cases it will be found that the pain disappears with systematic salicylate saturation. For this purpose the sodium salt is probably the most generally useful. Yet in mild cases it would seem unnecessary to subject the patient to the very unpleasant by-effects attending large doses of the salicylates. The toxic manifestations are very readily produced in some persons and in these recourse must be had to some other salicylic compounds. When the pain is severe and the general aspect of the case is acute there is no better substitute for the salicylate of soda than Aspirin in doses of 15-20 grains every three or four hours. The advantages this drug possesses over the salicylate of soda are several. It is tasteless; it does not disturb the stomach and it does not produce the annoying head noises unless given in very much larger doses than those here indicated. In very large doses it will produce symptoms of salicylic intoxication and may act as a cardiac depressant. Its administration therefore requires some care and watching in enfeebled cardiac states. For the milder, muscular cases, salol and salophen are excellent remedies, but they cannot be depended on in the more acute types.

With respect to local treatment an important question comes up. Shall the joint or limb be immobilized or not? Whenever possible the part should be put at rest. Soothing lotions may be applied. In cases following fracture the symptoms may appear at the time when passive motion is necessary to restore function. These should also be put at rest. Because, in this way, with proper treatment, the acute condition will pass away in a very few days and the time will not be long enough, in any event, to jeopardize the restoration of function by prolonged immobilization.

Heat is especially grateful to these lesions, particularly in the form of dry, superheated air. The old-fashioned plan of ironing out a pain in the back is effective and has much to commend it.

When the pain is in the lumbar muscles, in selected cases, there is no remedy so good as acupuncture. For this purpose the punctures should be made in several places with a rather coarse needle. The needle should be thrust laterally into the lumbar mass and should penetrate deeply, say three or four inches. The relief which follows this procedure is very great.

In four cases of the series here reported, I had very excellent results from the use of the new local anti-rheumatic mesotan.

Mesotan is the methyl-oxy-methyl ester of salicylic acid. It is an oily liquid and is applied directly to the painful part; one-half to one or two drachms being used at a sitting, depending on the size of the painful area. This drug is rapidly absorbed through the skin and appears in the urine as salicylic acid in from one-half to one hour. It has not only a general action but also a local action probably on the sensory nerve ends in the diseased area, and therefore is especially valuable in these cases.

CONGENITAL ULCER OF STOMACH, WITH REPORT OF A CASE.

By J. N. HALL, M.D. and THOS. H. HAWKINS, M.D.
Denver, Colo.

While the diagnosis in this case is only a presumptive one, since the baby has recovered and we had no opportunity for an anatomical demonstration of the ulcer, it will be considered, we think, that there is sufficient ground for such a diagnosis, in view of the markedly acid character of the gastric juices, the gastric irritability, and the hemorrhages.

Dr. Hall saw baby L., female, 67 hours old, with Dr. Thos. H. Hawkins on January 5th, 1905. She was a well-developed baby of good parentage, and normal in appearance at birth, excepting for a moderate pallor. The delivery had been a normal one. Within 12 hours of birth the fluid regurgitated from the stomach, flowing over the right cheek and ear, excoriated these parts so that an almost continuous scab covered them on the second day. Careful questioning of the nurse showed that there had been no bile in this ejected fluid, and the cloths stained by it showed no color. The vomitus was strongly acid to litmus paper, when tested by Dr. Hawkins.

There was much vomiting during the first 4 days, black in color from the first. About 48 hours after birth a drachm or more of pure, bright red blood was ejected from the stomach. This occurred on 5 other occasions during the second 48 hours, probably two or more ounces being vomited in all.

The stools were black and tarry from the first, evidently from old blood clots. The early appearance of tarry stools indicates that hemorrhage had occurred in the alimentary tract before birth. No evidence of hemorrhage elsewhere was noted.

The temperature was subnormal, but the pulse was very weak, and the collapse severe. The abdomen was rather rigid, but no especially tender point was found.

A diagnosis of ulcer of the stomach was made. The treatment was: Bicarbonate of soda in half grain doses every hour, with bismuth. Soda was also given in the drinking water and lime water in the milk. This treatment was instituted within a few hours after birth of the child. Doses of 1/10 minim of the onethousandth solution of adrenalin chloride were given every 15 minutes upon the occurrence of bleeding. There was no hemorrhage after the sixth day, and the baby has followed an entirely normal course since and at present is plump and well and in every respect a normal and healthy baby.

We have abundant support from the pathological side, for such a diagnosis, since many cases have been reported of ulcer found in babies less than a week old or even in those still-born. We know of no other condition which could produce the clinical picture here given, with recovery in such a manner.

