troubles. Dr. Foges has obtained equally favorable results with this treatment in cases of suffocation. This method may be employed for several hours at a time, and is said to be harmless for the patient and easy for the physician.

The Therapeutic Gazette HEMORRHOIDS. for November publishes treatment for hemorrhoids. Palliative treatment should consist, first of rest in the recumbent position, the relief of constipation, if any exists (by using a pill or tablet of aloin, belladonna, and strychnine, some preparation of cascara sagrada, confection of senna, or glycerin suppositories), and the application of continuous cold, by means of the irrigating tube or cold compresses, and the use of suppositories containing opiates, cocaine, hyoscyamus, and belladonna, or tannin, sulphate of zinc, alum, and like astringents. But do not forget that astringents of the tannin group are incompatible with morphine, cocaine, vegetable alkaloids, and salts generally. A suppository contains

Solid extract of ergot, gr. ii;
Extract of opium,

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symptoms moderated for a couple of days. Then Dr. Bayley was again sent for, and he found the patient suffering from a combination of symptoms suggesting appendicitis. There was pain over right half of abdomen, wit nausea; rigidity of muscular walls over right iliac region, the McBurney point being clearly marked on pressure being applied.

The treatment consisted of administration of morphine, one-sixth grain hypodermatically, followed by phenacetin in five-grain doses every three hours. The morphine was later replaced by opium, one grain every three or four hours for two days, and subsequently sm er doses. Calomel was administered in four-grain triturates every three hours, until soreness of gums resulted.

Then potassium chlorite was used as a mouth wash and gargle. The calomel, with occasional doses of Rochelle salts, caused free movements of bowels and relieved the tympanic condition. Hot turpentine applications were made externally.

The temperature steadily rose to 103° F. on fourth day. A lessening in rigidity of muscles over iliac region occurred cotemporaneously with decline in temperature. Within a week the temperature was normal, and patient became convalescent. She had a normal, though a more tedious labor than on previous confinements, and made a satisfactory recovery.

With a view to corroborate or strengthen his report of this case, Dr. Bayley furnishes some details of a case of appendicitis with similar symptoms which was under his care at the same time. The second patient was an unmarried woman of 28 years, who had suffered from a previous attack of appendicitis during the year. The prominent symptoms were: Fever rising to 103° F., rigidity of muscles in iliac region, slight dulness, pain at McBurney's point, and somewhat tympanitic abdomen. The treatment was again by opium and calomel, together with ice bag, instead of hot applications of turpentine. Recovery occurred.

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how shall the nurse act when confronted with unexpected emergencies? One of the questions which bureaus for the supply of nurses are apt to place considerable stress upon is this: "Is the nurse modest about the assumption of responsibility?" There is a danger in either extreme. A doctor of necessity confides a good deal to the nurse's discretion. Certain things are to be done under certain conditions; but, if new conditions develop, certain different things are to be done. It is possible for a nurse to be too weak and hesitating. On the other hand, she may be too confident in her own knowledge, and may fail to recognize the importance of symptoms which in some cases would have little significance, but, in the particular case under her care, stand for a great deal. It is wiser to err, if at all, in the direction of over-prudence than in that of rashness and assumption. If new conditions develop, the doctor should know of them with as little delay as possible. But, even in the face of startling changes, the nurse must be calm and composed, else she will certainly demoralize both the patient and the household.

Not only as regards the development of new conditions, but with reference to the ordinary progress of a case, the doctor depends upon the nurse to keep him informed. Some one has said that the ability to see what is before his eyes and to see it knowingly, is more than half of what makes a successful doctor. The same principle holds true of a nurse. You will be well repaid if you cultivate the habit of noticing closely and recording concisely everything that happens to your patient. All doctors appreciate this kind of work.

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and tried every treatment to restore the man to conciousness, and in the meantime Garrett lies in a comatose condition.

"The only indication of importance, which serves to puzzle the doctors more, is that there is a reffex action of the nerves. This was demonstrated by a peculiar twitching when the surgeons tickled his feet. In fact, the man's condition is that of one completely paralyzed over his entire body." In an interview with the reporter the surgeons made the following remarks on the case: "You know there are twenty or thirty different causes of coma. Without some definite knowledge of the patient's former medical history it is hard to say which condition is present in this particular case.

There are two possibilities. It may be that there has been an effusion of blood between the brain matter and the covering membrane, which would be diffused over the entire surface, and present similar symptoms to those of Garrett. Then it might be that it is a result of some kidney disorder or resulted from one of the uræmic comas of that disease. The man might have had a convulsion in his sleep, and brought on the cerebral trouble. There are objections to each of these theories.

"There are no indications of poisoning or of a condition that follows asphyxiation by gas. Catalepsy is also precluded for this reason. In that condition you can raise the arm of the patient, and it will remain in the position you put it for some time. In this case you raise the man's arm and it falls back limp upon releasing it. It's a remarkable case, in fact, the most remarkable that has come to the attention of the profession in this city."


