dyspnea. The disadvantages of the passage through the mouth are the need of a gag, which is apt to injure the lips or break the teeth of the patient, and the possibility of the gag slipping out, and so rendering biting and swallowing the tube, or injuring the operator's fingers, probable. The latter accident happened to the writer once, causing a poisoned wound of a finger, and consequent inability to use the hand for a week; but during this time he was able to pass the nasal tube with the left hand, a statement which shows how easy the operation is.

Diet Given.-Breakfast at 9 a. m.: A pint and a half of milk, two eggs, with one ounce of whisky. Dinner at 2 p. m. A pint and a half of beef-tea, two eggs with two ounces of port wine and one ounce of maltine. Supper at 7 p. m.: A pint and a half of milk, two eggs and one ounce of whisky.

The food is given warm and the patient kept lying down for half an hour afterwards. Medicines are given with the food as required. Generally a purge is needed every two days, when half an ounce of castor oil may be added. Occasionally the juice of half a lemon is added to the dinner.

CAUSATION OF CHOLELITHIASIS.

In a thoughtful article on the causation of cholelithiasis (Montreal Medical Journal) Dr. William Hunter says that although cholelithiasis is a common disease, yet in its mode of origin it is still exceedingly obscure, running a very varying clinical course, sometimes without symptoms, at other times causing the most intense suffering and presenting in its course problems in diagnosis and treatment baffling at times physician and surgeon alike. Under general etiology he considers: (1) Age. The disease increases with advancing age, as is shown in tables given by Schroeder and Brockbank. (2) Sex. The female sex is about five times more subject to the disease than the male. (3) Pregnancy. Out of 115 women in whom gall stones were found, no fewer than ninety per cent had borne children (Schroeder). (4) Tight-lacing. The same observer found gall stones in more than one-half the women whose livers showed any evidence of furrows due to tight lacing. (5) Laxity of abdominal walls, by allowing the liver to fall down so that the fundus of the gall bladder is considerably below the level of the junction of the cystic duct with the hepatic duct, favors retention of bile in the gall-bladder. (6) Diminished move

ments of the diaphragm. Expulsion of bile is at all times greatly influenced by the movements of the diaphragm, and any restriction in the range of its movements correspondingly favors its retention. This is probably the manner in which pregnancy operates in favoring the production of gall stones, tight-lacing and sedentary habits. (7) Sedentary habits. This factor probably induces the liability to gall stones seen with advancing age, also seen in inmates of lunatic asylums. (8) Heredity is regarded as a factor by some, on insufficient evidence, however, the author considers. Out of 165 cases Bouchard only found a parental history of gall stones in only thirty-six. (9) Gout is also regarded as favoring gall stones. In 95 out of 166 cases Sinac found a history of heredity or acquired gout. On the other hand Bouchard found it in only thirteen out of 165 cases. (10) Influence of food. Habits of life as regards food and water have been regarded as factors in producing gall stones; also as serving to explain the greater frequency of cholelithiasis in different countries and in different parts of the same country. As a matter of fact, cholelithiasis occurs in every rank and class of society-in the poor and sparely nourished as much as in the obese and over-fed. (11) Influence of disease. Inmates of insane asylums are prone to gall stones, doubtless in consequence of the sluggish, apathetic habit so characteristic of many forms of insanity. Heart disease seems to favor occurrence of gall stones. Cholelithiasis is found in twenty-nine out of 165 cases of chronic rheumatism. Bouchard observed diabetes in sixteen out of 165 cases. A relation has been said to exist between the occurrence of gall stones and renal calculi, but the statistics of observers leads to no support of this view.

General etiology throws but little light on the causes underlying the disease. It only brings out one fact, that anything which favors stagnation of bile in the gall bladder favors the occurrence of cholelithiasis.

