that acute paranoia can exist, but Kroepelin doubts its possibility; his chief objection to the term is that the word paranoia carries with it the idea of incurability. Köppen meets this objection by two suggestions: First, by the fact that it is by no means settled that paranoia is of necessity a condition which is incurable. Secondly, he has records of ten cases from Jolly's clinic which were cured in from two to three years. Acute paranoia is to a certain extent a modification of the chronic form, having the following characteristics: The illusionary system is not strictly systematized, but the patient is in the midst of a disordered mass of hallucinations and illusionary ideas. The feeling of personality is not lost to the patient, but he has not as yet begun to develop his illusions into a well regulated system. General disturbances, as in all acute psychoses, also are found. Disturb ances in ideation may occur. The sensory impressions of the patient are directly affected. Everything Everything appears changed to him. Impulsive sensations further complicate the picture. Anxiety and attacks of mania are present. Although the picture may not appear clear at times, yet one can see always that the idea of personality is always apparent, and always tends to develop itself in the light of the illusions which are present and grow with them. In this respect it differs from the other forms of acute insanity in which the sense of personality is quickly lost. The etiology of acute paranoia is as vague as in the chronic forms. Alcohol, over-exertion, insomnia, strong excitement, sudden change in conditions, etc., are mentioned. It is found frequently in imbeciles and other degenerates. The prognosis of acute paranoia is much more favorable than that of the chronic form.

Colored Children; A Psycho-Physical Study.A. MACDONALD* reaches the following conclusions in his study of this subject: Bright-colored boys excel dull-colored boys in height, but the latter excel in sitting height; among colored boys and girls, the per cent of long heads is greater after puberty than before; this is true also of white boys but not of white girls; there is a sudden increase and high percentage of brightness in colored girls at the age of eight; at this age colored boys also show an increase of brightness but less marked, the boys at this age too have a much higher percentage in average ability in most all branches of study; colored children generally increase in brightness as age increases, whereas the reverse is true of white children; colored children are much more sensitive to heat than white children, their power of discrimination being better, not that they suffer more; white children, relatively to their height, are longer bodied than colored children.

*Jour. Am. Med. Assn., May 27, 1899.

An Old Plaster Splint Modified, and a New One. -W. C. HOBDY* describes a method of applying a plaster splint to the leg which leaves the anterior part visible, is easy of application, and adapts itself to changes in the limb. Pieces of old cotton sheeting are cut to extend from the mid-popliteal space to the ball of the foot and wide enough to embrace the limb except two inches of the anterior surface; these are then spread with a thin layer of plaster-of-paris and two of these pieces applied and bound in place by a roller bandage; only one layer of sheeting need intervene between the plaster and the skin. For fractures anywhere in the lower third of the leg, Hobdy describes a splint which transmits the weight in walking from the knee to the ground and so allows the patient to walk immediately. It consists of a foot-board projecting two inches beyond the heel and toe and slightly wider than the ankle, and two strips of wood, which extend from the tuberosity of the tibia two inches below the sole of the foot. After reducing the fracture and applying a light plaster bandage, the footboard is bandaged firmly to the sole of the foot and then the side strips are bandaged in place, a firm shoulder of plaster, properly padded, having been made for them at the knee; the strips do not touch the leg below the seat of fracture and are held in place below by being firmly bound to the foot-board. The weight is thus transmitted directly from the tuberosity of the tibia to the ground, and the patient can walk as soon as the plaster has thoroughly dried.

Thrombosis of the Anterior Cerebral Artery.— G. BIKILES† describes a case of apoplexy in which a thrombosis of the anterior cerebral artery was found, post-mortem. A woman, aged forty-six, was suddenly attacked with a paralysis of the left side during the night; no loss of consciousness. Soon after the patient died under dyspnea and general heart symptoms. Autopsy showed a general atheromatous condition; hypertrophy of the right heart and fatty infiltration of the heart muscle. On the right hemisphere of the brain, involving a large part of the frontal convolution, a large focus of softening was found, resulting from a thrombosis of the anterior cerebral artery. A second focus was found in the strio-lenticular part of the internal capsule. In this case the following are to be noted: First, the lack of an extensive degeneration of the internal capsule, in spite of the fact that the specimen was treated with so delicate a staining method as the Marchi stain. This would tend to show that there may be an indirect effect of a hemorrhage, which is more functional than anatomical. Second, the degeneration found within the lenticular nucleus, which is here secondary, though in most cases a simple atrophy is found.

