we have no evidence of middle-ear exudation, and where the sound of the tuning-fork or watch is badly transmitted through the cranial bones, or when closure of the meatus makes no difference in the intensity of the note. So are those cases in which we have proof of oldstanding tubal closure and enervation, middle ear ankylosis and adhesions, with noises which have gradually increased until they have perhaps assumed intolerable proportions.

As to the treatment of tinnitus we may broadly say that the indications are (a) to restore equilibration in the middle ear and labyrinth; (b) to correct abnormal tension (excess or decrease) in the vessels of the tympanum and labyrinth; (c) to regulate general arterial tension; (d) to modify and control excess of reflex excitability and morbid central impulses; (e) to correct local causes of pressure, traction, irritation; (f) to restore tone to enervated tubal and tympanic muscles; (g) to promote healthful nasal respiration by attention to the nasopharynx, and to subdue congestive and inflammatory states of the naso-pharyngeal mucous membrane.-Dr. H. Macnaughton Jones, London Practitioner.

URETHRAL CALCULUS.-The patient entered the hospital service of Dr. J. Mason Warren (Boston) in 1865, at the age of four and a half, his parents having noticed frequent micturition for eighteen months, twelve times in twentyfour hours. There were increasing difficulty and pain in the passage of urine, which had contained blood for three months. There was no steady stream, but the urine dripped. He drew continually upon the end of the penis, which was large and inflamed. A stone was detected by sounding under ether, and the urethra was found to be unusually capacious. The stone was removed by Dr. Warren through a perineal incision, a lateral incision being made into the prostate, and a stone the size of a filbert was removed by stone forceps.

Twenty years later he returned with a stone in a pocket in the membranous or the anterior part of the prostatic urethra, and this was removed by Dr. Porter last month.-Boston Medical and Surgical Journal.

RE-PIRATORY CROAKING OF BABIES.-Dr. Samuel Gee has seen about a dozen cases of what he calls respiratory croaking in babies, and thus describes the affection: Breathing is accompanied by a croaking noise, which seemed to Dr. Gee to have the characters of stertor more than of stridor; or, in other words, the sound seemed to be produced in the fauces and not in the larynx. The croaking usually accompanies inspiration only; but in one of these

cases it accompanied expiration only. The noise is constant, both when the child is awake and when she is asleep; yet it may cease for a short time now and then. The tone of the cry is natural, and this is another reason for believing the noise not to be laryngeal. No dyspnea, no recession of chest-wall during inspiration. Fauces look natural. The noise continues when the nose is pinched. The croaking has nothing whatever to do with the crowing of laryngismus stridulus; the two disorders resemble each other in no respect, except that there is a noise produced in each. The ages of Dr. Gee's patients ranged from three to nine months. It is a remarkable fact that all of them were girls. The general health of some of the children was good, but most of them were weak and sickly. Two children suffered from congenital diseases of the heart, and one was an idiot. In some of the children this croaking began at or soon after birth, and in no case did it last much beyond the end of the first year. There is no special treatment; indeed, the disorder causes more annoyance to others than to the child herself.-London Practitioner.

JEJUNOSTOMY, RESECTION OF THE PYLORUS. Although the results in these two cases were not successful, there can be no doubt that jejunostomy, as it has been called, deserves further trial as a palliative measure, being less difficult than opening the duodenum, and not so dangerous as Wolfler's operation of gastro-enterostomy. Resection of the pylorus for cancerous disease has not gained any favor in this country. It is still occasionally performed by some German surgeons, and is advocated by Gussenbauer, who has recently reported a case in which the patient was living in good health three years after the operation. Attention has again been directed by Lauenstein, of Hamburg, to the risk in this operation of subsequent gangrene of the transverse colon, as a consequence of dissection and removal of considerable portions of the meso-colon that have become adherent to the malignant growth. Another danger to which Gussenbauer refers is the great difficulty in preventing, in the operation, the passage of the contents of the stomach into the peritoneal cavity.-British Medical Journal.

SUPRAPUBIC CYSTOTOMY. — The claims of suprapubic cystotomy as the preferable operation for the removal either of vesical tumors or very large calculi are the results of improved methods of procedure based on the experiments of Braune and Garson, and quite recently of Fehleisen, of Berlin. This last named author found, on examination of frozen bodies, that

while fluid distension of the bladder alone has very little influence on the prevesical fold of peritoneum, and while with considerable distension of the rectum, the bladder containing but a small quantity of fluid, the fold is raised to a point about one inch and a half above the upper margin of the symphysis pubis, when both bladder and rectum are fully distended, the prevesical fold is raised about three inches and a half above the symphysis. Fehleisen agrees with Petersen that, in the suprapubic operation, it is necessary to distend both bladder and rectum, but holds that it is necessary to inject much more fluid into the latter cavity. After the rectum has been distended by about four hundred and eighty cubic centimeters of water, an injection of about two hundred cubic centimeters into the bladder will suffice to raise the prevesical fold about one inch and a half above the top of the symphysis. The bladder is thus not only raised, but is also elongated in a vertical direction, rendered more accessible, and placed in the most favorable condition for direct surgical examination of its interior.—British Medical Journal.