In cholelithiasis we have to do with a precipitation of certain of the biliary constitutents in insoluble form: (1) Cholesterin, which is normally held in solution in normal bile by the bile salts and the traces of fatty acids and fats present in the bile. (2) Bile pigment, which is normally in solution, is now thrown down as an insoluble compound in combination with calcium, another normal constituent of the bile.

The problem of the causation of cholelithiasis thus narrows itself to the question: What are

the conditions, general or local, that determine the formation and precipitation of these normal biliary constituents in the same mass and in the form they are met with in gall stones?

THE ABATEMENT OF NUISANCES. The question of the right of health officers to destroy private property as being a nuisance was recently before the court of appeals of Colorado (Medicine). It appears that one Corbin was carrying on the ice business in Denver, selling ice, as he claimed (but this was disputed) for refrigerator and not for drinking purposes. Munn, the health commissioner of the city, condemned the ice and forbade its sale, for any other purpose within the city limits. This edict of the commissioner was based upon a complaint made by Dr. Couch, bacteriologist of the bureau of health, and J. Baum, health inspector, and was to the effect that in a cubic centimeter of the iceequivalent to about twenty-five drops-the number of germs that were alive and had been grown from it varied from 40,000 to 80,000; and that these germs were of the variety known as "liquefying" and "gas-producing" and were dangerous to health. The finding of the commissioners was that the ice furnished by Corbin was obtained from Sloan's lake, and that he and his agents and employes so conducted the sale of their ice as to threaten the lives and health of the inhabitants of the city. The proceedings of the health commissioner were received by certiorari in the district court of Arapahoe county and annulled, and the court of appeals affirmed the judgment.

The court in passing on the case said: "We cannot conceive that it was the intention of the legislature to commit the fate of property, regardless of surrounding conditions, to the arbitrary and irresponsible decision of one man, and so clothe him with an authority which might be used without limit for purposes of oppression. If the statute must be so con. strued, it is in violation of rights guaranteed by the constitution, and therefore void. Under ordinary circumstances, whether the use made by an individual of his property constitutes a nuisance is a question of fact upon which, before property rights can be destroyed or impaired, the owner of the property is entitled to a hearing, to be conducted in accordance with legal rules. After property has been legally and regularly adjudged to be a nuisance, the health officer can proceed in the exercise of the powers with which the statutes clothe him."

ASEPSIS IN DAILY LIFE. Dr. Julia W. Carpenter, in a paper in the Woman's Medical Journal, makes a number of valuable practical suggestions regarding asepsis in daily life. After mentioning the more stringent quarantine regulations in times of threatening danger; greater cleanliness in the cities, especially in the hot season; greater care in isolating those with contagious diseases; a stricter application of knowledge in the care of all sickness; better methods of disposing of garbage and all the effete materials that are the result of life, and the measures to prevent the floors of cars and the sidewalks from being used as spittoons, she says there is still a simple but a very radical measure to be taken that would be wonderfully conducive to asepsis in daily life, and hence cause a still greater lessening of disease.

A handkerchief should be made of some inexpensive material, and when once used it should be burned. This should be the universal law for sick and well. The handkerchief is the receptacle of the evidence of the chronic catarrhs, the sore throats, the decayed teeth and untidy mouths, and the bad colds of so called well people.

All these discharges should be burned and not be carefully put away in fine linen to await a turn in the laundry. That simply gives this effete matter the opportunity of being carried out into the sewers and rivers and returning again in the drinking water. Pollution of water could in this way be prevented.

Handkerchiefs could be made of some material so inexpensive that their use and destruction would cost no more than their laundering. Cheap handkerchiefs to be burned would greatly facilitate the carrying out of the measure to prevent expectoration in cars and on sidewalks. The handkerchief could be the receptacle and its destruction would be such an advance toward aseptic living that there would be a great decrease in the number of influenzas, catarrhs and especially in contamination from tuberculosis.

If such a measure was advocated and explained to the people it would not be difficult to enforce it, for in these days of frequent sudden advancement in knowledge, people are learning to adapt themselves to new methods.

