EDITORIAL ITEMS.-Continued.

Cerebral Pneumonia.-The ataxic apex pneumonia of drunkards, with marked cerebral symptoms, is treated by Anders with hydrotherapy, including the ice cap; arterial stimulants and morphine.

Lacerating Injury of Brain Tissue.-Charles C. Allison advocates the ice cap; mercurials and morphine or bromides; and a dark, quiet room. No operative interference should take place until shock has been combatted and reaction secured, unless there is excessive hemorrhage.

Injury to the Cervical Spine.-Perfect rest, says Herbert W. Page, is the chief consideration. Asepsis for wounds is in order, and hot flannels or linseed poultices for sprains. Ice locally -and ergot or gallic acid internally are indicated for hemorrhage.

Spinal Apoplexy.-Gowers advises absolute rest on face or side; scarify beside the spine opposite seat of pain, allowing blood to flow freely; follow this with application of ice and administration of ergotin; move bowels freely; sedatives usually required for pain.

Traumatic Fever.-Frederick S. Eve advises drainage, cleanliness and avoidance of tension; remove sources of irritation and pain if possible; aconite early; quinine or sponging with tepid water or the bath for excessive fever; cinchona when hectic, the result of exhausting discharges.

Traumatic Asphyxia.-The institution of artificial respiration, in conjunction with oxygen inhalations (Journal of American Medical Association) is of most service immediately after the release of an individual who has been subjected to forcible compression and presents livid or cyanotic discoloration of the face and neck.

The Rhythmical Pulsating Pain of Renal Colic.—Angelo Signorelli (quoted in Medical Record) calle attention to the

rhythmical pulsating pain, which he considers peculiar to this affection, which is present only during the violent colic and which is due to increase of tension in the arteries obstructed by the calculus.

Saline Enemata.-MacCallum (Journal of American Medical Association) has studied the effect of saline purgatives and diuretics, and finds that the sodium salts are safest and most effective. The premature expulsion of saline enemata, owing to the peristaltic effect of the sodium chloride, can be prevented by the addition of a small amount of calcium chloride, which is in general inhibitory to the action of sodium salts.

Management of Apoplexy.—Anders advises to keep quiet as possible in the recumbent posture with the head somewhat elevated and clothing loose around neck; ice bag to head and hot bricks or hot water bottles to feet; sinapisms to back of neck or other parts of body; venesection if pulse full, strong and incompressible and face congested; one or two drops of croton oil by mouth-also an enema; liquid food for several days.

Value of Olive Oil in Gastrointestinal Diseases.-Cohnheim (quoted in Journal of American Medical Association) has found olive oil effectual in relieving and curing gastrectasia not due to an organic obstacle, and even in organic and relative stenosis it proves a valuable lubricant. He gives a wineglassful half an hour or an hour before meals, two or three times a day. The remedy is of no benefit in purely nervous or hysteric gastric affections.

Practical Method of Destroying Snake Venom.-It is positively established, says L. Rogers (quoted in Medical News) that potassium permanganate will destroy in vitro nearly its own weight in every class of snake venom. Brunton and Fayrer advise ligation above the inoculation, then incision of the wound, followed by the rubbing in of pure crystals of the salt. Brunton has devised a lance surrounded by a sheath in the base of which permanganate crystals are kept, the whole outfit being easily carried in one corner of the vest pocket.

Bacteriologic Diagnosis of Typhoid Fever.-Ruth and Rider (Journal of American Medical Association) place the bacteriologic examination of the blood above even the Widal reaction. They say that Eberth's bacillus can be found in from 80 to 90 per cent. of the cases, most frequently from the second to the fifth day, a much earlier date than the agglutination test. The skin of the forearm is sterilized, a vein rendered prominent, and by means of a sterile aspirator needle, blood is withdrawn, and inoculated into a tube of blood serum or agar, and after from 24 to 48 hours in an incubator the bacillus is identified by its cultural and morphologic peculiarities. The use of plate cultures is recommended as an aid in the identification of the colonies, and an additional safeguard against contamination of the cul

tures.

Sterilizing Catgut.-Weller Van Hook (Medical News, May 14) has used the Elsberg method for two years with great satisfaction. Select raw, rough, unbleached material. Soak for a week in pure ether or a mixture of one part chloroform and two parts ether. Wind on glass spools in single layers. Soak for three days in aqueous solution of chromic acid 1:1000. Boil for twenty minutes in water to which, while boiling, chemically pure ammonium sulphate has been added until the crystals cease to dissolve. Wash the catgut for half an hour in cold water. Place the spools in a solution of corrosive sublimate, one part in 1000 parts of 95% alcohol. Should the material become infected, it may be reboiled. The use of the ammonium sulphate depends on the principle that organic substances are insoluble in the fluids by which they are precipitated from their solutions.

