Editorial Items.—Continued.

The Slow Pulse in Syphilis.-M. Degnys (quoted in Medical Record) says that syphilis affects the heart not only by way of its muscular fibres, its interstitial tissues and its vessels, but also by central innervation, giving a permanently slow pulse.

The Hot Bath as a Sedative.-According to the Clinical Review, "The hot reclining bath, continued for from fifteen minutes to an hour, is a veritable sheet anchor in the sleepless states of nervousness, with high arterial tension and rapid heart action."

Intestinal Hemorrhage of Typhoid.-Aromatic sulphuric acid is one of the best remedies, says S. C. Dumm (St. Louis Medical Era). It should be given in doses of 20 drops every hour or two till the bleeding is checked, then at longer intervals for several days. Ice locally and liberal doses of opium are also indicated.

Coincident Use of Antagonistic Drugs in the Treatment of Diseases.Under this heading, Dr. N. S. Davis contributes a characteristic article to the August Clinical Review, in which he shows the folly and danger of giving together opiates with tea or coffee, alcoholics and strychnine, and brandy or ether injections for dangerous symptoms of chloroform anesthesia.

A Harmless Hair Dye. For people who must dye, Leonard recommends to be applied in the morning a lotion of 1 oz. bismuth citrate, 12 oz. alcohol and a few drops of ammonia water. In the evening a solution of 11⁄2 oz. sodium hyposulphite in 4 oz. water is to be applied. A brown color may be obtained by a mixture of pyrogallic acid and rose water.

Enteroptosis. According to Charles G. Stockton, more than 50 per cent. of all civilized women in all classes of life have developed enteroptosis, owing to the corset and other abominations of feminine wearing apparel. This condition, he affirms, is more than any other cause responsible for the constipation, backache, debility, biliousness, early loss of complexion, headache and other ailments of civilized women.

When to Operate in Appendicitis.-Murphy concludes an article on this subject in the August Chicago Clinic as follows: "Therefore, my conclusion is that we are not justified in holding a single case of appendicitis beyond the first twenty-hours after the diagnosis is made, and it is my belief that in an enormous percentage of the cases the diagnosis can be made as absolutely in the first twentyfour hours as it can at any other time."

Labor Down Hill.-A practical suggestion is Irwine (Virginia Medical Semi-Monthly, July 13).

that by Alexander

He has the woman

in labor take the kneeling position with elbows resting on the bottom of a chair, keeping the knees as close together as possible. In this way the full benefit of gravity is secured, and the weight of the body on the knees causes the pubic joint to spread, thus obviating in many instances resort to the forceps.

Vulvovaginitis in Children. In addition to the removal of any exciting cause, such as dirt, worms or foreign bodies, Dr. H. B. Sheffield (New York Medical Journal) recommends vaginal injections of 1 or 2 ounces of 1 or 2 per cent. protargol solution, allowing it to remain for five minutes and repeating three to five times in twenty-four hours. This injection should be preceded by a thorough cleansing with a 5 per cent. solution of sodium bicarbonate.

Bedbugs. We have forgotten the Latin name of this insect, which by the way our homeopathic friends include along with cockroaches in their materia medica. The itching question, however, is not what to call them, but how to get rid of them. Hellebore and other insect powders, and the bichloride solution in alcohol are conspicuous failures in the presence of lively specimens of this species. The one remedy that seems to be really effective is the oil of cedar, applied freely along the trail of the bloodthirsty night-wanderer.

Dr. Love Goes to New York.-Dr. I. N. Love announces to his confreres that during September, 1900, he will remove permanently to New York City, to engage in the practice of his profession, having accepted an opportunity for work in the department of Internal Medicine and Diagnosis in the Post-Graduate Medical School and Hospital. He will be pleased to have you call upon him when visiting the city. His address will be Hotel Iroquois, No. 49 W. 44th Street, New York City, N. Y. Phone, 38th Street, 3791; and his latch string will hang on the out-side and there will be no red tape on it. Pull and Love will do the rest.

Differentiation of Gonococci.-To distinguish gonococci from simulant diplococci, Ogden recommends the following method: (1) Cover the preparation with aniline-gentian-violet (without heat) for 30 seconds; (2) wash in water for two or three seconds; (3) cover the preparation with Gram's solution of icdine (iodine, 1 part; potassium iodide, 2 parts; water, 250 parts) for 30 seconds; (4) wash with 95 per cent. alcohol until the color ceases to come out of the preparation; (5) wash in water for two or three seconds; (6) counterstain with saturated aqueous solution of Bismarck brown ten seconds; (7) wash in water, mount and examine. Gonococci are stained brown, other diplococci blue.

Infantile Colic. This is commonly due in nursing infants to excess of proteids in the mother's milk. Such excess is diminished, says John Zahorsky (St. Louis Courier of Medicine) by restricting in the mother animal food, by having her drink more water, take more exercise, get normal sleep and be free from mental excitement. Proteid gas production is also greatly inhibited by giving the child 1⁄2 to 2 ounces of sweetened gruel just before each nursing. Cane sugar solution in the form of condensed milk is recommended for the same purpose.