*N. Y. Med. Rec., May 20, 1899.
+Neuroglische Centralblatt, May 15, 1899.

Albuminuria in Life Insurance.-C. S. RODMAN,* reaches the following conclusions from a study of albumin tests: 1. That nitric acid contact is to be preferred as the most accurate, though phenic acid is somewhat more sensitive. 2. That albumin of not less than one-hundredth of one per cent. can be estimated with sufficient accuracy by the Esbach method. 3. Albumin in from 1 in 10,000 to 1 in 20,000 may be defined as a trace, and detected by the contact test. 4. That albumin in less amount than 1 in 20,000 is of no clinical importance on account of the uncertainties which attend its demonstration.

United States and Foreign Army Rations Compared.-C. E. WOODRUFF† compares the army rations of the United States with those of foreign nations and finds that on the poorest ration possible the American soldier stands in the middle; the Spanish, German and Russian faring better, while the Austrian, French and Italian fare worse than he. An accurate comparison is impossible; the ration is fixed by law here, and the only way the soldier can get extras is to sell part of his rations to get funds to buy. In all other countries only a portion of the ration is supplied, and the soldier provides the rest himself; the United States alone does not supply funds for purchases of extras, except by selling part of the rations. In time of peace, one ration is amply sufficient, but the methods of increasing the variety, amount and efficiency of the ration are unreliable; the purchaser is too far from the consumer, and fresh articles can rarely be purchased in sufficient quantity and sent long distances.

Segmentary Pseudo-Acromegalic Hypertrophy of the Upper Extremity, with Symptoms of Syringo-Myelia Having the Same Topography.A. CHANFFORD and V. GRIFFON describe a case of this rare combination, of which five cases have already been reported. The case is that of a man forty-eight years old, whose chief complaint was a hypertrophy of the right upper extremity which had existed for eight years. A very decided augmentation in the volume of the right arm, shoulder and fingers was found. No other symptoms of acromegaly were present in the larynx, voice, tongue, or the inferior maxilla. The sensibility to touch remained normal, but a total anesthesia to pain and to temperature existed on the right side of the face, neck and the arm and shoulder, and also on the right side of the thorax. As special peculiarities in this case are mentioned the absence of atrophy of the muscles and the non-existence of hypertrophy in the facial region. The authors can give no reason for these departures from the typical.

*Med. Examiner, May, 1899.

†N. Y. Med. Rec., May 20, 1899. Revue Neurologique, May 15, 1899.

A Rare Omental Tumor.-G. G. EITEL* reports a case of abdominal tumor attended with marked ascites but no pain or other symptoms. Operation revealed the tumor to consist of the omentum rolled upward and inward, forming a mass about seven inches long, four inches broad, and four inches thick; passive congestion of a greater portion was present. The tumor was unravelled readily and spread out over the intestines, after which the large veins disappeared from view and the omentum assumed its normal appearance. The patient made a good recovery in ten days.

Concerning Involuntary Micturition Caused by Laughing.-W. v. BECHTEREW† describes two cases of involuntary micturition in women which occurred always in the act of laughing. In the one case where this symptom was especially developed, there was a neuropathic history. In both cases no exercise of will power had any effect whatever on this uncomfortable phenomenon, nor did circumstances exercise any controlling force. In other respects the control of the sphincter was perfect. In these cases there was no incontinence of urine, but an analagous state which is observed especially in children, where, under strong emotional excitement, involuntary micturition takes place. The etiology in these cases is not clear. The condition probably dates from early childhood and is due to a hereditary taint. The prognosis and therapy are left undecided, as it was not possible in either case to carry out a systematic treatment.

Tetanus and Tetanus Antitoxin.—H. S. COLLIN‡ reports that a patient with history of a wound was admitted to the hospital unable to swallow; a rigid body; exaggerated patellar reflexes; and a septic wound whose discharge showed bacilli which may or may not have been tetanus bacilli. The wound was dressed with carbolic fomentations, and 10 cc. of antitetanic serum tetanic serum was injected hypodermatically every four hours, with the exhibition of 15 grains of chloral hydrate every four hours. A temporary relief was obtained, and a week later it was decided to inject the serum into the sub-dural space. Trephining was performed, and 10 cc. of Roux's serum was slowly injected into the sub-dural space. Recovery was slow, but under treatment with chloral hydrate was finally consummated. C. WACE reports a case where anti-tetanic serum did not save the patient. The onset occurred a week after the wound; on the next day the antitoxin was injected hypodermatically, and the next day the patient died; no post-mortem allowed. The head was held stiff, but at no time was there opisthotonus.

