A Study of Enuresis. From a study of 226 cases of enuresis treated in the out-patient department of the Massachusetts General Hospital Schwartz (Boston Med. & Surg. Journ.) arrives at the conclusion that the causes of this condition are various. In some the nervous element undoubtedly plays a part, and in others faulty habits. Local irritation from any source is a predisposing cause. Excessive fluids result in a greater secretion of urine, while too little fluid results in a concentrated urine, which, whether it contains crystals or not, may irritate the base of the bladder and cause the desire for frequent micturition. Enlarged tonsils and adenoids apparently have no connection with enuresis. Digestive disturbances did not in themselves have any connection with the condition, but it is conceivable that constipation may be a predisposing factor.

The treatment, while varying with the cases, followed the following lines: All the cases seen were put at once on an enuresis regime. This included all the various aids to cure usually recommended, such as no fluids after 5 p. m., elevating the foot of the bed, light supper, sleeping on the side, light covers, hard bed, and modifications of the diet when indicated. In no instance did these methods alone effect a cure. Drugs given to make an acid urine alkaline seemed to be of doubtful value. The usual doses of alkalies recommended in these cases were too small to change the reaction of the urine. Potassium citrate had to be given in large doses before it changed the reaction from acid to alkaline. One patient who had a high acidity and uric acid crystals in the sediment showed no improvement whatever following the administration of twenty grains of potassium citrate three times daily over several weeks' time. This patient later was cured by the use of atropine.

Results with thyroid extract were not as favorable as reported by Williams or Firth. Following Ruhrah's experience, whose good results with thyroid extract were obtained immediately or not at all, the administration of this drug was limited to a period of two weeks. Seven cases were given thyroid extract; no cure was effected. Four

showed some improvement, one case varying directly with its administration; three showed no benefit whatever. Of the four improved cases, one was a child of slightly dull mentality. The other cases were average consecutive cases. As it has been pointed out by Firth that the best results were obtained in backward children, this may explain the lack of results in the present series. Eleven cases were given atropine. Of these two have been cured, six improved, and three not benefited. In two cases the enuresis ceased spontaneously without anything being done.

This ointment may be applied, night and morning, with much advantage. Frequently, it is essential only to smear over the piles as they appear at the margin of the anus. Again, it is well, in addition, to insert with the finger a small quantity of the ointment within the external sphincter. The ointment is not painful and will contract and heal the piles, and also arrest any slight or moderate hemorrhage from them. If there be an anal fissure or ulceration at the entrance of the rectum, it will cure it.

In treating internal hemorrhoids, and when hemorrhage is frequent, he gets excellent results with flaxseed enemata given night and morning. The whole flaxseed should be boiled for twenty minutes, four tablespoonfuls of seed being added to about one quart of water. The strained decoction should be about as thick as very rich cream. Inject with a Davidson syringe, patient lying on the left side. Robinson also uses a suppository containing from a grain to a grain and a half each of aesculus and hamemelis-presumably of the extracts.

One of these suppositories is used almost immediately (within five minutes) of the time when

the enema is finished.

ing in the morning.

Another is used on awaken-
After the stool (as a rule,

in the morning), and the injection then of the flaxseed enema, another suppository is introduced. A suppository is also introduced half an hour before lunch and half an hour before dinner. Two rubber bulbsful of flaxseed decoction are injected and this is increased to eight gradually. which equals about eight ounces. This amount is seemingly entirely absorbed, and does not appear in the movements. Further, it is retained by the bowels and does not occasion a movement. Whenever there is constipation, a pill of cascara, 2 grains; podophyllin, % grain, and extract belladonna, 1/16 grain is employed; one or two may be taken at bedtime if required.

When the loss of blood had greatly diminished or had completely finished, the so-called "anusol" suppository has been found very useful. are stated to be composed of bismuth, iodine and resorcin, with zinc oxide and balsam of Peru.

They

Of course, the habits of the patient should be carefully attended to, and alcohol, coffee and tea, meat and sweets, should be permitted only in very small or moderate amount.

Linseed oil, when fresh, may be given with advantage by the mouth in some instances, but at the present time it seems preferable, if need be, to employ the purified mineral oil in this way, as it is non-absorbable and is usually well supported by the stomach.

The Menace of Cholera.-Even in our American possessions there is a cholera problem-in the Philippines, for instance. Thus, in the Medical Record we find the following in a letter from Manila:

