We have seen that the essential faults of colds have been more or less successfully treated in the past, but with only a vague idea of the real nature of the pathology of the condition, and less so of the etiology.

The maldistribution of the blood has been powerfully affected and restoration of equilibrium more or less accomplished by subjecting the entire body to even temperatures of hot or cold water, mud or air baths, and areas suffering most from anemia have been benefited by localized hyperemias accomplished by local irritation (the so-called counter-irritation).

Oxidation has been accelerated by oxygen inhalations, alkalinity has been increased by the internal administration of alkalies, the most frequently of all that popular catalytic agent, quinine, has been utilized, but all of them largely empirically, and based upon the clinical observations of benefit derived. Comprehensive prophylaxis against sources of acidity and other factors of suboxidation was unthought of, and, in fact, changes of temperature, only have received any degree of consideration in the role of etiology.

BIBLIOGRAPHY.

1. Hill, Leonard: The Mechanism of the Circulation, Schafer's Physiology, Vol. II., New York, 1889.

2. Livingson, Alfred T.: Some New and Unusual Therapeutic Applications of Ergot, Jour. Am. Med. Assoc., March 21, 1903. Ergot in Surgery, N. Y. State Jour. of Med., June, 1904. Ergot in General Practice, Jour. Am. Med. Assoc., August 27,

1904.

3. Wakefield, Homer: (a) Some Observations on Modern Cardio-Therapy, Medical Record, Sept. 14, 1901. (b) The Pathology of Catabolism in Relation to Cancer and Allied States, American Medicine, Nov. 22 and 29, 1902. (c) The Heart Cure; Its Terminology, Purposes, and Achievements, Including the Etiology of Fatty Degeneration, Medical News, Nov. 21, 1903. (d) Commentaries upon Lues and Leprosy as Subcatabolic Diseases, Medical Record, Jan. 2, 1904. (e) The Ra

tional Treatment of Malignant Tumors, American Medicine, April 23, 1904. (f) A Contribution to the Etiology of Malaria, Medical Record, Jan., 1905. (g) A Dissertation on Temperament, Diathesis, Dyscrasia, Predisposition, Cachexia, Susceptibility, Idiosyncrasy, and Heredity, American Medicine, March 18, 25, and April 1, 1905.- Medical Record.

Extracts from Home and Foreign Journals

SURGICAL

THE AMBULANT TREATMENT OF INTERNAL HEMORRHOIDS.

Collier F. Martin asserts that the treatment of internal hemorrhoids by hypodermic injection has fallen into disrepute among surgeons because it is the accepted method of the advertising quack. The many complications and accidents must not be ascribed to the method itself, but to the unscientific and unsanitary technique employed by this ignorant class of irregular practitioners. It is to be remembered that the injection method is a surgical procedure as truly as the clamp and cautery or the ligature operations, and is therefore not a method to be employed by the general practitioner. The advantages of the injection method are that the patient need not give up his business while under treatment, and is not required to take an anesthetic like ether or chloroform. The treatment is usually painless and the complications few if the case be properly handled. The disadvantages are that, in a few instances, the treatment may be a little prolonged, and where the piles are greatly thickened and fibrous they do not completely disappear. For these cases the author usually employs the ligature, operating under local anesthesia. The complications, such as pain, hemorrhage, and strangulation, can be avoided by performing a free divulsion of the sphincter muscles under nitrous oxid anesthesia. This anesthetic is quick, safe, and non-irritant, and the patient need not be confined to bed after the operation. About four days after divulsion, or when the primary soreness has subsided, the treatment by injection may be commenced. He employs a fifty per cent. solution of phenol (Bobœuf), injecting from 7 m. to 10 m. of this solution directly into the center of the pile. The injection is made through a conical speculum, care being taken first to swab off the surface of the pile with an antiseptic solution. The speculum is then withdrawn, allowing the rectal walls

to collapse, after which the syringe may be removed. After introducing a suppository containing 3 m. of ichthyol the patient may return to his usual occupation. These suppositories are also used twice daily one after stool and one at bedtime. Treatments should be given at intervals of from two to seven days and should be continued until all the hemorrhoidal masses have disappeared. The method, if properly used, is perfectly safe, and when it fails to cure, no harm has been done, and one of the other operative methods may be tried.- Medical Record.

PROPHYLAXIS OF BLADDER INFECTION.

Dr. C. Jewett called attention to a method which had served him well for preventing bladder infection when the bladder has to be catheterized. It is a rare thing that a patient is subjected to catheterization for many days without showing some evidence of bladder infection. Now and then a serious cystitis may result, particularly after labor, owing to lowered resistance and bruising of the bladder walls, and the more or less septic surroundings; the lochia always contain microbic organisms after the first few days. His practice is to give urotropin, 71⁄2 grains. t.i.d., so long as the catheter is in use. He has not seen a case of post-partum or post-operative bladder infection since adopting that plan. Brooklyn Medical Journal.

CONGENITAL LUXATION OF THE HEAD OF THE RADIUS.

Dr. E. E. Blodgett of Detroit, by invitation, reported a case of bilateral anterior luxation of the head of the radius occurring in a girl fifteen years of age. Decreased function was first noted when the patient was an infant by her inability to hold a lump. of sugar in the palm of the hand. Chief complaint at the time of examination by the author was a partial disability in either arm, shown by an inability to grasp objects with the thumb on the upper surface. At one time she had sudden pain in the left elbow.upon flexion. This gradually disappeared. The forearms were fixed, in respect to rotary motion, in full pronation. Flex

ion and extension were free. Hyper-extension beyond straight 16° on left and 20° on the right. The space usually occupied by the head of the radius was vacant. Another case occurred in a boy of six years. Since birth the forearms had been fixed in pronation and extension. Skiagrams showed bilateral anterior luxation of the radial heads. Owing to fixation, the disability was great. The upper end of the radius on either side was excised, and the result showed some improvement eighteen months after operation, but the patient still grasped objects with the thumb underneath.- Boston Medical and Surgical Journal.

THE CONDITION OF PATIENTS AFTER THE REMOVAL OF THE VERMIFORM APPENDIX.

L. Jones has investigated the after-history of 87 cases with reference to (1) pain, constipation, flatulence, etc., as referable to possible adhesions; (2) tenderness of the scar; and (3) ventral hernia. The results are as follows: (1) In some of the cases in which there was definite suppuration around the appendix the viscus was removed during the patient's stay in the hospital, while in others the abscess cavity was merely drained, the appendix being left untouched. Considering these two classes apart, the first included 22 patients, and of these 12 could mention no defect in their present health, 3 suffered with slight occasional local pain, 3 had noticed some bulging of the scar, I was more constipated than formerly, and I was more flatulent. Two ascribed definite lesions to the operation: the first had become ruptured in both groins, an effect, he considered, of his abdominal scar; the second, whose scar had "reopened" after leaving the hospital, wrote pages describing various vague complaints, and has probably developed a ventral hernia. Of these two the former has no proper ground of complaint. (2) The patients, upon whom operations had been performed during an acute attack but before obvious peritoneal infection had occurred, numbered sixteen, and in no case did any of these instance trouble sufficiently severe to incapacitate them in any way. Twelve were in perfect health; in one case the scar was slightly