patient is free from any pain. His stream is forcible but thin, and of short duration; the urine is clear, but he is worried by the frequency of incapacity, being only able to retain a wineglassful at a time. Every half hour by day and night the urine is passed, and he clamors for some relief from the distressing frequency, the annoyance of the urinal, and the chafing of the abraded, urine-sodden glands. Surgical interference is without value in these cases.

5. Primary Tuberculous Prostatitis simulating Gonorrhaal Infection of the Onanitic Prostate.-The majority of cases of primary prostatic tuberculosis are recognizable per rectum by the discovery that one or both lobes are occupied by one or more hard nodules, which vary from small shot to a horse-bean in size. Moreover, the persistency of the irritability of the bladder, the unrelieved pain in the perineum and glans penis after micturition, the occasional appearance of blood at the end or at the commencement of the stream, the agony of instrumentation, together with the presence of pus and debris in the urine, will be enough to guide you after the rectal examination to a correct solution as to the trouble. Sometimes, however, when the deposit is buried in a general swelling of the prostate, it is impossible to make the diagnosis, except, perhaps, by using a weak solution of tuberculin. All instrumentation should be avoided in these cases.

Primary Urethral Tuberculosis simulating Stricture. This is an exceedingly rare affection. Tuberculosis should afford, however, a better prognosis here than in any other part of the tract, for the constant passage of urine over the surface sweeps away the irritating secretions. All manipulation is out of the question, but much good may be done by iodoform urethral bougies gently insinuated into the deep urethra, the general health being at the same time well supported. International Med. Magazine.

STRENGTH FOR SUFFERING WOMEN.- Dr. Andrew Wilson, the editor of "Health," has the following to say in a recent number of his excellent Journal.

Considerable interest has been excited by Prof. Lombroso's recent article in the Fortnightly Review, in which he endeavors to prove as the result of his experiments, that women are less sensible to pain than men. The question is certainly one worthy of attention, and we will doubtless hear enough about it before long. But whether women feel pain less acutely than men, or no, all, we suppose, will admit that women as a whole, are subject to more pain and bodily ills during the prime of life, that is from fifteen to fifty, than men during the same period. Men are more exposed to the elements, to the ever changing moods of our climate, and to the wear and tear of business, and the struggle with the world, but they are physically equipped for the contest, and they have often only themselves to blame when illness lays them low. But woman in her natural function in pregnancy, childbirth and nursing, up to the change of life, has periodic attacks on her system which have no counterpart in the lives of men. It is then very important that her strength should be maintained at the highest possible standard. Food must be nutritious, and digestion must be good. reason tea should be avoided. A most excellent stimulant nutrient is now to be had, known as Mosquera's beef cacao. It has a most agreeable flavor like that of the best chocolate, and is at the

For this

same time an extract of beef far better than most of those which are advertised and sold everywhere. When we state that is contains twice as much nourishment as an equal weight of lean beef we give only a partial idea of its value, for it is very important to know that the extract, or preparation of meat, is in the very best form for digestion, having been already partly digested by means of a ferment found in pineapple juice. This does not mean that it has lost any of its good qualities, but only that it has by these means been coverted into a form in which it is more readily absorbed by the stomach, thereby giving that organ the least possible amount of work to do. Indeed actual experience shows us that beef cacao is tolerated even when the digestive system is in the most irritable condition, as for instance in the vomiting which is often such an unpleasant accompaniment of the early months of pregnancy. Here nothing could be better than a cup of beef cacao taken before rising in the morning. In fact, for all the ailments of women, this preparation promises to be one of the most valuable food medicines which have been introduced into this country, and we most strongly recommend our readers to give it a trial.

