is abandoned. On this point there must be no mistake.

3. Medical Treatment.-During an attack of acute cardiac palpitation, medical treatment of a direct kind can only be palliative. It is a common practice to place the patient in the perfectly recumbent position, but as this positian leads, frequently, to breathlessness and much discomfort, I never enforce it unduly. The sufferers usually find out the best position for themselves, and standing up, and even gentle walking backward and forward, commonly appear to bring relief, as if the general muscular action equalized the local over-action.

For the actual palpitation, digitalis is the only remedy I have found of any positive service, and it combines well with remedies which have a tendency to promote quickly the cutaneous and renal excretions. 1 usually prescribe the tincture of digitalis in five or ten minim doses, with half a fluid drachm of nitric ether, and two fluid drachms of the liquor ammoniæ acetatis. In instances where there has been prolonged sieeplessness, with palpitation, I have combined morphia, in full doses, with digitalis, with good effect, adding the narcotic dose to the formula just named.

In general treatment I am accustomed to follow, whether the heart be organically sound or unsound, the same methods as those described in my previous essay on intermittency. The organic bromides of iron, quinine, and morphia, and the mixture of iron carbonate ammonia, and morphia, are excellent remedies. The only difference in treatment, in fact, relates to the use of alcohol, which, valuable in some cases of intermittency, is less compatible in cases of palpitation.

4. Treatment of Epigastric Palpitation. The rules already offered for the management of cardiac, apply equally to the epigastric palpitation. There is, however, in cases of epigastric palpitation more frequent necessity to meet dyspeptic symptoms, including flatulency and constipation, by alterative and mild aperient correctives.-Benjamin Ward Richardson, M.D., F.R.S., in Asclepiad.

THE ABUSES OF MILK DIET IN THERAPEUTICS.

The therapeutical employment of milk, not only has been popularized and the lay public made familiar with its various adaptations, but in the wake of the general appreciation has followed the usual exaggerations, and hence it is prescribed with little regard to the conditions properly requiring it. Under these circumstances it seems desirable to indicate the limitations of this therapeutical food, and to show wherein it may be hurtful rather than beneficial.

In certain disorders of the digestive functions,

milk causes a sense of discomfort, decided uneasiness, oppression-sometimes even pain, and it prolongs the morbid condition. The cases of this kind may be grouped into two classes: those in which the casein is the offending material; those who cannot properly digest the cream or butter. We find examples of the first class more frequently amongst children, but they are by no means uncommon in adults. They are detected the more readily in early life, because the curds are rejected by vomiting, or appear undigested in the stools. Adults unable to digest casein, or who digest it slowly or painfully, have epigastric distress, heaviness and oppression for several hours after meals, stupor and disinclination for exertion coming on after an hour or two and continuing until the offending material has passed well down the intestines.

An excellent substitute for the milk when the casein disagrees is barley-water with cream. The barley-water should be carefully strained and have the density of good skimmed milk, and one-sixth or one-fourth cream added, so that the mixture has the consistency of rich milk.

Another class of subjects to whom milk is unadapted are the cases of duodenal, hepatic and pancreatic diseases, because of the deficiency in the secretions necessary to the process of emulsionizing fats, and preparing them for entrance into the lymph vessels. Fats decomposing form very irritating fat acids, and the change in the reaction of the intestinal juices is the cause of various secondary troubles in the biliary functions and

elsewhere. To fit milk for use, under such circumstances, it must be skimmed, and about the time the stomach digestion is completed, aids to the intestinal digestion should be administered. Such aids are a soda alkali, and it may be, some pancreative solution to effect complete digestion of the fatty constituents.

The mere bulk of the milk is an objection to its use in certain diseases. In dilatation of the stomach, the space occupied by the necessary quantity perpetuates the disease. The reflex effects of distension of the stomach in cases of weak heart, and in angina pectoris, may not only cause distressing symptoms, but may even prove fatal. It cannot be too strongly stated that milk is a highly objectionable aliment in heart diseases, whenever the motor apparatus of the organ is diseased, and whenever its movements are readily influenced by morbid states of the stomach through the reflex channels.

In no malady, as I conceive, is milk more abused than in acute rheumatism. It is very often the chief-sometimes the only aliment employed during the whole course of this disease. Besides the objection inherent in its mere bulk, certain theoretical considerations of its nature should have considerable weight in deciding the question of

For Delirium Tremens.—In quieting the delirium of acute alcoholism, I sometimes use chloral hydrate or the bromides, but more often rely upon R. Extracti lupulinæ fluidi, extracti hyoscyami, aää f ss. M. Sig. One teaspoonful every two or three hours until delirium subsides. Monobromide of camphor acts well to control the persistent in

somnia in certain instances.

For Diarrhea.--In controlling obstinate cases of diarrhea there is nothing more efficacious in my hands than the old prescription: R. Pulv. opii, camphoræ, plumbi acetatis, ãà gr. x. M. et dispens in capsul. No. x. Sig. One capsule every two hours until the diarrhea ceases. In some cases large doses of tannic acid may be used or bismuth

subnitrate in combination with one or more of these three drugs; but when other remedies have failed this prescription will be found to check the discharges, particularly if there be blood in the feces.

