Tinct. of iron meets several of the indications,

independent of its constitutional effects. It is an astringent, an antiseptic, and combined with quinine, a most potent stomachic tonic. By its administration, it is almost directly applied to the locality in which the disease is seated, and benefits the diarrhea, checks the tendency to hemorrhage, acts antiseptically on the contents of the bowels, and possibly on the ulcers, and, we have, found agrees with the stomach as well as most other remedies. We are aware that some recent authorities dispute the correctness of some of the views hitherto entertained in reference to the therapeutical qualities of iron, its mode of action, and effects. Yet we hold that its evident utility in many diseases where the blood is impoverished or morbidly altered, cannot be successfully disputed. Experience has taught us that it is eminently useful in enteric fever. We have employed it for over ten years, in addition to the usual approved remedies, and have made it the central remedial agent in this disease, around which other subordinate remedies were prescribed, as circumstances seemed to indicate. If permitted to found an opinion on the results attained, we can truthfully assert that it is actively serviceable. We admit it is possible that the very satisfactory results may not have been attributable to the iron; but this is not probable. We know that we have been more successful in the treatment of typhoid since we began its use than before. During the past year we havetreated no inconsiderable number of cases, without a single death. That it is destructive to, or prevents the multiplication of typhoid bacilli, we know not, nor are we in any sense assured as to what its manner of action is, bnt we believe firmly in its value in this disease. Of course we do not advocate its exclusive use in any case, but as it does not in any way interfere with the usual approved treatment, and can be administered without risk, we bespeak for it a trial at the hands of the profession, that fnrther experience may either establish its value in typhoid, or prove its worthlessness, and relegate it to the extensive list of useless remedial agents for that disease.

THERE are fifteen thousand nurses in Great Britain. Mr. Henry C. Burnett is now advocating the establishment of a national pension fund for them and for hospital officials.

CHIAN TURPENTINE IN THE TREATMENT OF UTERINE CANCER. The question of the curability of this scourge by the use of Chian turpentine is still causing some debate. Mr. Clay, of Birmingham, was the first From time to to speak well of the treatment. time cases of cures have been published in the various medical journals. Mr. Clay, as late as 1881, wrote to the Lancet as follows:

"An enlarged experience, however, has confirmed the statements made in my original paper, and I have now the satisfaction of being able to declare that I have nothing to withdraw or to qualify as regards the statements I then made as the result of observation as to the effects of Chian turpentine

in uterine cancer."

Unfortunately the number of failures has been so far in excess of successes for this remedy, that few in the profession, in this country at any rate, have any faith in its power to check the morbid growth. We do not know that it has ever been sufficiently tried here to decide pro or con as to its value. In one case which came under ou r notice, the patient, who was the daughter of a medical man, was, or thonght she was greatly relieved by its use, but she eventually died of the disease.

The truth as to the value or worthlessness of the remedy is of such vast importance that it would be well if more light could be thrown on the subject. Mr. Elder, of Nottingham, makes an appeal (Lancet, Dec. 3) to the profession as follows:

Un

"From time to time he (Mr. Clay) has favored his professional brethren with repeated cures of cancer by this remedy, and even so recently as in your last week's issue three more examples are given. But what about the failures? In the interest of the public at large, such claims as Mr. Clay makes for Chian turpentine ought not to pass unchallenged by those who differ from him. fortunately, examples of cancerous disease are only too common upon whom this remedy (supplied, if necessary, by his own chemist) might be tested by a tribunal in whom the profession at large would have confidence, and the doubt once and for all resolved. If this drug came out of the ordeal triumphantly, then I feel sure there would not be a single dissentient to Mr. Clay occupying a position not inferior to Jenner or Harvey, as one of the greatest benefactors of our species; but if, on the contrary, it is wholly useless as a remedy, then let it drop into a well-merited, and not too premature oblivion."

The suggestion as to where the drug is to be

obtained is a valuable one. A drug which is not even mentioned in such text-books on Materia Medica as those of Lander, Brunton, and Bartholow, will not be likely to be obtained pure from the ordinary chemist. There seems to be something essentially unscientific in the treatment of such a pathological condition as a cancerous os, by the internal administration of medicine; but equally strange propositions as to the treatment of disease have proved beneficial to humanity, which, after all, is the great end for which we working.

DISPOSAL OF SEWAGE.

are

From the excellent report of the Maryland State Board of Health, lately received by us, we take the following conclusions as to the disposal of sewage. They are clear and to the point, and deal with a matter which is becoming of greater interest every day. The whole profession both in the city and country should be aroused to the necessity of more attention being paid to sanitation. When we read of the scourges of epidemics of diphtheria, typhoid and other preventible diseases, and consider what they cost the country in cash, it is to be wondered at that the powers that be do not aid the various health organizations more generously, not only by placing adequate sums of money at their disposal for the carrying out of their absolutely necessary work, but also by so legislating as to give them the necessary power to make that work a success, not in theory or on paper, but in practice.

