and it is characterized by the persistence of the diarrhoea after defervescence; this diarrhoea is rebellious and sometimes requires an energetic treatment and a strict diet. Vomiting is frequent enough in children to be regarded as a part of the regular train of symptoms of the disease. Lack of appetite in young children is so pronounced as to become almost a veritable danger. M. Moussous has cited two cases in which the children refused everything, except a few mouthfuls of pure water, for twelve days.

With regard to the appearance of the tongue, the author states that in many cases observed by him in very young children, in which the temperature rose to 102.6° and 104.5° F., the tongue remained moist.

The temperature is very nearly like that observed in adults, although it often assumes a less regular progress in children. This irregularity has led to much discussion in regard to its prognostic value. The only fact that seems to the author worthy of mention, concerning the temperature in young children, is the very frequent occurrence of hyperthermia and the facility with which it is borne by the patient.

Dicrotism of the pulse has never been observed in very young children. During the height of the disease the pulse is generally regular, ranging from 100 to 140 pulsations a minute. During the defervescence and convalescence, however, it may present a peculiar characteristic which has been fully dwelt upon by de Gassicourt and Revilliot, who occasionally saw the pulse become slower and present irregularities which caused it to resemble the pulse in certain stages of meningitis. This peculiarity, which lasted from eight to fifteen days, did not seem to have any unfavorable significance. The irregularity of the pulse in the febrile period is more serious, for it indicates then a cardiac exhaustion which often presages death. The heart, however, is rarely seriously involved in typhoid fever in young children; myocarditis is exceptional and always slight, and sudden death has been observed only two or three times.

Thoracic symptoms are in the normal forms less marked than in adults, although broncho-pneumonia is a very grave complication in abdominal typhus in children under five years of age.

Lenticular rose-colored spots are the only pathognomonic symptom of typhoid fever in young children; they present no peculiar characteristic either in their frequency, their time of appearance, or their prognostic importance. Epistaxis is considered by the author as being altogether exceptional in young children. Sudamina are frequently observed, and they generally appear shortly after the red spots. Livid streaks near the articulations, particularly the knees, are peculiar to infancy, and they are due to an increase in growth which is sometimes surprisingly rapid. The frequency of desquamation is also a peculiarity of infancy.

With regard to the possible complications of typhoid fever in young* children, the author mentions those of the nervous system, which, he says, are seldom observed in children under five years of age.

Other complications, such are as arthritis, otitis, thrush, torticollis, stomatitis, and phlegmasia alba dolens, are also frequent in verv young children. Abnormal eruptions are more frequent in children than in adults.

The duration of the fever is shorter in infancy. According to some authors, relapses occur more frequently, but they are usually less serious than the first attack.

Convalescence is, therefore, rather rapid, and the child recovers with a rapidity that is sometimes astonishing. The aphasia of convalescence, which is very frequent in children, is nearly always curable.

The prognosis of typhoid fever in young children is dependent upon their age. It is very grave in children under three years of age, not so serious at four years, and nearly always favorable at five years and over.-N. Y. Medical Journal.

THE VALUE OF HOT SALINE IRRIGATION OF THE INTESTINE IN CASE OF URAEMIA.-In the American Medico-Surgical Bulletin of September 26, 1896, Grandin states that he has seen cases where, after delivery of the foetus or after an abdominal operation, the kidneys reufused to functionate, and where, with absolute certainty, uræmic symptoms would supervene unless the excretory organs could be persuaded to do their duty anew. Acute suppression of urine to a greater or less degree, headache, spots before the eyes, clouding of the intellect, twitching-symptoms always of such bad omen-such is the clinical picture he has in mind, and for which he recommends, above the administration of drugs, continuous irrigation of the bowel with hot normal saline solution. While the catharsis which is indicated is awaited, while the problematical effect ot one or another drug is hoped for, the intestine may be irrigated, with the result of most profuse diaphoresis and, in the relief of the congestion of the kidneys, the betterment of all the alarming symptoms. In the cases under consideration, what we aim to secure is free catharsis and diaphoresis, with consequent abstraction from the circulation of the toxic elements which are at the bottom of the alarming symptomatology. The physician is dealing with a complication which must either be relieved speedily or, as a rule, eclampsia, coma, and death ensue.

To irrigate the bowel properly he proceeds as follows: The woman is placed in the left lateral position, with buttocks elevated and head lowered. A large rectal tube is inserted into the bowel as far as may be, usually up to the sigmoid flexure. The rectal tube is connected with a gravity syringe, which is hung at least six feet above the patient's head. In

case such a syringe be not at hand, the physician will find a funnel in every household, and this may be connected with the rectal tube by means of rubber tubing. Hot salt water is used for irrigation. The strength of the solution should be about one per cent., and the temperature of the water in the receiver about 188° F. An attendant should hold the rectal tube at the anal margin to prevent its being expelled as, under the provoked peristalsis, the water is driven out of the bowel. From eight to ten gallons of water should be allowed to flow in. This accomplished, the woman should be wrapped in blankets and made comfortable in her bed. Meantime croton oil may be placed on the tongue, and glonoin may be administered in full doses hypodermically in the event of the character of the pulse demanding it. It may be stated here that, as a rule, in the condition under consideration, glonoin is called for, but the dosage must be large--that is to say, fully one-twenty-fifth of a grain, repeated half-hourly until the physiological effect has been secured. This drug offers us the the readiest of all means for relaxing the spasm of the renal capillaries.

Very soon after the irrigation, profuse diaphoresis sets in, followed by abatement in the alarming symptoms, and shortly thereafter the kidneys may begin to excrete again.

The explanation of the effect of hot saline rectal irrigation is not far to seek. The nerve centers are stimulated; the kidneys are direclty stimulated; the skin is called into action; peristalis of the intestinal tract is evoked. In short, every indication is promptly met.-Therapeutic Gazette.

INGUINAL HERNIA CONTAINING A PREGNANT FALLOPIAN TUBE.— Jordan (Münchener Medicinische Wochenschrift, No. 1, 1897), reports the following case from Czerny's clinic in Heidelberg: The woman had undergone several operations for pyosalpinx and vesico-vaginal fistula. The pyosalpinx had ruptured into the right broad ligament, the pus finding its way under Poupart's ligament where it had been evacuated, leaving a scar. The patient had been seized with severe abdominal pain and repeated vomiting, and suspecting pregnancy had visited the clinic for examination. Upon admission she appeared very anæmic with a pinched face and rapid pulse. Above the scar in her right side was a swelling as large as a fist and tympanitic on percussion. Below the scar was another tumor smaller in size, soft, and non-reducible. A third swelling was found to the outer angle of the scar corresponding in position to the internal inguinal ring. This was the size of an apple, soft, irreducible, and painful on palpation. High rectal enemas were administered and resulted in neither stool nor flatus. Purgatives were not retained. Operation was decided upon two days after admission on account of increasing severity of the symptoms of intestinal obstruction. An incision was made parallel

to Poupart's ligament showing a hernial sac containing a large mass of blood-clots, a foetus about three months old, the uterine adnexa, and coils of intestine. The wound was cleaned as much as possible and tamponned with gauze. The vomiting continued and death occurred the following day. It was found by autopsy that the intestinal obstruction was caused by numerous adhesions which were beyond surgical relief.-Univ. Med. Mag.

AN UNUSUAL CASE OF LOCKJAW.-Sachse reported in the Centralbl. f. Chir., No. 40, 1896, an unusual case of lockjaw, occurring without known cause in a male, aged 24 years. On waking one morning he found he could not open his mouth as far as usual. The disability increased daily, until he was unable to separate his teeth. For four years he was treated without benefit, until it was discovered that the right upper wisdom tooth pointed directly outward, and so pressed against the internal pterygoid muscle as to prevent the jaw from opening. It was removed with difficulty. Immediately after its extraction the jaw could be partially opened, and in eight weeks function was fully restored.

FIBRINURIA.—Arthur Klein (Wien. Klin. Woch.) gives the history of a case in which fibrinous clots were passed, and analyzes the previously recorded instances (4 in number) in which this has occurred. The patient was a man aged 52 years, who had been ill for fifteen months with cough, headache and dyspnoea on exertion, to which had recently been added swelling of the extremities and rigors. Examination led to the diagnosis of Bright's disease; the urine was acid, of specific gravity 1,013, and contained a large quantity of albumin, with numerous hyaline and epithelial casts. Treatment consisted in hot baths and milk diet, and the patient improved considerably, the cedema almost completely disappearing. Ten days after admission it was noticed that the urine, which was slightly alkaline, contained a large number of grayish white clots, some rounded and others flattened, and varying in length from half an inch to four inches; some were as much as two inches thick. These, if allowed to stand, settled to the bottom, and the supernatant urine sometimes showed a further curious phenomenon in the shape of fine threads, which formed a network extending throughout the fluid. On shaking, this became detached from the sides of the vessel, and formed a well-marked clot; the urine had thus clotted just like a serous fluid. The amount of deposit remained constant except just before a rigor, when it diminished, fo return to its former amount with the subsidence of the temperature. If the clot was allowed to remain in the urine for a few hours it disappeared entirely, probably by a sort of process of self-digestion. Chem

ical examination proved the clot to be composed of fibrin. The urine from which it was deposited showed, as compared with that at other times, alkalinity, much diminution in solid contents, an especially minute amount of phosphatet, but an enormous quantity of albumin.

There could be no doubt as to the renal origin of the fibrin, but it was very hard to define its pathological cause; evidence of nephrolithiasis, kidney abscess, etc., which had been present in former cases were here wanting, nor did hematuria ever appear. Klein attributes the coagulation to the alkaline reaction, the large quantity of albumin, and the almost complete absence of phosphates; it bore also, no doubt, some relation to the sudden rigors and rises of temperature.

Some time after the completion of the experiments the patient became worse and died; the kidneys were found to be in a condition of amyloid degeneration, and their tubules contained hyaline masses and threads giving Weigert's reaction for fibrin. Klein adds the notes of analyses of two other kinds of clots. The one was found in the urine in a case of cystitis; it consisted of a capsule of mucin. The other was a cast from a patient suffering from plastic bronchitis, and this failed to give the fibrin reaction either in bulk or in section; it consisted of mucin, and contained large colonies of diplococci.-Br. Medical Journal.

Professor Kocher, of Berne, has the most remarkable record of the world's history in the extirpation of goitre. In a late summary of his work he said that during the past ten years, in which he has performed the operation on nine hundred patients, he has met but one case in which cachexia strumipriva developed. This was entirely owing to the fact that he always leaves a small part of the thyroid gland, which is sufficient to carry on the functions of that organ. In the single case in which the cachexia developed, the extirpation was unilateral, but after the operation it was found that the other side was atrophied; the patient recovered through thyroid feeding. In speaking of the mortality in his operations, Kocher says that he deducts thirty cases of malignant goitres in which unusual and peculiar difficulties militated against success. Of the remaining 870, eleven died, but in six only was death the direct result of the operation, and these three were operated on for Graves' disease. The extirpation of the goitre in the latter disease he regards as dangerous. For the latter he prefers to ligate the thyroid arteries, but never more than three of them.

In a report entitled "The Use of Antitoxic Serum in the Treatment of Diphtheria, Under the Supervision of the New York City Health Depart