prejudicial to these other persons; hence he thought it was not possible to get the very best results in large public institutions.

Dr. JOSEPH COLLINS said it was most encouraging to learn that there was at least one asylum superintendent who knew something more than the superintendence of buildings, the laying out of gardens, and could do a cer*ain amount of clerical work. The paper of the evening had contributed important facts to the science of medicine. He was disposed to believe that it was not at all extravagant to state that 10 per cent. of epileptics could be cured. He would like to go on record as subscribing verbatim to the statements made in the paper, with one exception, i.e. that the prognosis was better in epilepsy developing late in life, for, according to his experience, this form of epilepsy was due to arteriosclerosis and was commonly followed by general paresis. He maintained that epilepsy might, or might not, be an organic disease; the one who held that it was of organic origin was as much entitled to his opinion as was he who maintained that it was purely a functional disorder. He had it directly from the mouth of Jacksonian himself that the form known as Jacksonian epilepsy was not an organic disease. The speaker said he could not agree to the statement that had been made, that patients presenting stigmata of degeneration justified a worse prognosis; indeed, his opinion was just the opposite of this. He had no patience with those who insisted upon some definite period of immunity from seizures as a guarantee that a cure had been effected. In conclusion, he would say that he was not familiar with any nervous disease of similar severity which was enitled to a better prognosis from intelligent, assiduous, and proper treatment than was this disease, epilepsy.

Popular Prejudice against Colonies.-Dr. W. M. LESZYNSKY said that nothing had been said about the lack of willingness of many epileptics to sacrifice their personal liberty with the object of going to the Craig Colony, even though this was the very best thing for them. He had found in dispensary practice that even though it were possible to gain admission for patients to this colony, the majority of this class of persons were entirely unwilling to go there. They could not be blamed for this attitude, particularly where they only had three or four attacks a year and were able to continue at their work.

Organic and Incurable Not Synonymous.-Dr. B. SACHS said that epilepsy was almost as severe a scourge as was tuberculosis, because it not only affected a large nuinber, but the affected persons commonly lived many years and became a heavy charge upon the community. It was a common experience to find that the parents of epileptics often showed evidence of having neglected their children because of the belief that epilepsy was incurable. This was one reason for taking a more optimistic view. For many years he had taken such a view himself, and had endeavored to exercise his personal influence toward spreading this gospel among the people. He could recall patients who had remained free from epileptic seizures for fifteen years; others who had been free from them for three, four, seven, and ten years. If a patient remained free from epileptic attacks for two or three years he should feel hopeful of a permanent cure, and should feel quite certain of it if the period was as long as seven years. He was sorry that nothing had been said in the paper regarding the treatment of these thirty-four cases which had resulted so satisfactorily. He was disposed to take the middle ground regarding the nature of epilepsy. Some years ago he had pointed out that a larges number of cases of epilepsy were due to distinctly organic causes, and that many cases usually considered to be ordinary erflepsies, were really associated with the early palsies. However, there still remained a very large number of cases which must be considered functional simply because we were ignorant of the underlying morbid condition. Some of the organic changes which had been detected might be secondary and not primary. Even if there were slight

changes in the cortical cells, it did not follow that epilepsy was incurable, because he could not bring himself to make organic and incurable synonymous terms. There was one principle of treatment which was of the greatest importance, and that was individualization. Great pains should be taken to ascertain and remove the exciting cause. This exciting cause might be an intestinal intoxication or something else. Above all things, for the sake of the community, we should drop the notion that epilepsy is an incurable disease; he believed it to be curable, and the more so the more we endeavored to analyze this disease and treat it in accordance with the results of such analysis. Dr. STRATLING closed the discussion. He said that he had not attempted to set any limit of time as indicative of a cure-certainly not seven years-but he had mentioned incidentally that one of the patients had now gone seven years without any seizure. More than 50 per per cent. of the cases received at the Craig Colony he had regarded as absolutely incurable at the time of their admission. This would leave six or seven hundred, of which number thirty-four were cured. It should be borne in mind that all of the cases were chronic ones. With regard to treatment, he would say that the day had gone by when one could say, "this patient has epilepsy; we must give him bromides." He had found it difficult to properly control the patient and systematize the treatment among the well-to-do, except when the patient had been removed from home. If the State of New York would undertake to give the Craig Colony a proper equipment, proper apparatus, drugs and especially competent physicians with sufficient remuneration to make them stay there, he would guarantee that the proportion of cures of epilepsy would be not less than 25 per cent. The State paid large sums of money for charity, and could afford only a small sum for the Craig Colony-at present, only $2.80 per week for each patient. The subject of prognosis was so broad that he did not feel that there was time this evening to take up also the question of treat

ment.