CORROSIVE SUBLIMATE IN CONJUNCTIVITIS. Below (L'Union Médicale) has placed on record sixty-five cases of conjunctivitis (twenty-six simple, nineteen pustulous, two diphtheritic, two gonorrheal, and sixteen granular), in which solutions of bichloride of mercury (1 to 2000) were used. From the results of these observations, Below draws the following conclusions:

1. Under this treatment, the diminution of the secretion, both in chronic and acute conjunctivitis, and the decrease of the hyperemia, are more rapid than in the similar use of nitrate of silver.

2. Simple phlyctena, thus treated, disappears as rapidly as under the use of calomel.

3. The use of a weak solution of bichloride of mercury in spray yields good results as a prophylaxis of gonorrheal conjunctivitis in the new-born.

The sponging is practiced two to eight times. daily, and the inner surface of each lid is separately subjected to the action of the solution. Philadelphia Medical News.

PARALDEHYDE AS A HYPNOTIC.--Paraldehyde has been used in the Insane Hospital, at Norristown, Pa., in doses of fifty to seventy-five minims, whereby, in the majority of instances, a quiet sleep of two to seven hours has been induced in ten to fifteen minutes after its absorption. It seems to have no particular action upon either heart or respiration, as in natural sleep the subject is easily aroused, but soon drops off again when let alone. No

convulsive effect or dreamy stimulation of the mind has been observed, its effect being apparently upon the cerebral hemispheres. The only undesirable feature thus far observed is the disagreeable odor of the breath, which lasts twelve to twenty-four hours. It does not act as an anodyne.

Dr. Hodgson finds it especially useful over chloral in gout, as it helps to maintain the excretion of urine, well charged with its usual solid constituents. It is, however, objectionable in irritable or inflamed condition of the throat or stomach, being liable to aggravate these. It should be well diluted when taken, and the following is a good preparation for it: R Spts. chloroform..... Paraldehyde..... Syr. aurant... Mucilag. acacia,

tragacanthe,

.m.xv;

3j;

3iv;

q.s.ad. 3iij.

S. Take the above at bed-time. It may be repeated in an hour or two, if necessary.

It has been found better to repeat a small dose than to give it in single larger doses.Boston Medical and Surgical Journal.

IODOFORM IN GONORRHEA.-Dr. Oger (in Journal de Médicine de Paris) says:

The best results are attained when it is applied to the diseased parts in a very fine powder. In this form Timmermans has obtained excellent results. Iodoform being insoluble in water, he suspends, in two and a half ounces of water, sixty grains of the drug, rendered impalpable by previous solution in sulphuric ether. The mixture being well shaken, a small glass syringe is filled and injection practiced. As it is important that the iodoform come in direct contact with the inflamed mucous membrane, the urethra should be thoroughly cleansed by urination immediately before the injection is made. The patient should lie on his back, and the injection be made in a direction nearly vertical, gravity thus causing the powder to seek the lower part of the syringe, and thus favoring its introduction into the urethra when pressure is made upon the piston. When the syringe has been emptied, it should be gently withdrawn, and while the meatus is compressed by one hand, with the other careful pressure is made, so that every part of the passage is reached by the fluid, and the iodoform thus deposited upon the mucous membrane. After four or five minutes the fluid is permitted to escape gradually, in order to avoid the ejection of the iodoform. The operation should be repeated at least three times a day. Whatever is the stage of the disease a prompt result

is certain, as is shown by diminution of painthe iodoform evidently acting as an anesthetic to the inflamed parts. The character of the pus is also changed, and its abundance diminished. Cure is promptly obtained; in one case resulting in five days.

