the bacillus Bulgaricus especially effective, however, in derangements of the small intestine, its effect upon the colon being not nearly so marked. He uses the bacillus Bulgaricus in nasal and tonsillar conditions, and has had excellent results in many cases. Nearly one hundred cases of diphtheria carriers have, in his hands, been cleared up by spraying cultures of the bacillus Bulgaricus into the nose and throat every four hours. Diphtheria bacilli rarely persist for more than seventy-two hours under this treatment, the majority of cases clearing up in forty-eight hours.

Leucorrhea and gonorrheal vaginitis have also reacted favorably and quickly to bacillus Bulgaricus treatment. Doctor Biehn now employs, as a matter of routine, a wet dressing of bacillus Bulgaricus bouillon as a prophylactic and curative measure in all open wounds, whether infected

or not.

Dr. Frank B. Kirby, Chicago, thinks that the flocculent casein of buttermilk is more easily digested than the solid curd frequently observed after drinking sweet milk. Convalescents who like buttermilk appreciate the possibility of a change in taste, too, when compelled to depend largely on milk. He has used the Bulgarian bacillius as galactenzyme for making buttermilk, but does not find that it makes a pleasing buttermilk flavor under ordinary house conditions. Here the doctor depends on the ordinary lactic acid. bacillus, expecting only increased nutritional value, not therapeutic effects.

Dr. Kirby has used the Bulgarian bacillus therapeutically, only in the shape of galactenzyme tablets, giving 2 tablets three or four times a day, either to be chewed or swallowed whole, with a little sweetened water. He has never found any contraindications to the use of the Bulgarian bacillus. He states that when this treatment follows an initial intestinal clean-out, there is a big reduction in the quantity and variety of intestinal bacteria. Changing the diet weakens the remaining organisms, which then succumb to the viable Bulgarian bacillus. In other words, there is a change in the intestinal flora. The only case of typhoid fever in which the doctor employed lactic-acid bacilli was in a patient who had an aversion to buttermilk. In this instance he did not use galactenzyme, but would do so if called on again in a similar case. In infantile diarrheas he always insists on omitting the milk diet, giving whey or albumen water and as much fresh water as possible. After a calomel purge and rectal enema, galactenzyme will give good results in an aqueous suspension. The doctor then cautiously returns to cow's milk diet, slowly increasing the milk and

decreasing the water. He has never had a case of gastro-enteritis in a breast-fed baby. He has never tried the Bulgarian bacillus in mucous colitis or other chronic affections of the alimentary canal. Neither has he had any experience with the use of the bacillus in injections, douches, sprays, etc.

Dr. A. L. Benedict, Buffalo, N. Y., thinks that as a food in the strict sense of the word, buttermilk has no advantage over sweet milk, having, indeed, less nutritional value. He uses both the ordinary buttermilk, sour milk, and that prepared from cultures or already bottled; he has had no special trouble preparing buttermilk from cultures in accordance with printed instructions. The doctor asserts that the Bulgarian bacillus is frequently contraindicated; in a great many cases in which it is prescribed there is already an excess of lactic acid fermentation. Its indiscriminate use as a food, he thinks, accounts for the disappointment experienced with it and its wholesale condemnation.

Dr. Benedict does not consider the Bulgarian bacillus as an antiseptic at all, except that when there is an excess of true putrefaction its administration, or that of any strain of lactic acid ferment, antagonizes the putrefactive organisms. He has not used the Bulgaricus in typhoid fever; and states that he very rarely encounters a case of diarrhea in which lactic acid fermentation, or some similar process, does not already exist. He has employed it in cases of mucous colitis, where much indol is formed-corresponding approximately to indicanuria-but does not think that the bacillus has any direct action on the

lesion.

Dr. J. H. Kellogg, Battle Creek, Michigan, says that buttermilk has the advantage that it is more readily digested than ordinary milk. It contains an acid which is to some degree antiseptic, opposing putrefactive processes and is also an aid to digestion in cases in which the stomach secretes a deficiency of HCl. Buttermilk also introduces into the intestine a harmless flora which opposes the development of putrefactive organisms.

