atropine to maintain mydriasis, thereby preventing posterior synechia should iritis be present, and to put the ciliary muscle at rest.

Dionin, in 2 percent or 5 percent solution, tends to aid in the absorption of inflammatory exudates through its lymphagogue action, and diminishes pain. This may be used early and, I think, tends to materially shorten the duration of the disease. Hot compresses are also efficient in diminishing pain. Local depletion may be practiced by leeches applied to the temples. Dark-colored glasses should be worn to protect the eye from glare.

General treatment is directed toward the underlying cause. In the majority of cases benefit is to be derived from the administration of mercury to the point of tolerance, to be followed by iodides. Probably the most efficacious mode of administration is by inunction of one drachm of mercurial or blue ointment daily, preceded by sweating through the use of the hot pack. This thoroughly stimulates nutritional changes, aiding in the elimination of toxic or effete materials from the body, and, aside from those cases which show a definite syphilitic taint, aids in the absorption of inflammatory products at the inflammatory focus.

Mercury has also been used by various observers in other forms: Gray powder and the iodides by the mouth; bichloride by hypodermic and by subconjunctival injection being recommended by some.

Salvarsan is now used by some with gratifying results in many cases of interstitial keratitis of syphilitic origin, injections of from 3 to 6 grains being given at intervals of three or four weeks until from four to six have been given, at the same time employing the usual mercurial medication during the intervals.

Vandegrift (Medical Record, Oct. 26, 1912) reports three pronounced cases treated by intramuscular oily injections of salvarsan in which the drug worked so quickly that little connective tissue formed. In each case the corneal infiltrate was absorbed more quickly than with mercury. He recommends that it be employed early in the attack to produce these good results, as old scars show little change.

According to some other observers, salvarsan has little influence in this disease, much less than upon syphilitic manifestations in other parts of the body.

In those cases in which tuberculosis is the causative agent, curative doses of tuberculin have given good results.

It is to be emphasized that in all these cases treatment should be roborant in character, us

ing all means in our power to increase general nutritive changes. nutritive changes. For this purpose, arsenic, iron, and cod-liver oil are used to improve the condition of the blood; constipation and imperfeet assimilation should be corrected; and the patient should have plenty of good food, outdoor exercise, and healthful surroundings to still further improve his condition.

After the local irritation has subsided, and when absorption is going on, the process may be hastened by one of the following means: First, by the use of dionin in 5 or 10 percent solution, instilled two or three times a day, which acts by increasing the lymphatic activity; secondly, by the use of subconjunctival injections of from 5 to 15 minims of normal salt solution, repeating them after the resulting irritation has disappeared; or, thirdly, by the use of mercuric oxide ointment, applied or introduced into the cul-de-sac and followed by massage of the cornea through the closed lids.

Iridectomy may be necessary if a dense central opacity remains, or if the intraocular tension increases and glaucoma threatens during the course of the disease.

TREATMENT OF HEMOPTYSIS. Every case of hemoptysis, no matter how small the quantity of blood lost, should be considered tuberculous. This is the opinion of Dr. Everett E. Watson, who writes upon this subject in the Virginia Medical Semi-Monthly. The exceptions from this rulè he believes to be so rare as to be negligible. He also shows that nearly half the patients suffering from phthisis have hemorrhages sooner or later this emphasizing the importance of knowing how to treat this symptom intelligently.

In the treatment of hemoptysis, he declares, there are two chief aims:

1. To reduce blood pressure.

2. To increase the coagulability of the blood. A patient with active hemorrhage must be put flat on his back in bed, preferably out of doors, with his head slightly elevated. He must not move a muscle, not even turn his head to expectorate, as this can be managed by some one wiping the blood from his mouth with a cloth. His fears and excitement must be allayed by encouragement; often the mere presence of physician or nurse in whom the patient has confidence will quiet and soothe the patient, thus avoiding the rise of blood pressure incident to fright and excitement.