The first anniversary of the Woman's Medical Club of Chicago reminds us again of the fact that women's clubs continue to multiply and flourish and gain respectful recognition, despite the suspicions of curious husbands, who were inclined to subject them to critical inspection when they first began to see light; and they have reached a point, too, where they represent as much diversity in tone as the man's club. This medical club, formed one year

ago, was the first one of the kind ever organized. Chicago, with the suburbs, claims two hundred and fifty women doctors, and many of those among the younger women are fitted to be surgeons. Dr. Gertrude Gail Wellington, who is a graduate of the Women's Medical College of the New York Infirmary, was the first President of the club. Aside from the social part, the women have done some good work in municipal reforms. By soliciting the aid of the press, and their own combined efforts, they succeeded in preventing the proposed abolishment of milk inspectors, and petitioned the City Council to consider the necessity of a smallpox hospital, which was finally built. The disposition of garbage and the best methods for removing it is another subject which has received their attention. The "pet scheme" which absorbs some of the attention of the club just at present, is to estabish a free hospital in connection with the International Medical Mission Institute, a college which gives both men and women a practical education in medicine.


In December number of Popular Science News Prof. Henry E. Chapin, M. Sc., writes: One of the great sources of infection is milk. Recognizing this fact, and that young children are wholly dependent upon this food, bacteriologists have been able to give to the world a practical method of sterilization, by means of which the milk will be rendered absolutely germfree, thus saving the lives of thousands of infants yearly. A practical method, however, of securing this result was not hit upon in an instant. When it was first suggested in Germany that all milk be sterilized, physicians readily responded, for it was recognized that the diseases of children would thereby yield more readily to treatment. But it does not follow that milk thus sterilized should constitute the only food, for experience in a Philadelphia hospital has shown that where this was practised a large percentage of the children died; that the weakly children could not thrive upon it. Milk, as it leaves the cow, is already nearly "digested," and intense heat melts the fats and destroys emulsion; turns the milk sugar into a caramel;


it destroys the starch ferment (infant's saliva containing no ptyalin); the casein will not curdle, and the albumen is coagulable. Milk thus treated, then, is unfit for a steady diet. But the bacteriologist is equal to the emergency, and has succeeded in showing that Pasteurizing renders the milk perfectly effective, and at the same time absolutely harmless. This is based upon the discovery that it is not necessary to bring the milk to the boiling point to destroy the pathogenic organisms, a temperature of 70° C. (158° F.) being sufficient. Thus it is possible to thoroughly sterilize all the food of young children, and at the same time retain the essential properties of that food. The milk should, however, be used soon after sterilization, Not only are the bacteriologists thus able to guard the children against disease communicated by milk, but the general milk supply has been very carefully studied and precautions advocated, which, if followed, will insure a markedly decreased death list. There appears good reason for declaring that milk acts as a carrier for at least five diseases, viz.: tuberculosis, typhoid fever, scarlet fever, diphtheria and cholera infantum.

The Popular Science News, in its issue for December, states that the excessive use of tobacco can be clearly demonstrated by the examination of a properly spread slide of blood. In such cases red corpuscles will be found to be crenated; that is, the corpuscle, instead of possessing the absolute regularity of margin noticed in health, will present a series of scallops somewhat irregular in their distribution. A few such crenated corpuscles, in the proportion of one to three hundred and fifty, occur in normal health, but in tobacco blood the ratio is often as high as one to ten and sometimes attains a much larger proportion. Opium and other narcotics produce the same result. Nervous excitement and certain diseases will frequently produce crenation, and the blood in dense urine will often be found in this state. Where the patient is otherwise healthy a number of crenated corpuscles in his blood may safely be ascribed to the excessive use of tobacco, opium, or


some narcotic, and it is then necessary to stop their use.

The Medical News of Nov. 23 publishes details of resection of lung for tuberculosis, as reported by Dr. Tuffier. The patient was a man, 29 years old, in whom four years previously he had performed pneumonectomy. At that time the patient presented the signs of tuberculosis localized to the apex of the right lung. An incision was made in the second intercostal space and an extrapleural pneumothorax established by detaching the parietal layer of the pluera over a considerable extent. The apex of the lung at once presented, and the diseased area, as large as a nut, together with healthy lung-structure for a distance of 2 cm. in every direction, was excised. The wound was closed without drainage and the patient was up and about on the ninth day. Tubercle bacilli had been found in the sputum and were also found in the excised tissue. The patient had followed various pursuits in the four years following the operation, but had suffered from no pulmonary disturbance, and physical examination failed to disclose any evidence of return of the disease. It was not contended that similar operative intervention is generally applicable, but it was maintained that exceptionally it is indicated absolutely.