*N. Y. Med. Rec., May 20, 1899.

+Neuroglische Centralblatt, May 15, 1899. Lancet, May 13, 1899.

A Case of Transitory Insanity.-T. DILLER* reports an attack of insanity in a man, whose family history showed no nervous trouble, who had never previously been insane, but who had a marked alcoholic history. The attack began suddenly, lasted eighteen hours, terminated suddenly, and presented the symptoms of acute delirious mania, except that there was no rise in temperature. Cases of this kind are of some interest from the medico-legal point of view.

Dermatitis Following Exposure to Roentgen Rays.-BURI† reports a case of severe dermatitis of both hands with involvement of the nails, after prolonged exposure to X-rays. The exposure was continued for about six hours on each of four successive days; soon after the last exposure there was severe pain in both hands, they became greatly swollen and inflamed; this condition lasted ten days, when the symptoms gradually subsided and desquamation ensued. The nails became bent and extremely brittle and eventually some of them were shed, but were at once replaced by the growth of new ones. The hair, which had fallen out during the desquamation, was renewed by a stronger growth.

Locating Foreign Bodies With the Roentgen Rays.-R. GALEAZZI* refers to the well-known fact that the best photographs lead to false conclusions with regard to foreign bodies, especially within cavities. This valuable article gives exact mathematical calculations in full and the description of an apparatus founded upon them. Justice can not be done the above in a review. Those who use the Roentgen apparatus could hardly do better than to read the original.

The Significance of Absence of Nucleated Red Corpuscles in the Blood in Cases of Grave Anemia. J. S. BILLINGS† reports a series of cases of grave anemia with complete blood examination, from which he concludes that the absence of nucleated red corpuscles indicates that no new formation of red corpuscles is taking place, and therefore the prognosis is extremely unfavorable. The presence of nucleated red corpuscles does not warrant a favorable prognosis, as in typical progressive pernicious anemia; but many end in recovery. Where the red corpuscles are above 1,500,000 to the cubic millimetre, the presence or absence of nucleated red corpuscles is of little significance; but where they are below that number, and where no nucleated red corpuscles are to be found, a fatal result may be confidently expected.

the patient around quicker, but had no effect on the bleeding itself.

Amputation of the Breast by Means of the Anterior Axillary Incision.-E. J. SENN? advocates this method for the following reasons: 1 It exposes a larger field for radical work than the ordinary incision; 2 by making traction on the axillary flap, it is easily freed from subcutaneous tissue, exposing the position of the axillary vein; 3 injury to the vein is greatly diminished and dissection is done away from the vein; 4 the axillary space is unfavorable to primary wound healing; 5 the incision is so situated that it does not impede free motion of the arm and there is no subsequent cicatricial contraction to interfere with the physiologic function of the arm; 6 the scar-tissue is little exposed to trauma through stretching and there is the diminished liability to recurrence of the disease.

*N. Y. Med. Rec.. May 20, 1899.

+Monatschrift für prakt. Derm., May 1, 1899. Lancet, May 13, 1899.

§Jour. Am. Med. Assn., May 27, 1899.

Concerning Diseases Which Simulate Influenza.-R. von JAKSCH‡ makes an energetic protest against the looseness of diagnosis in regard to influenza, and reports a series of twelve cases to illustrate the point. According to his standpoint, no case of influenza should be diagnosticated as such unless the

culture or staining methods. There are many cases, which clinically are very similar to influenza, but which, according to the bacterial investigation, must be regarded as another disease entirely. In the twelve cases reported only one showed the typical influenza bacillus. In some, in which the symptoms showed a certain resemblance to influenza, the infection was due to a streptococcus invasion of a less degree of virulence than the bacillus of influenza. In three cases a diplococcus and streptococcus were found, which produced a very violent form of intoxication in animals. The conclusion which Jaksch draws from the above observations is, that the diagnosis of influenza is made on altogether insufficient grounds very often, and that pseudo-influenza diseases are very common, which are caused sometimes by a streptococcus invasion and sometimes by agents that are as yet unknown, but which have nothing at all in common with the etiological factor found in influenza.

