pain. The most common one in young infants is colic of intestinal origin. Colic of this type always signifies indigestion. The colicy infant expels an undue amount of gas. The abdomen is distended and a gurgling sensation can be felt, due to the increased peristalsis of the intestine. It is well to bear in mind that colic may be due to protein decomposition causing constipated grey fetid stools, or it may be due to carbohydrate or fat fermentation producing green watery stools. The latter type very commonly occurs in infants two to three weeks of age, or during a mild attack of fermentative diarrhea. It is cured almost invariably by modifying the mother's milk, with a milk which contains a high per cent of protein, (either buttermilk, eiweiss or protein milk) until the stools are a smooth yellow pasty. That type of colic due to protein decomposition is much more persistent, and the relief often will be obtained only after a very thorough study of the mothers milk as regards quantity, composition, the nursing interval, ets. It is difficult in this type of case to distinguish between colic and hunger. Again these two conditions may be associated and frequently are. It is a very common experience to have a baby come under observation with a history of having been crying for one or two months, with what the mother terms "three months colic." It is undernourished and patently a hungry baby. Yet throughout this whole period of time no attention has been given to the feeding. The only measures suggested to her for relief have been opiates or laxatives. This is mentioned for the sake of emphasizing the importance of obtaining a careful history, particularly as regards the baby's appetite, the amount of food obtained at a nursing, and the gain in weight during the period of time the baby has been crying. Miliaria seen most frequently during the hot period of the year, or in children wearing. woolen under garments, is a frequent cause of fretfulness. The relief of the irritation will allow the baby to sleep soundly. The hypertonic infant is always. brought to the physician with the mother's statement that it cries continually day and night. Other symptoms of hypertonia, such as vomiting, constipation, precocious muscular developement, and restlessness enables one to recognize this condition and relieve it by proper medication. The infant which cries whenever it is touched, as in picking it up from the bed, should be suspected of having scurvy or arthritis, or some of the other conditions causing tenderness. The history of food having been deficient in vitamine should make one suspect scurvy. If there is swelling at the junction of the epiphyses and diaphyses of the long bones, congenital syphilis may be the underlying factor. Arthritis, secondary to focal infection is seen not uncommonly and should be borne in mind. The salient features of these diseases with the means for their relief will not be discussed. They are named to remind you that they not uncommonly occur, and are the cause of this particular type of crying. There are other types of crying less: often encountered than the above. The feeble, complaining continual cry of the new born infant, following application of forceps, a precipitate or a dry labor suggests birth trauma. This type of cry should cause the attending physician to do a careful physical examination... A lumbar puncture should not be omitted, since it may be the only means of detecting intra cranial hemorrhage. The hoarse dry coughing cry of laryngitis stridulosa need only be mentioned. It is very similar to that of diphtheria of the larynx, or laryngitis from other infections causing a membrane formation. The short grunting cry heard at the onset of the acute pneumonias is significant, and signifies pain. It frequently enables one to obtain a fairly accurate idea of the state of affairs before the infant is examined. It also should remind us that the pain is severe enough to demand relief by the administration of an opiate. The cry emitted by mentally defective infants, particularly the microcephalic, and the hydrocephalic, are significant and peculiarly noticeable, because the infant cries without rhyme or reason:" It may be laughing at one instant and screaming at the next. The crying i of short duration; and there is no definite purpose to or for the cry. It ceases to cry as suddenly as it begins, and this fact alone will often cause an observer to suspect the true state of affairs before other stigmata manifest themselves. The moaning cry of chronic intestinal indigestion is fairly characteristic. The child sleeps fretfully, tosses in bed and gnashes its teeth, and occasionally cries out loud a few times without waking. The feeble whine often repeated is heard in states of extreme exhaustion, experienced so frequently in severe dysentery. It has an ominous meaning to one who has had many experiences with the condition. The loud wailing screech of the hydrocephalic can never be forgotten if once heard. Unfortunately it cannot be relieved. The cry of the premature infant sounds more like the screak of a mouse. The same type of cry is omitted by the infant suffering from asthrepsia, in Regarding the milk diet, Dr. J. C. Howell states in the Medical World (April, 1922) that in the treatment of gastro-intestinal diseases, diseases of the liver, nervous system, kidneys, circulartory system and kindred diseases, it is his belief that it is one of the greatest therapeutic agencies when properly used that any physician can employ. The