maintaining the hydrotherapeutic principle in a modified form, is attended with less inconvenience. The patient, instead of being immersed in tepid water, is slung in a hammock, which is stretched on a frame erected over the bedstead. The surface of the abdomen and the lower part of the chest are covered with a light flannel compress on to which a stream of water at a temperature of 80 degrees is allowed to trickle continuously, the excess of water as it escapes being collected in a bucket placed beneath the hammock at its most dependent part. The patient wears no body linen, but his legs and thighs are covered with a blanket, and his comfort is increased, if necessary, by keeping a large spirit lamp continuously burning under the bed. By this means the sensation of chilliness is to a large extent removed while the evaporation of the water is facilitated and its refrigerative influence is correspondingly increased. A large bed cradle is placed over the patient, covered only with a single sheet so as to interfere as little as possible with the vaporization of the water. Dr. Barr speaks very highly of this method in severe attacks, and says that it has so far been successful in every case in which he has employed it. Another means of refrigeration which has been used a good Ideal is what is known as the "ice cradle." The patient, but lightly, if at all, covered, lies under a bed cradle in which are hung a number of little pails containing ice. These are frequently replenished, and as a result the temperature of the air surrounding the patient is maintained at a low level. It probably falls far short of the cold bath as a systematic method of treatment, but it is certainly devoid of the difficulties which are incidental to the bath on whatever lines it may be employed. From a purely antipyretic point of view the "cold-air bath," as it might be termed, is excellent, but it is without any influence in stimulating the excretory activity of the skin and kidneys and thus promoting the elimination of toxic products which is so marked an attribute of the cold bath. The use of the wet pack, whether applied to the whole surface of the body or to the chest and abdomen simply in the form of what is sometimes called an “ice poultice," though capable of abstracting a considerable amount of heat from the skin, is mainly useful by its sedative effect on the nervous system. Although the temporary application of a cold compress to the abdominal wall for the relief of pain or tenderness is often of the greatest value the influence it exerts on the internal temperature of the body, as revealed by a thermometer placed in the rectum, is frequently very transitory. And the same thing is true of the practice of cold sponging of the surface. Cold sponging, like the occasional application of a wet pack, or an ice poultice, though often employed with undoubted advantage in special cases, can hardly be regarded, for reasons that I have already mentioned, as a serious rival to the cold bath as a systematic method of treatment. Of the various antipyretic drugs which have been used in combination with the cold bath, sulphate of quinine is the only one which appears to merit any confidence. It has been extensively used by some continental authorities as an adjuvant in certain cases in which the pyrexia has proved refractory to the influence of cold bathing alone, and apparently with success. The tonic effect which quinine exerts on the circulation, an effect which, it should be mentioned, is not usually apparent during the first twenty-four hours of its administration, though remarkably persistent, has led to its being employed in combination with a tepid bath in cases where the presence of either cardiac or pulmonary disease or great circulatory enfeeblement renders immersion in cold water inadmissible. In these circumstances a marked antipyretic effect may often be obtained in addition to the other benefits conferred by hydrotherapy. The liability of quinine, however, even when guarded by opium, to set up vomiting, when given in large doses may prove an absolute bar to its employment. in 3. Next, with regard to antiseptic treatment. Originally, no doubt, antiseptic drugs were administered on the supposition that they were competent to exert a direct bactericidal effect on the specific organism present in the intestine. Murchison, formulating rules for the treatment of enteric fever, gave as the first indication, to neutralize the poison and improve the state of the blood, and he further stated that antiseptic agents might be expected to act directly on the poison in the intestinal canal. Niemeyer's teaching was in the same direction. Since the days of Murchison and Niemeyer our knowledge of the specific agent concerned in typhoid fever has been, to say the least, considerably advanced, and it is now recognized that any attempt to achieve the destruction of bacilli in the lower region of the intestinal canal by the administration of antiseptic drugs by the mouth is nothing short of futile, unless given in such strength or in such quantity as to be extremely prejudicial to the patient. Without claiming for a moment that antiseptic drugs are competent to exert a direct germicidal effect on organisms present in the intestine, blood, or tissues, it is not unreasonable to expect that even when given in relatively small and harmless doses they might be capable of exerting some restricting influence on the multiplication of bacteria in the mucous membrane and contents of the bowel, whether specific or otherwise. That such is actually effected in respect to the various putrefactive organisms which, as a matter of fact, are generally more resistant than the pathogenic species to the action of antiseptic agents, is obvious from the marked diminution in the fetor of the stools which is usually soon apparent as the result of their administration. Further, recognizing, as