the pharynx. Throw the head backward, and the fluid flows against the pharynx, and is partially applied to palate by the air which gradually escapes from the lungs. If necessary for the fluid to reach posterior nares, the patient should lie down, take a mouthful of the fluid, draw out the tongue as far as possible with a handkerchief, and gargle while in that position. By throwing the head suddenly forward the liquid may be brought through the nose.

-Under certain conditions, Dr. Sajous considers that cocaine for acute rhinitis is

beneficial, say for two or three applications, but for constant use, this agent is exceedingly injurious and may cause paralysis. If the patient consults you early, order three powders, each containing

R. Cocaine hydrochlorat.,

Morphiæ acetat.,

Pulv. talc.,

Bismuth subnit.,

SIG.-Ft. pulv. j.

gr. gr.

gr. j gr. iv.

M.

One every three hours: after three powders have been used, continue the same prescription minus the cocaine. When the malady has reached the third or muco-purulent stage, the treatment is more difficult, but we can hasten a cure by two-drop doses of we can hasten a cure by two-drop doses of tinct. belladonnæ every three hours, with the addition of a little quinine.

-Two ligatures should be applied to the umbilical cord. The reasons for the additional ligature are, first, cleanliness, and, second, it is probable, not proven, however, that a placenta when only partially emptied of blood is more easily detached by uterine retraction than one which is flaccid, and, hence, which may more readily follow the lessened size of the uterus and diminished surface of attachment without separation. In multiple pregnancy the second ligature is necessary because of the possible vascular connection between the circulation of the two fœtuses in the placenta. Divide the cord between the two ligatures, leaving a large button-like projection at fœtal portion, so that the ligature cannot slip off. Dry the foetal portion with a soft cloth, and watch the end for a few moments to see

-The following is the substance of the treatment for epistaxis recommended by Dr. Sajous Position is an important element. Have patient stand up, if possible; if not able to stand, lie flat upon the back. Immerse the feet first thing in hot water. Apply blister over liver. Insufflate a powder Apply blister over liver. Insufflate a powder composed of equal parts of tannin and gallic

acid or a drachm each of the above to an ounce of water, and apply with cotton wool.

If all this does not stop the hemorrhage, we must then resort to plugging. For anterior nares use small pieces of sponge fastened to a string, which serves to draw them out. To plug posterior nares, pass a flexible catheter through the nares to pharynx, and bring it out of the mouth with long forceps; to the end projecting from the mouth attach a string which has a plug of cotton secured near the centre; draw the catheter out through the nose. This leaves one portion of string projecting from nose, and the other end hangs from the mouth. In this way you have full control of the plug. Plug should never be left in the nose over thirty-six hours, ten hours the minimum. Remove with care. is well to apply a spray of warm alkaline water before removing.

THE TREATMENT OF SYPHILIS BY THE HYPODERMATIC INJECTION OF THE INSOLUBLE SALTS OF MERCURY.

As long ago as 1864, Scarenzio introduced the treatment of syphilis by intra-muscular injections of calomel. His method, however, attracted little attention and was soon forgotten, but was revived in 1885 by Neisser, of Germany. Since that date a large number of communications have appeared in the German and French journals. It is a remarkable fact, however, that this method of treatment has received but little notice among English and American physicians. During the past year a brief note upon the subject was published by Bloom, and somewhat later an extended historical review by Morrow. Neither of these observers reported any extensive series of personal observations. Within a few weeks, Dr. J. C. Wilson read before the College of Physicians of Philadelphia a clinical paper upon this subject, detailing the method of treatment and the results in twelve cases. His results appear to us to have been extremely favorable, especially in inveterate forms of tertiary syphilis that had proved rebellious to the ordinary methods of treatment.

Very great differences of opinion have been expressed in regard to the advantages of this treatment on the one hand, and the objections to it on the other. Among the advantages are these, that the digestive apparatus is spared

courses of anti-syphilitic remedies; that a greater precision and certainty of dosage is obtained; that the administration of the medicine is wholly controlled by the physician; that the patient, not being obliged to take medicine, is less exposed to the liability of his condition becoming known; that a greater promptness of action is thus secured, and that the risks of salivation are diminished. The cleanliness of this mode of treatment must also be regarded as an advantage.

