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the fingers are redipped, as the coating wears off, but one application on the hands and forearms is sufficient for the entire day. The skin of the operator does not become water logged" or shriveled with the solution, as it does with the rubber gloves. The coating is best removed by washing the hands in benzine and drying rapidly with a towel.

I quote as follows from a letter from Dr. Van Buren Knott, of Sioux City, as an example of many received:

"I have used the gutta-percha solution for three weeks, and am very much pleased with it. I think it a very valuable protection during operative procedures. I have used the solution with and without gloves, and in either manner have been well pleased. I find it a most excellent means of protecting the hands in the application of plaster-ofparis, as it prevents the plaster from sticking to the skin, and avoids the harsh, rough feeling which follows the application of a plaster cast."

Since my previous report, I have used the solution on my hands and on the operative field in all operations, septic and non-septic, and am convinced that it is a simple and practical means of protection for the operator and patient.

Pain in the Heart.

By G. MILLER, M. D., Watsonville, Cal.

Pain in the heart is generally not due to heart disease. It is in most cases caused by neuralgia, pleurodynia, myalgia, local pleurisy, periostitis (of syphilis or typhoid), abscess (tubercular abscess between pericardium and walls of thorax- these last two being very rare causes), or gastric trouble (with flatulence, feeling of weight and fullness in the stomach or acidity of stomach-this last being a very common cause).

Pain in the heart or epigastrium, with fever, irritable cough, rapid, irregular pulse, anxiety, dyspnea, in early stage a friction sound, and later on signs of effusion (and sometimes headache, vertigo, delirium, nausea, and vomiting), especially when occurring in connection with rheumatism, occurs in "acute pericarditis."

Pain or feeling of distress in the heart, with rapid pulse, sometimes irregularity, and usually but not always moder

ate fever, cough, dyspnea, anxiety, and a soft blowing murmur, which murmur changes location from time to time, occurs in "acute simple endocarditis." This acute endocardial murmur must be carefully diagnosed from a chronic murmur, with accidental febrile accompaniment.

Pain or feeling of distress in the heart, which may be absent at times, with considerable fever, or chills and fever, profuse sweating, diarrhea, rash or erythema, sometimes pronounced cerebral symptoms and a murmur varying in location from day to day occurs in "malignant" or "ulcerative endocarditis.".

These forms of endocarditis are very liable to be found in conjunction with rheumatism.

Pain or feeling of distress in the heart, with rapid; feeble, irregular heart action, dyspnea, great anxiety, nervous excitement, fainting fits, cold skin and turgid veins, occurs in "heart clot."

Pain or feeling of distress in the heart, with symptoms of poor circulation, such as cold feet and hands, dyspnea, or vague symptoms, and following a spell of severe sickness such as typhoid fever, occurs in "acute myocarditis."

Pain in the heart of an agonizing kind, and often running down the left arm, with restlessness, shallow breathing, pale face, great uneasiness and prostration, although sometimes the pulse is normal, occurs in "angina pectoris."

Pain in the heart, with palpitation, and occurring in anemic persons after severe exercise, or from excessive use of coffee or tobacco, or sexual excesses, or in hysterical persons, or in rheumatic or gouty persons while sufforing from indigestion, and with symptoms often closely resembling true angina pectoris, occurs in "false angina." It is a neurosis.

Pain in the heart, with palpitation, rapid action of heart, and later on thyroid enlargement and prominence of the eyeballs, occurs in "exophthalmic goiter."

Pain in the heart, or near it, and with other symptoms of pressure, such as displaced heart, enlarged veins, aphonia, dyspnea, cough, dysphagia, and sometimes bronchial hemorrhages simulating phthisis, occurs in "aneurism of the orta."

Pain in the heart, with dyspnea, venous stasis, edema of

the feet, and a murmur, occurs in "valvular heart disease," especially in aortic regurgitation.

Pain or feeling of distress in the heart, with a pulse that beats very rapidly a few minutes and then falls to forty or fifty, with a greasy or pasty yellow skin, with weakness of heart action, poor circulation, a true arcus senilis (which latter has a blurred outline, is yellow in hue, and with a cloudy cornea), with paroxyms of dyspnea after exertion, with some cerebral symptoms such as irritability and depression of spirits, and at times with fainting spells, occurs in "fatty degeneration of the heart."

Pain in the heart, with rapid, feeble pulse, restlessness, faintness, cold skin, dyspnea, and occurring in a person suffering from some form of heart trouble, occurs in "partial rupture of the heart."

Pain in the heart, with sudden death, occurs in "complete rupture of the heart."

