Current Surgical and Medical Selections.

ACUTE DELIRIUM AND UREMIA.-A. Cullerre reports two cases which bear out the idea that some cases of delirium are due to nephritis. In the first case, that of a woman picked up in the street and taken to an asylum, suffering from delirium with hallucinations of vision and uncontrollable restlessness, an autopsy showed no other lesion than that of granular kidney. In the second, that of a man of forty-two years, there was mental excitement with confused religious mania, turning to mutism, and later to profound melancholy with suicidal notions. Amelioration of the condition occurred, but nine years later the patient again was seized with homicidal and suicidal mania, followed by prostration, aneuria, continual vomiting, mussitation, coma, and death. No autopsy was held, but the symptoms of uremia were, in the three days preceding death, too evident to be mistaken.-Archives de Neurologie (Medical Record).

A CASE OF PSEUDO CIRRHOsis of the LIVER.-M. Strajesko reports the case of a man suffering from this rather rare disease, which is characterized by the symptoms of true cirrhosis, but differs from it anatomicopathologically, there being no proliferation of the connective tissue of the liver. It is due to an inflammatory process which is chronic in its course and invades several serous cavities, resulting often in complete adhesions of the pericardium, the pleura, and thickening of the peritoneum covering the diaphragm and the liver. The cause of the inflammatory process is not known, but tuberculosis is frequently found in the family history of the patient. Clinical diagnosis of the disease is difficult, but is helped by coexisting heart disease and by long observation, which shows that the liver diminishes in size, that the spleen does not increase, and that ascites is quickly produced. Treatment consists in regulation of the heart's action and in puncture for the relief of the ascites. In some cases calomel is of use, and may even render the treatment by puncture unnecessary.—Russki Arkhiv. Patologii, etc. (Ibid).

WHENEVER the most accurate approximation of tissues is required, as in plastic operations or in operations involving the abdominal wall, it is most important that all bleeding should be checked, since collections of blood prevent the tissues from adhering closely, and the serum discharged may act as a medium for infection. In placing the skin sutures it is important to see that no small vessel has been pierced by the needle. If this has occurred it is best to withdraw the suture and place another, as the bleeding in the layers beneath the skin may be quite considerable. When this occurs the blood coagulates, and after six or seven days a little discharge of serum may take place, lasting two or three days more, or even longer. This discharge occurs between the lips of the wound or along the track made by one of the stitches; an infection may take place unless great care is exercised.-International Journal of Surgery.

THE DUTY OF A PHYSICIAN TO HIMSELF.-The newspapers announce the death of a venerable physician in the interior of the State, who after a practice of fifty-five years leaves uncollected book accounts amounting to $50,000. It will be in order now for the lay press to moralize the case, and to refer to the noble almsgiving propensities of the medical profession. Some people will see in this story the evidence that physicians are a noble, self-sacrificing class, while on the other hand certain Philistines will say that the case simply proves that doctors have not sense enough to collect their bills. Judgment in such a case depends somewhat upon the point of view. Both interpretations are valid, but on the whole the Philistine judgment is the one that goes straighter to the point. It is somewhat deplorable that the medical profession should have forced upon it the reputation of being an eleemosynary corporation simply because it has slack business methods, and it is not desirable that it should have to support such an undeserved reputation for benevolence at the expense of its own bread and butter. The dear public is not slow to adopt the comfortable idea that physicians practice medicine for the love of their fellow-men, and to let the doctors have the full benefit of this reputation when the bills are presented. There is danger of insincerity and cant on one side and of injustice and fraud on the other. Fifty thousand dollars in uncollected book accounts is a poor asset for any doctor's estate.-Philadelphia Medical Journal.

