vascular changes precede the kidney changes, as the result. The source of these toxins is two-fold, the gastro-intestinal tract and the products of metabolism. The liver does not functionate properly, and as a result there is incomplete elaboration of the food before it reaches the circulation. The management of a case of Bright's disease according to Dr. Croftan should be considered under: (1) prophylactic treatment; (2) symptomatic, directed primarily against the development of cardio-vascular changes, and secondly, against the nephritic changes; (3) the treatment of the patient as a whole.

TO PREVENT INTESTINAL PUTREFACTION.

The diet should be properly guarded and the stomach washed out if necessary. The author recommends especially in this connection the use of zinc sulpho-carbolate given in doses of one grain (.06) each at frequent intervals, together with about twenty grains (1.30) of bismuth daily. If the zinc preparation is used in sufficiently large doses it will prevent the black stools of the bismuth, as it checks putrefaction, and thus prevents the formation of bismuth sulphid. The color of the stools, therefore, should govern the amount of the zinc salt given daily and when this is obtained the urinary evidence of bowel putrefaction will disappear, as shown by the reduction of indican, etc. bile salts are also of value in this same connection.

The

To strengthen the heart and to reduce the blood pressure, small doses of digitalis are recommended, one drop (.06) of the tincture, three times a day, is a sufficiently large dose to render the heart less susceptible to the disturbing stimulation of the circulating toxins. Large doses of digitalis are contraindicated. Nitro-glycerine is the best remedy to reduce the blood pressure. As adjuvants to these preparations the hot bath, rest in a warm bed, life in a warm, dry climate and massage are of value.

The author believes in a liberal diet and one which will least irritate the kidney and at the same time adequately nourish the patient. He condemns the use of an exclusive milk diet, as it must be given in enormous quantities to properly nourish the patient. If administered in such large quantities it causes flooding of the heart and arteries with water, and thus overtaxes them. It is deficient in iron, and in time leads to deficient hemoglobin, and its use, sooner or later, becomes monotonous. The diet, therefore, should be a mixed one, and should contain a moderate amount of albumin.

The amount of water should be restricted; for the kidney,

when it becomes diseased, stops eliminating water as the first thing, consequently the practice of "flushing out" the kidney should not be encouraged. The chief advantage of "sweating" is to get rid of the water.

WITHDRAWAL OF SODIUM CHLORIDE.

The nephritic kidney fails in properly eliminating sodium chloride, and, therefore, favors edema, as the salt draws water from the tissue by the process of osmosis. Consequently, the ingestion of salt should be restricted. The surgical treatment of decapsulating or splitting the capsule is condemned by this author.

USE OF WATER IN NEPHRITIS.

Broadbent, in an abstract in American Medicine, states that the use of water depends on the time when it is taken. A glassful taken night and morning makes it effective as an eliminant. Specific growth of the urine is a more important factor in this disease than the amount of albumin. The tension of the pulse is an indication in the prognosis and treatment. When a high tensioned pulse is present he employs a mild mercurial aperient. According to his statement, the effect on the arterial tension of a single grain of a mercurial preparation with slight aperient action is much greater than repeated liquid motions induced by saline; and the renal elimination is increased by the mercurials. This author believes, also, that the starting point of chronic nephritis is some impurity in the blood which acts as an irritant, that by its elimination the renal trouble may be prevented, and that calomel aids in this elimination. Acting on the basis that uremic convulsions are caused by interference with the cortical circulation of the brain, he frequently advises venesection in this condition, but when there is only threatened uremia he orders free purgation by calomel, which usually causes the symptoms to disappear, and the tension of the pulse to be reduced.

case.

SURGICAL TREATMENT.

An account is given in the same periodical of six cases of Bright's disease operated on by P. Rosenstein, and decapsulation of the kidney performed with negative results in every The author's conclusions are as follows: Decapsulation of the kidney in grave Bright's disease is a dangerous operation; a permanent cure has not been recorded in any case; improvements were noted, but in one of the improved cases the albumin and casts continued to exist, only the edema disappearing; in the other, headache and scotoma persisted.

INDICATIONS FOR TREATMENT.

The indications for treatment of chronic Bright's disease may be summed up as follows:

1. Early in the disease, to reduce the effect of the toxic substances, in the circulation, on the heart, arteries and kidney substance.