THE PATHOGNOMONIC SIGNS OF PERFORATING ApPENDICITIS. Dr. Simon Baruch (Med. Record) emphasizes the point that symptoms of shock, carefully looked for, may always be found in perforating appendicitis. These are as follows: The countenance is anxious, the finger-tips, nose and ears are cool; pulse and respiration are out of proportion to temperature, the right inguinal region is very tender, the patient usually lies with the right leg drawn up. Guided by them, Dr. Baruch opposed the views of an experienced physician in one case, insisting upon the operation; and in another did not approve of the operation advised by an experienced surgeon. In both cases his reliance on these pathognomonic signs proved useful to the patient. On the ground of his own experienced, as well as that of others, the author urges that when perforating appendicitis is diagnosed, either positively or probably, an immediate operation to remove the exciting cause is as imperative as ligation of the vessel in hemorrhage.

The fact that laparotomies are now constantly performed, under strict asepsis, with absolute safety, should induce the attendant to clear up a doubtful diagnosis of perforating appendicitis by an operation before septic peritonitis forbids it.-Int. Jour. of Surgery.

THE TREATMENT OF CHOREA IN THE HOSPITALS OF PARIS.--Marcel Beaudoin (Revue de Therapeutique Medico-Chirurgical, April 1, 1892), after consulting the physicians of the hospitals of Paris, publishes the different opinions expressed regarding the treatment of chorea.

In ordinary cases, See recommends antipyrin and arsenic as the best remedies. In rheumatic cases, the salicylate of sodium, according to this author, should be associated with the antipyrin and sulphur baths. In cardiac choreas, to the heart remedies should be added the administration of iodide of potassium, and especially the iodide of calcium.

Gilbert Ballet believes that common chorea tends to a spontaneous cure, and that, therefore, all disturbing medication should be withheld. He condemns antipyrin, but recommends arsenic (Fowler's solution

n small doses, that is, from six to twelve drops a day according to the age of the patient), tonics and iron in anæmic cases. In serious cases he advocates the local application of ether to the vertebral column, and the bromides in patients laboring under psychical troubles. Above all, the author advises hygiene, a good alimentation, and walking in the open air avoiding fatigue.

According to Dejernie all special medication in infantile chorea is useless. He recommends tonics, massage, gymnastic exercises, dry frictions, saltbaths, and particularly insists on the application of good hygienic measures.

In mild cases, Jofflroy attaches particular importance to allowing children to sleep as long as possible; in such instances he is wont to employ daily doses of from 1 to 1.75 grammes of chloral, according to the age of the patient. Fatigue, as well as all physical and mental excitement, should be avoided. In serious cases he believes that antipyrin is useless, and he then resorts to the application twice a day of wet cloths.

Antipyrin has given the best results in the hands of Albert Robin. He combines this drug with bicarbonate of sodium, and gives it in as high dose as two grammes a day. After fifteen days' use the antipyrin is substituted by the arseniate of sodium in doses of two teaspoonfuls a day, of a solution of five centigrammes to 300 grammes of water: This solution finished, is followed by the readministration of the antipyrin.

Raymond thinks that only two remedies are to be relied upon in the treatment of chorea; chloral and antipyrin; he has seen acetanilid do good in some cases.

Sevestre believes in the use of both antipyrin and arsenic. The first medicament is administered in doses of from one to two grammes, and even three and four grammes a day. He employs, at the same time, Fowler's solution in daily amounts of from six to twelve drops or a solution of the arseniate of sodium (five centigrammes in 250 grammes of water) in doses of two or three dessertspoonfuls a day.

Massage, according to Ollivier, has given satisfac. tion in the treatment of coheric patients. This author also prescribed, as a general medication, iron, arsenic and hydrotherapy.

D'Heilly recommends hygienic measures, tonics and prolonged sleep. In slight cases he thinks that such remedies as arsenic, iron, bitters and baths are sufficient. In more serious cases he resorts to antipyrin and chloral as the best drugs.

Antipyrin is likewise highly recommended by Legroux in doses of four grammes per day. In hysterical cases the bromides and cold douches have given him the best results.

Comby insists on the application, firstly, of a moral and physical hygiene; secondly, in the sedation of the system by bromide of potassium, in daily doses of from two to four grammes, and the use of cold douches. If no amelioration follows this treatment. antipyrin, in daily amounts of from two to three grammes, should be resorted to.

