suddenly removed, and in many cases the foreign body will be expelled with the emerging stream. If no urine can be forced. past the obstruction a ligature is placed about the penis on the vesical side of the obstacle to prevent its retreat toward the bladder, and the necessary dilation of the anterior urethra is effected by injecting water into it with a syringe; the expulsion is then carried out suddenly as before.-Centralblatt für Chirurgie.

PRIMARY THROMBOSIS OF EXTERNAL ILIAC ARTERY.

M. Thorner, Indianapolis (Journal A. M. A., March 24), reports the case of a patient who after two embolisms of the arteries of the leg succumbed to exhaustion and gangrene. The postmortem revealed a thrombus of the left iliac artery up to about three-fourths of an inch above its bifurcation into the internal and external iliacs. No bacteria were found in the diseased portion, and the cause is attributed to a gangrenous area of the small intestine in immediate contiguity to the artery. There was a compression of the artery, probably aiding the toxic influence from the necrosis. The cardinal factors of thrombus formation were present; disturbance of circulation, local vascular lesion and changes in the chemistry of the blood-a marasmic state, either primary or secondary to the toxemia from the intestines. He remarks on the treatment of such cases, advocating conservatism, encouragement of collateral circulation, elevation of the limb, warm applications and general asepis, together with the use of iodin preparations.-Colorado Medical Journal.

MEDICAL

PERMANGANATE OF POTASSIUM AS A REMEDY IN SKAKE-BITE.

In the issue of the Therapeutic Gazette for June, 1905, we called attention to an article by Captain Rodgers, of the Indian Medical Service, published in the Indian Medical Gazette of Calcutta for February, 1905, in which he strongly advocated the use of free crucial incisions of the bitten part, with thorough flushing of the wound with a hot solution of permanganate of potassium. We note with interest a further report of Dr. Rodgers in the Indian Medical Gazette for October, 1905, in which he records twelve cases treated by this method with ten recoveries. Of these twelve cases two were known to be due to the Russell viper, seven to the cobra, and three by a snake not identified. He analyzes the results both as to the nationality of the patients treated, their age and sex, the kind of snake, the position of the bite, and the time after the bite when the treatment was commenced. He also discusses the question of the influence of the number of fang marks. The position of the body is of course an exceedingly important factor. Thus when the fangs strike upon a part, such as the hand, in which they come in contact with bone the fang may not penetrate deeply enough to permit all of the venom to enter the tissues, whereas when soft tissues are bitten all of the poison enters into a vascular network with great speed. The conclusions at which he arrives are that permanganate of potassium is certainly to be regarded as one of our most valuable remedies in combating this condition, and he advocates the employment of the lancet which Sir Lauder Brunton and Sir Joseph Fayrer and himself described in the Indian Medical Gazette for September, 1904. It will be remembered that this lancet was so devised that by its use the permanganate of potassium could be immediately injected directly into the poisoned area. It is interesting to note that in the same issue of the Indian Medical Gazette, in the department of Correspondence, there is a letter from Civil Surgeon Choudhuri reporting an instance of viper bite in a

dog which was treated with permanganate of potassium, the dog surviving. In this instance the surgeon to whom the dog was taken, after having had a ligature applied upon the proximal part of the leg, made an incision into the area which was bitten, and then rubbed crystals of permanganate of potassium into the part. Two other dogs were bitten at the same time by the same viper and did not receive this treatment, dying within two and a half hours after being bitten.

As the reporter points out, there are five interesting points in connection with this case: First, that it really was a case of snake-bite because the snake was killed and identified; second, that two officers saw the snake bite the dog, and hanging on to it, so that there could be no doubt that the bite was effective; third, that the dog that was bitten was the first of the three, and therefore got a very full dose of the poison; fourth, that a ligature applied immediately was effective in one and a half hours in preventing the absorption of a fatal quantity of the poison; fifth, that the other two dogs which were not treated succumbed within two and a half hours.-The Therapeutic Gazette.

ACUTE DILATION OF THE STOMACH.