A pearl of amylnitrite is broken before the nose; as the effects of this only last approximately fifteen minutes, a hypodermic of nitro

glycerine, grain 1-100, and morphine sulphate, grain 1-16. is given, the nitro-glycerin keeping the blood pressure down for possibly forty-five minutes, while the morphine will allay the cough and quiet the patient.

Dr. Watson cautions against the too free use of morphine, as many patients have lost their chances of recovery by the excessive use of this drug, the only indications for which are excitement and cough; in the absence of these it is best to eschew it entirely. Morphine, by deadening the terminal nerve filaments, will allow the clotted blood, which is an ideal culture medium, to fill the surrounding lung spaces where it remains, often giving rise to an acute condition simulating pneumonia, with a consequent spread of the disease.

An ice cap to the chest has a soothing and quieting effect on the heart and should always be used. After giving the nitro-glycerin, it is well to start on the vaso-dilators, that have a more lasting effect, and probably the best is sodium nitrite, every three hours, in 12 to 1 grain doses. Often the same results can be accomplished by the use of veratrum viride in from 4 to 8 minim doses, the dosage of each being governed by the blood pressure, which should be kept below that at the time of hemorrhage.

Dr. Watson thinks the next most important aid is catharsis, one ounce of magnesium sulphate being given soon after the hemorrhage and repeated every morning until six days after last show of fresh blood. The next consideration is the diet, which should be non-stimulating solids, and given cold. Liquids must be forbidden as much as possible, a little water or cracked ice being given with a spoon. The patient should not be allowed to feed himself or turn on his side for from several days to two weeks, according to severity of hemorrhage.

So far there has only been mentioned the means of maintaining a low blood pressure. To increase the coagulability of blood, calcium lactate is given, grains 15, every four hours for three days. Theoretically, calcium lactate is a splendid combination, and one he has seen used a few times with splendid results; also he has confidence in horse serum subcutaneously.

In massive hemorrhages, atropine, grain 1-50, often acts well to prevent the pneumonia, which is occasionally such an unfortunate sequel. Other remedies, which are used occasionally but with which Watson has had no experience, are emetine, 5 c.c. of 15 per cent. saline solution given intravenously, constriction of extremities, and chloroform inhalations.

In recent years artificial pneumothorax has

come to the front, and has proven itself an invaluable aid in checking pulmonary hemorrhages. As a usual rule, it is not difficult to ascertain from which side the hemorrhage is coming, and by injecting several hundred c.c.s of nitrogen, we are able absolutely to stop it. Of course, we are not able in every instance to collapse the lung, on account of adhesions, and, too, it is sometimes not advisable on account of a far advanced lesion in the opposite lung; however, it is well worth trying in every suitable case, and will stop the bleeding when nothing else will.

Other drugs, which have been tried but which have proven not only useless but positively harmful, are ergot, adrenalin, and pituitrin. It has been shown that these drugs exert slight if any action on the pulmonary vessels as vasoconstrictors, even in a healthy lung, and with a vessel whose walls are diseased, as is likely to be the case in a tuberculous lesion, they are worse than useless. They raise the blood pressure without constricting the bleeding vessel, thus adding, "fuel to the fire."

In conclusion Watson says:

1. Every case of hemoptysis should be considered the result of tuberculosis until proven otherwise. If sputum be negative, if you are unable to find any signs by physical examinations, if the temperature and pulse taken for a week at two hour intervals are not significant, by no means turn this patient loose until you have excluded tuberculosis by a negative subcutaneous tuberculin test. Many of us have seen just such cases go from one year to eighteen years before breaking down, and so long as they live they will never stop condemning the physician who failed to diagnose tuberculosis at the time of the first hemorrhage.

2. In the management of hemoptysis, the most important considerations are (a) absolutely perfect rest, mental and physical; (b) early and free catharsis with magnesium sulphate; (c) control cough; (d) maintain low blood pressure with nitrates or veratrum; (e) diet, composed of non-stimulating solids given cold; (f) calcium lactate; (g) artificial pneumothorax.