Stated Meeting, Held January 21, 1904.

ANDREW H. SMITH, M.D., PRESIDENT.

The Behavior of the Costal Arch in Diseases of the Abdominal Organs, and Its Importance as a Diagnostic Symptom.-Dr. ELLSWORTH ELIOT, Jr., presented a paper with this title. He said that in a normal state the costal arch participated in the respiratory movements of the chest and abdomen. The arc of excursion gradually diminished as the person grew older. In the healthy adult the completion of ossification in the contiguous ribs accounted for the fact that the movement of the costal arch was not so extensive as in children, although it was very much more extensive than in old persons. Asymmetry of the elastic recoil of the costal arch was observed chiefly in connection with contiguous neoplasms and cysts, and in inflammatory conditions after the subsidence of the acute stages. Any change in the passive movement of the arch could be detected naturally only by palpation, and in eliciting this sign not only should the resistance to the finger be determined, but also whether the resistance was participated in equally by the entire arch or chiefly by one of its segments. The examination should always be conducted with the patient in the dorsal position, and the abdominal muscles should be relaxed by flexion of the thighs, and having the patient breathe quietly with the mouth open. The extremities of the second, third, and fourth fingers of the hand should be placed upon the corresponding segments of the costal arch, and quick pressure should be made during expiration toward the vertebral column. Proceeding downward and backward from the sternum to the tenth rib, successive segments should be compared with one another. In case of bilateral costal resistance, pressure exerted simultaneously on the costal arches would decrease the distance between them to a very

much less extent than normal. The greater normal elasticity of the sternal extremity must not be forgotten, and also the desirability of comparing the abnormal with the normal side. Under normal conditions, the costal arch might be compressed in this manner a very appreciable distance. In children this distance was somewhat more than an inch, while in adults it varied between half and three-quarters of an inch, and in old people was considerably less than half an inch. In the presence of an acute or subacute inflammatory process the costal resistance was highly elastic, and its movement was quite limited. Asymmetry of costal resistance might be detected when there was no marked difference in the respiratory movement of the costal arches. Increase in costal resistance might, or might not, be associated with tenderness on pressure. The behavior of the costal arch in the presence of painful inflammatory conditions of the lower half of the abdominal cavity sometimes deviated from the normal. In these cases the respiration was largely thoracic, and there was a symmetrical decrease in the costal respiratory movement.

Dr. Eliot then demonstrated the method of examining the costal arch, and reported a number of operative cases to show the accuracy of this diagnostic sign in various pathological conditions in the abdomen. The speaker said that rigidity of the costal arch was present in a very large number of cases of abscess and inflammation of the gall-bladder. In neoplasm the symptom was of value only when the liver was increased in size. The sign was often of value in differentiating between acute appendicitis and cholecystitis. The presence of costal resistance almost always excluded appendicitis. In subacute cholecystitis a considerable degree of costal resistance was present. Only one opportunity had been afforded for observing the behavior of the costal arch in acute pancreatitis, but in this case the increase in resistance of this arch was very marked. In cases of pancreatic cyst the symptom occurred only when the cyst was so situated, or had reached such dimensions as to lie under the second costal arch. When the kidney was increased in size, or there was a paranephritic abscess, the symptom was of value. In all cases of enlargement of the kidney, whether inflammatory or neoplastic, the increase of resistance was invariably most pronounced in the lower segment of the arch.