A buttermilk of excellent flavor can be made from the bacillus Bulgaricus by the following method: First, use well skimmed milk. This is important because the bacillus Bulgaricus decomposes fat and produces substances having an unpleasant flavor. The desired amount of cream may be added to the buttermilk when eaten.

Second: Boil the skim milk for fifteen minutes then allow it to cool to a temperature of about 104 degrees and add to each pint of milk a couple of specially prepared tablets dissolved in water, or better a tablespoonful of buttermilk

previously prepared. When the lactic germ is prepared in tablets it is necessary to make several cultures, using a portion of the first preparation for the second, some of the second for the third and so on. About the third or fourth culture will develop a good flavor.

Dr. Kellogg uses the Bulgarian bacilli as an clement of an antitoxic diet. It is necessary that meats of all sorts should be excluded from the dietary and in some cases as shown by Tissier of the Pasteur Institute, it is necessary also to exclude eggs and milk. The bacillus Bulgaricus does not become domiciled in the human intestine so it is necessary that its use should be continuous or practically so in order to insure permanently beneficial effects. There are no contraindications excepting in cases of gastric ulcer and in chronic gastritis, when the patient is extremely sensitive to acids.

The Bulgarian bacillus is not an antiseptic. It is beneficial only when used in connection with an antitoxic diet and increased intestinal activity secured by a laxative diet, and is necessary by the use of paraffin oil and agar-agar or their equivalents. Dr. Kellogg has had no experience in the use of the bacillus Bulgaricus in typhoid fever and thinks that on the whole milk products are better avoided in cases of this sort. A culture of the bacillus Bulgaricus made without milk or made with whey will, he thinks, prove beneficial in these

cases.

Dr. Kellogg has found the bacillus Bulgaricus highly satisfactory in treating diarrheas when used in connection with the bacillus bifidus of Tissier. The culture must be made without milk and the use of milk should be avoided. The bacillus Bulgaricus combined with the bacillus bifidus is a very valuable remedy, indeed, in the treatment of colitis. It should not only be taken by mouth, but should be injected into the colon. Astonishingly good results may often be obtained in a very short time by this means. "I think it also an advantage," says Dr. Kellogg, "to combine the glucobacter with the bacillus Bulgaricus and the bacillus bifidus, and I add a small amount of malt sugar and starch to the culture, especially when used for injection into the colon. It should be freely used. About half a pint of the culture should be taken daily in three portions by mouth and half a pint to a pint should be introduced into the colon. I have employed this method quite extensively and with very satisfactory results. I have used the mixed culture above referred to in the treatment of indolent ulcers and suppurating surfaces with good results."

Dr. J. D. Justice, Hunter, Oklahoma, in discussing the food value of buttermilk says that

sweet milk contains about all the essentials needed by the body; buttermilk merely lacks fat or cream and is comparable to sweet milk, skimmed. The best buttermilk is made from freshly separated milk. He has had no experience with buttermilk prepared with the Bulgarian bacillus. He is, however, very fond of the Bulgarian bacillus tablets as a therapeutic agent. These can be dissolved or suspended in water and in this form there is no trouble in administering them, even to an infant. The dose depends entirely on the effect required, and he repeats the tablets, from one to four several times daily, until he gets the effect required. There are absolutely no untoward results-at least in his experience.

For clearing the intestinal canal, or as an "intestinal antiseptic," Dr. Justice has found the Bulgarian bacillus tablets very efficient, though he does not attempt to explain their action. He has not yet tried the remedy in typhoid fever, but for three summers has absolutely relied upon cultures of this organism in the treatment of the summer diarrheas of infancy and childhood and he has never been disappointed where large enough doses have been employed. He first cleans out the canal thoroughly, then begins the administration of the tablets, pushing them to effect. He has also found the tablets of great value in grown-ups where the milk is the diet of choice, but disagrees because the coagulated casein induces constipation and toxin absorption. One or two of the Bulgarian bacilli following a glass of sweet milk are all sufficient. He has also tried the same remedy in mucous colitis and had good success, if the canal is first carefully cleared of debris.

