syphilitic,) but the men would fear that, if they infected others outside, they would be subject to legal penalties.

I believe, therefore, that such a law would not only greatly diminish the frequency of syphilis, but would also be in the direct line of breaking up licentiousness. When the step is once taken of placing syphilis among the contagious diseases, subject to law, the details necessary to enforce such a law will naturally follow. The force of the argument rests on the necessity of examining the men instead of the women; for any proposition looking to the latter has always met with resistance at the hands of many classes in every community, who urge the degrading character of police inspection. That a person may legally be held liable for communicating syphilis is abundantly shown by the many cases occurring in the literature of foreign countries The works of Tardieu,1 Fournier, 2 and others are full of accounts of legal action taken, and fines and imprisonment imposed, for the wilful or careless transmission of syphilis; and in some instances the actions were against physicians who had exercised every possible precaution. In our own country syphilis has sometimes been the subject of judicial action; in a recent case before the Court of Appeals, of Kentucky, it was decided that syphilis pleaded in answer to an action to recover damages for breach of promise of marriage, is a complete defence; this followed the decision of the supreme court of North Carolina, in which the same defence was interposed and sustained in a similar action.

One of my own patients recently received five thousand dollars from the man who infected her with syphilis; in this instance the case did not come to court, though it was settled through legal counsel.

How far the matter can be carried in regard to the restraint of syphilitics from exposing others, cannot now be decided. Much enlightment of the community is yet necessary in regard to this subject, and much thought will be requisite to determine exactly the best methods of checking the slow but steady extension of syphilis which is now taking place. These matters can safely be left to future consideration. The first step is now to be taken by the legal recognition of syphilis as one of the contagious diseases which are dangerous to the life and health of the nation-as a pest against which society has the same right as in the case of other contagious diseases namely, to protect itself by

1 Tardieu. Etude Medico-legale, etc., Paris, 1879. 2 Fournier. Nourrices et nourrisons syphilitiques, Paris, 1878.

3 Jour. of the Amer. Med. Asso., Oct. 8, 1892, p. 445.

scientific treatment and by legal penalties.

[This plan-making the communication of all such contagious diseases a criminal offense -has been advocated by us in our editorial columns.-Ed.]

How to Live Where There Is Malaria.

In his recent work on "The Climate of Rome and the Roman Campagna," Professor Tommasi-Crudeli devotes a valuable chapter to the subject of the preservation of human life in malarious countries. Our readers will be

glad to have in a compact form the views of so eminent an authority on this very important and interesting topic. We must be content to admit for the present we have no precise knowledge of the nature of the malarious poison, or of the means whereby it can be extirpated from the soil of an infected locality. That the poison inheres in the soil; that it is under the influence of season, temperature and rainfall; that it is excited to fresh activity by all measures involving the disturbance of earth long left quiescent; that its ravages have been much reduced by drainage, by the conversion of naked soil into meadow land, and by the erection of houses and laying down of paved streets-these facts are certain, and almost exhaust our knowledge on the subject.

Professor Tommasi-Crudeli points out that. the traditional precautionary measures long adopted in malarious countries have had two ends in view, viz., to reduce as much as possible the quantity of the malaria ferment which enters into the system through the air breathed, and to prevent a lengthened abode of the same in the system. The first point is sought to be achieved by avoiding agricultural operations during those hours at which the malarious influence is most potent, viz., about sunrise and sunset; hence, according to the writer, is really explained the much misunderstood dictum of the ancient Sybarites: If you wish to live long and well, do not ever see the rising or the setting sun." Another point of the greatest importance is to avoid breathing the air in close contact with the soil, as it can be shown that the malarious poison rises only a short distance in a vertical direction. Thus in the Pontine marshes, an intensely malarious region, platforms four or five meters high are erected, upon which the people sleep in the open air with comparative impunity. In Greece the jungles of the East Indies, and Central and Southern America, similar devices have been adopted with beneficial results. Another mode of eluding the malaria laden air in close contact with the ground is to construct the dwellings in such a way that when the door is shut the

i

internal atmosphere is renewed only by the strata of the local atmosphere which are near the roofs of the houses. This is managed in some localities by so arranging that the only opening in the outer wall is the door, and all the windows open on an inner yard at a higher level than the ground floor of the house.

It is advisable also to keep the windows of the houses closed in the morning and during the early hours of the evening, especially if any excavations should be going on in the neighborhood. Care should be exercised regarding the effects of placing vases of flowers in occupied rooms; either these should be entirely excluded from houses when malaria is rife, or the utmost vigilance should be taken to secure thorough ventilation.-Lancet, in American Analyst.

