There are at least three good reasons why we should not bleed in uræmic eclampsia. 1. The procedure is without important effect upon the demonstrated cause of the disease. The amount of excrementitious material that can be eliminated by bleeding is comparatively trivial. Blood pressure cannot be depressed for any considerable period of time, unless the patient be dangerously exsanguinated. Hæmorrhage into the brain, as a consequence of puerperal convulsions, is an extremely rare finding. The indication for bleeding in eclampsia is not stronger than in the convulsions of Bright's disease in the male and non-pregnant female. Clinical experience teaches that much better results are now obtained without bleeding than were formerly observed when venesection was commonly practiced. If blood letting in eclampsia is unphilosophical, if it is opposed by clinical experience and the weight of professional opinion, upon what grounds can this practice be tolerated? If one must bleed, let them "bleed the woman into her own veins" by the use of veratrum viride.

SURGERY.

NEPHRECTOMY OF A HORSESHOE KIDNEY. -Dr. Socin of Bale ("Brit. Med. Jour.") has recently removed a horseshoe kidney. The patient was in excellent health four months after the operation.

PRE-CANCEROUS STATE OF THE BLADDER. -Dr. E. H. Fenwick ("Brit. Med. Jour.") claims that by aid of the electric light a pre-cancerous stage of the vesical mucous membrane can be determined. The membrane appears blurred, lumpy and gelatinous.

FROG SKIN GRAFTS IN CHRONIC ULCERS. -The "British Medical Journal" states that in four cases of old standing, intractable, extensive and deep ulcers of the leg, foot and thigh, where, after all ordinary means had failed, the transplantation of grafts of frog's skin was invariably followed by a permanent healing in from nine to fourteen days. Dr. Nesteroosky takes an ordinary frog and keeps the lower portion of its body immersed in a sublimate solution (1 to 1,000) for five minutes; then he pinches up a piece of skin on the abdomen with forceps, and cuts out as many grafts as are required, each the size of a finger nail. Having washed the pieces as well as the ulcer with a four per cent. solution of boracic acid, he carefully places the grafts on the granulating surface, and covers the part with a layer of boracic gauze and a piece of tow, fixing the whole with wax cloth and a starched gauze roller. The dressing is changed and the ulcer washed first on the third or fifth day. He

concludes:

55

I. In all cases of extensive and badly cicatrizing ulcers, skin grafting is indicated. 2. Skin which is quite free from glands and hairs is most suitable for the purpose. 3. Frog's skin completely satisfies those conditions. 4. The method is simple, safe, easily used everywhere, cheap, and most effective.

LUMBAR HERNIA.-Dr. G. H. Hume ("Brit. Med. Jour.") reports a case of lumbar hernia, in which the hernial protusion had taken place in front of the quadratus lumborum and had expanded but not pushed through the anterior portion of the latissmus dorsi. Lumbar herniæ have been mistaken for chronic abscesses even by such surgeons as Delbeau.

ABORTING BOILS.-Dr. Halle ("L'Union Med.") claims that the following mixture will abort boils:

B Tincture of arnica flowers...fl 3 ijss.
Powdered tannic acid.......

M.

Powdered gum arabic, aa... 3 jss.

Paint the boil and surrounding skin every five minutes until the coating becomes thick and hard. The pain soon disappears.

BONE GRAFTS IN FINGER INJURIES.-Dr. H. M. Sherman reports ("Pacific Med. Jour.") the following case: A boy, thirteen years old, working in a tin shop, had a punch driven through the ungual phalanx of the thumb. The instrument entered at the inner side of the base of the nail by a small aperture of entrance, passed directly through the thumb and came out, by a large and lacerated aperture of exit, on the outer border of the pulp, comminuting and carrying out with it the entire phalanx, except a very small scab attached to the flexor tendon. The nail was torn away and there was much contusion of the soft parts. A wedge, containing bone and cartilage, and the line of ossification, was taken from the scapula of a healthy Newfoundland puppy, cut to the shape and size of the lost phalanx, and implanted in the cavity. The result was very good. Extension of the phalanx was complete, and there was flexion of about forty-five degrees, a little lateral motion existed, but this was progressively less, and the thumb could bear increasing amounts of pressure on the tip. There was also an abortive attempt at the reproduction of the nail.