In a private letter Dr. Justice says that he cannot explain why it is that the lactic-acid bacilli form and distribute lactic acid-and this he leaves to us to explain. He adds: "If we observe the adult who imbibes freely of sweet milk at meals, who by reason thereof constantly emits a dead-house breath, is constipated and wears that proverbially stinking coated tongue which no amount of elimination, under the best directed regime, has the least effect upon, we should put him on one or two tablets of Bulgarian bacilli (I prefer Abbott's galactenzyme) immediately following a meal. There will be no more sewage escape, the oral cavity will be cleaned up and the improvement will be maintained provided the treatment is kept up-in stubborn cases for some weeks.'

VE VE VE

For Facial Neuralgia. Ether, essence of lavender, of each 50 grams; menthol, 5 grams. Apply with friction.-Formulaire Astier.

Constitutional Treatment of Epilepsy.-Becker (Merck's Archives) declares that arsenic is of first value in the treatment of epilepsy. He esteems it mainly on account of its bloodbuilding and alterative properties. There is often a profound secondary anemia from the prolonged use of the bromides; to overcome this it is best administered hypodermatically in the form of the sodium cacodylate, two or three grains every second or third day; as an alterative and in conjunction with iodine and mercury it is helpful in hindering the sclerotic process in the brain cortex. In epilepsy there is a diffuse neuroglia, sclerosis, progressive in nature, which affects the cerebral cortex. Whether this process is primary or secondary there is reason to believe that these dugs have a prohibiting influence on this change. The iodine may be administered in the form of potassium iodide, but Becker prefers the syrup of hydriodic acid in one or two teaspoonful doses diluted and taken twenty to thirty minutes before meals to obviate a chemical incompatibility with starchy foods. The mercury may be administered in combination with arsenic in the shape of Donovan's solution in doses of from one to ten minims three times daily; likewise protoiodide or biniodide can be given in tablet form.

Next in importance to arsenic as a tonic and hematinic ranks iron. For overcoming anemia it may be given in five grain doses of fresh Blaud's mass or in the shape of the soluble scale salts, in solution.

Phosphorus is useful and may be combined with Blaud's mass in the shape of zinc phosphide, one-thirtieth grain per dose. The gly cerophosphates may be given in the form of an elixir and the hypophosphites in a syrup form. Quinine is too stimulating for use in epileptic cases except when there is a history of malaria. If there is a doubtful history of syphilis a Wassermann test should be performed before giving large specific doses of mercury and potassium iodide. In gouty and lithemic patients a stricter diet is to be enforced, a modified vegetarianism and alkaline salts and mineral waters prescribed.

When there is loss of vaso-motor tone as indicated by a low blood-pressure on the spygmomanometer ergot is of very great service. It is administered in pill form of one to three grains of the aquaeous extract. Ergot may be considered almost in the light of a specific adjuvant in epilepsy. Care must be taken, however, not to prescribe too large a dose as it is apt to cause dizziness and light headedness from the cerebral anemia produced. Women tolerate larger doses than male patients.

Strychnine, of course, is contraindicated in epileptics using bromides because of its therapeutic incompatibility with the same; likewise when administering calomel it is well to bear in mind the possibility of its forming a poisonous salt when bromide is being employed.

Furunculosis in Infant.-Le Grand Kerr (Long Island Medical Journal) reports the occurrence of a crop of boils in a nineteen months' old infant. This infant was breast fed for one year and had experienced a perfectly normal development until the time of the present trouble. In October of 1912, there developed one superficial furuncle which was followed in a few days by three more that seemed to have their origin deep in the skin. These deep seated boils then continued to appear at rather regular intervals until December 30th. The infant was under the care of a surgeon (or to be more accurate, a gynecologist) who had applied a strictly surgical treatment of the local condition without any attempted attention to the more general details. The treatment was invariably incision and drainage. Fifteen boils had been treated in this manner and as they did not develop about any particular area, the little girl was considerably scarred.