On the other hand, the disadvantages of this treatment as compared with the methods in general use are pain and the danger of the formation of abscesses. It is true that a certain amount of pain almost always follows the injection of the insoluble salts of mercury. It is, however, rarely severe and usually very transient. Both the pain and the danger of the formation of abscesses are diminished by throwing the medicament deeply into the muscular masses; masses; while while the danger of abscesses becomes absolutely nil if the procedure be conducted strictly in accordance with antiseptic methods.

The two insoluble salts of mercury which have been employed are calomel and the yellow oxide. Dr. Wilson's observations have been made with calomel alone. The drug is suspended in glycerine, as suggested by Smirnoff, and in order to secure greater accuracy of dosage, the doses are ordered from the apothecary separately, in drachm vials. The average dose is one grain.

This method of treatment differs from the treatment by the hypodermatic injections of the soluble salts of mercury in this important particular, that the insoluble salts, being gradually acted upon in the presence of the fluids of the body, slowly undergo chemical changes which result in their ultimate conver

sion into a double chloride of mercury and sodium. The gradual action of this remedy is shown by one of Dr. Wilson's cases, in which slight ptyalism occurred at the end of the ninth day, whereas the injection of a soluble salt of mercury is followed by rapidly developing constitutional effects of the metal. While it is not probable that this method of treatment will come into general use, it must be regarded as an important addition to our therapeutic resources.

THE ETIOLOGY OF YELLOW FEVER.

Dr. George M. Sternberg, appointed last year by the President of the United States special commissioner to investigate the subject of the etiology of yellow fever and preventive inoculation as practiced by Freire in Rio Janeiro, quite recently communicated the results of his labors to the College of Physicians of Philadelphia. This communication took the form of a preliminary report, and anticipates the more elaborate official report to be hereafter published by the government. Dr. Sternberg's elaborate and painstaking investigations conducted in the city of Rio Janeiro have led him to startling results. He failed to discover the specific microbe described by Freire, and sharply criticises that observer's technical methods. As a matter of fact, Dr. Sternberg is forced to the conclusion that Freire himself has failed to isolate any specific pathogenic yellow fever germ.

Dr. Sternberg then turned to an examination of the results of preventive inoculation as practiced by Freire, and from a personal investigation of a large number of cases subjected to this procedure, was able to show that the method as practiced was useless, and that Freire's conclusions were absolutely without warrant.

INDEX MEDICUS.

We have on several previous occasions called attention, editorially, to the self-sacrificing spirit of the publisher, Mr. Geo. S. Davis, of Detroit, in supplying, without remunerative return, so valuable a periodical to the profession. Reiteration of this view may lead reading medical men to inquire more fully into its merits, and to lend their aid, by subscription, to continue a publication so worthy of their support.

Selections.

ADDRESS BY PROF. J. M. DA COSTA AT THE DINNER TO PROF. D. HAYES AGNEW.*

Fifty years ago, on this very day, there stood, with the honors of a University just received, a young man on the threshold of his life. His thoughts were the pleasantest ones of the occasion; his aspirations had hardly taken shape; he was the popular comrade of the hundred and fifty-five whose real life, like his own, was to begin. Fifty years have passed, and their Agnew has become our Agnew of the many thousands of the Ameri-can profession.

Honored Guest:-In addressing you tonight I feel that I speak not simply for those who are gathered around you, nor for those in this Commonwealth whose interest will centre here, but for the whole profession who hold you in such esteem, and whose sympathetic thoughts, could they reach you, would come to you in messages of such good will and affection as to overwhelm you with their warmth.

