PHIMOSIS AND CIRCUMCISION.-Dr. Horace G. Wetherell concludes an article on this subject, University Medical Magazine, with the following:

My observation, experience and mature deliberation have led me to conclude in reference to this matter

1. That each male child should be examined at birth for obstructive phimosis when we examine for imperforate anus.

2. That the prepuce should be retracted fully, and all adhesions to the glans broken up, all smegma be removed, and the nurse be instructed to retract, wash and anoint the parts daily for two weeks and once each week thereafter.

3. That a long and redundant foreskin, though freely retractable, may be a cause of local and reflex diseases, may occasion, or at least exaggerate, an undue sexual appetite, and so predispose to masturbation, sexual excesses, and ultimately to venereal diseases.

4. That such cases should be circumcised, as should the cases where the foreskin is not retractable.

5. That routine circumcision of all male infants is to be condemned. That the prepuce plays an important part in the human economy, and should not be amputated except for good and sufficient reasons.

6. The unhappy experience of the fatal case cited demonstrates that this little operation may be attended by grave dangers, and should be undertaken with this risk in view and only after we are assured that the parents' families are not bleeders.

7. That infants may endure a copious hæmorrhage far better than we have heretofore supposed.

ings and large openings into the pleura or other pusholding cavities.

4. Large cavities require adequately large openings.

5. Ribs and periosteum, intercostal vessels and nerves may be largely excised with advantage immediate and prospective, so long as ordinary precautions are observed.

6. Lack of early and adequate operations is an important, though not the exclusive, cause of delay in the closing of cavities.

7. Lung abscesses and gangrene and bronchiectactic cavities, with certain obvious exceptions, are amenable to surgical explorations and treatment.

8. Hydatid cysts in the lung or pleura may be successfully extracted or otherwise cured by thoracotomy.-Med. Review.

BORIC ACID AS A SURGICAL DRESSING.-Four cases, illustrating the union of tendons and bone with the restoration of a joint after accidental opening, have recently been treated by me in the Public Hospital, and show the value of boric acid as an antiseptic dressing.

The first case was that of a young man, M. W., who had, with a sharp knife, accidentally cut off the tip of his left thumb, end of index finger (top of phalanx cut through), leaving bridge of skin, and end of middle finger (cut passing obliquely through middle of phalanx), leaving a bridge of skin.

The severed portions of the index and middle fingers were carefully cleansed with boric-acid lotion, sutured, and kept in position with splints.

There was complete and immediate union, not only of the soft tissues, but of the bone, and now no deformity of the fingers exists beyond the faint line of cicatrix across each phalanx.

a

The second case was that of a young man, H. L., carpenter, who accidentally, by a blow of his chisel, completely laid open the metacarpo-phalangeal joint of his left index finger, across the dorsal aspect; a small bit of the cartilage on the proximal end of the phalanx was also cut through, but was kept in posi tion by fibers of the joint-ligaments. tendons were not completely severed. well irrigated with boric acid lotion. closed with catgut sutures and the skin-wound with silk, and dressed with boric acid. The result is complete recovery with a perfect joint.

The extensor The joint was The joint was

The third case was that of a coolie girl, S. W. A jagged wound was accidentally self-inflicted, with a grass cutting knife, at the end of the left index finger, dividing the extensor tendons. The proximal ends were retracted for about an inch and half. The incision was lengthened for the purpose of reaching the proximal end of the tendon. The cut ends were united with catgut sutures, as was the skin-wound, and boric acid dressings were applied. The result was a speedy and complete union, with restoration of the function of the tendons.

The fourth case was that of a boy aged 11. The left tendo Achillis was accidentally divided with a machete. The cut ends were united with figure-of-8 catgat sutures; the skin with silk. The wound was irrigated with bôric acid lotion and dressed with boric acid powder. The result was complete recovery, union being immediate and firm.-Satellite.

Therapeutics.

BROUSNIKA (Vacinium Vitis Idea) AS AN ANTI-RHEUMATIC. This plant (red whortleberry, red bilberry), known in Russia as brousnika, the acidulous berries of which are often used as a condiment in cooking, has enjoyed for a long time the reputation as a domestic remedy against rheumatism. Several recent observations by two Russian confreres, Dr. T. Hermann, of St. Petersburg, and Dr. S. Smirnow, of Cronstadt, confirm this reputation.

Hermann prescribed a decoction of brousnika for an old man suffering with an inveterate chronic articular rheumatism, which had proved rebellious to the usual modes of treatment. At the end of a few weeks the improvement was striking; two months later the patient could be considered cured.

