surgeon to be at last under control. Following an operation for dislocation of the hip-joint on a child suffering from whoopingcough, and who had averaged thirty-nine attacks during twentyfour hours, the operator noted that the child was free from coughing, and attributed the cessation to the chloroform inhaled. Following up his idea that chloroform might serve as a cure for the disease he has since treated nine other children with unusually severe whooping-cough by having them inhale a mixture of chloroform and oxygen for five minutes. In two the attacks have not recurred; in the others they dropped from twenty-nine to twelve, not returning after the fourth day. While his procedure is a dangerous one and should be used with the greatest caution, it will be warranted if further experience shows that by it whooping-cough can be cured.- Medical Age.

THERE is one point that must always be thought of when pus has been aspirated after an exploratory puncture for either suspected empyema or liver abscess; make sure that the "pus" does not come from a bronchus. This can be determined, as a rule, by microscopical examination of the aspirated fluid.- American Journal of Surgery.

THE LENHARTZ TREATMENT OF Gastric UlceR.— J. V. Haberman (Medical Record, June 16, 1906) in describing the Lenhartz treatment says that this investigator, in his search for a diet for cases of gastric ulcer, tried concentrated egg-albumen diet. It was especially desired to combat the hyperchlorhydria, reenforcing at the same time the enfeebled and anemic condition of the patient. The concentrated egg-albumen diet, after being tried in many cases, was followed by such excellent results that this method became the routine hospital treatment at the Eppendorfer Krankenhaus. The writer gives the following tabulated treatment of gastric ulcer: Absolute rest in bed for at least four weeks; avoidance of all mental excitement; the almost continual use of an ice-bag over the stomach for two weeks; the administration of between two hundred and three hundred cubic centimeters of iced milk, given in spoonfuls, and two to four beaten eggs;

the administration for ten days of two grammes of bismuth subnitrate at a dose. The eggs are beaten up entire, with a little sugar, and the dish containing them is placed in a receptacle filled with ice; sometimes a little wine is added. This food at once "binds" the supersecretive acid, mitigates the pain, and causes the vomiting to cease. After a few days some raw chopped meat is given. In the third week quite a mixed diet is allowable.-Medical Age.

PULSATION in the course of an artery should not lead to the hasty conclusion that one is dealing with an aneurism. A tumor overlying a large vessel, and also a vascular sarcoma of the bone, may simulate an aneurism very closely.- American Journal of Surgery.

TYPHOID FEVER. For intestinal hemorrhage occurring in typhoid, immobility, ice, and opium are the standards in their order of the writer. Latterly he has discarded the opium, because it masks the signs of perforation - which is apt to occur in hemorrhagic cases. These signs must be recognized promptly if the patient is to have any chance for his life. Ergotine, hypodermically, or adrenalin, now takes the place of opium, but it is extremely doubtful if any drug of the vaso-constrictor class has any real effect in checking intestinal hemorrhage. Collapse is best met by the subcutaneous injection of sterilized salt solution, about a pint being given in from two to four places. External heat, absolute quiet, absolute deprivation of fluids by the mouth, posture, and hypodermic injections of stimulants will all be required in addition; but we must carefully steer between overstimulation on the one hand and fatal syncope on the other. There is no longer any doubt about the necessity for surgical operation in cases of perforation, nor any wisdom in selecting cases for operation. Every patient should have this chance of rescue from certain death, and the only contraindication to operate is a moribund condition. Early diagnosis and early operation mean the saving of one-third of these cases, and the weight of opinion and experience is now against waiting until the second

twelve hours. The symptoms of perforation should be constantly in mind in every case of typhoid, and should be promptly recognized before peritonitis supervenes to cloud the picture and to render surgical help futile. A peculiar change in the facial expression associated with a feeble running pulse and shivering often precedes the development of the characteristic pain. This pain is of sudden, severe onset and increasing intensity, localized at first in the right iliac fossa but soon becoming general. Tenderness and rigidity, followed by symptoms of collapse, and later by abdominal distention, make up a suggestive picture, but it is doubtful if there is a single distinctive symptom, although muscular rigidity newly arisen, with coincident increase in the pulserate, may furnish the key-note of diagnosis.