3. By all means avoid stimulants and vasoconstrictors, as ergot, adrenalin, pituitrin, strychnine, and the like.

BROADENING USES OF EMETINE. We quote from the Charlotte Medical Journal the following excellent abstract of the remarks of Low before the Royal Society of Medicine. Doctor Low said that an analysis of cases enables one to come to certain conclusions. Emetine

is not a specific in the sense that it completely sterilizes the body from amebæ. Relapses after its use occur, and these are by no means infrequent. The drug may be compared with mercury and salvarsan in syphilis and quinine in malaria, where, again, even after long periods of treatment, relapses or recrudescences are met with. Protozoal infections are always very difficult to eradicate, and when anything detrimental to the parasites causing them happens, forms arise which are specially resistant, and though remaining quiescent for long periods, under circumstances favorable to themselves, often give rise to the disease again.

In amebic dysentery the ameba become encysted, and then apparently the emetine cannot kill them, this stage being a very resistant one. At later periods these become transformed into the living forms again and so produce relapses. Treatment, therefore, for amebiasis must be conducted on similar lines to that of malaria by quinine. Suitable doses must be given and kept up for prolonged periods of time. Low therefore gives 2-grain doses of emetine hydrochloride until 10 grains in all have been taken. Then, if all symptoms have abated, the drug is stopped and the patient kept on a strict diet. Some cases, even after this relapse, and then a second course of the emetine has to be given, and so

on.

Sometimes injections are inconvenient, and in these instances keratin-coated tablets may be tried. His experience of these is that some patients can take them without vomiting or any unpleasant symptoms; others are sick for the first day or two, then tolerate them; while a third group keep on being sick each time they take them. In this latter case injections must be substituted. The dose by the mouth is 1-3 to 2 grain, and if not vomited is quite as effective as injections. As regards the latter, it is more satisfactory to inject the drug intramuscularly than subcutaneously. Some stiffness may even then result, so it is well to vary the site of the injection. Some cases do not do so well with emetine as others. Low recently saw a case in which the stool still showed blood and mucous after twenty 14-grain injections, and another whose stool was teeming with cysts after a short course of the drug. The efficacy of the treatment is tested by frequent microscopic examination of the stools passed per day, and by microscopic examination for the entamebæ from time to time; these usually disappear very quickly from the stools after the first two or three doses have been taken.

In addition to the emetine treatment a milk diet, and then later a milk and white meat diet,

must be insisted upon, and no alcohol in whatever shape or form is to be allowed. The patient should remain a teetotaller for a year or more after all signs of the disease have disappeared.

Amebic abscesses discharging through the lung or discharging externally are greatly benefited or even cured straight away, without surgical interference, by emetine. When an amebic abscess is opened and drained emetine injections should be started at once, as they will help greatly in the healing process.

Cases of amebiasis without signs of dysentery or hepatitis or abscess have also been met with. In these there is a high temperature, this quickly falling, however, and all other signs disappearing on the administration of emetine.

In addition to its use for dysentery, injections of emetine have lately been tried in the treatment of hemoptysis and intestinal hemorrhages. Flandin in France, impressed by the prompt disappearance of blood from the stools in cases of amebic dysentery treated by injections of the soluble salts of emetine, suggested the possibility of the drug being similarly effective in hemoptysis. Eight cases of this condition were treated, and in all of these, with the exception of a galloping case of tuberculosis, the hemorrhage was definitely arrested, the bleeding stopping immediately. No bad symptoms, such as nausea or depression, followed the administration of the drug. In some cases, though all traces of blood may disappear from the sputum, blackish clots may remain for some time. If after one injection there is a tendency for the hemorrhage to return, Flandin gives a second injection twelve hours later, and again on the following day. The doctor's dosage was 0.04 of emetine hydrochloride dissolved in 1 Cc. of distilled water. The arterial pressure was taken both before and after the administration of the drug, but no change was noted either in it or in the coagulation of the blood, or in the blood count.