Hematemesis could scarcely occur in a baby from cancer, hepatic cirrhosis, varices in the esophagus, aneurism, or the other causes occasionally noted in the adult. It appears to us that the case should not be classed as one of morbus maculosus neonatorum, since the bleeding was confined to the stomach to the best of our knowledge, and was accompanied by the marked gastric irritability, and hyperacidity so well known in connection with ulcer. In Townsend's cases the temperature was often elevated, while in this case it was depressed. "The general and not local nature of the affection, its self-limited character, the presence of fever, and the greater prevalence of the disease in hospitals, suggests an infectious origin" (for morbus maculous neonatorum) (Townsend). Says Dreschfeld: "The temperature (in ulcer) is normal, or even subnormal if the nutrition suffers much." The absence of jaundice and the recovery would also favor the probability of our proposed diagnosis, for but 19 out of 50 of Townsend's cases recovered.

Kundrat states that small ulcers are quite frequently found in children even only a few days old, but states that he has never known chronic ulcer to develop from these little ulcerations, probably because acid catarrh is rare in children. Henoch speaks of the occurrence of ulcer in the new-born, while Widerhofer denies its presence in childhood.

Dreschfeld states that "Before the age of puberty gastric ulcer is of very rare occurrence; yet it has been observed in infants, and occasionally soon after birth. The melena of the newly-born, though often due to erosions and small multiple ulcerations, has in some cases been found to be due to simple ulcers of the stomach with regular well-defined borders, varying in diameter from one to three centimeters, and situated in the stomach or duodenu. In other cases of melena neonatorum no lesion has been found in either the stomach or intestines."

Some of the American authors agree with the former authorities. The positive evidence is of much more value than the negative, here as elsewhere. The absence of history of pain and tenderness in so young a child, bearing in mind the difficulty of eliciting exact symptoms in a baby already nearly collapsed with frequent vomiting and loss of blood, could count but little in view of the presence of the severe vomiting, the hematemesis, and the corrosive action of the regurgitated fluids.

The prognosis seems to be better in children than in adults. Correction of the hyperacidity is looked upon as of great importance by most writers. We know of nothing promising better results than the adrenalin so far as the danger from hemorrhage is concerned. In cases of perforation attempt at operation might be justifiable, although the mortality would probably be excessive at this age.

INFECTION WITH FLY LARVAE.*

WM. C. MITCHELL, M.D.

When the female fly deposits its eggs in living tissue and the eggs develop into larvae, the diseased condition is known as myasis. A study of the literature of this somewhat obscure subject shows that the condition is by no means so rare as one might sup

*Read before the Denver Academy of Medicine, April, 1905.

pose. The eggs may be deposited on the mucous membrane of the eye, on the mucous membrane of the ear, on the mucous membrane of the nose, or in open wounds,-myiasis conjunctivae, myiasis aurium, myiasis narium and myiasis vulnerum.

It is a matter of common observation on the farm or on sheep ranches that at times wounds on cattle, horses or sheep may become the breeding places of maggots, so that the wound may teem with these pests. Such observations are also frequently met with by surgeons in open or exposed wounds.

In studying the natural history of the family Muscidiae, which embraces both the house flies and the blow flies, it develops that the mature house fly deposits her eggs chiefly in excrement, that of the horse being preferred, and after about 24 hours the eggs develop into larvae. The insects remain in this, the larval state, for about six or seven days. They then go into the pupal state and after from three to four days emerge as young flies. The blue bottle or blow fly prefers dead animal matter as a depository for its eggs, although in emergency it deposits them elsewhere, many cases being on record of the deposition of these eggs and their subsequent development on living animals. Lydekker in his chapter on diptera mentions that toads seem to be a particular object of attack by blow flies. In one instance nearly a whole colony of toads were exterminated by the larvae of these flies which chiefly infected the nostrils. As testifying to the most extraordinary vitality of these larvae may be mentioned the case of a lizard that dined on gravid blow flies. The eggs of these flies hatched out in the stomach of the lizard and promptly attacking the internal organs, killed the lizard. Other instances are also on record of the digestive tract of these animals being destroyed by fly larvae taken in as food.

A very different life-history is given by the bot flies of horses, of cattle and of sheep which form an entirely different family, the oestridiae. The larvae of these flies are forced from the very first to lead a parasitic existence in the bodies of their respective hosts. The horse fly deposits its eggs on the hide of the horse and when these eggs develop into larvae they irritate the skin. The horse licks the irritated part and swallows the maggots which promptly fasten to its mucous membrane. Here they live for about a year, when they pass out with the excrement, burrow into the ground