meals, as muriatic, nitro-muriatic, or phosphoric. Certain bitters, as nux vomica and strychnine combined with gentian or calumba. An alkali a few hours after meals when there is great acidity, but should not be used too frequently. Dilatation of the Stomach: Treatment. Dry, solid food, under-done meats, no milk. Carbolic acid to allay fermentation. Wash out stomach occasionally. Strychnia hypodermically or by mouth.

Chronic Gastritis: Treatment. Cause to be removed. A scanty supply of food. Pepsin at each meal, five grains. Milk, with a little meat, may be taken as food. Oxide of silver one half grain a dose, will be found of value. Bismuth is useful. Avoid tonics, but use the mineral waters to keep portal system drained.

Gastric Pain (gastralgia): Treatment. Diet of little importance. Stimulus at meals in small quantities. Morphia relieves at once, but use it carefully. (1) Bismuth, with a little opium. (2) Nitro-muriatic acid, two to three drops, diluted, or

Fowler's solution, beginning with one drop and increase to five drops, ter die.

Hematuria. Treat the cause as well as the symptoms, though the treatment of both is generally the same. (1) Gallic acid in doses of ten to twenty grains, repeated every hour or two. (2) Sulphuric acid, alone or with gallic acid, unless contra-indicated by scarlet fever,

etc. (3) Fluid extract of ergot, twenty drops, increased to one fluid dram. All three of the above are reliable remedies.

Medical Treatment of Diabetes Mellitus. Do not use bromide of potassium; it is valueless. Quinine is of no use. Opium is of value, and is one of the best agents, but care should be taken in its use. Codeia, one fourth to one half ter die, is much used in France. Trousseau's plan with strychnia is very useful. The salicylate of sodium, ten to twenty-five grains ter die, in compound spirits of lavender and water, is Prof. Da Costa's favorite. Ergot is useful, but less so than the others. The alkaline plan, which is quite popular in Europe, is of value. Aloes or aloine should be used for constipation that may arise.

Diabetes Insipidus: (1) A course of iron for its tonic effects. (2) Strychnia is very useful. (3) Ergot gives the best results; absolute cures follow its use; one half to one dram of the fluid extract should be given ter die.-Da Costa in College and Clinical Record.

GUARANINE AND THEINE.-Dr. Thomas J. Mays, of Philadelphia, esteems these two articles as of great efficacy in certain affections. Guaranine is supposed to be principally ob tained from the seeds of Paullina sorbilus, which enter largely into the composition of a mixture called guarana. It is chemically identical with caffeine. Summary:

1. It affects both sensory and motor nerves; the former before the latter.

2. It paralyzes sensation and motion from the spinal centers, and not, like brucine and cocaine, from the periphery.

3. It produces hyperesthesia of the whole body, and after which convulsions.

4. Its convulsions are spinal and not cerebral.

5. It first increases and then decreases respiration.

6. It differs in its action from that of caffeine, in that it has a stronger affinity for sensory, and less for motor nerves, and that it is more analogous to theine in its action.

Two cases of sciatica were treated by guaranine, introduced subcutaneously:

Case 1. Injected one sixth of a grain of guaranine (Merck's) into the thigh, a little above the seat of greatest pain, and in four minutes the whole leg was relieved of pain.

Case 2. Had been a sufferer from sciatica for many months, and had passed through the routine medication for this disease without the least benefit. The first injection of guaranine relieved the patient entirely before she left my office, and three more injections cured her.

From my clinical experience with guaranine and theine I believe that they are identical in their effects on the human body, and by reason of the cheapness of theine (the price of guaranine is about six cents a grain, while that of theine is only forty cents a dram), I have used it exclusively of late, and with the most gratifying results. I find that from one third to one half of a grain, and even more, is tolerated with benefit. I hope that the profession will be led to give theine a speedy trial in sciatica, brachialgia, cervico-occipital, intercostal, and dorso-lumbar neuralgia, believing that it affords greater relief in these affections than any other single agent hitherto known in the materia medica.-The Polyclinic.

