subservient to the will. (4) Remedies applied to the origin or over the course of the phrenic nerve or to the cervical spine-such as blisters, icebags, compression, etc.-have no effect, while those directed to the diaphragm, the stomach, and the solar plexus are generally effective. (5) The connection between the pneumogastric and phrenic nerves by means of the third, fourth, and fifth cervical nerves is remote, and were this the route taken the impression must travel more than double as fast on the phrenic nerve as it does on the recurrent nerve, since it reaches the diaphragm before the larynx-conditions, the author remarks, which are unphysiological. (6) Romberg's and Bright's experiments show that direct irritation of the phrenic nerve will not produce hiccough. (7) There is a perfect reflex-loop between the stomach and the diaphragm which answers the purpose more directly, separated from the function of respiration and beyond. the patient's control. (8) Hiccough is influenced by swallowing and by vomiting to a greater degree than by any respiratory effort.

Some clinical evidence is on record in favor of the agency of the phrenic nerve in the production of hiccough. One piece of this evidence, among others, is the statement by M. Leloir that he has stopped hiccough. in a child twelve years old by pressing with the finger for three minutes on the phrenic nerve between the two attachments of the sternocleidomastoid muscle, also that he had resorted to this method in a great number of cases, and always with success. How is it possible, asks Mr. Symes, that M. Leloir can so exactly confine the pressure in such a region as the neck? "Can he," he continues, "prove to us that his digital compression did not equally affect the child's pneumogastric, or even the superior and inferior cardiac nerves which are contiguous? We do not, however, doubt his cures, but the laying of so much stress upon the phrenic nerve in particular in the pathology of these cases seems to us, after a very careful and unprejudiced inquiry into the phenomenon, to be at least an assumption of facts which have not been proved."

Mr. Symes says it is his fervent wish that his article may help to elucidate a most distressing condition, "an awful malady," and rescue it from the domain of quackery and empiricism, and he adds that he will feel that he has not written in vain if it guides others for even a few steps through the darkness and obscurity that still surround the subject in case they engage in similar researches.-New York Medical Journal.

THE PREVENTION AND TREATMENT OF DIPHTHERIA.-Babes and Talasescu (Roumanie Méd.) record a number of experiments made in order to verify the results obtained by various observers with respect to the attenuation of the diphtheritic virus by trichloride of iodine, by heat, and by cultivation on extract of thymus. But the main object of their experiments was to render immune animals that should be able to supply vaccinal blood in large quantities. The following are the results obtained: By vaccination of animals with cultures of the diphtheria baccillus attenuated by

growth in thymus bouillon, and then heated for fifteen minutes at 65°C., immunity can be produced so that the animal is able to resist an infection which would otherwise have been fatal. By heat and trichloride of iodine virulent cultures are transformed into a vaccine, but in order to obtain favorable results the inoculations ought to be continued for a long period. Sheep acquire immunity by this method in three months. At the end of this time their blood serum, by intra-abdominal injection, will protect guinea-pigs against a subsequent diphtheritic infection twice the strength of the usually fatal dose; but the blood serum has no influence on infection during treatment. The filtrate of cultures of the diphtheria bacillus, when treated with a solution of iodine and iodide of potash (solution of Lugol), in the proportion of one to three, one to two, and one to one, and administered in doses of one to five grams at intervals of from four to five days, protects rabbits and guinea-pigs against a diphtheritic infection twice the strength of the usually fatal dose. This method has the advantage of being constant and more rapid. The same method of treatment can be employed in the case of large animals, which, after once having acquired a high degree of immunity, are able to furnish blood which may be used clinically for the prevention and cure of diphtheria in children.-British Medical Journal.

THE COLD BATH IN PUERPERAL SEPTICEMIA.-Macé (Archives de Tocol. et de Gynéc.) strongly advocates this treatment. He has collected seventy-four cases. They include seven deaths-three from peritonitis, one from pyemia, one from exhaustion after a long shoulder-presentation labor, and two from severity of the infection; the baths were given with too much timidity. The cold bath is contra-indicated when peritonitis, phlegmon of the broad ligaments, or phlegmasia dolens exists. It has proved successful when grave maladies, such as measles, erysipelas, eclampsia, or bronchitis have complicated the puerperal infection. The obstetrician must not delay treatment when high temperature and general constitutional disturbance have set in. First of all, he must make sure that the uterus is free from products of conception. Then, should the temperature rise over 101°, the bath must be used. It is often of value when the temperature is lower, the patient already suffering from headache and hot skin. The bath should be a little over 75° F. as a rule. Macé insists that it is right to leave the patient in till she shivers, especially when hyperpyrexia is the most marked symptom. In other respects the same precautions are needed as in typhoid fever. Subcutaneous injections of caffeine or sparteine should be given before the bath when the symptoms are severe, so as to counteract the tendency to syncope.-Ibid.