Jules Simon gives the following points: (1) During the first fifteen days the child is to lie in bed, and revulsion applied over the upper part of the back, by warm frictions, mustard plasters or dry cupping, and the use of aconite and hemlock. (2) After this time, the child is made to get up, and then antipyrin should be administered in progressive doses of one, two,

three, four and five grammes in the course of the twenty-four hours; this medicament to be continued for several weeks. (3) This period, especially when the movements are sluggish, should be followed by rhythmical gymnastics. The same author prescribes, at the same time, the least exciting tonics, such as salt baths, dry frictions, etc.; but a stay at the seaside is condemned.-Univ. Med. Mag.

HYDROCHLORIC ACID IN THE TREATMENT OF VOMITING. (Lancet.) Dr. Alkie wiez, writing in the Nowing Lekaiskie says that he has found much benefit in the various kinds of vomiting from small and frequent doses of hydrochloric acid well diluted. The cases mentioned include one case of pregnancy, ten cases of cholera nostras, several cases of acute dyspepsia from errors in diet, besides others where this symptom occurred during the course of one of the exanthemata. -Int. Med. Magazine.

TREATMENT OF CHOLERA.-The following resume is given by The Therapeutic Review, of Manchester, England: There appears to be an impending attack of this dire and typically infective disease, judging from the reports in the lay press as regards its European progress. Little has been discovered as to means of specific treatment, the comma bacillus notwithstanding; but from the symptoms and condition of those attacked, it may be taken that any medicines that will relieve pain and obviate the thickening of the blood, will assist toward recovery. Recently a number of observations on the importance of calcium salts in the process of blood coagulation have been published, and such medicines, for example, sodium phosphate and potassium oxalate, as would remove calcium combinations should have the desired effect on absorption.

A recent paper by Professor C. A. Peckelharing, of Utrecht, in Virchow's Festschrift, and other communications to the Academy of Sciences at Amsterdam, are much to the point. (See the British Medical Journal, April 23, 1892.) In our last issue, page 82, an abstract was given of Dr. Mackintosh's treatment by intravenous injection of a saline solution containing rather more than the normal amount, i. e., 34 per cent of sodium chloride and bicarbonate. Dr. Little, at the London Hospital in 1848-49, successfully employed in cholera cases saline injections amounting to as much as four pints; and again, Mr. L. S. Little in 1886-7. Of course it is well known that in cases of hæmorrhagic collapse it is the loss of volume which must always remain proportionate to the capacity of the vascular system, independently, for the time being of the red corpuscles and the nutritive constituents of the blood, which causes the immediate danger, and if the depletion of the circulating fluid from either cause can be directly obviated, it would seem that saline injections are obviously the most expedient method.

We need not here insist on the absolute necessity of rigorous hygienic conditions, especially in respect of food and water, as being in a general sense prophylactic, nor enter into their details, for when an attack has to be dealt with, it must be done promptly. With this view we reproduce our articles in No. 4, page 52.

Dr. J. Carrack Murray, of Newcastle-upon-Tyne, after premising his qualifications in cholera from having had it twice, and seeing three epidemics of it, submits the following for trial:

"One drachm and a half of hydrate of chloral, 11⁄2 drachms of bicarbonate of soda, 1 ounce of compound camphor tincture, 1⁄2 drachm of tincture of capsicum, 1⁄2 drachm of hydrocyanic acid, water to 8 ounces. One tablespoonful to be given immediately on seeing the case, and a dessertspoonful every fifteen to thirty minutes afterward. Should collapse be present, the hydrocyanic acid must be omitted, according to the present theory of cholera. The second dose of the foregoing receipt will probably be retained, chloral being an anti-emetic; but should it be rejected, an ounce, more or less, in gum acacia solution might be thrown well up into the bowels. For the board-like feeling of the muscles during cramps, flannels wrung out of warm water and sprinkled with strong solution of hydrate of chloral should be applied to the abdomen, over the kidneys, legs and hands, with such adjuncts as might be thought useful. Hydrate of chloral, discovered by Liebig when the first authenticated epidemic of cholera was raging in Europe, was not generally known until Dr. Otto Liebreich in June, 1879, by his pen, brought it from darkness into, perhaps, a too full blaze of light. Hydrate of chloral has not been given internally for cholera so far as I know. From its antiseptic, anti-emetic, anti-spasmodic, and other qualities, it should be useful, and may be sufficiently potent to destroy the poison of cholera.'