The observations of Smirnow were made upon nine patients (sailors and soldiers), from 22 to 27 years of age, six of whom had acute articular rheumatism and three were suffering from the chronic form. All the patients had received previous treatment, but without success, by salicylates and iodides, warm baths, and by local applications of turpentine, belladonna and mercurial ointment. Red bilberry was given to them in decoction, 30 to 60 grammes (2 to 4 drachms) of the entire plant (leaf, stem and root) in 180 grammes (6 ounces) of water, which quantity was taken during the twenty-four hours. The duration of treatment was from one week to three months. Of the nine patients treated seven were cured. In all the cases, however, a slight increase in the quantity of the urine was noticed.

Smirnow insists on the continuance of brousnika for some time after the complete disappearance of all the morbid symptoms, that a relapse shall not take place, and advises that sedative local applications be used at the same time.-Les Nouveaux Remedes Satellite.

ALCOHOL AN AID TO DIGESTION.-Dr. Erchenberg, a German scientist of much note, has just published the result of his experiments with alcohol, and he is convinced that digestion is aided by moderate doses

The results obtained by Dr. Erchenberg are interesting. A small amount of brandy or whiskey shortens the time that food in general, whether animal or vegetable, or a mixture, remains in the stomach by half an hour. A similar, but not quite so marked an effect, is produced by a dose of diluted hydrochloric acid or mustard. Pepper and condurango diminish. the time the food remains in the stomach by a quarter of an hour; while beer and an infusion of rhubarb have no effect. Dr. Erchenberg advises persons troubled with indigestion to partake of alcohol before meals. Diet. and Hyg. Gazette.

THE THERAPEUTIC USE OF SYRUP OF CHLORIDE OF IRON (Ved.)-Owing to its destructive action on the enamel of the teeth and liability to disturbance of the stomach, the tincture of iron is objectionable. It may be advantageously replaced by the syrup. In this preparation the excess of acid is neutralized by an alkali, and while still presenting an acid reaction, it does not attack the teeth nor discolor the tongue. When it reaches the stomach, it meets the free HCI and becomes therapeutically identical with the tincture. The syrup is more assimilable, and neither gives rise to nausea nor digestive trouble. Dose,

3ss, three times a day.-Le Medicine Moderne.- Times and Register.

STRYCHNIA IN LEAD COLIC.-According to Seeres, ticularly efficacious in lead colic. strychnia administered three or four times daily is parHe attributes this result to its action on the spinal nervous system and the muscular coat of the intestine paralyzed by the toxic agent.

PERMANGANATE OF POTASH IN GONORRHŒA.-Dr. Reverdin (Le Bulletin Medical,) employs the permaganate of potash, in irrigations, in the treatment of gonorrhoea. He passed an unoiled catheter into the urethra and connects the end with a rubber tube, which is in turn connected with the reservoir of the solution. The solution varies in strength, but is of a strength of 1 to 5,000 in general. In temperature it may be used at about 45° C. The solution is allowed to pass until about a quart and a half has passed, and it is given twice a day. A roll of some waterproof stuff may be placed around the penis of the patient in order to carry off the liquid and to prevent it soiling his clothes. The treatment generally lasts about 15 days, the patient ceasing to have any discharge after two or three irrigations, and rapid improvements following. Orchitis has never been observed as a complication in this metod of treatment.— Lancet Clinic.

1. Antipyrine, phenacetine and phenocoll all fail to produce any effect on the heat functions of the normal animals.

2. Antipyrine produces a decided fall of temperature in the first hour after its administration in the fevered animal. This reduction is due to a great increase in heat dissipation, together with a fall in the heat production.

3. Phenacetine, both in septic and albumose fevers, produces a very slight fall of temperature during the first and second hours after its ingestion by the stomach, but the greatest reduction occurs the

third hour after its ingestion. The fall of temperature results chiefly from a decreasd heat production, with a slight increase in the heat dissipation. The increase in dissipation is not as great as with antipyrine. Probably the delayed action of the drug depends on its insolubility.

4. Phenocoll causes in fever a very decided fall in temperature, which occurs the first hour after the administration of the drug by the stomach. This reduction is the result of an enormous diminution of heat production, without any alteration of heat dissipation.

Our experiments with antipyrine are in accord with the results obtained by Martin, Wood, Reichert and Hare, together with Destree, have reached the conclusion that antipyrine reduces the temperature by a decrease in heat production, and that heat dissipation also falls with the production.