SUTURE OF RUPTURED UTERUS PER VAGINAM.-Cholmogoroff (Zeitschrift f. Geburts. u. Gynäk.), in a bad case of rupture of the uterus, where the laceration was situated low down, succeeded in effecting suture from

below. The breech had presented; it was drawn down, then the aftercoming head had to be perforated through the hard palate. Expression proved useless for expelling the placenta; the hand was introduced into the uterus and a transverse laceration was detected, four inches long, an inch above the external os. The placenta was found lying amid intestine, and was extracted. Cholmogoroff feared to perform laparotomy; the labor had not been conducted antiseptically, and he believed in Mikulicz's iodoform gauze tamponade. He washed out the peritoneal cavity by means of a long glass tube with a warm two-per-cent solution of boracic acid. Then he steadied the cervix with four volsella forceps, and introduced sutures into the edges of the laceration. The serous coat was included. One end of the wound was left open, and the end of a long strip of iodoform gauze passed through it into the abdominal cavity. The opening was long enough to admit two fingers. The bleeding then ceased. The uterine cavity and vagina were packed with iodoform gauze, and the ends of the ten sutures wrapped in gauze. On the fourth day the tampons were removed, but the strip of gauze entering the peritoneal cavity was left alone; the vagina was again packed. The gauze was removed from the peritoneal cavity on the eighth day. On the tenth day there was a rigor due to inflammation of the left breast, an abscess formed and gave trouble. The sutures were removed, and it was found that the laceration had united by first intention. Cholmogoroff considers this practice good surgery, as the laceration is closed and antisepsis insured by drainage. Suture of a uterine laceration is only practicable from the vaginal side when the rent lies below the contraction ring. This position is, however, the most frequent after labor.Ibid.

THE ANTITOXIN TREATMENT OF DIPHTHERIA.-Hager (Centralbl. f. inn. Med.) has treated twenty-five cases of diphtheria with antitoxin, with only one death. The death occurred in an infant, aged eight months, who was nearly moribund within twenty-four hours of the onset of the disease. Of the remaining twenty-four cases eight were mild, six of medium severity, and ten severe or very severe; 250 immunity units were required in one case, 500 in three, 600 in six, 1,000 in seven, 1,200 in three, and 2,500 and more in two. Recovery followed in such a way as to leave no doubt as to the favorable action of the remedy. In three cases in which the process had apparently extended into the bronchi, retraction was marked in two and only slight in one. In two cases paralysis of the palate supervened, lasting fourteen and four days respectively. In another case paralysis of accommodation appeared after the child had gone to school. Only in exceptional cases was there albuminuria. No unpleasant consequences were noted, but an urticaria-like eruption appeared in five cases. Of thirty-five children inoculated against the disease two fell ill with it, but the attack was abortive. A third subsequently developed diphtheria. The diphtheria bacillus was found in most of the cases by Ackermann. Moeller (ibid.) has

treated seventy-six cases with the serum. Neither the very slight cases nor those which were moribund were injected. The mortality in his institution during the past five or six years has varied from 51 to 64 per cent, only once being 48 per cent. In the seventy-six above-named cases, fortyeight of which were tracheotomized, the mortality was 39.6 per cent. In 42 per cent of the seventy-six cases albuminuria was present, and in six cases urticaria.—Ibid.