These results were confirmed in twelve other cases by other physicians, while Renon also succeeded in obtaining the disappearance of blood from the sputum in two cases of lung carcinoma by the same treatment. The latter observer later tried emetine injections for serious intestinal hemorrhages. The writer quotes Valossopulo, of Alexandria, and Edham, of Salonica, as having good results from these in hemorrhage from a carcinoma of the large intestine, and from a case of mucomembranous enterocolitis. In his own experience Flandin's five cases of severe intestinal hemorrhage, including hemorrhage due to biliary and hypertrophic cirrhosis, hemor

organ.

These results would seem to indicate that in emetine we have a useful means of arresting hemorrhage. Why this should be is not altogether clear, but as it has been stated that the drug exerts a powerful local constricting effect upon blood vessels, it is possible that this is the explanation of its action in these cases.

THE ENGLISH DUMDUM-IS IT A MYTH? The Medical Record believes that the charge made by the German emperor, that the French and English troops are using dumdum bullets, is founded on insufficient knowledge of modern projectiles, as shown by the quotation from the Record which we give below. On the contrary, the Germans have published statements made by the colonel and lieutenant-colonel of the Gordan Highlanders, now prisoners in Germany, admitting the existence of flat-nosed balls issued for use in revolvers.

The editorial from the Record is quoted herewith:

The German emperor recently sent a note to President Wilson complaining that the French and English were using dumdum bullets, a practice condemned by all civilized nations as inhuman. President Poincairé and Sir Edward Grey have officially and categorically denied the charge, and there can be no doubt whatever that the Emperor was mistaken. The Allies have made the same accusation against the Germans, and, of course, are equally mistaken.

The explanation of the error on both sides is not far to seek. In an editorial comment on Colonel La Garde's recent work on "Gunshot Injuries" in the Medical Record of May 2, we prophesied that there would be a return to inhumanity in the next war because of the use of the spitz bullet recently introduced by Germany and adopted by several other armies, that of Great Britain and the United States among them. This bullet is quite short, of conical shape, and tapers so gradually that the center of gravity is thrown back near the base; consequently, in spite of its great initial velocity and flat projectory, it has a tendency to turn sideways upon meeting any obstacle, although it will go through the soft parts making a small clean-cut channel,

In the article on "Gunshot Wounds" in the fourth volume of the "Reference Handbook of the Medical Sciences" Colonel La Garde says of this bullet: "The least resistance upsets it and in turning at great velocity the wounds it inflicts are very much lacerated and otherwise attended with destructive effects which are not unlike the wounds inflicted by dumdum bullets. For this reason, the new pointed bullet is a great disappointment to military surgeons. In experiments which we conducted two years ago, we found the resistance encountered in the hipjoint, chest, and abdomen of cadavers sufficient to cause the bullet to turn and the resulting wounds were like those of an expanding or metal-patch bullet. Colonel Roosevelt, in his 'African Game Trails,' refers to the wounds of the pointed bullet as having a slashing effect against large game. At 280 and again at 180 yards he brought down two bulls each with one shot, the bullet making 'a terrific rending compared with the heavier ordinary shaped bullet of the same composition.'

In all probability these spitz-bullet wounds have been mistaken for the explosive lesions of the dumdum bullets, and the accusation of the German Emperor was therefore made in good faith, but in curious ignorance of the effects of the missiles used by his own army. Nevertheless the dumdum or a similar bullet has been occasionally used in this war, but by civilians. East Prussia, for instance, is a game country and the hunters there use the dumdum type of bullet in the chase. The Russian invaders of that country have been frequently attacked by "snipers" who used their hunting rifles loaded with dumdums. It is possible that the civilian hunters in eastern France did the same, and so an occasional dumdum may have been found in the bodies of the German wounded, but that the armies of any of the nations now at war are using this bullet is altogether improbable. They have no occasion to use it, for the spitz bullet is almost as destructive and its employment is just as brutal.

ican Medical Editors' Association I am believed to be the only man impervious to the wiles of

woman.