In several cases of calculi in the kidney no increase in the resistance of the costal arch had been noted. The following were some of the author's conclusions: (1) The symptom of costal resistance could always be elicited in an acute or subacute inflammatory process of the contiguous underlying organs.. (2) In chronic inflammation of these organs it was present irregularly.' (3) In neoplasms and cysts, increase of costal resistance could only be obtained when the tumor had reached a sufficient size to interfere mechanically with the motion of the arch. (4) The degree of resistance was in direct ratio to the intensity of the inflammatory process. (5) It was most marked in that segment of the costal arch most closely situated to the original point of infection, or, in the case of neoplasm, to that part of the arch which lay over the most prominent part of the tumor. (6) As a diagnostic symptom it was of the greatest value in pathological conditions of the upper half of the abdominal cavity. (7) The presence of asymmetry in the elastic recoil was very much less frequently observed than asymmetrical increase of costal resistance, the former being present only in cases of cysts, neoplasms, and inflammatory exudates in which the acute symptoms had subsided. (8) With the subsidence of the inflammatory process, whether by radical or palliative procedure, the costal resistance returned to its normal condition. (9) The presence of this symptom was very valuable, not only in facilitating accurate diagnosis, but also as a useful guide to that incision through which the inflammatory focus could be most rapidly exposed and satisfactorily treated.

Dr. ROBERT F. WEIR said that the method proposed in this paper was not new, and had probably been more or less employed by most surgeons, and yet he was free to confess that he had not personally attached much importance hitherto to this mode of examination. The author had done a service in so carefully observing this diagnostic sign and presenting it in this interesting and accurate way to the profession. The value of the method had been abundantly demonstrated by the series of cases reported. It was true that many of those cases were associated with symptoms which general surgeons were accustomed to rely upon a good deal, such as rigidity of the abdominal muscles and the presence of certain characteristic points of pain. However, in a few of the cases reported these well-known signs were absent, and, hence, the great importance of the costal arch sign. The test was so easily applied that the general practitioner as well as the surgeon must feel indebted to Dr. Eliot.

Dr. A. JACOBI regretted that the reader of the paper had not stated the condition of the costal arch after recovery. It occurred to him that a number of conditions might impair the value of this diagnostic sign. For example, there were changes in the chest wall of long standing which might easily greatly modify the behavior of the costal arch. The rachitic rosary would be perceptible not only in childhood, but throughout later life. In these rachitic subjects the ribs would be found thicker, harder, and more resistant than normal. It had long ago been claimed that premature ossification of the upper ribs predisposed to tuberculosis; if such premature ossification took place in the lower ribs this would certainly modify the behavior of the costal arch and interfere with the diagnostic value of the sign under discussion. In tall men with long chests one frequently met with a certain amount of ptosis of the liver and spleen. With this was associated a certain degree of ptosis of the heart, a condition recently described by Dr. E. G. Janeway. It was conceivable that the immobility of the diaphragm associated with peritonitis might interfere with the proper interpretation of the be havior of the costal arch. In old cases of thickened pleura there must be abnormal rigidity of the costal arch. These facts suggested that the method might not always be easy of satisfactory application. In an ordinary ulcer of the stomach one would not expect any abnormal action of the costal arch; the reason the sign was of value in the case of perforating ulcer of the stomach reported in the paper was that this was associated with peritonitis.

Dr. A. ERNEST GALLANT said that he had noticed a rigidity of the costal arch in cases of jaundice and c hydronephrosis associated with movable kidney, but he had never before compared the two sides, and, hence, had not learned to appreciate the true value of this diagnosti method. There must be a considerable difference in the re sistance of the chondral border in women and in men

Dr. Eliot closed the discussion. He said that his re marks were based upon the normal stage of the costal arch and he had specifically stated in one or two instances tha the arch had returned to its normal condition after re covery. He did not think the value of this diagnosti sign would be materially impaired by the pathologica state of the costal arch resulting from rachitis; certainly i would not be if the rachitic changes were symmetrical.

To Distinguish Pseudolymphocytes from Lymphocytes.According to H. C. Earl, the following points will assist in distinguishing pseudolymphocytes: (1) Neutrophile gran ules may be found in them; (2) their zone of protoplasm is generally wider than that of lymphocytes; (3) they ar naturally more common in effusions of a polynuclear char acter; (4) when stained with methyl-green pyronin thei protoplasm only takes on a light rose color, while that o lymphocytes stains a deep red.—The Dublin Journal o Medical Science.

