ever, germane to this subject and they should be briefly sketched as follows: Strictures of the upper gastro-intestinal tract, malignant disease of œsophagus or stomach, cases of acute gastritis with extreme exhaustion, neurasthemic states associated with pronounced anorexia, and frequently acute emotional insanity.

Cases of gastro enteritis with nausea in which the catarrhal process has involved the entire tract promise nothing with this method, as the absorptive power is so greatly obtunded. Concerning the absorptive power of the intestinal mucosa, there is no doubt that this function is exercised more promptly when the nutrient material or medicament is administered per rectum than when given by the mouth, since considerable time is lost in their passage through the normal digestive routine. As to the form of nour ishment to be employed, the choice must depend largely on the individual case. My own preference has been to use an enema composed of milk one pint; cream, two ounces, in which are stirred the whites of two eggs. This makes a bland, non-irritating and easily digested dietary.

Brown-Sequard gave two-thirds of a pound of raw beef and three-quarters of a pound of fresh pancreas finely minced twice daily. Another course of practical worth was formulated by Leube, and is as follows: Five to ten ounces of raw beef chopped finely, half this amount of fresh pancreas, also finely divided, and the whole rubbed up in a mortor with five ounces of tepid water and then given per rectum. The two last named formulas have the disadvantage of not always being at hand and requiring considerable care in preparation. Among the prepared foods may be mentioned Bovinine, which is probably best combined with milk in the proportion of one to four. Liquid Peptonoids, Panopepton and Trophonine are proprietary preparations containing finished peptone.

The modus operandi of giving the enema is perhaps carried out as follows: A four-ounce hard rubber piston syringe is attached by means of a short piece of tubing to one of the three limbs of a perfection bladder irrigator cock, to second limb the rectal tube or a soft rubber catheter, and to the third a piece of tubing to be placed in the nutrient fluid. The cock can then be thrown alternately to fill and empty the syringe. After the injection is given it is necessary to request the patient in case of adults to make an effort to retain the fluid. In case of infants or young children it is my practice to press the buttocks closely together and apply an adhesive strap tightly across them for a half hour or so. The intervals of feeding while depending on the status of the case should be made to conform as nearly as possible to the normal. The amount to be given may vary from two to four ounces in the infant, to six to sixteen ounces in the adult. Before giving an enema the rectum should in every instance be previously flushed with warm water. I have made it a routine practice in giving nutrient enemas to always use a small amount of brandy, as I believe it hastens absorption by stimulating the mucous membrane of the bowel and operates much the same as liquor will frequently do when given in cases of delayed or imperfect stomach digestion.

To sum up: Nutrient enemata are useful in proportion to the care with which they are employed. They need not be predigested. They may be used alone or as supplemental to the regular means of feeding. The degree, of their digestion and absorption is in direct proportion to the health of the intestinal mucosa.

And in conclusion, though rectal feeding would hardly furnish a permanent practical means of nourishing the human body, it may, when carefully and intelligently employed be made to tide over an emergency situation which will operate greatly to the credit of the physician and to the benefit of the patient.

Nose, Throat, Heart and Lungs.

CONDUCTED BY

DR. J. MARTIne Kershaw, ST. LOUIS.

A CASE OF LARYNGEAL DIPHTHERIA TREATED WITH ANTITOXIN.

