8. Osmic-acid injections are uncertain in effect as to the cure or relief of neuralgia.

9. A large percentage of cases of neuralgia will be relieved for months by osmic-acid injections.

10 The injections of osmic acid for the relief of tic douloureux is justifiable, even if it should become necessary to repeat the injections at intervals of a few months, particularly in view of the unfavorable results of the so-called radical operations.

11. The local irritation produced by the acid and the remote and irritant effects are not serious in their consequences and have no meaning as to the effect of the osmic acid in relieving neuralgia.

12. The solution of osmic acid should be made fresh for each operation, as deterioration is rapid.

13. Pain persisting several days in a small oircumscribed area means that the filaments supplying this area have not been acted on by the acid. The acid usually finally deIt may become necstroys such filaments. essary, however, to open a wound for the purpose of injecting such filaments.

14. Mere suboutaneous injections are of little or no value.

THERAPEUTICS.

W. T. HIRSCHI, M.D.

The Diet for Gastric Ulcer.- Lenhartz (Med. Klinik., No. 52, 1905) does not approve of the old Ziemisen-Leube regime which consists largely of milk, for the reason that either subnutrition follows which inoreases the anemia and causes the ulcer to heal less rapidly, or if sufficient milk is taken to nourish the patient properly (about 3L. a day) the stomach becomes dilated and overloaded, again retarding the healing of the ulcer. He proposes a diet of small volume non-irritating to the ulcer, being highly nu. tritious and containing a fair amount of albuminous substances, to furnish a sufficient amount of nourishment and combine freely with an excess of hydrochloric acid. From one to eight eggs are given at first raw, and later soft boiled. These can be eaten soon after a slight hemorrhage. Milk beginning with about 100 com.and gradually increasing to one liter is also permissible. Sugar from 20 to 50 grams, and near the end of the first week finely scraped beef are well borne. During the second week boiled rice, butter and toast and raw ham may be used. Patients recover more quickly, have fewer relapses, regain their strength and are able to resume work sooner than with the Leube

method. Wirsing reports 42 cases and Winkowski 30, which were treated with Lenhartz's method, and they also prefer it to Leube's method. Most patients can easily. digest this diet. The advantages of milk diet being partly the small amount of NaCl, can also be achieved by Lenthartz's method by using little salt in the eggs, ham, butter, eto. Winkowski deviates from Lenhartz's method by abstaining from all food drinks and ice pills for several days after a profuse hemorrhage, and nourishes the patient through rectal enemata or subcutaneous injections during this time. The patients are more willing and can easily carry out this method of dieting. Lumbar Puncture. (Juincke, Deutsch Med. Woch., Nos. 6, 7, 1905.)-It is barely fifteen years since the author introduced lumbar puncture as a diagnostic and therapeutic measure, but it is very extensively known and used. The removal of some cerebro-spinal fluid in healthy or somewhat diseased patients can be done without danger to the individual. The nature of the fluid and the pressure under which it is removed should be noted. If albumins in excess of 0.5% are present an inflammation or venous stasis are to be expected. The normal specific gravity is 10061007, and the freezing point is 0.56 to 0.75 deg. The normal pressure is about 125 mm. water; respiratory movements cause it to vary about 20 mm. The patient is placed in a horizontal, left side position, with lumbar Insert the needle in the third inkyphosis. terstitial (lumbar) region. For diagnostic purposes and under normal pressure 1-5 ccm. may be removed, but the pressure should not sink below 100-80 mm. In increased pressure it should not fall below 120 mm. Never use suction. After puncture the patient must remain in bed at least twenty-four hours and receive no alcohol. Juincke considers an angioneurotic hydrocephalous as a cause of the severe headaches in many cases of chlorosis migraine and similar paroxysmal cerebral affections.

The Treatment of Pneumonia.-Fraenkel (Therapie de Gegenwart, No. 1, 1906) advocates the use of digitalis according to Traube, only that Fraenkel uses it in larger doses. He does not give more than 0.4 of the infusion in twenty-four hours, and does not continue it more than two or three days to regulate the heart action and arterial pressure. Digitalis was used only in severe infections with a very frequent pulse and low arterial tension. Digitalis increases systolic contraction, gives the heart a better chance to fill during diastole and slows the pulse, through irritation of the vagus centre. It also acts somewhat as an antipyretic. The cumulative