J. B. Herrick, Chicago (Journal A. M. A., March 31), reports two cases of acute gastric dilation, one of which terminated in recovery, the first case he thinks with such outcome when complicated by pleurisy or pneumonia. Herrick reviews the symptoms, the distention, the characteristic vomiting, etc., and remarks on the diagnosis and the extremely unfavorably prognosis in these cases. The value of the succussion sound in diagnosis is emphasized. He is convinced that the treatment used in this successful case was life saving. It consisted in frequent gastric lavage, use of normal salt solution hypodermically and by the rectum, nutrient enemas and hypodermic use of strychnin and digitalin. He also used a binder in his case, which he thinks possibly helped somewhat, at least, by keeping the stomach in its proper place. The possible value of ice applications in causing

the stomach to contract is also mentioned. Herrick thinks it a treatment worth trying in future cases, though he did not employ it. Hot water or even hot air introduced into the stomach through a tube, he thinks, might also be of value. The etiology is in many cases obscure and the theories of the disease are not entirely satisfactory.-Colorado Medical Journal.

THE DIAGNOSTIC VALUE OF LEUCOCYTES.

Grunbaum (Practitioner, Dec., 1905) believes that an accurate leucocyte count is a valuable index in determining the presence of pus in the body. A large increase in the polymorphonuclear neutrophiles, together with a glycogen reaction, an increase in the blood-plates and in the fibrin of the blood is strongly indicative of pus in the economy. When counts are made at short intervals (every four hours) and the leucocytes found to be on the increase the assumption that the inflammation is extending is justifiable. A negative blood examination, on the other hand, does not warrant the exclusion of pus. A palpable gastric tumor of obscure nature with a pronounced digestive leucocytosis is a strong evidence against malignancy, pointing to an inflammatory trouble, although small cancers of the stomach are frequently associated with a considerable digestive leucocytosis. The presence of chlorine in the blood is an important symptom in the differential diagnosis between hysteria and disseminating spinal sclerosis, as this substance is only found when there is an active process of nerve degeneration going on in the body.-The Medical Fortnightly.

CARBOHYDRATES IN DIABETES.

The amount of carbohydrates permitted is best considered in terms of wheat bread; and most patients prefer to take the amount of carbohydrates permitted them in the form of good wheat bread. Some, however, would rather have it as flour-cakes,

and there is no objection to their having it in the form of any simple carbohydrate that they prefer. If the patients take their carbohydrate partly as wheat bread and partly in some other way, then we must subtract the latter amount from the total that is permissible. Suppose, for instance, that the patient is allowed 100 grams of wheat bread-about 60 grams of oatmeal as equivalent to wheat bread, and, therefore, we form, for instance, as oatmeal or rice, in soup, 10 grams being sufficient to make a large dish of a quarter of a litre; or he takes balls of oatmeal, or 25 grams of oatmeal alone. Oatmeal and rice contain about 75 per cent. of starch. We can consider the 10 grams of oatmeal as equivalent to wheat bread, and therefore, we must subtract 10 grams (or to be quite accurate 12 grams) from the daily allowance (100 grams) of wheat bread. Twenty-five grams of grits. or rice are equal to about 30 grams of wheat bread. Of course, the patient may have other forms of bread instead of wheat bread. Rolls are useful for this purpose, the amount of starch being almost the same as in wheat bread. The rolls may be cut in small slices and spread with butter. Rye bread is also serviceable; it contains 15 per cent. less of starch, but is heavier and more compact. Aleuronat bread contains only about one-half as much starch as wheat bread, but there are few diabetics who like this bread, although among all the varieties of so-called "diabetic bread" this has the most agreeable taste. (Diabetes mellitus. Practical therapy. Modern Clinical Medicine. CabotSalinger. 1906.)

A MORE LIBERAL DIET IN TYPHOID FEVER.

It has been proved experimentally that the digestive and absorptive powers during typhoid fever fall off only 5 to 10 per cent., so that impaired digestion is not sufficient argument in favor of the exclusive milk diet. The present trend of thought is toward the belief that the majority of diseases being due to specific poisons, recovery depends upon either the exhaustion of that poison, or the development of an antibody of some sort