the disorder steals on, sleep becomes disturbed, and the cheeks occasionally flush. With these symptoms there may be no elevation of temperature, and no acceleration of the pulse, for the nervous system has not yet transmitted any disquieting influence to the circulation. A considerable time may elapse before we know there is any headache, for the child may be too young to express its sensations, but if the hand is frequently raised to the head while it rolls from side to side on the pillow, we may be tolerably certain that it is uneasy and painful.

In typical cases of congestion of the brain in children there are, in addition to the symptoms I have enumerated, severe headache and often vomiting. Sometimes there is much oppression, lividity of the face, and a tendency to heavy sleep, hence the similarity to meningitis in its later stages. Usually, however, the two affections run a different course. In simple congestion, if the constitution is good and no convulsions occur, the fever is slight and the attack passes off in a few days. This is not the rule in meningitis.

If we turn to the temperature as a means of diagnosis, it is worthless if not taken in connection with other signs. The temperature in fatal cases of meningitis may not reach the height it does in simple irritation, but it generally does, and at the time of death is much higher. In the fifth case the temperature ran up to 104°, and yet the constitutional symptoms were nothing like so severe as in the first, second, and fourth cases. The temperature is exceedingly mobile in children of nervous temperature, rising and falling with extraordinary rapidity on very slight provocation.

In long-standing examples of cerebral congestion and disturbance, vascular changes may be expected to occur in the optic disks. Active congestion is such a near approach to inflammation that the line of demarkation can hardly be drawn. The two conditions are generally blended, a minor degree of inflammation being mixed up with, or superadded to, the cases of irritable brain and congestion. It is in cases of purely irritable brain that ophthalmoscopic changes are generally absent, and accordingly in nearly all the cases I have related none were found. Too great importance should not be attached to any ophthalmoscopic appearances that may be present in the cases I have been describing. We have seen that no optic changes were noticed in the cases that were irritable rather than congestive. As these are often absent in simple meningitis, and sometimes in the tubercular variety, even when it occurs, as it generally does, at the base of the brain, I think caution is needed. before coming to a hasty conclusion.

Treatment. A favorable result depends in a great measure on meeting the symptoms with promptitude at the outbreak, when there are only slight headache, alteration of manner, and disturbed sleep to guide us in that early stage, when it is impossible to say what is the essential cause of the trouble, what is its exact nature, and what is its probable termination.

Rest, in these cases of irritable brain, is to be strictly observed, since it checks the overexpenditure of nerve force by conducing to repose. and sleep. The brain being sensitive, exhausted, and easily fatigued,

absolute rest is as much needed for its recoveryas it is for a broken limb or a dislocated joint. This simple precaution is seldom sufficiently insisted upon until it is too late. Strong light, noises in the room, and the presence of anxious friends tend to excite these young patients. Through the medium of the nervous system the circulation becomes disturbed. Physiological rest tranquilizes the circulation, allays excitement, and favors recovery.

If the head is hot (and this belongs to the congestive rather than to the irritative class) a cold lotion or ice-water rags may be applied to it. Cold continually applied to the head will often induce tranquillity and sleep, when bromide and chloral fail. Cold soothes the patient. If we dread the approach of meningitis, henbane, and even small doses of morphia in combination with hydrate of chloral, will prove of the utmost benefit in the early stages.

An aperient will generally be demanded. A grain of calomel, followed by a little syrup of senna, or by a few grains of sulphate of magnesia and nitrate of potash, will answer well, if the strength is good and there is any heat of head. After this some bromide of potassium, with small doses of the iodide or hydrate of chloral, according to circumstances, should be given regularly. When the symptoms of cerebral congestion predominate the bowels can scarcely be kept too open,

and if there be arterial tension aconite in combination with the bromide will tend to reduce it and calm the excited brain at the same time.

The feeding of these cases is important. It should be nourishing from the first, and in the absence of vomiting (which we have noticed in all the cases) milk and beef-tea are to be freely given. Food from the first, in a nourishing and a readily assimilable form, should be given.

