1. Defi

There are many different factors concerned in the production of constipation, which act in varying degree in different cases. cient fluid in the intestinal canal, caused by deficient supply in food, excessive waste, or deficient secretion from the intestinal mucous membrane. 2. Deficient peristalsis, especially of the large intestine, from defects of diet, or from atony due to over-stimulation by purgatives or to degeneration of the muscular coat. 3. Inhibitory imfluences of the nerve centres of the brain and cord, probably affecting both peristalsis and secretion of fluid. 4. Deficient bodily exercise and movement. 5. Dilatation of the intestine, especially the colon, due to debility of the intestinal wall or to actual dilatation by accumulated feces, gaseous distention, repeated enemeta, or laxness of the abdominal wall.

3. Deficient

Such are the chief causes which give rise to constipation. They are not all met with in the case of children, however—at least not in equal degree. Thus, weakening of the muscular fibre of the intestine by the deterioration of age, mental depression, deficient bodily exercise, or astringent food rarely can be credited with the production of deficient peristalsis in early life. Putting aside malformation, such as atresia more or less complete, peritonitis, intussusception, and the like, the causes which are chiefly operative in childhood are: 1. Food which leaves little residue very completely digestible food-eg., milk: fecal matter too small to duly exite peristalsis. This is a common cause in very young children, and in like manner a too great uniformity of food fails to exite peristalsis. 2. Deficiency of liquid in food, not enough to drink, is another not infrequent cause in children: causing too dry feces. biliary secretion, "acholia": unstimulating feces. 4. Deficient secretion of glands of mucous tract: dry feces. 5. Over-stimulation and consequent atony of intestines: loss of excitability and loss of power, caused -(a) by coarse foods, (b) by frequent purgatives, (c) by too frequent use of enemata. To these may be added the dread of evacuation from pain caused by hard stools. The latter is frequently operative in children. Instead of aiding the avacuation of the bowels, the child resists it with all its might. This resistance to the passage of feces, partly voluntary and partly reflex, is caused by the pain of extrusion through the sphincter of a hard rough mass, or the existence of a fissure or sore of the When once constipation has occurred this is an important cause of its continuance, to be overcome only by inducing absolute liquidity of stools for a time.

anus.

Now the symptoms produced by retention of fecal waste in the in-.

testine vary remarkably. In some cases, especially in very young milkfed children (and the fresher and better the cow's milk the more constipating is it, i. e., non-fermenting, not acid), there may be absolutely no derangement of general health. The child eats well, sleeps, is hearty and • robust the picture of health. There appears to be no fecal poisoning by reabsorption of foul matter from the intestine. The chief difficulty is the pain caused by the passage of the hardened dry feces.

This causes

the child to resist all attempts to go to stool. It screams and cries, and dreads the action, and thus, refusing to assist by its own efforts, the bowels remain closed for days, perhaps, until a good dose of castor oil or other domestic medicine compels evacuation. In addition to this there may be restlessness and night terrors; but the tongue is usually clean, and digestion and nutrition good.

Strong purgations enervate and wear out the tone of the bowel. Continued enemata impair tone and do harm by dilatation. Intermittent treatment aggravates the evil. First, be sure that there is no malformation, intussusception, no painful sore about the anus. Use saline laxatives, as they increase the flow of intestinal fluids. Further aids are strychnia or nux vomica, iron and belladonna.

In the case of children under two, simple carbonate of magnesia (gr. v. to xx.) in milk is sufficient. In older children the sulphates of magnesia and soda, with the above-mentioned tonics and daily massage (abdominal?), are useful. In older children still a pill of aloes or euonymin, with sulphate of iron and nux vomica, may be given as an alternative to the course of salts and strychnia. In mild cases, perhaps, or if the liver is not acting, a dose of calomel, grey powder, and soda and senna may be given. Regimen is an important element in the treatment if the child should have chronic constipation: abundant water, pure, not hard; "salutaris" water is excellent. In little children add a good infants' food to milk; fruits; fruit jellies; treacle; cooked green vegetables of the softer and more delicate kinds. Some variety of food is useful; a good mixture is better than a monotonous diet. It is, I think, extremely doubtful if coarse food is useful in the long run. It causes atony and weariness of muscle eventually by over stimulation. And you must insist on regular evacuations. Take care that the stools are not dry and hard, or the child will resist action and increase constipation. Other useful adjuncts are: abundance of fresh air, which aids in improving nutrition; and exercise, which mechanically aids the passage of the contents of the intestine down the tube, and improves general health and muscular tone.-W. B. Cheadle, in Lancet—Analectic.

CASES OF SKIN ERUPTIONS AND SYPHILIS TREATED WITH HORSFORD'S ACID PHOSPHATE.—(Mr. James Startin, Late Honorary Surgeon and Lecturer, St. John's Hospital for Skin Diseases, London; Honorary Consulting Surgeon to the Sheffield Public Hospital for Skin Diseases).— It appears to me that the "Acid Phosphate" originally prescribed by Prof. Horsford, of Cambridge, U. S. A., is not so well known in this country as its merits deserve. A glance at its formula will however readily convince one of its value in suitable cases. Each fluid drachm gives on analysis 21⁄2 grains of free phosphoric acid, and nearly four grains of phosphate of lime, magnesia, iron and potash. The following are a few brief notes of the cases in which I have prescribed it with complete success:

Mr. G., aged 69, consulted me November, 1885, for eczema on the arms, legs, palms of the hands, and trunk. The patient complained of much debility and nervous exhaustion, and he was a man who had led a very busy business life, with much worry. In December, 1885, I prescribed Horsford's acid tonic with much good effect, as in February, 1886, I heard that he was quite well.