FRIEDRICHSHALL WATER IN THE TREATMENT OF HABITUAL CONSTIPATION.-"The mildness of the effect of Friedrichshall water in these cases," says Mr. A. S. Gubb (Medical Press and Circular, Nov. 11, 1885), "is, according to my own observations, well marked. The nonoccurrence of the reactionary constipation which so generally follows the habitual use of aperients is doubtless to be attributed to the large quantity of chlorides present in Friedrichshall water, and to their favorable influence on the progress of digestion and diffusion. The class of cases in which I have found this water of especial service comprises hemorrhoids accompanied by habitual constipation, hepatic congestion, and in the constipation of pregnancy, which is so often complicated by derangements of the digestion, headache, and dyspnea. It has long had a high reputation in the treatment of gravel and for the prophylactic treatment of renal calculi. It has appeared to produce a favorable impression in the numerous cases of strumous and glandular swellings, where we have to contend with a sluggishness of the bowels and of tisue-change generally. Here Friedrichshall water acts as a stimulant as well as an aperient. A certain diuretic effect which is manifested is not uncommonly of service in cases where it is desired to increase the proportion of watery constituents of the urine. To lessen venous congestion by gentle and continous means, Friedrichshall water is peculiarly indicated, and is perhaps without a rival."

TREATMENT OF CHOLERA.-Dr. John R. Burke, of Ireland, divides the subject into two parts-a, Prophylaxis; and b, Treatment, divided into four parts, according to the stages of the disease, namely, (1) malaise, (2) diarrheal stage, (3) rice-water stage and collapse, (4) reaction. The author suggested that the patient should lie on the right side on a bed, to be tilted to that side by blocks under the legs, to relieve internal organs, promote circulation in the liver, and help, by gravitation, to stop discharges, as also to let them drain away into disinfecting vessels, the patient being laid on a water bed or a water-proof sheet, with the edges turned up. Peritonitis being not now so much dreaded as formerly, it was suggested that non-irritating aseptic fluids should be allowed to gravitate gradually, as absorbed into the abdominal cavity, through a needle or cannula, strapped out

side transversely to the abdominal walls, to prevent injury by spasm of the rectum. This would allow fluids to pass direct to the intestines, and spare drain on blood-vessels and tissues. British Medical Journal.

TARTAR EMETIC IN THE TREATMENT OF CONSUMPTION.-Bucquoy (Gaz. des Hóp.) has been led by a number of successes to recommend this drug anew. At first he gives from a grain and a half to two grains and a quarter in the course of the day, restricting the drink in order to prevent vomiting. The daily amount is then reduced to three quarters of a grain, and its use is continued, with the result of diminishing the fever, increasing the appetite, overcoming constipation, allaying the cough, and reducing the expectoration. The only contra-indication consists in diarrhea and intestinal ulceration.-New York Medical Journal.

STRYCHNINE IN ACUTE ALCOHOLISM.-Lardier (Jour. de Méd. et de Chir. pratiques, June, 1885,) has long employed strychnine in the treatment of delirium tremens, for which he regards it as a specific. He insists upon the use of large doses. In one case he had for several days given

grain every two hours without any appreciable result. He then increased the amount, part of which he gave hypodermically, giving in all one grain and two thirds in twenty-three hours. The patient soon fell into a refreshing sleep, and there was not the slightest symptom of strychnine poisoning.

CELERINA. Dr. Nicholls, writing to the Medical Brief, says:

From my experience with celerina, I believe it to be a remedy that will meet the indications of all those cases where nervous prostration plays so important a part. I have used it in nervous headache, nervous dyspepsia, spermatorrhea, heart trouble dependent on disordered nerve action, and many other troubles dependent on an exhaustion of nerve force. and it has given a satisfaction I have found in no other remedy.

CASE OF AMYOTROPHIC LATERAL SCLEROSIS. At a recent meeting of the London Medical Society Dr. C. E. Beevor showed a woman, aged twenty-eight, who had been the subject of this disease for two years and a half past. It began in the right hand with weakness and wasting of the muscles of the thumb and interossei, and this soon extended to the other hand. There was now marked claw-like deformity of the hands. The tongue was also affected. The reflexes every where were greatly exaggerated.

Mr. Jonathan Hutchinson recently delivered a lecture before the Medical Society of London on certain problems in the natural history of syphilis problems concerning which there is still great diversity of opinion, and on whose final elucidation necessarily hangs somewhat of the prophylaxis as well as the treatment of this wide-spread affection.

Whatever Mr. Hutchinson says on any subject is entitled to more than ordinary attention because, in addition to a robust and eminently judicial mind and great innate love of truth, he has had opportunities for observation limited only by the power to use them. It is with great diffidence, therefore, that we venture to call in question the correctness of some of Mr. Hutchinson's observations, and the soundness of some of his deductions. But our experience in certain particulars has been so very different from his that we believe its record may, perhaps, serve to throw some light on the questions under discussion-questions which, it goes with out the saying, have long vexed the minds of students of syphilis every where. Mr. Hutchinson states that "the true chancroid on the

