rapid and her respirations shallow. She presented all the features of shock, though there was not undue hemorrhage, nor was there any discoverable lesion of the soft parts. Strychnia was used hypodermically and heat applied externally. It was two hours before her condition became reassuring. She made a good recovery, the highest temperature being 100.5°. The child was. delivered on the 242nd day from the last menstrual period, or 38 days before the computed date of full term.

The diameters of the head were as follows: Occipito-frontal, 11 cm.; biparietal, 9 cm. ; suboccipito-bregmatic, 9 cm. Weight, 6 pounds.

The child is now six months old. He is above the average in weight and development. Much credit is due the nurses for their efficient and faithful care of the child.

Operating Phimosis Without
Circumcision.

Dr. Lambert, of Dunkirk, operates phimosis without having recourse to the classical method of circumcision. His method is based on the principle that the phimosis comes from atresia of the mucous membrane, and that it suffices to effect a cure by simply increasing the diameter of the membrane without touching the cutaneous envelope.

After having prepared the parts by means of antiseptic irrigations, and made one or two injections of cocaine to obtain the necessary degree of anesthesia, he seizes the prepuce with three forceps disposed at equal distances from each other. Taking a pair of scissors, he makes a small nick in the mucous membrane between each forceps, through which he introduces the fine point of the scissors, passing between the membrane and skin, and slits up to the sulcus. The prepuce thus dilated the glans becomes free. The small incisions are sutured, and the wound dressed in the usual way. The prepuce is then drawn over the gland, remaining thus dilated until the cicatrization is complete. - Paris Cor. Med. Press and Circular,

With the building of the new waterworks plant at California, Ohio, it was thought not unlikely that instances of this peculiar affection would occur. Several workmen have, indeed, suffered from the milder symptoms, and within the past few days one man has been transferred to the Cincinnati Hospital with paraplegia, presumably a result of "divers' paralysis," as it is often called. This disease is one not unknown in this country-indeed, has been studied more thoroughly here than abroad-the cases occurring at the building of the East River Bridge and the bridge over the Mississippi River at St. Louis being notable examples that were thoroughly investigated.

As a rule, symptoms do not arise unless the workman has been subjected to over three atmospheres of pressure, nor do these symptoms come on until after he has left his work, sometimes not

for several hours. It was not unnaturally thought that the sudden diminution in pressure was the underlying etiological

factor, and, working along this line, Rosental, Bert and others were able to show that under such circumstances hemorrhages occurred in various organs, and that nitrogen gas was formed in the blood as well as in other fluids of the body.

While the autopsies on the victims. of caisson disease have, fortunately, been few, they have shown that hemorhages, for the most part minute, have taken place in the spinal cord and its membranes; in addition, irregular peculiar fissures without hemorrhage have been noted in the same locality. The idea was derived from these findings, and with reason, that the sudden release of nitrogen gas, formed and stored in the blood, the cerebro-spinal and other fluids, was sufficient to lacerate the delicate nervous structures of the spinal cord. The fact that multiple disseminated foci of sclerosis were present in the cords of some patients, the subjects of the disease under consideration, dying months afterwards of an intercurrent affection, seemed to lend strength to this view.

The symptoms seem to be of three grades. In the mild cases there is usually a complaint as of rheumatism affecting the joints, particularly the knees, which supervenes on leaving the caisson. This is in all probability due to sudden increase of the blood supply to these parts, which in turn increases the fluid in the joint cavity, so that the pain is entirely the result of pressure. In the same manner hyperemia of the brain and cord causes cerebral excitement and an incoördination of muscular movement, the patient tottering as if under the influence of alcohol. The pulse, which, while within the caisson, increases rapidly to 120, becomes steadily slower on leaving, becoming in a short time greatly retarded. In more severe

cases we have, in addition, complete paralysis of both legs, with a corresponding loss of sensation, diminution or loss of electrical excitability, and at paralysis of the sphincters of the bladder and rectum. Paralysis of a single limb or of all four extremities may be present. In a few cases sudden death has been observed, the condition being practically indistinguishable from apoplexy; indeed, the underlying pathological process is similar.

As a rule, the more mild the attack, the better the outlook, the great pains, dizziness and vertigo usually passing off in a few hours. Usually, too, the paralyses gradually disappear, though in some instances they have been permanent, proving beyond question that the primary lesion was severe and destructive.

The treatment should be on a line of an endeavor to prevent the existence of any such case-that is to say, strictly prophylactic. As regards divers, implicit instructions should be given that they always come slowly to the surface. In the work in caisson a number of "locks" should be established, so that the pressure may be diminished gradually until it is about that of the atmosphere. When the work requires over three atmospheres of pressure the period of labor should not exceed an hour, while fully that time or more should be spent in the ascent through the various locks. It is well, in conducting enterprises necessitating much caisson work, to have a chamber specially constructed, in which a man who exhibits signs of the disease may be again subjected to pressure somewhat greater than that of the outside atmosphere. Under such conditions the alarming symptoms will usually abate. Other treatment will, of course, be entirely symptomatic, and depend upon the exigencies of the case.