action of digitalis must not be overlooked. Fraenkel uses digitalis if he sees the case inside the first three days; if no arteriosclerosis, organic heart disease or chronic nephritis are present. If digitalis is used later in the disease it must be given in smaller doses and with greater caution. Formerly the collapse was considered as being due to cardiac insufficiency and the vasomotor action was ignored, but now the vascular paralysis is considered the chief cause of collapse. The arterial paresis is due to the large amount of

bacteria in the blood. The arterial tension is reduced in about 66% of all cases, and is never absent in the most severe infection. The

hearts of pneumonia patients which term. inate fatally rarely show marked pathologio changes. At times the right ventricle becomes incompensated on account of the great resist ance in the lesser circulation. Caffein stimulates the vasomotor centre and is indicated in pneumonia, with low arterial tension, high frequency and cyanosis with dyspnea. It is best given hypodermatic in 10% solution, using from 10-25 grains in twenty-four hours. Caffein produced insomnia and cerebral irritation in 10% of these patients. Caffein may be combined with digitalis camphor or alcoholic stimulants in the treatment of severe cases.

Digitalis Therapy.-(F. Umber, Die Therapie der Gegenwart, No. 1, 1906.)-The correct indications and methods of administering digitalis are very essential to obtain good results. The great variability of digitalis has led various experimenters to isolate the active principles, e. g., digitalin and digitoxin, while others advocate dialysed digitalis. Digitalin is almost insoluble, resorbed with difficulty, readily disorganized in the stomach and at times produces alarming symptoms. Digalen (soluble digitalin) is used subcutaneously, intravenous and internally. The writer used digalen in sixty cases suffering from cardiac lesions. He observed that digalen similar to other digitalis preparations if given in therapeutic doses in well compensated cardiac lesions has little effect on blood pressure and diuresis, and at times produces irregularity in the pulse. With incompensation digalen increases blood pressure, diuresis and the pulse becomes less frequent. At times digalen or digitalis act more promptly if combined with a diuretic, e. g., diuretin, caffein natrio benzoic or agurin. Circulatory disturbances due to vasomotor paresis occurring during acute infectious diseases should be treated by combining diuretics with cardio-vascular stimulants. Digalen produces little pain at the site of injection if ad. ministered intravenous, but is quite painful if used subcutaneous. For the prolonged

use of digitalis, neither digalen or digitoxin are to be used, as they have a more rapid cumulative action than the original drug.

The Treatment of Goitre. Hildebrandt (Therapie der Gegenwart, Nc. 1, 1906) uses the usual classification parenchymatous, fibrous, vascular, cystic, colloid and those with oalcareous deposits. The internal administration of iodine or iodine containing sub. stances, e.g., thyroid glands is often beneficial, but owing to the resulting loss of weight and cardiac irrritation it must be used rationally. Surgical interference is necessary if the goitre interferes much with respiration. Large cysts are at times enucleated successfully. Vascular goitres may be improved by ligating the larger vessels. The dangers in surgical interference are postoperative hemorrhage and pneumonia.

DERMATOLOGY.

ROBERT H. DAVIS, M. D.

A Note on the Spirochaeta Pallida.-Herman (N. Y. Med. Jour., Dec. 9, 1905) says that, at the present moment, it cannot be said with certainty that this organism does, or does not, play a part in the causation of syphilis. To base a positive diagnosis on its presence, or to exclude syphilis on its absence, is certainly premature. If a dili gent search is made, the micro-organism will be found in the majority of cases of syphilis, most frequently in the secondary stage, especially in the latter manifestations; less frequently in the primary lesions, the lymphatic glands, and the blood; and rarely in the tertiary manifestations of the disease. Recently it has been demonstrated in the serum of blisters artificially produced on syphilitics. The author gives the following method for this procedure, which has the advantage of being both simple and rapid: A small pad of gauze, one-half an inch square, is saturated with strong ammonia (28%), and then applied. It is covered by a watch glass to prevent evaporation, and this may be conveniently held in place by a rubber band, if the application is made to an extremity. This is allowed to remain for three or four minutes. The gauze pad is then removed. In about fifteen minutes a vesicle begins to form, from which the serum is collected in a capillary tube (such as is used for vaccine), and sealed. A portion can be used for the examination of the organism in the hanging drop. It has been claimed by Thesing that organisms morphologically identical with the spirochaeta pallida may be found in the fluids

