holding the legs only. A part only of the milk introduced into the mouth was swallowed, and the attempt produced cyanosis and short feeble cries. Nutrient enemata, chloral, and bromide constituted the treatment.

On the seventh day an alarming collapse took place, but passed off. Similar attacks followed on succeeding days. On the tenth day there were eight of these attacks, and the child died in the evening of this day.

On the eighth day of the disease four tenths of a gram of antitoxin was given subcutaneously, and during the ninth day two injections of the same amount were given.

On the tenth day eight-tenths gram was given at one dose. The total given thus was two grams.

In the Quarterly Medical Journal two cases of traumatic tetanus in adults are reported, both successfully treated by antitoxin. The antitoxin treatment was begun on the ninth and third days of the disease respectively. In both these cases repeated doses of the antitoxin were required, and improvement in the symptoms followed each dose.

It is interesting to note that in the last case, a child of six, a rash. resembling measles with fever and swelling of the cervical lymphatic glands appeared on the twelfth day after the discontinuance of the antitoxin.

That a similar rash has been often noticed after the antitoxin treatment of diphtheria is interesting, and points to the fact that the rash may be due to the serum itself, and not to the particular antitoxin it contains. The failure of the serum in the case of tetanus neonatorum can not be considered as indicating its unreliability, when we consider that the eighth day of the disease in a new-born child is a much later period with reference to effective treatment than it is in an adult. The possibility of complications, as suggested by the jaundice and attacks of collapse, which are not usually symptoms of tetanus, is present. Unfortunately no autopsy was allowed.

In the light of these cases, and in view of the widespread reports of the success of antitoxin in diphtheria, we think the time has come when public authorities should take into serious consideration the general problem of assuring to the profession and to the public reliable sources of supply of such antitoxins as are proved by sufficient and careful experience to be curative--Boston Medical and Surgical Journal.

Some of the Vagaries of EPIDEMIC INFLUENZA.-" I apprehend from the present state of our knowledge (of influenza) that we can hardly venture to say what it is not, still less to affirm with any probability what it is." The same author speaks of erysipelas being of common occurrence in the epidemic of 1775. I have seen only two such cases. The first was in a man, eighty years of age, who had the disease in a chronic form, and was insane therefrom. When first seen his nose was swollen to three times its natural size. I thought he had received a blow, although he declared he had not. By the next day the disease had extended to the eyelids, where it stopped. The man remained insane, but the erysipelas yielded to the usual remedies for influenza, calomel and soda. The other case was that of a young lady

whose erysipelatous attack was exactly similar to the one described. In this malady I have seen a difference of nearly twelve degrees in temperature in persons seemingly affected alike. I have seen the pulse so irregular that, had it been ten years ago, I would have thought these persons had hardly a day to live, yet they were going around and attending to their business as though nothing was the matter. I have seen a great many cases in which inflammation of the aural cavities was the only local lesion. I have had several influenza patients with chronic inflammation and enlargement of the testicles. One of these was recently castrated for the relief of enlarged prostate, when the removed glands were found to be not much more than large pus-sacs. Many symptoms have been described during the present epidemic of influenza, such as every form of eruption and inflammation of the mucous membrane lining every cavity of the body, but I have never seen orchitis spoken of as a part of this disease.-Dr. Edward Anderson, in Medical News.

A NEW METHOD OF OPERATING FOR THE CURE OF SUPERFICIAL VARICOSE VEINS.-A varicose condition of the veins of the legs often gives rise to a most troublesome and unyielding state of affairs. It is most common in persons of lax fiber who are compelled to be upon their feet a good deal, and women suffer more largely than men. Pregnancy is often an exciting cause. Beyond the annoyance and distress inherent in the condition, together with the interference of locomotion which it entails, are the dangers of ulceration and rupture. A measure of relief may be afforded by the use of support and compression in various forms, but these are not unattended with petty difficulties, and hold out no promise of cure. Numerous radical procedures have been proposed for relief from the condition, and have met with varying degrees of success. That which most commends itself in these days of aseptic surgery as the most rational and the most simple consists in the excision of the affected vessels, in part at least. It has been customary to ligate the divided veins, but experience has shown that the ligature is not entirely free from danger. With these facts in mind Stoker (Dublin Journal of Medical Science) substitutes compression for the ligature after excision of a portion of the affected vein. He has applied his method to the treatment of varicose veins of the legs and varicocele when the operation can be performed high up, close to the external abdominal ring, and when the tissues of the groin afforded good counter-pressure to a compress and a well-applied spica. The following are the various stages of the operation: The patient is kept in bed for two or three days, the bowels are well cleared out, and the skin of the parts to be operated on is rendered aseptic by (a) thoroughly scrubbing with soap and water; (b) washing with ether; (c) keeping for twenty-hours in a dressing of 1 in 40 solution of carbolic acid, covered with mackintosh, and changing two or three times. An anesthetic is not employed, unless the patient insists on it. The pain is insignificant, and the probable struggling under anesthesia would interfere

