New York University. Announcement of Summer Courses, July 9, to August 17, 1895. Rational Therapeutics of Cholera Infantum. By Gustavus Blech, M. D., St. Louis. Reprint from the New York Medical Journal.

The Treatment of Opium Poisoning by Potassium Permanganate. By William Moor, M. D. Reprint from the Medical News.

Intestinal Anastomosis, with Report of a Case. By Frederick Holme Wiggin, M. D. Reprint from the New York Medical Journal. Double Athetosis. Report of Three Cases. By Wm. F. Drewery, M. D., Petersburg, Virginia. Reprint from the Virginia Medical Monthly.

Bellevue Hospital Medical College of the City of New York. Circular of Information, 1895-1896. Twenty-Fifth Annual Course of Instruction.

Special Courses designed for Graduates in Medicine offered by the Johns Hopkins University and Hospital. 1895-96. Baltimore: The Johns Hopkins Press. 1895.

Annual Report of the Department of Health for the City of Chicago for the year ending December 31, 1894. Arthur R. Reynolds, M. D., Commissioner of Health. Chicago: 1895.

On Whooping Cough; Its Great Fatality, and the Necessity for Isolation and Rest in its Treatment. By William W. Johnston, M. D., Washington, D. C. Reprint from the Archives of Pediatrics.

Some Minor Studies in Nerve Cell Degeneration as Presented by a Case of Localized Cerebral Atrophy. By Thomas P. Prout, M. D., Morris Plains, N. J. Reprint from the American Journal of Insanity.

Circular on the Care and Deposition of Per. sons Found Unconscious on the Streets or Elsewhere. Prepared by a Special Committee of the Medical Society of the County of Kings, New York. Reprint from the Brooklyn Medical Journal.

Supra-Pubic Cystotomy for Calculus of the Bladder. Trendelenburg's Transverse Incision; Transverse Division of the Recti and Pyramidalis Muscles; Incision of the Bladder without Inflation of the Rectum or Injection of the Bladder. By A. H. Meisenbach, M. D. Reprint from the Journal of the American Medical Association.

CURRENT EDITORIAL COMMENT.

YOUNG DOCTORS.

Journal of the American Medical Association. BE guided then by the voice of experience in all things not controverted by recent facts, and try yourself to become that ideal being the old doctor would be, had he only your growth and recent knowledge to add to his tact and savoir faire. Watch him closely! he knows men as open books; he knows how to manage and control them; he knows when to smile and when to be grave. He has learned his community; he knows what he can do without offense, and how best to acquire its good will. He knows best how to set forth the knowledge he has to its best advantage. Take all you can of his method, it is the result of experience, and pay him that deference when you meet him, that you yourself would like to receive from the classman of 1945 freshly filled with the new doctrines of which you will have only heard through your journal.

NEW EDITIONS OF MEDICAL MEN.

Gaillard's Medical Journal.

AT the resent Alumni dinner of the University Medical College, Prof. William H. Thomson, among other true and pertinent things, said that every medical man should at certain intervals get out a new edition of himself. Medical books unless they are revised from time to time get out of date and behind the times. It is easy for the medical man to drift into the same condition. In the cities, doctors by frequent attendance upon medical societies and constant contact with their professional brethren, unconsciously absorb many facts and are kept more or less up to date. We say more or less advisedly, for Dr. Rip Van Winkle is not uncommonly met upon the city streets. It is our opinion, too, that of all benighted doctors, the city Rip is the most hopelessly so. A man in the country may fall behind the times through causes for which he is not entirely to blame. The old fogy of the city is so either from mere laziness or mental deficiency and inability to learn. In either event the case is hopeless. By careful and conscientious reading, any physician may keep himself well abreast of the times and more radical methods of revision will be but little required.

PUBLISHERS' DEPARTMENT.

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The safest mode of remittance is by bank check or postal money order, drawn to the order of the Maryland Medical Journal; or by Registered letter. The receipt of all money is immediately acknowledged.

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MARYLAND MEDICAL JOURNAL, 209 Park Avenue, Baltimore, Md.

NOTES.

DIABETICS are poor subjects for anesthesia. Coma is apt to follow.

*

CAFFEINE markedly increases the diuretic action of digitalis. The combination is of especial value in cardiac dropsy.

*

DR. WEILL claims that every form of vomiting during gestation can be relieved by a twenty per cent. solution of menthol in olive oil; dose, ten drops on sugar whenever nausea appears.

A PERIODONTITIS may frequently be aborted by painting the inflamed gums several times a day with a mixture of iodine and aconite, one drachm each, and chloroform and tincture of benzoin, each fifteen minims.

*

TINCTURE of iodine of double strength, or one drachm to the ounce of 95 per cent. alcohol, when thoroughly applied by means of a feather, or better by a camel's hair pencil, to boils, etc., will relieve all pain and shorten the stages of suppuration more than one-half.