*Centralblatt für Chirurgie. May 6, 1899.

† N. Y. Med. Jour., May 20, 1899. Berlin klin. Woch., May 15, 1899.

Practical Therapeutics.

The Mixed Toxins of Erysipelas and Bacilius Prodigiosus in Post-Operative Malignant Growths. -There is an extensive literature upon the treatment of inoperative malignant growths. Various substances have been recommended, but the most important of these is undoubtedly the toxins of erysipelas and the bacilius prodigiosus. Coley has studied the subject with greater care than any other surgeon and reports 148 cases, in which the treatment was successful in twenty-four, or fifteen per cent. If these toxins have the power of inhibiting the growth of an inoperable tumor to the extent shown by Coley's statistics, they undoubtedly have an extended range of application in the post-operative treatment of malignant growths. Even after the most complete extirpation, a certain percentage of relapses occurs. The question as to whether a large proportion of these could not be prevented by welldirected treatment following operation is one that has not been sufficiently studied. As a rule, after an extirpation, the patient is allowed to pass from observation, and is only ordered to report in case there is a recurrence of the disorder.

It would seem that just

after operation would be a golden opportunity for so fortifying the system that the disease would not recur. The use of the toxins has given the most strikingly favorable results in the spindle-cell sarcoma, and it would seem to be desirable that every operated case of this character should be treated with the toxin, at least for a time. Unfortunately, in the carcinomata the results with the toxin treatment have not been favorable.

Cold Baths in Tropical Fevers.-C. E. WOODRUFF* believes that the cold bath is a necessity in the treatment of fevers in a tropical climate; loss of heat by radiation is trifling when everything around us is little cooler than our bodies and the atmosphere already loaded with moisture; the cold bath is therefore the only safe way to reduce the body temperature. The best results are obtained under these conditions, if the patient is immersed in water of 90° F.

Metatarsalgia and its Surgical Treatment. — This disease, known as "Morton's neuralgia," is considered by PERAIRE and MALLY* strictly a surgical complaint. It consists in a painful deformity or subluxation of the metarso-phalangeal articulation of one or both feet. Histologically a condensing astitis is present. The chief predisposing etiological factors are heredity, rheumatic diathesis, neurasthenia, epilepsy, and hysteria. The disease is one of adult life, and affects women more commonly. Exciting causes are trauma, illy-fitting shoes, and prolonged walking or standing. The Roentgen rays are of great diagnostic value here. Clinical forms of the affection are: (1) a benign, in great part nervous, curable without operation; (2) a medium form, after trauma always, of worse prognosis than the above; (3) a grave

form, in which the joint must be resected. In the third form patients always remove the shoes after a short walk. The joint is not sensitive to pressure from above, but if palpated from the plantar surface or moved intense pain results. All forms of rheumatism are to be diagnosticated by pain on pressure on the dorsum, diffuse swelling, redness, and heat of skin; none of these appear in the subjects treated. Radical treatment consists in resection of the head of the metatarsal; brilliant results have been achieved, and the gait of the patient been less affected than one would suppose.

Treatment of Infected Wounds.-D. N. EISENDRATH† divides the varieties of infection into three groups: 1. The circumscribed, as seen in a folliculitis, a furuncle, paronychia, or an acute abscess. 2. Phlegmonous inflammation with suppuration. 3. Progressive purulent infiltration. The general principles of treatment must be changed to suit the particular anatomical region in which each group occurs. The use of hot wet dressings for all forms of local infection is advocated; a weak boracic acid solution, a one-fourth to one-half per cent. solution of formaldehyde, one per cent. acetate of aluminum, are suitable for this dressing. In infection of the fingers, a longitudinal incision should be made on either side of the tendon and the wound kept open with gauze packing. In the second group, long

into cold water at once the temperature comes down more slowly and does not remain down so long; the shock of the cold water to the vaso-motor nerves causes a contraction of the arterioles of the superficial circulation, so that it is difficult to cool off much more of the body than the skin and subcutaneous tissues, the internal heat not being conveyed to the surface at all. Observations in Manilla show that perfectly healthy men may have a mouth-temperature of 100°

or 101°.

