length of life after gastro-enterostomy for cancer.

2. Size of Stomach.-It tends to return to the normal; the longer the dilatation has existed the less the stomach will contract after operation, and vice versa.

3. Motility. This is never fully restored. 4. Secretion.-Acidity is decreased after operation in almost all cases.

Bile is found in almost every such stomach; it is that poured in continuously after each meal. It enters through the new opening. The best method of preventing this is the making of an intestinal anastomosis.

On dogs and men a fistula between gall bladder and stomach has been established without consequent digestive trouble-bile is simply precipitated by the stomach juices. To be really dreaded is the return of food into the duodenum, and not the merely coincident biliary vomiting.

5. Excreta. The constipation incident to pyloric stenosis and lessened amount of intestinal contents always disappears. Sometimes diarrhea makes its appearance.

The urine is likewise increased in amount and from a like cause.

Three Conservative Cesarean Sections in the Same Woman.-DR. EMIL POLLAK* states that two Cesarean operations have been done on the same woman in thirty cases, three such in only twelve. Four women have undergone the operation four times each. Birnbaum did it five times on the same woman in eight years. Thinning of the scar tissue has led to rupture in a few succeeding gestations. Pollak, however, anticipates no such accident in cases where the muscle is well sewn with silk and a Lembert suture put in the peritoneum.

Some Suggestions in the Treatment of Chlorosis.-The most suggestive point brought out by THEODOR DUNINt in this very carefully written. paper is the importance of a correct diagnosis between chlorosis and the other anemias. In the former the iron treatment is almost a specific, in the latter it may be injurious.

The diagnosis of chlorosis depends upon the blood examination-which is not characteristic. Waxen, yellowish-green (not pale) color of the skin; pallor of the mucous membranes (not of the skin); preservation of the fat layer, (reichliches Fettpolster). Accidental heart murmurs, leerer bruit du diable, rapid, soft pulse, pulsation of the vessels of the neck, disturbances of the respiration, sleepiness, disturbances in menstruation, etc. The beginning of the attack is mostly acute, differing in this regard from the so-called Centralblatt für. Gynäkalogie, March 15, 1899. + Ber. klin. Woch.

pseudo-chlorosis. In the latter conditions administration of iron is not always to be recommended.

The author gives iron in some form of Blaud's pills. He lays stress upon the fact that the important thing is not in what form the iron is administered, but how systematically and how much. Ordinarily 0.8 gr. daily is given in two doses of the Bland preparation. With each dose comes 0.003 ac. arsenicum. If there is a tendency to diarrhea, opium is given. Neither the latter nor dyspeptic symptoms are contra-indications.

The author lays great stress also upon the fact that after the disappearance of all chlorotic symptoms, the iron must be given in order to avoid relapse. From four to six weeks is necessary for the chlorotic symptoms to disappear, then for a whole year, every muoth for ten days, the iron should be taken.

Very important is the avoidance of all muscular exercise. Rest in bed for from three to six weeks or longer during the administration of the iron gives the best results. Then a stay in the country or in mountains further is favorable. According to the author, opium-hydrotherapy has a very limited use in chlorotics. Especially cold water is to be avoided. The diet should be simple and nutritlious, though no special regulation is suggested. Milk

when well borne is recommended.

*

Variations in the Motor Phenomena of Chorea. From the examination of numerous specimens of handwriting of choreic children, taken by Jas. W. RUSSELL, it would seem that voluntary movements tend to make choreic movements better instead of worse, as Prof. Henoch claims. Cases examined are divisible into five groups, which are: (1) Little no control over movements, inco-ordination probably present in many cases; (2) power of control practically complete, no inco-ordination; (3) no choreiform movements, or very slight, much inco ordination; (4) control over choreic movements perfect, great inco-ordination; (5) movements moderate, much central defect, writing impossible.

or

Pyelonephritis and Ulcerative Endocarditis as a Complication of Gonorrhea.-HENRY W. BERG gives the history of a patient twenty-one years old, who had been under observation from the twelfth day of an attack of gonorrhea, when his temperature rose to 102.8°. Physical examination was negative; the temperature curve appeared septic and there were occasional chills. Four days later marked tenderness appeared over the left kidney, pus cells and casts in the urine; twelve days later, after frequent attacks of eclampsia, a *Lancet, April 1, 1899.