Phenocoll Hydrochlorate in Malarial Fevers.

Professor Guido Ancona has employed this remedy in various forms of malarial fever, especially the typhoid and pneumonic varieties, with very high temperature. In regard to the dose, he states that adults require more than 1 gramme daily, since Allastoni and others have found this quantity produce no effect. Even in children of 5 and 7 years of age it was necessary to give a daily dose of 1 gramme. As a rule, 1 grammes in the twenty-four hours sufficed for adults. In cases of mild recurrence the remedy should be given for two or three consecutive days or before the day on which a paroxysm should be expected. Subjective disturbances were never excited by the drug, but it should not be administered just before the hours of sleep. Of 30 cases in which phenocoll hydrochlorate was used only 2 experienced no benefit, while in 28 cases the febrile paroxysms were checked soon after the exhibition of the first dose. Swelling of the spleen, when present, was unaffected. The effect is more profound and more lasting than that produced by quinine, which must, moreover, be employed in larger doses. Phenocollum hydrochlorate succeeded in many cases where quinine had failed. Deutche Med. Zeitung.--Med. Bulletin.

Treatment of Malaria by Means of Potassium or Sodium Nitrate.

Dr. Peter Buro, of Arva-Polhora, who lives in a malarial district, has had many opportunities of demonstrating the value of these salts in malaria, and has formed the following conclusions: 1. The nitrate of potassium and the nitrate of sodium are specific remedies in typical malarial intermittent, whether it assumes the quotidian, tertian, or quartan form. 2.

Both salts manifest an exact action, but the sodium salt has the advantage of being free from the slightly toxic effect of nitrate of potassium. It is likewise better adapted to subcutaneous administration, being three or four times more soluble in water than the salt of potassium. 3. The usual single dose for adults is from 15 to 24 grains, and it may be given in either the febrile or the afebrile stage. Larger or more frequently repeated doses are, however, often required. 4. Cases occur, though rarely, in which the saltpetre fails to prevent an attack. 5. A decided advantage of these salts is that they exert no ill effects upon the digestive organs or nervous system, nor do they produce any untoward results. They may also be easily exhibited in a palatable form, which recommends them to juvenile patients. Deutche Med. Zeitung.-Ib.

Solution of Epsom Salt for Burns.

Dr. N. F. Howard, of Dahlonega, Ga., reports to the Atlanta Med. and Surg. Jour. an interesting case of very severe burns of both hands, in which the usual applications failed to relieve the pain. The hands were immersed in a solution of one pound of epsom salts to two quarts of water, when the pain ceased at once. After holding them in the solution one hour the redness, swelling, heat and pain were entirely gone, when they were given the usual dressings of oil and oxide of zinc and the burned surfaces proceeded to rapid healing. Let us bear this in mind and make use of it in the next case. It is well known that bicarbonate of sodium will give practically the same results.

tax.

Cheap Infant Foods.

There is no doubt that several of the infant foods now on the market, if properly adminis tered, can be substituted efficiently for human milk. Buf among the poorer classes, the expense attending the use of these foods is a great Dr. H. D. Chapin, and Dr. S. Eiloart have undertaken a series of experiments for the purpose of obtaining a cheap substitute for human milk, using cow's milk as a basis. Dr. Chapin advises against the complete sterilization of city milk, but thinks that its partial sterilization or pasteurization is necessary in order to kill the microbe of lactic acid fermentation. The milk used is the ordinary cow's milk of the city, which is twenty four to thirty-six hours old. This is allowed to stand, and the upper half only used. This contains, according to Drs. Chapin and Eiloart, 4.9 per cent. fat, as against 3.03 per cent. in the lower half. The object sought for by the investigators was to secure some diluent for the milk which would properly

enrich it, and at the same time prevent its coagulation in large tough curds. For this purpose the milk is diluted with barley, oatmeal, or wheat flour gruel, and then diastase in the form of malt added. The results obtained from the use of this food on thir y seven cases were good. The special directions for making the food are as follows:

RECIPE 1.-Materials.-Wheat flour or barley meal, two ounces (two tablespoonfuls heaped as high as possible); water, fifty-six ounces (a quart and three-quarters); extract of malt, half a teaspoonful or a small teaspoonful.

Process.--With thirty ounces (a scant quart) of the water make the flour into a gruel, boiling ten minutes in a double boiler. Take out the inner vessel and add the rest of the water cold, the malt extract being dissolved in the last few ounces added. Let it stand fifteen minutes. Put back the inner vessel and heat again in the double boiler fifteen minutes. Strain through a coffee strainer of wire gauze.

