earned solace of a hard day's march? We believe notand that the open air will have saved what might have been the untoward results of smoking when unfed." The most suggestive part of this instructive article is that which refers to the cases of mental derangement in the course of campaigns and their connections, if any, with smoking. Insanity has been considerable among our soldiers in the Philippines, and the surgeons there might with advantage investigate the question raised by The Lancet writer as to the capacity for sleep previously evidenced by those who broke down and also of their indulgence or non-indulgence in tobacco.-[Medical Record.

ANGINA PECTORIS.-Angina pectoris may be defined as a symptom complex dependent upon disturbance in the functional activity of the heart muscle, resulting either from organic causes, such as disease of the coronary arteries or of the myocardium itself, or from toxic influences, such as may arise from excessive indulgence in alcohol, tea, or coffee. It has been the custom to designate cases of the first kind "true" and those of the second kind "false," but it would seem better to employ instead the qualifications "severe" and "mild" respectively. Derangement of function must always be referred to alteration in structure or in nutrition, and the degree of the former will necessarily vary with the character and the intensity of the latter. Normal function must be looked upon as the resultant of metabolic activity, whose derangement will be attended with altered nutrition, which if profound or long continued or frequently repeated, in consequence of either intrinsic or extrinsic influences, may lead to structural alteration. In accordance with the foregoing considerations, angina pectoris would not necessarily be a disorder of the degenerative period of life, and not invariably fatal, but the prognosis would vary with the nature of the underlying condition. In reporting briefly five cases of angina pectoris, three of which terminated fatally, and in two of which recovery ensued, Salomon (Berliner klinische Wochenscrift, 1900,

No. 36, p. 275) points out that, inasmuch as the etiological factors are so varied, it is not to be expected that the lesions present should always be the same. Thus, among the conditions assigned as causative influences are syphilis, alcoholism, long-continued mental and physical strain, frequently repeated and long-continued depressing emotional states, diabetes, gout, acute infectious diseases, excessive indulgence in tobacco, tea and coffee, over-eatlng with insufficient exercise, and lead poisoning. In any event the treatment is much the same. In the paroxysm inhalations of ether, chloroform, or amyl nitrite, hypodermic injections of morphine, or the administration of nitroglycerin may be practised, while in the intervals the diet and the mode of life generally will require to be regulated, and iodide should be administered.-[Medical Record.

GIFT OF DR. SENN.-Dr. Nicholas Senn recently gave to Rush Medical College $50,00 which insures the beginning of a building project which will give the college the finest and best equipped structure for clinical work in the West. Architecturally the structure will follow the Italian Renaissance, the first few stories being of stone, and the four upper stories of terra-cotta and brick. The recitation room and the dispensaries will occupy the first, second and third stories. They will be equipped with all the latest improved medical and surgical appliances. On the fourth floor will be the laboratories. Their equipment will be the finest and most modern. The fourth floor will be conducted with the Presbyterian Hospital building by a covered bridge. Two amphitheatres for clinical work, capable of seating 150 students, will occupy the fifth floor. [Med. News.

AMPUTATION of the cervix may be useful in certain conditions, but certainly not in cancer. In this disease it is unjustifiable, for it does not remove the disease and it does hasten the general involvement, and an imperfect operation for cancer is a blot upon surgery.-[International Journal of Surgery.

A NEW OPERATION FOR HEMORRHOIDS.-Ellsworth Eliot in Medical News, Dec. 1, 1900, states that the following procedure, which has been tried during the past six months in the Presbyterian Hospital of New York, has given excellent results in a number of cases: After the customary preparation and with the usual precaution of as perfect cleanliness as is possible under the circumstances, an anæsthetic is administered, and the sphincter having been stretched the hemorrhoids are allowed to protrude. Each advanced hemorrhoidal area is treated similarly as follows: Opposite the base of the hemorrhoid, parallel with and corresponding to the muco-cutaneous junction, a curved incision is made and carried upward in the same plane as in a Whitehead operation, beneath the pile-bearing area until the base of the hemorrhoid is reached. A second curved incision is then made in and through the mucous membrane, forming an ellipse with the first-mentioned incision and including within this ellipse any area of ulceration at the base of the hemorrhoid that may have developed as a result of the irritation to which the exposed surface of the mucous membrane overlying the hemorrhoid is subjected. From the junction of the two curved incisions an incision is carried vertically upward through the mucous membrane only, and the resulting quadrangular flap of mucous membrane is reflected from the surface of the underlying hemorrhoidal area, having its base of blood-supply superiorly. After the dissection of this flap, the same vertical incision is deepened through the hemorrhoidal tissue proper, forming a rectangular mass of hemorrhoidal tissue which is transfixed at its base with stout catgut; the ligatures are then tied tightly and the mass is removed. The rectangular flap is stitched to the skin and the retention of any discharge prevented by cutting the catgut ligature long and allowing the ends to protrude below, thus acting as a drain. This same procedure is repeated in not more than two other places where the hemorrhoids are most pronounced. A dressing of sterile gauze is placed over the suture line, a large tube, surrounded by iodoform gauze, having been previously in