For Vomiting of Pregnancy.-For this often intractable trouble I generally give: R. Acidi carbolici, gtt. ij; bismuthi subnitratis, 5j; aquæ menth. pip., f3 ij. M. Sig. One teaspoonful as often as necessary to check vomiting. If one dose be ejected, wait a few moments until the nausea subsides and then repeat. Certain cases do well on iced champagne, while others persist until dilatation of the cervix is performed.

For Sleeplessness.-When opium is contra-indicated, and there is persistent insomnia, my choice usually is R. Ammonii bromidi 3 iij; aquæ q. s. ut ft. sol. tincturæ hyoscyami, q. s. ad f3ij. M. Sig. One teaspoonful every hour or two until sleep is produced.

For Fetid Sweating.-For the fetid secretion of the axilla or of the feet, a solution of salicylic acid is excellent, or this may be used: R. Potassii permanganatis, 3j; aquæ, Oj. M. Sig. Apply to the parts night and morning. -Amer. Med. Digest.

MEDICAL NOTES.

Among the numerous agents used to deodorize iodoform, freshly pulverized coffee is useful.

"A persistent fissure in the middle of the upper lip is a very suspicious sign of a scrofulous diathesis."

Dr. Longstreth recommends a large-handled knife for post-mortem operations as less tiresome to use than one with a small handle.

Soft, thin, waxed paper is found to answer the purpose of oiled silk or muslin in the majority of dressings, and is very much cheaper.

It is not an uncommon thing to have the temperature of a typhoid fever patient rise as much as 2° when a storm is approaching, and then revert again when the storm is settled or øver.

The carbolic acid solution, formerly 3, used for washing surgical instruments in the Jefferson Hospital, has been reduced to 2%; this answers the purpose and does not affect the hands.

doses of effervescing bromide of nickel in comProf. Da Costa recently prescribed five-grain bination with iodide of potassium three times a day, for a girl, 19 years old, suffering from epilepsy. A practical way to distinguish atheromatous degeneration of the arteries from a wiry pulse, is to place the finger lengthwise along the artery, and the difference is very noticeable. (Da Costa). For a case of gastro-intestinal catarrh, Prof. Da Costa ordered broth diet and a prescription containing

A neat and convenient way to handle corrosive sublimate for making antiseptic solutions is to dissolve 15 grs. in f3j of alcohol, which, added to a quart of water, makes 1-1000, and does not undergo chemical change if used immediately.

Prof. Da Costa has noticed what he calls an emotional temperature in cases, most especially women in childbed. The temperature may reach as high as 110, and yet recovery take place. The duration is very short, only lasting a few minutes at a time.

The following prescription has been used with favorable results in general constipation among the patients of the out-door department of the Jefferson Hospital:

R.

:

Ext. cascara fluid, Ext. glycyrrhizae fluid, SIG.-Teaspoonful at bedtime.

ää fzj. M.

Prof. Bartholow used for a long time a five per cent. solution of carbolic acid in a case of epithelioma, injected hypodermatically two or three times a week; not curing but preventing further growth after two surgical operations had failed to remove the trouble.

Cocaine hydrochlorate is rapidly increasing in favor as an anesthetic; a great deal of minor surgery is done without any suffering of the patient by its use, a 4 per cent. solution being the strength generally employed. Inject in and around the part; allow five minutes before operating.

Prof. Parvin treated a case of umbilical hernia in an infant by reducing the hernia, pinching the skin together and painting with collodion, and ordered the painting to be repeated three times a week; the truss that the child had been wearing

£3j. gtt. iij.

M.

R. Syr. calcii lactophosphatis, Liq. potassii arsenitis, . SIG. Ter die. Also of ol. morrhuæ 3j ter die. Locally, to lessen congestion, a constant, descending, stabile galvanic current as strong as could be borne was advised to be used to the affected nerves; faradisın, if need be, to exercise the mus

cles; and for the pain, if it became at any time necessary, the hypodermatic injection of cocaine in the neighborhood of the nerve. -Col. and Clin. Rec.

BONE-SETTERS AND SURGEONS.-In commenting on the recent death of R. H. Sutton, the bonesetter, who was well known in London, and especially in sporting circles, the British Medical Journal remarks: It is significant, though by no means surprising, that the daily press has taken the opportunity of singing the praises of bone