THIRD DAY-THURSDAY, JANUARY 28.

Old Time of Meeting Restored.-The action of the society, changing the time of the annual meeting to Tuesday noon and Thursday evening, inclusive, was reconsidered, and, after some discussion pro and con, it was finally voted to go back to the old order of things.

Officers Elected.-President, Dr. Hamilton D. Wey of Elmira; Vice-President, Dr. Joseph D. Bryant of New York; Secretary, Dr. Frederic C. Curtis of Albany; Treasurer, Dr. O. D. Ball of Albany.

A Case of Recurring Membranous Stomatitis Associated with Erythema Exudativum Multiforme (Hebra).-Dr. LOUIS E. BLAIR of Albany reported this case. A peculiar phase was the appearance of the skin affection at least one week after the mouth disease. It lasted for four weeks, but left coppery stains, which were visible for months. White, contracted scars could be seen a year later. There were several subsequent attacks. The membrane in the mouth was firmly adherent. The mucous membrane about the anus, glans penis, and urethra was covered with a membranous deposit. The eruption on the skin, when at its height, resembled a confluent variola.

He

The Hospital Car; Its Equipment, Use, and Importance. -Dr. W. W. SANFORD of New York read this paper. described a modern hospital car. It was sixty feet long,

finished in white within and without, and was practically dustproof. It was divided into two compartments, a small one for an accident ward, and a larger one for a hospital ward. Sliding doors were provided for the passage of stretcher carriages. The car was well lighted from above, both by day and by night. Experience, he said, had abundantly proved the value of these cars, and their more general adoption should be urged by the medical advisers of railroad companies.

Symposium on Nephritis.-The following papers were the only ones presented in this series:

Renal Decapsulation from the Pathologist's Point of View.-Dr. J. M. VANCOTT of Brooklyn sent a paper on this subject, which was read by his colleague, Dr. Murray. The author first described the renal circulation very minutely. He pointed out that three-fourths of the blood supply passed anteriorly, and that the supply was distinctly an end-artery system. From this consideration of the renal circulation it was concluded: (1) That the arteries were terminals having nowhere any direct communication with each other, the only possible communication being through the capillary system; (2) that all of the vessels varied systematically in diameter in certain locations, thus definitely affecting the blood-pressure in various parts of the organ; (3) that with the exception of a few of the interlobular arteries and a few arteries entering the cortex, the only communication was capillary. Therefore, by decapsulation the delicate parenchyma of the kidney was subjected to loss of nutrition and to alteration of pressure and reversal of the current in the vessels of widely varying diameter, conditions commonly found in connection with renal infarction. Litten's experiments had demonstrated that the collateral circulation was not sufficient to restore the equilibrium of the circulation in the kidney after decapsulation. The stripping of the capsule completely cut off what little peripheral circulation was derived from the capsular arteries. Summing up all the facts, the conclusion was reached that very little could be expected from the renal collateral circulation when the main supply of blood was compromised. It had been shown that regeneration of the parenchyma of the kidney did not occur, the repair always taking place in the usual way, i.e. by cicatrix. The author said that Dr. Edebohls's theory regarding renal decapsulation for the cure, or even the relief, of nephritis must fall to the ground. The fact seemed to have escaped notice that when the capsule was torn away the vessels that should renew the circulation

were torn away also, so that nothing could be done in the way of restoring the circulation except by capillary anastomosis. It also seemed to be forgotten that there must be inevitably death of considerable areas of the cortical parenchyma, for the reason that all authorities agreed that renal epithelia die in two hours after being deprived of their blood supply, and it required at least four days for the production of new capillaries. The operation of Edebohls totally disregarded the fundamental principles held regarding chronic diffuse nephritis, for this disease was merely a local expression of a general condition. Where the kidney had been dislocated or pressed upon, it was easy to see how good might be accomplished by removing the abnormality, and so improving the circulation of the kidney. No amount of restoration of renal circulation could restore the integrity of the cortex. Drs. Vancott and Murray had made a series of laboratory experiments on cats, and, in general, they agreed with the experiments of Litten on the renal circulation. All of the new capsules showed a tendency to project new fibrous tissue into the cortex. Not the slightest evidence of regeneration of the cortex was found. These experiments showed that decapsulation worked only positive injury to the normal kidney, and was of no benefit to the large white kidney.

