Bielefeld a large colony, with hospitals, schools, shops, farm-houses, shoefactories, book-binderies, and buildings for numerous other occupations in which epileptics are employed. Between the founding of the institution in 1867 and the end of the year 1888, 2,534 epileptic patients were treated in this institution. During the year 1888, 1,091 patients were cared for by 67 brothers and 68 sisters of religious orders, showing that one attendant was necessary for approximately seven epileptics.

The idea of formning colonies for persons suffering with chronic incurable diseases is not new, for the leprous have been colonized since early times; but in this and similar instances the sick were segregated for the benefit of the well, and not out of any special regard for the former.

The extension of the practice for the good of the afflicted is purely humanitarian and the natural outgrowth of the spirit of altruism which now pervades christendom.

There can be no question that epileptics can be better managed and more successfully treated in institutions devoted to the purpose than at home or in the public hospitals and dispensaries; but private institutions can avail the poor nothing, and they are compelled to drag out a wretched existence, handicapped by a cruel disease, shunned by their neighbors, and neglected, through ignorance or necessity, by their kin. To such a State sanitarium or farm is indeed a godsend, nor is it to be forgotten that many who are able to pay for care and treatment would gladly escape into such a place from surroundings wherein their epileptic seizures are a perpetual source of mortification.

The work is Christian, is humanitarian, is beneficent, and no argument is needed to commend it to the favor of every lover of his kind. It is stated that Massachusetts and Ohio are preparing to follow the lead of New York in this good work, and there can be little doubt that the other States will soon do likewise.

Notes and Queries.

ADMINISTRATION OF THYMUS IN EXOPHTHALMIC GOITRE.-R. H. Cunningham gives three cases of exophthalmic goitre in which a diet of thymus produced good results. Case 1.-Miss B., aged 20, first seen October 2, 1894; had been told by several physicians that she had Basedow's disease. Her immediate complaint was of weakness and insomnia. Her hereditary history was noteworthy. Her deceased father had prominent eyes, suffered from insomnia, and died of pneumonia two years ago. Her paternal aunt had prominent eyes and a slight swelling in the neck, had complained much of palpitation and general weakness. Her death was said by the doctor to be due to "heart trouble." Miss B.'s brother, aged twenty-five, has prominent eyes, but is strong and active. Except for measles Miss B. enjoyed good health until two years ago. Shortly after a great grief she began to suffer from palpitation on slight exertion. Next the eyes became gradually prominent, but insomnia has only troubled her for a year. She also complains of mental depression, loss of energy, excessive right-sided sweating at night, sensations of flushing, tremor of the hands, and occasional headaches. The appetite is poor, the bowels constipated. On examination exophthalmos is present in fair amount, both Von Graefe's and Stellwag's symptoms being present. Slight inco-ordination on convergence. Apex beat 124, strong, regular, no displacement, not much evidence of hypertrophy. Thyroid moderately enlarged, soft, compressible, a moderate bruit over it. Slightly anemic, red corpuscles 4,600,ooo per c.mm., hemoglobin 60 per cent. Thyroid tablets (5 gr.), one t. i. d., were given, and trional for the insomnia. October 4th. Feels worse, has slept no better. Heart-beats increased to 136, irregular at times; respiration 28. The thyroid tablets were omitted, and fresh lamb's thymus given, minced fine and taken raw. October 10th. Has taken the gland slightly broiled, as taken raw it produced sickness. Heart now 120, regular, respirations 20. Has slept better; no other change. October 20th. Has slept well for the past few nights (without a hypnotic); has taken the thymus raw for three days without nausea; pulse 100, respiration 18. March 10, 1895. Feels as well as ever; the neck swelling has gone; is not tired by considerable exercise. Pulse 72; is sleeping well. Eyes no longer prominent, color has returned to cheeks. Case 2 was irregular over his treatment, but improved in many respects. He presented lessened energy, severe insomnia, palpitation, fatigue, and moderate dyspnea on slight exertion, prominent eyes, with lagging upper lids on looking downward, slight horizontal nystagmus on rapid convergence, slightly enlarged thyroid, pulse 100 to 110, a well-marked, fine-waved tremor of the hands. These