+ New York Medical Record, April 29, 1899.

loud, blowing murmur was heard at the apex of the heart and a rough systolic over the base. Twenty-four hours later the patient died. Autopsy revealed large vegetations with ulcerations upon two flaps of the aortic valves; one flap revealed a perforation. The kidneys presented the appearance of pyelonephritis, which was substantiated by microscopical examination. In the vegetations on the aortic valve there were diplococci, which were decolorized by Gram's stain; morphologically they resembled gonococci. Blood cultures made during life were negative.

Complications of the Serum Treatment of Diphtheria.-CHAS. BOLTON* reports one hundred cases: (1) Rashes; 25 per cent were urticarial, 31 per cent erythematous, 44 per cent combined. The erythematous are subdivided into (a) scarlatiform, (b) morbilliform, (c) resembling erythema multiforme, (d) simple erythema in patches. (2) Pains in and around joints; sometimes they resembled rheumatism, sometimes aching for a day or two, followed by stiffness. Site of pain was: hips, knees, wrist, hands, and vertebral column. (3) Fever; temperature between 100° and 105° F. (4) Albuminuria present in 54 per cent; amount very slight. (5) Abscess; usually in septic and scarlatina complications. (6) Bruising; 8 per cent of cases; spots from size of quarter to palm of hand. (7) Sloughing; one case of scarlet fever complication; death in fifteen days. (8) Constitutional disturbances; three cases: first two had rigor and convulsion with temperature of 105° F., third, vomited in fifteen minutes, followed by rigor and collapse in two hours.

The After-Treatment of Cataract in Persia.J. G. WISHARDT states that the hot, dusty summers in Persia render it dangerous to use any ointment or sterilized vaseline about an eye upon which a recent operation has been performed. He, therefore, covers the eyeball with finely powdered iodoform; the line of incision and all bleeding points are touchod with pledgets of cotton covered with iodoform; the lids are then carefully closed, and a pad of iodoform gauze is applied, held in place by a firm band; the eye is left for a week or ten days, when the band is removed and the incision is healed.

Vicarious Menstruation.-R. H. RICE reports severe hemorrhage from the mouth in a patient, six weeks after delivery; the hemorrhage was preceded by bearing-down pains. Ordinary hemostatics had no effect; hot foot baths and a hot vaginal douche resulted in the cessation of the hemorrhage, with the slightest vaginal show of blood.

*Lancet, April 1, 1899.

+ New York Medical Record, April 29, 1899. New York Medical Record, April 29, 1899.

Devious Manifestations of Epilepsy. - DR. SANGER BROWN* calls attention to some of the deviations in the manifestations of the classical fit of epilepsy, and expresses the conviction that the main pathological feature in epilepsy consists in a sudden disturbance of equilibrium between the several forces of the central nervous system, this equilibrium being soon restored, and a permanent tendency to recurrence remaining. The most potent etiological factor consists in a predisposition inherent in the cerebral tissues to undergo those changes which give rise to epileptic phenomena. He cites five cases, as follows:

Case I.—Migraine, culminating in grand mal, with some hysterical complications; then, after a year of freedom, petit mal for a year, and, finally, permanent establishment of both major and minor attacks.

Case II.-Nightmare, developing into epilepsy; retention of consciousness throughout seizure.

Case III.-Epileptic tremor; consciousness of impending seizure.

Case IV. Slight, disregarded mental equivalent, followed by intense, post-epileptic cephalalgia instead of sleep.

Case V.-Strong, exciting cause, long continued, producing slight manifestations, major attacks being long delayed, indicating that predisposing tendencies were not strong.

A Case of Cerebro-Spinal Meningitis Treated by Laminectomy and Incision of the Dura Mater in the Dorsal Region.-H. D. ROLLESTON+ reports: Patient, twenty-four years old, was admitted to St. George's Hospital, complaining of diffuse pains over the body, ringing in the ears, and mental dullness. To these symptoms were added vomiting, headache, delirium, flexion of thighs and legs, tache cérébrale, occasionally convergent strabismus with horizontal nystagmus. By the third day the pulse was 124; constipation and retraction of head with rigidity of the muscles of the back were present. No petechiæ, no sensitive spots along the spine, fundi oculorum normal.

Dr. Allingham made a laminectomy of the seventh and eighth dorsal vertebræ, followed by a one-inch incision of the dura. About three ounces of coagulated lymph and cerebro-spinal liquid were removed, in which no diplococci were found. Drainage was instituted, and patient became better. In about three and a half weeks the wound healed and symptoms returned, necessitating a redressing of the wound, whereupon the symptoms disappeared. Patient, at present, weak, anemic, and slightly deaf.