AMMONIA IN THE TREATMENT OF ANTHRAX AND CARBUNCLE.--The London Lancet states that Dr. Avendano read a paper before a Lima medical society, in which he testified to the great value of ammonia in anthrax and “carbunculous diseases," adding that it was a specific, and should be the only drug used. In cases of malignant pustule, after an incision

has been made, the official solution should be dropped into the wound, in the hope of its destroying the baccilli there, and of some of it finding its way into the blood before the bacillus does, so as to make it impossible for the parasite to multiply in that fluid. In addition, some salt of ammonium, such as the acetate, should be given internally, and, on the slightest suspicion of general infection, resort should at once be had to intravenous injections of ammonia, in doses of ten drops of the official solution with the same quantity of distilled water. In cases of malignant edema and carbunculous fever, too, "the microbe should be attacked directly in the blood, ammonia being injected into the circulation." Several successful cases were related.-New York Medical Journal.

IMPUNITY OF OPENING THE KNEE-JOINT. — Dr. H. B. Sands, Professor of Surgery, College of Physicians and Surgeons, New York, concludes an article in the Medical News on opening the knee joint as follows:

That which has most interested and gratified me in this and in several other severe operations I have performed, in which the knee-joint has been involved, is the impunity with which this articulation may be opened, and indeed somewhat roughly handled, provided antiseptic precautions are scrupulously observed. This fact was especially forced upon my attention in a case of old fracture of the patella, in which I wired the fragments, one year ago, in Roosevelt Hospital. The operation was performed in the usual manner, but the fracture was found to have been comminuted, and the fragments could not be brought into apposition without much difficulty, nor until the quadriceps muscle had been extensively and repeat edly cut, in order to obtain the necessary elongation. Meanwhile, the bleeding was free, the knee-joint was frequently sponged out and irrigated, and the operation was prolonged as well as severe; yet the patient recovered without an unpleasant symptom under the use of a single dressing; and when this was removed, at the end of eight weeks, I discovered that the wound had healed throughout by the first intention, and that neither suppuration nor adhesive inflammation had taken place within the joint, which had a limited range of motion. Such a case affords, according to my judgment, indubitable proof of the marvelous improvements in operative surgery which have been wrought by antiseptic methods; and, when I see it stated in a standard American text-book, published only three months ago, that "the alleged superiority of the antiseptic method can not be said to have been as yet demonstrated," I am amazed at the author's incre

dulity. Even among those who practice antiseptic surgery, however, some hesitation is occasionally felt about opening the larger joints, and operations involving the healthy knee-joint are at present regarded by many with the same kind of apprehension which, not many years ago, deterred surgeons from invading the peritoneal sac. The latter procedure is, as we now know, reasonably safe, and I can not doubt that the operation of opening the knee-joint is already, when properly performed, far safer. I confidently anticipate the time when skillful and careful surgeons will be able to divest it of all danger either to life or limb; and, whenever this period arrives, our time-honored, but clumsy, tedious, and uncertain method of treating both fracture of the patella and rupture of its ligamentous attachments may well be abandoned in favor of some form of operation calculated to secure an immediate union of the divided parts.

GASTRO-ENTEROSTOMY.—A woman was recently admitted into University College Hospital, suffering from symptoms of pyloric obstruction. As a very mobile tumor could be felt in the situation of the pylorus, an exploratory laparotomy was performed by Mr. Arthur E. Barker. The new growth was found to extend too far along the lesser curvature to permit excision of the whole tumor and pylorus, and a palliative operation was therefore performed. A loop of the jejunum was picked up, and an opening one and a half inches long made in it; an opening of similar dimensions was then made in the stomach, and the two stitched together. In this way, a short cut was provided by which the chyme could pass from the stomach into the jejunum without traversing the diseased structures. The patient bore the operation well, and was able to take food by the mouth five days after the operation. Fourteen days after the operation she was completely convalescent, and expressed herself as greatly relieved.-British Medical Journal.

KIDNEY.--The relationship of nephritis to various acute diseases has been now well established, and its occurrence as a sequela of scarlatina and typhoid is commonly recognized, but Dr. Högyes has shown that it may occur after varicella. The unity of Bright's disease has received further support and confirmation from Ducini. Langhaus has published the results of further researches on the changes in the glomeruli in nephritis. According to him, in or dinary nephritis, the glomeruli and tubules are equally affected. In nephritis after measles and scarlatina, the glomeruli are almost exclusively affected; while in the nephritis of icterus

and some toxic conditions, the kidney-lesion is almost exclusively confined to the tubules. D'Espine has found that there is a great accumulation of potassium-salts in the blood during attacks of uremic eclampsia; and his results afford some support to the views of Feltz and Ritter, who attribute uremia mainly to this cause. Professor Salvioli has been able to determine hydremic edema in dogs by ligaturing the renal and mesenteric vessels before injecting the saline solutions; and his investigations lead him to the conclusion that the localization of the edema in subcutaneous tissue in the hydremia of nephritis in man is due. mainly to the function and structure of the human skin. Kottmayer has shown pretty conclusively that the precipitate formed by mercuric chloride in urine, which does not contain albumen with ordinary tests, probably consists of mercuric urea.—Ibid.