In Jan

Mrs. S., aged 46, consulted me in Dccember, 1885, for psoriasis all over the body, more or less, especially on the legs and arms. uary, 1886, I prescribed a teaspoonful of the acid tonic three times a day with marked good effect. Patient had been much exhausted by continuous nursing on an invalid mother.

Mr. C.. aged 64, consulted me in September, 1885, with one of the worst attacks of late syphilis I ever saw. After he had been relieved from the distressing symptoms, and ulcerations, I prescribed the acid tonic for epileptiform fits from which he suffered, with excellent results.

Mr. McJ., aged 63, consulted me in November, 1885, for lichen ruber, which was accompanied with intolerable itching. He was a nervous, irritable man. I prescribed the acid tonic with the effect that in December he presented himself quite convalescent.-Med. Press, London, England.

SORE NIPPLES.-Among the numerous remedies recommended for sore nipples, Prof. Parvin pronounces the compound tincture of benzoin the best, as a local application. As the saliva of the infant is liable to be productive of fissures, etc., by its irritation, the nipple should always be carefully cleansed and dried after the nursing of the child.

REMARKS ON THE USES OF PAPINE.-(William J. Crittenden, M.D., Unionville, Va.)-In the practice of medicine we are often called upon to treat patients who possess a peculiar idiosyncrasy as to the effects of opium or any of its preparations.

During January, 1886, I was called to see a lady suffering with acute peritonitis. She assured me that she could not use opium, as she had tired of it previously. But I gave her one-eighth grain of morphia sulphate and one one-hundred-and twentieth grain of atropia sulphate hypodermically, and in a few moments the depressing effect was noted, both upon the respiration and circulation; the pupils also became visibly contracted. I then tried the various usual substitutes for morphia in suc cession, but to no effect. I determined to try papine; but not being able to give it by the mouth on account of nausea, and as she objected to the use of the hypodermic needle, I gave her two drachms per rectum, and repeated it in one hour. The result was that she sank into a quiet, peaceful sleep, which lasted for several hours. During the remainder of her sickness I gave her papine with the most gratifying results. As soon as her stomach would retain it, I gave it to her by the mouth in onedrachm doses.

I have also used papine in a case of uterine cancer, in lieu of morphia. In cases in which patients have been taking morphia until it has lost its anodyne influence, papine is well adapted.

Some time ago (in absence of the family physician) I was called to see a lady one night, in great haste, who was suffering with malignant disease of the uterus. On my arrival the nurse informed me that she had given her a grain of morphia, with suitable percentage of atropia, every hour for five or six hours, and during the intervals she had given her chloroform, but to no effect whatever. Accordingly, I gave her xxx min of papine with eighth grain morphia sulphate, repeating it in fifteen minutes, and in a short time she fell asleep and slept for six hours, which was more than she had slept at a time for months.

In pneumonitis, pleuritis and bronchitis, I have found papine to an swer an excellent purpose. In dysentery it is useful both as an anodyne and in relieving the tenesmus. In the diarrhea of children I frequently

combine with it bismuth sub-nitrate and prepared chalk. I have used it also in cystitis. In neuralgia, when I wish an anodyne, I use papine. As an anodyne it is equal if not superior to morphia; and I have never yet seen any unpleasant effects from its use. As a hypnotic I find it to be an agent of great value.

It is inferior to bromidia when we simply wish the effect of a hypnotic. But it fulfills the indications when we wish a decided anodyne as well as a hypnotic influence.

I trust that the readers of the Monthly may give this drug a trial, as I feel that they will be amply repaid for their trouble.- Va. Med. Monthly.

AN ANALYSIS OF TWO HUNDRED AND FIFTY AUTOPSIES ON DrunkARDS.-(Illustrating the most prominent anatomical lesions of chronic alcoholism.)-Dr. Formad, in a paper on the above subject, considered the most conspicuous lesions to be cyanotic induration of the kidneys, fatty infiltration of the liver, and mammillated stomach. His cases had been those in which there had been a history of a long-continued series of debauches, the subject often dying in one of these debauches, and did not include moderate drinkers or those who perished after imbibition of an enormous quantity of alcohol without any previous chronic excesses. He thought that the exposure, irregularities of diet, etc., incident to a state of drunkenness, had much-probably more than the alcohol itself— to do with the productions of the lesions; but it was not at all possible to separate one from the other. He gave a long list of lesions considered by various authors to be results of chronic acoholism, among which the cirrhotic liver with contraction held a prominent place. He had himself at one time considered cirrhosis a very frequent, if not almost necessary, concomitant of long-continued, excessive use of alcohol, and had even testified in court that a certain person was not likely to have been a hard drinker, because at the autopsy no cirrhosis of the liver was found. He had thought, too, that the connection between the two was so close that it was impossible to have a case of cirrhosis without a previous history of alcoholism, as is held by various authors. Therefore, it was surprising to meet in his two hundred and fifty autopsies with only six cases of cirrhosis of the liver with contraction. In two hundred and twenty cases, the liver was considerably or even very much enlarged, the enlargement in most cases proving to be due to a fatty infiltration. Cyanotic induration of the kidney and chronic gastritis, with mammillation of the stomach, were found in nearly every case. This cyanotic induration is peculiar, and differs from the cyanotic induration due to heart disease. — Phil. Med. Times.