It seemed necessary to have some one unrestrained by conscience who could eulogize the ladies without backing over the precipice to a terrible hereafter. I was informed that many of the ladies would be accompanied by their husbands, and anything said to make them feel better would be appreciated. It is a work of kindness of heart to raise some women in the estimation of their husbands.

Tradition says there was a scarcity of solid elements at the time woman was created. At the beginning of time, Twashtri, the Vulcan of the Hindu mythology, created the world, but when he wished to create a woman he found that he had employed all his materials in the creation of man. He, therefore, took the roundness of the moon, the undulations of the serpent, the entwining of climbing plants, the trembling of the grass, the slenderness of the rose vine, and the velvet of the pansy, the lightness of the thistledown, and the glance of the fawn, the gaiety of the sun's rays and the tears of the mist, the inconstancy of the wind and the timidity of the hare, the vanity of the peacock, the modesty of the wren, the softness of the down on the throat of a swallow, the hardness of the diamond, the sweetness of honey, and the bitterness of gall, the innocence of the lamb and the cruelty of the tiger, the warmth of fire, the chill of snow, the chatter of the jay and the cooing of the turtledove. He united all these and formed a woman. Then, he sent her to where Adam, the first man, lay sleeping. And as the woman bent over the form of the man there burst upon the silent night a heavenly melody. "Her fragrant breath on Adam's cheek was sweeter than ever swooned in the rose garden of Cashmere; there was a touch upon his forehead softer than the white dove's fluttering bosom." He was awakened by a voice in his lonesome ear crying, "Get up, Adam, it is time to start the fire." And he got up, and he has been doing things she wanted him to do ever since.

Eight days later the man came to Twashtri and said. "My Lord, the creature you sent to me poisons my existence. She chatters without rest, she takes all my time and is always complaining."

Twashtri received the woman again. But eight days later the man came to the god and said, "My Lord, my life is very solitary since I returned this creature. I remember how she danced before me amid the sensuous perfume of dew bespangled flowers. I still feel the mes

meric touch of her hands and the wild thrill of heart pulsing against heart as we 'tangoed' together. I recall how we sat in the mellow moonlight by the river's bank and walked in the forest aisles by day, how she murmured sweet nothings to me in a voice low and sweet as the thrush's song, and I cannot give her up, my Lord."

And Twashtri returned the woman to him. Three days only passed and Twashtri saw Adam coming again. "My Lord," said he, "I do not understand exactly how, but I am sure the woman causes me more annoyance than pleasure. I beg of you to relieve me of her." But Twashtri cried, "Go your way and do your best." And the man cried, "I cannot live with her!?! "Neither can you live without her," replied Twashtri. And Adam was sorrowful, murmuring: "Woe is me, I can neither live with her nor without her.'

I know about how the man felt at times, and so does every other man here. I well remember how some thirty odd years ago a girl played with a skilled hand on all my senses until the last one of them passed in music out of sight and left me a mental bankrupt. She made me drunk with the music of her voice. Her every posture was a living picture, her slightest movement a sensuous symphony, and when I harrowed the peachbloom on her cheek with my whiskers, I was uncertain whether I had hit the lottery for the capital prize or had been nominated for justice of the peace. It was then I acquired the pernicious habit of writing poetry. This sweet period of irresponsibility and incoherence of thought ended soon after she married me, and I gradually returned to the normal, and again became a sane man and a moderately useful member of society, with a rapidly increasing appreciation of the value of a dollar.

But that girl is now Empress of my home, but never satisfied until she has fooled me into the belief that I am the real ruler.

Not satisfied with being empress of the home, the true helpmate, stirring the man to fight always for his better nature, rousing ever his highest aspirations, woman precipitates on this unhappy land the suffrage question. She insists upon voting, even though she may know less of political economy than does a prohibition orator. Her example has bred a train of ills or benefits whose culmination even the wisest philosopher cannot foresee. Already there is many a town she has made as dry as the Sahara. The suffragette is quite the antithesis of the soft, clinging creature who makes glad the heart of man by handing him buckwheat cakes hot off the