MALARIA ON THE Dr. William Osler, of ATLANTIC SEA- Baltimore, calls attention, in the Medical News of Nov. 23, to the importance of Lavaran's discovery of the germ of malaria. He holds that the profession at large has not yet laid to heart the following rules: 1. That the diagnosis of the malarial fevers can be made with certainty by the bloodexamination. 2. That an intermittent fever which resists quinine is not of malarial origin. The U. S. Census Report for 1890, recently issued, which covers the six years ending May 31, 1890, gives the following number of deaths from malaria, to which I add for comparison those of typhoid fever: Washington-Mal. fever, 500; Typhoid fever 850 Baltimore934; 66 904 66 2060; New York00 2031 Brooklyn1413; 1092 That in Baltimore, New York, and Brook





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lyn the deaths from malarial fever exceeded those from typhoid will, no doubt, be read with astonishment, particularly by those familiar with the conditions of practice in those cities. Any reasonable physician in Philadelphia or Baltimore will at once acknowledge that a death from malarial fever is a great rarity, while deaths from typhoid fever are only too common. Dr. Osler quotes the death returns of the New York hospitals to show that very seldom a death from malaria occurs, and in Brooklyn the mortality is steadily declining.

He says: The conclusion of the whole matter may be thus briefly expressed-the mortuary bills dealing with malaria are false, due either to ignoranee or to wilful deception on the part of those who make the returns. Malaria is a disease that now rarely kills in the large towns on the Atlantic seaboard, and it behooves the profession to abandon the practice of making a careless diagnosis of the disease in every case of obscure fever which proves fatal, and the Medical Boards should refuse to receive death certificate signed "malarial fever" without more specific details than have heretofore been demanded.

Dr. W. W. Keen, of Philadelphia, contributes to SURGERY. the Medical News, Nov. 23, an interesting article on "European Surgery." The following are excerpts:

The general impression made upon me by what I saw was that in matters of scientific research and of original investigations Europe is much in advance of us. The length of the course of study and the support by the government of pathologic and bacteriologic Institutes, combine to foster original investigations in scientific subjects much more than with us. Our young men must necessarily earn their living, and as these investigations require a great deal of time and bring little, if any, direct income, there are but few who can devote their time to science, pure and simple. Another thing which fosters this spirit of original investigation is the governmental control of the universities, at least on the Continent.

But when it comes to practical surgery, whether it be of mechanical means or operative procedures, or of careful antisepsis, I


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On the Continent the needless exposure of patients in many cases struck me rather unpleasantly. Both women and men were brought in almost, and, in many cases, entirely nude, when it seemed to me not a necessity. We are more careful of the ordinary proprieties of life, it seems to me, in this respect, with no diminution of surgical safety and a great gain to social decorum.

I can scarcely wonder at the frequent deaths from chloroform which one sees so constantly reported in the medical journals abroad. In six weeks I saw six patients within an ace of dying. The rule that my old teacher, Prof. S. D. Gross, always laid down, that chloroform was to be given with plenty of air, seemed to be almost ignored. The chloroform was poured in considerable quantities on a towel or napkin, which was pressed close down on the patient's face, so that he breathed almost absolutely pure vapor of chloroform. In each of the six instances I speak of the operator had to discontinue his operation, and the patients were restored with difficulty by artificial respiration and rhythmic traction of the tongue. Apparatus such as Clover's or Ormsby's, for the administration of any anesthetic, was rarely employed excepting in England.


The Medical News of AND DIPHTHERIA Nov. 23 says: While a ANTITOXIN. great deal has been said of late about the effect of injections of diphtheria-antitoxin, comparatively little study and attention have been bestowed upon the effect of the serum itself when injected into a human being. It is rather strange that so many physicians should have taken it for granted that the serum is inert. If this assumption proves to be without foundation, then we have another and important disturbing factor introduced into

the already complex problem of determining the real practical value of the diphtheria-antitoxin treatment.

At a recent meeting of the New York Academy of Medicine an attempt was made to clear up this part of the subject. Dr. Henry Dwight Chapin detailed a series of experiments that he had made on animals with a view of determining the effect, if any, of injections of serum obtained from healthy horses. These experiments prove in a general way that the injection of the horse serum produces a moderate reduction in the number of red blood-globules, and causes congestion of the spleen, congestion and cloudy swelling of the kidneys, and sometimes areas of fatty degeneration. Most of the experiments were performed upon rabbits. These results indicate that it is no longer wise to look upon the serum as an inert and harmless substance, and suggest that greater caution should be observed in adopting this treatment. Several observers have noted that the transfusion of the blood of the lower animals into the human subject is followed by a temporary rise of temperature and an acceleration and weakening of the heart's action, and that in addition to a marked destruction of the red blood-cells there have been pathologic changes observed in the kidneys and hemopoietic system. An erythema, similar to that so commonly seen after the administration of the diphtheria-antitoxin, has been known to follow the injection of the plain serum from a healthy horse. There can be no doubt, however, that the trend of scientific opinion among those best fitted to judge is that the treatment of diphtheria with the antitoxin has tremendously lesened the average rate of mortality. Despite all adverse facts, that appears to be beyond dispute



The New York Medical REGION OF THE Journal of Nov. 23 publishes the President's address delivered by Dr. John O. Roe, of Rochester, N. Y., before the American Laryngological Association, at its seventeenth annual congress.

The climate of the region of the Great Lakes, he said, is especially productive of diseases of the nose, throat, and lungs, and a comparative freedom from disease of the

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