used for staining this organism. Granting that this is the case, they might still be different. "In all probability there are a number of varieties of spirochaetae, and it is fair to assume that some of these resemble each other very closely in their morphology and in their tinctorial reactions as seen under the microscope. (Compare the tubercle and lepra bacillus.) Organisms inorphologically identical with the spirochaeta pallida have been found by a few investigators in nonsyphilitic lesions. Hoffman examined several cases of ulcerating carcinomata, and found spirochaetae which could not be easily distinguished from the pallidae. He stated that there were some very fine morphological differences, but did not say what they were. This objection might be niet in the same manner as the first. Though morphologically similar, they might still be entirely different. The fact that the organism is difficult to find, more especially in the blood of syphilitic patients, does not disprove their possible causative significance. The same is true in other conditions, such as tuberculous meningitis, for only very long and diligent search will discover the tubercle bacillus in the cerebro-spinal fluid. The author claims that the length of the spirochaetae, as seen under the microscope, is a variable quantity, and that the thickness depends, to some extent, at least, on the method of fixation and staining. When the specimens are fixed with alcohol, the organisms are apt to appear somewhat finer. When stained by the Giemsa method, they appear finer than when some other methods (e.g., Loeffler's method for flagella) are employed. This may depend upon the fact that the Loeffler method stains also the envelope which surrounds these organisms. The number and depth of the coils of each spirochaeta is also a variable quantity, and depends on the vitality of the organisms, in part at least. The spirochaeta pallida has been found in the lymphatic glands, in the papules, and in the blood of syphilitic patients; that is, at points distant from the primary lesion. This, however, is not pathognomonic. Spirochaetae have been found at some distance from the primary lesion in non-syphilitic cases, for example, in a metastatic abscess of the femur, the primary lesion being in the lung; in the bone marrow of the femur, and in the muscle of the small intestine in a case of severe anemia; and in the cervical and submaxillary glands in a

of noma. The successful inoculations, says the author, that have been made with the syphilitic virus do not prove that the spirochaeta pallida is the sole, or most important, micro-organism concerned, for no inoculations have, as yet, been made with the

spirochaeta pallida alone. His final conclusion is, that, at present, it does not appear probable that the. spirochaeta pallida is the sole cause of syphilis, and that, if it does play a part, it represents only one stage in the life of a protozoon which is the cause.

A Study of Some Cases of Epidermolysis Bulbosa with Remarks upon the Congenital Absence of Elastic Tissue.- Engman and Mook (Jour. Cut. Dis., Feb, 1906) cite four interesting cases of this rare malady, and give the results of exhaustive microscopical examinations of sections from two of these. These sections were stained with a variety of stains, and the most striking finding was, as indicated in the title, the practical absence of elastic tissue in the papillary and subpapillary regions of the derma, and its sparse distribution and deformity in the deeper regions This absence of elastic tissue was not due to the constant moisture (from the edema) in the skin of the patient, as there was an absence, also, of degenerated elastic fibres and elacin. Also, elastic fibres are very resistant to edema. They put forward the view that "this absence of elastic tissue in the upper portion of the derma could explain the histologic picture in the normal skin of these patients, and the clinical phenomena charaoteristic of this affection. "It is thought that elastic tissue acts as a support to the cutis, giving it tenacity and tone, and, in this way having a controlling action over its lymphatic and capillary circulation, besides acting in a similar capacity in its situation in the walls of the larger vessels." If the elastic tissue be absent from the upper portions of the derma and deficient in its lower portion, we would expect to find the cutis bathed with moisture from the loss of tone of the capillaries, and a partial stasis from the deficiency of this tissue in the deeper portions of the cutis. The tissue being thus constantly bathed with serum we would expect to find a

chronically sodden and weakened epidermis which could be easily detached from the underlying tissue on pinching and traction (a peculiar characteristic of this trouble), as the elastic fibres which normally mount from the cutis to the epidermis are absent. "When trauma is occasioned, the consequent reaction, not having the usual control exerted over it by the elastic tissue, would allow an excessive flow of serum into the tissues, which would seek the place of least resistance, and dissect or lift up, the chronically sodden epidermis into a bulla. The pale scars are due to (1) secondary infection; (2) complete destruction of the epidermis over a large area, when no islands of epidermic cells are left upon the floor of the bulla for regeneration,

and (3) by the poor effort of the elastic tissue to regenerate. "There are several cases cited in literature where the affection disappeared later in life, at the time when, according to Ravogli and others, there is an increase in the elastic fibres,"

SOCIETY PROCEEDINGS

MEDICAL SOCIETY OF THE MISSOURI VALLEY.