In 'our experiments with antipyrine the composite curve shows the rise of heat dissipation. We believe, therefore, that this phenomenon is effected through a thermotaxic rather than through a thermogenic mechanism. We further believe that phenacetine and phenocoll reduce the temperature by a decrease in the heat production through their action on a thermogenic nervous center. The fact that all drugs here studied fail to produce any effect on the normal heat function proves that they affect these functions through the nervous system. Probably the fact pointed out by Hare in his excellent essay that many investigators

do not take into account other circumstances, such as tying animals down, and confinement in a box, may explain many of the results obtained by some observers in the normal animal.

In concluding this study we are justified, judging from the results of our experimentation, in saying that of the three drugs in question, the safest for practical purposes, especially as regards an action. upon abnormal temperature, would be phenocoll. Phenacetine is slow on account, no doubt, of its insolubility, and is comparatively feeble as antipyretic. Antipyrine, it is true, is soluble and prompt in reducing feverish conditions, but its action upon the circulation, particularly upon the heart, is so pronounced, even when administered in therapeutic doses, that it is, for this reason, a dangerous substance to use. Phenocoll, on the other hand, is readily soluble, rapidly absorbed, and undoubtedly promptly eliminated. Its power to reduce abnormal high temperatures is very decided, and it does this in therapeutic doses, without depressing the circulation. Phenocoll, therefore, would seem to be superior to antipyrine and phenacetine as an antipyretic.

ATROPINE FOR HYPERSECRETION OF GASTRIC JUICE. -Voinoitch (Les Nouveaux Remedies) recommends atropia in doses of r of a grain, three times daily, as the best remedy for combating hypersecretion of the gastric juice (without hyperacidity), basing this use of the remedy named, upon the experimental researches of Netchaeff, upon the inhibitory action of the secretion of the gastric juice. It is claimed that the It is claimed that the remedy diminishes the pain, and completely controls the vomiting. An obstinate case was completely cured by the use of the remedy, within ten days.-Bacter. World and Mod. Medicine.

HÆMATOTHERAPY IN TUBERCULOSIS.-The remarkable experiments of Drs. Bertin and Picq, in the

treatment of pulmonary tuberculosis by the injection of goat's blood, have attracted much attention. These experimenters seem to have surrounded their work with every possible precaution, and to have so far as possible avoided sources of error. They have now employed this method in 150 cases with the following results, which we quote from the Journal D' Hygienė: "At the beginning of the disease the patient's condition is so much improved that a cure may be said to be effected. In the period of softening, very great improvement is often obtained, the cough and expectoration diminishing and the strength returning, even when all the classical modes of treatment have completely failed."

It seems that this method of treatment will probably have a future, and that it will not fall into disrepute so promptly as have many of its predecessors. The recent researches in bacteriology have placed the method upon a sound physiological basis, and there seems to be a good prospect that further study of this new mode of combating one of the most terrible maladies known to man, will result in establishing it upon a sound therapeutic basis.-Bacter. World & Mod. Medicine.

PERMANGANATE OF POTASSIUM IN DIPHTHERIA.—ACcording to the Australian Medical Gazette, February, 1892, diphtheria is so prevalent a disease in that country that the journals devote a great deal of space to its discussion. One of the most recent of these is that of Dr. Bowman upon the employment of permanganate of potassium in the local treatment of the disease. He advocates the employment of a solution of three grains to the fluid ounce, which is just onehalf the strength of Condy's fluid. From three to four applications are made directly to the membrane with a large camel's hair brush, every hour for eight or twelve hours. The brush must not drip, as the swallowing of the fluid is apt to produce vomiting. After the prescribed time has been passed the application should be continued every two to six hours, until the membrane breaks away. Iron is used internally, and a nourishing and stimulating diet pursued. Dr. Bowman reports a number of bad cases treated in this way most successfully. In a lengthy discussion which followed, Dr. Furnival states that he had used this treatment with uniform success, but advocated the use of a spray instead of the brush.