The chief practical objection to the author's valuable paper is that in daily life, despite the advancement in knowledge, the people are too careless or too ignorant to co-operate with the medical profession in its hygienic propaganda.

Criminal Abortion.-Dr. C. D. Arnold of El Reno, Okla., has requested the physicians of the United States to furnish him definite or approximate statistics regarding criminal abortions on the lines indicated in the following questions:

1. Give total number of abortions from all causes that occurred in your practice in 1897. 2. In how many of these abortions were the elements of criminality to your mind apparent? 3. In how many of these abortions, except those classed in question 2, were the elements of criminality to your mind probable?

4. How many of the abortions named in questions 2 and 3 were followed by puerperal septicaemia or other diseases?

5. How many deaths resulted from the abortions named in questions 2 and 3?

6. How many still-born in your practice? 7. How many infanticides?

8. How many viable children born in your practice?

9. How many cases of puerperal mania resulted from the abortions classed in questions 2 and 3?

Dr. Arnold assures the profession that all information will be held strictly confidential.

Urticaria. -Dr. Bernard Wolff of Atlanta, Ga., has become thoroughly convinced of the value of phosphate of soda in the treatment of urticaria. He has used this drug for the past year in a large number of cases, and with such uniform success that he regards it as absolute master of the disease.

In acute cases in adults he gives dram doses of a supersaturated solution of phosphate of soda; that is, sixty to eighty grains to the dram, the salt being dissolved in its own water of crystallization. This is repeated every three hours, and in addition the following antipruritic lotion is recommended:

Pulvis calamin and zinc oxid, aa 3 iss; acid. carbolic, 3 ss; aq. calcis, j; Aq. rosae, ad 3 iv.

This is to be applied frequently and freely.

The dose of the salt may be appropriately reduced in the case of children, and the quantity of carbolic acid in the lotion diminished. The effect is prompt; within a few hours the acute symptoms subside, and in from twelve to twenty-four hours the eruption ceases to appear. In the chronic type of the disease the relief afforded is equally prompt, but recurrences are apt to follow. The remedy should be given in doses of one dram or more after meals and

should be continued until all tendency to recurrence of the attacks has disappeared. Patients do not acquire a tolerance for the drug, and therefore it may be administered in unchanging doses as long as is necessary without any injurious effect.

The remedy is especially applicable in urticaria of gastro-intestinal origin, and is consequently applicable to fully ninety per cent of all

cases.

Sodium phosphate is regarded as one of the most reliable hepatic stimulants and intestinal antiseptics, and its curative influence over urticaria is probably based upon this physiological action.

Cancer of the Uterus and the General Practitioner. - Dr. John M. Fisher (Am. Gyn. and Obst. Journ.) says that considering the fact that cancer of the uterus can with few exceptionts, be diagnosticated in a comparatively early stage as readily as the same affection in other more exposed parts of the body, the statement that only about ten per cent of these patients, when first presented to the surgeon, have any chance of benefit from a radical operation, is an evidence of the gross ignorance and careless indifference on the part of women respecting the condition of their sexual organs on the one hand, and a sad reflection upon the professional care of patients by the family physician on the other. The average physician's skill to diagnosticate the disease upon making a proper physical examination cannot be questioned, but the whole difficulty lies in the fact that he is either not consulted or is not permitted to make an examination at a sufficiently early period; or, as is too often the case, he neglects to insist upon the necessity of such a procedure, and dismisses such a patient with a placebo and the assurance that the symptoms concerning which she sought his professional opinion are mere coincidents of a normal physiological change at her period of life. Thus the case is allowed to go on until unquestionable discharges, pelvic pain and evidences of constitutional disutrbance invasion at last force a knowledge of the true condition upon the patient and physician at about the same time.

Dr. Fisher draws the following conclusions: 1. Cancer of the uterus is a local disease at first, and in this stage is amenable to radical surgical treatment.