Pain in the heart at its base, with feeble pulse, cold extremities, palpitation, systolic murmur, and hard tortuous peripheral arteries, especially in old people, occurs in "atheroma" (of aorta especially).

Pain in the heart, with aphonia, cyanosis, difficulty in swallowing, and with a feeling of oppression in the chest, occurs in "carcinoma" and "sarcoma of the mediastinum." The diagnosis of this latter condition is very difficult.-Merck's Archives.

*Hospitals and Other Medical Institutions in Denmark, Sweden and Norway.

Schaper has returned from a trip to the northland full of admiration for the modern medical institutions he found there. Every one of the larger hospitals in Norway and Sweden has one pavilion devoted to all kind of baths in addition to the ordinary bathing facilities in each ward. Male nurses are very rare. The nurses, after 25 years of service, are entitled to a small pension. In case of an infectious disease an ambulance is dispatched on receipt of the telephone message, and the hospital and ward are notified by telephone that the patient is coming, by which means contact with the affected subject can be avoided. He (The Medical Institutes and Hospitals in Denmark, Sweden and Norway. Schaper. From society address.-Berliner klinische Wochenschrift.)

adds that the lack of these precautions was grievously felt in the recent plague case in Berlin. The hospital facilities at Stockholm are so ample that there are 8 beds for each 1,000 inhabitants. The medical course in Sweden requires 20 semesters and in Norway 14, but the first two years are devoted more to the accessory sciences. Owing to the ample material, during the last six semesters the students are given special patients in the hospitals to treat, and are compelled to write out in detail the reports, which are then gone over by the professor in the class and criticised. The great Sabbatsberg Hospital at Stockholm has a detached tuberculosis annex and also a most attractive convalescent home. Still another annex is for delirious and noisy patients. Stockholm also has two shelters with 12 beds in each, for persons who become helpless in the street, with separate rooms for delirious subjects. Christiania has a model centralized arrangement for reception of the sick. The physician in charge resides, with his family, in a centrally located building, formerly a hospital. Every morning the different hospitals telephone to him what empty beds are at their disposal in the different wards. He is notified by telephone when a sick person is coming. He can thus distribute to the best advantage the sick as they arrive. He keeps a detailed register of each person, .noting where he comes from and other minor details. The city has only 250,000 inhabitants, and this plan was opposed at first by some of the professors, but as time has shown its advantages, all are now enthusiastic over it. In Sweden and Denmark anti-diphtheria serum is given free. for prophylactic injections and the dose of 4,000 units costs only about six cents. Schaper describes Finsen's Institute in detail. The state pays $7,000 that the poor can be treated there without charge, but this amount does not pay more than half the expense, the rest being made up by wealthy persons. Finsen has been constantly confined to his room during the last few years, but from his sickbed he has been able to almost eradicate lupus from Denmark. The average duration of the affection in the 1,000 patients treated was eleven years, but 5 have been cured who had been afflicted for fifty years. In 72 per cent of his total material the mucosa were involved. Last year he published the detailed; report of his first 800 cases, with 51

per cent apparently cured and 24 per cent progressing toward a cure; 11 per cent materially improved; 5 per cent not satisfactorily influenced, and 9 per cent who abandoned. treatment for personal reasons. Of the total number 33 have died, 21 from general tuberculosis, 4 from heart disease and 4 from cancer. The treatment was more or less successful in 737 out of the 800 cases, that is, in 94 per cent. With improved technic the duration of treatment has been reduced, although he still estimates that from 40 to 200 exposures are necessary. Mild cases can be cured in six weeks; moderately severe in three months; extensive cases in six months, and very extensive in a year. Two sittings a day cause a strong reaction, but the inflammation completely subsides by the end of the week, when the patient is ready for another sitting. Arrangements are made in the Institute for the instruction and amusement of the patients under treatment, and opportunities are given them to be more or less self-supporting.-Jour. A. M. A.

Three Chlorides (liq. ferrisenic Henry).

"Three Chlorides (liq. ferrisenic Henry) is suitable for the prolonged treatment of children, adults and the aged; for the cure of anemia and bodily weakness; in convalescence from acute diseases and after surgical operations; for the paleness of and impaired appetite of children; boys and girls at the age of puberty and women at the menopause; in children with chorea or rickets, or who are backward in development, in whom exists an aversion to meats aud fats.

"This combination of iron and its corrigents, arsenic or mercury, a ferruginous laxative tonic, is pleasant and assimilable, of non-astringent taste; highly suitable for prolonged administration without its becoming a disturbing element in the stomach or injuring the teeth."-Medical Essays.-HENRY.

KENNEDY'S Extract of Pinus Canadensis is a valuable agent in chronic diseases of the mucous membranes, and admirable for the removal of morbid discharges of every kind.