pleural serous effusions, unless they show a tendency to early absorption, should be removed. 2. Granting that in the majority of such cases pleurisy is the dominant feature and removal of the fluid the proper procedure, and that such removal will probably tend to arrest the pleural tuberculosis, which is usually, nevertheless the best results ought to be obtained by dealing with each case on its own merits. 3. In cases in which the pleurisy is the sole or dominant feature, the removal of the fluid is the proper treatment; and in proportion to the accuracy of differentiation between the pleural and the pulmonary disease will be the promise of good results by the removal of an effusion. 4. In cases in which the tuberculosis of the lung is evidently or probably the overshadowing feature, a conservative course as regards the removal of a serous effusion is the proper one. In some cases the fluid had best be left to Nature to take care of, with the hope that the compression, immobilization, and physiologic quietude of the tuberculous lung may tend to arrest the disease. In other cases of this type the removal of the fluid should be undertaken only after due consideration.- Louisville Monthly Journal of Medicine and Surgery.

THE USE OF RYE BREAD IN DIABETES.

The Medical Record for Nov. 4, 1905, quotes the Intercolonial Medical Journal of Australasia as follows: M. C. Lidwill has for some time been prescribing black rye bread (pumpernickle) in the case of diabetic patients. It is used as a substitute for wheat bread. The results of its use are entire disappearance or diminution of the sugar from the urine, gain in weight, and contentment on the part of the patient. The writer was led to the use of rye bread by the craving and empty feeling of which patients complain who are on the so-called diabetic diets. He sums up the advantages of rye bread as follows: It is satisfying; it stops the empty feeling; patients eat but little of it in proportion to wheat bread, about one and a half loaves sufficing for each week. This bread contains but little digestible starch; it is a laxative, combating constipation. The sugar in the urine during its use

decreases to a considerable extent. Patients do not tire of it. It is a cheap food. The writer adds that rye bread is employed with the greatest benefit in the milder forms of glycosuria met with in the middle aged or old.- St. Louis Medical Review.

SUPRARENAL EXTRACT IN ASTHMA.

Dr. G. W. Kirby, Millersburg, Ind., calls attention to the marked opportunity before the physician to fulfil his high aim of relieving suffering and of prolonging life by relieving the intense suffering produced by a severe asthmatic attack. He declares that more rapid relief cannot be obtained in any condition than that secured in the use of the blood-raising principle from the suprarenal gland. He injects subcutaneously from 8 to 15 drops of adrenalin, which has been diluted with an equal amount of sterile water. This affords the patient almost instant relief. Aside from a throbbing sensation in the head and a weakness of the limbs due to the stimulation of the heart, no bad results follow. To my knowledge, he continues, this drug has not been advertised to be used in this condition, nor have I known of its general use in practice. It gives some relief in every case, but its chief use can be considered specific in the treatment of the spasmodic form of asthma, where so much morphia is given.Jour. A. M. A.

TOXIC AMBLYOPIA DUE TO COPPER.

The patient

He

Jean Galezowski reports this interesting case. was a man fifty-seven years old; for seven years he had suffered from clouded vision. His pupils reacted slowly to light. When he was examined he showed all the signs of toxic amblyopia. The cause was discovered with some difficulty. worked in the fields by day, but it was learned finally, that at night, in order to eke out his income, he played sometimes for many hours on a musical instrument. The mouth-piece, originally silvered over, was made of copper. His two upper median incisors were covered at the border of the gums with a

greenish substance. He had played upon this instrument since he was twelve years old. In this way he had absorbed a quantity of the copper. This may have occurred both through his lips and by means of his hands as well; for while holding the instrument, he perspired freely and then ate his food without washing his hands. He drank very little, neither did he smoke much. He seemed to be saturated with copper, since his teeth and gums were covered with it, and his hands impregnated with it. For some years he had suffered from violent gastric pains which were probably due to the copper intoxication. It must be admitted that copper may exert over the optic nerve the same influence as alcohol, tobacco, and lead.— Recueil d' Ophthalmologie, October, 1905.

OBSTETRICAL

INTESTINAL OBSTRUCTION AND PELVIC OPERATIONS.

