THE CONTAGIOUSNESS OF CHRONIC GONORRHEA --A. Neisser writes that the chronic urethral discharges denoting gonorrhea are uniformly the result of the true form of that disease, but are not invariably of a gonorrheal nature, that is, they are not infectious. The absence or presence of the gonococcus decides for or against the gonorrheal character of the secretion. The investigation must be thorough. The gonococcus was found by Neisser in eighty out of one hundred and forty-three cases. Practically the matter to decide in each case is (1) whether there are deep ulcerations of the urethra, (2) whether gonococci are present. These two questions decided in the negative, all active therapeutic measures are to be discontinued; if they are present they are best combated by means of irrigation of nitrate of silver, one to two parts in three thousand. As soon as they disappear recourse is to be had to astringents. The use of balsam copaiba is not to be entirely rejected because it has a strong antiseptic action on the discharge.Deutsche Med. Zeitung. Abstracts and Selections. THE TREATMENT OF CHRONIC CATARRHAL GASTRITIS. Dr. Francis Delafield, President of the Association of American Physicians, made chronic catarrhal gastritis the subject of his address. He spoke thus of the treatment of this distressing affection : In attempting to establish a satisfactory treatment for chronic gastritis, it is important to state as clearly as possible the problem to be solved. First, we must remember that all patients that suffer from gastric symptoms do not necessarily have chronic gastritis. Besides those who have functional disturbances of the stomach, or cancer or ulcer of the stomach, we find many others in whom gastric symptoms are due to diseases of other parts of the body. Anemia, uterine disease, the neurotic and hysterical condition and constipation often behave in this way. In old people the function of gastric digestion is often impaired simply as a result of old age. To each one of these conditions belongs its appropriate treatment, but it is not the treatment of chronic gastritis. Still further, we must remember that in many cases of gastritis palliation of the symptoms is all that we can hope for. This is true of the gastritis associated with heart disease, emphysema, phthisis, cirrhosis, Bright's disease, gout, rheumatism, and alcoholism. It is also true of the cases in which the inflammation has gone on to the destruction of the peptic and mucous glands. After excluding all of these there remains a large and important group of cases of chronic catarrhal gastritis, in which we may hope not only to alleviate the symptoms but to cure the disease. It is evident from the nature of the disease that any treatment intended not merely to palliate, but to cure, must be of long duration, and that it must be repeated from time to time when the inevitable relapses occur. The different plans of treatment which may be adopted are: (1) The curative treatment of climate and mode of life; (2) the regulation of the diet; (3) the administration of drugs, and (4) the use of local applications directly to the inflamed membrane. I believe climate and mode of life offer the most certain means of curing chronic gastritis. It is unnecessary to lay down rules as to the sort of climate. The two points of importance are, first, the locality selected must be one where the patient can live an out-of door life; and second, the patient must live in this climate, either for several years or for a considerable part of each year. The regulation of the diet is a matter which demands consideration in every case of chronic gastritis. In trying to ascertain the best way of feeding these patients, I have found only one satisfactory method, and that is to feed them experimentally with different articles of food, and then, after an interval of several hours, wash out the stomach and see how thoroughly these articles of food have been digested and removed from the stomach. After pursuing this course for a number of years, I have arrived at the following conclusions: It is necessary that the patient should be well fed, a starvation diet never answers. The stomach does not require any rest from the performance of stomach digestion, on the contrary, it is all the better for being called upon to perform its natural function. The patients' own ideas as to what agrees with them are usually erroneous. They are apt either to starve themselves or to select the least nutritious articles of food. The use of artificially digested foods, or of substances such as pepsin to assist stomachic digestion, is unnecessary. The starches, oatmeal, cornmeal, bread, the cereals, the health foods are, as a rule, bad. Portions of them remain undigested in the stomach for many hours. Milk in adults is an uncertain article. It answers very well for some persons, not at all for others. Meat is usually readily and well digested, but there are occasional exceptions