or germicide-bichlorid, ranging around 1/2000, is generally the best, also peroxid 4 per cent, urotropin (formin) 5 grains to the ounce hinders the ammoniacal decomposition, and guaiacol carbonate, 20 per cent, in olive oil allays pain and frequency of mictrurition; useful in typhoid and tubercular infections. "Kelly's Practical Gynecology" recommends a 2 per cent ichthyol solution. For pain, I or 2 drams of a 4 per cent cocain solution left in the bladder after irrigation secures rest.

Vesical Irrigations.-For reconstructing tissue and restoring nutrition as well as cleansing, nothing serves a better pur pose than Seiler's tablets, 2 drams in 1 liter of water, into. which is put 1 ounce of a strained infusion of calendula, verbascum, pinus canadensis, balsam of Peru or tolu. The benzoate of soda may be substituted for Seiler's tablets.

Whether the case be acute or chronic the propogating and perpetuating infection is present, which indicates the line of treatment and the prognosis depends on which prevails.

Chronic cystitis occasioned by prolapse or retroversion of the bladder, or by mechanical obstruction, is not hopeful in prognosis except when normal anatomical relations are restored.

Acute cystitis impinging on a chronic form is tedious. If from relapse, morbid growth, or hypertrophied prostate, the urine should be drawn at least twice daily to prevent the evils of residual urine and treated as in the above uncomplicated form of cystitis. If the urethra be closed by pressure a metallic catheter should be introduced and secured by a T-bandage for the female, and a suspensory for the male, and kept intact until the danger from the special pressure be passed, thereby providing for the emptying and treating of the bladder, after which the catheter should be tightly corked.

Two years ago and after vain attempts by several to pass a catheter past a hypertrophied and acutely swollen prostate, and after the part was quite lacerated, a catheter was finally introduced through the stricture and kept in place for sixteen days through which the chronic cystitis was treated several times daily. Since then he has had no trouble. This illustrates many similar cases.

Bronchiectasis in a Four-Year Old Child.

W

By J. R CLEMENS, M.D.,

ST. LOUIS, MO.

HERE, in a patient, a differential diagnosis between consolidation of lung and empyema; between consolidation (upper portion) and atelectasis (base) in the same lung; between tubercular cavitation and bronchiectasis, has to be made and where many signs were equivocal, the writer thinks the case sufficiently interesting to report.

W. S., aged 4 years and 2 months, was brought to St. John's Clinic in December, 1904, with the following history: Mother's Observation.-Vomiting, two week's duration― the child would eat ravenously and then almost immediately vomit the contents of the stomach. The child's legs ached so that he would not attempt to walk.

Family History.-Mother had had three miscarriages. Phthisis on mother's side of family.

Past History.-Whooping cough when 3 months old; measles one year ago; late in walking (third year of life). Cough slight except when the patient was angered, then the cough would become violent, a large amount of sputum would gush from the mouth, after which the child would be easier for a time. Marked sweating; feverish almost constantly; fever worse toward night.

Present Condition.-Temperature, 101.5°; pulse, 120, regular and strong.

Inspection.-Child small for its age, markedly anemic, no wasting, the child being fairly plump; breathing shallow, rapid and easy, resembling that present in lobar pneumonia with extensive consolidation; no cyanosis. Fontanelle widely open and pulsating. Deformities of the thorax, inequality of two sides; pigeon breast, deficiency of movement of the smaller side (left). In the upright sitting posture the child bent to the left with a compensatory lateral curvature, dorsal, with its convexity to the right; the finger tips were clubbed. No apex beat visible in the usual situation. The child was lethargic and easy to examine.

Palpation.-Unequal movements of the two sides of the

chest, the left being almost motionless; marked, tactile fremitus over the right chest; ribs beaded. Apex beat high up in the left axilla, between the mid-axillary and posterior axillary lines. Spleen and liver enlarged; flesh flabby.

Percussion.-Right side: Hyperresonance, front and back. Left side: Absolute dulness except in the following three situations: 1, Apex in front; 2, suprascapular region behind; 3, oval patch of the lung behind (2"x1") with the long axis vertical, extending from the level of the lower third of the scapula downward between it and the spine. The percussion note over I and 2 was hyperresonant; over 3 amphoric in character, where a cracked pot sound could be elicited. Over most of the left lung undue resistance was felt by the pleximeter finger.