If for any reason it is desirable, and in cases of diarrhea, to give a smaller proportion of maltose, the following recipe is used, and we get a food containing only one-fourth of the solid matter in the form of maltose:

RECIPE II.--Materials as in RECIPE I. Proceed as before, but reserve only one pint of the water for adding cold. After adding the cold water with the malt extract dissolved in the last few ounces of it, let it stand only three minutes instead of fifteen minutes. Then heat ten minutes in a double boiler and strain.

To make the gruel well and quickly, beat the flour with very little water. A little beating with little water is better than much beating with much water. Beat smooth, therefore, while the paste is still almost a dough; then add cold water to make a thin paste, and to this add the rest of the first part of the water boiling hot, with stirring. If these directions are followed, very few lumps will remain on the strainer; in fact, only about five per cent. of the meal need be lost in this way. The water in the outer vessel of the double boiler must be kept boiling throughout. Whichever recipe is followed, the food should be taken mixed with milk.-Med. Record.

Treatment of Diarrhea of Children.

In treating diarrhea of infants, children or adults, we should always remember that the secretions are defective, as indicated by a dry or coated tongue, unnatural color of stools, etc., and to attempt to arrest the watery discharges with such a pathological condition present by opiates and astringents will not last-will do injury,harm instead of good. Therefore firstuse:

However, if the fever is not very high, I content myself with the external application of cold, such as the wet pack, sponging with spt. myrciæ, one ounce to a pint of water, and the ice bag. I also use Yeo's chlorine water with When there is moderately successful results.

much tympanitis, or a more marked tendency to delirium, or when the tongue is harsh and dry, I add from two to three drops of oil of turpentine per dose to the above prescription.

In conjunction with the above treatment I use some acidulous drink, as nitro-muriatic acid, which allays the intense thirst, though

Thyroid Feeding in Exophthalmic Goitre. BY DAVID OWEN, M.R.C.S., L.S.A., MANCHESTER, ENGLAND.

Now that the use of thyroid gland in the treatment of disease is receiving so much attention, the following case may be of interest:

W. U., aged 46, a laborer, came under observation last May on account of an attack of diarrhea, which had kept him awake the whole of the night before. He said that for twenty years he had had a swelling in the neck and a prominence of the eyeballs. Several doctors had noticed these peculiarities. During that time he had suffered much from palpitation and breathlessness, which rendered him unable to do a good day's work.

His face wore a very anxious expression, the eyeballs were very prominent, a wide ring of sclerotic being visible; the upper eyelids did not accompany the eyeballs in downward movement, and carrying the hand rapidly in front of his eyes did not cause blinking. There was visible arterial throbbing in the neck, and a fullness in the thyroid region protruding well in front of the anterior border of the sterno-mastoid muscles. Pulse 126. The apex beat was in the sixth intercostal space just outside the nipple line. The upper margin of the cardiac dulness was in the third intercostal space, the right margin at the left border of the sternum. No murmur was detected. There was no albumen in the urine.

The diarrhea was checked by opium. Then quinine, iron, digitalis, and arsenic were given for a fortnight without benefit. He was then put upon raw sheep's thyroid (a quarter lobe per diem,) minced and flavored with a little salt and vinegar. His wife gave him, through a misunderstanding, lb. daily for two days. This caused dyspeptic symptoms- nausea, eructations, vertigo, and insomnia. His face and legs swelled, in consequence, he thought, of the neckbergs," by which name thyroids are known to butchers in this locality. The thyroid was discontinued for a week, and the unpleas ant effects of the previous mistake having passed off, was resumed in the quantity origin

66

ally prescribed. He steadily improved, and for the last three months has been able to do heavy work without the slightest discomfortan experience nnknown to him, he says for many years. The exophthalmos is now scarcely perceptible, and would not be suspected without close examination. There is now a depression in place of the previous fullness in the thyroid region. The pulse is 76. The area of cardiac dulness is unaltered. Arterial throbbing has disappeared. The patient is greatly surprised at the change which has come over him, and continues to take a quarter of a lobe twice a week. One cannot be sure there is a connection between the treatment and the improvement, though the patient has no doubt on the matter.-Brit. Med. Jour.

Injection Method of Treating Certain Classes of Hemorrhoids.