to this rule. Vegetables and fruits can be eaten, but the varieties must be selected experimentally for each patient. I do not believe that any case of chronic gastritis is to be cured by diet alone. Even the exclusive milk diet, while it often relieves symptoms, is, as a rule, only temporary in its effects, so that the patient simply loses a certain amount of time by employing this instead of more efficacious plans of treatment. The advantageous use of drugs belongs to the earlier stages of chronic gastritis. At that time they often palliate symptoms, and sometimes even seem to cure the inflammation. In the latter stages of the disease their use becomes more and more unavailing. Yet the reliable drugs for this purpose are not numerous. The preparations of soda, potash, and bismuth, the mineral acids, glycerine, some times carbolic acid, sometimes iodoform, sometimes the bitter infusions. If none of these answer, it is hardly worth while to look any further. If we can combine with the administration of drugs the regulation of the diet and of the mode of life of the patient, then, of course, our chances of success are much greater. The use of local applications made directly to the mucous membrane of the stomach. This I regard as the most efficacious plan of treatment for those patients who are not able to leave home and seek a proper climate, but ask to be relieved without interruption to their ordinary pursuits. The local applications are readily made by the introduction of a soft rubber tube through the esophagus into the stomach. Liquid applications are the best. They should be made in such quantities as to come thoroughly into contact with the entire surface of the mucous membrane, although the pyloric end of the stomach is the region where the inflammation is principally situated. They should be made at a time long enough after eating for the stomach to be as nearly empty as possible For many cases warm water alone in considerable quantities is the only local application needed. In some, however, there is an advantage in medicating the water, and for this purpose I employ a variety of substances. The alkalies, the mineral acids, bismuth, carbolic acid, the salicylates, iodoform, belladonna, ipecac, gelsemium, may each one be employed according to the particular case. For the first week it is often necessary to put the patient on a milk diet, and this can be done even with those patients who, under ordinary circumstances, can not take milk at all. Then after a time, to the milk we add one solid meal composed of meat alone. Next, this single meal is increased by the gradual addition of fruits, vegetables, and bread. Then comes the giving of two solid meals a day, instead of one; then three solid meals, and now we get rid of the milk, in part or altogether. For the first week of this treatment it is wise not to expect any special improvement. Indeed, even a longer time than this may try the perseverance of the physician and the confidence of the patient. Sooner or later, however, the expected improvement begins; the nausea and vomiting cease, the constipation or diarrhea is improved, the flatulence is no longer troublesome, the headache becomes less frequent, and, of more real value than these, the improvement in the general condition of the patient becomes evident. The color, the weight, the appetite, the sleep, the spirits of the patient, all show a change for the better. Of all the symptoms, the pain is the one which is apt to persist the longest. For two or three months the patient has to be kept under observation, and the applications to the stomach made by the physician. After this the patient is dismissed, but continues the treatment himself, first every other day, then twice a week, then once a week for several months. The regular relapses of the disease are managed in the same way, but are much more quickly relieved. TREATMENT OF TYPHOID FEVER.-Dr. F. Peyre Porcher, of Charleston, S. C. From & paper read on this subject before the Association of American Physicians, we make the following abstract: He described a method of treatment which he considered very satisfactory. As in all cases of high temperature there is costiveness, the result of the arrest of the intestinal secretions, he recommended a mild laxative at the beginning of the treatment. Any laxative may be employed. The following combination is useful: latter element of the treatment. In reducing the temperature the speaker had resort to the use of ice-cold water, which was applied to the head, hands, and arms by the use of towels wrung out of the water and reapplied as frequently as necessary. The applications are continued for ten to fifteen minutes, until the heat of the skin is reduced. The use of baths was considered objectionable on account of the difficulty of their application and on account of the prejudice against them. He prescribes for internal use a fever mixture prepared thus: B. Potassii acetatis........ Liquor amonii acetatis..... zi; zi; .3ss; .3ss; ...3iv. Sig: A dessertspoonful in a little water every two hours so long as the fever continues. Morphia or the bromides may be added to the above preparation. It may also be employed in other fevers. Hot pediluvia may also be employed. In malarial cases quinine and arsenic are employed. Later the mineral acids are added. With reference to the use of stimulants, these may be continued as long as the tongue is dry. Oil of turpentine is often called for on account of tympanitic distension of the abdomen. It is also of value as an astringent and as a general stimulant. The speaker had treated thirty cases in private practice in this manner. Three died. In these cases there were causes sufficient to explain the fatal termination. Dr. James Tyson, of Philadelphia, described a case in which, to reduce the temperature, he wrapped the patient in a sheet which was kept constantly wet with ice-water. This was entirely successful. In this case both antipyrin and thallin were employed; but although they promptly reduced the temperature, it soon returned to its original position. When it is necessary to keep the temperature continuously reduced, he considered some modification of the cold pack is the best method. Dr. James T. Whittaker, of Cincinnati, remarked that we should not lose sight of the possibility that the high temperature may be nature's way of getting rid of the poison. It has been found that the virulence of the typhoid fever bacillus can be reduced by heat. It is also possible that the changes formerly attributed to heat may be due to bacilli. Dr. E. Darwin Hudson, of New York, said that when he assumed his duties at the Bellevue Hospital he found a simple and successful plan of treating typhoid fever in vogue. He was confident that under that treatment the successes among the pauper patients in that institution are greater than among the private practice of many physicians. The treatment is almost negative, consisting in sponging the patient every two hours during the continuance of the temperature above 102.5°, and adherence to an absolute milk diet. The only other measures employed are those directed to the relief of special symptoms occurring in the course of the disease. Dr. Samuel C. Chew, of Baltimore, had employed with success quinia by hypodermic injection in order to reduce the temperature. It seems to have almost a specific action when used in this way. He used a solution of the hydrobromate, in which 20 minims represented 4 grains of the drug. Dr. William H. Draper, of New York, remarked that there is perhaps nothing more fallacious than statistics in typhoid fever. Cases of fever not truly typhoid are confounded with typhoid fever. All have seen cases in which there was a continued fever, but in which the temperature did not run the typical course. In such cases we have no evidence that they are cases of typhoid fever. Experience shows that the value of antipyretic treatment in typhoid fever may be readily overestimated. In the majority of cases the value of antipyretics is not so much in reducing the mortality as in affording comfort to the patient. That it does do this, no one can doubt. The mortality of typhoid fever in the majority of cases depends upon conditions over which a reduction of the temperature would have no influence. He Dr. William Pepper, of Philadelphia, said that we have statistics showing the normal course of typhoid fever, which would make us slow to accept a mortality of 15 or even 10 per cent as evidence of much success. thought it doubtful if the normal mortality would be over 15 per cent under good nursing. Successes vary. He had treated a series of 104 cases without a single death, and again he had treated 20 cases and lost 5. It is evident that in typhoid fever we have different sorts of fevers, and a remedy applicable to one set of cases may not be to another. An excellent rate of mortality may be secured by absolute rest from the first moment of suspicion, and a rigid diet of milk or milk diluted. In addition he believed that the abstraction of heat is of great value. He thought that some remedy directed to the constant and important lesion of typhoid fever aids in reducing the temperature. His own preference is for the salts of silver. If the case comes under observation early, is put at absolute rest, receives proper treatment, the mortality should not exceed 5 or 6 per cent. In private practice he believes that it can be kept down to this. HEADACHE IN CHILDREN. Dr. Sturgis (Boston Medical and Surgical Journal) describes and treats the recurrent variety of this affection as follows: It is not uncommon to see children complaining of headache, whose general health is apparently good. Such children usually are troubled with headache more or less severe, recurring at intervals of days and weeks, and each attack lasting from a few hours to a day or more. You will generally find