. Jour.) uses a half-strength solution of hydrogen dioxid to disintegrate hardened wax in the external ear. Five or ten minutes is required, and very little syringing is necessary. The ear should be perfectly dried, petrolatum applied, and a plug of cotton kept in place for twenty-four hours after the cleansing. Nasal Disease a Cause of Headache.

Dundas Grant (Jour. Lar. Rhin. and Otol.) says: As regards the forms of nasal disease which may give rise to headache, the most common may be first quoted, namely, adenoid vegetations of the nasopharynx. It is a most usual experience after the removal of adenoids to observe the disappearance of headaches which were previously of frequent occurrence. Hyper

trophy of the middle turbinated is another frequent cause, and that it should be so, is very readily understood, when we consider the comparative narrowness of the space in

which it lies, and the rigidity of the walls which bound that space, all being richly supplied by branches of the great sensory fifth nerve.

Treatment of Internal Hemorrhoids.

Dr. J. Boas (Deutsche Medizinal-Zeitung, October 30th) says that treatment of this condition must be based upon the fact that hemorrhoids is a disease of the rectum. The idea that congestion dependent upon the heart, lungs and liver gives rise to rectal varicosities has been disproved by numerous authors. Local causes are always responsible for the development of hemorrhoids, and treatment of these causes a cure. Among local causes those which prevent the return circulation through the portal system and vena cava naturally play the most important role. Rectal and perirectal tumors, the pregnant uterus, tumors of the large intestine, disease of the adnexa, stones in the bladder, intestinal ulcerations, stenosis, catarrh, etc., may give rise to hemorrhoids. The most important and benign causes, however, are those which are due to the pressure of hard and stagnated feces upon the rectal ampullæ or sigmoid flexure. Cases also exist in which hemorrhoids develop with normal defecation, with alternating constipation and diarrhea, or, indeed, even with diarrhea alone. In the first instance there is present a certain hypoplasia of the venous plexus, perhaps also an atrophy of the rectal mucous membrane itself. In the latter there exists, as a rule, a more deeply situated catarrh of large intestine or rectum, under whose influence an increased congestion of the hemorrhoidal plexus might occur. Most frequently, however, there is present an habitual disturbance of defecation, particularly in the lower bowel, which in time causes circumscribed, diverticula-like fecal reservoirs. The most frequent and most satisfactory therapy lies in the treatment of habitual constipation, in the prevention of large fecal accumulations, and this not

In

by means of laxatives, but rather by persistent dietetic treatment which produces large and soft evacuations, and prevents fecal impaction, especially in the rectal ampullæ. Mention must here be made of the general ideas as to the value of the bland, that is, the non-irritating diet. The "bland diet" is the one which tends most of all to keep intact the integrity of the hemorrhoids, inasmuch as it favors constipation, more so than any other. Single, long-continued and large hemorrhages justify a relative diminution of alcohol, pepper, mustard, etc. addition to diet, generally hygienic measures must be observed-exercise, gymnastics, riding, billiards, lawn-tennis, football, etc. Herewith is included rectal toilet, cleansing of the anal portion with astringent solutions, preferably tannin or alum. enemata, with gradually elevated douche, are very serviceable. These simple measures suffice in the first stage of the affection and in the absence of complications; indeed, in a large proportion of cases the varicosities disappear altogether. Even the rectal catarrh, which the patient falsely call "catarrhal hemorrhoids," gradually disappears, once the lower intestinal tract has been cleared of the fecal accumulations, or the irritation consequent upon their decomposition. Hemorrhoids ought to be treated in their very incipiency. In the later stages, the regulation of the constipation or the cure of a constipative intestinal catarrh is more difficult, and requires the aid of laxatives and irrigations. Among the former, only such are indicated as after habitual use do no harm to the gastro-intestinal tract, produce a mild and satisfactory effect, and do not wear off too quickly. This list includes rhubarb in its various compositions, sulphur, compound licorice powder, magnesia usta, and citrate of magnesia.