Dr. Reddie, of Unno, in Ooude, has administered chloral in one epidemic, but has now abandoned it in favor of chlorodyne, with carbolic acid one part, and tincture of iodine five parts, water four parts, ten minims to be exhibited by the mouth, or hypodermically, according to circumstances, every half hour.

Dr. J. Mortimer Granville suggests the use of the electric bath, in which the patient, whose bed is insulated, has the prime conductor of the electric machine applied to his body, and food and medicine administered to him with nonconducting chinaware, without touching the body.-Lancet, July 28 and September 29, 1883.

Mr. H. C. Taylor, Jersey, proposes to inject the active principal of bile, bilin or taurocholic acid, in the form of its soda salt, as an adjunct to the treatment generally adopted. Arguing that in cholera the liver extracts all the bile from the blood without being able to discharge it into the intestine, and the intestine, were it supplied with bile, either by mouth or rectum, would be unable to absorb it, owing to its inflamed condition, he concludes that this absence of bile causes the thick and clotty state of the blood found even during life in choleraic attacks, and the fluidity would be restored by injection of the active principle of bile. Bilin is prepared from ox-bile, by first adding ether to extract the fatty matter. This is separated by decantation, and the residue is treated with acetate of lead, which forms the taurocholate of lead. After filtration, this precipitate should be suspended in water, and sulphuretted hydrogen gas passed through; from this the deposit of sulphide of lead is obtained, and the taurocholic acid (bilin) left in solution. After another filtration, the solution of taurocholic acid is submitted to the action of carbonate of soda, thus forming taurocholate of soda, the best preparation for injection. This salt should be purified by crystallization. The quantity employed in the twenty-four hours should be one hundred grammes, dissolved in a litre of water at the temperature of the blood (37° Centigrade); that quantity

corresponds to the bile usually secreted by the liver. --British Medical Journal, July 14, 1883.

In the collapse stage, nitrate of amyl inhalations seem to have given satisfactory results; and we would add that for the onset of the attack, an heroic dose of infusion of capsicum; one drachm to the pint, with some salt added, as one draught has been asserted to be a complete abortive, and so also the administration of one large dose of boric acid, in other instances huge doses of bismuth subnitrate every hour have been relied on.

Dr. A. Harkin, of Belfast, has recommended stimulation of the vagus nerve, extending in the course of the pneumogastric nerves, as far as the angle of the lower jaw by the application of liquor epispasticus, so as to inhibit the action of the sympathetic on the abdomen, and found this treatment to effectually stop the cramps and purging without other medicine.Times and Register.

THE CONTAGIOUSNESS OF MEASLES.-Bard (Reveue d' Hygiene et de Police Sanitaire, Paris) says in relation to the contagiousness of measles: 1. The germ of measles does not remain in a locality from which those who have suffered with the disease have gone away. Hence, disinfection of bed, furniture, etc., is unnecessary. 2. Contagion is always direct in an epidemic of this disease, from person to person, though the author admits that it passes through the intervening air. 3. The power of the contagion is such that under favorable circumstances it attacks all who are susceptible. 4. Contagion is possible three or four days before an eruption is evident.— An. of Gyn. and Ped.

TREATMENT OF POISONING BY COCAINE.-Eloy gives the following directions for the treatment of acute poisoning by cocaine. The patient is placed in a horizontal position in order to prevent syncope, and the face bathed in cold water. If convulsions come on cold should be applied. If asphyxia is present flagellation, massage, and artificial respiration are resorted to, and if the respiration depends upon the tetanic contraction of the respiratory muscles inhalations of chloroform are employed. For the intense pallor it is well to give inhalations of nitrite of amyl. Should these means be insufficient, it may be well to administer strong coffee or caffeine, or if swallowing is impossible, hypodermic injections of ether. The entire object of the treatment is to moderate the reflex excitability of the nervous system, to sustain the heart, and to re-establish the equilibrium of the circulation. -Med. and Surg. Reporter.