that the child has been subject to those headaches for a year or more before treatment is sought for this particular symptom. As a rule, it will be noticed that the patients are of nervous temperament, that they do not sleep well, that they grind their teeth at night, and frequently suffer from bad dreams and nocturnal terrors. Frequently these children will have a spasmodic cough, particulerly at night, even if there be no signs of pharyngitis or laryngeal irritation to account sufficiently for such cough. It may be noticed that the child has difficulty in keeping its hands quiet, that if told to keep standing quietly it will constantly change its weight from one foot to the other. temper the child is apt to be fretful. Nothing particular is to be noticed about the face with the exception of a peculiar heavy expression about the eyes. This expression is noticed in people with migraine, and also in any depressing illness. Dr. Warner, after careful examination, thinks this expression is due to lack of tone in the orbicularis palpebrarum, giving "an appearance of flabbiness about the lower eyelid; the skin hangs too loose, with an increase in the number of folds, and in place of falling neatly against the lower eyelid as a convex surface, it falls more or less in a plane from the ciliary margin to the lower margin of the orbit, a condition often best seen in profile." This heavy expression about the eyes is not noticed in all cases of recurrent headaches. In These headaches generally come on in the morning, though the child may be perfectly well on going to bed the night before. The pain is generally localized in some particular part of the head, either side, frontal region, or vertex. The pain is severe during the seizure, usually preventing study or play. It is not unusual for there to be optical illusions of sparks, or bands and spots of color. There may or may not be nausea during the attack. The child generally feels cold, and in winter prefers to lie near the stove huddled up in a chair. Since 1882 I have seen sixteen cases of recurrent headache. At first, I spent a long time unsuccessfully in trying to relieve the patient by attention to diet and hygienic surroundings; by general tonic treatment and the exhibition of citrate of caffein and guarana. At last, remembering what Niemeyer calls the "fanciful hypothesis of Du BoisReymond and Möllendorf," that the pain may be due to excitement of the terminal sensory filaments of the fifth pair by dilatation of capillary blood-vessels of the dura mater, I thought I would use ergot for its effect on the circulation through the arterioles. The results have been highly satisfactory. The longest time required to free a patient from the attacks has been four weeks. In one case two doses of ergot gave relief. It has been my practice to give Mx of the fluid extract three times daily after meals, and to continue the treatment for two weeks at least after disappearance of pain. I generally have used ergot alone, but in one case combined it with iron. Dr. Eustace Smith uses strychnine in combination with ergot. SPONGE-GRAFTING IN THE MOUTH.-In the address on Dental and Oral Surgery, before the late meeting of the American Medical Association, Dr. John S. Marshall, of Chicago, speaks as follows of this procedure: This subject of sponge-grafting has for the last two or three years been receiving considerable attention by way of experimentation from specialists in dental and oral surgery; but operations in the direction of restoring lost tissue in the mouth by this means, have until lately met with very limited success. During the last year mnch better results have been obtained, consequent largely upon the improved methods in preparing the sponge, in protecting it against septic influences after being placed in position, and in lessening its liability to become displaced. Much greater difficulties have to be overcome in using the sponge-graft in the mouth than upon the external surfaces of the body. In the latter the usual antiseptic dressings are all that is needed to protect the sponge and wound from the entrance of micro organisms, and to retain it in position; while in the former no such dressings can be employed, as they immediately become saturated with the oral secretions and fouled by the introduction of food into the mouth. The sponge also needs to be prepared in such a manner as to render it as nearly permanently antiseptic as possible, for the reasons just mentioned. The method generally followed in preparing the sponge for grafting is that introduced by Dr. Edward Borck, of St. Louis, viz., to remove all the earthy matter that might be contained in the sponge by placing it in dilute hydrochloric acid, and then, after washing it, to render it antiseptic by treating it in iodoform dissolved in sulph. ether, the sponges afterward to be dried and excluded from the air by being placed in tightly corked bottles. Sponges, however, prepared