This progressive body, now in its nineteenth year, has forged its way to the front, and has become one of the best, if not the largest, independent organizations in the United States. Composed of able, active men, and drawing from seven of the largest states in the middle West, this association has become a factor in the medical affairs west of the great Missisippi river. The sessions of this society are devoted entirely to scientific work, and the papers read before it are both entertaining and instructive. Its sessions are held in the spring and fall. The good work accomplished by this body of earnest men is a matter of history, and a most commendable feature of these meetings is that no time is devoted to ethical, political, or personal debate, and "society politics" is an unknown quantity in its ranks.

For the above reasons, as well as many others we would recommend this society to our readers. If you want a real intellectual

feast and a season of social intercourse with a congenial body of scientific men, attend the next meeting at St. Joseph, March 22 and 23. A pleasant feature of this meeting will be the attendance of the presidents of the State associations within the province of the Missouri Valley.

Headquarters, Hotel Metropole.

EXCURSION TO EXCELSIOR SPRINGS.

Ex

A cordial invitation for the society to visit Excelsior Springs has been received by the secretary, from the Commercial Club and Medical Society of that popular resort, and arrangements are being made for train service to accommodate our members. celsior Springs is a famous watering place twenty-five miles from Kansas City and forty miles from St. Joseph, the waters of which have a world wide reputation. An opportunity will be afforded our members at this time to visit this picturesque and attractive resort, through the courtesy of its citizens and med. ical profession. Special rates will be obtained on the railroads. It is probable that a

special train will leave St. Joseph on Friday afternoon, March 23, and returning on Saturday, although many will no doubt spend Sunday at the Springs. Bring your wives and daughters and enjoy an outing of a few days in the Carlsbad of the West." Following is the preliminary

PROGRAM:

N. S. Davis, Jr., Chicago, Oration on Medicine.

L. L. McArthur, Chicago, Oration on Surgery-"Surgery of Intestinal Tuberculosis." C. H. Mayo (President of Minnesota State Medical Association), Rochester, Minn., "Surgical Treatment of Goitre."

Wm. Jepson (President Iowa State Medical Association), Sioux City, Ia., "Prostatism and Its Management.

D. C. Gore (President Missouri State Medical Association), Marshall, Mo., "State Medicine."

Fenton B. Turck, Chicago, "Medical and Surgical Treatment of Gastric Diseases."

A. F. Jonas (President Nebraska State Medical Association), Omaha, Neb., subject not announced.

S. Grover Burnett, Kansas City, "Some Pathology of the Morphine Habit, and My Preferred Method of Treatment."

Prince E. Sawyer, Sioux City, Ia., "Curettage of the Uterus; Its Dangers."

Bernard A. McDermott, Omaha, "Some Principles in the Treatment of Rupture of the Male Urethra."

C. O. Thienhaus, Milwaukee, Wis., "Review of My Operations for Total Prolapse of the Uterus.

W. F. Milroy, Omaha, "Indirect Effects of Valvular Lesions."

Frank Parsons Norbury, Jacksonville, Ill., "Individual Treatment of Borderline Cases of Mental Disease."

T. C. Witherspoon, St. Louis, "Removal of the Uterus in Certain Inflammatory Conditions."

R. D. Mason, Omaha, "Some Advances in the Office Treatment of Rectal Diseases."

R. C. Moore, Omaha, "The County Sanatorium for Pulmonary Tuberculosis.

L. J. Dandurant, St. Joseph, "Ligation of Common Femural Artery for Large Aneurism in Scarpa's Triangle; recovery; presentation of patient."

E. T. Shelly, Atchison, Kas., "The Expectant Mother."

J. H. MUSSER, M. D. Chairman American National Committee.

The meetings of the congress will be held at the Medical School of Lisbon, which is a very large and spacious buildng, and will be under the patronage of the King and Queen of Portugal.

The meetings of the sections will take place in the various halls of the building, besides which there will be others devoted to the comfort of the congressists. The largest hall of the building will be a general loafing or clubroom, in which the congressists can read, write and converse, while two adjoining rooms of large size will be reserved for the ladies of the party. On the terrace of the University there will be a buffet where the physicians can walk about or sit down and have refreshments served at all hours of the day. Everything will be under one roof, and everyone will know where to find every thing connected with the Congress, as well as everything that is needed in a general way. There will be the office of the presi dent, secretary and treasurer of the Congress; telephone room; typewriting room; press room; information room, where one can find out all particulars regarding the various