September 15th.-Temperature 100; some curds passing in stools; some distension of abdomen; lungs negative. September 19th.-Temperature 100.2. Until this morning the child was doing nicely, except for some tympanites, which was relieved by enemata. This morning the mother noticed. slight twitching of fingers and forearms on left side. (He had all the time held both thumbs flexed into the palms and fingers clasped over them, so that where the index fingers crossed the thumbs there appeared a small ulceration. We had previously secured the thumbs outside the fingers to allow these to heal.) When I arrived at the house both forearms were involved in the muscular spasm, and the toes of both feet were markedly flexed. The lungs were negative, and the glottic spasms were less frequent and milder. Color of skin was even better than when last seen. September 20th.-Temperature 100. Tremor is about the same, but has not had any glottic spasms since night before. Present weight 9 1-2, showing a gain of a half pound. Has had no general convulsion. September 22nd.-Temperature 101. Tremor was less yesterday, but has increased to-day; some sore throat; a fine, elevated, glistening eruption has appeared over upper part of chest, shoulders and neck. Skin is quite red with a few minute pustules. Small ulceration appeared on umbilicus. Sweats a great deal. Bowels moved three times. September 24th.-Temperature IOI. Tremor about the same; color of skin better; eruptions disappeared; umbilicus better; profuse sweating, especially of head. Some abdominal distension: ear and scalp wounds healing nicely and urine is now quite clear. Sleeps well; no undigested food in stools. Has had slight cough for past thirty-six hours; lungs negative. September 27th.-Temperature 104. Eruption has reappeared on chest and neck; cough has disappeared; some mucus in throat; bowel movements from two to four a day; quite marked abdominal distension; respiration somewhat rapid; a few fine subcrepitant rales found in upper lobe of right lung posteriorly left side negative; tremor present as before. September 27th.-Temperature 107.4 (axillary); marked dyspnea; pulse rapid and weak; tremor has disappeared; skin dark; coarse rales over all portions of both lungs; has occasional glottic spasm; liver enlarged downward three inches. After use of cold towels for from fifteen to twenty minutes, temperature was 103: cold was discontinued, and an hour later it had dropped to 101. When temperature fell, the tremor reappeared, in hands first and finally in feet. September 28; 9.00 a.m. Temperature 101; has risen to 103 once during night; no more glottic spasm; respiration is rapid and very difficult; condition of lungs unchanged. Tremor of upper extremities as before, and mild in toes and plantar muscles. The child died at noon, the tremor subsiding only immediately before death. Treatment. The treatment of this case was, from the beginning, an effort to supply a better quality of food. Working on the theory that the disease is of gastrointestinal origin, the aim was to rid the intestinal canal of its toxin-producing material by administering at the beginning a full dose of calomel, and each subsequent day three or four one-tenth grain tablets, so as to produce from two to four free evacuations each day. To supply the lack in food a good quality of cow's milk was given at alternate feedings. Pure cream and saccharum lactis were added as needed. Comments. The theory of auto-intoxication is advanced as the determining cause of tetany, as given by Strong, Loebl and Moynihan-Peters of Berlin, in an excellent discussion of the pathologic anatomy, as a result of a histologic examination of eight cases, says that it is an organic affection, the lesion consisting of an interstitial neuritis or ganglitis, the process involving the nerve roots, innervating the parts that are the seat of the muscular spasms. This over-excitability of the motor nerves is the result of mechanical compression of the motor fibres in the root regions, by the products of the inflammation. That tetany in infants is nearly always preceded by some disorder of nutrition is very good evidence in favor of the autointoxication theory. Rachitis is a common forerunner of the disease, and while the case just detailed presents a few of its symptoms, it is hardly enough to say that, had the child lived six months longer he would have developed the disease in a wellmarked form. It might be added that antipyrin and bromid of sodium were both used in this case, with apparently little effect. I would also call attention to the fact brought out that the general condition of the child was improving up to the development of the lung complication, as evidenced by the gradual healing of the ulcerations about the head. The Management Hernia in Infancy and Childhood: ot Therapeutics. 1. If 3. In the Journal of the American Medical Association, January 14th, 1905, Dr. William B. Coley, of New York, tells of the management of hernia in infancy and childhood. In Dr. Coley's opinion truss treatment should always be the method of choice in children under the age of four years. He cites these objections to this general rule: there is a history of strangulation that has become reduced by taxis, I believe that an operation is indicated, no matter how young the child. 