The conclusions are as follows:

་་

"1. That the proper disposal of sewage involves the beneficial appropriation of refuse matters, so as to make them actually productive, avoiding

interference with those domestic uses of inland

waters for which they are properly adapted. 2. That sewage matters should be made available for agricultural purposes, and the results in this respect are limitable only by considerations of expense as weighed against the value of the result. 3. That the great importance of avoiding all sources of unhealthy and offensive effluvia, and of preserving the foundations of buildings and the sub-strata of towns and cities in a dry and clean condition, creates an absolute necessity for relinquishing cesspools and all receptacles for sewage connected with any building or other place, except such as are thoroughly water-tight and for the most part airtight. 4. That all unhealthy putrescible matters should be removed at short intervals from within

the limits of centres of population, either by means of air-tight pipes, or in vessels or tanks hermetically closed. 5. That privy-pits, unless they are perfectly water-tight, will infect, (a) the surrounding soil by transudation of their liquid contents; (b) the air by exhalations or gasecus emanations through a polluted soil; (c) the sources of domes tic water supply by percolation through intervening strata of earth. 6. That the use of water from dug wells should be prohibited for drinking and culinary purposes in every instance where privypits not absolutely water-tight exist in proximity to or within 1,000 feet of such wells. 7. That there exists between the air of water-carriage sewers and the external atmosphere a constant interchange, and as is the air of the sewer, so will be the air of the street. 8. That without considerable fall or grade, flushing is utterly inefficient for cleansing sewers, except where the matter is carried by pneumatic pressure or aspiration, even in the case of small sewers with large quantities

11.

of water. 9. That the impermeability of brick sewers can never be absolute, and, therefore, should they convey excrementitious matters, the surrounding soil and the water of neighboring wells will be at all times liable to dangerous contamination. 10. That excrementitious matters ought to be rigidly excluded from all storm-water sewers. alone is not efficient in a sanitary point of view, That the epuration of sewage water by the soil as has been demonstrated by both experience and chemical analysis. 12. That no system of sewage can be approved, which permits the pollution of either air, water or soil; and that, in order to fulfil the requirements of proper sanitation, all excrementitious matters and kitchen slops should be conveyed from towns by pipes absolutely air-tight, or in hermetically-closed vessels to a point sufficiently distant, where they may be manufactured into a dry manure powder without offence."

SUPERFETATION. Dr. Godfrey, writing to the Lancet, gives the following account of an interesting case of superfetation: "I was called on August 17th of the present year to Mrs. H-, aged twenty-nine, to attend her in her fourth continement. She stated she was seven and a half months gone and had been in pain all night, with considerable loss. On examination I found a three and a half months' fetus in the vagina, which came away without difficulty. The uterus was large, rising about two inches above the umbilicus, and I could distinctly feel the movement of another fetus. The placenta did not come away, and all pain ceased.

I then left her, as there was no hemor rhage or pain, and returning in an hour and a

half found things in statu quo. This state of affairs continued for four days, when the pains returned, and the breech of a child was born before my arrival. I immediately removed the child, still-born, though the nurse informed me that the legs moved after their delivery. The child must have been quite seven months, as the nails were commencing to form and its weight was 4 lbs. The placenta of the second child came away naturally, but was followed by a great deal of hemorrhage; there was no sign of a second after-birth attached to it. Traction on the smaller cord failed to detach its placenta, so I introduced my hand into the uterus and removed it piecemeal; it was completely adherent and attached to the upper zone on the right side, measuring about three inches across; it was not putrid. All the bleeding immediately ceased, and my patient made an excellent recovery, without a drawback.”

THE VOMITING CENTRE. Professor Fremas, (Lancet) who has been investigating the subject of vomiting, finds that in dogs and cats, section of the medulla at the level of fourth ventricle does not prevent the induction of vomiting by hypodermic injections of apomorphia. By touching different parts of the medulla with a weak solution of apomorphia, so as to induce vomiting, he was able to localize with tolerable precision the situation and extent of the vomiting centre, which he says lies in a small space before and behind the calamus, and in the deeper layers of the medulla. He believes that the absence of vomiting, which is observed in ruminants, rodents, and some other classes of animals, is due to the absence in them of a vomiting centre, or to the very rudimentary condition in which it exists. In a rabbit on which he tried in every way to induce vomiting, no signs of gastric movement of that nature could be detected.