COMMA-BACILLUS.-A committee, with Sir William Jenner for President, and Sir William Gull, Dr. Burdon Sanderson, Professor de Chaumont, Sir Joseph Fayrer, and other experts for members, convened to consider the report of Dr. Klein and Dr. Heneage Gibbes, arrived at the following conclusions, which, it will be observed, disagree very importantly from those announced by Dr. Koch:

1. Comma-shaped organisms are ordinarily present in the dejections of persons suffering from cholera, but not in the blood, the intestinal mucous membrane, or any other tissue.

2. Comma-shaped organisms of closely allied morphological appearances are ordinarily present in different parts of the alimentary canal in health, and are developed in an unusual extent in certain diseases in which there is copious intestinal secretion; the predominant form in any given case depending in great measure on the nature of such secretion.

3. The comma-shaped bacilli ordinarily found in cholera do not induce that disease in the lower animals, and there are no real grounds for assuming that they do so in man.

4. Sanitary measures in their true sense, and sanitary measures alone, are the only trustworthy means to prevent outbreaks of the disease, and to restrain its spread and mitigate its severity where it is prevalent.-British Medical Journal.

TUBERCLE BACILLI.-A writer in the British Medical Journal, after examining the sputa from a large number of cases of chest disease for tubercle bacilli with Gibbs's double stain, says:

The absence of tubercular bacilli from any sputum, when tested on several different oc

casions, is no proof that such bacilli do not exist in the lung. For, unless there be considerable disintegration of pulmonary tissue and free communication with a bronchus, the tuberculous debris may not be expectorated. Even a comparatively large cavity may be formed in the extreme apex, and it may, post-mortem, furnish tubercular bacilli in great abundance, yet during life the cavity may never have been evacuated; clinically, the only signs may have been dullness and a few large rales; and the bacilli may never have been present in the sputa. This is doubtless due to the situation, to the loss of elasticity in the pulmonary tissue, and to the frequent cicatrical contractions. A similar retention of tuberculous matter in the lower portions of the lung (where the expulsive efforts of coughing take greater effect) may be met with in the insane, in cases of advanced phthisis unaccompanied by cough.

DIAGNOSIS OF GONORRHEA IN THE FEMALE. Dr. Martineau claims that a specific may be distinguished from a simple vaginal discharge by the simple expedient of using a piece of litmus paper. In the specific form the reaction is always acid, while in the simple form it is always alkaline. The same test is also of value in cases of rape in deciding whether the person who committed the crime was then suffering from gonorrhea, as the vaginal discharge proceeding from this cause would be acid.

TREATMENT OF FRECKLES WITH CARBOLIC ACID. Dr. Halkin's procedure is as follows: The skin, being washed and dried, is put on the stretch with two fingers of the left hand, and a drop of pure carbolic acid is applied exactly over the patch. When it dries the operation is completed. The skin becomes white, and the slight sensation of burning disappears in a few minutes. The thin crust which forms after the cauterization should not be disturbed; it detaches itself spontaneously in eight or ten days, leaving a rosy coloration, which is soon replaced by the normal color of the skin.

SUGAR.-Nylander recommends the use of the alkaline bismuth solution as a test, the reduction to which Fehling's solution is subject from the presence of such bodies as uric acid, kreatinin, etc., not affecting its accuracy as an indicator of sugar. The solution recommended is thus prepared: bismuth subnitrate, two grams; Rochelle salts, four grams; soda solution (eight per cent caustic soda). Filter. It is to be added in the proportion of one to ten of urine; 0.025 gram of glucose is easily detected. If albumen be present, it must be removed.--Ibid.