This method, though generally condemned, is sometimes very efficient in simple hemorrhoids without ulceration, and where the sphineter is relaxed. The bowels should be washed out with enemata, and antiseptic precautions carefully observed. The tumor is brought into view, without a speculum, if possible, the parts thoroughly cleansed, and a needle introduced from the base of the tumor to the center. The blood is then pressed out of the tumor with the finger, and great care taken to see that the needle is neither in the cellular tissue beneath the hemorrhoid, or immediately adjacent to the mucous membrane. The fluid is to be injected in very small quantities in different parts of the hemorrhoid through the one puncture; two are generally sufficient-never than four

more

minims. I prefer the following modified Shuford's solution:

The fluid should always be perfectly clear, and should never be used when of a reddish or yellow color, for it is then likely to cause considerable irritation. The injection causes no pain, and does not interfere with the patient's occupation. It is sometimes necessary to repeat the operation on a large hemorrhoid, but this should not be done for three weeks. There is nothing in the fluid to produce suppuration, and when this occurs it is due to faulty technique. I have never had death, hemorrhage fistula, stricture, or protracted ulceration produced by this method in nearly one thousand injections, and I believe this is due to antisepsis, and the injection of very small quantities of weak solutions. Some cases recur in from

two to four years, but the treatment can then be repeated satisfactorily; in the majority of cases there is no return.-Am. M. S. Bulletin.

Ammonium Embelate as a Tenifuge.

Dr. A. Durand (Inaugural Thesis; Bordeaux, 1893.) The author has conducted a series of clinical experiments with AMMONIUM EMBELATE, which prove the reputed anthelmintic value of this remedy. Of eight cases the tenia were killed and completely expelled in seven, while in the eighth, in which pelletierine had proved of no avail, the parasite was only partially removed. The patients were subjected to the milk-diet for three days-ammonium embelate being given on the morning of the second day, on an empty, stomach, in doses af 40 centigrammes (6 grn.), taken in wafers and followed by a purgativepreferably castor oil in 30 gramme (1 fl. oz.) doses after 24 hours. The author considers

ammonium embelate a reliable and harmless tenifuge. Amer. Med. Surg. Bulletin.

A Good Recovery From a Bad Injury. BY T. J. NEWLAND, M.D., SURGEON, N.P.R.R., ELLENSBURG, WASH.

On January 16, 1893, Mr. B., aged about 30 years, while acting in the capacity of brakeman for the N. P. R. R., fell from the top of a box car of a moving train to the track, and a loaded car passed over his left foot diagonally from the heel forward across the arch, inflicting a severe compound-comminuted fracture of the tarsal bones, and a greatly lacerated condition of the soft tissues, almost severing the foot, with the complete distruction of all the principal nutrient blood vessels- a sickly sight of mangled tissue.

was

It was found necessary to remove many fragments of bone, and when the wound properly cleansed and ready for the dressing, I write for description." Communica haming

this basis, and get the benefit of his enterprise.

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that was left of the patient's foot. piece of moist sterilized gauze was drawn through the foot, and all the openings well packed with the same sort of material. Circulation by the superficial vessels remaining was encouraged by artificial heat, which was found to be essential for about three weeks. It was dressed as often as deemed necessary.

The large cavities filled but slowly on account of the deficient circulation, by granulated tissue, without suppuration, the wound remaining aseptic throughout. The foot shortened some by contraction of the remaining tendons, and in a couple of months there was considerable strength in the foot, and the patient was going about comfortably on crutches.

On April 26th following he was transferred to the company's hospital at Missoula, where the remaining granulating surface was successfully covered by skin-grafts by Dr. J. J. Buckley, chief surgeon, and the patient soon discharged. Today, and for several weeks past, only a little more than twelve months since the accident, the man walks as rapidly as the average individual. True, he limps some, but the foot has become quite strong. The new tissue formation has become dense and hard, forming a good false joint.

fo

This case has been of great interest to me, and I believe it should be to every surgeon, on account of the anatomical arrangement of the bony structure of the foot being so extensively disorganized, and yet its functions so nearly restored. It should teach us that conservative surgery should never be lost sight of, and that it is very often rewarded by flattering results. -Med. Sentinel.

The Sulphites and Hyposulphites.

In an interesting and exhaustive article in the Jour A. M. A., Dr. Joseph Jones, of New Orleans, gives some important facts regarding this useful class of agents (the sulphite and the hyposulphite of sodium calcium potasium or magnesium). In the treatment of wounds they present the following advantages: 1, anesthesia of the wound; 2, prevention of nervous accidents; 3, excitation of granulation and accelgeration of cicatrization; 4, diminution of the quantity of pus, which it renders viscid, sweet, inodorous and neutral.

Under the head of Physiologic Action the author concludes as follows: Giving credit to the consciencious experiments of Polli and of Burgreave upon animals, it becomes difficult to refuse to admit 1, that these salts exercise upon the economy a very marked action, an action almost specific in certain cases; 2, that their