2. In cases in which, despite carefully directed truss treatment, the hernia has become irreducible, or reducible. with difficulty, I think early operation should be advised. In cases in which the rupture cannot be controlled by a truss and, as a consequence, is gradually increasing in size. 4. In all cases of femoral hernia, the reason for prompt operation in this class being that a cure by persistent truss treatment is practically unknown at any age. 5. Immediate operation is indicated in all cases of hernia associated with reducible hydrocele, or fluid in the hernial sac, inasmuch as it is impossible to control the rupture by means of a truss, and there is, hence, nothing to be gained by waiting. Dr. Coley considers the " oppositeside" or "cross-body" truss the best. As to duration of treatment if a child has attained the age of four years, and the rupture has not been cured, then an operation should be performed. Bread Substitutes for R. T. Williamson, M.D., in the Medical Chronicle for January, says in deciding whether a diabetic bread-substitute should be employed or not, it is necessary to determine: 1st. Whether it is practically free from starch and sugar. 2nd. Whether the taste is agreeable to the patient. 3rd. Whether the cost of the preparation is too great for the patient's means or not. 4th. In the case of diabetic biscuits sold by various firms, whether they can be broken up by the patient's teeth. The following are the most useful of these bread-substitutes: Prepared from vegetable albumens-Roborat bread, Aleuronat cakes and gluten bread. Prepared from nuts-Almond cakes and cocoanut cakes. Pre pared from milk albumens-Plasmon powder and biscuits, protene bread and biscuits, casoid bread and biscuits (kalari and pro-lacto biscuits). Hemorrhoids: Samuel G. Gant, M.D., New York, in N. Y. M. J. and P. M. J., says that he has operated upon more than two hundred and fifty cases of hemorrhoids, under sterile water anesthesia with the most gratifying results; one hundred and eighty-six of these were included in a collection of three hundred and twenty cases of various rectal operations performed under this method of anesthesia. This group of operations embraced every variety of pile tumor, under all conditions ordinarily encountered, and effective radical treatment was rendered by this method, so simple and easy to accomplish in the office, patient's home, or dispensary, without resorting to general anesthesia, and with so little danger and inconvenience to the patient, that in the writer's opinion it should relegate to oblivion the much vaunted but uncertain and dangerous injection method of treating hemorrhoids which has accomplished little and caused much suffering, but, nevertheless, has enabled the quacks or medical vampires throughout the country to extort enormous sums from this class of sufferers. Anesthesia is produced by injecting sufficient sterile water into the centres of the tumors; then they can be painlessly operated on by the ligature, clamp and cautery, or linear excision methods. The Treatment of Charles Greene Cumston, M.D., Boston, in the American Journal of Dermatology thus describes Volkman's operation for the radical cure of hydrocele: Under narcosis the sac of the hydrocele is split open by a free incision extending from the external inguinal ring to the base of the scrotum. The cavity of the tunica vaginalis is thoroughly irrigated with a 3 per cent. carbolic acid solution, and the tunica vaginalis is carefully sutured to the borders of the cutaneous incision. About fifteen to twenty sutures are necessary, and catgut or fine silk may be employed. In applying the dressings they should be put on in such a manner as to compress the scrotum tightly, so that the tunica vaginalis is everywhere in close contact with the parietal vaginalis of the testicle, and the incision is left open. A drainage tube is only necessary in those cases where the vaginalis forms multiple folds, but when such is the case, Dr. Cumston believes it better to excise as much of the membrane as may be required to avoid this condition of affairs. Recovery follows as a result of the adhesions between the two serous surfaces. Lobar Pneumonia in Dr. John Lovett Morse, Boston, in American Medicine, January 28th, 1905, delivers himself as regards the treatment of lobar pneumonia in infancy: The treatment is hygienic and supportive rather than medicinal. The infant should be disturbed as little as possible. It must have the greatest amount of fresh cool air. If possible it should be kept out of doors during the day; next best, close to an open window. Regulate diet to suit weakened digestion; use stimulation only when indicated. When required strychnine is most useful, alcohol next. If fever accompanied with nervous symptoms, cold externally, not coal tar drugs. Use hot applications for pain, bromide and codeia for restlessness. Prostatic Hyper trophy: Fifteen The present attitude regarding the treatment of prostatic hypertrophy is dealt with in the Medical Record, December 31st, 1904, by Martin W. Ware, M.D., New York. years ago the routine treatment was self-catheterization, and when exact anatomical knowledge enlightened surgeons as to the condition present, there was rapidly evolved and developed a well-planned operation by the perineal or suprapubic route. The operation by the perineal route is the elect operation for obvious reasons. In this the pendulum has swung far to the operating side of the question, and it has undoubtedly proven another triumph of modern surgery. Puerperal Infection: Rudolph Wieser Holmes, M.D., Chicago, in the Clinical Review, January, says: "Sera.-Theoretically sera are the only curative measures for puerperal infections; but, unfortunately, practically they are all of small use. For example, streptococcic serum must have been produced from identically the same germs as produced the |