a more benign course than that due to other micro-organisms, and compares it with his own experience, which was almost exclusively confined to children. In 1897 he met with sixteen cases of the disease, of whom five were surely due to the pneumococcus. Three of these died from extra-ordinarily severe complications. The following year he also treated sixteen cases, with two deaths. Ten were due to the pneumococcus, and one died. In other cases, a report of which is incoporated in the paper, an empyema so small as to be difficult of diagnosis reduced the patient to a critical condition, which improved after the evacuation of, at times, a few cubic centimetres of pus. These observations, he says, show exclusively the extreme variations in the malignity of the affection, which is little, if at all, dependent on the amount of pus. They further show how much risk one may run in spite of their undoubtedly frequently benign character, and irrespective of the amount of the exudate, in delaying operation. At least so far as children are concerned, and probably also for older persons, there is no difference, from the standpoint of treatment, between the metapneumonic and other forms of empyema. A prompt and complete evacuation is necessary.-Boston Medical and Surgical Journal.

RECOVERY FROM BROKEN NECK.

We recently reported the recovery of a hod carrier from a broken neck at a hospital in Yonkers. We have now to report the promising convalescence of a gentleman who sustained a fracture of the fifth cervical vertebra in August last while diving off his yacht into shallow water. The X-ray disclosed the fact that the fractured vertebra was pressing heavily against the spinal cord. In September last an incision was made and the laminæ of the fifth and sixth cervical vertebræ were removed. The cord itself was not interfered with, but remained slightly dislocated. At the time of the operation the patient had neither motion nor sensation below the point of injury-indeed, the operation was done without an anesthetic and without any sensation on the part of the patient. There has been slow but gradual improvement in the patient's condition since the operation, and on Feb. 25 he sat

upright for the first time in an invalid chair and was able to propel himself about the room. Only certain movements of the fingers and entire mobility of his lower limbs are still uncontrolled by his will The operation was done by Dr. Abbe

at St. Luke's Hospital. -Medical News.

A NEW METHOD OF SUTURE IN OPERATIONS FOR INGUINAL

AND OTHER FORMS OF HERNIA.

L. Freeman exposes the internal ring, ligates and cuts off the sac, which is knotted on itself. The cord being held out of the way, a loop of silkworm gut is passed from without inward through the muscular tissue on the umbilical side of the ring, then carried through Poupart's ligament from within outward. Another loop is similarly inserted near the pubic limits of the opening. A piece of stiff silvered wire long enough to reach the entire length of the inguinal canal is run through the loops, which are pulled tight enough to hold it in place. Another wire is laid along Poupart's ligament between the free ends of the loop, which are firmly tied over it, thus approximating the wires and bunching a quantity of muscular tissue against the ligament. The wires are bent upward at their pubic extremities so as to protrude through the external incision, thus facilitating their removal. The ends of the wires farthest from the pubes must be so placed that they leave the new internal ring neither too large nor too small. The cord is now dropped in place over the line of union, and the aponeurosis of the external oblique united above it, the upturned ends of the wires passing through the external ring. In uniting the skin, the free ends of the loops and the ends of the wires are brought out through the incision between the stitches. In from ten days to two weeks, which is long enough to procure reasonably firm union, the wires are removed by pulling on their protruding ends. This frees the. loops, which are likewise readily extracted.-Medical Record.

EXCISION OF JOINTS FOR RHEUMATOID ARTHRITIS.

F. A. Southam (Lancet, Dec. 9, 1899; Medical Review of Reviews, January) records three cases in which he excised joints with excellent results for rheumatoid arthritis. In the

first case a woman, aged 29, compietely bedridden previously, had both knee joints and the right ankle joint excised in 1893, with the result that she was soon able to walk several miles, and continued well up to the time of writing. In the second a woman, aged 30, had both ankylosed knee joints excised in 1894 with excellent results, locomotion being restored. In the thir, a woman, aged 30, the left elbow, previously anky. losed at an obtuse angle, was excised, with the result of ob taining a movable joint.-N. Y. Medical Journal.

