cord more nearly with that of the findings of Vickery, who states that all varieties of valvular lesions may show high pressures, but the majority of those with very high tensions are cases of those in which compensation was broken. The lowest reading is that of 133 mm. Hg., where compensation was good and hypertrophy had not taken place. The highest pressure was found in a case with incompensation, in which the readings varied from 186 to 222 (moderate sclerosis existing).

In exophthalmic goitre there was found, as would be supposed, an increase of arterial tension, which showed very little sign of diminution accompanying improvement in the condition of the patients.

In a series of eleven cases of pernicious anemia only three showed a normal tension; all the rest were subnormal, one very markedly so, showing only a pressure of 87, with mild arterio sclerosis.

A point of particular interest suggestive of the great diagnostic value of blood pressure readings is in typhoid fever, which, according to the authors' findings, showed a lower pulse tension, the readings averaging lower as the disease progressed. Mention is made of the very significant findings of Crile and Briggs, who have reported a sudden rise in arterial tension following perforation, or in the stage of peritoneal irritation, and, if further work confirms these observations, the changes of blood pressure will be a very great aid in making a dignosis of this complication, seeming to offer one of the most important and promising fields for blood pressure work.

DIGESTIVE TRACT-STOMACH AND INTESTINES.

B. F. Z.

Treatment of Amebic Dysentery. (American Medical Journal.) Musgrove disapproves of routine treatment, and emphasizes studying the individual case.

They should be confined to bed and placed upon a liquid diet; opiates to relieve pain in the acute stage.

Clean food and pure water are essential. He believes bismuth salts are good, but they are abused. An occasional saline aids their action. Ipecac is valueless in amebic dysentery, but in small doses may be tonic to mucous membrane.

Intestinal antiseptics may prove useful when fermentation occurs in stomach or upper bowel.

Avoid strychnine while using enemas, and use diffusable stimulants, as punches, dry sherry, etc. Calomel in small doses is useful.

When malaria is present he prefers quinin by enema.

Local Treatment.-Cold enemas, as advised by Little, does good in some cases. Quinin is of most service, varying from 1-1500 to 1-750 solution. Sodium chloride, morphine, or cocaine may be used in solution to favor retention of fluid and ease pain. One to three enemas in twenty-four hours is sufficient in most cases.

Treatment of Chronic Round Ulcer of the Stomach.—(American

Medicine.) Murdoch's experience shows the average duration of chronic ulcer to be about five years, which is equal to that of Fenwick, or four years and eight months.

He believes the time to begin solid diet is when the tenderness disappears. Orthoform in five (5) grain doses once or twice a day has proved of service in relieving the pain.

[When ordering orthoform, specify "new," as the unpleasant effects are avoided by the improved process in manufacturing.]

The Art of Eating Properly and Harm from Eating too Rapid and too Slow. (Medical Record, Jan. 4, '05.) Einhorn calls attention to the importance of mastication, and eating when the body is at rest and mind at ease.

"Pleasant company, light conversation, jokes, and stories add to the enjoyment of food." Most people eat too fast, but some eat too slow and too little quantity. He reports two cures of indigestion.

An Experimental Study of the Movements Produced in the Stomach and Bowels by Electricity.-(Medical Record, Jan. 7, '05.) Marshall concludes that electricity, either external or internal, does not cause contractions of the stomach or bowels. Hemmeter, Manger, and Metzer are of the same opinion, while Einhorn and Ewald believe that contractions do occur.

Marshall believes the sensation of contraction is caused from the action of the diaphragm. He also concluded, after an interesting experiment, that the gastric mucous membrane is not such a poor conductor of electricity as it is generally thought to be.

Etiology of Gastric Ulcer.-(Medical News, Jan. 14, '05.) Ackerman reports sixteen cases from Dr. Cohnheim's clinic, in Berlin, illustrating the importance of trauma and chronic compression of the epigastrium, as occupation, corsets, etc.