The frequency of intestinal obstruction occurring as a postoperative condition in pelvic surgery is shown by the statement of E. M. Conner (Practitioner, August, 1905), that it is relatively frequent. He considers the operation which stands pre-eminent among all others in causing this complication, to be supravaginal hysterectomy. While adhesions may be present without producing any symptoms, the presence of attacks of localized abdominal pain, associated with vomiting, after an abdominal operation, and especially after a pelvic one, should raise the question of the advisability of exploration. The intestinal obstruction usually results from the intestine forming a kink, or better a volvulus, using the uppermost adhesion for a fixed point on which to rotate. The cause of this volvulvus, in far the majority of cases, is an increase of pressure within the bowel, produced by gas formation, meteorism. The origin of the meteorism is to be found in some error of the diet or the digestion. Sometimes strong peristalsis draws out the adhesion into the form of a band, under which a coil of small intestine may be ensnared. Meteorism produces a volvulus in almost every obstructed loop. These

adhesions antedate the obstruction, showing that the latter is merely a complication, and raising the suspicion that, for every case in which this does occur, the probability is, that there are many in which it does not occur. The presence of the uterine stump among the small intestines undoubtedly disposes them to become adherent. How this adhesion takes place is not quite clear. Perhaps the most favored suggestion is that the row of sutures and knots offers the opportunity for the bowel to adhere. In consequence of the sutures being tied firmly, if not tightly, the tissues within their grasp are lessened in bulk, fluids being squeezed out of them. There is a tendency for each stitch to lie in a groove of its own making. The fluids which have been expressed in tying the ligature will swell the bulk of the contiguous tissues. The slight injury, thus inflicted, calls forth a reparative inflammatory reaction, augmented later by the irritative action of the aseptic stitch, causes a small effusion of lymph which soon covers the stitches. In the case of a uterine stump, with gaping of the peritoneal edges, the formation of adhesions with the intestines is invited.- Medical News.

SHOULD A MOTHER HAVING SCARLATINA BE ALLOWED TO NURSE?

Salge answers this question in the affirmative, and says that the current tendency both among the laity and medical men to accept all sorts of disturbances of the health of the mother as an excuse for stopping nursing is quite unnecessary. It is supposed that the milk will be injurious, or that the child will be infected, etc., but this is not the case even in dealing with the acute infectious diseases. The author describes the case of a girl of seventeen who about six weeks after confinement developed scarlet fever, which ran a course of medium severity. Up to the fourth day she was able to satisfy the child's hunger, but from then until the seventh day bottle feeding was given in addition, and after that the milk ceased entirely. On the eleventh day it appeared again, so that the mixed feeding could be resumed, and after the twenty-sixth day the artificial food was dropped entirely. The child did not suffer at the time

nor subsequently. Breast milk confers on the child an enhanced power of resistance against all infections, and its value is so great that tuberculosis is the only disease which, as a routine measure, demands weaning. Measles and diphtheria do not, though in the latter case the infant should be immunized.- Medical Record.

ULCER OF THE STOMACH AND PREGNANCY.

Mild dyspeptic troubles and subacute gastritis are of frequent occurrence during pregnancy, but ulceration is rare. M. Le Play (Annal. de Gynecol. et d'Obstet., May, 1905) describes the case of a woman twenty-seven years old, six months pregnant, who had vomited almost continuously for over three months. Her stomach was dilated and very tender. Later she passed large quantities of blood from the bowels and had several attacks of hematemesis in rapid succession. She rapidly became very weak and died after presenting a clinical picture resembling progressive pernicious anemia. At autopsy the larger curvature of the stom

ach showed an ulcer 12 cm. x 9 cm., with raised margins. The base extended to the peritoneum, but there was no perforation. There was marked sclerosis of all the adjacent vessels. Owing to this condition of the blood-vessels, the nutrition of adjacent areas suffered and had undergone degeneration, offering but feeble resistance to the action of the acids of the gastric secretion. The writer considers that pregnancy by favoring sclerotic changes in the blood-vessels would thus predispose to the formation of a gastric ulcer.- Medical News.

ECLAMPTIC CONVULSION OCCURRING FOURTEEN DAYS AFTER CON

FINEMENT.

George Cuscaden reports this case. Fourteen days after the patient's confinement, on her return from a call across the street, she was seized by an epileptic form of convulsion lasting thirty minutes. Six hours later another fit, lasting twenty minutes, occurred. The muscles of the nostrils and the face moved