At this time, the father, alarmed at the increasing scarring and the persistence of the development of the furuncles, called in a physician and Dr. Kerr was consulted to see the infant. At his first examination there were two boils in early stage of development. These were treated locally by thorough cleansing of their surfaces and the surrounding skin and the injection of tincture of

iodine into the center of the inflamed area. Both aborted. Besides a strict attention to the details of elimination, diet and the avoidance of local irritation of the skin, a stock vaccine was administered and repeated on the third day. While Kerr realized the advantages of an autogenous vaccine in these cases, he did not feel that the patience of the parents would stand much more temporizing, so the stock vaccine was chosen.

The result was immediate. There has been no further development of furuncles and the area about the aborted ones is clear. Outside of the fifteen scars left by the gynecologist, the girl shows no evidences of her prolonged attack. This and many similar experiences, emphasizes the fact that of all the vaccines, that for furunculosis is the most certain in its results.

Petrolatum.-Manquat has made some interesting observations on petrolatum administered by way of the stomach. His first point of inquiry was, what disposition is made of the substance in the alimentary canal, and his conclusion was that petrolatum passes through unabsorbed and unmodified. Any disagreeable features following its use may be ascribed to impurities in the petrolatum. When administered in chemical purity, this substance permeates the fecal mass, keeping it soft, and lubricates the surfaces of the intestine and the feces, and thus it mechanically promotes evacuation. This is the main function of the remedy. Incidentally, by its presence, it relieves spasm and colic rigidity, besides lessening intestinal absorption considerably.

If the patience allows time, the beneficial result is infallible. There is no colicky pain, not even the sensation of imperious need of defecation. The first evacuation is followed by others, naturally, and the doses of petrolatum may be gradually taken less and less frequently, until eventually they are no longer needed. The disadvantages are: the lack of agreeable taste, the expulsion of much gas, the sense of weight in the stomach if taken after meals. For the lastnamed reason, the petrolatum should be taken as far as possible away from meals. The common dose is a dessert or a teaspoonful before meals three times daily, of the liquid petrolatum; but these doses may be doubled.

Besides, for habitual constipation, Manquat advises its use in typhoid fever, chronic appendicitis, hemorrhoids, prostatic troubles, in mucomembranous enteritis, for the aged, and whenever it is advisable to avoid straining at stool. But, petrolatum is neither a purgative nor a laxative. In hard fecal impactions it is useless, as also in extreme cases of intestinal atomy, in severe gas

troplores, and in certain as yet unexplained circumstances.-(Le Monde Medical, Feb. 15, 1914.) VE VE VE

A Simple Remedy for Burns. In a recent number of the Muenchener Medizinsche Wochenschrift, Bamberger recommends the common household washing-soda as a remedy for burns. The application is very simple. A crystal of soda is dipped into water and then gently rubbed over the burned spot. The pain ceases almost immediately in burns of the first degree. For second and third-degree burns a compress wet with a 10-per cent solution of the soda may be applied or the soda may be added to the continuous water bath. If used at once, the treatment seems to prevent the formation of vesicles.

Tapeworm Treatment. Here are two suggestions for the treatment of tapeworm submitted by two readers of the Medical World. The first of these, J. C. Dreher, cleans out his patient with the calomel, podophyllin and bilein pills given at night and followed by a saline laxative the next morning; no breakfast; then he gives his patient five 5-grain capsules of thymol, patient to take one of these capsules every twenty minutes till all are taken. Give with half a teaspoonful of hot milk. If the worm doesn't come, repeat the

Copaiba and Phenol Cure Piles.-About thirty years ago, says Dr. J. F. Gibson in the Medical World, I had some trouble in the treatment of piles until I found the following remedies, namely, copaiba balsam and carbolic acid, which in all cases gave prompt relief. The first case I gave it to was a housewife who did her own work like most women, and had to do the family washing. The heavy lifting of the clothes boiler and washtub brought on an attack of piles, and the treatment she used was to lay up and poultice them until they broke, discharged and healed up. She had consulted eminent physicians before my treatment without much benefit. After getting over one attack to be followed by another

one from same cause, she finally started with my treatment. I painted the pile with carbolic acid once a day and gave two 15 minims each of Plantin's copaiba balsam capsules every day, which gave prompt relief and in a few days effected a cure.