Surgical Treatment of Nephritis.-Dr. WILLIS G. MACDONALD of Albany made some remarks on this subject, in lieu of the paper on this topic that was to have been

presented by Dr. Edebohls. Dr. Macdonald said that in those forms of nephritis dependent upon a general systemic condition, and associated with marked vascular changes and sterile or nontoxic urine, he did not believe any form of surgical intervention would be of avail. But in infectious nephritis, an inflammation of the kidney due to local bacterial infection by such germs as the gonococcus, streptococcus, and the staphylococcus, he expected aid from surgery. Again, in the so-called cases of surgical kidney in which there was suppression of urine within thirty-six hours after an operation on the genitourinary tract, ordinary medical treatment was usually powerless to avert the rapidly fatal termination. He had recently seen a case of this kind in which, after forty-eight hours' suppression of urine, incision of the capsule of the kidney resulted in a speedy relief of the urinary suppression.

General Treatment of Nephritis.-Dr. BEVERLEY RobINSON of New York read this paper, referring only to acute and chronic diffuse nephritis. He said that a great many cases of acute nephritis were found to be grafted on a former process which had existed for some time, and had probably been caused, in the first instance, by harmful modes of life, or had developed in the course of some infectious disease. The first thing to do in all cases of acute nephritis was to put the patient to bed. He should be clothed in woolen and surrounded on all sides by blankets. Heat to the surface, continuous in character and more than agreeable, was imperatively demanded. The two cardinal principles to be kept in view were: (1) Physiological rest, so far as possible, to the diseased organ; (2) relief of function, especially through the supplementary action of skin and bowel. The first indication was supplied by going to bed, as already stated. The diet was next to be considered. During the great engorgement of the kidneys the food should be fluid, and given in small quantities, so as to least irritate the kidneys. The diet should be almost exclusively milk, and this should be insisted upon with certain sensible limitations. Milk did not agree with every person, however, when given undiluted and in the raw state. For many persons, one must use gruels, jellies, and, after a few days, amylaceous food. After a day or two, spring water should be given freely. To the water might be added a little weak tea. If the oedema or dyspnoea were threatening, or if the urine were scanty and concentrated, the bowel should be emptied rapidly

by enema and by salines. Then a hot wet pack should be given. Hot water baths were very troublesome, were no more efficacious, and were often dangerous if not given with extreme care. Hot-air baths were very useful in institution practice, but in private he greatly preferred the hot wet pack because of its simplicity. When there was pain over the loins, and especially if the urine were concentrated and contained much albumin and many casts, mustard poultices were useful by diminishing the congestion of the kidney. High rectal irrigations, by means of Kemp's tube, promoted diuresis. He was of the opinion that, in the adoption of this latter acquisition to our armamentarium, a means was at hand which, when suitably employed, was of the greatest value. Pilocarpin was a dangerous drug and should be avoided; he had known it to cause fatal bronchitis. If an attack of acute uræmia were impending, a few doses of nitroglycerin would often relieve the situation very rapidly. It was also well to add sweet spirits of nitre. This agent relaxed the arteries, acted as a diaphoretic, and was effective and innocent. It acted on the small vessels very much as did nitroglycerin and the nitrites. Abstraction of blood by wet-cupping or venesection was most valuable if the danger of uræmia were great, and it was often well to follow this by saline infusion. In a few instances it might be necessary to give chloroform by inhalation, or morphine hypodermically. He did not object so much to morphine in acute nephritis as in chronic nephritis, but he was still reluctant to give it except, perhaps, in convulsions of puerperal nephritis. In some of these cases repeated inhalations of oxygen were valuable in averting uræmia and in promoting recovery when uræmia was already fully developed. As the acute stage passed off, the fever would disappear and the blood would disappear from the urine. At this time, eggs, fresh fruit, bread, a little fish, puddings, and green vegetables might be added to the diet, and the patient be permitted to sit up a little. For the pronounced anæmia some good form of iron should be given; the best, in his opinion, was the old tincture of the chloride of iron alone or in the form of Basham's mixture. When possible, these patients should be removed to a warmer climate, if living in a cold and changeable one. The albuminuria might exist for a long time and prove very obstinate under treatment. Our aim should be to promote the general health in every way possible, and we should not forget to keep the bowels free and the skin active. Undue physical effort and indiscretions in diet must be guarded against. If the acute nephritis passed into the chronic form, nausea and repeated vomiting might require very careful treatment. After other means had been exhausted, he had occasionally found that repeated small doses of Kirchwasser (a dry alcohol containing hydrocyanic acid) beneficial. The diarrhoea of Bright's disease was sometimes controlled very satisfactorily by prolonged irrigation of the bowel. When the skin becomes very tense, several punctures or incisions should be made, under aseptic precautions, and the parts bandaged. Occasionally it was desirable to insert a small capillary tube into the skin and connect it with a small rubber tube in order to secure continual drainage into a vessel. When there was marked dyspnoea from accumulation of fluid in the abdominal cavity or in the pleural cavities, paracentesis of these cavities might be required. Cream of tartar drink was often very useful, unless the stomach did not tolerate it well. Digitalis, strophanthus, and strychnine often proved very beneficial.