He believes that the authors pay too little attention to this etiological factor in gastric ulcer.

Duodenal Ulcer.-(The Lancet, Feb. 11, 1905.) Moynihan has operated upon fifty-one cases in the past four years.

There were 7 perforating, with 5 recoveries; 22 associated with gastric ulcer, with one death; 23 operations for duodenal ulcer alone, with I death.

He believes duodenal ulcer more common than the text-books teach, and that the "symptoms are perfectly characteristic, and admit of an unhesitating diagnosis."

Of the 51 cases, the ulcer was found in the first portion of the duodenum in 50 cases, and one in the second portion. The age ranged from 19 to 61, 32 males and 19 females.

He again calls attention to the resemblance of duodenal ulcer to ap

pendicitis. "In my series of 51 cases, 19 had been operated upon after an erroneous diagnosis of appendicitis had been made."

Pain is the most characteristic, varying from a burning to cramp, which may be severe and diffuse, though usually located to the right of median line, and occurs two or three hours after taking food.

Hæmatemesis and melæna occurred in 4 of the duodenal ulcers, hæmatemesis alone in 3, and malæna in 2. In the 21 cases associated with gastric ulcer, hæmatemesis and melæna occurred in 6, hæmatemesis alone in 4, and melæna alone in 3 cases.

Mucous Colic.-(American Medicine.) Kemp believes that ptosis of the colon and gastroptosis is the prime factor in this condition.

During the attack he confines them to bed, and allows a fluid diet. Tr. belladonna, 10 drops, every three or four hours for pain.

Hot normal saline irrigation may prove useful. Injection of milk of asafetida, or high enema of olive oil, to relieve spasm of colon.

During the interval of attacks, his object is to "put on fat." He supports the abdomen with the Rose belt. Cascara segrada for constipation.

Medical Treatment of Gastric Ulcer.-(American Medicine, March II, '05.) Henry believes that medical treatment is conducive to the healing process.

He prefers the use of bismuth suspended in barley water or mucilage. For control of hæmatemesis, hypodermic use of ergot and adrenalin, and ingestion of cracked ice. Gallic acid and acetate of lead are useful. Occasional laxative dose of saline is good, but calomel purge is to be avoided. Brinton says, "A single calomel purgative has even appeared to undo all that months of sedulous treatment had been able to effect toward the relief of a gastric ulcer." He follows Leube's advice, and uses poultices during the day and cold applications at night. Recent hemorrhage contra-indicates the use of poultice.

To overcome constipation he uses a teaspoonful of the following: Rhubarb, 20.0; sodium sulphate, 15.0; sodium bicarbonate, 7.5.

He emphasizes the importance of system in treatment. that has made the success of the spas of Europe.

DISEASES OF THE THORAX.

It is system

J. J. M.

The Pseudo-malarial Types of Infective Endocarditis.-The importance of infective endocarditis and the difficulty often encountered in arriving at a correct diagnosis justifies a consideration of the pseudomalarial forms under which it may be masked (Warren Coleman, American Journal of Medical Sciences, March, 1905). That this form of endocarditis is preceded by an attack of malaria, which gives the peculiar periodicity to the febrile wave, the author considers unlikely, since no other febrile disease, when following a malarial attack, pursues such a

course. Nor has it been proven that the majority of cases have been recently preceded by malaria.

The cases of pseudo-malarial types of infectious endocarditis which have been reported fall broadly in two groups, acute and chronic; the duration of the acute case is measured by weeks, of the chronic by months. Cases that have died after a few weeks' observation give histories extending over several months. Other chronic ones may continue for eighteen months or more.

The pseudo-malarial forms differ from the frankly septic and pyæmic forms rather in the periodicity than in the nature of paroxysms. The paroxysms may occur at regular periods, even at the same hour, and the intervals be fever free.

No especial infective agent is responsible for the pseudo-malarial types, nor is it necessary that there shall have been previous cardiac valvular disease.