FRACTURE OF СоссҮХ, WITH SUBSEQUENT SPONTANEOUS REMOVAL.-Dr. W. J. Jolly writes to the Atlanta Med. and Surg. Jour. thus :-I was called to Mrs. M., November 1st, 1887, primiparæ, aged 21 years, who was in labor. Nothing unusual occurred until the head was pressed against the coccyx, which did not yield. I applied the forceps and delivered her without any trouble and without any laceration of perineum. Immediately after delivery she suffered intense pain in

the region of the coccyx, for which I gave an opiate and examined the bone. Found some displacement which I corrected, supposing it to be fractured. The opiate soon relieved the pain; she did not suffer any more until the 9th day, except some tenderness in the region. She had some slight pain on that day. On the 10th she passed

a bone per anum and sent it to me, stating that she thought she had passed a joint of her backbone. Upon examination I found it to be the lowes segment of the coccyx. She has had no trouble since. As I have not seen a similar case on record, I send it to you for publication.

PURGATIVES.-The

THE ACTION OF SALINE following are the conclusions arrived at by Lenbuscher (Edin. Med. Jour.), as to the action of saline purgatives :-"1. That an exaggeration of the peristaltic movement of the intestine only plays a secondary part in the action of saline purgatives. 2. In whatever manner saline purgatives may be introduced into the intestine, the intestine becomes the site of a great secretion of liquid, which is the principal cause of the purgative action. 3. It is impossible to claim for saline purgatives that they act as a barrier to re-absorption. 4. Saline purgatives introduced into the circulation in sufficient quantity produce constipation."

OUR NEW YORK LETTER.-We regret that owing to the sudden and unavoidable departure of our correspondent from New York, we have no communication from that city in this issue. We shall endeavor to make such arrangements as will ensure for February, and all subsequent numbers,

THE CARDIAC RELATIONS OF CHOREA. Dr. William Osler has carefully re-examined (Am. Jour. Med. Science) 110 of the choreic cases treated at the Infirmary for Nervous Diseases between 1876 and 1885. In each case the patient was examined more than two years subsequent to the attack of chorea. He found 43 normal hearts, 53 with organic and 13 with functional troubles. He draws from his study the following conclu

sions :

1. That in a considerable proportion of cases of chorea-much larger than has hitherto been supposed the complicating endocarditis lays the

foundation of organic heart disease.

2. In a majority of the cases the cardiac affection is dependent on rheumatism, and cannot be regarded as in any way associated with it; unless,

indeed, we hold with Bouillaud, that in the disease "chez les jeunes sujets, le cœur se comporte comme une articulation."

3. As the presence of an apex systolic murmur in chorea is usually an indication of the existence of mitral valvulitis, as much care should be exercised in this condition as in the acute endocarditis of rheumatism. Rest, avoidance of excitement, and care in convalescence, may do much to limit a valvulitis, and obviate, possibly, the liability to those chronic nutritional changes in the valves wherein lies, after all, the main danger.

TURPENTINE IN DIPHTHERIA. Not a few practitioners in this country have strong faith in the beneficial action of turpentine in diphtheria. It will, therefore, be interesting to know the results in fifty-eight cases treated by it by Röse, of Hamburg (Therap. Monats.; Med. Prog.). He had a mortality of five per cent. His treatment was as follows:

He gave oil of turpentine three times a day in teaspoonful doses, mixed with spirits of ether.

1. Rapid lessening of the pulse-rate and of the temperature. 2. Rapid alleviation of the subjective symptoms. 3. Shortening of the duration of the illness. 4. No exacerbation of the local process after the first dose of turpentine. 5. Only once was there danger of suffocation, and tracheotomy was done.

was

Röse thinks that pencilling the throat, as done in private practice, is generally useless. He uses great caution in pushing the turpentine in anemic cases, and in patients with weak hearts; and excessive cardiac action, from any cause, carefully treated. The food given in his cases consisted of bouillon, old port wine and milk; and ice and aërated fruit juices were given to quench thirst. The turpentine was discontinued when the patient was free from fever. In ordinary cases doses of from 3 to 5 drachms were used, and no intoxication was seen. In one case paralysis of chlorate of potassium. occurred, but the patient recovered under the use

INFANTILE MARASMUS.-The following conclusions have been arrived at by Dr. Isaac N. Love (St. Louis Courier of Medicine) as to the cause of infantile marasmus :

1. Infantile marasmus is dependent primarily on torpidity and inactivity of the glandular system; and is aggravated by unsuitable, over-abundant, or insufficient food and unsanitary surroundtreatment, to arouse secretion and excretion, the 2. It is of the first importance, in ings. best remedy being calomel in one-twentieth of a grain doses, with the free administration of water; stimulating the secretion of the digestive juices, both of these agents exciting glandular action, and promoting diuresis and intestinal secretion. 3. "In the matter of diet, mother's milk is the best, and some other mother's milk the next best.” 4. In extreme cases, administer soluble foods in the forms of baths, and practise gentle friction and massage, with an occasional bath in water containing a diffusible stimulant.

SPARTEINE, THE NEW HEART TONIC.-The