troduced into the lumen of the gut. Prompt union is generally secured and the complete excision of all areas of ulceration at the base of the hemorrhoid is attained.[Medical Record.

WHY ARE TYPHOID AND OTHER FEVERS SELF-LIMITED ?— J. O. Malsbury believes that the law which governs higher animal life, namely, that constant interbreeding results in less vigorous progeny until finally there ceases to be fertility, holds good in the case of lower animal organisms. In typhoid fever it is fair to assume that there is a new production every twenty-four hours, since there is a reasonably regular variation of temperature of about one degree during that time. This specific element or spore reproduces within and of itself, and with each successive reproduction the spores become less vigorous, until finally fertility ends, reproduction ceases, and the active phenomenon-disease in this particular case-is at an end. If a patient be infected with vigorous spores the attack will be malignant, severe, and abrupt, while if the spores of infection be such as would be found after several successive reproductions, the attack would be mild. Cases that increase in malignancy may have been infected with mixed spores, the cross resulting in increased vigor. Repeated interbreeding would of course end in failure to reproduce, but owing to the severity and prolongation of the attack the patient's vitality may end first. [Indiana Medical Journal, November, 1900.

THE PNEUMONIA OF THE AGED.-Professor Lemoine (Le Nord Medical, August 15, 1900, p. 181) discusses the treatment of pneumonia in the aged, so far as it differs from pneumonia in the adult. The differential characteristics of the affection are briefly as follows: As in the adult the onset may be marked by shivering; dyspnoea may occur, but as a rule it is not intense; the pulse does not exceed 90 to 100; expectoration, generally slight in amount, is ordinarily composed of greenish masses; the cough is not very frequent; the temperature follows a

similar curve to that in the adult, but is a degree or more lower. The summit of the lung is more often affected than the base. Stethoscopic examination may give the same signs as in the adult, but in other cases absolutely nothing is heard and the diagnosis must depend upon the general symptoms. Between these two extremes we may get all varieties, but as a rule crepitation is absent and subcrepitant rales are most commonly heard. The indications on which treatment must be based are to diminish the flux of blood, to calm the respiration, to sustain the heart and the general strength. In addition, the elimination of toxins must be aided and the expectoration must be facilitated. Hyperpyrexia is unlikely to occur. Acetate of ammonium and ether are among the most valuable stimulants. Alcohol is often most valuable as a general stimulant except in alcoholics. In these musk deserves to be more widely used. Strychnine and nux vomica are most valuable aids to expectoration because of their effect on the muscular tissue, which is deficient in power in these patients.-[Treatment.

Diabetic Diet.—The vitiation produced by routine habit is exemplified in the universal and indiscriminate withdrawal of carbohydrates from the diet of diabetics. Dr. J. S. Ely has recently recorded his observation that in a number of cases this has been followed by the development of coma, probably from the readiness with which proteid food yields acids in process of decomposition. To avoid this he suggests the institution of alkaline treatment prior to the reduction of carbohydrates. This is a practical point of which wide-awake practitioners will realize the significance.-[Medical Age.

HYDROGEN PEROXID AS A HEMOSTATIC.-The Sem. Med. quotes Rifaux to the effect that hydrogen peroxid is extremely effective as a hemostatic. A tampon moistened with it and inserted in the nasal fossa in case of hemorrhage will arrest even the most serious and uncontrollable epistaxis.