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operation necessary.

Even in the chronic cases unless there is bony necrosis, the same plan of treatment will give equally good results."

Again he says, "I do not mean that never are we to perform the radical operation, but I wish to call attention to the fact that many patients who are subjected to the radical operation would and should be cured without any such procedure.'

Alcoholic Injections in the Treatment of Neuritis.

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A practice has become quite popular with neurologists and surgeons of treating neuritis by injection of alcohol in the vicinity of the nerve involved. This practice has been in vogue long enough now to show that the relief afforded is but temporary and that cases of neuritis so treated almost invariably relapse and are sometimes made worse. If the correct view of the actual condition of neuritis and its treatment by measures which dissipate the local inflammation and consequent infiltration were generally adopted, very few of these cases would go beyond the first stage; for sciatica, brachial neuritis, tic douloureux, herpes zoster, and neuritis located at other points are very promptly cured, generally within a week, when treated at the outset, by proper electrical methods. That the members of the profession who are treating these conditions are not con`versant with effective methods of relieving this trouble is evident from the fact that alcoholic injections are ever resorted to.

There are few cases of neuritis that come under observation even some time after the outset that cannot be cured by methods which will not relapse, to ever lead to the employment of the method by alcoholic injections. It is the mechanical currents, particularly the static currents, which invariably cure these cases in the first days, that are indicated.-Journal of Advanced Therapentics.

SUPERIOR.

The choicest garb, the sweetest grace,
Are oft to strangers shown;

The careless mien, the frowing face,

Are given to our own.

We flatter those we scarcely know,

We please the fleeting guest,

And deal fully many a thoughtless blow
To those who love us best.

Diabetic Coma Cured by Intravenous Injections of
Bi-Carbonate of Soda.

At a recent meeting of the Hospital Society of Paris (Abst. in Deutsch. Med. Woch. 49, 1911) Labbe and Carrie reported the case of a woman of 35 years with diabetic coma following diabetes of 10 years standing. They first gave 500 c.c. of a 3% solution of sodium bi-carbonate intravenously and 60 grms. by the mouth. The coma disappeared and the treatment (what part of it?) was continued for 5 days, and then stopped; whereupon coma reappeared. They then gave one litre of the sodium solution, intravenously, and 20 grms, per os. At this, a definite recovery from the coma ensued with no relapse after 5 months. The authors found only 8 such recoveries reported. The great thing is to begin the treatment early.

Gifford (Omaha).

Acute Indigestion As a Cause of Death.

The recent regrettable deaths of Rear Admiral Roberly D. Evans and Alfred Tennyson Dickens were reported to be due to acute indigestion. While an attack of acute gastritis might conceivably prove fatal to a man of late middle age, from exhaustion or shock, the cases of which we hear so much as carrying off men of advanced years are very frequently the gastritis of Bright's disease, which ushers in the fatal coma of that affection. The violent vomiting may kill in itself, or the patient sinks exhausted into unconsciousness which is prolonged till the fatal outcome of uremia. In default of an autopsy, which is not always permitted, a diagnosis of acute indigestion is the only one possible, for that of nephritis is not scientifically possible without an examination of the kidney, whatever may be the suspicions of the attending physician.--New York Medical Journal.

Primary Intussusception of the Appendix.

Inflammation involving the vermiform appendix presents a widely diversified clinical picture, and this is accounted for chiefly by the position of the appendix; its length; the direction of the distal extremity; the location of the early inflammatory process; the amount of leakage; the virulence of the sepsis; the resistance of the patient; the degree of development of the omentum; and the early steps taken in its treatment.

The writer encountered a pathological mass in the neighborhood of the caecum in one case so rare that its report may be interesting and useful.

Primary intussusception of the appendix with the base of the appendix entering the caecum without inversion has been met with by the writer but once. The patient being a physician forty-two years of age, complained of having had a good share of pain at intervals of some three or four years, and he was in the habit of taking rather liberal amounts of salines for his obstinate constipation.

The operation revealed an intangible looking mass about the caecum which upon being oriented, by liberating adhesions, revealed intussusception of the appendix to the degree which left about 1-3 of the appendix yet in the abdominal cavity, and it was possible to reduce the intussusception after further separating the adhesions and making a short incision into the caecum. The appendix was a large one, sharply inflammed, and after the removal, the hole in the caecum was closed in the usual way, the patient making a good recovery.

The clinical report is made chiefly because we believe that intussusception of the appendix usually means an inversion of that organ, and that this later form is secondary to intussusception of an adjacent coil of the bowel.

Allison (Omaha).

The Reaction of Cow's Milk.