PIPERAZINE. Besides knowing that piperazine is PIPERAZINE.-Besides a powerful uric acid solvent, which will combine with at least twelve times more uric acid than will lithium and forming a soluble urate salt while the urate of lithium is practically insoluble, and that piperazine is therefore primarily indicated in all diseases due to uric acid diathesis; it is valuable alike to the physician who prescribes and to the pharmacist who dispenses, to note and remember the following:

1. Piperazine occurs in crystalline form, but it is a hygroscopic body and will deliquesce on exposure to the air; hence

2. Piperazine must never be dispensed in powder form, pills, tablets, capsules, or any other similar form.

3. Piperazine is supplied by the manufacturer in one size vial only, containing five grammes (75 grains), or sufficient for five days' dosage; therefore it is practical, economical and preferable that

THE CARDIAC TONICS AND THEIR INDICATIONS.-At the meeting of the British Medical Association the subject of the heart-tonics was discussed. Broad bent spoke of rest or moderate exercise, and of eliminative agents. He said that strophanthus seemed to be the typical heart-tonic, since it increases the power of the cardiac systole without modifying the contractility of the blood-vessels. The author, who appears somewhat partial to this medicament, asserts that the failures reported at various times, regarding strophanthus in practical medicine, are due to the impurities of the preparations used. After strophanthus he places digitalis, adding that the former remedy sometimes acts from the first or second dose. He said that digitalis increases the elimination of liquids, while caffeine enhances that of the solids, and hence the utility of prescribing these two agents in combination in order to obtain the same good effect that a large single dose of digitalis would produce. Lauder Brunton answered that digitalis is at the same time a cardiac and a vascular tonic, but that it must not be forgotten that the principles of the drug do not act in the same manner: Digitaline, he said, increases both the contractility of the cardiac muscular fiber and that of the coats of the blood-vessels, while digitoin produces a contrary effect; thus, when in a cardiopathy there is an excessive constriction of the bloodvessels, it is advisable to combine digitalis with vasodilator substances as nitrous ether, for example. Alongside of strophanthus Brunton places the oxyspartein which, like it, acts decidedly upon the heart, but not so much upon the vessels themselves. He believes that the best cardiac medicaments after digitalis are strophanthus and nitrous ether. The same author also insisted on the employment of muscular exercise in order to increase the arterial tension, but without putting strain upon the heart. In mitral disease, for instance, the rule is to have absolute rest, but in such cases massage is to be resorted to, a method by which the general nutrition may be increased without producing cardiac muscular exertion.

ercise. Lastly, Brunton recommended, in the treatment of mitral disease for example, the administration of blue mass during the night and jalap by day. -Univ. Med. Magazine.

THE TREATMENT OF PHTHISIS BY MENTHOL.-At the meeting of the British Medical Association, held between the 26th and the 29th of July last, at Nottingham, Brookhouse (Revue Générale de Clinique et de Thérapeutique, August 3, 1892) called attention to the parasiticidal powers of menthol, a remedy that must be daily applied through the trachea, in doses of four grammes of a twelve per cent solution made with sterilized oil, in the treatment of pulmonary consumption. Administered in this manner the drug was well borne by patients, and under its use the cough, expectoration, night-sweats, the hectic fever, and even the emaciation, were diminished. The observations were made at the Nottingham Hospital. The value of menthol in laryngeal phthisis is well established, and in pulmonary tuberculosis it is worthy of trial by the method indicated, a method that is simple and without mystery, unlike that of the famous tuberculin.-Univ. Med. Magazine.

FOETAL HEAD RETAINED OVER THREE MONTHS IN THE UTERUS. Loisnel (Nouvelles Archives d'Obstetrique et de Gynecologie, describes the following extraordinary case which came under his observation: In November of last year, Dr. Notto was called to attend a woman who had felt labor pains at term three months before. She was III-para, her previous labors resulting in spontaneous delivery. The doctor attempted turning, and failing, amputated the leg. On the day following he cut off the other leg. Next day he decapitated and removed the trunk and arms. Antiseptic injections were prescribed, but, through ignorance of the patient, were not given. The woman resumed her work, but was annoyed by the lochia continuing longer than usual. The doctor found a vesico-uterine fistula and a solid body occupying the uterus. He extracted a piece of maxilla by the aid of forceps. The patient was then admitted to a hospitThe os was dilated and the foetal skull removed in pieces. There had been up to this time no signs of septicemia. Afterward there was an occasional rise of temperature during recovery. The vesicouterine fistula closed, but a communication established itself between the rectum and genital tract.

al.

Dr. Hergott had once extracted the placenta from a woman who had been delivered seven months previously. There had been no septic symptoms. In the

He

RETAINED PLACENTA: EFFECTS OF ATMOSPHERIC PRESSURE. Cavilan, of Durango, Mexico (Arch. de Tocol. et de Gynec.,) attributes retention of the placenta to atmospheric pressure. His father, in the course of a large practice, only met with one case in thirty-five years of true, adherent placenta. maintains that all the morbid conditions which might cause adhesions, such as uterine inflammation and placental apoplexy, produce abortion before any firm adhesions could be established. The common socalled adherent placenta" represents an effect of atmospheric pressure. The central part of the placenta is first detached, and thus between the uterus and the maternal aspect of the placenta a vacuum is formed, the placenta being in the mechanical condition of a cupping glass. Its edges are firmly pressed against the uterus. Pulling on the cord simply encourages the vacuum. Abuse of ergot does the same kind of harm. Credé's method of expression prevents or overcomes the vacuum. When the placenta is distinctly "adherent," the vacuum must be destroyed. Cavilan acts in the following manner. The midwife or assistant pulls the cord firmly, obstetrician steadies the fundus with the left hand and perforates the placenta, close to the cord, with the right fore and middle finger. As the uterine tissues are far tougher than the placental tissues there is no fear of perforating the uterus with the fingers. The air then enters the vacuum and the placenta can easily be detached. The strongest antiseptic precautions are necessary during this manoeuver.--Brit. Med. Jour.

OVULATION WITHOUT MENSTRUATION: PREGNANCY.Loviot (Arch. de Tocol. et de Gynec., January, 1892) related at a recent meeting of the Paris Obstetrical and Gynecological Society, the case of a woman who had not seen a monthly period for fourteen months. Rheumatic pains set in and the abdomen became swollen. He discovered pregnancy between the sixth and seventh month. The mother did not believe in this diagnosis; nevertheless she was afterward delivered of a very small child.--British Medical Journal.

higher from the third to the twentieth year of life. In infancy, and also in old age, the male mortality from diarrhoea and dysentery exceeds the female mortality, but in the child-bearing period, from fifteen to fortyfive years of age, the mortality is distinctly higher among females. among females. And even more striking in this connection are the statistics of phthisis than those of zymotic diseases. Phthisis is more fatal to males than females under five years of age; but then a change takes place, and from five to ten it is much more fatal to females than to males; while from ten to fifteen it is more than twice as fatal to females as to males. From fifteen to twenty phthisis is still much more fatal to females than to males; from twenty to twenty-five the mortality from it is exactly equal in the two sexes, and from twenty-five to thirty, and at all subsequent ages, the mortality from it is much greater among males than among females. Dr. Browne is inclined to attribute this to over-pressure in education; but surely there are many other factors more important in lowering the vitality of young women. Med. Record.

SODIUM SALICYLATE IN MENSTRUAL DISORDERS.— Dr. Cheves Bevill, Medical Mirror, has used sodium salicylate in dysmenorrhea with satisfactory results. In one case, a woman, æt. 34, in whom the menstrual period was preceded by epileptic convulsions, heroic doses of bromides had failed, the uterus was curetted, fibroid growths removed, the salicylate administered and a cure resulted. In eighteen cases of amenorrhoea success attended its use in seventeen cases. These patients ranged in age from fifteen to forty years. One of them was subject to cataleptic convulsions, which were treated, and then the salicylate was given. The menses appeared normally, the patient became pregnant, and her health has since been good. In the one case in which failure occurred; the patient had a child six months old; was in bad health. The symptoms were ameliorated though no flow resulted. He has found the drug valuable in suppression of the lochial discharges, but cautions against its too free exhibition in this condition, as the resulting hæmorrhage is liable to be profuse. He prefers administering the medicine after meals and in a capsule or mucilage. The dose ordinarily used was ten grains

FOOD AS A MEDICINE IN UTERINE FIBROIDS.Ephraim Cutter, M. D. (Medical Mirror) reports admirable results from restricting the diet of patients suffering with fibroid tumors of the uterus. He allows the following articles of diet: Beefsteak: sirloin steak; porterhouse steak, roast beef, corned beef, cold pressed corned beef, smoked and dried. beef, beef tongues, tripe, ox-tail soup without potatoes, veal, calves' feet and head, pork, fresh, salt and corned, pigs' feet and head, sausages properly made, ham, mutton, lambs' tongues, cucumbers, venison, turkey, game, chicken, geese, pigeons, squabs, milk, butter, eggs, cream, cheese, vegetables without or with little starch, tomato, onion, lettuce, dandelion, parsley, cowslip, parsley, cowslip, radish, horseradish, cranberry, turnip, rhubarb, squash, carrot, pickles, sour fruits, apple, pear, melon, nuts, Irish moss, fish, salt and fresh, fresh and Oregon salmon, cod, haddock, eels, soup, perch, etc., scallops, oysters, shrimps, halibut, trout, sword-fish, cusk, lobsters, clams, tongues and sounds, cabbage, celery, spinach. He forbids these: Starches and sugars, common white flour, in all and