RECTAL ENEMA FOR WASHING OUT THE KIDNEY.-Dr. Jenks (“Annals of Gyn.") cites the case of a patient suffering from continuous backache whose physician told her that the cervix was lacerated, but that after an operation all her symptoms would disappear.

The operation was done. The backache became worse. The doctor said that it was a matter of time, but that it would be all right. Dr. Jenks found the urine heavily loaded with pus. After washing out the bladder and bowels, examination revealed a tender ovary as the source of the pain. Careful inspection demonstrated that there was a suppurating kidney, and in this connection he was led to speak of large rectal enema as a method of washing out the kidney. A patient to whom he had given a large injection returned very little of the water by the bowel. The amount of urine passed, however, was enormous. In another patient, now under treatment, the same thing had happened. He recommended that opium be given previous to the injection, and if the fluid could not be forced up high enough, that the patient be placed in the knee-elbow position.

In

THE CHOICE OF OPERATIONS FOR THE REMOVAL OF URINARY CALCULUS.-Dr. W. T. Briggs of Nashville, in a paper before the American Medical Association ("Jour. Am.Med. Asso.") draws the following conclusions: children under 16, the cutting operation should by all means be chosen; after puberty, litholapaxy. In old age mortality is greater in both operations, but crushing in the hands of a skilful operator is better. The composition of the calculus is important. Large uric acid calculi, or oxalic calculi, are hard to crush, and better be cut for. Stones return with less frequency after litholapaxy. The size and toleration of the urethra are important factors. Lithotomy should be chosen in the following cases: 1. Children; 2. Large and hard stone; 3. Encysted stone; 4. Indurated and crooked urethra; 5. Prostatic enlargement; 6. Prostatic overgrowth; 7. Prostatic enlargement with putrid urine; 8. Tumor of bladder; 9. Chronic cystitis.

Litholapaxy should be chosen: 1. For adults; 2. In cases of soft stones; 3. Where urethra is of good caliber and tolerant. The supra-pubiclithotomy may be performed in cases where stone is too hard to be crushed, and too large for perineum. The raphe is nature's field for incision, and the medio-lateral incision is almost devoid of any danger to life.

TREATMENT OF GLYCOSURIA.-DujardinBeaumetz claims ("London Med. Rec.") that the arseniated lithia treatment of Dr. Martineau (MEDICAL STANDARD, Vol. I.) is of value in glycosuria. He gives eight grains of carbonate of Allium in a glass of Vichy water, to which two drops of Fowler's solution is added, to be taken before each meal. In diabetes of nervous origin, characterized by extreme polyuria, he gives 10-grain doses of methozin, sweetened with

saccharin, three or four times daily. Its effect is to reduce the quantity of urine eliminated, as well as the sugar, the latter not only pari passu, but absolutely. Phenacetine and exalgine bring about the same results. He advocates the use of saccharin for sweetening purposes, and states that, provided the quantity ingested does not exceed two grains daily, no inconvenience is likely to be caused. He speaks very highly of "soja" bread, the only drawbacks to the use of which are its disagreeable taste and laxative action on the bowels. With reference to the use of potatoes, he points out that they contain 17 per cent. of glucose, as compared with the 19 and 20 per cent. of best gluten bread; hence, that potatoes are preferable to gluten of bread. The quantity ingested must not exceed seven ounces daily, as otherwise it would do more harm than good. Milk augments considerably the proportion of sugar in the urine, and the same remark applies to fruits, and especially grapes. To make up for the loss of carbohydrates, fats and viands containing fat are to be recommended-caviar, sauerkraut, etc. Alcohol must be given with caution in limited quantities.