Submucous Ligation for Rectal Hemorhoids and Prolapse. This method is described and illustrated by B. Merrill Ricketts in the Medical Review of Reviews for July 25. It consists simply in thorough divulsion of the rectum and the passage of a kangaroo tendon submucously around each group of piles, by means of a large needle, describing more than a semicircle. After making the ligature taut, it is sometimes desirable to puncture some of the larger tumors. For the first degree of rectal prolapse, the needle is applied precisely as for hemorhoids; for the second degree, the ligature is placed deep into the muscular tissue.

Abdominal Malarial Neuralgia.-Four cases of malaria, associated with acute abdominal pain, and occurring in the wards of the Massachusetts General Hospital, are reported by Dr. Joseph A. Capps in the Journal American Medical Association of Aug. 4. They were all sent to the hospital for surgical treatment-the first as acute salpingitis, the second as gall-stone colic, the third as extra-uterine pregnancy, and the fourth as appendicitis. A few plasmodia malariae were found in the blood of each patient during the febrile paroxysms. Leucocytosis was absent is every instance, and there was considerable secondary anemia. The abdominal pain, which was quite severe and variously localized, subsided with the other symptoms (nausea, vomiting, fever and enlarged spleen) after large doses of quinine. Post-infective malarial neuralgia is not accompanied by plasmodia in the blood. It must be diagnosed by its periodicity and by occasional trifling hot and cold stages and enlargement of spleen. Amenability to quinine is not certain evidence of a malarial origin, since other periodic neuralgias may yield. to large doses of this drug.

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The lingual or fourth tonsil has been the subject of histological and pathological study for many years. Valuable contributions to the literature of this structure were made as early as 1852 by Kolliker, since which Lennox Browne, in 1880; McBride, 1882; Swain, 1884; Kronenberg, 1894, have added greatly to our knowledge, while Michael in Heymann's Handbuch, 1897, completed, just prior to his death, a most comprehensive article with complete bibliography. Besides these, innumerable short articles, reports of cases and anatomical studies have been interspersed by many authors, all combining to form a very comprehensive literature.

Notwithstanding this, the student of this subject and particularly the special practitioner is struck by the many unsettled views and the paucity of definite knowledge upon questions having a practical bearing upon the diseases of the lingual tonsil. He is also impressed with the frequency with which symptoms easily demonstrated to be due to disease in this region are referred to other structures and to erroneous causes by the specialist as well as by the general practitioner. It is the general consensus of opinion, with possibly a few exceptions, that once the practitioner's attention is called to the pronounced symptoms of diseased tissue at the base of the tongue, he finds frequent occurences and recalls past experiences, the explanation for which, while formerly doubtful, is now entirely clear.

The fourth tonsil when diseased is easily recognized, being situated at the base of the tongue, anterior to the epiglottis, and when not seen with the laryngoscope has been simply overlooked. This structure is a collection of follicles, in most respects identical histologically with the faucial and pharyngeal tonsils, belonging to the ring of lym*Read at the Rocky Mo ain Inter-State Medical Association, Butte, Mont., Aug., 1900.

phatic tissue described as the "ring of Waldeyer." This ring "runs from the tonsilla pharyngea to the region of the eustachian orifice, from there to the posterior rim of the velum palati, around the posterior palatal fold to the faucial tonsil, over the base of the tongue to the opposite side and by the same direction back to the pharyngeal tonsil." (1.)

Lennox Browne (2) claims that certain structures of the lingual tonsil differ from those of the other lymphatic groups, particularly in the existence of more mucous and albuminous glands, and the absence of certain "patches of honey-combed homogeneous colloidlooking substance," which are very frequent in the pharyngeal tonsil and probably indicate a degenerative process.

Michael (3) gives a very complete list of the diseases of the lingual tonsil. He finds anemia, hyperemia and edema associated with these conditions of adjacent structures. Acute inflammation occurs, although rarely. Abscess formation has been noted, varicose veins, hemorrhage, atrophy, follicular inflammation, mycosis, tuberculosis, lupus, syphilitic manifestations and leprosy, in this region have been described. A variety of tumors are reported, such as dermoid, chondroma, adenoma, cystoma, carcinoma.

The most frequent disease undoubtedly is chronic hypertrophy, more or less marked and attended with certain mechanical and neurotic symptoms, the latter being so frequent as to be called neuroses of this region. The symptom known as globus hystericus has been shown by Lennox Browne (4) to be less frequently a manifestation pure and simple of hysteria, than is usually supposed, but to be more commonly an indication of some pathological lesion of the lingual tonsil.

Our attention having once been called to this region certain symptoms will quickly arouse our suspicions, which a laryngoscopic examination will at once confirm. These symptoms are cough, discomfort in the lower pharynx, desire to clear the throat, sense of foreign body, difficulty in using the tongue, feeling of fullness in the throat, vocal fatigue, huskiness and hoarseness, difficulty in breathing, difficulty in swallowing, sense of oppression, soreness, hemorrhage. All these symptoms may not be present to the same extent in all cases, and in fact many of them may be entirely absent. They are usually most pronounced in individuals of a neurotic type, and the more nearly the patient approaches the hysterical, the more severe and prominent will be the throat symptoms. General physical depression, such as is associated with anemia, particularly in young women, increases the severity of the local symptoms in the same proportion as it increases the neurotic habit.

Depending upon the prominence with which certain individual symptoms exist, one may class these cases into: First, those of simple