The following pseudo-malarial types have been reported: 1, double quotidian; 2, quotidian; 3, tertian; 4, quartan; 5, septan; 6, mixed types; 7, irregular.

A single case may present during its course several of these types, yet at a particular period each type be pure. It is almost characteristic of these cases that they change their course. In spite of this fact, it is advisable to speak of distinct types.

The diagnosis is often very difficult, the heart often giving neither signs nor symptoms. If the infective process has been engrafted on an old valvular lesion, the diagnosis need not present much difficulty.

The failure of quinine to mitigate or arrest symptoms, gives the first intimation that the case is not malaria, assuming, of course, that a blood examination has not been made, though the presence of malaria does not necessarily exclude the presence of an infective endocarditis.

Fear in Heart Disease.-Wm. Rush Duncan, Jr. (Journal American Medical Ass'n, March 4, 1905) takes up this interesting phase of cardiac disease, and in a rather preliminary and incomplete report points out the frequency with which heart lesions are associated with apprehensive neuroses. He is inclined to consider the anxiety shown in these cases as explained by the individuality or personal peculiarity of the patient. The conclusions the author draws are as follows:

1. The cardiac lesion is not the primary factor in causation of the associated state of apprehension.

2. For want of a better term, what we call the idiosyncrasy of the patient is largely responsible for apprehension associated with cardiac lesions.

3. In neurasthenic types a want of vagus control is an important etiologic factor.

4. Our knowledge of this subject is not yet exact enough. On this last point let me urge you to urge on your friends who are engaged more

actively in clinical medicine investigation of this condition of apprehension in their heart cases.

Syphilis of the Lung Simulating Phthisis.-That luetic disease of the lung may be mistaken for phthisis, especially where there is no absolute history of primary chancre, is the belief of Drs. Hughes and Wilson (Medical News, Feb. 25, 1905). Attention is called to the fact that as early as 1858, Virchow described a pulmonary condition which he called "white hepatization," and which he noted especially in the lungs of syphilitic newly-born infants.

In support of their belief that syphilis may invade the lung, the authors quote Wagner, 1863; Pavlinoff, 1879; Schnitzler, 1879; Hiller, 1884; Heller, 1888, and more recently Councilman, Greenfield, Kidd, Perry, Rolleston, Weber, Wilks, Aufrecht, and Stengel, all of whom report cases of apparent syphilitic involvement of lung.

All of the signs and symptoms of tubercular diseases were present in the rather unique case reported by Drs. Hughes and Wilson, with the exception of night-sweats, loss of weight, and loss of appetite, though there was a continuous expectoration of muco-purulent prune-juice.

sputum.

Under the administration of large doses of iodide of potassium, the patient in twenty-four hours showed marked signs of improvement, expectorating less and bringing up less blood.

It is interesting from the pathologic standpoint, and in view of Virchow's comment upon the occurrence of brown induration and pigment and its histogenesis, that so many of the cases present hemoptysis as a prominent clinical feature.

Observation on Tubercular Infection.-David Walsh (La Revue Internationale de la Tuberculose, Feb., 1905) reviews the present status of measures looking toward the prevention of tuberculosis, and in doing so takes occasion to bring out some impressive facts regarding the inadequacy of the Government (British) regulation concerning meat and milk inspection.

"In the great London meat markets at Smithfield inspection is carried out by men who have not received any proper scientific instruction in physiology, pathology, and in the use of the microscope and other technical laboratory methods. These men trust to a naked-eye and empirical acquaintance with tubercular tissues. When certain parts only. of a carcase are infected, they are empowered by a Local Government Board regulation to pass the remainder for sale. In the opinion of many sanitarians, this permissive authorization is absolutely unscientific and wrong, as it assumes that tuberculosis may be restricted to a group of important organs without general infection of the rest of the body. The inspectors, if they find the pleura removed from the thoracic cavity, assume that this "stripping," as it is termed in the markets, has been done in order to remove the evidence of tubercular infection, and the