SURGICAL DRESSINGS AND WOUNDS.Dr. R. T. Morris in a paper read before the American Medical Association states that vaseline or oil spread upon any textile fabric represents the worst type of dressing, because the unguent mingles with the discharges and retards organization; because the textile fabric entangles new epithelium-cells and connective-tissue cells, and because there is nothing in the dressing to prevent fermentation and wound-infection. Lint and cotton are even worse than textile fabrics. The cerates spread upon textile fabrics are one point better, in that new epithelium and connective-tissue cells are not entangled in the mesh. Balsams spread upon textile fabrics or upon lint or cotton, are better than vaseline or cerate, because they limit fermentation. There are only two perfect types of dressing. The iodoform covering for small wounds represents one of these. Iodoform forms a thin, firm coagulum with lymph and this is not easily attacked by microorganisms. Beneath this coagulum the processes of repair go on smoothly in small wounds, even when a certain number of microbes are at work, because the iodoform neutralizes the ptomaines. The other perfect dressing is the one suitable for larger wounds, and it possesses the following properties: First, smoothness and impenetrability to new epithelium and connective-tissue cells (Lister's protective oiled silk.) Second, a bulky mass that is highly absorptive, to draw serum away from the wound, and to

Take of Sublimed sulphur.....

100 grs. Aromatic powder... ....100 grs. Mix and make into twenty capsules. Dose: One capsule three to four times a day. Take of Tincture of capsicum..... I dr. Bicarbonate of sodium.. .. 100 grs. Peppermint water...

........

5 ozs. Mix. Dose: Two teaspoonfuls in water three times a day.

TREATMENT OF SEMINAL EMISSIONS.-Dr. J. K. Mitchell (“Univ. Med. Mag.") advises in these the use of a blister over the sacrum. He says that the cases are, roughly speaking, divisible into two classes. One has emissions, usually during sleep, without erection or with only an attempt at erection; in the other the semen is only voided during erection or upon some irritation, mental or physical. In the former sort, the treatment should be tonic. He uses the following formula:

B Strychninæ...

. gr. j. .fij.

Acidi phosphorici dil... M. Sig. 25 drops in water after each meal. In the latter kind, bromides, or, better, a mixture of hydrobromic acid and bromide of soda or of lithium, have done good service. Of course, the usual precautions must be taken that no old stricture be left to keep up an irritation, and hygienic directions given—a hard bed, not too heavy coverings, light suppers, little meat, a sponge bath in the mornings, the bowels kept free, and all causes of sexual excitement avoided.

57

EYE, EAR AND THROAT. INSECTS IN THE EAR.--Barclay ("N. Y. Med. Jour.") says that oil should not be used to kill or remove such intruders. If the insect is very small, it may sometimes be ejected by forcibly blowing into the canal. If the invaded ear is upturned and filled with warm water, the insect will either at once seek the surface or perish for want of air. In the latter case it may subsequently be removed by syringing, which is the preferable method, or with a cottonwool brush or curette. A little reflection will show the folly of hurriedly probing the ear for the removal of a live insect. Abrasion of the canal and drum-head at least, and very often complete rupture of the latter, is apt to be caused by such a procedure. In many cases the insect will have already escaped from the ear before the remedial attack upon the organ is begun. Should there be any doubt as to the insect still being within the ear, the doubt should first be satisfied by ocular inspection of the canal. If the patient is suffering pain from the movements of a live insect in the ear unnecessary delay would be cruel, and we should at once upturn the canal and fill it with warm water. Dr. Verity (MEDICAL STANDARD, Vol. IV) has found chloroform of value.

FUGITIVE EDEMA OF THE EYELIDS.Schweinitz ("N. Y. Med. Jour.") reports a case of this nature occurring in a woman who was subject to periodical headaches, which usually appeared once in every ten days or two weeks. Recently, after a severe headache, lasting for three days and located chiefly in the distribution of the right supra-orbital nerve, oedema of the right eyelids and the right half of the forehead appeared, accompanied by a throbbing sensation at the upper and inner angle of the eye. Under the local use of hot stupes and the internal administration of Basham's mixture, this oedema subsided in a few days. Three weeks later, after another headache, the œdema again appeared. Under the same treatment, with the addition of potassium iodide and sodium salicylate, the swelling and pain again subsided, to recur again ten days later. Since then there had been no reappearance of the adema, though the headaches had continued.

