fuse in summer and after long walks. In chronic cases, maceration of the skin takes place, it becomes soft, wrinkles and easily loses its protective epithelial layer and in this manner excoriation and ulceration result. Hyperidrosis Palmae Manus is also a very annoying affliction. These individuals, who always have damp hands, are frequently shunned by society for the reason that their hand-shake is disagreeable, and that they ever leave their finger marks on anything which they handle. As in H. P., the skin is changeable, becoming soft and dilation of the pores is plainly visible. The sweat of this kind is greasy, but this is not necessarily due to the secretion of the fat forming or Sebaceous glands, but the cholesterin formed from the keratin substances of the skin. In mild cases five per cent of salicylic in boracic acid as a dusting powder, combined with daily cold sponging, is sufficient, while in the more aggravated forms, painting the surface with a five per cent chromic acid solution has proven a prompt and efficient remedy, especially in the German army, where it has been extensively tried. Reverting to Radiotherapy in Acne and Hypertrichosis, and while I fear the time allotted me is too short for an exhaustive treatment of the subject, I wish to especially mention a few facts in connection with the X-rays. In 1895 Professor Roentgen, of Wurzburg, found that when a Crooke's tube was excited by an electric current of high potential, peculiar rays were given off, which he modestly designated X-rays, because of their unknown character. These rays were first employed alone for diagnostic purposes, but the accidental production of structural changes in the skin led to their trial in cutaneous diseases, by Freund and Schiff, of Vienna. The rays may be generated from an induction coil or a static machine. The important part of the X-ray apparatus in the treatment of skin lesions, is the tube depending chiefly upon the degree of vacuum in it. A tube of high vacuum offers great resistance to the passage of the electric current and gives off rays which penetrate to considerable depth and exert but a minimal influence upon the superficial tissues. A tube of low vacuum, on the other hand, gives off rays which do not penetrate to great depth, but exert a maximum influence upon the superficial tissues. The mode of action of the rays in cutaneous diseases, according to Schamberg of Philadelphia, is that they stimulate and alter the function and structure of living cells: Doubtless, as a result of this, the vitality and resisting power of tissues are increased, and the invasion of bacteria prevented or the bacteria destroyed. In the treatment of Acne, a medium soft tube should be used, with no more current than is necessary to produce a quiet green light, two or three times a week at first, the frequency to be diminished later. The distance from the anti-cathode should be in the neighborhood of six inches, the duration of the treatment five or six minutes. Upon the first sign of an erythemia, treatment should be suspended and not resumed until the redness has disappeared. Hypertrichosis is one of the most difficult of all conditions to treat, and requires the greatest degree of skill. It is obvious that to destroy the hair papillae without causing a destruction of other elements of the skin, requires very fine adjustment of the rays. Freund, of Vienna, effects a falling of the hair in twenty treatments. Some Obstetrical Methods Practiced in the Philippines. The Wm. Duffield Bell says that the be lief that the women of semicivilized races escape many of the pangs of child-birth is certainly erroneous regarding the Philippine natives. life of the Filipino woman is compartively short, due to her many pregnancies, much manual labor, insufficient food, and most of all to the crude, brutal, and ignorant practices employed as obstetric aids. The two chief procedures used to facilitate expulsion of the fetus consist first, in a stout band of cloth passed about the woman's abdomen and pulled tight by four persons, who are seated, two on each side of the patient, with their feet against her body, and second, in a plank six or eight feet long by a foot wide, which is placed across the woman's abdomen while another person, mounted on the plank, rises on his toes and lets the heels descend forcibly. The birth of the child is followed by the expulsion of the placenta by the above means, and, should the process be delayed, forcible traction on the umbilical cord is made to such an extent as to tear away portions of the placenta, and often large sections of this body are left to find their way from the uterine cavity of their own accord. Weeks and even months later the results of such practice are noticed in the septic conditions which would naturally follow retention of the membranes. The author gives some statistics showing the frequency of complications attending or following this crude midwifery, and then describes a case of imperforate hymen in a young girl. On account of the tumor caused by the accumulated blood she was supposed to be pregnant and was subjected to both the cloth and plank treatment. She was then brought to the author, who incised the occluding membrane and liberated two quarts and four ounces of thick, offensive menstrual blood.Medical Record. In cases presenting the symptoms of acute epididymitis and orchitis, in which the history and examination fail to show any evidence of gonorrhea, it is always well to consider the possible presence of a torsion of the spermatic cord. The symptoms of the latter condition often resemble those of an acute orchitis, namely, pain, swelling, marked tenderness, and more or less fever. The chief distinguishing points are that in torsion of the cord the pain comes on suddenly after physical exertion, straining, coughing, etc., and is often attended with marked depression and even collapse. The tenderness also appears earlier than in orchitis and is much more intense, while on examination of the cord a very sensitive swelling can be felt.-International Journal of Surgery. MALARIA AND THE KIDNEY By IRA B. BARTLE, M. D. Eugene, Oregon Read before the Lane County Medical Society Although there has been much said on the subject of the effect danger of kidney complications even in the simpler cases should cause a urinary analysis to be made in each and every case regardless of its severity. I wish to call attention to a few of these complications, and especially those that accompany Estivo-autumnal fever. All cases of malaria should have a blood examination. Those cases showing the greater number of crescents and flagellated parasites and the most free pigment, require the most watching. In these cases I make a daily microscopical examination of the urine, for if there is an excess of malarial infection there is an excess of toxines. (The excreta of fully developed parasites.) These create or produce inflammatory changes, and later granular degenerative changes in the interstices of all glandular elements of the body, and especially the excreting organs. Among the excreting organs most notably affected are the skin and kidneys. When either of these begin to fail the other is overworked, and needs immediate attention; when the skin is acting beautifully there is but little cause for worry coming from the kidneys: unless the case tends toward the pernicious type: then all the corners must be watched and the cobwebs brushed down, for we may expect trouble from any source. The pronounced toxemia that accompanies a serious case of malaria may cause so numerous and varied a symptomatology that the diagnosis is made with difficulty when one has to rely on the physical signs alone, hence often estivo-autumnal fever is treated as typhoid or named Typho-Malaria when it is truly a case of irregular fever and is not amenable to typhoid treatment. I have often said that if you will show me a physician whose cases are all typhoid and they all recover in from two to three weeks (unless some complication arise), I will show you a lot of cases where Widal's will bear negative of malaria on the kidney, there is much still to be said. And the results and malarial parasites will be found in the blood. It has never been my bad fortune to see the two infections in combination, nor one following closely on the track of the other. I do not deny such possibilities. Marchiafava and Bignami say: "That typhoid fever has been regarded by many as a frequent complication of malaria, but we have not seen a case of the co-existence of the two infections. