In delicate, weak and debilitated patients this is a serious matter and the treatment then becomes barbarous.

In these days of elegant pharmacy and improved methods of administering drugs, there is no need to hold on to the old, yet efficient, methods, but turn our attention to applying these same old remedies in a better and much more acceptable form.

To this end I have found a combination of two of the drugs mentioned, namely, male fern and pelletierine, most suitable, and applied in the following manner :

There is no necessity for the patient to make several days' preparation. The loss of one meal-breakfast is all that is required. In many cases the most convenient day to select for giving the medicine is Sunday, for the reason that most patients are at leisure at that time.

Instruct the patient to clear out the bowels the day previous with one or two large doses of castor oil or salts. One dose may be given in the morning and one at night, an hour or two after a light supper.

The next morning, as early as possible, say at 6 o'clock, give at one dose a pelletiérine tannate, 20 grains, in two capsules. When this has operated freely, in about two or three hours begin with the following:

Of course, it is understood that no food is taken during this time. In about two or three hours the worm will be expelled whole, with its head fastened to its neck.

Recently, in seven cases, I have found this method to give successful results without any recurrence. It is generally difficult to find the head, on account of its small size, and one cannot give assurance that there will not be a return of the parasite unless the head is found, or after the lapse of six or eight weeks, when no segments are found in the stools.

It is well to instruct the patient to pass all the bowel movements into a vessel of warm water on the morning the medicine is taken. In this way the worm can be secured when it is passed and saved for examination. No traction on the protruding worm should be permitted for fear of tearing the head off and losing it.

The patient can then rest, and if there is any depression light food may be allowed. This depression is slight and has never been known to last longer than two hours.-Medical News, November 14, 1903.

William F. Baker, A.M., M.D.

TERMINAL SYPHILIS.-(Dougherty.)-The article is written as opposing Fournier's view and term of "parasyphilis." The writer thinks the term terminal syphilis corresponds more accurately to our knowledge of the existing conditions. Locomotor ataxia is used as the condition representing his claims; this disease, he says, is not diagnosed in 50 per cent. of cases in the earlier stages. The chief reasons advanced by those opposing the syphilitic nature of tabes are: 1. That the statistics always contain a number of

cases that are not apparently specific cases. 2. The pathology of tabes does not resemble syphilitic lesions. 3. Uselessness of antisyphilitic remedies in the treatment of disease. 4. The rarity of tabes as compared with syphilitics. 5. The comparative infrequency in races which are particularly prone to syphilitic infection, namely, Chinese and negroes. 6. The infrequency of tabes among prostitutes. Notwithstanding these many valid reasons the writer maintains that they are insufficient to substantiate the fact.

It has long been a well-understood fact that the patient's statement cannot be taken as proof positive in these cases; again, ignorance of the existing condition may be a cause for denial, as a child having contracted syphilis in early life. The lessened frequency in the Chinese and negroes can be ascribed to the methods of life. Mane and Guilliau have advanced a theory concerning tabes, and that is that the posterior columns and spinal pia have a separate system of lymphatics, and they regard the tabetic process not as a lesion of the posterior root axones nor of the neuroglia, but simply as a syphilitic disease of the posterior lymphatic system: a syphilitic lymphangitis. -Medical Record, November 14, 1903.

William F. Baker, A. M., M.D.

OCULAR HEADACHE AND OTHER OCULAR REFLEXES: A STATISTICAL STUDY.-(Zimmerman.)-Two series of 1000 cases each were selected for observation, and of these 2000 cases coming under the writer's care during his ophthalmic practice, 1427 presented headache in some one of its forms as a symptom. Frontal pain seems to predominate, next fronto-occipital pain, and next occipital.

An attempt was made to determine, if possible, a definite relationship between certain forms of headache and certain refractive errors, but results failed to give any satisfaction. This fact was established, however, that a compound hyperopic astigmatism of small degree was responsible for most cases. The onset of the pain bears a close relationship to work, usually coming late in the day. Continuous work within the reading range is by far the most common exciting cause, intense watching of distant objects perhaps comes second. Travelling offers a third cause, giving rise to so-called "travellers' headache."-New York and Philadelphia Medical Journal, November 21, 1903.

William F. Baker, A. M., M.D.

TREATMENT OF ANGINA PECTORIS.-(Waugh.)—In a short and interesting article the author sets forth the following views: This distressing and alarming malady appears to be increasing in frequency; at least reports of its occurrence come to me in increasing number. It is usually associated with some organic affection of the heart or of the thoracic vessels, no one of which has been found constantly associated with angina pectoris, yet there is not one with which these seizures have not been recorded. Toussaint, however, asserts that this is often a pure neurosis, and that no organic lesion is found on autopsy.

Be this as it may, angina pectoris is one of the most frightful of seizures. The attack comes suddenly; the patient is seized with agonizing, cramp-like pains in the region of the heart, his face is white, shrunken, the features expressive of the agony he suffers. The body is bathed in cold sweat, the voice lost or sunk to a husky whisper. The universal description he gives of the sensation is that of an iron hand crushing his heart in its relentless grasp.

The pain may follow the course of the intercosto-humeral nerve to the left shoulder and down the inner aspect of the left arm. The pulse is feeble, thready, or scarcely discernible. The condition is one of imminent danger, and many cases end in death during the paroxysm.

The treatment of the paroxysm is simple. Glonoine most quickly unlocks the spasm and returns the blood to the skin. Give ʊ grain, and repeat every minute until relief ensues and the face flushed. This effect is deepened and prolonged by giving atropine o grain every ten minutes till the mouth begins to dry. The patient may then rest assured that there will be no further attack as long as this effect endures. It may be indefinitely prolonged by repeating the atropine whenever the dryness of the mouth subsides. While any salt of atropine will answer, it has seemed to the writer that a speedier action results from the valerianate.

Structural lesions of the heart are to some extent amenable to treatment. Rheumatic, syphilitic and other deposits waste away under the influence of such remedies as the following: Mercury biniodide, gr. 26; iodoform, gr. §; arsenic iodide, gr. 7; and phytolaccin or stillingin, gr. ; to be taken before each meal and on going to bed, and continued for months. The arsenic exerts an action upon the nutrition of the heart that would not be believed by those who give it in maximal doses for a week or two only. Uric acid manifestations likewise subside under the influence of colchicine.-Therapeutic Gazette, November 15, 1903.

William F. Baker, A. M., M.D.

THE RATIONAL TREATMENT OF POST-PARTUM INFECTIONS OF THE UTERUS. (Gillian.)—The normal death-rate of puerperal infection was about 1 per cent., but after curettage it amounted to 20 per cent. The sharp curette was especially dangerous, as it not only failed to remove the germs, but destroyed the protective barriers. As it was impossible to say that streptococcus infection was not present in any case, the only safe way was to eschew the sharp curette entirely in puerperal infection. Curettage was permissible only when there was known to be puerperal debris in the uterine cavity, and when there was reason to believe no streptococci were present. The finger or dull curette with stiff handle should be used for this. Flushing, if done at all, should be done with every precaution against infection. The patient should be on a table in a good light, the vulva and vagina cleansed, the latter with 5-per-cent. creolin in liquid-green soap, mopped, dried, the retractor introduced, the cervix grasped, drawn down and steadied with forceps, the cervical canal wiped out with gauze and bits of membrane picked off with forceps. Introduce the irrigator gently and flush. If the pulse and temperature dropped, repeat daily or oftener, otherwise discontinue.—Medical Record, October 31, 1903.

THE MUD BATHS OF FRANZENSBAD FOR THE TREATMENT OF DISEASES OF WOMEN. (Nenadowitsch.)-The physiological effect of the mud bath shows that in a bath of 40° C. there is a diminution of pulse, temperature and blood-pressure, with reaction after the bath, all of which is due to the effect of the baths upon the nervous-system, especially the vasomotor. The diminution of blood-pressure in the bath during the first few minutes is in direct proportion to the temperature of the mud and the degree of the pressure. In the next few minutes nature strives to preserve the status quo, but

a high temperature interferes with the increase of blood-pressure. The increase of the blood-pressure after the cleansing bath corresponds to the difference in the temperature of the mud and of the cleansing bath. He arrives at the following conclusions:

1. The highest temperature for mud baths at Franzensbad must be 40° C. 2. Exudates in the small pelvis require a higher temperature than hæmorrhage from the genitalia.

3. The temperature of the cleansing bath must be lower than that of the mud bath, if we wish to increase the effect of the latter.

4. The mud bath, independent of temperature, must be thick in all cases. 5. The patient should not remain sitting in the bath longer than ten minutes.

6. The cleansing bath should not be longer than five minutes.

7. In cases where the full mud bath is contraindicated on account of diseases of the heart and lungs or brain, the half-bath or Sitz bath can be used. -Centralblatt fur Gynakologie, No. 29.

THE METHOD OF OPERATION FOR CANCER OF THE UTERUS.-(Olshausen.)—The principle of operating in all cases by the abdomen shoots wide of the mark and will alter itself in time. Olshausen has had 18 per cent. of permanent results in the vaginal operation. In recent years he has operated on 50 per cent. of all cases. The last two years he has had 341 cases of cancer and operated upon 210. In 206 of these the vaginal operation was performed, with 17-per-cent. mortality. There are 4 abdominal operations with 1 death. It is impossible to remove all of the pelvic connective tissue, and therefore some glands will remain. The abdominal operation is to be preferred in those cases where it is necessary to protect the ureter, if the examination shows that the ureter may be involved in the growth of the cancer.

Winter has had in his clinics 240 cases of cancer of the uterus and performed the radical operation upon 57 per cent. of them. The cellular tissue was free in 40 per cent. He estimates that there are upwards of 25,000 cases of cancer of the uterus in Germany.

Glockner reported 59 cases of extirpation of the uterus by Wertheim's method, with a mortality of 10 per cent. At the present time there were only 10 recurrences, which was scarcely half the number observed in the same space of time which had been operated upon by the vaginal method, a fact which he believed warranted further use of the abdominal method.

Wertheim states that the absolute or final results in the Vienna statistics are three times larger for the abdominal than for the vaginal operation.Centralblatt fur Gynakologie, No. 29.

THE TREATMENT OF DEPRESSIONS OF THE SKULL IN THE NEW BORN.(Baumm.)-The writer reports four cases. All of them were difficult deliveries and contracted pelves. In three cases the impression was made by the promontory of the sacrum on the parietal bone, and in one case there was a multiple fracture of the frontal bone. A corkscrew was quickly disinfected, and through a small opening bored into the bone and the depression raised in a few minutes. Respiration and heart-beats immediately improved, but the child died later. The post-mortem showed that the brain was not injured, but there was a very considerable intracranial hæmorrhage. It was not dependent upon the hole in the bone made by the corkscrew, which appeared

to be quite a simple puncture. The writer on this account had made an instrument for the purpose of raising these depressions, which resembled a very small corkscrew, with the spirals close together. In both of the next cases this instrument was bored directly into the depressed bone without a previous incision. The bone was easily elevated. One of these children died from intracranial hæmorrhage and the post-mortem showed that the corkscrew was in no way to blame. It need hardly be said that the instrument was only screwed in barely deep enough to hold the bone. The other child made a good recovery, and a similar result was obtained in the fourth child, in which the forehead was badly broken, which was all the more remarkable, as it was a case of premature labor at the thirty-sixth week.

It is possible that the two children which were relieved might have lived without operation, but it would remain to be seen whether such a deformity of the skull might not result in some affection of the brain.-Centralblatt fur Gynakologie, No. 19.

A CASE OF VAGINAL CÆSARIAN SECTION FOR ECLAMPSIA.-Westphal had a case of typical eclampsia in a 23-year old woman pregnant for the third time. She had had three severe convulsions, when several large doses of morphia were administered, and after several hours delay, during which she had another convulsion, she was removed to the hospital. Here, after suitable preparation, Westphal rapidly dissected off the bladder from the anterior wall of the uterus up to the vesico-uterine fold of the peritoneum, where the anterior wall of the uterus was incised, and the foetus removed, the procedure requiring in all but five minutes. On account of atony of the uterus, a severe hæmorrhage set in, which was controlled with tamponade of the uterus, after which the incision was sutured. No more convulsions followed the delivery, and Westphal believed that to the rapidity of the delivery is ascribable the favorable result.-Centbl. f. Gyn., 1903, 46.

Theodore J. Gramm, M.D.

HYSTERECTOMY FOR PUERPERAL INFECTION.-Doleris remarks that the indications are as yet undetermined, although over 100 cases have been published. The mortality is still over 90 per cent. In two cases examined postmortem, the author believes there may have been a possibility of saving the patient by operation. He does not favor operation, but thinks that now and then a case may be encountered in which operative intervention might avail.Centbl. f. Gyn., 1903, 47.

Theodore J. Gramm, M.D.

GONORRHOEA AND THE PUERPERAL PERIOD.-Audebert reaches the conclusion that gonorrhoea may cause illness during the puerperium. Although the disease, as a rule, remains localized in the genitalia, it must not be overlooked that the gonococcus shows a predilection for the endometrium. During pregnancy gonorrhoea not rarely induces pyelonephritis, a fact which has not, as yet, received sufficient attention. -Centbl. f. Gyn., 1903, 47.

Theodore J. Gramm, M.D.

RUPTURE OF THE UTERUS.-Ivanoff (Moscow) has shown from 124 cases that the most frequent cause is contracted pelvis. In the flat pelvis the tear is always transversely in the supravaginal portion of the cervix. The patients were all multiparæ. The mechanism of labor in certain cases of pronounced flat pelvis brings about the occipito-posterior position, whereby pronounced