Fetal Nutrition.-J. Veit (quoted in Obstetrics, Practical Medicine Series) explains the special blood changes in pregnant women as due to deportation of chorionic villi and interaction of these with the red and white blood cells. Using the hemolytic method of Ehrlich, he finds there is formed syncytiolysin and hemolysin, producing a solution of hemoglobin and syncitial protoplasm in the blood serum. The nourishment of the child depends on the absorption of albumin dissolved in the serum, and

the loss of substance due to dissolution of chorion epithelium is replaced by syncitium growth. This balance of exchange may be disturbed, as when too many chorionic villi are deported. Then hemolysis produces hemoglobinemia, albuminuria, hemoglobinuria and less syncytiolysis. When too little chorionic epithelium is received, the pregnancy changes are less marked, and on these differences may depend certain abnormal nutritional conditions of the fetus and diseases of pregnancy.

Age and Smallpox.-The age incidence of smallpox has been markedly altered by the general practice of vaccination. In the 18th century 95% of the deaths from this plague were in children under ten years. Of new-born children one-third died of smallpox in the first year-one-half before the fifth year. In Massachusetts during twelve years, 1888-99, the variola mortality of children in the total population constituted 26% of the total deaths from this cause, but no vaccinated children under ten years died of smallpox. A parish priest in London has recently issued a sermon-pamphlet beginning with these words: "In the town of Gloucester there is a beautiful cemetery, and in one corner of the cemetery there are the graves of no less than 280 little children, all under ten years of age, all of whom died seven years ago when a terrible attack of smallpox visited that town. Of these 280 children who died of smallpox, 279 were unvaccinated, and only one was vaccinated."

Points on Taking Temperature.-The carefully taken records of Burton-Fanning and Champion (International Medical Annual) show that the rectal temperature is on an average 0.4° higher than that of the mouth, 0.6° higher than the groin, and c.9° higher than the axilla. In healthy men a very slight amount of movement only is required to produce an appreciable rise in the mercury, while with more exertion they noted a rise of as much as 32°. These fluctuations can be reliably observed only in the rectum. The exercise reaction is not peculiar to tuberculosis, but usually exceeds that of health or other diseases. The authors note the frequency of a distinct rise of temperature during the six days preceding menstruation in 18 out of 34 women

under treatment for pulmonary tuberculosis. They recommend keeping the mouth closed on the thermometer for ten minutes, particularly after breathing cool air with parted lips, exercise entailing rapid respiration, or the contact of cold with the outside of the cheeks. They also found that certain drugs raised the oral temperature, presumably by dilating the capillaries. Thus, the sucking of a menthol lozenge for half a minute caused a rise of 1.6°.

Knopf on Tubercular Homoptysis. His treatment comprises absolute rest and reassurrance; small pieces of ice to suck or small sips of ice water; morphine or atropine by injection, or hydrastis canadensis; bags of morseled ice, or a piece of coarse linen wrung out of cold water and folded triangularly (renewed as warmed), placed over pectoral region of apices; hypodermic of ether, digitalin or caffeine if much shock, or rectal irrigation with hot saline solution; venous ligation of lower or upper limbs near trunk, loosening bands every half hour or so; hot water bag to feet; ergot or gallic acid (dose, ten grains) and iced drinks continued for some time after hemorrhage stopped. He advises deep, quiet respirations every 30 or 60 seconds in an hour or two after an acute attack of hemoptysis has subsided, to hasten complete cessation of bloody expectorations; also outdoor life and respiratory exercises or pneumatic cabinet treatment and careful administration of saline cathartics, for chronic bloody expectoration due to congestion of respiratory organs.

Compulsory Vaccination. The imperial German law, put in force April 1, 1875, requires the vaccination of every child before September of the year following its birth, and revaccination of all the inhabitants every twelve years. It has been executed with exceptional thoroughness, and the results have been most striking, lowering the death rate from smallpox of 262.67 per 100,000 inhabitants in 1872 to a general average of 1.91 per 100,000 in the years 1875-86. No other nation has enforced compulsory vaccination so completely and continuously, and at the present time Germany is the only country that enjoys comparative immunity from variola. The disease has indeed become almost exotic, nearly all the cases occurring on the borders of