*New York Medical Record, April 29, 1899. +Lancet, April 1, 1899.

Hydrocephalus and Hypoplasia of the Suprarenal Capsule.-AD. CZERNY* found that the brain showed after death only the effects of the fluid collection.

There is surely some interference with the outflow of ventricular fluid. To ascertain how the same is accomplished normally, the author injected Berlin-blue into the ventricles of white rats, and in the abdominal cavity, and found it first appearing in a lymph vessel which sent a branch to the suprarenal capsule.

The clinical reports of five cases are given. In all these cases autopsy was performed and the capsules examined microscopically. Every one showed the same condition, viz., complete absence of the medulla. An examination of the suprarenal capsules in twenty cases where no brain lesion existed, showed no such change.

The Beard as a Carrier of Germs in Aseptic Operations.-W. HUEBENER+ held open dishes of "agar" a hand's-breadth under the beard while a sterile instrument stirred the same lightly.

Twenty-six beards were examined thus, and in 42.3 per cent of the number pus-producing germs were found.

In this paper various masks are discussed, but not a single mention made of the possibility of dispensing with those magnificent beards, and thus according the same respect to practical as to theoretical hygiene.

Eclampsia, Cesarean Section, Post-mortem, Living Child.-KOENIG‡ reports a successful Cesarean section performed post-mortem. The patient was brought into the clinic with intense inspiratory dyspnea, due to a hemorrhage into the enlarged thyroid, producing pressure upon the trachea. The urine contained 1 per cent of albumin. The section was performed as quickly as possible after the death of the patient. The child was removed and resuscitated through artificial respiration. Previous to this but five cases of sectio Cesarea postmortem in eclampsia have been reported. The more sudden the death of the mother the better is the prognosis for the child, and vice versa. It is rather remarkable, therefore, that the child should have survived, since the mother died of suffocation, and the blood was laden with carbon dioxide.

On Cerebral Tumors and Spinal Cord Changes Found in Such Cases.-DR. A. SCHUELES describes a case of cerebral tumor in a young woman of sixteen. The symptoms pointed to a tumor of *Centralblatt für Allgemeine Path. und Path. Anatomie No. 7, 1899.

+Centralblatt für Chirurgie, No. 11, 1899.

Centralblatt für Gynäkologie, April 22, 1899.

§Neurologisches Centralblatt, April 1, 1899.

the cerebellum. The autopsy and subsequent microscopic examination showed a glio-sarcoma of the right semiovale involving the thalmus opticus. The spinal cord, stained by Marchi, showed degeneration of the posterior nerve roots. The author brings forward several theories to explain the pathological changes in the posterior columns. First, increased pressure of the cerebrospinal fluid upon the posterior roots. Second, degeneration following cachectic conditions-as for example, in carcinoma.

In this case neither of these two explanations would be satisfactory, as there was no cachexia and the cerebro-spinal fluid was not under increased pressure.

The following explanation is suggested by the author: Inasmuch as the spinal cord was very edematous, this edema exerting pressure upon the substance of the cord, quite independent of the cerebro-spinal fluid, caused the degeneration of the

posterior columns.

Trachoma Toxins and Antitoxins.-E. F. SNYDACKER* says that his experiments with trachoma antitoxin are of more interest from a scientific than from a practical standpoint; they show that the organism of trachoma produces specific toxins which cause local and systemic effects, and that the body produces antidotes to these toxins. In chronic cases, where cicatrization has become well established, much cannot be expected of the antitoxin, but in the early stage of the disease it exhibits a specific and curative action.

Acute Inflammation of the Tympanic Cavity. S. MACCUEN SMITH+ states that the entire clinical aspect of inflammatory diseases of the ear can be said to occur as follows: First, hyperemia and swelling of the mucous lining, with accumulation of the consequent hypersecretion; second, rupture of the distended membrana tympani, with escape of the confined exudate; third, continuation of the discharge, finally becoming chronic. The intimate connection between the middle ear cavity and adjacent important structures calls for prompt treatment of the first stage, preventing a more severe inflammatory condition and the greater danger of complications. The treatment of acute inflammation of the tympanic cavity will depend on` the cause, stage and severity of the attack. If the iuflammation does not yield and pain continues, the membrane should be incised in the posterior inferior quadrant. Syringing should not be employed unless there is some special indication; after cleansing the canal with hydrogen peroxid and drying, a strip of iodoform gauze is introduced and renewed daily for a week.

*Journal of the Amer. Med. Association, May 6, 1899. +Philadelphia Medical Journal, May 6, 1899.