genitals is seldom seen, excepting in those who have had syphilis already." My own observation is almost the opposite of this. I can not, I think, be mistaken when I say that I have seen. many genuine local sores derived from other sores of like character, possessing all the accepted features of true chancroid, occurring on the genitals of individuals who not only had never had syphilis but who contracted chancroids during their first sexual act, and not one of whom ever developed a symptom of constitutional disease. I believe I have seen chancroids in newly married women who could by no possibility have ever had opportunity to contract syphilis, nor were these followed in any case by syphilis. I believe I have seen chancroids in married men who in one unguarded moment yielded to temptation, and sinned not again, who lived long lives without ever having one symptom of constitutional disease. I am sure I have seen sores with ragged edges, gray base, multiple, punched, affording abundant secretion and accompanied by suppurating buboes, themselves furnishing inoculable pus, that were derived from a man who had chancroids that I was treating at the time, and though neither individual admitted previous disease of any kind whatever, and both had been known to the writer professionally for years, and were seen daily long after the sores were well, neither ever manifested a single symptom of constitutional syphilis. The couple subsequently married the mother gave birth to many healthy children, and never had an abortion or miscarriage. A young man of good character and habits was engaged to be married. Two days before the celebration of the event some friends gave him a dinner; he drank much wine, and woke the morning after in a bawdyhouse. He had never had any form of ven ereal. He married; five days after he came to me with three chancroids on the lower edge of the prepuce. A week later I saw his wife, who then had several sores in the fourchette. Buboes which suppurated occurred in both cases. Legal separation of the couple soon followed. I continued to treat both; neither individual had one symptom of syphilis. They received local treatment only. They subsequently came together again. The woman in

due time became the mother of " a brace of lusty boys." She had neither abortion nor miscarriage, nor did she or her husband ever present one mark of syphilis.

I could add many similar examples from my own experience; and I feel that I hazard little in saying I could increase them enormously if I sought the experience of either my hospital colleagues or that of other practitioners in this city. These suffice, however, for my present purpose.

I believe that, in my own field of observation, the following statement of the connection between the chancre and chancroid would be almost universally received by my fellow-workers as true, to wit, that chancroid occurs in the great majority of instances in persons who have never had syphilis, and, BEING CHANCROID, is never followed by syphilis. When syphilis does occur as a result of what seems to be chancroid, the sore is or subsequently becomes chancre entirely independent of the chancroid; or, in other terms, both sores are derived from an individual who is the subject of both diseases, chancroid and syphilis the former, as is its unvarying history, showing itself within a few days after connection, while syphilis, always true to itself in this respect at least, shows itself as a chancre at a much later period. This is but another way of saying that these are "mixed

sores."

Mr. Hutchinson, with his accustomed candor, admits that the typical chancroid is sometimes seen in those who have never had syphilis." This, it seems to me, is a practical surrender of the question. Did Mr. Hutchinson ever see a typical chancre which was not followed by constitutional syphilis? He must have seen many typical chancroids which came, ran their accustomed course, disappeared, and left not one sign of constitutional taint. If he has not, then chancroids in England differ from chancroids in the United States.

We will resume this subject, touching on other moot points, at an early day.

Notes and Queries.

Editors American Practitioner and News:

HAIR ON THE EYE-BALL.-In your issue of January 7, 1886, page 30, appears a note under the title of "Hair on the Eye-ball." In April last Mr. Lance, a farmer who lives near, asked me to take some hair out of a calf's eyes. On examination I found the entire conjunctival surface of the lower half of the balls and lower lids covered with a thick growth of hair. In October, Mr. Howard, a farmer who also lives near, called my attention to a calf in his yard that had in each eye patches of hair, growing from the underside of the ball, the size of the thumb-nail. The hair itself was one and a half inches long.

TEASDALE, MISS.

C. H. TEASDALE, M. D.

INTERNATIONAL MEDICAL CONGRESS.-We have received an article on the International Congress, in which such gentlemen in the United States and the Canadas as withdrew from the Congress are characterized as "widemouthed soreheads," "monkeys," "parrots," "wild asses," "kangaroos" and "skunks." The author asserts that all "this noise and din about the Congress is but the expression of disappointed ambition on the part of a few conceited ourang-outangs."

At a recent meeting of the Philadelphia County Medical Society, there were 169 members who voted against the Congress, as at present organized, to 39 members who voted for it. for it. "Ourang-outangs" must abound in Pennsylvania. The communication is anonymous, and it is well for its writer that it is so.

NO INCREASE IN MEDICAL SCHOOLS AND STUDENTS DURING 1885.-In a pamphlet recently issued by the Illinois State Board of Health, entitled "Medical Education and Medical Colleges in the United States and Canada, 1865-1885," it is stated that the most suggestive facts revealed by a study of the tables and data presented are: First, that the number of medical colleges has not increased dur

medical students and of medical graduates is