*Phila. Med. Jour., May 27, 1899.

area involved, and the wound irrigated with strong bichloride solution or hydrogen peroxide. The third group, erroneously called phlegmonous erysipelas, is an advanced stage of the second, and requires large incisions extending to the fascia, connecting with each other or with counter-drain openings. The maxim in the treatment of all infected wounds should be early and free incision, disinfection and packing of wounds, wet dressings and systematic

treatment.

*Revue de Chirurgie, April 10, 1899. +Medicine, June, 1899.

Miscellany

Publishers' Department

HUTCHISON has recently determined by careful experimental inquiry that petroleum emulsions are devoid of nutritive value. In fact, they are not absorbed, and he was able to show that all of the petroleum administered by the mouth was recovered from the stools, none of it having been absorbed into the circulation.

THE extent to which medical services may be cheapened by clubs is shown in Australia, where this form of medical attendance has become almost universal. The average club fee is 3d. a week. It is stated that it is no uncommon thing for a medical man to attend a man of wealth, making anywhere from one to two hundred visits in a year, and to receive the usual thirteen shillings for the year's work. Medical clubs are gaining ground in this country, and if the medical profession does not earnestly set its face against this evil, the result will be more deplorable than it has been in England and Australia.

THE last number of the Medical and Surgical Review of Reviews states that the editors are very much gratified at the success which has attended that publication and the liberal manner in which their pages are quoted by other medical journals. They refer to the March issue of the Canadian Lancet, and claim that out of sixty-one pages of closely-printed matter, which contained in all ninety-one articles and abstracts, eighty-five (forty-one pages out of sixty-one) were taken verbatim from the January number of their journal without the slightest acknowledgement.

AT Jasbrabask, in Hungary, an epidemic of a peculiar and hitherto unrecognized disease is said to prevail, and three hundred out of the five hundred inhabitants have died with the affection. The disease is thought to be contagious, and it is accompanied by violent mania and profuse hemorrhages. It is said that medical men have been sent from Buda-Pest and Vienna to make a careful study of the disorder.

THE military medical man should be first a sanitarian, next a physician, and last a surgeon. The statistics of the late war show that 329 men were killed in battle, and 125 died of wounds. 5,277 died of disease during the campaign, being about 12 deaths from disease to 1 in battle or from a wound.

THE following is the program for the St. Louis Medical Society of Missouri, Saturday evening, June 17, 1890: Some Points in the Anatomy, Physiology and Pathology of the Fore-Brain," by Dr. Arthur E. Mink.

Pruritus Vulvæ.-"Two weeks ago I was asked to prescribe for a distressing case of pruritus vulvæ. The condition had existed about two years. A solution of morphine in camphor water had been applied locally until the patient had become addicted to the habit. I prescribed Unguentine, to be applied night and morning, after thoroughly cleansing the parts with pure castile soap and water. The effect was simply magical; the itching ceased, the swelling has subsided, and the lady says she feels like a new woman.' She is well. So much for Unguentine, the (to me) indispensable."" Yours truly,

FERDINAND KING, Editor N. Y. Polyclinic.

A Perfect Vehicle for Irritating Remedies.-The practitioner naturally seeks anything that will enhance the physiological action of a drug, render it more readily assimilable or less disturbing, and is puzzled at times to find a medium which will enable him to get the very best results frequently demanded by the conditions. Drugs that cause gastric irritability-like the salicylates-must often be abandoned (though absolutely indicated and requiring to be "pushed") because of the adverse effects set up. So, too, with turpentine, how difficult to emulsify and render it non-irritating. The bromide or iodide of potash, especially with children, has to be abandoned at times because of the nausea and vomiting so frequently experienced.

What the practitioner may not know and what we want him to know is, he has at command a perfect vehicle for a wide range of drugs that will permit a tolerance not to be found with other menstra, and one that will also form many desirable combinations

the Phillips' Milk of Magnesia. The range of usefulness of this hydrate antacid (locally and systemically) is as broad as the acid conditions calling for its employment. It is a particularly advantageous adjunct in the administration of the drugs named above.

In the gouty and rheumatic diathesis due to uric, lactic or lithic acidity, it is valuable, while in the intestinal indigestion of infants attended with flatulence, it serves admirably, alone or in combination with some of the carminatives. The assertion can be made positively that it produces no concretions, as with the calcined, or carbonic acid, as from the carbonate form.

We can emphatically endorse and commend this preparation to our professional friends.