Simmons is not the man for the place he occupies as editor of the official organ of the Association, which goes, each week, to 43,000 doctors, and should be the leading professional magazine in the world.- Extract from Editorial in Charlottte Medical Journal, July, 1906.

REFLEX SYMPTOMS AND REFERRED PAINS CAUSED BY STONE IN THE KIDNEY.-Stella Stevens Bradford gives the history of a patient whose principal symptoms were nervous exhaustion and pain and weakness of the lower extremities, movable right kidney, pyuria, retroversion of the uterus, and defective circulation of the lower extremities. No improvement had resulted from change, travel, rest, and various methods of treatment which she had undergone. The patient was a woman thirty-two years old, a librarian. The family history was negative. The mental condition was excellent. After she was sent to the writer a thorough examination was made in order to detect, if possible, evidences of organic trouble. It was found that while clear amber urine flowed from the right ureter, a thick whitish fluid came slowly from the left. An x-ray picture of the kidney confirmed the diagnosis of stone. Operation proved this diagnosis to be correct. The patient died on the third day after the operation. The writer suggests that the irritation in the kidneys or pancreas, or both, caused the so-called referred pain of head, and brought about reflexly a spasm of the vasomotor nerves derived from the lumbar and upper sacral segments. This caused contraction of the blood vessels of the lower extremities. The ischemia in the nerve endings caused the deep-seated pain, and in the muscles the weakness.-Medical Record, July 21, 1906.

CIRCUMCISION.-John Knott says that among the utilitarian motives which may have promoted the adoption of circumcision, those connected with the cleanliness and hygiene of the person seem to be very important. Again, the reflex irritation caused by the condition in children gives rise to various disturbances. Among these are dysuria, enuresis, hernia, hydrocele, vesical calculus, prolapsus recti, epileptiform convulsions, and reflex

paralysis. The writer believes that the sacrificial theory of the origin of the practice of circumcision - national and tribal-or rather the combination of the sacrificial and initiatory ceremony would appear to furnish the most acceptable account of this widely-spread practice. In all ages and among all tribes and nations who have practiced circumcision, this operation has usually been the nucleus of some special ceremonial. The writer takes up in considerable detail the history of circumcision.- Medical Record, June 9, 1906.

RESECTION OF THE STOMACH FOR CARCINOMA.- Franz Torek believes that although in most cases of carcinoma of the stomach when the tumor is large a successful resection is impossible, nevertheless, the procedure in each special case depends upon its own merits. The operability cannot be determined alone by the size of the tumor. Several questions must be considered: the ability to resect well beyond the limits of the disease, the extent of lymphatic involvement, the presence or absence of involvement of the pancreas or other neighboring organs, and the nature of the adhesions. The writer then cites an illustrative case.- Medical Record, June 9, 1906.

DIARRHEA OF TYPHOID FEVER.- Wilson holds that preparations of bismuth alone or in combination with small doses of opium, Dover's powder, or deodorized laudanum, constitute in most cases efficient medication. For children, Charles W. Earle

prescribes :

B Ol. terebinth., m ij; acidi sulph, arom., m iv; syr. acaciæ; aq. menth. pip., aa q. s.

M. Sig. A teaspoonful. During convalescence from typhoid, with diarrhea, Thornton gives ten minims of turpentine in capsules every eight hours.- Denver Medical Times.

HERPES ZOSTER.- A patient under treatment for neurasthenia was referred to me by Dr. G. T. B., who two months previous to visit had an attack of herpes zoster, and since that time has had two relapses. As there was a pronounced area of inflammation a solution of lead water and laudanum was suggested to be

kept in contact with the eruption for twenty-four hours, after which an ointment as the following was to be spread over the

area :

Re Acidi borici, gr. xv; zinci oxidi; pulv. amyl, aa 3 ss; vaselin. pur., 3 iv.

M. et ft. ungt.

When the pain is excessive, a small quantity of cocaine or morphine was to be incorporated with the above ointment, and over this a dusting powder and cotton or gauze. In this class of cases the nervous system should always receive appropriate treatment. The Medical Bulletin.

IT is remarkable how frequently a purulent pericarditis may exist without causing many or severe symptoms.

Never neglect

an examination of the cardiac area, therefore, in cases of suspected sepsis. American Journal of Surgery.