In persons past middle life, digitalis could rarely be given with good effect unless its action on the peripheral vessels was counteracted by the addition of nitroglycerin. In the treatment of the fever it was important to avoid the use of chlorate of potash or of sodium salicylate, because of their well-known irritative action on the kidneys. It was wise in every case to watch

the quantity of albumin and the number and nature of casts passed in the urine from day to day, and regulate the diet accordingly. In the infectious diseases we should be guarded about the prognosis on the occurrence of albumin and casts in the urine until satisfied that the infectious process had left behind it a damaged kidney, In all cases of prolonged albuminuria following acute nephritis, one should carefully guard against impru dence of diet, exposure to cold, and fatigue. If chronic nephritis persisted, one should be especially solicitous about the development of all subacute forms of nephritis. It was frequently difficult, or impossible, to treat the original cause of the chronic nephritis. If syphilis, malaria, or suppurative processes were present, we should not ignore the indications proceeding therefrom, but should remember that the medicinal treatment of these diseases sometimes caused increased irritation of the kidneys. It was a temptation to endeavor to combat an intestinal toxæmia, but in doing so we should be slow to make use of such drugs as the salicylates and phenol derivatives. In the chronic cases, too close confinement would result in diminished appetite and strength; hence, theory must be tempered by wisdom and practical experience. Among the remedies that had been vaunted for increasing the quantity of urine in chronic nephritis without increasing the albumin, must be mentioned iodide of potassium. Its use in large doses had been urged by Ringer, but the speaker said that he was not personally disposed to employ such large doses. Even in moderate ones, iodide was apt to derange the stomach and diminish the appetite. If headache, malaise, and disordered digestion were occasioned by a liberal diet, it should be abridged considerably, but if these did not occur, and the patient's general health and strength seemed satisfactory, he would persist in a fairly liberal diet, even though a considerable quantity of albumin was excreted. In general. sufferers from nephritis were better off without alcohol in any form, but there were exceptions even to this rule, he would not withhold alcohol if the person had been in the habit of taking it in moderate quantities for many It should be taken with the meals in small years. quantities, well diluted. When there was much exhaustion, small quantities of alcohol should be given for a time as both a food and a stimulant. There was much good authority in favor of the use of morphine in uræmia, but, personally, he had found it useful wher the pupil was dilated, and harmful when the pupil was small. For sleeplessness he preferred the bromides to chloral. He had found saline irrigations of the bowe frequently as useful as intravenous injections of saline solution. In some of his worst cases of weak hear and general anascara he had obtained excellent result from Trousseau's Diuretic Wine, which is composed o digitalis, squills, juniper berries, acetate of potash and white wine. Certain experiments pointed to the value of theobromin as a diuretic.