with the delicacy of the method, would cause bleeding at the time, and, if subsequent vomiting takes place, might produce a blood-clot under the dressing. If anesthesia is decided upon, it should be general, and an Esmarch bandage should not be applied. If any doubt exists as to the position of the veins, the patient is made to stand up, and a slight scratch with a sharp knife is made over the distended vessels at the points selected for operation. At each place where it may be thought necessary to divide the veins an incision about half an inch long should be made in the vertical axis of the limb, the superficial fascia divided with an oculist's scissors, the vessel lifted from its bed, a quarter of an inch cut from its length, and gentle pressure applied with a sponge. When this procedure has been repeated at all necessary points the parts should be thoroughly irrigated with a warm sublimate solution, flat compresses of sterilized gauze applied to each incision, a dressing placed over them, and the limb bandaged from the toes to above the seat of operation. The patient should be kept in bed and not allowed to rise from the horizontal position for a week. If the dressings are then removed, a superficial linear ulcer will be found at the seat of each incision. These can be treated by wet dressings for a few days, when they will be found to have healed. As we have said, the method commends itself for its simplicity, its rationalness, and its comparative freedom from risk. It need scarcely be added that the result will depend upon the perfection of asepsis in the performance of the operation.-Medical News.

TREATMENT OF AFFECTIONS OF THE HEART FOLLOWING INFLUENZA. Dr. Ernest Sansom gives an account in The Practitioner of the nervous disturbances of the heart following influenza, and adds some practical points in treatment. For influenza itself, Dr. Sansom seems to rely chiefly on sulpho-carbolate of soda in half-dram doses, for what reason he does not tell. He adds to this, however, when needed, quinine and phenacetin for fever, and, in adynamia, five grains of musk.

The signs and symptoms referred to the heart resulting from influenza in cases under the writer's observation were thus distributed: In one hundred cases: pain referred to the heart, twenty-three cases; the rapid heart (tachycardia), thirty-seven cases; the irregular heart (arhythmia cordis), twenty-five cases; the slow heart (bradycardia), five cases; organic disease of the heart, ten cases.

In heart pain he gives a hypodermic of morphia with a diffusible stimulant, such as: Spiritus etheris, 3 ss.; spiritus ammonia co., 3 ss.; tinct. sumbul, 3 ss.; aquæ camphora, 3 iss.; to be taken as a draught before the administration of morphia, and repeated an hour afterward. Once the severity of the pain is thus mitigated, other agents than morphia should be employed. Quinine in five-grain doses dissolved in hydrobromic acid is often very effectual. Local sedative and counter-irritant applications may also be required.

Tachycardia after influenza is sometimes not noticed, and the pulse may not be much above 100. Some of the vaso-motor and eye symptoms of

Graves' disease may be present. Dr. Sansom regards digitalis and strophanthus as not only useless but dangerous, and he also avoids opium. He prescribes bromides with arsenic and symptomatic drugs for dyspeptic symptoms which are apt to be present. In many cases drugs are of no avail, and he advises that a mild galvanic current be given three times a day for six months! He states truly that patience is required. The irregular heart is usually associated with symptoms like those with tachycardia, and much the same treatment is indicated.

Bradycardia sometimes occurs, and may be severe and persistent. In one case the pulse fell to 19 per minute. Phenacetin and camphor with local warmth and counter-irritation are effective in mild cases. In the more obstinate tincture of belladonna may be given in ten-drop doses. Medical Record.