VERTIGO OF CEREBRAL HYPEREMIA.-- Belladonna is valuable in both the acute and the chronic forms. In passive congestion

it is important to remove obstructions to the circulation. In portal disturbances Mitchell advises aperients and lessening of animal foods. In active congestion from overwork or beginning inflammation, Stewart uses cold to the head; ergotin, bromids and at times derivatives. In plethoric cases Tanner prescribes : R. Pil. hydrarg., pil. rhei co., ext. hyoscy. aa. gr. I 2-3: Two pills occasionally at bedtime.- Denver Medical Times.

A PERSISTENT, chronic discharge from the nose should lead one to suspect chronic disease of the frontal or other accessory sinus. American Journal of Surgery.

NEURASTHENIC VERTIGO.- James C. Wilson recommends rest, proper and sufficient dietary, laxatives, mineral acids and strychnin. Gelsemium in small doses is useful for general depression. When giddiness is due to overwork, and is accompanied by restlessness, insomnia, depression of spirits and a sense of impending evil, Waring recommends ammonium bromid in effervescing form.

with cascarilla.

Philip Zenner directs to lessen irritability of the nervous centers with bromids, belladonna, aconite or phenacetin, making the improvement permanent by general tonic treatment. Denver Medical Times.

THE following are some of the conditions in the presence of which an examination for tabes dorsalis should never be omitted: 1. All primary swellings of the knee or ankle joint without apparent origin. 2. "Sciatica" and "lumbago." 3. A deep ulcer on the base of the great toe. 4. Repeated vomiting at various intervals, with periods of well-being intervening. 5. Abdominal pains without other evident cause.- American Journal of Surgery.

WHO WOULDN'T?

"Should you say that a man is sick of

a fever' orill of a fever'?"
"Depends on how long he has been that way.
I should think he would be sick of it."- Judge.

If it is long,

IT is surprising how much information can be derived by abdominal palpation conducted with the patient in a hot bath, the temperature of the water being gradually raised to 105° F. usually secures as much relaxation as does the administration of an anesthetic, sometimes even more. In addition to the avoidance of the dangers and the disagreeable features of narcosis, it has the important advantage that the patient is able to call the examiner's attention to sensitive areas.— - American Journal of Surgery.

INSOMNIA. Daniel R. Brower in Merck's Archives for December, 1905, states that in acute insanity insomnia is one of the most urgent symptoms and its relief is always a difficult problem. The surest hypnotic is chloral in ten to twenty grain doses, largely diluted with water. It is contraindicated in cardiac impairment, and its disagreeable taste is often a barrier to its use. Chloralamid is one of the best substitutes for chloral in that it is less depressing to the heart and almost tasteless. In depressed cases, opium in the form of the deodorized tincture or aqueous extract is a valuable hypnotic, and relieves the psychic pain, better than anything

in the Pharmacopoeia. In the excited cases hyoscin hydrobromate is of great value; it is powerful, some patients bear it badly, but used with caution it will often produce satisfactory results. Finally in considering the therapy of acute insanity, we must always be mindful of attention to the general health of the patient.

THE best site for an urgent tracheotomy is through the cricothyroid membrane. To hold the opening apart a couple of hair pins bent at the end may be used as retractors.- American Journal of Surgery.

APPENDICITIS IN CHILDREN.- Dowd, in the Medical News, Sept. 23, draws conclusions upon appendicitis in children from seventy cases between two and fifteen years old, occurring in his practice. The cases are classed as (1) Early cases, operated within forty-eight hours; (2) Later cases of varying activity; (3) Interval cases. In group one the rapidity of the progress of inflammation is remarkable, but operation gives good results. Group two has a mortality rate of about one per cent. in this series; immediate operation is advocated by many surgeons who counsel delay in the same stage of adult cases; this is because the omentum in children is small and fails to wall off the infection. In group three there is no mortality and there are no peculiarities.

Among the symptoms and signs, pain was always present, but its expression in children is seldom definite; vomiting is noticeably constant; rigidity is very well marked over the point of inflammation, the muscles reacting to slight stimuli; hence palpation is better before anesthesia than after. The disease is more rapid and insidious than in adults; leucocytosis is comparatively higher; constipation is not the rule. Early pneumonia often simulates appendiceal trouble, as does hip-joint disease occasionally. Children bear operation well and they more often survive a general peritonitis than adults.

Do not consider too lightly a history of "growing pains" in the extremities in children. These symptoms may be due to a grave osteomyelitis.- American Journal of Surgery.