symptoms had increased progressively for four years. After an irregular administration of slightly cooked lamb's thymus for two weeks the pulse fell to 78, and perfect regularity. Slept better and felt stronger. Eyes much less prominent. Von Graefe's symptoms obtained only by searching examination. Later still the eyes were apparently normal, pulse 76, capacity for hard work greatly increased, tremor of hands quite gone. In Case 3, presenting the usual symptoms, twelve to fifteen thymus gland (15 gr.) tabloids per day were given, with great improvement, especially as regards the ocular symptoms and enlarged gland.—British Medical Journal.

THE TREATMENT OF CHRONIC CONSTIPATION WITHOUT MEDICINE.J. Schreiber (Wien. med. Presse, Nos. 21 and 22, 1895,) calls attention to the great change in the treatment of chronic constipation during the last ten years. Before he had adopted the mechanical treatment he was unsuccessful in relieving ten per cent of his patients; since then he has had only three failures in one hundred cases. His course of manipulation extends over six weeks to three months, and consists in systematic massage of the large intestine for eight to ten minutes daily. A considerable amount of power is employed, and the rubbing and pressure are directed by anatomical considerations. The cure is assisted by gymnastics and exercise; if necessary, mild aperients may also be employed. The diet also is carefully regulated. Before massage is begun the absence of floating kidney, uterine or ovarian disease must be ascertained. Schreiber distinguishes four forms of chronic constipation: (1) In strong, healthy, often young patients, due to hereditary predisposition or sedentary life, or to no ascertainable cause; (2) from the endless forms of digestive disturbance; (3) in patients weakened by neurasthenia or anemia; (4) in the corpulent. In all these the mechanical treatment is the most certain means of cure. It is of the greatest service in the first form. In the second it will not succeed unless combined with severe and rigid dieting. In neurasthenic cases it must be associated with the means usually employed in the treament of that disorder, such as change of air, distraction, wet packing, electricity, mental influences, and pleasant occupation. The treatment of chronic constipation by purgatives and enemata undoubtedly lessens the suffering, but at the same time depresses the energy of the intestinal muscles; the longer medical treatment has lasted, the more difficult and tedious will be the mechanical cure.-Ibid.

ACTINOMYCOSIS.-Choux (Arch. gén. de Méd., April, 1895,) begins a study of this subject. In man the lesions are associated with suppuration, whereas in animals small, hard tumors are formed resembling sarcoma. The identity of the micro-organism in these cases has been proved. The lesions in animals occur in association with lower jaw, tongue, pharynx, and respiratory organs. In man they appear most often in the neck. The parasite provokes a round-celled growth, the cells in contact with it under

going degenerative changes. Thus, a small abscess is developed containing the parasite in the form of a yellow granule. It tends to make its way to the surface, but also invades the deeper tissues. Cavities and osteophytes are produced in bone. In the lung the lesion is either peribronchial or intrapulmonary. It varies in size from a millet seed up to a cherry, or even an apple. It may make its way through the pleura and chest wall. The heart muscle and pericardium may be involved secondarily. In the alimentary canal the lesions may be superficial or deep. In the former case the parasite invades Lieberkühn's glands and forms placques; or it may penetrate deeper, and, in the case of the cecum, simulate an appendicitis. In the abdomen adhesions are formed. Actinomycosis may also involve the genito-urinary organs, and also the brain. Joints near the disease may also be implicated. Distant or metastatic lesions may occur. The author then begins an account of the various clinical types. The most common manifestation of the bucco-cervical type consists in a hard swelling, beginning mostly in the upper neck, and particularly behind the angle of the jaw in the near neighborhood of a carious tooth. There is marked induration about it, and fistulæ subsequently appear. In the thoracic form the disease may have spread from a neighboring primary focus or it may be metastatic; most often it is primary. It has been known to penetrate veins, and thus spread by embolism. Occasionally in the primary form acute symptoms have been present at the outset, but more often it begins more gradually, with pain in the side, increasing dyspnea, etc. There may be signs. of effusion; if it involves the apex it may be put down as tuberculosis. Eventually an indurated patch, which may soften, appears on the chest wall, due to the invasion by the parasite. The tendency is to the invasion of all neighboring tissue.-Ibid.