HIGH TENSION.—In every line of business there continues to be, particularly in our own country, an unwarranted rate of speed. The fierce conflict and rivalry among men is resulting most disastrously to our people. There can be but one result where men toil ceaselessly, giving little or no attention to the care of their bodies, and that result is physical bankruptcy at an early date. The writer's attention has been startlingly drawn to this fact by a series of fatalities among his professional friends and acquaintWithin a comparatively few months seven of his fellow-physicians, noted for their ceaseless toil and apparently tireless energy, have died. In each case the cause of death was to be found in the kidneys. Our attention has been called to the fact by German and American writers that it is no longer an accepted truth that the excessive or continuous use of alcoholic liquors is necessary for the production of disease of the kidneys, particularly the parenchymatous variety. It is now recognized that auto-intoxication, found so frequently in so-called "hustlers "-persons who work unceasingly, eat and sleep irregularly, take no systematic exercise-is by all odds the most frequent cause of kidney degeneration.-Medical Herald.

CHALODERMIA. This term is employed by L. von Ketly (quoted in New York Medical Journal) to a peculiar change observed by him in the skin of certain parts of the body in which, instead of being merely excessively ductile or distensible, it hangs in loose, flabby folds. In a case observed by him in a woman of thirty, the skin appeared on the thighs like a baggy pair of drawers.-Denver Medical Times.

PHYSICIANS AS BUSINESS MEN.-In this intensely utilitarian and commercial age doctors must adopt sound business methods. To charge well and collect systematically is a good plan to follow. People appreciate you more if you value your own services. They pay nearly everybody else better than the physician. The doctor gets less when he saves a human life than the undertaker would have received if he had had the patient to bury, and much less than the lawyer would have charged if he had had the chance to settle the succession. If your services are valuable, make the patient understand and pay for them in proportion. Your family will be better off and the profession will have a better business reputation, even if there are a few people less who say, after you are dead, how kind you were.-New Orleans Medical and Surgical Journal.

MALARIA. The chief interest in connection with malaria at present centers in the relation of this disease to the anopheles mosquito. Mauser, for example, allowed himself to be bitten by mosquitos fed in Rome on a case of tertian malarial fever. The period of inoculation was between ten and sixteen days; he then developed fever, and the parasites were found in the blood. Nine months later, when he had been apparently cured by quinine, he spontaneously developed malaria.

Young stated in a discussion before the British Medical Association that in Hong Kong the occurrence of malaria was always associated with the appearance of the anopheles mosquitoes; and Manson urged that the natural conditions antagonistic to this insect should be discovered and employed to exterminate them. Fernside stated that it was impossible to eradicate the mosquito in India, because to do so would destroy the riceswamps. Natal stated that the anopheles are attracted by dark colors and repelled by light colors, a hint that may be of practical use. On the other hand, Egbert states that in the mountains of Honduras, at an altitude far above the mosquito belt malaria, fever of both the quotidian and tertian types is frequent, and he thinks it is propagated by fleas.

The prophylactic treatment, of course, consists in avoiding mosquito bites, for which Bras employs the punkah or the electric fan, and Macgregor recommends extermination by filling the swamps or covering the pools with kerosene. He warns that results should not be expected for two or three years, and in the meantime prophylactic doses of quinine should be employed. Ewing contributes a valuable study of the life history of the malarial parasite, which serves to show how incomplete is our knowledge of this organism at present. The relation of quinine to malarial hemoglobinuria is still unsettled.

Klein reports fifteen cases in which this complication followed almost immediately the administration of quinine. He cautions against the careless administration of the drug in large doses, and thinks that black water fever is the result of poisoning by it. Smith and Taylor report two cases, one in an officer who had been taking quinine in moderate doses for a long

time; the other in a negro soldier. The parasites appear to have been exceedingly few in the blood.

Two extraordinary complications are noted. The first, observed by Mellroy, was a negro who went into a state of coma lasting seven hours; bullæ developed upon the knees, and four weeks later they became gangrenous. The æstivo-autumnal parasites were found.

The second, observed by Ewing, was a girl who was brought to the hospital suffering from fever, vomiting, and constipation. There was considerable albumen in the urine, and a diagnosis of typhoid fever with acute nephritis was made. At the autopsy the renal tubules were found packed with malarial parasites. Ewing concludes as the result of a study of recorded cases that malaria may produce acute degeneration of toxic origin in the kidneys, or focal necroses with numerous hemorrhages, and the parasites may be massed in the renal capillaries, causing hemorrhage and thrombosis. The last form occurs only in æstivo-autumnal infections.-Philadel phia Medical Journal.