The dose should be as small as possible. The treatment of hemorrhoids with mineral water is very popular; the results here depend entirely upon the laxative properties of the given water as well as the local effect of the baths upon the hemorrhoidal nodules. This method seldom gives permanent results. Under the same category might be included the grape cures, which also produce a regulation of the bowel function, and thus might favorably influence the condition; once, however, the treatment is stopped, the condition recurs in the majority of cases. The success of the internal therapy of hemorrhoids depends upon the treatment of etiological factors. If this fails, then all other intervention will have but a transitory and symptomatic effect. This brings us to the local treatment by pessaries, suppositories and ointments. The former are of temporary value and may produce a certain amount of relaxation of the sphincter by compression of the varicosities. The suppositories and ointments may be of service in excoriations of the varicosities and in slight hemorrhages. The following suppositories and ointments are very much in use:

R

Extra. fluid. hamamel. virgin. 100 S. 3i. t. i. d. in a glass of water. Suppositories might also be used. In acute and alarming hemorrhages the best treatment is tamponing of the rectum with ferripyrin, chlorid of iron, or iodoform gauze. Care must be taken that the tampon reaches the bleeding point, otherwise the hemorrhage will continue. At the same time a full dose of opium is given in order to quiet intestinal peristalsis. In three days the tampons may be removed, and a dose of castor oil given. In constriction of the hemorrhoids, protection and avoidance of forcible reduction are indicated. If possible in suppository or cocain and opium is to be introduced, in order to immobilize the lower bowel. Then, after a thorough inunction of the entire anal portion and the rectum itself, reduction of the constricted portion is carefully undertaken in the side position, if needs be with the aid of chloroform, ether or Schleich anesthesia. Leeches might be applied in the region of the varicosities; after sufficient blood has been withdrawn reduction is usually easy. If gangrene supervenes reduction is, of course, contraindicated, and treatment with antiseptic powders is in order. In prolapse, Esmarch's "rectal carrier" might be of service.-Medical Record.

Gallnut for Hemorrhoid.

The Medical Times for November cites Dr. Rogers S. Chera of Calcutta (Medical Age, Aug. 25, 1899) as saying that medical literature teems with modes and results of the surgical eradication of piles. He never performs an operation now, and never needs to, as there is a very simple remedyso simple, indeed, that the profession refused to accept it, because it was unscientific. I also laughed at it at one time, but results brought the laugh against me. My tutor was an intellectual untitled fakir, who dropped into my surgery one morning as I was asking a man with a huge bunch of extremely painful and bleeding hemorrhoids whether he would submit to operation.

"Sir," said the fakir, "pardon my interference, will cutting away swelled veins alter the current of the blood permanently? That man is afraid of the knife. Let me whisper in your ear. Take a chota harra (the lesser gallnut); broil it as you would a coffee berry; then powder it, and mixing the powder with a little fresh butter, let the man apply it to the piles after each stool. If it

fails to cure him may Allah send me to perdition."

Don't muddle this with the "unguentum galla" of the pharmacopeia. Reader, skeptic of results, I tried it. Eight applications cured the man, and to my surprise the first application stopped the bleeding entirely. Since then I have cured some hundreds of cases with the same thing.

Ectopic Gestation.

Dunning (Am. Journal Obstetrics, Nov. '99) discusses the question "Shall the case be operated upon at or near term, the child being alive?""

He cites the tables of Ayres and Harris and reports five cases, a total of twenty-five cases all operated while the fetus was living, with a mortality of ten mothers. He is firm in the belief that the trend of opinion is decidedly in favor of operating while the fetus is viable, rather than waiting until after the fetus is dead.

(This question will doubtless engage the attention and discussion of operators for some time before a unanimous opinion is reached).

Determination of Sex.

Dunsmore (Northwestern Lancet) after investigating this subject carefully thinks that Thury's theory is the most rational one yet promulgated. Thury's theory is that sex depends on the maturity of the ovule at the time of impregnation, thus the most mature ovule, if impregnated, results in a male. Breeders adopt this theory and put it in practice with a reasonable degree of

success.

Fractures and Other Injuries of the Child During Delivery.

Under this caption Dr. D. J. Doherty (Am. Gy. and Obs. Journal, Nov. 1899) calls attention to the frequency of injuries during parturition and points to the fact that breech presentations, either primary or secondary, furnish by far the greater per

centage of these injuries. He reviews the observation of the best obstetricians from Smellie to date, and concludes that these accidents are in the majority of instances unavoidable. He also cautions the obstetrician against yielding to the importunities of the friends and interfering too early.