HYPERTROPHIC CIRRHOSIS WITH ICTERUS IN CHILDREN.-A. Gilbert and L. Fournier (Sem. méd., 1895,) have recently observed seven children, four boys and three girls, with hypertrophic cirrhosis and icterus. The first symptoms appeared at the ages of five, nine, eleven, twelve (four cases), and seventeen years. These patients presented certain interesting peculiarities. In the first place, the spleen is usually of considerable size; its vertical diameter may reach twenty-six to thirty centimeters. These large measurements, of course, vary with the size of the patient. In some instances the development of the liver remains so much behind that of the spleen that one might readily be led to believe that they had to deal with a primitive splenopathy.

In the second place, it is not at all infrequent to find the last phalanx of the fingers noticeably hypertrophied, the nail at the same time becomes. deformed, incurved, and altered in structure. Moreover, the extremities of the tibia, fibula, and femur increase appreciably in size, and a small quantity of fluid appears within the synovial sacs of the knees, and there is pain in the different articulations, even in those which show no changes. The

authors at first thought that these osteo-arthropathic troubles could be referred to the interference with the movement of the diaphragm, resulting from the hypertrophy of the abdominal organs and the consequent restriction of the respiratory field, but having observed the same phenomena in a case in which liver and spleen were but slightly enlarged they were forced to abandon this explanation.

Finally, hypertrophic cirrhosis with icterus interferes with the growth of the children, whose height and weight remain below the normal average. The limbs are thin and the muscles poorly developed. The children appear younger than they really are. When they reach the age of puberty this is indefinitely postponed or completely absent.

BREECH PRESENTATION: RUPTURE OF CHILD'S PERINEUM BY MIDWIFE.-Sawicky (Przeglad Chirurgiczny, vol. ii, part 3, 1895,) writes of a breech case which the midwife mistook for a vertex presentation. After a few hours the child was delivered, the breech coming first. A rupture of the perineum was detected. A month later Sawicky was consulted, as the child suffered from incontinence of urine and feces. There was the usual eczema, with cystocele, cicatrization of the perineal rent, a very patulous vaginal opening, and slight prolapse of the rectum. The anus was involved, the rent extending through the external sphincter. The eczema was cured, and then the parts repaired by Tait's operation. The anterior part did not unite, so the vulva still gaped, while the posterior part of the perineum and the anal ring assumed their normal condition. There was no more incontinence of urine or feces. The mother had been normally delivered eight times before, the vertex presenting on all those occasions. Laceration of the child's perineum occurs sometimes in breech presentations which was not suspected at first in this case, owing to the previous history-through the child's anus being mistaken for the mother's os uteri, and dilated in consequence by the finger of the midwife.-British Medical Journal.

THE FALL OF Adam and EVE.-This is a Frenchman's version of the fall of Adam and Eve: "Monsieur Adam he vake up-he sees une belle demoiselle aslip in ze garden. Voila de la chance! 'Bon jour, Madame Iv.' Madam Iv, she vake; she hold her fan before to her face. Adam put on his eye-glass to admire ze tableau, and zey make von promenade. Madame Iv, she feel hungry. She sees apple on ze arbre. Serpent se promene, sur l'arbre-make one valk on ze tree. 'Monsieur le Serpent,' say Iv, 'vill vous not have ze bonte to peek some appel? j'ais faim.' 'Certainement, Madame Iv, charmes de vous voir.' 'Hola, mon ami, ar-r-retz, vous!' says Adam-stop, stop! que songez vous faire? Vat madness is zees? You must not pick zee appel!' Ze snake he take one pinch of schnuff, he say: 'Au, Monsieur Adam, do you not know how zere is nossing proheebet ze ladies? Madame Iv, permit me to offer you some of zeese fruit defendu