permitted. This was the shortest attack so far. The child did not have another attack until November 4, 1902. The longest interval she had ever had since the beginning of her trouble. On November 3, temperature 1025, pulse 140, respiration 36. Pulsatilla 6x given. Vomited the following morning at 4 A.M. and a number times thereafter till 8 A.M. Temperature 99%, pulse 122, respiration 30. Vomited several times through the day. The father gave an enema of peptonized milk and opium 3 drops. At night the remedy was changed to ipecac 6x. There was but one attack of vomiting after that. Next day the child was well.

Goat's Milk.- Barbellion (Bull. de l'Acad. de Med., Paris, March, 1902) has for years been an ardent advocate of the introduction of goat's milk for infant and invalid diet. He describes tests which show that the coagulum is soft and very soluble, like that of human and asses milk, while the coagulum from cow's milk is much more compact and difficult to digest. Comparative tests with gasterin showed that while cow's milk was scarcely affected by it during twenty-four hours, human, goat and asses' milk was completely digested. He reports a number of cases showing the remarkable manner in which infants thrive on goat's milk. The Académie voted in favor of his conclusions as to the advisability of establishing numerous goat milk depots throughout the city. One of the principal advantages of the goat for this purpose is that it is refractory to tuberculosis. Journal of the American Medical Association.

Pet Animals and Children's Diseases: An Editorial in the Archives of Pediatrics for September sounds a note of warning in regard to the association of pet animals with children. The writer states that cats suffer from diphtheria and scarlet fever, and possibly from other infections, and that they may also carry infections in their fur. Dogs are not less dangerous. Diphtheria has been transmitted by dogs, also probably scarlatina, measles and whooping cough. In Europe it is believed whooping cough is frequently carried by dogs. It has been shown that dogs frequently suffer from tuberculosis, not always in the lungs. Often there are tubercular sinuses from bones of the face to the nose. In these tubercular bacilli swarm in the nasal discharge. The dog is also the host of the well-known hydatid cysts which are becoming much more frequent throughout the civilized world. Ozena is another disease that may come from dogs. The dog's filthy habit of sticking his nose in all sorts of animal matter makes him especially nasty. The writer says: "If we are insisting on special precautions with regard to food contamination by flies because of the habits of these domestic pests with regard to excrementitious material, it is almost more important that dogs should not be allowed to become distributors in the household of at least as dangerous material in considerably large quantities." Birds also may distribute disease. Parrots suffer from psittacosis-a disease that is intensely contagious for human beings. In an epidemic of over fifty cases in

Paris in 1897 more than half were fatal. Chickens are liable to tuberculosis.

The writer says more care should be exercised by parents and guardians in protecting children from contamination by pet animals. The abstractor thoroughly agrees with him. Animals should be rigidly excluded from houses. Their place is outside.

Lumbar Puncture in Meningitis.-Dr. Hand read a paper at the May meeting of the Philadelphia Pediatric Society on "Positive Diagnosis of Meningitis, Particularly Tuberculous, by Lumbar Puncture." Dr. Hand reported thirty specimens of cerebrospinal fluid examined, of which twenty-one contained tubercle bacilli, two of pneumococcic meningitis, one of cerebro-spinal fever that recovered, one of normal fluid, one of suspect brain tumor, one of serous meningitis, three of undetermined origin, but probably septic.

The technic of the examination is of the highest importance, that used by the writer being the following: The fluid should be collected in a sterile test-tube plugged with cotton, and allowed to stand until a strand of fibrin has formed; this usually forms in from two to six hours, and settles in the bottom. A straight platinum needle-not a loop is touched to one edge of the fibrin, which is then transferred to a slide, care being taken to tip the test-tube so that the fibrin constantly floats in fluid. The excess of fluid is then drained off from the slide, and the remainder evaporated by gentle heat; it being not only unnecessary, but usually fatal to the success of the examination, to press the fibrin between two slides. The film is fixed by heat, stained in the usual manner, and then carefully gone over with a mechanical stage. Since adopting this method, the writer believes he has been successful in 100 per cent. of the tuberculous

cases.

In the discussion that followed it seemed to be the impression. that the type of cell or other substances found in the cerebro-spinal fluid did not necessarily mean tubercular meningitis, unless the tubercle bacilli were also demonstrated. It was claimed by several that lumbar puncture had a beneficent effect on the case, probably by relieving pressure. Griffith stated that he had never seen permanent relief follow lumbar puncture, but it gave temporary relief and should always be resorted to for palliative effects in desperate cases.

Infant Mortality.-A paper read before the Section of Public Medicine of the British Medical Association, by Dr. J. Milsen Rhodes, of Lancaster, gave some startling figures. Of 927,062 children born in Great Britain in 1900, there were 142,912 dead before they reached the age of one year. This is approximately 15 per cent. He says notwithstanding the progress of sanitation, which has reduced the average death rate in fifty years from 22.0 to 18.2 per 1,000, there has been no improvement in infant mortality. In 1900 the mortality in Great Britain among infants under one year of age was 163 per 1,000, the highest on record in the Registrar-General's office.-British Medical Journal.

J. T. O'CONNOR, M.D., PH.D.,

CONDUCTED BY

AND

WALTER SANDS MILLS, M.D.

Anesthesia of the Drum Membrane.-Dr. G. B. McAuliffe of New York (New England Medical Monthly), pursues the following method. First he uses hydrozone to cleanse the ear. This is then mopped out with absorbent cotton. This is followed by filling the canal with a solution of 5 to 20 per cent. of cocaine in equal parts of absolute alcohol and aniline oil. Anesthesia results in 10 to 15 minutes.