Auscultation.-Over the whole of the right lung loud, rough compensatory emphysematous breath sounds, with some coarse, sticky rhonchi. Over the left lung with the exception of the areas 1, 2 and 3 there was suppressed and distant tubular breathing, front and back, for the upper two-thirds of the lung; the lower third gave no breath sounds even when the child struggled and inspired deeply. Over 1 and 2 there was emphysematous breathing, with some coarse rhonchi. Over 3 the breath sounds were cavernous, together with a confusion of other adventitious sounds, fine consonating râles predominating. The heart sounds were good. The cardiac dulness could not be percussed out owing to its abnormal position where its dulness blended with that of the left lung's.

Blood Examination. (Unstained).—Many deep pigmented white corpuscles (malaria). No specimens of sputum and urine.

In the differential diagnosis empyema could at once be excluded from the fact that the heart was drawn toward the dull area and because on increasing the percussion stroke the note became duller instead of resonant.

In the differential diagnosis between the conditions obtaining in the upper two-thirds and the lower third, respectively, of the left lung, absence of breath sounds, even on deep inspiration, indicated collapse at the base.

In the differential diagnosis between ulcerative phthisis with extensive cavitation on the one hand, and bronchiectasis on the other, the points that bulk most prominently in favor of the latter are the age of the child, the situation and size of

the cavity, the traction of the heart up into axilla (Holt's denial to the contrary, notwithstanding), the character of the cough and the state of nutrition of the child. The pyrexia and sweats could not be appealed to as they were pathognomonic of both, and to a third condition actually presentmalaria.

The limb pains might be rheumatoid and are often present in chronic bronchiectasis (Gerhardt) or malaria.

The case is interesting from the point of view of the diagnosis, the classical symptoms of bronchiectasis present in so young a child and the multiplicity of its ills-that is, rickets, malaria, bronchiectasis and atelectasis. As regards the diagnosis, traction of the heart in bronchiectasis is generally hori zontal, but in the case just narrated the oblique upward direction of traction could be explained on etiological grounds of there being as a primary condition either a pleuropneumonic fibrosis or an interstitial pneumonia with fibrosis, either of which conditions would also explain the collapse present at the left base.

In conclusion, apologies must be made for reporting the case without several examinations of the sputum or observations of the cavity as regards changes in it, day by day, but clinical patients are at best unsatisfactory for complete studies where undue interest on the part of the clinician results not only in resentment on the part of the parents but, a more important point, the disappearance of the child.

[NOTE.-Four days after this report was written the mother brought the child back, saying that after a few doses of quinin the child was greatly improved and simultaneously with the improved condition he began to walk again, and vomiting had ceased. Physical examination revealed that the child was brighter looking; temperature 100°. Bronchietic cavity filled so that on percussion a dull sound was elicited over it, and on auscultation practical absence of breath sounds.]

The American Anti-Tuberculosis League,

For the prevention of Consumption will meet in the Hall of the House of Representatives, Georgia State Capitol, Atlanta, April 17, 18 and 19, 1905.

LEADING ARTICLES.

THE INTERNATIONAL CONGRESS OF ARTS
AND SCIENCES.

By EDMUND A. Babler, M.D., St. Louis.

(Concluded from page 30, January Number).

PEDIATRICS.

Dr. Thomas Rotch, of Harvard University, presided over this section which convened on Wednesday. Prof. Theodor Escherich, of Viennia, was introduced and presented an interesting monograph.

Dr. Jacobi, of New York, addressed the congress on the History of Pediatrics and its Relation to other Specialties. He stated that more than seven thousand works had been published on pediatrics before 1849. In America pediatrics was at first associated with diseases of women but in 1860 the New York Medical College instituted a separate clinic for the diseases of children. It was about this time that the European colleges gave the subject considerable attention. Considerable literature upon pediatrics was presented by the European investigators which considerably advanced our knowledge, concerning children's diseases.

The growth of pediatrics had been increased since the eighteenth century. At present periodicals devoted to pediatrics existed to the number of five in Germany, two each, in France, Italy and the United States, and Spain one. In 1769, Dr. Armstrong established the first institution for sick children. The Hôpital des enfants malades, the largest hospital in Europe, was established in 1802, by the first French Republic.

Hospitals especially devoted to the diseases of childhood had since then been established throughout the entire civilized world. The beginning of childhood was not the day of birth; evolution went gradually forward from the moment of conception. The structure and nature of the child rendered the laws of heredity distinctly perceptible