ENEMA FOR PHTHISICAL DIARRHEA AND FOR CHRONIC DYSENTERY. First give the patient a hypodermic of o gr. sulph. atropia; wait half an hour, place the patient in Sims position, clothing loose; then cleanse the rectum by repeated washing with Packer's tar soap-water of mild strength and as hot as can be borne. This cleansing lavement should be introduced very slowly through a small, soft, oiled catheter as far in the bowel as possible, and in as large a quantity as the bowel can be made to hold, without pain, with moderate pressure. The bowel being well cleansed and emptied, then very slowly inject, through same catheter, as far up the bowel as possible, one to two ounces of a mixture made as follows: Oil sassafras, oil camphor, and eucalyptol, each 3 i. ; lanoline (or some other very bland oil), q. s. ad. f. 3 viij.

This operation may be repeated one to three times a day, as the case may require, and the oil mixture may be made milder should it cause severe pain, which rarely, if ever, occurs.-So. Pract., Epitome.

TREATMENT OF AORTIC INCOMPETENCE.-Dr. Solomon C. Smith, discussing the action of digitalis in aortic regurgitation, says that, accepting as true the recognized dogma that the slowing of the heart lengthens the diastole more in proportion than it lengthens the systole, and permits more regurgitation, there are other considerations which diminish the evil import of this fact. In aortic regurgitation the tension of the arterial system very rapidly diminishes during ventricular diastole; the great harm, so far as reflux is therefore done at the first moment. goes, Further, the lengthening takes place just at the moment when the left auricle wants time effectually to insure the due onflow of the blood stream. The good effects of digitalis do not depend on its power of slowing the heart's beat nearly so much as on its influence in securing that each contraction is efficient, and that each cavity empties itself as it goes on. Asystole is the most serious of all the results of valvular disease, and when it begins to be established in aortic regurgitation it is apt to be progressive. It is over this state of imperfect systole that digitalis has so marked an influence.-Brit. Med. Journal.

The ETIOLOGY OF PRIMARY CROUP.-In a recent work, F. Egidi and L. Concetti (Archivio Italiano di Pediatria, 1892-Rev. inter de Bibliog. Med., April 25, 1892) appear to have established an identity in the nature It seems that the of primary croup and diphtheria. dual theory of the disorders referred to, has made great progress in Italy, and that the majority of practitioners admit that croup is not as contagious as diphtheria. The authors show, from their studies, that we must go back to the original conception of Bretonneau and of Trousseau, and consider the two affections as two different localizations of the same disorder: diphtheria. Egidi puts forth the clinical reasons that sustain this theory. In a recent epidemic of croup observed in Rome, the patients, after being operated upon by tracheotomy or intubation, would succumb in the course of two or three days, with symptoms of adynamia. Concetti made cultures from the false membranes of such patients, and found the bacillus of Klebs-Löeffler. The cultures were inoculated into animals, causing in them all the symptoms of diphtheria. Upon sixteen clinical patients suffering from primary croup, bacteriological examination revealed, in fourteen of them, the bacillus just mentioned. This latter author, Concetti, then affirms that in the cases observed by him, the primary croup was of a diphtheritic nature in the proportion 87.5 per cent. The negative results observed in the other two cases are explained by a defective maneuvre. Concetti describes minutely the process of cultivating the bacillus for examining and inoculating purposes. He further insists upon the fact that in from twenty-four to forty-eight hours, bacteriological examination constitutes an exact test in a doubtful case of croup.-Med. and Surg. Reporter.