following rules are laid down: First. Complete rest for all the organs of the body except those concerned in the production and circulation of the blood, and those connected with the elimination of waste and poisonous matter. Second. An ample supply of the food that will make an immediate large production of the blood possible-milk. Third. An unlimited quantity of pure air to oxidize and cool the blood, and carry off the expired gases. Fourth. Warm water baths to soften the skin, equalize the circulation, relax tense muscles, and regulate the body heat. Fifth. When the body is ready for it, exercise, to strengthen the muscles, expand the lungs, limber the joints, stimulate the circulation, increase the elimination, purify the blood, develop normal secretions, train the nerves and, generally, to fix and make permanent the benefits acquired while resting and building up the body. Could Move an Audience "Do you know what it is to go before an audience?" "No. I spoke before an audience once, but most of it went before I did.” DIGEST OF CURRENT MEDICAL AND Intravenous Use of Quinine in Malaria Limitations to the use. of quinine intravenously in malaria treament is the subject of a report by Dr. K. F. Maxcy just published by the U. S. Public Health Service. desirable to use the intravenous route of administration in the simple acute or chronic infections ordinarily encountered, whether tertian or aestivo-autumnal. When the clinician decides that the method is warranted, the effect upon the patient must be borne in mind. Particularly is it necessary to be sure that the patient is not already suffering from circulatory embarrassment. The technique of the injection must be such as to minimize the danger of untoward effects by observing three cardinal principles: Careful aseptic technique; giving the drug in moderate doses and in dilution; and introducing the solution slowly. When quinine is given intravenously by routine in malaria treatment it can hardly be claimed that the procedure is without danger. The sudden introduction of a concentrated solution into the blood stream tends to cause circulatory depression and distressing nervous phenomena. Accidental extra-vasation into the tissues at the point of injection is apt to cause local necrosis and sloughing. Against these dangers is the unquestionable radpidity with which the drug is brought into contact with the parasites in the blood stream. Except A Successful Non-Surgical Treatment for this there is no clear evidence, at present that in ordinary malaria infections the method is more effective than mouth administration in curing an acute attack, in ridding the blood of sexual forms, or in preventing relapse. Its proper field of usefulness seems to be upon urgent clinical indications of two sorts: first, in cases in which prompt absorption by the gastro-intestinal tract, following mouth administration, is not to be expected because of violent gastro-intestinal disturbance of other cause, or in which it is impossible to give the drug by mouth on account of delirium, coma, etc; and second, in cases which are gravely ill when first seen by the physician and in whom it is deemed imperative to secure immediate cinchorization. It does not seem necessary nor All the precautions which are observed in giving a dose of salvarsan should be observed in giving quinine. -S of Prolapse of the Rectum The plan of dilating the colon and whole large bowel by means of passing large quantities of water into the lower bowel for prolapse of rectum is set forth in an article by Dr. J. S. Beeler in American Medicine (May, 1922). The method of treatment is as follows: 1. Always return the prolapsed rectum, when possible, before inserting a large catheter or colon tube well into the bowel. 2. The patient is best placed on his left side either in bed or on the floor with hips slightly elevated. 3. Water or normal salt solution of body temperature is allowed to flow as rapidly as the patient's comfort will permit. 4. As much fluid is given as patient can stand, which at first will be small in amount, but try to give to an adult at least one-half gallon. To prevent To prevent griping allow the fluid to flow very slowly. 5. Always remember that the object is to dilate the large gut and to exercise the musculature, therefore increase the amount daily, or best every other day up to the giving of one gallon and a quart. Of course in children and babies the amounts used will have to be much smaller. 6. Rectal massage of the sphincter muscles is of utmost importance. It is best done with the electric cone vibrator and dilator. If this cannot be obtained a bivalve speculum can be used by alternately opening and closing, in this way both massaging and dilating with ease. This tones up and increases the strength of the muscles very quickly. even lowed by iron and arsenic or calcium. Sometimes in old cases the calcium iodide will wake up an old lesion and make a little trouble; so reasonable care must be exercised; but it is good. policy to give it whenever possible. Keep after these patients. They are backsliders as soon as improvement. manifests itself. Take 30 grains of true salicylic acid, 40 minims of glycerin, 60 grains of sodium phosphate, boil in 20 mils of distilled water until dissolved, filter and give at one injection at about body temperature with a Luer syringe. If you do not wish to prepare this solution, have it done by one of the firms who makes these intravenous remedies. -S After each injection this prolapsing gut will be