Conditions which may simulate perforation are pleurisy, pneumonia, cholecystitis, perforation or rupture of gall-bladder, acute gastrointestinal indigestion, iliac thrombosis, appendicitis, sloughing of a mesenteric gland, peritonitis, renal calculus, distended urinary bladder, rupture of an acute splenic abscess, and abdominal myositis. In cases of doubt it is better to operate, as typhoid patients stand exploratory laparotomy very well. Cases of peritonitis not due to perforation will not be injured by laparotomy. It must never be forgotten that perforation often occurs without the fulminant symptoms supposed to be characteristic.— Nammack in Medical Record.

GRADUALLY increasing jaundice without previous history of pain, or with a history of very slight pain, is very suggestive of malignant disease.- American Journal of Surgery.

TO PREVENT STRUGGLING DURING NARCOSIS. One of the most disagreeable features associated with nearly every operation is the struggling of the patient during the early stages of anesthesia. To obviate this a method of procedure is advocated by the eminent German surgeon, Gersuny. This consists of having the arms and forearms enclosed in long cuffs of celluloid which project several inches beyond the tips of the fingers and make it impossible for the patient to grasp the hands of the anesthetist

or the inhaler; the cuffs are kept from slipping off by a tape fastened to the upper end of each and passed over the patient's shoulders. Attempts to sit up are easily frustrated by having a nurse place her hands under the patient's heels and keep them continually elevated one or two inches above the surface. As long as the heels are raised it is impossible for any one to sit up; it requires no muscular strength to effect this. The simplicity of Gersuny's plan to prevent struggling will commend itself to operating surgeons as worthy of being followed.- Medical Age.

Do not amputate an extremity for sarcoma without a previous careful examination of the lungs and mediastinum for metastasis. Such symptoms as continued cough, a small hemoptysis or beginning dyspnea, should be regarded as highly suggestive of such a complication.— American Journal of Surgery:

ASCITES in the presence of a mass in the pelvis usually, but not necessarily, means malignancy.-American Journal of Sur

gery.

STARCH DIGESTION IN YOUNG INFANTS.-C. E. Corlette finds (Australasian Med. Gazette, January 20, 1905) 2.03 per cent. of starch in barley water and 2.25 per cent. in rice water made aðcording to the usual formulas. There is no adequate evidence that “infants cannot digest starch." Those who use starch may diminish the milk with its useful salts to such an extent as to produce scurvy and rickets and also lessen the fuel value of the food and cause nitrogen starvation. Old authorities agree that the secretion of the infant's parotid is actively amylolytic. Animal experimentation shows that the secretion of the pancreas becomes from day to day more adapted to the requirements of the food. The adaptation is slow, and sudden change to a different regime. can produce serious illness. The absence of amylolytic ferment in the pancreatic juice in early life is due to the lack of adequate chemic stimulus. The augmenting action of the bile and intestinal juice also depends on the nature of the food. A certain amount of dextrin is probably taken up in normal digestion without reach

ing the stage of maltose and some maltose is absorbed before it has been inverted to dextrose. Further conversion is believed to occur within the intestinal cell. Whether infants ought or ought not to be given starch is a purely clinical question.- American Medicine.

Do not be too sure that a mass in the region of the pylorus is a carcinoma. In some cases the infiltration around a chronic ulcer is very extensive and may simulate the feel of a new growth. -American Journal of Surgery.

ETIOLOGY OF CROUPOUS PNEUMONIA.— Formerly it was believed that the diplococcus of Fraenkel was the sole cause of true lobar pneumonia, but the importance of the diplo-bacillus of Friedländer was soon recognized. Now H. Schottmüller (Münch, med. Woch., July 25, 1905) states that the Streptococcus mucosus is also an etiological factor, since he found it in pure culture in the lungs of five cases. The clinical symptoms were onset with chills, high fever, delirium, and stupor and albuminuria. Frequent complications were empyema and pericarditis. The defervescence was more often by lysis, and the sputum was generally very tenacious and hemorrhagic or orange-colored. The microscopical appearance of the diseased lung did not differ from that of pneumococcus pneumonia, but the exudate was marked by being very thick and tenacious. In a few cases the germ could also be cultivated from the blood during life. The percentage of positive blood-cultures obtained by the author in pneumonia in general was 23 per cent., but not all of these cases died. Conversely, the disease may be fatal, even if germs cannot be obtained from the blood during life. The importance of the Streptococcus mucosus as a cause of pneumonia is evident if the advances of serum therapy in pneumonia are noted.— Medical News.

SURGICAL SUGGESTION: In determining the cause of a postoperative fever never fail to look at the throat.- American Journal of Surgery.