Your career has been, indeed, a remarkable one; and you must pardon me, and let the occasion be my excuse, if in your presence I allude to its success, and to the main causes of that success. Nor is it wholly unfitting in one to do so who has known you and watched

Given by his Medical friends in honor of Prof. Agnew's fiftieth anniversary of entrance into the profession.

your progress with friendly interest almost since you came to this city to try your powers in a wider field. The training you brought with you as a rural practitioner of note was indeed valuable. Self-reliance, cool judgment under difficult circumstances, are not the least reward of a country physician's hard life. You enrolled yourself as a teacher of medicine in its most laborious branch, and fittingly took charge of a school which has been the nursery of famous anatomists and surgeons,-where Godman's practical skill was displayed, and Joseph Pancoast laid the foundation of that intimate knowledge of the human frame which made him afterward so great a surgeon.

This Philadelphia School of Anatomy, in College Avenue, has indeed left its mark in the history of medicine. It has been to us what the Windmill Street School was to the London of William and of John Hunter, of Hewson, of Cruikshank, of Baillie, of Benjamin Brodie, of Charles Bell. Its rickety structure harbored not only anatomists-some of them your own pupils, who were to succeed you as celebrated teachers—but its dingy walls heard eloquent discourses on diverse branches from more than one of your future colleagues; in its garret, independent and fruitful researches on the textures of the body were pursued; in its cramped lower room, physiological experiments were carried on, which have made their deep impress on the science of our day.

For ten years, working in this school of anatomy, you lived laborious days and nights, and in its stern training your classes grew, until the narrow quarters would hold them no more, and you became the popular, admirable teacher you have proved yourself since, on a larger scale and on a different branch, as Professor of the Principles and Practice of Surgery in the famed University with which your reputation is forever identified. You learned to present facts plainly and impressively, to teach Nature's truths with Nature's simplicity, and without a deadly paralysis of words.

But in these ten years of unremitting work you did something more than teaching. You

laid, by exact knowledge, by steadiness of purpose and affability, the foundations of that large practice which you have since enjoyed, developing every day, more and more, into the trusted surgeon whose deft hand and cool judgment caused his advice to be generally sought. Every country shows in its professions the national traits. You certainly represent as a surgeon, besides much skill, the American characteristic of resolute common

sense.

You have been tried in many a hard case. In none harder, than when your reputation caused you to be selected among the counsellors at the wounded couch of one for whose relief millions were anxiously watching. That in these trying times you bore yourself with the same calmness and dignity we know in you, every one in these millions recognized.

Your success as a surgeon of great repute must, indeed, have been gratifying to you. Not only for the opportunities it afforded you of doing so much active work in your profession; not only because it gave a personal value to your writings, especially to your opinions expressed in your elaborate work on Surgery; but because it enabled you to carry out a plan of action, of which I may not speak,-one which showed you to be possessed of the same high sense of honor for which Sir Walter Scott has received the unbounded admiration of mankind.

May you, dear sir, who have these many claims to distinction and esteem, may you on this the fiftieth anniversary of entrance into a profession which you have graced by your industry, your sagacity, your skill, your character, may you accept the homage of those who are engaged with you in the same pursuit, as a sign of widely-felt regard and appreciation. May your vigorous frame preserve your power of doing good, of teaching truths, for many a long year. May there always remain with you the assurance that, as age gently lays its hand on you, the chilling finger of time will not lessen the respect, nor benumb the tenderness of feeling with which old and young alike regard you.

Our Library Table.

[All new publications noticed in this department, and all other medical works, may be procured by addressing WM. F. FELL & Co., 1220-1224 Sansom St., Philadelphia.

THE NOVELIST, Alden's new weekly maga

zine of American fiction, undertakes to give the worthiest fiction that American authors can be tempted to produce; foreign authors not admitted. Terms, $1.00 a year, at which rate it will give over 2500 pages, equal to from eight to twelve ordinary American dollar novels. A specimen copy will be sent free on request. Address, John B. Alden, Publisher, 393 Pearl Street, New York; P. O. Box 1227.

A TREATISE on Fractures and DislocaTIONS. Vol. II. Dislocations. By Lewis A. Stinson, B.A., M.D. 8vo. 541 pages. 163 illustrations. (Vol. I. Fractures.) Price $3.00 per vol., cloth; $4.00, leather; or $5.50, cloth, for the two; $7.50, leather. Lea Bros. & Co., Philadelphia.