2. Two erroneous popular notions lead to postponed examinations, and are responsible for the vast majority of deaths from this dis

ease; the one almost universally entertained by the laity is that pain is an essential symptom of cancer, and the other, held by the community at large, including the great mass of family practitioners, is that a typical menopausal hemorrhage is physiological.

3. The diagnosis at the time the patient first presents herself to the physician is readily made in at least ninety per cent of the cases.

4. In the order of their importance, hemorrhage, discharge and pain are the three cardinal symptoms of the disease, and the presence of one or more of these in a woman of advanced years, especially, should induce the physician to insist upon a local examination.

The Health of Chicago.-The annual report of the commissioner of health for 1897 demonstrates that Chicago ranks second in point of low mortality among the cities of the United States.

Chicago, says the report, has enjoyed its full share of the good health with which nearly every part of the civilized world has been blessed during the year 1897. We have not only been spared from any epidemic of con tagious disease or pestilence, but the preventable causes of death have generally continued to show the same gratifying decline to which attention was called in the report for 1894.

In that report a table of the populations, total reported deaths and the death rates per 1,000 of population of all cities in the United States claiming to have populations of more than 200,000 inhabitants showed Chicago to have the lowest rate in that year. For the year just closed a similar table is here given -compiled from weekly and other reports received up to December 18, and estimated for the remainder of the year-with the rates for 1894 appended for comparison:

the country during the past three years-Philadelphia and New Orleans only showing no reduction of mortality. For Chicago it is especially satisfactory, when the figures of the group of cities having populations of more than 500,000 are considered. These cities, the first seven in the table, embrace a population of 7,587,000, and their average annual death rate during 1897 was 18.2 per 1,000. If Chicago is deducted, the average rate of the remaining six cities is 18.7 per 1,000, or nearly 28 per cent greater than the Chicago rate-13.46 per 1,000

This 13.46 per 1,000 is the lowest mortality rate ever recorded. so far as is known, for any city of more than 500,000 inhabitants, either in this or any other country.

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Hemophilia Treated by the Thyreoid Substance. In the Scalpel for November 7 (Independ. Med.; N Y. Med. Journ.) M. L. Dejace reports the following interesting case: A woman had suffered for two years from hemophilia, which had reduced her to a condition of excessive anemia. When she presented herself for examination she stated that she had undergone varied and most energetic treatment. Her face was bloodless, the mucous membrane was absolutely colorless, and the gums bled profusely at the least touch. The legs, the arms, and the body were covered with spots of purpura. During each menstrual period the blood was discharged in an alarming abundance, and the menses lasted on an average from twelve to fourteen days. The patient's appetite had remained rather good.

She had made use of all the hemostatics, and repeated injections of ergotine had been practiced, but without avail, and the hemorrhages had continued in abundance, rendering the patient more and more anemic.

The author's treatment was based on certain observations made in regard to the action of the thyreoid substance in the treatment of metrorrhagia. He prescribed for this woman capsules of the thyreoid substance, as it was difficult for him to obtain the fresh gland. The patient took regularly three capsules a day, beginning on the 9th of October. On the 12th the menses appeared, and instead of continuing for twelve days, as had before been the case, lasted but four days and were moderate in quantity. On the 18th the loss of blood from the gums disappeared.

On the 27th the patient, whose weight had diminished only a little over twelve ounces, stated that she had had no hemorrhage since

the last menstrual period. The purpuric spots had disappeared, the gums had become hardened, and the face had regained a rosy color. The patient no longer complained except of slight palpitations. Up to the time of the report she had not exceeded the dose of three capsules a day.

This observation shows, the author thinks, that the thyreoid substance exercises an action as yet unknown on the plasticity of the blood.