MEDICAL.

SANTONIN IN EPILEPSY.

After citing the ills of surgical treatment for certain epilepsies, bromide treatment for other epilepsies, with the attendant acne of the skin and degeneration of the mind produced by this method, G F. Lydston (Therap. Gazette, Feb. 15, 1900) offers as a substitute for this class of drugs a remedy quite as efficient as a palliative and perhaps more so as a curative measure This substitute is santonin The author disclaims priority in its use, but says that he has used it in the treatment of epilepsy for nearly twenty years, and as yet has never seen it mentioned by any other author. His attention was first directed to the value of santonin in spasmodic affections of children, in whom he has seen it given indiscriminately for spasms whether due to "worms" or not and with whom it was uniformly successful. As a result of his long experience with the drug he has proven to his own satisfaction (1) upon the average, epileptic patients show better results under santonin than under the bromides; (2) santonin acts well in cases in which the bromides for one reason or another are not at all tolerated; (3) santonin gives distinctly beneficial results where the bromides fail altogether; (4) santonin is free from injurious effects which cannot be said of the bromides. Thus, there is no resulting melancholia, mental hebetude, profound nervous and circulatory depression

and disfiguring eruptions. Whatever disagreeable effects santonin may have are not severe, as a rule, and are transitory. If santonin is given, as the text-books on materia medica prescribe, only disappointment can result. Lydston begins in the adult with a dose of from two to five grains. As its taste is not disagreeable he gives it uncombined. The dose is then gradually increased up to the point of tolerance. This he finds to be in many patients as high as twenty grains thrice daily for some weeks. As a rule, the dose is gradually increased to fifteen grains three times a day or possibly four times. The peculiar twitchings about the mouth said to be characteristic of santonin have not occurred in the adult in his experience. The most important clinical feature of the use of the drug is the yellow coloration of the urine accompanied by painful micturition and varying irritability of the kidney. This shows at least that caution in the use of santonin should be used. Idiosyncrasy must be guarded against. In some cases the combined use of bromides and santonin may be desired. A large dose of the bromide is then given at bedtime. The alternate use of santonin and bromides is often of great service.-Medical News.

GASTRIC ULCER.

Cases of gastric ulcer are, no doubt, frequently diagnosticated as chronic gastritis on account of the similarity of symptoms, but largely due to the lack of a thorough examination of the patient. B. Reed (Inter. Med. Mag., Feb., 1900) points out the important diagnostic features. The three cardinal symptoms are, pain, hemorrhage, and circumscribed tender spots. The pain, as a rule, begins soon after the entrance of food into the stomach and often remains until vomiting occurs, or until the food has been passed on to the intestine. The fact that the pain is absent when the stomach is empty and much less when liquid food only is taken is almost diagnostic. The hemorrhage may be observed by the vomiting of fresh blood, or dark changed blood, or by the passage of tarry stools. Marked circumscribed tenderness in the epigastrium just below the ensiform cartilage and to the median line, and also on the left side of the spine over the

origin of one of the last three ribs, is a most constant symptom. Vomiting of food after eating is seen in so many diseases that it is of less diagnostic value. Vomiting usually occurs from one-half to two hours after eating and is followed by cessation of pain. This distinguishes it from carcinoma. An almost constant excess of hydrochloric acid is one of the important corroborative signs of gastric ulcer. The appetite is usually good and may be excessive. Marked anemia is frequently present The most liable complications are (1) fatal hemorrhage; (2) perforation with localized or general peritonitis, or (3) a subphrenic abscess.-Med. News.

OBSTETRICAL.

A CASE OF PLACENTA PREVIA AND RUPTURE OF THE UTERUS.

This case, reported by James Pearse, is interesting as hav ing ended in recovery with practically no treatment. In order that union might not be disturbed, the bowels were kept locked for a week, and during this time douching was avoided for the same reason. The author says that while laparotomy is undoubtedly the ideal treatment for this complication, such cases as the above serve to prove that even when this is impossible the outlook is by no means hopeless.-Med. Record.