belong to four classes-two known, the bacterium termo and bacterium lineolum, and two unknown. Their studies were confined to the two latter. Both formed round colonies of a yellowish color, and developed rapidly under a temperature of from 30° to 35° cent. (86 to 95 Fahr.) One of these bacteria is smaller than the b. termo, has no spores, and, besides the Brownonian movement, has a motion of its own. It may be stained by an aqueous solution of Fuchsin, or by methylene violet. The other may be colored in the same way, only the red of the Fuchsin becomes violet in about twenty-four hours. The form of the latter is rod-like, the larger ones having a spore at the extremity.

A small portion of microbes of the first variety was injected into rabbits. This was uniformly followed by a rise of temperature lasting twenty-four hours, but no lesion was discovered in any case. They accordingly called this micro-organism the bacterium pyrogenum.

In six rabbits, a cultivation of the other bacteria were injected. All died in from one to thirteen days. The intestines were found completely filled with a thick mucus, the bladder full of urine, the spleen black, and the intestinal vessels filled with dark blood. The six rabbits presented a clinical picture of acute epidemic dysentery.

The bacilli were not found in the blood, nor in the intestinal walls, but only in the secretion around ulcerated points. With a specially prepared apparatus, they sought for this microbe, which they have named the bacillus dysentericus, in the air of rooms in which. dysenteric patients were lying, but failed to find it. But they did succeed in discovering it in water. This was cultivated, injected into rabbits, and produced the same symptoms as were developed in the six rabbits mentioned above.

These important discoveries will undoubtedly be applied in therapeutics. A reliable germicide must be obtained, which, if thoroughly applied, will work an infallible cure.-St. Louis Medical and Surgical Journal.

Dietetic Fallacies.

1. That there is any nutriment in beef-tea made from extracts. There is none whatever.

It

2. That gelatine is nutritious. will not keep a cat alive. Beef-tea and gelatine, however, possess a certain reparative power, we know not what.

3. That an egg is equal to a pound of meat, and that every sick person can eat them. Many, especially those of nerv. ous or bilious temperament, cannot eat them; and to such, eggs are injurious.

4. That because milk is an important article of food, it must be forced upon a patient. Food that a person cannot endure, will not cure.

5. That arrow root is nutritious. It is simply starch and water, useful as a restorative, quickly prepared.

6. That cheese is injurious in all cases. It is, as a rule, contra-indicated, being usually indigestible; but it is concentrated nutriment and a waste-repairer, and often craved.

7. That the cravings of a patient are whims and should be denied. The stomach often needs, craves for, and digests articles not laid down in any dietary. Such are, for example, fruit, pickles, jam, cake, ham, or bacon with fat, cheese, butter and milk.

8. That an inflexible diet may be marked out, which shall apply to every

A diet which would keep a healthy man healthy, might kill a sick man; and a diet sufficient to sustain a sick man, would not keep a well man alive. Increased quantity of food, especially of liquids, does not mean increased nutriment; rather, decrease, since the digestion is over taxed and weakened. Strive to give the food in as concentrated a form as possible. Consult the patient's stomach in preference to his cravings; and, if the stomach rejects a certain article, do not force it.-Technics.

DISEASES OF THE URINARY ORGANS. Commencement of Dropsy as a Point in Diagnosis.

Apropos of the subject of dropsy, there has seemed to me to be one very good mechanical indication for distinguishing whether dropsical effusion springs from disease of the heart, or from disease of the liver, or the first local seat of the effusion. If dropsical effusion begins in the lower extremities, and proceeds to the abdomen, the evidence is fairly sound that the obstruction is direct from the heart, and that the liver is free, the stagnation and transudation being due to a failure of the return column of blood from the extreme parts. If, on the other hand, the accumulation of fluid begins in the abdomen, and extends to the lower limbs, the evidence is equally good that the arrest of the circulation is in the hepatic system. This distinction may be of moment sometimes in deciding on the question of tapping. In a case where the dropsy occurred first in the extremities, and afterward in the abdomen, it would be good practice to delay the tapping until the effect of removing fluid by puncture of the lower limbs had been carried out. But in a case where the effusion is, primarily, into the peritoneum, and afterward into the extremities,

tube is provided with an obturator, which serves the double purpose of being the point of attachment for the applicator, and also giving to the extremity of the cannula a rounded and smooth surface. The applicator is shown in the cut with the tube attached. By means of a thumb piece upon the handle of this instrument, the tube can be held in place while the obturator is withdrawn. The instrument for removing the tube has a jointed point, which, after insertion into the orifice of the tube, can be made to expand, giving a firm hold upon the tube. The gauge is designed to determine the length of tube to be used for any given age.