A sharp rise of cholera has occurred during the past month, spreading from Manila northward along the railroad as a result of temporarily incomplete and ineffective measures for control. Manila itself is showing an average of but one or two cases a day, but the problem is particularly perplexing because of the high proportion of healthy persons who are found bacteriologically to be carriers'' of cholera vibrios and whose occupations may be such as to render them particularly liable to convey their infections to others. Thus in one day three handlers of cooked food in native restaurants were found to be carriers. In another series, of one hundred and sixty-nine persons coming to autopsy from causes other than cholera, seven were found to be cholera carriers. In fifty-three persons taken at random from an infected district, eight were found bacteriologically positive for cholera. Of twenty-six contacts with a tuberculosis case found to be a cholera carrier,

nine were found to be carriers also. A very high proportion of cases presenting disorders of the intestinal tract, as dysentery, tuberculous ulceration, diarrhea, etc., appear also to be true cholera carriers. As a result of these healthy and other carriers, there is a constant upcropping of cholera cases, but as yet in no instance developing into a local epidemic. The cases are scattered and the measures taken are usually entirely and promptly effective in preventing the development of further cases from these foci. The problem now seems to resolve itself into considering the frank cases of cholera as merely the expression of latent conditions in the healthy population, the cause of which can only be removed by the detection and isolation of the healthy harborers of the cholera vibrio. This, for a population of approximately a quarter of a million, is a task of herculean proportions. However, it will probably suffice in practice if the carriers of the most dangerous class can be reached and quarantined, and this especially dangerous class is undoubtedly to be found in the handlers of cooked food in tiendas and the kitchen forces of hotels, clubs, boarding houses, restaurants, ice cream parlors, etc. Plans are under way to examine all members of this class of persons, and the Bureau of Science is making examinations at the rate of some eight hundred per day. As a result, reports show that nearly a hundred carriers are constantly in quarantine at the cholera detention hospital. Many cases have been removed from hotels and other places where their presence was liable to start local epidemic outbreaks at any time. Most of the carriers seem to clear up in about two weeks under the use of saline cathartics and intestinal antiseptics like salol-though how much real value the latter possesses for the purpose is problematical. Cases are held in quarantine until negative to two examinations several days apart. Examinations are based on cultures made from feces, or from swabs taken from the rectum, and given the agglutination test.

A tendency of cholera cases to gradually crop up along the railroad north of Ma..ila has led to an investigation of the privy closet facilities at the railroad stations. Out of one hundred and sixty-three stations, only fifty-eight had closet facilities, fifteen of the latter were closed, and of the forty-three in use only twenty-four were reported as being fairly good as to surroundings. Most of those in use were found to be open to flies. In many of them the waste disposal methods were ineffective. In the majority of cases, the closet was found to be kept locked as a convenience for the station master and his family only. As a result, the vicinity of almost every station was found fouled by human deposits, and as food exposed

to flies was sold at many stations, the possibility of transmission of infection introduced by carriers and disseminated by flies and food was very great.

Diuretic Properties of Lavender. We learn from an abstract of an article in the New York Medical Journal that L. Morpurgo, in Quinzaine thérapeutique for May 10, 1914, is credited with calling attention to the possible utility of lavender as a diuretic. Being given to drink by mistake an infusion of this drug instead of one made with fennel, he was troubled with abundant diuresis the following night, and was soon enabled, by exclusion, to trace this to its actual cause. The effects of a hot infusion of 5 drams (20 grams) of lavender in 6 ounces (200 grams) of water were thereupon tested in a number of patients presenting, from various causes, a diminished urinary flow, with almost constant free diuretic response. The increase in the output of urine in twentyfour hours ranged from 1.66 to 16 ounces (50 to 500 grams).

Remarkable Experience with Cataract. The quantity of operative work upon the eye performed by our American surgeons is small indeed when compared with that of oculists in India. For instance, we learn from the New York Medical Journal that 1,024 cataracts were removed between January 1 and February 15, 1914, in a single hospital connected with the Quetta Medical Mission in India. Compare this record with the 183 operations for cataract in a year at the Manhattan Eye, Ear, and Throat Hospital between October 1, 1911, and October 1, 1912, to be divided among seven surgeons, four junior surgeons, and a large number of assistant surgeons. The Quetta hospital, according to Dr. H. T. Holland in the Indian Medical Gazette for June, has three surgeons, one assistant surgeon, one subassistant surgeon, one sister, one compounder, two dressers, and three ward boys, on entire staff and force of twelve, who work at the highest possible pressure daily from 8:30 a. m. to 6 p. m. During these six weeks 2,330 operations were performed, 1,024 of them for cataract. The maximum number of

outpatients in any one day was 706, the largest number of operations 129.

With an experience like this it is hardly to be wondered at that Indian physicians have perfected the technique for the cataract operation to the highest point known.

Quinine and Other Oxytocic Remedies.-We learn from the Charlotte Medical Journal that Tassius, writing in the Archiv fuer Gynakologie,

believes that quinine may be used in the period of dilatation as well as during that of expulsion and it is also of value in cases where labor is induced before term. Pituitrin was found to be a reliable remedy in secondary inertia and the effect increased with the period to which labor had advanced. In the process of abortion it favors the process of dilatation and makes curettage easier. For the induction of premature labor it was found of less value during the puerperium, especially for hemorrhage it was very serviceable. Tassius is convinced however that it cannot induce labor pains. Unfavorable influences on either mother or child are relatively rare if care in the administration is observed. Pituglandol was found to be very efficient in secondary inertia as well as in abortions and the induction of labor, although it is not efficient for the production of the latter. The writer states that it is valuable in eclampsia, placenta previa, uterine hemorrhage, particularly in combination with ergot preparations. Secacornin, an ergot derivative, was not found to be of value during labor or in the treatment of abortions, and the site of injection was likely to be painful. It was particularly applicable however to the postpartum period after the delivery of the placenta.