CONTAGIOUSNESS OF VARIOLA AT THE BEGINNING OF THE ERUPTION.-Lancereaux reports three cases occurring in his hospital service, in which smallpox was transmitted at the beginning of the eruption. From these facts he draws the conclusion that variola may transmit itself on the first or at least the second day of the eruption, since the smallpox patient admitted by mistake in the hospital was transferred two days after the appearance of the eruption. This is, however, not the opinion commonly admitted. An English physician of great celebrity, Herberden, following the citation of Dezateux and Valentine, asserted that he was in possession of facts demonstrating that smallpox could not be communicated until after the second or third day of the eruption, and that persons who had never had it might, up to this period, sleep with those who had it without risk of taking it.-Bul. de l' Academie de Médecine.

URETHAN AS AN HYPNOTIC.-In the clinic of Riegel in Vienna, urethan has been given in a variety of cases, with the object of testing its action as a soporific. In chronic weakly conditions, and in heart-cases uncomplicated by excessive cough or dyspnea, it was found to produce sleep in from one quarter to half an hour. During sleep the tendon and other reflexes are unchanged, the pupils reacting to light; on waking, there is no heaviness or drowsiness. The doses given, in twenty-seven cases with sixty-seven administrations, varied from one to four grammes. It is concluded that urethan is useful as a "pure hypnotic," but that it can not replace morphine in the relief of pain of cardiac dyspnea.-British Medical Journal.

ICHTHYOL.--Dr. Lorenz recommends ichthyol in a variety of cases. In a thirty-per-cent solution, it relieves the severe itching of senile prurigo; for pruritus, a weaker solution is used, namely, ten per cent. As an application to slowly granulating burns and ulcers, he has had excellent results; and internally, in doses of four tablespoonfuls of a one-per-cent solution in the day, he has relieved the symptomsvomiting, etc.-of catarrh of the stomach.Ibid.

TUBAL PREGNANCY.--Mr. Lawson Tait has reported several cases of tubal pregnancy, in which the fallopian tubes had ruptured, and in which he opened the abdomen, removed the dilated ruptured tubes, tied the pedicle, and closed the abdomen. Of nine cases of this kind all recovered, except one. The bold treatment adopted by Mr. Lawson Tait in these cases has

been so successful that obstetricians generally will not hesitate in future to follow the same line of treatment.-Ibid.

SANTONIN IN AMENORRHEA.-W. Whitehead, F. R. C. S. Eng., F. R. S. Edin., Surgeon to the Manchester Royal Infirmary, prescribed ten-grain doses of santonin to he taken for two consecutive nights, and to be followed each morning by a seidlitz powder. No worms made their appearance, but a few days afterward, menstruation, which had been in abeyance for several months, occurred. Santonin in amenorrhea, and in many cases after the permanganate of potash has been tried in vain, and in chloro-anemia, subordinate to amenorrhea, appears to be of the most signal value. With the return of menstruation, or a discharge of blood from the vagina equivalent in effect, every symptom has rapidly subsided.-London Lancet.

STRYCHNINE AS A PREVENTIVE OF POSTPARTUM HEMORRHAGE.-Mr. Holclough Hoey, Assistant Master, Coombe Lying-in Hospital, Dublin, writes to the British Medical Journal:

I can answer from experience as to the efficacy of strychnine combined with ergot in postpartum hemorrhage. I have seen cases of severe bleeding, in which the uterus was large and relaxed, completely controlled within five or six minutes after this drug being administered.

MEDICATED VAGINAL TAMPONS. -At a meeting of the British Gynecological Society Dr. Fancourt Barnes showed some medicated vaginal tampons composed of absorbent cottonwool and elastic fibre enveloped in sublimated gauze. In the center of the wool is a small hermetically sealed glass capsule containing a drug in concentrated form. Before applying the tampon to the vagina, the capsule containing the drug is broken by pressing the tampon between the finger and thumb, thus liberating the contents, which diffuse themselves through the tampon. In this way iodoform, cocaine, eucalyptol, or any other drug, can be preserved intact and ready for use until required.-Ibid.

TREATMENT OF PSORIASIS-In psoriasis Dr. Guibout prefers the oil of cade, having it well rubbed in, and ordering soda baths every day or so, this treatment to be continued until the pigmentation due to the disease has disappeared. If, for any reason, he can not use the oil of cade, he employs a five to fifteen per cent pyrogallic-acid ointment, having it applied twice a day, and directing the patient to take a daily bath.-Gazette des Hôpitaux.