*

NEVER prescribe for an inflamed eye without doing three things: 1. Without examining for a foreign body embedded in the cornea or lodged beneath the lids. 2. Without seeing if cornea or iris is implicated. 3. Without determining the presence or absence of tension of globe. Never use violence in opening the eye if there be much swelling or spasm, because if a deep ulcer of the cornea be present, perforation may take place. Never trust the nurse with verbal instructions for washing out the baby's eyes in infantile ophthalmia.

As a result of the series of careful experiments during the past winter with regard to the hypnotic effects of Trional in such cases as came under the treatment of the general practitioner, Dr. Doermer warmly recommends this remedy. On comparing it with the majority of customary hypnotics he has become convinced that it is not only equal to them but surpasses many of them as regards reliability of action and innocuousness of effect when administered for long periods. He has never observed disagreeable effects from its use and has given it in two gramme doses

daily for a number of weeks without any disturbance of the appetite or general health. In some of his cases it was found possible to produce a satisfactory and refreshing sleep with one gramme doses, as for instance in articular rheumatism; and even 0.5 grammes sufficed to bring about a quiet sleep of five hours' duration in a case of progressive paralysis, in which obstinate sleeplessness was one of the most disagreeable features. A dose of two grammes, however, always gave rise to a light or deep sleep, even in severe febrile diseases terminating fatally, such as pyemia, tuberculous meningitis following chronic otitis media, carcinoma of the colon, etc. In but one case of ascites due to cirrhosis of the liver was it found possible to obtain sleep, but in this instance the other hypnotics also proved inefficient and hypodermics of morphine had to be finally resorted to. The author's manner of administering Trional differs in nowise from that generally recommended, the patients being directed to take half a pint of soup or some carbonated water after its ingestion. He either gave two grammes in a single dose or 1.0 gramme repeated at intervals of an hour, the former method being frequently more effective. In conclusion Doermer states that Trional belongs to the permanent acquisitions to the modern materia medica, and that it will maintain its high position in the future.

IN the after-treatment of a case where an operation for the relief of an impermeable occlusion of the oesophagus of five years' standing had been performed, which operation was reported at length in the New York Medical Journal of March 23, 1895, Dr. Augustus C. Bernays, A. M., M. D., Heidelberg, M. R. C. S. Eng., Professor of Anatomy and Clinical Surgery at the Marion-Sims College of Medicine, the operating surgeon, says: "The patient rallied fairly well after the operation, but she became greatly emaciated. Liquid food was given at short intervals and stimulants as indications demanded. In order to allay the extreme nervousness and irritability, antikamnia was given and it acted promptly and satisfactorily in every instance." Of the further history of the case it may be stated that on the seventh day after operation, the patient took into her stomach through the natural channel the first food which had passed it in five years; and that in two

months convalescence was regarded as fully established.

THE superiority of Wine of Coca as a gentle stimulus, without reaction, and a reliable tonic, powerfully impressing and energizing the nervous system, without any unhappy sequelae, is recognized by the medical profession throughout the world. Argument to sustain this proposition is unnecessary, as the use of Coca in the practice and hospitals of civilization is firmly established, and the praises of its action are the proofs of its efficacy. Variation of result, however, frequently following the administration of many different makes of this remedy, even at the hands of the most observant and painstaking practitioners, has induced careful examination into the causes of such variation. A close study of this circumstance revealed the fact that difference in the alkaloidal strength of various lots of the leaves was the primary cause. Accordingly, Messrs. Gilpin, Langdon & Co. of Baltimore determined to make an ideal wine of coca, and the high commendation of physicians who have prescribed it justifies their claim to have accomplished the result. The Coca leaves entering into its production are very carefully selected, assayed and standardized, the wine used is the choicest for the purpose and the manipulation such as to produce perfect results. It is one of the most agreeable and grateful of stimulants and tonics, being especially efficacious in anemia, chlorosis, pulmonary ailments, scrofulous troubles, gastralgia, weakness of the throat and vocal cords, asthmatic conditions, slow convalescence, general debility, physical and mental depression, brain and nerve exhaustion, stomach diseases, dyspepsia, peculiar types of nervousness in women, languor and weariness, loss of appetite, results of excesses, and in other diseases and conditions where a tonic and strengthener of the general system are prime requisites. A special virtue of their Wine of Coca is its strengthening and beneficial action on the voice and vocal cords, suggesting its use for lawyers, ministers, singers, teachers, orators, and others who find it necessary to employ the vocal cords to a greater or less extent. Its pleasant taste will suggest its special adaptation for children and those of weak or rebellious stomachs. Each fluid ounce of this preparation contains fifteen one-hundredths of a grain of cocaine.

WHOLE NO. 746

SO MUCH is being said about pelvic disorders, especially about pus in the pelvis, that one is at a loss what to think is the best method of dealing with a patient suffering from this most grave affection.

There are those who say that operation is never necessary, but that rest, medication and other mild means are all that is required.

On the other hand, there are those who think that all pelvic pus must be removed by operation and especially by so-called laparotomy.

