and that the temperature should be taken again half an hour after the bath, when a fall of about two degrees might usually be expected.

In this country the use of the cold bath has been mainly restricted to the combating of hyperpyrexia in special cases. As a systematic method of treating enteric fever it has received comparatively little support, although it has been recommended by such high authorities as Sir William Broadbent and Dr. W. Cayley. Professor Osler, who is a firm supporter of the coldbath treatment, strikes the right note when he states that he regards it as "not so much special and antipyretic, as tonic and roborant," and were one to supplement this criticism by claiming for it in addition a powerful eliminative agent, one would probably not be overestimating its virtues. Although Brand claimed for the cold bath that its action was essentially protective against a high temperature the fact that he enjoined more or less continuous friction of the skin throughout the period of the patient's immersion suggests that he was probably alive to its action as an eliminant. It is by no means improbable that it is to its salutary influence on the nutrition of the skin and to its power of maintaining the excretory activity of both the skin and kidneys that the cold bath mainly owes its marked superiority over all other therapeutic procedures of which the primary aim is refrigeration.

(To be continued in February issue.)

Clinical Department.

A Case of Fracture of the Surgical Neck of the Humerus in an Octogenarian. PHILIP E. HILL, M.R C.S. (ENG.), Surgeon to the Crickhowell Workhouse Infirmary, England, in The Lancet.

A man, aged eighty years, was admitted into the Crickhowell workhouse infirmary on October 20th, 1904, suffering from a fracture of the surgical neck of the right humerus. On examination the arm was found to be swollen considerably, with ecchymosis extending from the shoulder to the wrist, and the patient was in great pain. Some days prior to his admission he had been seen by a medical man, who had placed a pad in the axilla and strapped the arm to the side. Coaptation having been effected, a pyramidal pad with its base upwards was placed in the axilla and two splints were applied, an angular one to the inner side of the arm, and an outer one extending from the shoulder to the elbow. The arm and chest were then bandaged together and the hand and wrist were enveloped in a sling. The patient was placed on a water bed and necessarily kept there during the whole of the treatment. Unfortunately, at the end of six weeks he died from cardiac failure induced by the excessively low temperature which prevailed at the time. I made a postmortem examination of the limb in order to ascertain what amount of repair, if any, had taken place. I found that the fractured ends were accurately adjusted and that firm, bony union had been accomplished, a result hardly anticipated in a man where the reparative processes are presumably deficient in consequence of the vital powers being exhausted by age and debility, as evidenced by the fact that from the first there was incontinence. of urine and feces.

A Case of Surgical Emphysema in Pulmonary Tuberculosis. R. D. ATTWOOD, M.R.C.S. (ENG.), L R.C.P. (LOND.), Assistant Medical Officer, Southwark Union Infirmary, England, in The Lancet. A man, aged thirty-eight years, was admitted into the Southwark union infirmary in June, 1904, with extensive phthisis of the right lung. On Nov. 12th his face was noticed to be extremely swollen; on examination he was found to have surgical emphysema of the face and right side of the chest. The emphy

sema spread to the left side of the chest and abdominal wall. The patient died on Nov. 18th. At the post-mortem examination it was found that the larynx and trachea were normal. There was no pneumothorax. The right lung contained many areas of consolidation and several small cavities. Near the right apex was a small cavity over which the lung was adherent to the chest wall, and which communicated with the parietes by a small opening in the third intercostal space.

A Case of Enteric Fever Due to Eating Oysters. JOSEPH CLOUGH, M.R.C.S. (ENG.), L.R.C.P. (LOND.), ENGLAND, in The Lancet.

The patient was a boy, aged four years, who, about the middle of August, went for a two hours' sail at Scarborough. He was very sea-sick and vomited violently. On landing he ate two oysters from a street stall without any vinegar on them. Seven days afterwards he fell ill, and fourteen days afterwards he had distinct enteric fever spots. For the first three weeks of his illness he progressed favorably, but at the end of the fourth week his abdomen became swollen and painful, and he suffered from vomiting, tendency to general coldness, and feeble circulation. During the first half of the fifth week he was sleepless and delirious, his temperature varied from 102.5 deg. to 103.5 deg. F., and there was diarrhea, some motions being passed in bed involuntarily. I ordered him chicken broth with plasmon in it, and castor oil in doses of about a teaspoonful, after which he immediately began to improve. His temperature did not become normal till the end of the seventh week of the illness. The boy is now as strong as ever.