ON the Antiseptic Effects of Vinegar and its Utilization in the Treatment of Diphtheria.-Under this heading Dr. Friederich Engelmann, of Kreuznach, publishes in the Centralblatt für Klinische Medizin, a paper, of which the following is a condensed abstract:

The fact of the absolute failure of the ordinary therapeutic measures in diphtheria induced Engelmann to institute trials with citric acid, which, as he had learned, was being successfully exhibited in the United States in this affection. The results obtained were sufficiently satisfactory and rather encouraging. In a grave case of diphtheria in the country, where citric acid could not be readily obtained, and a prompt interference was indicated, the author resorted to vinegar, and was gratified with the result obtained. He used partly ordinary vinegar, partly the officinal acetum, internally, in the proportions of one to four as a gargle, one to two and even undiluted as a spray, one to two or three for painting undiluted.

Engelmann tested the antiseptic action of vinegar after the ordinary methods, and was surprised at the degree of antisepsis obtained, which even surpassed that of a five-per-cent solution of carbolic acid. He added to fluids crowded with bacteria a quantity of vinegar and twoand a half and five-per-cent solutions of carbolic acid separately, and

obtained astonishing results after having transferred the fluids to gelatin plates.

Three to ten of vinegar suffices to completely check the development of micro organisms, while of a two-and-a-half per-cent solution of carbolic acid an addition of ten to twenty, and of a five-per-cent solution of carbolic acid an addition of five to ten was required for the same result.

Other comparative researches of the same nature gave invariably identical results.

If these experiments are accurate, and if their results should be confirmed by other observers, we possess in vinegar an antiseptic agent of the highest type, which strangely has hitherto escaped the attention of therapeutists. Even Koch never alludes to vinegar as antiseptic medicine in any of his experiments of disinfection. Alongside of its disinfecting efficacy, rivaling and surpassing apparently that of carbolic acid, vinegar possesses such other advantages as will insure for it the first rank whenever an antiseptic remedy is needed for internal use and for the mucous membranes of the mouth and pharynx. It is not caustic or irritating, and is wholly innocuous. Later researches will no doubt determine whether and to what extent the well-known action of acetic acid on the animal cells and tissues need be considered in the application of this remedy.

The harmlessness of vinegar, together with its alleged powerful antiseptic influence, ought to induce practitioners to give the remedy a trial in diphtheria. If it is not productive of good, it can at least do no harm, and that is more than can be said of many therapeutic interferences practiced in diphtheria.-Therapeutic Gazette.

HEADACHES in Diagnosis.-1. When pain is located between the ears at the occiput, below the lambdoidal suture. The gastrodigestive apparatus, the automatic centers of life and the sexual organs will be the seats of disturbance.

2. When pain is located in the region of the parietal bone, from the coronal to the lambdoidal suture, and from the squamous suture to the superior outline of the parietal eminence. The duodenum and small intestines will be the seat of distubance.

3. When pain is located in the forehead, from the coronal suture to the superciliary ridge below, and within the temporal ridges on either side. The large intestines will be the seat of disturbance.

4. When pain is located below the superciliary ridges, including upper eyelids, to the external angular processes on either side. The nasal passages and buccal cavity will be the seats of disturbance.

5. When pain is located in the temporal fossa, from the squamous suture to the zygoma below, and from the temporal ridge to the mastoid process. The brain and its meninges will be the seats of disturb

ance.

6. When pain is located at the vertex, from the coronal suture and two inches posterior to it in the median line, and two inches on either side of that extent. In the female the uterus, and in the male the bladder, will be the seat of disturbance.

SPECIFIC for Cousumption.-M. Naudin, member of the French National Institution, writes to the Journal d'Hygiène that mutisia viciæfolia cures consumption promptly and thoroughly. This statement is based on the experience of Dr. Sacc, who has been living for many years in Cochabamba, and succeeded in obtaining the stated plantwhich grows in Bolivia, and is jealously guarded and kept secret by the natives by trickery, flattery, and great presents. The plant enjoys the enviable reputation of curing phthisis and every affection of the respiratory apparatus. Dr. Sacc claims to have frequently found occasion to witness the verification of these statements regarding the plant, and does not doubt for a moment but this plant will in the shortest time acquire great celebrity. If these claims of Dr. Sacc are true, mutisia viciæ folia will become the greatest benefactor of mankind.

Detailed knowledge regarding this plant is as yet totally wanting. Mr. Naudin received thirty seeds of the plant, collected from about two thousand flowers, from Dr. Sacc. These seeds were planted in the Jardin des Plantes and in Algiers, and we will no doubt soon hear more about the plant. More important for the moment is the news that Dr. Sacc has sent to the hospital for consumptives at London and to various hospitals in Paris large quantities as an extract prepared from the plant. Thus the results will probably soon be rendered public, and we all trust that for the sake of suffering humanity these results will not fall short of his expectations.