McFarlane (Glasgow Med. Jour., Sept. '99) describes four cases of missed labor in the same patient; the pregnancies being prolonged from two to ten weeks. In each case labor set in and a badly decomposed fetus was expelled.

Cavity in Lung of Infant Eleven Months Old.

M. Susset in Société Centrale de Médicine du Nord, May 12, 1899, reports the finding of a tubercular cavity in the apex of the lung of an infant eleven months old. He calls attention to the fact that in autopsies on a very large number of children this was the youngest in which this pathological condition was found.

Eclampsia.

In an analysis of 79 cases of eclampsia occurring in the Boston Lying-in Hospital Dr. F. S. Newell (Boston Med. and Surg. Jour., Nov. 9, 1899) states that 72.2 per cent were primigravida, a remarkably close relation to the observation of eminent European authorities. In his series of cases 40.5 per cent were antepartum, 27.8 per cent intrapartum and 31.7 per cent postpartum. Of the antepartum cases there was a mortality of 31.2 per cent; of the intrapartum, 27.2 per cent and of the postpar

tum, 20 per cent. Of primiparæ 21 per cent ended fatally and of multiparæ 41 per cent. The number of convulsions in the fatal cases varied from one to forty-six. He deprecates the use of morphine and pilocarpine and strongly advocates the use of saline infusion and immediate emptying of the uterus.

Treatment of Pertussis.

November

Pediatrics contains a review of the therapeutics of pertussis by Kaumheimer in which he reports bromoform as the most satisfactory agent in relieving the frequency and severity of the spasmodic seizures and shortening the duration of the disease. Dosage-one drop for each year of age given three and four times a day. It is best given in mucilaginous or syrupy mixtures and should always be prescribed by drops, as the fluid dram contains 480 drops, while the dram by weight, 160 drops. The susceptibility of patients varying, many cases of intoxication are reported, one fatal.

Cyanosis in Croup.

The following editorial paragraph appears in Pediatrics, Dec. 1, 1899: Many who have had but little experience in croup are too often misled as to the dangerous symptoms present, by the absence of cyanosis, thinking cyanosis to be the cardinal indication for operative interference. They seem to forget that the exhaustion incidental to drawing sufficient air through the

narrowed chink of the glottis by means of the powerful auxiliary muscles of respiration, is of itself a serious menace to the life of the patient, whose heart is already enfeebled by toxins. The recessions of the supraclavicular and intercostal spaces and sub-sternal region are most important reasons for immediate intubation. Perhaps the generally most satisfactory sign for interference when in doubt is, as pointed out by O'Dwyer, incomplete aeration of the posterior portion of the lungs, as evidenced by greatly diminished or absent vesicular breathing.

Physiological Action of Diphtheria Antitoxine.

Brodie (Brit. Med. Jour., Nov. 4, '99) in discussing the physiological action of anti-toxine in diphtheria says (page 1283):

From these and other confirmatory experiments it is shown that the chief cause of death following within forty-eight hours of an injection is due to a failure of the blood vessels and consequent fall of blood pressure. Whether the failure is due to the action of the toxins on the muscular walls of the arteries or on the nerve centers or nerves is at present not decided; though so far as they go, the experiments show that the first is the true explanation.

The action on the blood vessels is further indicated by the rapid fall in temperature which is observed to take place during the few hours preceding the death of the animal.

Tuberculosis in Cows.

The history of a tuberculous herd of

COWS.

H. L. Russell (Bulletin No. 78, University of Wisconsin Agricultural Experiment Station) records some very interesting and valuable observations made upon a herd of tuberculous cows. In 1891 a farmer in one of the eastern counties of the state thought to increase the character of his herd of cattle and bought a few pure bred

animals for this purpose. For three years these new animls were kept apart from the original herd and then all young animals were placed together and the mature animals were kept on one side of the barn. In 1895 some of the pure bred cows began to fail and in that and the following year two of them died of tuberculosis as shown by autopsy. The tuberculin test was now applied to the entire herd, with the result that thirteen out of sixteen of the ma