A FATAL CASE OF BROMIDE OF ETHYL NARCOSIS.From Prof. Billroth's clinic comes a warning which is reported by Dr. Afred Gleich, in the Wiener Klinische Wochen-schrift, 1892, No. 11, S. 167. Hav

ing successfully employed this anæsthetic in nearly four hundred instances, he records a fatal issue after the use of five drachms. The operation was multiple incision in a carbuncle in right deltoid region, and death resulted in three minutes from the commencement of the narcosis, the heart and respiration ceasing. The necropsy showed parenchymatous and fatty degeneration of the walls of both ventricles of the heart, as did the liver, and parenchymatous degeneration of the renal epithelium.-Amer. Jour. Med. Sci.

Surgery.

A SIMPLE AND ECONOMICAL FORM OF TRACHEOTOMY TUBE.-(Brit. Med. Journal) A very efficient tracheotomy tube for use after the tract has become fairly free by wearing a silver tube for two or three days, can be easily made with a piece of India rubber drainage-tube in the following manner : An oval piece is cut out of one side of the tube, the shorter diameter of the oval reaching about half way around the tube. Two longitudinal cuts are then made, one on the same side as the oval opening and the other opposite to it, reaching from the end of the tube to a point about a quarter of an inch from the opening; this distance will, however, vary with the depth of the wound that the tube is to be inserted into. In the lateral flaps made by these longitudinal incisions holes are cut for tapes. The piece of tube beyond

the oval opening is the part which is put into the trachea. This tube has the following advantages. 1st. It fits the trachea well, having an angle instead of a curve, and tilting of the lower end cannot occur to cause pressure and ulceration. 2d. The window allows laryngeal respiration to take place as soon as the diminution of the swelling has made the glottis patent. 3d. The cost of the tube is practicall nil. 4th. Being made of drainage-tubing it is nearly always at hand.

EVILS OF CATGUT.-Some interesting experiments have been made by Klemm (Bull. Gen. de Therapeut.) in which was demonstrated from an aseptic standpoint the superiority of silk over catgut for suturing wounds. When catgut is employed in surgery, suppuration occurs in spite of all precaution. This led Klemm to suppose that the catgut, itself sterile, afforded a favorable culture medium for the development of such germs as get into a wound during an operation. To ascertain the correctness of his views, he made a number of comparative experiments on cats and rabbits with silk and catgut, with results as above indicated. The gut, after being used, and then placed upon a gelatine culture medium, developed as many as 2,500 colonies, while silk, similarly treated, showed only seventy-five. He, therefore, concludes that catgut, notwithstanding the thorough method of sterilization, as employed by such men as Riverdin and Brunner, is unfit for employment in surgery. New York Journal of Gynecology and Ob

stetrics.

MODERN BRAIN SURGERY.-Kirchoff (Therapeutische Monatshefte) says that three groups of symptoms are to be distinguished in every brain abscess.

(1) Those symptoms dependent upon suppuration, as fever, etc.

(2) Those dependent upon the increase of intracranial pressure.

(3) Those symptoms which arise at the seat of the abscess.

The cranium should never be opened, upon mere supposition, for the relief of this condition.

The operation for the removal of brain tumor has given but few good results; only encapsulated tumors should be removed. All infiltrating brain tumors which occupyt he important regions of the brain should be allowed to remain.

Operations for epilepsy should be performed in those cases where the symptoms indicate cortical lesion, as in Jacksonian epilepsy.

For hernia cerebri, Von Bergmann recommends ligation of the protruding mass. In cases of tumors of the posterior part of the cranium only small meningoceles should be operated upon.

Draining the cavity of the cranium for serous effusion in tubercular meningitis has been found only temporarily to relieve the pain or headache.

Puncturing the cranium for chronic hydrocephalus has been done since the days of Hippocrates, but no permanent cures have been reported.

Craniotomy for microcephalus has been performed many times and apparently with good results, but the operation is of too recent origin to report positively.

Trephining for headache should only be done in those cases where there is a localized obstinate pain. This may be due, in some cases, to pressure of a Pacchionian granulation.-Univ. Med. Magazine.

THE TREATMENT OF FRACTURE OF THE CLAVICLE AND A NEW DRESSING FOR THE SAME.--Büngner (Deutsche Medizinische Wochenschrift,) recommends for the treatment of fractured clavicle the following dressing.