THE DIAGNOSIS OF DIABETES AND GLYCOSURIA BY EXAMINATION OF THE BLOOD.—Bremer (Centralbl. f. d. med. Wissensch.) describes a modificaof Ehrlich's method of staining cover-glass preparations of blood with eosin and methyl blue. By this method of staining in normal blood, the red blood corpuscles appear brownish red, but the color varies from a clear reddish brown to a deep chestnut brown. The nuclei of the leucocytes stain blue. Bremer found that in diabetes and glycosuria the red blood corpuscles either remained completely unstained, or they were simply tinted light yellow or greenish yellow. Only occasionally a small peripheral zone of the red corpuscle was tinged slightly red. Other minor changes were found in the leucocytes. With acid fuchsine and other so-called acid dyes, the red corpuscles of diabetic blood stained just in the same manner as those of normal blood. It was only eosin which did not stain them. In order to determine whether this loss of staining affinity for eosin was due to the abnormal amount of sugar in diabetic blood, Bremer treated coverglass preparations of normal blood with a solution of sugar. But he found that the red corpuscles still stained with eosin, as in normal blood. If, however, a cover-glass preparation of non-diabetic blood was floated for twenty-five to thirty minutes in a diabetic urine, the red corpuscles failed to stain brownish red with eosin; they remained unstained or were only slightly tinted yellow or greenish yellow, as in diabetic blood. But the red corpuscles in a cover-glass preparation of non-diabetic blood, treated with urine free from sugar, stained well with eosin. In glycosuria produced artificially by the administration of phloroglucin for three days, the red corpuscles failed to stain with eosin, as in diabetes.-Ibid.

THE COMPENSATORY ACTION OF THE CEREBRAL HEMISPheres.Marie de Manacein (Neurol. Centralbl.) has tested this capacity by various methods. Assuming that sleep is most profound during the first two or three hours, and that the left cerebral hemisphere normally being the seat of the speech and right-hand centers is more active in the working state, and therefore more exhausted and less accessible to stimuli than the right during sleep, it was found that on lightly tickling either side of the face of ordinary persons in this stage of somnolence, the sleeper made repellent movements invariably with the left hand, even when from lying on the left side it was necessary for the sleeper to withdraw the limb from beneath the body. In eight left-handed persons the right limb alone was moved. These

experiments, the author maintains, are demonstrative of the compensatory or vicarious action of the one cerebral hemisphere during deep sleep. further illustrations of the point, it is mentioned that in dogs exhausted by complete deprivation of sleep, reflex movements only occurred on one or other side, alternating periodically as if one half of the brain were temporarily asleep. In cases of left hemicrania with disturbance of speech and writing, the latter act could be accomplished with the left hand better during the attack than at other times.-Ibid.

A CASE OF STRANGULATED FEMORAL HERNIA DURING PREGNANCY.Gauctier (Revue de Chirurgie) reports a case of strangulated femoral hernia on the right side in a patient, aged forty, who had reached the ninth month of pregnancy. The hernia, which had existed for six years, had previously given but little trouble, and the patient had never worn a truss. Kelotomy was performed twenty-four hours after the earliest symptoms of strangulation, and, after the reduction of a loop of deeply-congested intestine, the sac was removed, and the opening closed by bringing Gimbernat's ligament into contact with the inner portion of Poupart's ligament by means of oblique metallic sutures. The patient, who was delivered of a living and full-grown child six days after the operation, made a speedy and complete recovery, and was discharged at the end of a month. The association of strangulated hernia with pregnancy must, the author states, be extremely rare, as he has been unable to find any previously recorded case; and, according to Berger, there is an incompatibility between these two conditions.-Ibid.

THE ADVANTAGE OF INTERNAL URETHROTOMY OVER FORCIBLE DILATATION. Cantalupo (Rif. Med.) advocates internal urethrotomy in hard strictures where a dilator can not be introduced, or, if introduced, can not be opened (in which case he uses Maisonneuve's urethrotome). The wound in internal urethrotomy is much less extensive than in forcible dilatation, and the dilatability of the stricture is much greater after urethrotomy than after divulsion. The chief dangers are: (1) Hemorrhage; this may be avoided by using small-bladed instruments-for example, Bottini's. (2) Extravasation of urine; best avoided by retaining a catheter of less caliber than the divided stricture, and using some drainage-tube as a siphon. (3) Pyemia may be excluded by antiseptic measures. (4) Fever, generally due to local retention of pus. Cantalupo finds a fresh indication for internal urethrotomy in cases of chronic gleet with stricture, where, after dilating the stricture up to a certain point, it still can not be dilated up to the caliber of the sound part of the urethra.-Ibid.

ULCERATIVE ENDOCARDITIS AND ACUTE ARTICULAR RHEUMATISM.Leyden (Deut. med. Woch.) first sketches the history of the bacteriology of malignant endocarditis. The cause of rheumatic endocarditis is not yet