Records of Swallowed Safety-Pins.

Seattle, Wash., in American Medicine.

ARTHUR DEVOF, M., of

Richard B., aged five years, swallowed an open safety-pin one and a half inches long at 8 o'clock a.m., September 4th, 1904. At II o'clock a.m., three hours later, by aid of the roentgen ray, the pin was observed in the esophagus just above the upper border of the sternum. The boy was soon chloroformed and the pin pushed down into the stomach. His parents refused to submit to a gastrotomy for its immediate recovery. September 7th, at I p.m., the pin not having passed the bowels nor produced any

symptom of distress, the patient was given stewed dried prunes to eat of freely. At 6 o'clock a.m., September 8th, the pin passed readily, along with a mass of partially digested prune skins notably visible.

This pin might have passed naturally into the stomach by the aid of some suitable effort at swallowing food or drink. Nothing of the kind was tried.

The safety-pin, a notable household and nursery convenience, made with bent wire, a spring temper, and a sharp point, is acquiring something of a record in medical literature for passing in open form through the alimentary canal in children. Once started, point backward, and it cannot start otherwise, this formidable looking affair seems to pass with unexpected readiness through the whole digestive tract, reappearing in a more or less corroded and damaged plight, the child meantime having presented few, if any, symptoms of distress from its presence. One, two, three, four, twenty, or even sixty days have been known to elapse between the ingress and the egress of the pin, the longer periods giving ample time, one would think, for the setting up of irritation by its presence in children aged nine months to four or five years.

Safety-pins are in such common and familiar use that it is well for all to know that they have been occasionally swallowed in open form, and, the habits and impulses of parents and children remaining as in the past, such accidents are bound to occur from time to time in the future.

Now, the mechanism of an open safety-pin is such that if placed in a vitalized muscular canal, like the alimentary tract, it must advance, if at all, "like a crab, backward," dragging the point and hood of the pin by a safe motion, which gives small chance to pierce the tissues. This is true especially of the esophagus and the small intestine, the canals of which are not wide enough to permit an end-to-end turning of a one-and-a-half or two-inch pin in its course. It is true that the larger spaces of the stomach and large intestine offer better opportunity for the tumbling process, but a careful study of the open safety-pin will show that it must soon right itself and advance in accordance with its name in true safety form, i.e., backward, eye or loop leading, point and hood following, the advancing loop affording a resting place for prune skins or other undigested shreds, thus assisting the progress of the pin.

Within the past two years, 1902 and 1903, the Medical World of Philadelphia has placed upon record quite a number of cases of children of various ages who have swallowed open safety

pins, and who have successfully and safely passed the same after varying intervals of time. Within the past month two cases have come to my personal knowledge in this city.

If I were to be given a choice for my child to swallow a safety-pin open at the usual angle or a common straight pin, I should consider the straight pin the more dangerous of the two.

Instantaneous Cure of Erysipelas.

W. B. TAYLOR, M.D., Dexter,

Ga., in American Journal of Dermatology.

In studying erysipelas I found in reading after Prof. Anders, of Philadelphia, in his text-book on practice, edition 1902, where he says a knowledge of the microbic nature has led to the local application of numerous antiseptic remedies, and it is along this line that the greatest advances in the treatment of the disease are to be expected. This led me to believe that we had some drug at our command that would dissolve out the sebaceous matter of the skin and penetrate the deep layers and superficial lymph vessels, the habitat of the streptococcus, and kill them.

In studying further into the subject, I concluded that creolin, being a saponified coal tar creosote, was worthy of a trial.

My first opportunity to use this remedy was some months after my study of the subject from an antiseptic standpoint, in May, 1903. My first case was a married lady, about thirty-three years of age, who gave a history of several previous attacks. Examination showed small wounds on both feet, evidently the point of infection. The disease had spread far above both knees, with intense, burning pain. I at once painted undiluted creolin over the affected area and waited three minutes and washed off same with plain water. The effect was instantaneous. The lady was cured, the skin resuming its natural appearance, with no damage done by the creolin.

I had the opportunity to use it in four other cases-two small children, one young adult female and one aged gentleman (sixtyfive years old), with same results as in first case.

If this treatment shall prove a success in the hands of the medical profession, thereby saving many lives from complications which are liable to follow erysipelas, I shall feel gratefully rewarded.

Hoping to hear results from any physician who has an opportunity and wishes to test the efficacy of creolin in the treatment of erysipelas.