All

THE CATARRHAL DIATHESIS.-In catarrhal affections of the various mucous membranes, particularly of the respiratory tract, there exists not only a relaxed atonic condition of these structures but an underlying constitutional state of malnutrition. authorities agree that in order to eradicate the local pathologic conditions, treatment by appropriate systemic remedies is indispensable; the patient's nutrition must be fostered and restored so that a degree of constitutional vigor is attained which antagonizes the catarrhal processes. Gray's Glycerine Tonic Comp. is the remedy par excellence in these cases because it has a two-fold action. Primarily and chiefly it overcomes malnutrition; it reestablishes normal nutrition by eradicating the ever-present atonic condition of the digestive organs, thus assuring the maintenance of normal digestion and assimilation of food; restoration of tone and nervous force to the entire system, and incidentally to the mucous membrane, is a natural sequence. Gray's Glycerine Tonic Comp. has, moreover, a direct local antiphlogistic and tonic influence upon the disordered circulation of the mucous membranes; it relieves engorgement and restores tone to the relaxed atonic blood vessels. The Purdue Frederick Co., No. 15 Murray Street, New York, are the sole proprietors.

Correspondence.

PHYSICIANS AND CHARITY. FORT WAYNE, IND., Dec. 10, 1899.

Editor LANCET-CLINIC:

Did you ever stop to consider what a vast amount of inexpensive charity is dispensed-inexpensive to the dispenser or assumed dispenser? Much of this kind of charity is dispensed by the mouth rather than by the heart-by speech rather than by true sentiment and corresponding action. While this charity is not expressed in an outlay of dollars and cents upon the part of those who seek to pose as its dispenser, the expense thereof must fall somewhere, and that somewhere" is upon the physician, and consists in time, work, worry, and often in money out of his own pocket. He is obliged too often to do hard, laborious, charitable work for which the party who solicited his services in behalf of the impecunious patient assumes all the credit.

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While the vocation of the physician is one necessarily calling for the exercise of more or less charity, advantage of this fact is taken by many people, who seem to take unto themselves the credit for its exercise, when that credit is entirely due to the physician whose services are rendered without any remuneration—a spurious charity based upon the genuine article dispensed by the physician.

I will try and make myself clearer to you, or better understood. I have frequently been called into wealthy, Christian(?) families, whose annual foreign missionary contribution was quite respectable in amount, to treat the “hired girl" or "servant." Before seeing her, the dear, good Christian mistress of the house was certain to remind me that the girl was poor, entirely destitute, an orphan, had no one to depend on but herself; that her wages were barely sufficient to keep her when able to work, to say nothing of her inability to earn any while sick, etc.; that she was an excellent girl, of good moral character, and a splendid worker, that she was very desirous of keeping her, for good girls were very scarce now,

but that she could not possibly keep her if she was going to be sick any length of time. Poor girl! I feel very sorry for her, but I don't know what I'm to do with her sick on my hands; if she is to be sick more than a day or two, Doctor, can't she be taken to the hospital, or to the County Asylum? I can't afford to keep her if she is sick. You do what you can for her, Doctor; try and get her up as soon as possible, and she may be able to pay you some day."

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Thus are the remarks of the mistress ostensibly in the behalf of the "poor hired girl," but it does not require a very great stretch of the imagination to conclude that they are made principally in her own behalf, with the view of getting as much service from the doctor as possible, with the implied understanding that she would be in no way responsible for the same, and with the implied hope that the doctor would not expect the poor hired girl" to be. The good (?), kind (?), charitable(?), Christian(?) mistress thus succeeds in securing professional services, and, perhaps, also the medicine, if the physician furnishes his own remedies. In every case, however, into which my curiosity prompted me to inquire every cent of money paid for medicine and every minute of time lost by sickness and failure to work was deducted from the "poor girl's" wages when, after recovery, she resumed her work. physician may be as impecunious as his patient, but that makes no difference to these charitable(?) Christians (?). Such Christianity is damnable. Hell is full of just such Christians. They are so close that it would be impossible to introduce a greased flaxseed into their "recti rectorum.'

The

No wonder that girls go to the bad when they find so little of the milk of human kindness in Christian families!

I used to think it was the "whole thing" to give a dollar to the tune of

"Greenland's icy mountains,"

but I will never give another d- -d cent to it until America's abused, poverty-stricken hired girls are better treated by our Christian (?) civiliza

tion(?). I would much prefer to contribute five dollars to that other tune"Alas! for the rarity Of Christian charity Under the sun. Oh, it was pitiful, Near a whole city full Home she had none."

H. V. SWERINGEN.

CONTAGIOUS DISEASES.

CINCINNATI, Dec. 12, 1899.

Editor LANCET-CLINIC:

The plan of protecting school children recommended by Health Officer Tenney is undoubtedly a wise one, but there are other sources of danger of greater magnitude than the school room. For example, many cases of contagious disease (the so-called mild) develop in families where no physician is called in to prescribe or give specific directions to parents in the matter of caring for and prevention of the spread of contagion. These children oftentimes are permitted to return to school before the danger of contagion has passed. This is especially true of scarlet fever cases. Very often they return to school while yet passing through the period of desquamation. I am quite sure this is one great source of danger. I have observed that contagious diseases are always more prevalent during or after the opening of our public schools, and until parents are taught the importance and necessity of care in the management of such cases the city will continue to be the breeding-ground and be visited by epidemics of more or less severity. I know of but one remedy for this evil, and that a bare suggestion; that would be a house-to-house inspection by competent and trustworthy men, or make it a punishable offense for parents to allow children to be on the streets or in public places while harboring contagious diseases, more especially the eruptive and diphtheria. Often, I think, the physician is not called in simply to keep the expense account down, and in a few instances through ignorance of the true nature of the trouble.

W. H. DEWITT.

61 Auburndale Place.