setters this week, to the disparagement of orthodox surgery, as far as diseases of joints are concerned. The subject, as we are all aware, has been repeatedly discussed in medical journals and before medical societies. Some of the many sources of the bone-setter's success are self-evident. The public believe in "gifts" and "inborn genius," in men who know without learning. This feature in human nature is reflected in works of fiction, where the hero is made to scribble off some masterpiece of literature, or to dash off a picture which puts the old masters to shame, all without study, his time being taken up, as the narrative usually shows, by more picturesque but less professional employments. The bone-setter is popular partly because he is believed to be a genius who has not crammed his head with Doctor's Latin. Another class of the public have some personal objections to medical men and chant the praises of bonesetters without looking into facts. There remain, however, the important truths that bone-setters have gained the confidence of hundreds of intelligent persons, and that, although it has repeatedly been shown that gross errors of diagnosis and complete failure have often attended the practice of these empirics, it is equally certain that they sometimes cure cases which ought to have been cured by qualified men already consulted. Patients with chronic articular diseases expect manual treatment, not advice. Too often they get only the latter from the surgeon, whilst the bone-setter does the work which the qualified attendant only tells the patient to do for himself, or at the most leaves it to be done by a "rubber." Thus not rarely we hear of a patient applying to some distinguished surgeon for relief from chronic synovitis of a joint, the result of a sprain He is told to rub the affected part, and perhaps some lotion is prescribed. Now it does not follow that he has the least idea how to rub the joint, and at the best, manipulative treatment of one's-self is unsatisfactory. The services of a rubber may be recommended; then, if the joint be cured, the rubber rather than the surgeon gets the credit. When, on the other hand, a patient consults the bonesetter for the same affection, the joint is dexterously wrenched after it has been pronounced to be "out," old adhesions are torn down, and permanent benefit often effected, and all this is done by the bone-setter himself at one sitting. course, a success of this kind inspires public confidence in favor of the empiric, who also knows when the extra services of a rubber are needed. He makes a show of doing something for the patient himself from the very first, and uses terms at random which give the impression that something definite has been done. The surgeon is consulted because he is supposed to cure with his hands. He is never above operating, so there is no reason why he should be above manipulating. When

Of

A NEW SEXUAL SEDATIVE, Salix Nigra.-J. Hutchinson, M. D., writes in the British Medical Journal, July 30th, of his experience with the salix nigra, or pussy willow, his attention having been called to the virtues of the drug by a report in the "Transactions of the Texas State Medical Association," from Dr. Paine, who prescribed it successfully in cases of ovarian hyperesthesia, uterine neuralgia, etc., and also in spermatorrhea and nocturnal pollution. His verdict upon the drug is that it is a powerful sexual sedative, similar in its action to bromide, but without its depressing qualities.

Dr. Hutchinson obtained a supply of the fluid extract, and has been employing it for some months. The most numerous class of cases in which he ex

hibited the drug were women of nervous temperament, in whom the nervous irritability reaches its height at the menstrual period, when, along with the general malaise, is added a very decided pain in one or other ovary. They also suffered from hemicrania, the pain being situated above the left eyebrow, and resembling the feeling as if a nail were being driven into the skull (clavus). Many of them, too, complained of pain under the left breast, and extending round to the back. On one or two occasions, he has noticed patients complain ing of the above symptoms, and in only a moderate degree, under favorable conditions-as for example, long-continued anxiety or alcoholism-go from bad to worse, till they become hystero-epileptics. In cases of this kind, it is supposed that the centre of inhibition has in some way got out of gear, and the severity of the symptoms depends upon

the amount of disturbance in this nerve centre.

In cases where the ovarian distress was the symptom for which advice was sought, as being, in the patient's eyes, the most prominent, he usually succeeded in eliciting other indications of an irritable nervous system, and placed them upon half-drachm doses of the fluid extract of salix nigra, three times a day. In quite seventy-five per cent. of the patients so treated, a great amount of relief was obtained after two or three days' treatment. Not only was the ovarian hyperesthesia relieved, but the nervous palpitation of the heart was abated, and the patient felt in every way stronger.

He has also given the drug in two cases of nocturnal emissions, with marked benefit. The pollution ceased entirely while the drug was being taken, and for several months thereafter. Virile power and passion were not much, if at all dimin

THE PRODUCTION OF ALCOHOLIC CIRRHOSIS OF THE LIVER. At the meeting of the Society of Biology, held in Paris, July 16th, Straus communicated the results of some experiments which he had made, with the assistance of his interne, Blocq, on the artificial production in animals of alcoholic cirrhosis of the liver. His experiments pertained to twenty four hares, into the stomach of which he had directly injected a daily dose of half an ounce of a mixture of absolute alcohol and methyl alcohol, diluted with three parts of water. Immediately upon receiving this injection, the greater part of these animals fell as if paralyzed, and for several hours they lay in deep coma. When, after the expiration of a certain time, these animals were killed, the experimenters invariably found the usual lesions of alcoholic gastritis, thickening of the mucous membrane, ecchymotic petechiae of the surface, etc., but what especially attracted their attention was the pathological condition of the liver. This organ did not present to the naked eye any very marked alterations; it was smooth on surface as well as on section; the acini, nevertheless, were surrounded by a reddish gray line, and in animals that had been kept most of the time intoxicated for three or four months, the ultimate perilobular portal spaces were found infiltrated with embryonic cells. had been kept constantly subjected to the action of the poison for seven or eight months, the hepatic lobules were completely surrounded by a crown of connective tissue cells, and the exthem typical cases of perimenters had before annular perilobular and monolobular cirrhosis. -Boston Med. and Surg. Jour.

In hares that