Biniodide of Mercury in Whooping-Cough.— In the treatment of whooping-cough Dr. A. H. Bigg of Detroit (Phys. and Surg.; Cincinnati Lanc.-Clin.)arrives at the following conclusions:

1. The association of excessive mucous discharge with the spasmodic stage of pertussis, taken in connection with the prompt relief of the cough that follows its expulsion, suggests its causal relation to the intense reflex excitation which is characteristic of the paroxysms.

2. Its manner of offending is probably by its irritating contact with the nerve endings in the mucosa. Hence the temporary efficacy of the emetics, ipecac and alum in causing its forcible ejection from the body.

3. Biniodide of mercury, by its specific liquefying action upon the glandular secretions, exerts an antidotal influence upon the disease, and thus directly lessens reflex excitability. Its potent germicidal property also renders it fully equal to any possible indication in that direction.

4. The use of the biniodide of mercury, as outlined above, is so far from being fraught with harm to the patient that, on the contrary, its wholesome stimulation of the emunctories and its beneficent action upon the blood itself, renders it a direct prom.oter of somatic nutrition, while the ease with which it can be administered, marks it as an ideal remedy for the class of patients who constitute one's clientele in this disease.

With the pleasing recollection of many dis tressing cases so modified by the treatment here advocated as to be borne by the little sufferers with comparative comfort, he recommends it to the favorable notice of those of the profession who are not satisfied that they already possess the knowledge of a better system.

Homeopathic Dilutions.-In answering the question as to how much alcohol it would take to bring one drop of a mother tincture to the thirtieth centesimal potency, an exchange presented the following calculation (West. Drug.):

Take first the different potencies up to the tenth and see how they multiply:

1st potency..

2d

3d

4th

5th

6th

7th

8th

9th

10th

100 drops.

10 oz. 3 dr. 10 drops. 8 gals. 17 oz. 5 dr. drops.

12 hhd. 7 gals 6 oz. 5 dr. 40 drops. 1.291 hhd, 37+ gals. 129.159 hhd. 3+ gals. 12,915,905 hhd. 60+ gals. 1,291,590,585 hhd. 0+ gals. 129,159,069,523 hhd. 51+ gals.

12,915,905,952,380 hhd. 60+ gals. Converted into cubic measure this last equals 108 776,145,442,708 cubic feet.

The cubic foot of this is 47,736, and this means a body of liquid equal to 47,736 cubic feet.

Divide this by 5,280, the number of feet in a mile, and we have 9 9-220 cubic miles of alcohol necessary to reduce one drop of a tincture entirely to the tenth potential.

But where do we land when we reach the thirtieth centesimal dilution? By the same process, a friend who has a greater love for figures and who had a thirtieth dilution to make one day, found by calculation that for one drop of fluid it requires

16,276,041,666,666.666,666,666,666,666+gals.

equal to 1,295,801 899 cubic feet, equal to 245,420 58-5280 cubic miles. This is equal to 30 677-1000 times the diameter of the earth, and the cube of 30 is 27,000. Therefore it would require for the thirtieth dilution 27,000 cubes of alcohol, each one of which would enclose our whole earth.

Now if atoms are indivisible, where is the medicine in one drop of such a fluid? And what is really meant by the "decillionfold" and quintillionfold" dilutions referred to by Dr. Hahnemann?

Micrococcus Ghadiallii. - The micrococcus ghadiall was discovered by Dr. Ghadially, the assistant to Prof. Hankin in the Agra laboratory (Brit. Med. Journ.; Am. Med. -Surg. Bull.). A description of its properties has been published in the report of the Chemical Examiner and Bacteriologist to the Northwest Provinces and Oudh (Government Press, Allahabad) for 1896. This microbe has been found to have the power of slowly destroying the enteric microbe in water and milk, and to a less extent in bouillon. It seems also to have some power of destroying the bacillus coli in water. In one experiment the four-thousandth part of an agaragar culture of this microbe was added to half a liter of unsterilized lake water that contained the bacillus coli. In eight days the latter microbe had died out. In a similar experiment one one