apparent strength to move; tongue fissured; cheeks sunken; abdomen tympanitic (slight); temperature 102.2; weight, seven pounds; stools ten to twelve daily, full of mucous and curds of undigested milk. I gave the mother a very unfavorable prognosis, but told her to secure a nurse for the baby, and we would do all that was possible.

Treatment: Milk was stopped at once. Child fed on barley water and albumen water. I then ordered the nurse to wash out the colon twice daily through a catheter with two quarts of a solution containing Glyco-Thymoline one part, and water ten parts. By the mouth I gave 1-20 grain Calomel tablets every hour for ten hours and twenty drops of brandy every two hours.

July 17. Child in about the same condition, except that it had had only nine stools in twenty-four hours, and they were of a trifle better color with less mucus and no curds. Continued irrigations, but stopped calomel. Continued with brandy.

July 18. Seven stools, quite watery, but of a much better color. Treatment continued until July 24, at which time the child was much improved, having only three a day and passing very little mucus. On this date I started the milk again, using a very dilute formula with three ounces of milk from top of bottle, one ounce of lime water, one ounce of milk sugar and fifteen ounces of boiled water. Continued irrigation with Glyco-Thymoline, one to eight once a day, but stopped all other medicine. The baby started to thrive at once and in two weeks more we again weighed the child and noted an increase of three pounds. I gradually increased the strength of his food until at the present time he is taking eight ounces of milk to eleven ounces of water and one ounce of lime water, which is almost the average for a child of his age (51⁄2 months).

This is only one case of a number that I have treated with nearly the same routine this summer, and with satisfactory results. I lay the success I have had to two factors-first, the immediate withdrawal of all milk, and second, the continuous and copious irrigation. For this irrigation I have tried numerous solutions, but nothing to equal Glyco-Thymoline in a one to ten proportion. It appears to cleanse the inflamed colon better than

anything else and in nearly all cases of this nature I have had quick improvement in the character of the stools after its use.

In conclusion, I would state that although in this case I did not give much treatment by mouth because the symptoms seemed to point more to a lower bowel acection, yet in many cases where gastric symptoms have been more predominant, I have combined with the irrigation treatment Glyco-Thymoline in 15-30 M. doses, combined with Liquor Bismuth, as follows:

This, in connection with rectal irrigation with Glyco-Thymoline, in proportion indicated will suffice in nearly all the cases of gastro-enteritis, entero-colitis and enteritis so common in artificially fed infants.

ALBUMIN IN THE URINE.

From any point of view the term "physiological albuminuria” is almost universally regarded as misleading, unsatisfactory, and inadequate. As long as albumin is a constituent of the urine, the individual voiding it cannot be regarded as normal. The mortality among such persons must necessarily be higher than among an equal number of individuals who do not show this phenomenon. The actual mortality rate among this class can best be approximated by a comparison of the records of half a dozen of the largest life insurance companies (dealing with hundreds of thousands of cases), over a period of twenty years at the least. The promptness of discriminating between the transient forms of albuminuria and those of real clinical significance may be found in some such therapeutic test as that of calcium lactate rather than by any further developments in the chemistry of the urine. Experience proves that a "faint trace of albumin" in the urine of an individual past middle life is often of greater sig

nificance than a "decided trace," by unexpectedly directing attention to the finding of casts of pathological importance, which might otherwise have been easily overlooked.

For practical purposes the heat and nitric-acid test for albumin is the best one, and the careful use of Roberts' solution is the most satisfactory control test in doubtful cases. For the proper diagnosis and prognosis, too much stress cannot be laid on a thorough consideration of the clinical conditions as a whole. —J. P. Tunis (American Journal Medical Sciences, July, 1906).

OBSTETRICAL

LABOR, ANAESTHESIA IN THE FIRST STAGES OF.

In comparing the results obtained by the use of ether and scopalamine-morphine, the writer believes that the action of ether during the first stage of labor is more certain, and less liable to be followed by uncomfortable after-effects than the use of scopalamine and morphine, but its administration involves more trouble to the attendant.

Definite results are to be expected from the use of scopolamine-morphine in combination in the majority of patients, and patients who are not susceptible to its effects do not seem to show any serious after-effects, while the frequency of operative delivery does not seem to be increased by its use.

The after-effects are slight when the dose is carefully limited, though the action of the uterus, after labor is completed, must be carefully observed, as relaxation, with the consequent hæmorrhage, is a distinct danger. Scopolamine alone seems to have no effect in controlling the pain of labor, while morphine alone may control the pain satisfactorily, but has no effect in hastening dilatation.

Although there have been no serious results among the cases on which the writer bases his paper, one patient whose heart reacted badly serves as a warning against over-free or indiscriminate employment of this method of anesthesia, and only a wider experience can prove whether the dangers are real or imaginary.-F. S. Newell (Surgery, Gynaecology, and Obstetrics, July, 1906).

Editorial

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STAB WOUNDS OF THE HEART.

We take pleasure in directing the attention of our readers to the case of Dr. Sharber, reported in this number of the Journal as a remarkable instance of surgical daring and promptitude of action. Though the patient died, that fact does not lessen the praises due the operator for having undertaken the operation. Among the last portions of the human body invaded by the surgeon, the heart stands prominent. Whilst operations upon all the other portions of human anatomy attest the skill and aggressiveness of modern surgery, the heart as the mainspring of life is the last portion to be attacked in life-saving efforts. Until quite recently, indeed, surgical authority, as for instance, Billroth, Druit, Stephen Smith, Ashhurst, Paget and others deprecate attempts at repair of heart wounds as useless and foolhardy. The first attempt at heart surgery was the operation by Callender in 1871, when he removed a needle from the heart by operation. Baron Larrey, in 1798, removed fluid by operation from the pericardium. In 1801, Romero operated upon the pericardium in three cases, recovery ensuing in two. John C. Warren, in 1852, was the first American to remove fluid from the heart sac by aspiration. Since then numbers of cases with varying success, have been reported of pericardial surgery. Treatment of wounds of the muscular walls of the heart are less numerous. Yet there is no reason to prevent surgical treatment of various heart wounds, abscesses and cysts of that organ, and removal by operation of foreign bodies, clots and organisms. Farina reports the first re