carbolic acid, and they would not say that it is of absolutely no value in poisoning by this drug. Its solvent action may nevertheless be, under certain conditions, a danger rather than an advantage, as shown by the more marked symptoms of intoxication seen when the poison has been taken in whiskey, and this seems to contra-indicate the alcohol being used as an antidote and left in the stomach. The procedure recommended is as follows: Immediate abundant lavage with 10 per cent. alcohol, this to be followed by lavage with plain water, and stimulation as indicated. To be effective, alcohol must be used while the acid is in the stomach; it is of no use after it has been absorbed. The danger of pneumonia from inhalation of the regurgitated stomach contents during lavage in an unconscious subject is pointed out, and the authors advise during lavage turning the patient on the side or face, with the head low so that anything entering the pharynx will flow out through the mouth. Since using this plan they have had but few pulmonary complications in their patients.Medical Record.

THE BORDER LINE IN MEDICINE AND SURGERY.

E. G. Janeway states that the rule which should be formulated in a physician's mind is that no operation should be performed without a careful examination of the body by a person competent to form an intelligent opinion. Certain cases arise in the experience of every physician in which the operation performed amounts practically to taking a surgical chance in hopeless diseases. If also in such a case a large fee is charged, surgery is apt to be brought into more or less disrepute. Before an operation a thorough inquiry should be made as to drugs which have been taken or administered. This is especially true in those cases in which the debatable point concerns nervous diseases. It is a complaint of some surgeons that cases of malignant growth are brought to them at a late stage. Time is a great aid in establishing the diagnosis, and oftentimes a case which is obscure to the medical predecessor is cleared up for the one who succeeds him. The question of cardiac strength is often as interesting to

the surgeon as to the physician. Many people fear heart failure under anesthesia. Observation has shown that many patients with heart lesions have undergone operative procedures most satisfactorily. It is always well to emphasize to a patient the importance of employing a thoroughly competent anesthetist. In cases of prolonged jaundice the physician has the responsibility of considering the danger of hemorrhage which might lead to a fatal result after operation. The writer is impressed, however, with the necessity of early operation in suitable cases. Kidney disease is no longer considered such a drawback to surgical procedures as it once was. The writer admits that he does not feel inclined to urge a patient to undergo dubious palliative treatment. -The Boston Medical and Surgical Journal.

THE SAND CURE.

From Toledo, O., comes the story of a man of 88 who is youthful enough to break in yearling colts, and considers that his good health is largely due to occasional teaspoonful doses of wellwashed sand. Fifteen years ago he developed some gastric affection which did not yield to medical aid, and in his efforts at selftreatment he finally hit upon the idea of taking the sand. The measure was promptly followed by an abatement of the symptoms and has continued to do so whenever he feels that a recurrence of the difficulty is imminent.-Medical Record.

ACUTE ARTICULAR RHEUMATISM.

Cole reports a case of polyarthritis of mild grade with marked effusion into only one joint, with streptococci cultivated from this joint, and rapid and complete recovery. Other cases are also reported to demonstrate that streptococci may induce a polyarthritis of very moderate grade. Cole thinks that there is one fact which seems to point to streptococci or some very closely related organisms as the cause of rheumatic fever. There are several diseases in which one attack predisposes to another; instead of immunity there follows heightened susceptibility. Among these

diseases are erysipelas, tonsillitis, pneumonia and rheumatism. The very close relation of pneumococcus to streptococcus is now well recognized. While probably of no special value in arriving at a definite conclusion, this association of these four diseases is of interest.

Cole thinks that there are three possibilities: First, that acute articular rheumatism is a definite, specific, infectious disease, the cause of which were secondary invaders. Second, that there is no such specific disease as acute articular rheumatism, but that the cases grouped under this term are those mild and moderately severe cases of general streptococcus infection in which the joints and heart are generally involved. Third, that acute articular rheumatism is due to a special form of streptoccocus, which at present we have no accurate method of distinguishing from streptococus pyogenes, but which, owing to the specific character of the lesions induced in man, must possess special characteristics.American Medical Association Journal.