more readily returned, and as the treatment is continued it will soon begin to go back of itself. As a rule, about twelve treatments are necessary Management of Prostatic Obstruction. before the bowel will return of itself. The maximum amount of water will be reached in about the same number of treatments. After this it will be safe to allow the patient to continue the treatments himself. He is instructed to keep up the treatments until he can have a stool without a prolapse of his rectum. -SIntravenous Medication in Chronic Diseases-Phthisis Pulmonalis Dr.M. G. Schantz has been treating t. b. patients with an intravenous injection of salicylic acid, 30 grains in 20 mils of sterile water, giving a treatment once a week. He writes in the Medical World (June, 1922) that in some cases he has given a double dose and states: Between these treatments I give either an injection of iron and arsenic or calcium iodide, 10 grains. I generally alternate, one week iron and arsenic, the next week calcium, but always at the regular intervals the salicylic acid (true). At other times I have given a course of six treatments of salicylic acid fol The retention of urine as a result of enlarged prostate may vary from a few ounces to enough to distend the bladder to above the umbulicus, writes Dr. H. B. Sweetser in the Journal-Lancet (April 1, 1922). The constantly distended bladder produces a back pressure on the kidneys, and these take on a diminished function with retention in the system of the products of metabolism, urea, uric acid, and creatinine. When this occurs, uremia supervenes, and the health deteriorates. Eventually acute retention occurs, and a catheter has to be resorted to for relief. This step very often heralds the rapid downward career of these old men. In passing, I would like to emphasize what we all know-namely, that a first-time catheterization ought to be considered a major operation; especially that an overdistended bladder should never be en→ tirely emptied, since the resulting congestion may produce acute fatal sup pression of renal function. Even with the best technic, repeated catheterization is sure to result in infection of the bladder. The resulting cystitis adds immensely to the suffering, especially if the urine becomes ammoniacal and ropy, or if calculi form. Eventually death occurs from uremia or sepsis, or, in these days, from the result of operation undertaken for relif. The writer states that we have become so accustomed to the operation of prostatectomy that we are liable to think of it as the sine qua non of treatment, and are apt to lose sight of the fact that the patient's condition is due to the retention of urine and the resultant damage to the renal, function or to, sepsis, and not by any means to the presence of the enlarged prostate. To make the removal of the prostate the first step in our treatment of prostatics is to court disaster. For a safe prostatectomy, the patient with great distension and foul urine, marked uremia, low kidney function, and high blood tension, with decompensated heart, requires a long preparation, even of many weeks, before he can be safely subjected to operation. The first and most important step in the preparatory treatment is to overcome the urinary retention. Many patients lose their chance and are changed from fair risks to practically hopeless ones by misguided efforts to relieve acute retention. The keynotes of success are rigid asepsis and extreme gentleness. If a soft-rubber tube cannot be passed, then one with a coude curve may be tried and is usually successfull. If a metal catheter becomes necessary it should be used with the greatest delicacy, always remembering that the difficulty is not from construction of the urethra, but from its tortuosity. Force with a rigid instrument is sure to cause lacertion, false passages, and often deep and fatal infection. If catheterization is impossible it is far safer to tap the bladder from above. When the bladder is overdistended, one should never be tempted entirely to empty it at one sitting. A soft catheter may be tied in and clamped, and a few ounces drawn off at intervals until the bladder is empty. As soon as the bladder is empty continuous drainage may be employed, either by a retained catheter in the urethra, which is feasible in the great majority of the cases, or through a suprapubic opening in the bladder, which is easily done under local anesthesia and with practically no shock. Efficient renal function, is of great importance as regards prognosis, and should always be determined. The phthalien (P. S. P.) test is the most reliable and simplest. An output below 30 per cent in the first hour indicates & poor risk. With an in-lying catheter, if the color appears within five minutes after an intravenous injection of phthalein, I have found the kidney function efficient and the patient a good risk. Elimination of retained products of metabolism is best accomplished by the ingestion of large quantities of water and by catharsis. The septic bladder and cystitis are treated by continuous drainage and by irrigation with mild antiseptics and weak silver nitrate solutions, and possibly by the administration of hexamethylenamine. Stones, if causing much pain, may be taken away through a suprapubic opening, which is much safer than removal by the lithotrite. For cardiac decompensation, rest in bed and digitalis are indicated. Of the two avenues of approach the suprapubic is far the most popular at present. Its advantages are (1) less chance of caus |