The first cite numbers of cases in which pus has disappeared by their mode of treatment, while the surgeon shows large sacs of pus he has removed and taking you around the hospital shows you the patients from whom they were removed still alive.

There seem to be very few who advocate both methods, whether because those who use milder means do not care to operate because they are unable, or from other like motives, or the surgeon on the other hand becomes so fascinated with operating that he is ready with his knife at the slightest excuse. Certain it is that the surgeon suggests that the former is a tinkerer and he in turn represents the surgeon as a roaring lion going about seeking whom he may devour.

Pus may exist in the pelvis, in the vagina, vaginitis, in the cavity of the uterus, endometritis, in the body of the uterus, metritis, in the Fallopian tubes, pyosalpinx, in the ovary, ovarian abscess, or may rupture from the tube into the ovary or vice versa, tubo-ovarian abscess, or it may rupture into the peritoneal cavity and be walled off by some other organs and constitute a pelvic abscess, and in the cellular tissue beneath the peritoneum, also called pelvic abscess.

Of pus in the vagina I will say nothing. In the cavity of the uterus, with the body fairly healthy and the uterine appendage comparatively normal, the very best method of treatment is with the sharp curette and afterwards packing with iodoform gauze. The gauze is not for drainage for it will not drain, but for antisepsis, and should be removed daily in bad cases and the cavity flushed with some antiseptic fluid using the return flow douche nozzle. The gauze should be pushed in, so that the uterus will be well distended. This should be continued till all pus has disappeared.

When the body of the uterus contains pus, either in small cavities or as it were unfiltrated through the muscle fibers, curetting and packing may be resorted to, but very great care must be taken not to use any force, for it is a very easy matter to puncture through into the

peritoneum either with the curette or in introducing the gauze.

Hysterectomy, either vaginal or supravaginal, is indicated if the curetting fails or seems to involve too much risk.

Pyosalpinx is usually caused by some acute poison and begins with symptoms like any other inflammation. The tube

is not only inflamed over its mucous surface but the whole substance of the tube is involved, including the peritoneum, and this being in contact with the peritoneum of the pelvis we always have more or less of a pelvic peritonitis.

During this stage the patient should be kept absolutely at rest in bed, very scant liquid diet and bowels freely moved each day. Prolonged hot douches with hot stupes and poultices to the abdomen. Morphia should be absolutely avoided if possible. Bromide of potash and hypodermics of hyoscine sometimes help over a rough place.

The patient will seldom die during this stage, nor does the peritonitis become general, but if it should, laparotomy is indicated.

Dr. Elliot of this city cites a case in which he catheterized the tubes through the uterus, draining off the pus. I do not see that much benefit could come from the general practice of this procedure, for to be catheterized the tube must be patulous at its proximal extremity and if this were so the pus would soon empty itself. In all the specimens In all the specimens I have seen the tube is almost absolutely closed at the uterine end, barely admitting a small bristle and the pus could not be squeezed through.

If the tube is large and filled with. pus and can be felt directly through the vaginal wall it should be emptied by puncture or incision through that channel. This procedure is very seldom available, for usually the tube is too far up to be reached with safety and usually the pus is contained in several pockets walled off in the caliber of the tube and these pockets can not be reached by the most skillful operator.

When a pyosalpinx is very large there is practically no difference between it and a pelvic abscess, or an ovarian abscess, and all should be treated alike;

the difference in treatment being according to the size of the cavity and the position of the abscess.

All collections of pus in the pelvis that can be emptied through the vagina. should be treated by that method. The difficulties that are encountered in this operation I will endeavor to illustrate by cases.

After determining the point of puncture the procedure is very simple but not without danger. The patient's hips are brought to the edge of the bed or table and she is placed in the lithotomy position, a nurse holding the leg on either side. The point of puncture is determined by the finger, a tri- or bivalve speculum is introduced and the puncture is made with a sharp bistoury, taking great care not to wound any of the vital parts. The incision should be large enough to insert the ends of one, or two fingers if the abscess cavity will per

The pus should be well drained out and the cavity flushed with a solution of hydrogen dioxide. A rubber T-shaped drainage tube is then introduced and the cavity flushed daily.

If all the pus cavities have been emptied your patient will improve rapidly and from the instant the pus is evacuated.

Segond of Paris and Bazy advocate the removal through the vagina of the uterus, leaving a large cavity in the pelvis through which all the pus may drain from the different foci.

I see no advantage in this over laparotomy. To remove a uterus so adherent must certainly be not an easy task and the risk to an adherent bowel is not small.

Every small abscess should be given an opportunity to be relieved before any of the severer operations are resorted to.

The patient should be put to bed, kept on light diet, the bowels freely solvent. If the pain is severe, electricity and hot douches are useful. Painting the vault of the vagina with iodine or ichthyol can also be done. Massage is practiced by some; but, unless the abscess is small and an old one, so that the sac is well organized, there is danger of rupture.