济济济

Oil of Turpentine in the Treatment of Puerperal Sepsis.-Cramer (Monatschr. f. Geburtsh. u. Gynak.) says that for the past ten years he has used the oil of turpentine in the local treatment of puerperal infections, employing the undiluted officinal oil in the form of a tampon to the infected mucous membrane of the vagina and wiping out the cavity of the uterus likewise. The absorption of the oil is very slight and the writer claims that no unfavorable symptoms are observed. In all cases it is necessary to completely free the uterus of all placental and decidual remnants, avoiding a sharp curet. The results in a considerable series of cases are presented and even where sloughing has already occurred, the healing process is favored. Also employs the oil of turpentine in gynecological treatment, especially in the presence of cervical and vaginal infection with streptococci and staphylococci. It also serves as a satisfactory prophylactic for disinfecting the vagina previous to abdominal hysterectomy for

carcinoma.

The preceding is quoted from the Charlotte Medical Journal.

Treatment of Septic Wounds. Here is a solution recommended by D. H. Stewart, in the Medical Summary-Chlumsky's solution. It is to be

M. Sig., ext. use. Spread the strips over the wound, dust them thickly with powdered sugar of milk, put on pads and bandages. Why sugar of milk? Because it does not lump, has a pumping force (sp. gr.) of 1,500 to glycerin's 1,250 or less, and is easily obtained in powder form. Put on plenty of it and leave wound, boil or other lesion, alone for a week or more, if there is no definite reason for disturbing the bandage, such as pain, soiling or evidences of strangulation.

Why bother with glycerin in such cases, asks Dr. Stewart. The Chlumsky solution is much better. It is analgesic and sedative, it has been widely used to relieve the pain of acute rheumatism, neuritis, etc., and it is applied as iodine or turpentine would be. Guaiacol may be added (or omitted) to ten per cent. in cases of gonorrheal knee for instance. The method of wound treatment gives the best results which might be anticipated from carbolic and glycerin; good antiseptics and dehydration, but it omits dermatitis and discomfort, which is generally considered a great gain.

斑

Diet for a Man Past Forty.-The following diet for a man past forty is laid down by Dr. Charles F. Bolduan, and is copied from the Dietetic and Hygienic Gazette:

In terms of calories (heat units) the human body has been found to need 3,000 calories, derived from all kinds of food, a day. Thus a day's meals should be about as follows:

Breakfast Oat meal to the amount of a good sized helping; a glass of milk and a little more with the oatmeal; sugar for the oatmeal and two slices of bread and butter. Here we have 1,000 calories already, which is all that can be allowed for breakfast. If coffee is substituted for milk it is necessary to subtract 300 calories and then make it up by eating another slice of bread, although coffee has no place in this diet.

Luncheon-Toast, milk and fruit to the quantity of 500 calories.

Dinner-Meat, three vegetables with gravy, but only one helping; two slices of bread and butter, one helping of prunes and tea with milk and sugar. This gives 1,500 calories, which

makes the 3,000 total for the day. With this a satisfying amount of water should be drunk at meals; and copiously between

meals.

Ichthalbin in Appendicitis.-When for any reason whatever laparotomy is impossible in an

acute attack of appendicitis, the timely administration of ichthalbin has given highly satisfactory results in the hands of B. Beldau, of Riga; his dosage being the amount that will lie on the point of a tableknife, together with 6 drops of hydrochloric acid, and repeated four times a day. Especially convincing are the results in the periodically recurrent cases of appendicitis, and in which during the quiescent periods slight subjective symptoms are manifest. Beldau assumes the bactericidal as well as the antiphlogistic properties of ichthalbin to be responsible for this action, by virtue of the gradual liberation of ichthyol in the intestine (he calling it "in statu nascendi”).

It will be remembered that ichthalbin is a compound of ichthyol and albumen, which is insoluble in acid fluids (gastric juice), but soluble, and gradually disassociated, in alkaline liquidshence, in the small intestine. The suggestion of Beldau's does seem worthy of attention; not neglecting, though, other measures approved in such "watchful waiting."

WE VE VE

Surgical Relief in Hirschsprung's Disease.-G. Perthes-who considers that the greater proportion of cases of Hirschsprung's disease (congenital dilatation of the lower colon) are a combination of a secondary, acquired, colonic enlargement based upon a less pronounced congenital abnormality-has described his method of operative procedure (Beitr. z. Klin. Chir., 1914, No. 3) by which in the case of one such victim he succeeded in affording considerable relief. The operation is also detailed in the Muenchener Medizinische Wochenscrift of June 2.

A New Alkaloid of Jaborandi: Carpiline.-E. Legére and F. Rogues have announced (Compt. Rend., 1912, p. 1088; cf. Pharm. Zentralh., 1913, No. 40) the discovery of a new alkaloid in jaborandi (pilocarpus), to which they give the name carpiline. They obtain it from the motherliquor of pilocarpine production. It contains a lactone group and is but slightly poisonous, while not possessing any sodorific properties. Certain French chemists, though, are inclined to suspect its identity with the pylosine of Pymann.