PRACTICAL THERAPEUTICS

A New Agent for the Treatment of Alopecia Areata.-G. MACGOWAN* recommends trikresol; the patch is cleansed with benzine, and the remedy applied pure to the scalp, and in 50 per cent solution with alcohol to the face; it is well rubbed into each patch by means of cotton wrapped about a tooth-pick. Within twenty-four hours a dry, brownish, superficial scale forms, which drops off in from four to ten days, when a new application is required. The average length of treatment necessary for a cure is two and a half months.

Massage of the Tonsil.-A recent iconoclastic departure in the medical press condemns the use of gargles in the treatment of tonsilar and pharyngeal affections. It is claimed that remedies used in this way do not reach beyond the anterior pillar of the fauces, and consequently the remedy is not brought in contact with the diseased surfaces. This is in line with claims which have long been made that the seat of inflammation in these cases is behind the tonsil or deep within its crypts, and that medication applied to other surfaces produces little or no result in eliminating these affections.

Some years ago massage of the tonsil was proposed

in acute inflammation. It was advised that the tonsil be "stripped" so to speak, that the finger or a firm, smooth instrument be pressed firmly at the base of the tonsil and moved downward over its surface, thus compressing it firmly against the pharyngeal wall, emptying the crypts and relieving congestion. Undoubtedly this precedure is followed by marked relief. A difficulty attending its application is the pain which it causes in acute inflammation. A recent writer claims that very marked benefit is to be obtained from massage of the tonsil in chronic enlargements of these structures. The finger is to be protected by a rubber cot, and a firm and continued massage is to be made over the tonsils for a number of minutes. It is claimed that this reduces these structures, relieves the engorged vessels, and empties the crypts.

Zine Chloride in Chronic Metritis.-A recent French writer declares that we have in zinc chloride a remedy that is far superior to the curette and that following its use there is no extension of the inflammation to appendages or an aggravation of pre-existing inflammation. He recommends a 20 per cent solution, of which about one dram is injected into the uterine cavity, after which a vaginal douche of boric acid is employed, followed by the application of a tampon. About three treatments is generally necessary to effect a cure, and it *Jour. of Cutan. and Genito-Urinary Diseases, May, 1899

does not require confinement to bed nor the use of an anesthetic, as does the curette. He objects to the use of the crayon of the chloride of zinc, claiming that it frequently capses atresia at the internal os.

We give this suggestion of the French writer for what it is worth, merely calling attention to the fact that a solution of the strength recommended by him may do considerable damage, as there is no telling just how deep its escharotic effect may extend. The great value of this substance in the

treatment of lacerations and erosions would lead one to think that the proposed method was of considerable value, providing its possible dangers do not outweigh the benefits.

Heroin. PROF. H. LEO* reviews the literature of heroin, and gives the results of his own investigations. Heroin (dose, one-twelfth to one-sixth grain) was introduced and recommended by Dreser as a substitute for codein in coughs, chest pains, and inflammation of the air passages. Since then Strube, Floret, Manges and others have reported satisfactory results.

Leo finds that, as a general narcotic, morphine and each in cases of sciatica, neuralgia, pleurisy, etc. codein far exceed heroin in action. He employed Even in coughs due to irritation, as in acute laryngitis, acute bronchitis, etc., the action of

heroin was not on a par with that of codein. It is in certain forms of dyspnea that heroin seems destined to fulfill its chief function. It tends to decrease the number of respiratory acts, at the same time increasing the duration and force of the

inspiration, comparable to the action of digitalis almost magic effect of heroių upon the dyspnea upon the heart. Upon this action depends the bronchial asthma, etc. The author recommends and cough of emphysema, chronic bronchitis, one-twelfth grain doses, claiming that one dose frequently suffices to alleviate the dyspnea of some of the most obstinate cases. One-eighth grain doses should be used only when a tolerance for the drug has been created. Unpleasant symptoms sometimes arise from the administration of onesixth grain or more. In some cases the dyspnea is quickly relieved, but expectoration is made more difficult. In such a case Leo recommends heroin given with potassium iodide.

EULENBURG* recommends hypodermic injections of the muriate of heroin. It is quite soluble and when used hypodermatically in one-sixth to onetwelfth grain doses brings relief in dyspnea, and more quickly and with greater intensity than when administered per os. According to Eulenburg the narcotic effect is about the same as that obtained from large doses of morphine. He especially *Deutsche med. Woch., March 23, 1899.

recommends heroin, therefore, in those cases where a tolerance for morphine has been created and large doses are required to obtain any results. On the other hand, it is of great value in those cases in which digestive disturbances and a general lowered vitality have been produced through long-continued injections of morphine. He hints that it may even serve in the treatment of morphinism.