The next case was an express-wagon driver, with a pile the size of a walnut and quite black, and making him unable to sit on the wagon seat. I painted the pile with the acid and gave the capsules, which treatment was to be followed every day. The second day he was able to resume work, and in a few days was well.

In my own case I was in the habit of walking fast up hill from my office to my residence every day, which brought on a good-sized pile. I paid no attention to it for several days until it got as sore as a boil, and got to that stage before I took the capsules. I would gamble that no remedy would prevent suppuration, but as soon as I took the capsules I got relief and a cure in a short time.

Successful Method of Treating Varicose Ulcer. -Dr. George B. Simpson does not claim originality for the following method of treating varicose ulcer, which he describes in the Medical World, but he has used it with such satisfaction that it seems worth printing again. He says:

"First, cleanse the ulcer by peroxide of hydrogen, applying it until all chemical reaction ceases. Then cut a piece of gauze just the size of the ulcer, and apply. Over this spread thickly a powder composed of equal parts of starch. and salicylic acid. Now apply a sponge wet, but not dripping; over this run a bandage as far up the leg as advisable, then cover all with cotton, and bandage again. Let this dressing remain for five days; and when it is removed the ulcer will be seen granulating, and healing from the outside inward. About three such treatments will cure almost any old varicose ulcer. I took an old woman off her crutches by using this treatment. WE VE VE

The Way to Vaccinate.-Every doctor no doubt thinks he knows how to vaccinate. But does he? He may well take heed to his methods lest he "slip" since in these days of antivac cinationist and antivivisectionist societies the occurrence of severe complications of any kind are likely to be visited by severe criticism or worse.

Dyer, in the Journal of Tropical Diseases and Preventive Medicine, gives the following directions:

1. Clean the area thoroughly with soap and water; follow with alcohol sponging. Be sure the alcohol dries off well, so as to leave the area aseptic but not antiseptic.

2.

Vaccinate by any aseptic method; the writer usually employs the point coming with the glycerinized vaccine and the area is scarified.

3. Cover the area of vaccination at once with sterile cotton and hold in place with collodion. A shield may be used over this dressing to prevent its removal.

4. Conduct the vaccination as you would any other surgical case. Have the patient return on the third, fifth and seventh days. If there are no symptoms of itching or of pain, do not remove the dressing until the fifth or seventh day. On the day the dressing is removed, if there is no sign of vesiculation, reapply sterile dressing as before. On the seventh day, look again for the vesicles; if none, repeat dressing. Do this every two days until the tenth or twelfth day. If no vesicles show, revaccinate and proceed as before.

5. If the vesicle shows at any dressing, brush the surface with tincture of iodine, or with pure alcohol, then carefully clip the top off of the vesicle with a pair of sterile scissors. Paint the base of the vesicle with a thirty grain to the ounce solution of nitrate of silver, or with pure carbolic acid (followed with alcohol). Put on a sterile dressing, or an antiseptic dressing. Change the dressing every two days.

At the end of four or six days, there is a dry crust (not pustulating). Now the patient can take care of the wound, with a dressing of ichthyol (20 grains), phenol (10 grains), ointment (oxide of zine ointment, 1 ounce), changed night and morning.

The evils of vaccination, particularly those incidental conditions following the pustulating arm, are prevented by such a procedure. There can be no impetigos, and multiforme erythema and its congeners cannot result from pus absorption.

A Supposititious New Endocrine Gland.-An Italian investigator, N. Pende, has announced (Riforma Medica, 1913, No. 22; cf. Muench. Med. Woch., 1913, No. 33) the discovery of a new glandular organ which, he is convinced, is one of the endocrine bodies, that is, a blood-gland. This gland has been observed in pregnant women and in bitches during the later months of gestation; being situated in the neighborhood of the thymus, thyroid, and parathyroid glands-especially near