From time immemorial it has been taught that cow's milk is acid in reaction and breast milk alkaline, and that it is advisable to add lime water to cow's milk in order to give it the proper alkalinity for infant feeding. But recent studies (Pediatrics, 1911, 127), have conclusively shown that:

(1) Breast milk and cow's milk are both acid; (2) the litmus paper test for milk is unreliable because of the variation in the quality of litmus paper, and the litmus taking part in the reaction and not acting as an indicator; (3) the effect of adding lime water or bicarbonate of sodium to feedings is to retard or inhibit the formation of curds by rennet; (4) the teaching that lime water, bicarbonate of sodium, or carbonate of potassium should be added to fresh milk or feedings simply because they are anti-acids is erroneous; (5) the addition to milk or feedings of alkalies or salts that become alkaline in solution is an empirical method of aiding digestion by preventing the formation of

dense curds that should slowly leave the stomach and be difficult of digestion in the intestine.

The opinion that breast milk is alkaline in reaction, and cow's milk is acid, and that alkalies should be given with cow's milk, in infant feeding, has been slowly changing, largely under the influence of the teachings of Dr. Henry Dwight Chapin who writes (Infant Feeding, Chapin, 1909, 70):

"It is often stated that cow's milk has an acid reaction when it leaves the cow or in its fresh state. Acidity of milk is never estimated directly, but by the use of some color indicator. Milk that is neutral to litmus is usually quite acid to phenolphthalien; but it is thought that this is not true acidity, but the effect of the salts and casein found in the milk. The acidity of milk that aids the action of rennet is true acidity and is shown by litmus. An interesting proof that the acidity of phenolphthalein is not true acidity has been shown by Babcock, Russell, Vivian and Hastings. They found that pepsin, which digests proteid only in the presence of acid, would not attack the proteids of milk that was acid to phenolphthalein until 0.2 per cent HCL was added, also that boiled milk would not coagulate with rennet; but it did so at once, as soon as acidified."

The Roentgen Treatment of Malignant Tumors. (By Professor Stephane Leduc, Nantes, France, Archives of the Roetgen Ray-London, August 12, 1911.)

"The surgical ablation of malignant tumours, cancer, epithelioma, sarcoma, and the like, results in permanent cure only in exceptional cases. As a general rule, surgical interference is followed sooner or later by local recurrence and generalization of the disease."

"For some considerable time after this regional infection by malignant disease, the lymphatic glands are able to defend the organism against the general invasion of the disease. The glands here play a double role; they are both fortress and garrison, arresting the invasion, and defending the organism against the entrance of the pathological germs."

"If this idea is correct, the surgical ablation of the lymphatic glands in an early operation for cancer is much to be deprecated, since their destruction removes the only barrier to invasion and the only defense of the organism. After the operation, the lymphatic circulation is re-established but without its natural protection. Hence the dispersion of the disease germs will be much more rapid and the generalization much more ex

tended. One cannot help suspecting that we should have heard less of the surgical removal of cancerous glands if the visceral generalization had been as seasily recognizable as is the local recurrence in the glands or scar."

"The action of the X-Ray on malignant growth is selective and specific. They attack the pathological tissue, and cause its disappearance, without affecting the normal tissue in which it is embedded."

"The introduction of Roentgen rays for the treatment of cancer resembles that of mercury for the cure of syphilis."

"I have convinced myself of this by the following evidence: On more than one occasion I have been able to follow the treatment of a series of cases of cancer under the care of most able surgeons.

"From a number of consecutive cases the surgeon has chosen those he considers most suitable for operation, while the less favourable cases have been submitted to radio-therapeutic treatment. I have observed that the results in the cases treated by radiotherapy has been much more favourable, and the time of the patients' survival has been much longer, in several cases as much as six years, as compared with six months after operation. At the present time I have under my notice a certain number of patients who had tumours of the breast which have entirely disappeared under radio-therapeutic treatment, and whose cure still remains perfect after five or six years."

"If surgical ablation is thought necessary, the radiotherapeutic treatment should be given before and not after the surgical interference." Why not before and after?

W. H. Mick (Omaha).

Prolapsus of the Uterus Complicating Pregnancy.

In the issue of December 30, 1911, of The Journal of The American Medical Association, Dr. Palmer Findley writes: Of the malpositions of the uterus, descensus is most often encountered. This applies as well to the early pregnant uterus in descensus of moderate degree. It is well known that a moderate degree of descensus uteri is not incompatible with pregnancy and with normal delivery, but complete prolapse of the gravid uterus is rarely seen and has never been observed at full term.

We seldom find prolapsus of the gravid uterus in a primipara. The displacement is usually the result of pregnancy, hence a condition common to multiparæ. As to the time of occur

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