Th

Dr. DELANCEY ROCHESTER of Buffalo said that h had yet to see the case of acute nephritis, with bloo casts, and suppression of urine that had not been re lieved by proper and energetic medical treatment. vigorous use of cups, both wet and dry, together wit leeching over the loin, and venesection were all indi cated. When there had been suppression of urine fo twenty-four hours, such measures would often caus a restoration of the excretion of urine. He believed th results from such medical treatment were just as goo as from any form of surgical treatment.

He had been deeply interested in Dr. Robinson' presentation of the subject, but could not agree wit him in confining the use of the hot-air bath to hosp tals. With an "elbow" of a stove-pipe, an alcoh lamp, and a couple of barrel-hoops one could easil apply the hot-air bath in any private house in a effective manner. For those persons who did not swea

mos

readily, he would recommend the hypodermic injection of minute doses of pilocarpin, followed immediately by the hot-air bath. Where convulsions were present, he favored the use of a moderate dose of morphine, immediately followed by the hot-air bath. In following the course of a case of nephritis, it was fully as important to determine the total excretory power of the kidney, as indicated by the total quantity of urea and of urinary solids, as it was to note the presence of albumin and casts. The degree of anæmia present, and its character, as determined by an examination of the blood, constituted an important factor in the prognosis. When there was much oedema, it was not advisable to inject salt solution subcutaneously, but if the oedema were not marked the results were as good as from the intravenous injection of this solution. In subacute nephritis, good results were obtained by washing out the bowel carefully once or twice daily with saline solution, allowing a certain quantity to be retained. Experience had taught him that sometimes the presence of an excess of indican in the urine was the forerunner of an increase in the albuminuria, and that by prompt treatment it was possible in this way to avert attacks of uræmia.

Dr. S. B. WARD of Albany deprecated the common custom of physicians of telling their patients that they had Bright's disease simply because albumin and casts were found in the urine, for the laity were so terrified by this term that it was hard to counteract the first false impression. In cases of chronic nephritis he had found arsenic a valuable adjuvant to iron in the treatment of the associated anæmia.

Books Received.

While the MEDICAL RECORD is pleased to receive all new publications which may be sent to it, and an acknowledgment will be promptly made of their receipt under this heading, it must be with the distinct understanding that its necessities are such that it cannot be considered under obligation to notice or review any publication received by it which in the judgment of its editor will not be of interest to its readers.

LESSONS ON MASSAGE. By MARGARET D. PALMER Masseuse and Manager of the Massage Department of the London Hospital. 8mo, 261 pages. Illustrated. William Wood & Company. Price, $2.50 net.

TEXTBOOK OF LEGAL MEDICINE AND TOXICOLOGY. VOL. II. By FREDERICK PETERSON, M.D., and WALTER S. HAINES, M.D. 8mo, 825 pages. Illustrated. W. B. Saunders & Company. Price, cloth, $5.00; sheep or half morocco, $6.00 net.

THE TREATMENT OF FRACTURES. BY CHAS. L. SCUDDER, M.D. Fourth edition. 8mo, 534 pages. Illustrated. W. B. Saunders & Co. Price, buckram, $5.00 net; sheep or half morocco, $6.00.

A MANUAL Of Operative Surgery. By SIR FREDERICK TREVES, F.R.C.S. 8mo, 824 pages. Lea Bros. & Company. Price, $6.50 net.

NINETEENTH Report of THE STATE BOARD OF HEALTH OF WISCONSIN, September 30, 1902. 8vo, 304 pages. Muslin.

THE PATHOGENIC MICROBES. By Dr. P. JOUSSET. 16mo, 192 pages. Muslin. Boericke & Tafel, Philadelphia. Price, $1.

Make 60 tablet triturates. Dose: One every four hours.

-Philadelphia Medical Journal.

Cardiac Hypertrophy.— R Tinct. digitalis...

3ii.

M. et Sig.: A teaspoonful in water after meals.

Angina Pectoris.

R Sodii iodidi.

Sodii arsenatis.

Illus

FATIGUE. BY A. Mosso. 12mo, 334 pages. trated. Muslin. G. P. Putnam's Sons, New York. Price, $1.50.

-DA COSTA.

gr. 80-160 gr. 1 q. s. ad. 3v

HUCHARD.

Aq. dest....

M. Sig. Two or three teaspoonfuls daily.