SCLERO-CORNEAL RUPTURES AND THEIR TREATMENT.--Nuel ("N. Y. Med. Jour.") describes the following operation for the relief of this condition: A broad sclerotomy is made, passing through the middle of the ectatic region, the edge of the knife being turned toward the equator of the eye. The conjunctiva is then to be sutured in such a manner as to close the

Sig. Two capsules three times daily after eating.

INTRA-PULMONARY THERAPEUTICS.-Pulmonary injections ("N. W. Lancet") by which antiseptic fluids are introduced directly into cavities in the lungs, when first suggested, seemed to afford a most rational plan of dealing with the bacillus, and for a time this method of treatment was often tried, occasionally with brilliant results. But its popularity soon waned, partly because so many failures attended it, but also because it often seemed to do harm rather than good. Dr. V. Y. Bowditch of Boston ("Boston Medical and Surgical Journal") cites two cases of phthisis in which he employed pulmonary injections of "carbolized iodine," prepared after the formula of Dr. John Blake White:

Atropiæ sulphatis...

Morphiæ sulphatis.

Tinct. iodinii...

Acidi carbolici..

Glycerini.....

gr.. .grs. ij. 3iij. .gtt. xx. 3 jss.

the

Spiritus vini rect. (20-30 per cent.), jss. Fifteen minims of this solution were injected repeatedly in each of the cases, and odor of iodine was almost immediately detected in the breath after each injection. In one case there was extensive gangrene in one lung, which was immediately checked by the injections, the patient recovering entirely and remaining free from symptoms of phthisis for four months, when the other lung was attacked, and a fatal issue soon followed. Although the other case was even less encouraging, nevertheless Dr. Bowditch thinks that pulmonary injections should be given a place in the therapeutics of lung diseases, and believes that if too much be not expected of them they will often give satisfactory results.

59

VALVULAR HEART DISEASE.-Longstreth ("Times Reg.") says that “much of the regulation treatment for valvular heart trouble is misdirected. Orthopnoea is relieved by a brisk purgative of calomel, when it will not yield to the regulation treatment with digitalis and cupping. The trouble lies behind, not in front of the heart. Once the valves are affected we cannot restore them to their normal state; treatment should, therefore, be directed to the point where it would be most beneficial, namely, the liver. Death is more frequently caused by nonnutrition, due to a failure of the liver to act properly, than by a failure of the heart due to defective valves. George Shaw, of beer-parade notoriety in Philadelphia, served as a clinical subject for five years. He had most marked valvular trouble, and suffered exceedingly from orthopnoea. Of the latter he was always relieved by a brisk purgative. He finally died, not from his heart trouble, but from red atrophy of the liver."

EPILEPSY. Dr. Kowalewsky ("Polyclinic") claims to have cured victims of epilepsy in whom the attacks have lasted less than ten years. The time required, which he usually divides into four semesters, is usually twenty-four months. He selects the form of bromide most suitable to the case, and during the first period (six months) gives a drachm of the salt in combination with three to five grains of the sodium iodide in twenty-four hours. He administers the remedy, well diluted, in three equal doses, in the morning, before dinner, and at night. The dose is to be lessened or intermitted in case of adynamia. In female cases the treatment is stopped during the catamenia. The patient is allowed a good supporting diet, milk and vegetables to be preferred. During the last three months of the semester the patient is usually free from the attacks. During the second period the treatment is to be the same as that of the first. Before it is begun, however, there is an intermission of from two to six weeks, when the medicants are withheld. During the third semester the sodium iodide is omitted, and doses of five to ten grains, morning and evening, of the bromides are given, the same regimen and diet being continued. In the last period he commences with five grains of the bromides per diem, gradually extending the time between the doses, so that toward the end the patient receives the five grains at varied intervals, even up to six days' intermission. The bromides are then entirely discontinued, and the patient receives small doses of trinitrine, the tincture of simulo being substituted in some cases. In the beginning of the