2. When the arterial tension becomes pronounced, to use means to reduce it.

3. Support the heart in well-advanced cases and promote elimination by bowels, skin and kidney.

In carrying out the first point the diet should be light, nonirritating, but not confined to a strictly milk diet. It should include well-cooked vegetables and a small amount of farinaceous and animal food; at the same time produce free elimination by the bowels. The arterial tension may be lessened by the use of calomel aperients and nitro-glycerine. To check the progress of arterio-sclerosis, potassium iodid is recommended by some authorities.

In the treatment of the anemia Weir-Mitchell recommends large doses of the tincture of ferric chloride, from thirty to sixty minims (2.-4.) three times a day.

To support the heart early in the disease, caffein, spartein sulphate or moderate doses of strychnia are of value. Later in the disease, when the heart has become greatly enlarged as the result of its efforts to overcome the great tension in the arteries and vessels of the kidney, strophanthus and later digitalis are necessary. Strophanthus has the advantage over digitalis in that it is a good heart stimulant and does not contract the arteries as does digitalis, but it has the disadvantage, as stated by some authorities, of irritating the kidneys. The ordinary pill of calomel, squills and digitalis is a valuable combination in the treatment of this disease.-J. A. M. A.

Society Reports--Notes of Interest.

Dysmenorrhea:

At the fourth Pan-American Medical Congress, recently held in Panama, Dr. Lucy Waite, of Chicago, stated that stenosis or flexion had nothing to do with causing dysmenorrhea; neither was childbirth the only cure. In three hundred cases the question had been put, Have you had more or less pain since the birth of your child?" There was more pain in 135; 89 had less pain; in 76 there was no difference. After these data, Dr. Waite thinks operations for relief should cease.

66

Dr. A. Alexander Smith, New York, said Typhoid Fever: before the Practitioners' Society of New York, that bronchitis had been a prominent feature in thirteen out of thirty-five cases of typhoid fever, recently observed by him. The fact that two of these cases had been sent into the hospital with a probable diagnosis of acute tuberculosis, emphasizes the care to be taken in making a diagnosis between typhoid fever and acute tuberculosis.

Alopecia:

Dr. L. Duncan Bulkley, before the Medical Society of the State of New York, gave an analysis of 755 cases of dermatitis seborroica, and 608 cases of alopecia. The latter disease he considers due to a parasite, although that has not yet been agreed upon by all observers. In the treatment of dermatitis seborroica he prefers lotions to ointments, if the scalp is involved, and the lotion he uses is composed of resorcin, alcohol, glycerine and rose water. In some cases he has used resorcin and chloral hydratis, and has found it give better results in these cases.

Cerebro-Spinal
Meningitis:

A symposium on the subject of cerebrospinal meningitis was held at the recent annual meeting of the Medical Society of the State of New York. Dr. W. T. Councilman, of Boston,1 told of epidemics in Massachusetts in 1809, 1864, 1874, and in 1897, the mortality ranging from 20 to 75 per cent. In the last epidemic the mortality had been 65 per cent. Dealing with the symptomatology and diagnosis, Dr. H. L. Elsner, of Syra

cuse, said he believed that Kernig's sign was an early manifestation of the disease, and that in 90 per cent. of the cases he had seen in six years it was present. He does not, however, consider it pathognomonic.

Water in Fevers:

Dr. Beverly Robinson, New York (New York State Medical Association-County Branch), stated he believed in giving water freely in continued fevers. Debove's statistics regarding the treatment of typhoid fever patients with large quantities of water internally show excellent results.

Prostatic Hyper

trophy:

The belief now obtains, says Dr. L. Bolton Bangs, of New York, before the Medical Society of the State of New York, that prostatic hypertrophy is a chronic inflammatory process which usually has been in progress many years. Among the causes, which may produce this condition are: Masturbation, sexual excesses, coitus reservatus, and gonorrhea. After carefully investigating over three hundred cases, Dr. Bangs states that in over 85 per cent. of these, some unphysiological sexual act was found as a causative factor.

Physician's Library.

During 1904, P. Blakiston's Son & Co., Philadelphia, sold 15,090 copies of Gould's Medical Dictionaries, making the total sales to date 181,173.

The Diseases of Society. By G. FRANK LYDSTON, M.D. J. B. Lippincott Company, Philadelphia and London.

To those members of the medical profession who are interested in the "vice and crime problem," Dr. Lydston's work will prove intensely interesting. After twenty-five years of more or less constant study of this subject-part of which time was spent as Resident Surgeon to the Blackwell Island Penitentiary, New York-Dr. Lydston may well be regarded as an authority on this subject, which is so forcibly coming before the medical profession and society in general.