The subject was a child of six years and six months of age, of somewhat delicate constitution, and a dainty eater. It was almost impossible to examine her throat, as she set her teeth tightly, kicked, struggled and fought desperately with every attempt made to see its condition. I finally obtained a view of the exudate which covered the right tonsil. I swabbed the diseased surface with the cotton plug of the culture tube and then rubbed the cotton plug with the diseased matter over the surface of the blood serum. I sent the outfit to Dr. Snodgrass, City Bacteriologist for examination, who promptly reported that it was a case of true diphtheria. I have thus carefully explained in detail my mode of examination that there may be no room for doubt as to the diagnosis. The child refused medicine most of the time, ate little, and became steadily weaker. The disease progressed downward rapidly and invaded the larynx. A hoarse croupy cough developed, the child was unable to speak except in a hoarse whisper, breathing became labored, and the face appeared dusky and cyanotic. It is needless to say that by this time, the child was greatly prostrated. She refused both food and medicine. Death appeared imminent in the very near future, and I strongly urged the parents to permit me to use antitoxine. They positively refused to permit the treatment at first, but finally consented when I told them the child would certainly die unless some positive help was given it at once. I injected one thousand units of Wyeth's antidiphtheritic antitoxin at once. The child rested better that night, was a little stronger the next morning was less fretful and called for food. I gave another antitoxine injection of one thousand units. The case began to improve immediately and in every respect. She began to eat (ravenously I may say), of substantial foods at every meal time, and she called for food between times also. She gained strength rapidly, but it was sometime before her voice was fully restored. Before the discovery of antitoxin, most cases of laryngeal diphtheria died. Most of the dainty eaters, and the

poorly nourished children had a hard struggle for life, and most of them died. Before the discovery of antitoxine, it seemed impossible to cure a case of diphtheria where the subject had no desire for food, would not eat, vomited if he did eat, and could neither be stimulated nor nourished. Most of the cases of diphtheria treated by antitoxin begin to eat, and eat well, soon after the first injection, and the appetite keeps up until well on to the road to health. Restful and quiet sleep soon follow without the aid of any other medicine. Does it not seem wonderful-a miracle almostthat a child can be snatched from the very jaws of death as it seems, and in a few hours, or days at most, be restored to health and to the hearts of those who love it, all this through the influence of a few drops of fluid known as antitoxin! Those of us who in the past have seen little ones go down to death, and have stood by helpless and hopless know what this J. M. K.

means.

Eye and Ear.

CONDUCTED BY

G. N. SEIDLITZ, M. D., St. Louis, Mo.

THE TREATMENT OF STIES.

Dr. Henry Dickson Bruns, of New Orleans, in a paper which was read by title at the recent meeting of the Louisiana State Medical Society, deals with the general subject of suppuration of the anterior structure of the eye, that of the lids, the conjunctiva, the cornea and the iris. Among the suppurative affections of the lids, Dr. Bruns deals with one that the general practitioner would seldom think of referring to the ophthalmologist-the rather commonplace ailment known as a sty.

Dr. Bruns does not go far into the subject of the abortive treatment of hordeolum, judging, perhaps, that any such undertaking had better be reserved for the specialist, yet it seems as if any well equipped physician might with a fair prospect of success and with no danger of doing harm, apply to the minute part at first affected such a germicide as should ward off suppuration. However, Dr. Bruns thinks that sty, once begun can seldom be aborted, although he says that frequently bathing with very hot water will occasionally bring about such a result, and he adds that in case it does not, it will give greater relief from pain than any other measure and hasten the pointing of the abscess, "which may then be opened by the patient with a new needle, or by the surgeon with some formidable instrument."

Sties commonly come in successive crops, Dr. Bruns remarks, and their recurrence must be prevented by destroying the pus-producing fungus on which they depend. This may be accomplished by causing the patient to scrub the edges of the closed lids, the lids themselves, the brow and all the neighboring skin with a solution of mercury bichloride of the strength of 1 to 1000. The solution, he says, should be freshly prepared each time, the

scrubbing conscientiously practiced night and morning, and the treatment continued for at least two weeks.

This practice should be accompanied by the removal of any discoverable source of irritation, such as any important lack of muscular balance or error of refraction. "The cure of recurrent sties by proper spectacles," he says, "is a commonplace to every oculist."-Dietetic and Hygienic Gazette, March, 1903.

(In the treatment of sties appearing in successive crops, chronic, so to speak, the constitutional condition of the patient should always be taken into consideration. When sties cannot be assigned to a definite local cause, the indication for systematic treatment should always be sought out.)

PRACTICAL POINTS ABOUT DISEASES OF THE EAR.

1. Do not forget to wash the ear out in cases of defective hearing; often the defect is due to hard wax.

2. When there is a swelling behind the ear and other symptoms of mastoid diseases, do not forget to have an aurist examine the ear, as a mastoid operation may be necessary at once.