THE PRODUCTION OF SERA.-Municipalities have usually quite enough to do to keep themselves ordinarily respectable, without going into the hardware, furniture, or pharmaceutical business. The manufacture of common honesty in official life is at least an indispensable qualification if they desire success in the pharmaceutical laboratory, and until municipalities show themselves more abundantly provided with incorruptible officials the manufacture of serums and vaccines is as much beyond their capacity as is the mensuration of the mountains of the moon.-Medical Fortnightly.

HOW TO SLEEP Soundly.-The "sure cures" for insomnia are almost innumerable. One of the latest is that of a German, Prof. Fischer (Doctor's Magazine), who claims that it will not only bring about profound and refreshing sleep, but also increased mental strength. The discovery consists essentially in putting the pillow or pillows under the feet instead of the head. The advantages claimed for the innovation are that the venous circulation is favored and the heart needs to work less during sleep, hence the tired feeling on waking is prevented. The professor claims to be in receipt of a great many communications from ladies all over the German Empire who are profuse in their praises of his epochal discovery.-Denver Medical Times.

REASONS FOR EMPLOYING HOT AIR.-The Medical Fortnightly gives these: 1. Dry heat is a valuable pain reliever without any of the depressant effects common to drugs. 2. In connection with constitutional and medicinal treatment we have in it a positive curative agent. 3. It is a stimulant to rapid repair and absorption. 4. It is one of the most valuable eliminative agents we possess. 5. Where indicated, it possesses a sedative action on the nervous system obtained by no other means.—Ibid.

TETANUS AFTER LAPAROTOMY.-Coe (American Journal Obstetrics, September, 1901) reports two cases of tetanus which occurred in the General Memorial Hospital, New York, at eighteen months' interval; there was no assignable cause. The hospital was opened in 1887, and the conditions. are very aseptic; in both cases the operations were "clean," and both were in Coe's wards. The first operation was the removal of a double salpingitis with cystic ovaries. There were no complications at the operation; convalescence was without fever. Stiffness of the neck was felt on the twentyfirst day, trismus next day. Death occurred on the thirty-sixth day; serum injections proved unavailing. The second patient underwent panhysterectomy for fibroid uterus and diseased tubes. She did well until the ninth day, when stiffness of the jaw set in; on the tenth day she could not swallow; fifty cubic centimeters of serum were injected into the veins; general convulsions occurred the night afterward; a second injection was made; death occurred on the eleventh day. Both patients were hysterical, so that

diagnosis was obscure at first.-British Medical Journal.

NIGHT SWEATS IN PHTHISIS.-All physicians know the difficulty of keeping the night sweat of phthisis in control. Almost every known remedy has been tried since the Greeks used agaricin down to the present. Graves and Stokes used Dover's powder, which in time gave place to mineral acids, zinc and belladonna, atropine, and a host of other specifics. To the long list Nolda adds tannoform, the external use of which he recommends. In seven out of eight cases in which he had the front and back of the thorax dusted with powdered tannoform, it checked the sweating (Berl. Klin. Woch.). This method of treating the symptom has the advantage of not interfering with the digestive function, which is usually so imperfectly performed in such cases; neither does it in any way preclude the use of any of the other antisudorifics. The powder of itself should prove an agreeable application to the skin, and promote the comfort which is such an essential factor in producing sleep in such cases.-Medical Press and Circular.

GASTROENTERIC FLATULENCE.-The Clinical Review recommends the sulphocarbolate of sodium. In the gastric form the drug may be given in the dose of 5 to 10 grains in aqueous solution after meals. In the intestinal form it is best administered in enteric-coated pills of 22 to 4 grains each. For the frequently coexisting constipation the aromatic fluid extract of cascara sagrada may be given.-Denver Medical Times.

PATHOLOGY OF INFANTILE ATROPHY.-According to Baginsky (Interstate Medical Journal) marasmus is a specific disease, depending upon general degeneration and atrophy of the greater portion of the duodenal and jejunal mucous membrane, subsequent to a severe intestinal infection. He has found that only about half of the nitrogen of the food is absorbed, the remainder being excreted with the feces.-Ibid.