An elastic T-shaped bandage is used, the crosspiece of which should be sixty centimeters long and four wide. The three tails which are fastened to the cross-piece, as the spokes to a wheel, should be each one hundred and twenty centimeters long and ten broad.

The cross-piece should be made fast to the sound shoulder, in such a manner that the middle and one side tail should rest on the back, while the remaining side tail should rest on top of the shoulder. The middle tail is then carried over the back, through the axilla and around the upper third of the arm of the injured side; it is then carried back to the starting point, and fastened. By this means the arm is

drawn directly backward.

The lower tail is likewise carried over the back and around the arm of the injured side, so that it grasps the elbow; it is then carried back to the starting point and fastened.

This part of the dressing not only draws the arm backward, but also somewhat upward. The remaining tail is then carried over the sound shoulder downward around the wrist, so as to form a sling for the arm of the injured side, then back over the seat of fracture and fastened to the two tails on the back. The author claims for this bandage:

(1) The arm is not fastened to the side, as in a Velpeau or Desault dressing, and is, therefore, not so uncomfortable.

(2) The elasticity of the bandage always holds it in the proper position, no matter what position the patient may assume.

(3) It can be used in any fracture of this bone.

MCBURNEY AND APPENDICITIS.-Dr. McBurney, in reporting a number of cases of appendicitis to the New York Academy of Medicine again calls attention to the comparative frequency of the trouble. Its assumed rarity in former years is explained by the fact that the disease was not well understood. Foreign bodies, fæces and other sources of irritation easily set up inflammation. A moderate rise of temperature (99-101) occurs with a feeling of nausea, followed by vomiting. There is abdominal pain, often diagnosed as a mere colic, and tenderness of the more or less rigid abdominal muscles. The point of greatest tenderness is found over a spot about two inches from the superior anterior iliac spine on a line extending from this point to the umbilicus. (Our readers will know that this is briefly referred to as the McBurney point.) On deep palpation a tumor may often be felt marking the seat of impactive swelling and inflammation. Suppuration ordinarily takes place; although under hot applications, opium, etc., the attack may be soothed down. The abscess is surrounded by a more or less developed pyogenic wall. Exacerbations may come and go, but with perforation death is sure to come. Primary operative interference is always indicated; delay means inviting uncontrollable danger. The most urgent cases are those of acute suppurative disease with perforation and gangrene of the appendix. The diagnostic signs pointing in this direction are: sudden severe pain on second day over McBurney point; rapid subsequent rise of temperature, existence of a palpable sensitive tumor. Ordinarily an incision 41⁄2 inches long should be made about one inch outside of the linea semilunaris. Examine carefully the caput coli; remove all pus; ligate appendix and disinfect with cautery; pack with antiseptic gauze and recovery is rapid and undisturbed.-New York Medical Record.

ABORTIVE TREATMENT OF BUBOES BY WELANDER'S METHOD. This consists in injecting into the center of the bubo, by means of a hypodermic syringe, a one per cent solution of benzoate of mercury, and then applying compression by a bandage. This must be done before suppuration occurs. in most cases is sufficient. Of the cases ninety-one A single injection per cent and eighty-seven per cent, respectively, have been cured by the author and by Lebrick, of Odessa.--La Revue Medicale.

FACTORS IN THE PRODUCTION OF SUPPURATION.--Dr. A. C. Abbott, of Philadelphia, in an excellent paper on this subject, concludes that suppuration cannot be considered a specific process in the same way that tuberculosis,diphtheri aand anthrax are specific processes, but that the causes underlying it are manifold, in most cases being the result of the presence in the tissues of the common pyogenic cocci; frequently following the invasion of the tissues by organisms not normally pyogenic in character; produced experimentally by a variety of irritating substances without the presence of bacteria, and by the poisonous products of the growths of bacteria, and, finally, following the introduction into the tissues of the proteid substances that make up the body of the bacteria themselves.-- International Medical Magazine, Satellite.