SCALP ISOLATION as a New TREATMENT FOR SCHOOL RINGWORM.

The author recommends that the scalp be shaved, rendered aseptic, exposed to the x-rays for ten minutes and then be painted with a ten per cent. salicylic acid collodion. This forms a cap that can be strengthened with rubber solution if necessary. In a week or so the whole cap will be raised from the scalp by the growth of the hair and can be pulled off. This removes the stumps of the diseased hairs. The advantages of this method are: (1) The isolation of each scalp renders the infection of other children impossible. (2) The general depilation hastens the cure and is slow and painless when the x-ray or other mild irritant is used. (3) This method combines direct and indirect treatment is necessary only every ten days and can be carried out at a central station.-Archives of Pediatrics.

OBSTETRICAL

GLYCOSURIA IN PREGNANCY AND THE PUERPERAL STATE.

Bini says that glycosuria in the pregnant and puerperal state is not constant, and is even quite rare. It is a true glycosuria, since out of twenty-nine cases examined by the author, it was found in two cases only that lactose appeared in the urine, while in the puerperal patients there was glucose and lactose; the glucose disappeared rapidly, the lactose disappeared after a few days in those who were not suckling their children, while in those that were nursing it remained for some time. The author interprets this glycosuria as of spontaneous alimentary nature, from alteration of metabolism generally dependent on pregnant intoxication directly, and collaterally from all such causes as dyscrasia, alimetary troubles, etc.-La Riforma Medica.-Medical Record.

ECTOPIC GESTATION.

In many fatal cases in which death is said to be due to socalled heart disease and other causes, the writer believes in reality it is due to internal hemorrhage from ectopic gestation. In cases of doubtful diagnosis a small vaginal incision may be made through the posterior vaginal vault, when the escape of free blood will verify the diagnosis.

The treatment is invariably surgical. As little of the anæsthetic should be used as posible, and stimulation should be withheld until the bleeding point is secured. When the abdominal incision is made no attention should be paid to the enormous quantity of blood that usually gushes forth, but the surgeon should place his hand directly on the ruptured tube and clamp the bleeding parts. After this, vigorous stimulation may be employed. The blood clots should be taken out rapidly and the abdominal cavity flushed with a large quantity of sterile saline solution. A quantity of this fluid may be allowed to remain in the pelvic cavity. Drainage is rarely necessary; in fact, it is

detrimental. In all cases in which a hematocele has formed, a vaginal incision may be made with the evacuation of the clots which lie in large quantities in the pelvic cavity; but the patient should be prepared for the abdominal operation, should it prove necessary, because of the recurrence of hemorrhage. W. H. Randle. (American Medicine, January 20, 1906).-Monthly Cyclopedia.

ACTION AGAINST PHYSICIAN FOR CONVEYING SCARLET FEVER TO A PUERPERAL WOMAN.

A remarkable case has just been decided in the courts which, in consequence of its widespread importance to the profession, has attracted much attention. A physician was called to a case of scarlet fever, after seeing which he went home and disinfected his hands. Two hours later he was summoned to a case of labor. On the fifth day the woman developed scarlet fever. The woman's husband alleged that the doctor conveyed the disease to her and claimed damages for negligence. For the plaintiff it was urged that a puerperal woman was specially liable to infection with scarlet fever in a specially malignant form and that more complete precautions against conveying infection should have been taken. Counsel supported this view by reading extracts from the writings of Dr. Galabin and Dr. Boxall, but as he did not call these authorities, the judge ruled that this was not evidence. On the other hand, Dr. Herman and Hunter were called for the defense and stated that a puerperal woman is neither more nor less liable to scarlet fever than other people; that puerperal scarlet fever is rare and that it is more dangerous than scarlet fever apart from the puerperal state. The next point in the plaintiff's case was inspired by the writings of Dr. Boxall, who stated that the following precautions should be taken after visiting a case of scarlet fever before going to a case of labor: “1, A disinfectant bath; the whole body should be immersed, the head above all, for the hair is a veritable network to entangle the poison; 2, a complete change of clothing; 3, active outdoor exercise." The physician, according to his evidence, after seeing the case of scar