we do, the extent to which the vital activities of micro-organisms are influenced by very slight changes in their environment, it is surely not too much to assume that, as the result of the presence of even very minute quantities of an antiseptic, typhoid bacilli present in the intestinal mucosa and at a somewhat later stage in the blood and tissues may be so influenced as to be rendered in some degree less capable of elaborating their particular toxin than would be the case were the fluids in which they were living free from any trace of such substance. That the virulence of a micro-organism could be artificially reduced by adding a small quantity of an antiseptic to the culture medium was clearly established by Pasteur, who for a time was in the habit of utilizing this method exclusively for attenuating cultures of the bacillus anthracis in the preparation of his anthrax vaccine. That the blood may actually become impregnated with the antiseptic is proved by its appearance in the urine, as in the case of carbolic acid, urotropin, and others, and the fact that certain volatile oils, such as cinnamon and eucalyptus, which are known to possess antiseptic properties, may be readily detected in the breath and in the exhalations from the skin as a result of their continued internal administration is additional evidence to the same effect. That the antiseptic method, though frequently misunderstood, is founded on a scientific basis is undeniable. This was vigorously maintained by Dr. I. Burney Yeo, who has done so much to popularize its employment. We do not give antiseptics in the belief that they are competent either to slay the germ of typhoid fever or to neutralize its toxin, but in the confident anticipation that they will exert a restraining influence on the propagation of the specific bacillus and its congeners and on the various putrefactive organisms which are associated with it in the alimentary canal. Moreover, even if antiseptic remedies are incompetent to exercise any inhibitory influence on the multiplication of bacilli which have already passed into the circulation and have been conveyed to distant organs, we are prepared to believe that some degree of attenuation of these organisms may be brought about by the presence of even minute quantities of an antiseptic in the blood and tissues of the body. In other words, we believe that the morbific agent may be rendered less capable of elaborating a virulent toxin in consequence of the modification of its environment which the presence of an antiseptic implies. To obtain the full benefit of the antiseptic method its adherents not unnaturally insist that the remedies should be given from an early stage of the disease and in adequate and sufficiently frequent doses. Under these favorable conditions it is claimed that the following clinical indications will be secured: first, that the duration of the attack will be curtailed and the intensity of the fever lessened; secondly, that the mouth and tongue will be kept more clean and moist, with the result that greater comfort will be insured and the appetite maintained; thirdly, that diarrhea will be controlled, meteorism will be held in check, and the fetor of the evacuations prevented; fourthly, that the incidence of the most serious complications-that is to say, hemorrhage and perforation-will be rendered less frequent; and, finally, that the duration of convalescence will be shortened. Some observers, moreover, believe that the chance of relapse is materially lessened if the treatment be continued throughout the earlier period of convalescence. (To be continued in March issue.) Clinical Department. Ectopic Pregnancy-A Case Report. H. C. CROWELL, M.D., Kansas City, Mo., Professor Diseases of Women, University Medical Mrs. D., wife of a physician, and herself a pharmacist, aged thirty-two years, weight 177 pounds, 5 feet 9 inches in height, makes the following history: Five years ago, had a full term child. Has since had numbers of abortions, not induced, occurring at from fifty to sixty days after conception. Sometimes would flow from thirty to forty days, succeeding the abortion. Has been anxious for a full term gestation. Before marriage was a school teacher and enjoyed good health. Dates the beginning of pelvic trouble back to 1896-7, when she was in Texas, and then suffered with metrorrhagia for ten months, which was followed, it is said, by the full-term labor. After the child-birth, had no trouble until about two years ago, when she had pain in the region of the appendix, which subsided after three to six days of catharsis and the bed. January 31st, 1894, was awakened in the middle of the night with intense pain in the region of the right ovary. Two physicians were called and administered morphine. She had chills with high temperature, and was said to be very much blanched. The pain was of a lancinating character. Was confined to the bed for seven days; was sleeping when attacked with this pain. During the months of March, April and May was attending the St. Louis Fair daily, writing for the "local press bureau," during which time seemed to be in normal condition, except that she experienced a constant tenderness in the right groin, which led her to favor it in walking and standing. She left St. Louis June 1st, returning on the 14th and remained till July 1st. She menstruated on the last day of May and June 1st, 2nd and 3rd. On the night of June 4th had intercourse with conception in view. On June 5th was very sick, following a sixty-mile trip, vomiting and purging badly. July 1st took sleeper to Parsons, Kan., next day took a chair car to Bartelsville. The next day In was in a wreck. Went from Bartelsville to Cushing. climbing into a caboose after the wreck seemed to injure or make worse her side. Began menstruating four or five hours before getting into the caboose. Was one day in bed at Cushing on |