Early Diagnosis of the Typhoid Bacilli.-Polacco and Gemelli found typhoid bacilli regularly in the roseola on fifty patients in the early stages of typhoid fever. The bacilli are so scanty that they require a liquid medium for further growth. "Vaccinostyle Marechal" was used for the culture medium and the differentiation of the culture was possible in twelve to sixteen hours. Journal American Medical Association.

Anemia Due to Small Hemorrhages. In certain instances the daily loss of even small amounts of blood may produce very severe anemias. J. B. Herrick (Jour. Am. Med. Assoc., September 27, 1902) has found that bleeding hemorrhoids nay, often cause this condition, and that recovery is almost certain after the proper remedial measures have been undertaken. He reports five cases which exmplified this condition, the anemia. being of the pernicious variety, and recommends that when a blood examination shows a chlorotic or secondary type immediate operative measures for checking the hemorrhage should be instituted.

Treatment of Spastic Aphonia. In the case described by Wicherek, the patient was a healthy young soldier who had been unable to utter a sound for eight months after a scuffle with a comrade who had slapped him in the face and choked him. The traumatism was slight and exclusion of other causes suggested the possibility of hysteria, although no stigmata could be discovered. Faradization of the throat muscles, systematic exercises in speaking and chloroform narcosis all proved ineffectual. The mucosa of the pharynx and larynx was then swabbed with a 20 per cent. solution of cocain, while the tongue was pulled out and held. The patient was then instructed to utter the vowel sound of A, repeating it after another person. After great effort he was able to accomplish this, and repeat it until he could say it fluently. Other vowel sounds were then taught him in the same way, while he put his fingers on the larynx of the person instructing him. Short words and sentences. were then tried. At the end of an hour of this exercise he was so exhausted that he had to go to bed. It was repeated again every day, and by the fourth, his aphonia had been entirely conquered. Journal American Medical Association.

NORTH AMERICAN

JOURNAL OF HOMEOPATHY.

Original Articles in medicine.

A NEW METHOD OF OUTLINING THE SEPARATE CAVITIES OF THE HEART.*

BY GEORGE F. LAIDLAW, M.D.,

New York.

'HE method which I shall recommend is not new in the sense of

known in this country and not widely accepted in any other.

Bianchi and Bozzi devised the phonendoscope in 1896, and the instrument made its way quickly over the world as a substitute for the ordinary stethoscope in auscultation; but Bianchi's method of outlining the internal organs by scratching the skin is still largely ignored. It is a refined variety of the old auscultatory percussion.

In 1900, at the Congress fur Innere Medicin, at Wiesbaden, Dr. A. Smith, of Marburg am Bodensee, reported his observations confirming the value of the Bianchi method as applied to the heart. He also pointed out several defects in the method, described an improved technique, and an improved phonendoscope by which the most exact measurements could be made during life, not only of the heart as a whole, but also of the auricles and ventricles separately, a thing never attempted by any other method of examination.

After a thorough trial of this method at the Metropolitan Hospital in New York, I can recommend it strongly to your attention as one of the most useful methods of examining the heart which has been devised since the adoption of auscultation itself. In proof of this statement, I ask you to look at these outlines of hearts which were drawn on the skin of the patients' chests and compare them with

* Read before the Homeopathic Medical Society of the State of New York.

the hearts themselves which were subsequently removed at autopsy. The outlines were made on the dead body immediately before the autopsy so that there should be no possibility of change in size or position before they could be verified. These outlines are the original direct impressions. By comparing the measurements of the hearts and even of the separate auricles and ventricles, you will see how accurately the work was done.

(Exhibition of the hearts and outlines.)

The method by which this work was done is simple and the instruments are inexpensive, a phonendoscope, a bristle brush and a pencil for marking the skin. These are the imported pencils, called dermatographs; but this ordinary indelible pencil gives better prints. This is the bristle brush devised by Smith, but as an interne of the Hospital suggested, a mucilage brush will do as well. It should be stiff.

The rod of the phonendoscope is placed over the right ventricle, which can be found in the fourth intercostal space at the left of the sternum. With a stiff brush or the finger tip, the skin of the chest is stroked firmly downward toward the lower border of the heart. A brushing noise is heard. When the border of the heart is passed, the sound changes abruptly. This point is marked with the pencil and, placing the rod of the instrument above the mark, the border is verified by careful stroking. This border determined, the rod is held at the same point, just above the lower border and the brush is stroked outward to determine the left border, then upward, and then to the right around to the starting place. By marking the places where the sound changes, an outline of the right ventricle is drawn on the chest wall.

Placing the rod in an intercostal space above the margin of the right ventricle, the left ventricle is mapped out in the same manner. Placing the rod at the right of the right ventricle, the right auricle and above this the left auricle are mapped out.

The left auricle is more difficult to outline than the other cavities both because it lies deeper in the chest, and because most of it lies behind the sternum, and the resonance of the bone is confused with that of the auricle. To overcome this difficulty, Wallach, of Cassel, Germany, devised this improved phonendoscope. The improvements consist in the valve, the opening of which makes the brushing noise more distinct, and in the hollowing of the rod.

This particular instrument is not a necessity. Some of these outines that I have exhibited were not all made with the phonendoscope but with a cheap imitation of it which I now show you. It