In performing the operation, Dr. Ingalls gives the following suggestion: The child should be wrapped in a sheet or shawl, which will pinion the arms, and then held upright in the nurse's lap; an assistant holds the child's head. The gag is then introduced between the jaws, and opened as wide as need be, but not with great force. Dr. O'Dwyer says that it is unnecessary to use the gag with infants who have no back teeth. The physician, sitting in front of the patient, passes his left index finger over the base of the tongue and down behind the epiglottis, and with it guides the end of the tube into the glottis. The handle of the applicator should be held near the child's sternum until the end of the tube has reached the pharyngeal wall, when the handle is rapidly elevated, and tube directed downward and forward along the index finger into the larynx. This will not be found difficult, but the infant's epiglottis is so small and flaccid, that the operator may not be able to recognize it, though he will have no difficulty in recognizing the larynx as a whole, which, except that it is slightly irregular, feels much like the end of one's little finger. The

operator should not expect to detect the opening of the glottis, but must be guided by his anatomical knowledge to pass the tube into the centre of the larynx. Unless he is careful to carry the handle of his instrument high and thus bring the tube as far forward towards the base of the tongue as possible, the tube will pass into the œsophagus. While it is desirable to accomplish this portion of the operation as quickly as possible, it should not be done with too great haste. Ten or twenty seconds, which is a long time for this portion of the operation, may be taken without danger. If the tube is not then introduced, it should be removed for a minute or two, to allow the child to breathe, and then the operation may be repeated; but if the tube seems to be in the proper position, whether the operator is certain of it or not, the slide upon the handle should be crowded forward, so as to disengage the obturator, which is then withdrawn. Some cough will occur at once, and if the tube has not been inserted into the larynx, or if it has not been passed down so that the rim rests on the vocal cords, it is likely to be expelled, and may be seen or felt in the back part of the mouth. If the tube has been properly inserted, respiration will become easier, and after a few minutes the operator cuts one end of the silk thread, passes his finger behind the epiglottis, and holds the tube while the thread is withdrawn.

It has been demonstrated that the constant irritation produced by the contact of the thread with the epiglottis and base of the tongue, is in some cases unendurable, and also it is difficult to prevent the child from pulling at it; therefore, the thread is always to be removed. The removal of the tube is more difficult than its introduction, according

to the experience of all the operators, it being no easy task, with a struggling child, to guide the extracting instrument into the narrow aperture of the tube, and in many cases an anesthetic is needed.

The advantages which intubation possess over tracheotomy are thus summarized by Dr. Waxham, who has had by far the largest number of operations up to the present time:

II. I believe it to be a more successful method of treating croup, either diphtheritic or membraneous, than tracheotomy.

The above list gives the advantages of intubation, but let us consider, too, the objections.

1. The difficulty of inserting the tube. This, though admitted, is certainly less than tracheotomy.

2. That the tube may become blocked with mucus or membrane. The recorded experience in thirty-seven cases would indicate that this does not occur, be

2. It relieves the urgent dyspnoea as promptly and as effectually as tracheotomy, and if the child dies, there is no regret that the operation was performed, and no discredit attached to the physician,

3. There is less irritation from the laryngeal tube than from the tracheal cannula. As the tube is considerably smaller than the trachea, it does not press upon it firmly at any portion, excepting at the chink of the glottis.

4. Expectoration occurs more readily than through the tracheal tube.

5. As the tube terminates in the throat, the air that enters the lungs is warm and moist from its course through the upper air passages, and there is less danger of pneumonia.

6. It is a bloodless operation.

7. It is more quickly performed, and with less danger.

8. There is no open wound, which may be the source of constitutional infection.

9. Convalescence is more rapid, and there is no ghastly wound to heal by slow granulations.

10. The patient does not require the unremitting care of the surgeon as in tracheotomy.

advantages of tubage over tracheotomy, the patient has the ability to compress the air in the lungs and expel it with an explosive force; in other words, to cough-thereby clearing the tube.

3. That the tube may slip through into the trachea. If too small a tube is used, this may happen, but from the length of the tube, it cannot sink out of reach, and may be removed by the mouth, or by tracheotomy.

4. That the child cannot swallow well. This is true only of fluids, and it is necessary to avoid giving liquids by the mouth. A few drops will trickle into the trachea and cause violent coughing, and this irritation will often lead to pneumonia. Dr. Waxham has devised a feeding-bottle for young infants and it may be necessary to use a small sized œsophageal tube in some cases.

5. The cannula may be coughed out in the absence of the physician, and death ensues before he can be summoned to re-introduce it. This danger is not nearly so great as that which attends the wearing of the tracheal tube.