ALBUMINURIA TREATMENT.--There is good reason to believe that sometimes the access of interstitial nephritis is marked by an attack of acute renal dropsy, in the same way that fibroid phthisis may begin with an interstitial pneumonia, and osteo arthritis with an acute illness very closely resembling ordinary rheumatic fever. But I know no means by which a certain diagnosis can be made in the acute stage, nor, supposing this to be possible, any indication for a line of treatment differing from that of acute parenchymatous nephritis, although of course the issue of the case would be much less satisfactory.

Chronic albuminuria (interstitial nephritis) is essentially a chronic disease. For many months, sometimes even years, it is often difficult to persuade the patient that his condition is one of serious, though it may be remote, danger. The indications for treatment, so far as the kidneys are concerned, are practically the same as in the acute forms of nephritis; but in fulfilling them we have a slightly different end in view, and there are certain special complications, particularly the vascular changes, against which we have it in our power to take certain special precautions.

In the earlier stages we have, not to relieve our patient from urgent though temporary symptoms, but to enable him to live with as little strain as possible upon the excretory functions of the kidneys. Diaphoretics, purgatives, and a carefully-regulated diet, especially as regards the amount of albumen con tained in it, are still the chief factors in our treatment; but they have to be employed continuously for long periods, and consequently their activity must be carefully adjusted, so as not to be followed by the exhaustion of the organs to which they are directed. It is impossible to lay down any rules equally applicable to all cases, or even to the same case at different periods. Each must be carefully. studied, and the details of treatment directed by the individual peculiarities of his constitution. One may get more relief from judicious use of purgatives, another from that of dia phoretics. In fact we have to ascertain on what organ or function we can best rely for the discharge of an extra amount of daily work supplementary to that of the kidneys. Hot air baths, or Turkish baths, must be employed, but not very frequently; and the use of purgatives must not be such as to be followed by constipation. If the liver, as often happens, is involved in the same fibroid change, a five or six weeks' course of ammonii chloridum, provided always that it does not set up gastric trouble, is often of great service. I believe, indeed, that it is well worth while to try it, even

when no change in the liver can be detected. We have to keep the general health as perfect as possible, but to do so without losing sight of the damaged state of the kidneys. Change of air, if possible to the sea-side, or a sea voyage, are potent for good, if the patient has sufficient self-control to avoid their special risks. The vascular and cardiac changes require treatment of a different kind, which, however, must not be pushed so as to endanger the general health. We have it in our power to diminish the intra-arterial tension from time to time, and in proportion to the degree in which this is accomplished we shall retard the development of that arterial degeneration and left ventricle hypertrophy which are such fatal elements in the disease.

On the whole, nitro-glycerine seems to be the best drug to employ for this purpose; but in the dose and in the frequency of its repetition we must be guided by the effect. Perhaps nitrite of potassium in small doses might also be given, but I have no experience of its use in chronic Bright's disease. There is one drug which demands special mention, for it is sometimes most valuable, sometimes most dangerous, viz., iron. One of the best cardiac tonicsI had almost said cardiac foods-it finds its proper place in the earlier periods of the disease. Then, by improving the nutrition, and thus increasing the vigor of the heart, it enables a comparatively small amount of muscular tissue to exert a large amount of force, and thus delays the advent of serious hypertrophy, and the greater the degree of hypertrophy the nearer is degeneration, with all its hopeless consequences. But toward the end of the disease, when the heart is already greatly hypertrophied, and the arteries degenerated and brittle, the incautious administration of iron gives to the contraction of the heart a power which the weakened vessels are unable to resist, and thus directly brings about cerebral hemorrhage, one of the most frequent terminations of chronic albuminuria.

Albuminuria dependent upon lardaceous disease of the kidneys may unfortunately be dismissed in very few words. Whatever be the case with interstitial nephritis, lardaceous change is always secondary to some pre-existing malady, and, except so far as it embarrasses the management of that malady, admits of no special treatment. Further, the change generally involves many other organs, some of them not less vital than the kidneys. Whatever its cause may be-syphilis, protracted suppuration, malaria, or exhausting discharges of almost every kind-it is that cause which we have to treat. The most hopeful form is the syphilitic, and in that I have seen great