TREATMENT of Asphyxia of the New-Born.-Dr. Sharp writes. that the prusal of an abstract with the above title has led him to describe a method accidentally discovered many years ago by himself. He was trying to resuscitate an asphyxiated new-born child, but did not succeed, and the pulsation ceased in the cord. "I cut the cord, and continued Marshall Hall's method till I became convinced the child was dead. So many years have now passed that I can not speak of the condition of the heart, but am under the impression I continued my efforts till the beat of the heart could not be heard. Then I asked for a cloth in which to wrap the body, and took the child in my hands, holding the feet in an elevated position with my right hand, while the back and shoulders of the child, in a depending position, lay upon my left hand. The nurse was tardy in bringing me the cloth, and while I was holding the babe it gasped. I laid it down on the bed, and again commenced Marshall Hall's method for resuscitation, but no result; I became convinced again that the child was dead. Taking it in my hands again in the manner above described, I asked for a cloth, and as before had to wait a little, and while waiting the child gasped. The thought came to me at once that the child gasped because the force of gravity carried the blood to the brain, and the lack of this was why the child was dying. I held the child in the same position till gasp after gasp brought respiration and circulation to a normal condition. The child lived. And many, many times since have I resuscitated children which I think would not have lived had I used the ordinary methods."-Med. Rec.

A PATHOGNOMONIC Sign of Cancer of the Stomach.—The Paris correspondent of the Lancet says that at a recent meeting of the Société Médicale des Hôpitaux, a patient was shown who exemplifies the condition said by German writers to be characteristic of cancer of the stomach, a condition found by M. Debove to be constant in such cases, and which he proposes as a pathognomonic sign of the disease. In malignant disease of the stomach, it will be found that hydrochloric acid is always wanting, whereas it lasts constantly during digestion in every other case. In M. Debove's patient, this absence of hydrochloric acid enabled a diagnosis to be made at a period when there was no other symptom of cancer, and the disease was looked upon as dyspepsia, an opinion shared by M. Debove himself until he had ascertained the composition of the gastric juice. Since the beginning of the year the man has been under observation, and the real nature of his disease, now constituted by a characteristic tumor the size of an egg, is no longer doubtful. In reply to questions, M. Debove said that he obtained the liquid for examination by means of the œsophageal tube, and that the test used for distinguishing the acids were those recommended by the Germans. A solution of gentian violet (1 to 5,000) gives a blue coloration with HCl. "L'orange Poirier" in saturated solution gives a red reaction with the same acid. Lactic acid is recognized by the increased yellowing of perchloride of iron, and by change in color of a mixture of perchloride of iron and carbolic acid, from amethyst-blue to yellow.

TO Ascertain if Gangrene is likely to follow Severe Injury of a Limb, Dr. W. Scott Lang advises elevating the injured member in order to render it temporarily anæmic; next applying an elastic bandage or tourniquet for a minute; then lowering the limb and removing the tourniquet; when, "if sufficient circulation remains, the part beyond the seat of injury will blush rosy-red, and will show in an unmistakable manner the condition of the blood-vessels." This expedient was adopted by the writer in a bad case of railway-crush of both bones of the leg, where the limb was almost dangling and apparently hopeless. Under antiseptic treatment (after removal of fragments of bone and securing bleeding points), the boy made an excellent recovery with a useful limb.--Edinburgh Medical Journal, January, 1887.

ACONITE in the Treatment of Pneumonia.-The treatment of pneumonia by tincture of aconite is not new, but its endorsement by Surgeon J. D. T. Reckett, of the Army Medical Staff (Indian Medical Gazette, October, 1886), is so unequivocal that it deserves attention.

For six years nearly every case of pneumonia which has come into his hands has been treated with aconite, and in this period he has had only one case which ended fatally. In adult men of florid complexion, high temperature, rapid and full pulse, and usually dyspnoea and pain, he gives five minims (B. P.)-equivalent to gtt. j-ij, U. S. P.—every two hours with half an ounce of water, until the urgent symptoms are relieved; subsequently wine of ipecac and solution of acetate of ammonium are substituted. Hot poultices of flaxseed are applied, and low diet given. The disease, thus treated, rarely passes into the second stage of red hepatization.