THE PATELLAR TENDON-Reflexes DURING PREGNANCY.-That a condition of general hyper-excitability is present during pregnancy is a matter of common observation. The fact is accepted without question, but the explanation, if it could be given, would prove most interesting. It is not unreasonable to suppose that it is to be looked for in the action upon the nerve cells of the brain and spinal cord of certain substances either normally present in the blood but now in excess, or altogether absent under ordinary conditions. Few systematic observations have heretofore been made in this connection. An interesting contribution to the subject has recently been made by Neumann (Centralblatt für Gynäkologie), who reports the results of a series of observations upon the knee-jerk during pregnancy. His examinations included five hundred women, and many were made during pregnancy, in the course of labor, and during the puerperium. In a large number he found the knee-jerk exaggerated. The impression was gained that the increase was progressive with the advance of pregnancy, little or no change being observed in the earlier months. The alteration was usually first observed in the second half of gravidity. It appeared that age, the number of previous pregnancies, and the position and presentation of the fetus had no influence upon the degree of increase, while the individuality as shown in the psychic condition seemed to have such an influence. In some cases no change was observed throughout. The knee-jerk was invariably increased in parturient women in whom the pains were active. Sometimes reaction was attended with unpleasant sensations. Often in the cases in which no change in the reflex had been observed during pregnancy such an increase appeared during labor. In a few cases in which the labor was complicated with premature rupture of the membranes and feeble pains there was no increase in the reflex. The exaggeration was progressive toward the end of labor, and reached its maximum during the period of expulsion. The return to normal ensued gradually during the puerperal period. The peculiarity is believed to be associated with the act of parturition, and was proportionate to the activity of the pains. It was

further frequently found that during the progress of labor other reflexes were correspondingly increased. The conclusion is reached that during pregnancy, and particularly during labor, the central nervous system is in a condition of heightened irritability. A convenient means of studying the knee-jerk in a recumbent individual was found to consist in having the thigh and knee slightly flexed, and the thigh rotated outward so as to lie on its outer aspect.

A study of the urine at different periods of pregnancy, particularly with regard to its convulsivant action upon lower animals, as compared with its action at other times, would be a natural complement to these interesting observations on the reflexes.-Medical News.

THE ULNAR SYMPTOM IN GENERAL PARALYSIS. Recently at a meeting of the Berlin Psychiatric Society, Boedeker and Falkenberg (Neurol. Centralbl.) gave the results of their researches on this subject. According to Cramer in 75 per cent of general paralytics the trunk of the ulnar nerve is not painful on pressure, while in most cases of other forms of insanity compression of the nerve as it lies between the olecranon and the inner condyle produces sharp pain and reaction. The authors examined 100 male and 25 female paralytics, and 300 non-paralytic insane persons. In 58 per cent of the paralytics the ulnar nerve was analgesic; in 35 per cent pressure caused pain; in 7 per cent the result was doubtful. Of the non-paralytics, 39 per cent showed ulnar analgesia; the remainder exhibited no such defect. The authors remarked on the fallacies apt to arise from the subjective element, and they concluded that analgesia of the ulnar trunk is of little value in the diagnosis of general paralysis. They found the ulnar symptom in 74 per cent of 31 paralytics who exhibited loss of knee-jerk. At the same meeting Mendel stated that he not infrequently had observed analgesia of the legs to be an early symptom of general paralysis in cases where knee-jerk was present and no other evidence of tabes existed.-British Medical Journal.

EXPULSION OF THE FETUS AFTER DEATH.-Mr. Evan Jones, surgeon to the Aberdare Cottage Hospital, sends us the following particulars of a case which was briefly reported by him at the meeting of the South Wales and Monmouthshire Branch on February 28th: The case referred to is that of M. M., aged thirty-seven, whom I saw in consultation with Dr. Thomas, of Hirwain. She was eight months gone in pregnancy. When seen she appeared in articulo; she had general dropsy, and was violently convulsed. The os was unusually rigid. I managed to dilate so as to admit an index finger. During manipulation her condition got so critical that we thought it best to delay dilatation. Dr. Thomas saw her four or five hours before death, and the os was then in the same condition. He saw her again five hours after death, and the child was in utero. He then assisted the midwife to lift her on to the bed. Two days afterward the undertaker, putting the body in the coffin, found the child and placenta between her legs, with fluid running freely from the vagina.-British Medical Journal.