in this manner, if kept for any length of time, shriveled, became soft, and soon disintegrated, thus rendering them useless, and making it necessary to prepare a fresh sponge for each case. To Dr. Wm. H. Atkinson,* of New York, belongs the credit of suggesting an improvement in the preparation of the sponges and in the means of retaining the graft in position. He says, "choose fine surgeons' sponges, free them from foreign elements," and then place in a "sterilizing solution made by adding one grain of bichloride of mercury to one ounce of distilled water," and then raise the temperature to 130° F., and maintain it at that degree for from ten to thirty minutes. He adds a word of caution in regard to the heating of the sponges, for if the temperature is allowed to go much above 130° the sponge is likely to be spoiled, for albumen begins to coagulate at 133°, and is cooked if it gets beyond 163° to 164°, and is then "not fit to be wrought into tissue." Sponges treated by this method can be kept for an indefinite period if placed in the above sterilizing fluid and excluded from the atmosphere. The methods which he suggests for protect ing sponge-grafts in the mouth from the dangers of being displaced by mastication or in cleansing the teeth, etc., is to form a splint from thin platinum plate, which shall cover the parts and be closely adapted, and at the same time free from pressure over the graft. The class of operations in which Dr. Atkinson has been most successful, are closing the pus-pockets resulting from pyorrhea alveolaris, the reproduction of lost alveolar and gum tissue, and the healing of chronic alveolar abscess. Few operations in the mouth outside of these just mentioned have yet been attempted, but there is every reason to believe that with care and skill, perforations of the hard and soft palates, the result of surgical operations, injuries, or specific disease may be successfully closed by it, and lost parts in other locations of the mouth and face more or less completely restored by the same means. The success of the operation, however, when made in the mouth will depend very largely upon our ability to prevent the contamination of the sponge with septic organisms. This in most cases may be accomplished by frequently and freely washing the parts with peroxide of hydrogen, followed by the bichloride solution, 1 in 1000. *Transactions American Dental Association, 1885, p. 149. THE BACILLUS OF TYPHOID FEVER.-Dr. George M. Sternberg, U. S. A., read a paper on this subject, giving the result of the latest investigation: Recent researches support the view that the bacillus described by Eberth in 1880, bears an etiological relation to enteric fever, although the final proof that such is the case, is still wanting. This proof would consist in the production in one of the lower animals of the specific morbid phenomena which characterize the disease as it occurs in man, by inoculation of a pure culture of the bacillus. Thus far we have no evidence that any one of the lower animals is subject to the disease as it occurs in man; but Fraenkel and Simmonds have shown that the bacillus of Eberth is a pathogenic organism, and that pure cultures injected into the peritoneal cavity of mice or into the circulation of rabbits causes the death of these animals, and that colonies of the bacillus are found in the spleen which resemble in every respect the colonies found in the spleen and other organs of typhoid cases. The researches of Eberth, Meyer, Gaffky, Fraenkel, and others, indicate that this bacillus is constantly present in the intestinal glands and in the spleen of typhoid cases, and Gaffky has shown that pure cultures may be obtained from the spleen, even in cases in which a microscopical examination fails to demonstrate the presence of the characteristic colonies. The researches of Brieger show that a toxic ptomaine is produced as a result of the vital activity of Eberth's bacillus when it is cultivated in albuminous culture media. This, injected into guinea-pigs, causes salivation, diarrhea, debility, dilated pupils, rapid respiration, and death at the end of twenty-four or forty-eight hours. Demonstrated facts relating to the propagation of typhoid fever indicate that it is due to an organism which is capable of multiplication external to the human body in a variety of organic media at comparatively low temperatures. Eberth's bacillus complies with these conditions. In consideration, therefore, of its constant presence and the absence of any other organism, as shown by microscopical examination and culture experiments, the inference seems justifiable, in the present state of science, that this bacillus bears an etiological relation to the disease in question. NATURE AND CAUSE OF INTERNAL ROTATION.-Dr. D. Berry Hart thus formulates a law governing the internal rotation of the fetus: 1. Whatever part of the fetal head or trunk first strikes a lateral half or lateral part of the |