3. Do not treat slightly a noise in the ear. This is generally due to middle ear catarrh, and may be relieved if properly treated.

4. Partial deafness in children is almost always due to adenoid growths, which should be removed at once, and done thoroughly, This is not always a simple operation.

5. In trying to remove foreign bodies from the ear, do not use any violence. Never push therein, and if you cannot remove them, simply send the case to an aurist, who is perfectly competent to do such work, as he is prepared for this, and it is generally very easy for him to succeed.

6. Remember that little boils in the outer part of the aural canal are no insignificant things, and that they may give rise to a great deal of trouble,

7. Remember that the artificial drums that you see advertised in the lay press are no good, and you had better warn your patient against the purchase of them.

8. Discard all such practice as dropping sweet oil and other oily substances into the ear. Better use a little warm soda water.

9. Do not "monkey" with an ear.

With the doctors permission we would prefer (1) to read:- Don't forget to remove impacted wax in cases of defective hearing.

Nothing in connection with otology is of greater importance than (3). Tinnitus is often one of the most distressing and at the same time intractable symptom. It certainly should be nipped in the bud. But how often is it ignored until too late.

We do not wholly subscribe to (4). Adenoids, it is true are very frequently the underlying cause of deafness, specially in infants and very young children. On the other hand, otitis, acute and chronic, suppurative

and non-suppurative is responsible for many cases, and tubal disease comes in for the share.

As to (6) we believe time is, as a rule wasted, in employing any other treatment than the knife.

7. In our experience the best artificial drum is a roll of absorbant cotton moistened with equal parts of glycerine and water.

9. Commends itself to all mankind.-Dr. Camady in Virginia Medical Monthly.

D. B. St. John Roosa, in the Medical Record, reports an interesting case of disease of the acoustic nerves, causing profound deafness, accompanied at a later stage with pleuritic effusion and fibroid phthisis, with ultimate recovery. The case was that of a man 49 years of age, who developed deafness after he had received a severe wetting. The author attributes the deafness to exposure and to quinine which the patient took after being exposed. He contends that the deafness was at first due to congestion and later to anemia of the auditory nerves. During this illness he developed an attack of pleurisy on the left side, from which he convalesced slowly. He then developed tuberculosis of the lungs, which the author states was of the fibroid form. It appears that he recovered from the pulmonary affection and that his hearing was gradually restored to its normal state.-Medical Progress.

HOMEOPATHIC ALUMNI ENJOY "MARINE BACILLI MAGNIFIQUE."

Twenty-nine men received degrees at the graduation exercises of the New York Homeopathic Medical College and Hospital, in Mendelssohn Hall, May 7. Dr. W. H. King, the dean of the faculty, delivered the address, in which he said that the figures from the report of the State Board of Regents showed that the graduates of this college had the highest average in the State. The degrees were conferred by Anson R. Flower, president of the board of trustees. Dr. J. H. Demarest awarded the certificates of the Metropolitan Hospital. Dr. G. W. Roberts announced that twenty-one had desired and received hospital appointments. The Rev. Dr. W. M. Smith, of the Central Presbyterian Church, addressed the class.

The dinner of the New York Homeopathic Medical College alumni in the ballroom at the Waldorf last evening was declared to be the largest ever given. More than four hundred doctors, with their guests, were at the tables and women filled the galleries. The "diet list" included such delicacies as "Marine Bacilli Magnifique," otherwise clams; "Appendix Saute, Surgical Dressing;" "Salade a Coroner," or calves' brains; "Alumni Vivace a la Entente Cordiale," alias lamb chops, and to wind up "Laryngitis Assorties" and the pleasing "Habitare au Bacterie."

The alumni association elected these officers: President, W. A. Dewey, of Ann Arbor, Mich.; Vice-Presidents, J. C. Fahnestock, of Piqua, Ohio; Luke Corcoran, of Springfield, Mass.; C. E. Lane, of Poughkeepsie, N. Y.; Treasurer, W. G. Crump; Recording Secretary, A. W. Palmer.