A New and Simple Method of Closing Persistent Perforations of the Ear Drum.-The

method first devised by Okuneff* in 1895, consisting in the application of trichloracetic acid to the edges of the perforation, is further tried by FELIX

PETTESOHN in his clinic.

The method is as follows: A few drops of a 10 per cent cocain solution is first spread upon the mucous membrane of the tympanic cavity. An aural sound with a bit of cotton twisted about its edge is saturated with a few drops of the concentrated trichloracetic acid. The edges of the perforation are then cauterized, at first frequently until scar tissue is formed, then at longer and longer intervals until healing is complete. Contra-indications: First, if the subjective noises increase with the narrowing of the perforation, then it is to be concluded that a total closure would increase them more and make them con

stant. Second, in cases of a purulent discharge, the perforation should not be closed until all pus is removed from the middle ear. With these few objections, this method offers a therapeutic result which has not been obtained by any other procedure.

Clinical Observations of the Antidyspneic Effects of Oxycampher (Oxophor.)-The effect of oxycampher (a preparation of camphor in which the atom H is replaced by OH) in eighteen cases of diseases of the heart, lungs and kidneys, where dyspnea was a prominent symptom, is described by RICHARD JACOBSON.* *The preparation has the quality of reducing the excitability of the breathing center, and for this reason it was used as a symptomatic remedy in the treatment of dyspnea. The oxycampher was given in the form of a solution:

Sol. Oxycampher (50 per cent).
Spirits Vini................

Succ. Liquir.

Aquæ ad.....

Three times daily.

10.0

20.0 10.0 .150.00

Tablespoonful. In nine cases of lung affections, eight reacted favorably to the remedy. In six cases of heart disease, five showed marked improvement; in four of kidney lesions, all showed a favorable result. No bad after-effects were observed.

The author concludes that oxycampher is a valuable drug for the symptomatic treatment of dyspnea in heart, lung and kidney diseases.

*Ber. klin. Woch., April 17, 1899.

open.

A Case of Inherited Myxedema; Improvement by Thyroid Tablet Treatment.-FRANZ SKLAREK.* SKLAREK.* A young woman, seventeen years old, the youngest of three children. Father alcoholic. No history of syphilis, insanity or nervous disorders. When the child was one year old the parents observed that she was not developing as a normal child should. She did not increase in length, the facial expression was stupid, the arms and legs were ill-formed and clumsy in movement. At the age of three the patient spoke the first word, at seven, she first began to walk. In March, 1897, patient being then seventeen years old, the following physical data are recorded: Weight, 15.350 kg.; height, 80 c.m. The great fontanelle is The hair is blonde, coarse and very sparse. The skin is cyanotic, rough and of a doughy consistency. No edema. The face is square, overcast, and has a demented expression. The upper eyelids are swollen, so that the space between the upper and The mouth is always lower lids appears narrow. open and the saliva flows freely from the mouth. The neck is very short and thick. In both supraclavicular fosse are small tumors. Glands are to be felt. The thorax is barrel shaped. lungs are normal. There is a lordosis and an umbilical hernia. Temperature, 36° C. The speech She answers questions and can name objects around is nasal and rough. Voluntary speech is rare. her. Diagnosis of hereditary myxedema was made, on these symptoms, as brought forward by Bourneville. The patient was put on thyroid tablets until two daily were given. The effect was very (Merck) 0.1 every two days; this dose was increased striking. The temperature returned to normal, the general somatic condition improved, the mental sexual development remained, however, unaffected, state approached more nearly the normal. The although two hundred tablets of oophorin (Freund) were given for four weeks. Continuous thyroid medicamentation is necessary to maintain the improvement. The two photographs in the article show the result of the thyroid treatment in a marked

manner.

Heart and

A GOVERNMENT SANITARIUM FOR CONSUMPTIVES. -Walter Wyman, surgeon-general of the Marine Hospital Service, has, with the consent of the President, taken possession of an abandoned military reservation, known as Fort Stanton, in Lincoln, Nebraska. The reservation contains several thousand acres of land, and the establishment will be conducted as a ranch upon which it is expected to employ all the patients that are able to work. The sanitarium is intended especially for Marine Hospital patients.

*Ber. klin. Woch., April 17, 1899.