THE TREATMENT OF HEMORRHOIDS BY INJECTIONS OF CARBOLIC ACID AND OTHER SUBSTANCES. By Silas T. Young, M.D. Second Edition. 12mo. 102 pages. Lafayette, Ind., 1888.

THE SURGICAL DISEASES OF THE GENITOURINARY ORGANS, INCLUDING SYPHILIS. By E. L. Keyes, A.M., M.D. 8vo. 704 pages. Cloth, $5.00. D. Appleton & Co., New York.

A GUIDE TO THE PRACTICAL EXAMINATION OF URINE. By James Tyson, M.D.

Edition. 12mo. 252 pages. Price $1.50. P. Blakiston, Son & Co., Philadelphia, 1888. CONTRIBUTIONS TO THE STUDY OF THE HEART AND LUNGS. By James R. Leaming, M.D. 8vo. 300 pages. Price $2.75. E. B. Treat & Co., New York.

THEINE IN THE TREATMEnt of NeuralGIA. By Thomas J. Mays, M.D.

12mo.

12mo.

84 pages. Price 50 cents. P. Blakiston, Son & Co., Philadelphia, 1888. ACCIDENTS AND EMERGENCIES. By Charles W. Dulles, M.D. Third Edition. 123 pages. Price 75 cents. P. Blakiston,| Son & Co., Philadelphia, 1888. ESSENTIALS OF CHEMISTRY AND TOXICOLOGY. By R. A. Witthaus, M. D. Second Edition. 32m0. 294 pages. Wm. Wood & Co., New York, 1888.

A COMPEND OF HUMAN PHYSIOLOGY. By

Albert P. Brubaker, M.D.

Fourth Edition.

I 2mo. Price $1.00. P. Blakiston, Son & Co., Philadelphia, 1888.

་

LECTURES ON DISEASES OF THE HEART. By Alonzo Clark, M.D., LL.D. 8vo. 252 pages. Price $2.75. E. B. Treat & Co., New York, 1888.

ATLAS OF VENEREAL AND SKIN DISEASES. By Prince A. Morrow, M.D. Fasciculus IV (Plates 16 to 20). Wm. Wood & Co., New York.

(Notices of these works will appear in a subsequent issue.EDITOR COLLEGE AND CLINICAL RECORD.)

PAMPHLETS RECEIVED.

'Modern Methods of Antiseptic Wound Treatment.' Johnson & Johnson, New York. 'Graduated Tenotomy in the Treatment of Insufficiences of the Ocular Muscles.' By Charles Hermon Thomas, M.D, Philadelphia, 1888. 'On Preventive Treatment in Primary Syphilis.' By Edward Bennet Bronson, M.D. New York, 1888.

'An Invalid's Day in Colorado Springs.' By S. E. Solly, M.D. Philadelphia, 1888. 'Biographical Notice of W. R. Cruice, M.D.' By Edward J. Nolan, M.D. Philadelphia, 1888.

Therapeutic Briefs.

[Short paragraphs embodying the practical personal experience of any of our readers will be acceptable as contributions to this department.-Editor College and CliniCAL RECORD.]

The following brief paragraphs are contained in an article by Dr. E. S. McKee, of Cincinnati, in the Cleveland Medical Gazette, April, 1888, on "The Progress of Obstetrics and Gynecology in Germany:"

HYPEREMESIS GRAVIDORUM is treated in a new and novel manner in the general hospital in Vienna. A hard-rubber speculum is introduced into the vagina, engaging the cervix uteri as much as possible. The external end is then elevated and a ten per cent. solution of the nitrate of silver is poured in, so the whole neck of the uterus is bathed in it for ten minutes.

Absolute non-interference is the rule in the THIRD STAGE OF LABOR among many German obstetricians.

The teachings of Credé are tending toward the entire letting alone of the genitals during LABOR and the days succeeding it. This dismality is present, does not make a vaginal tinguished obstetrician, unless some abnorexamination at all. He makes his diagnosis entirely by external palpation and manipula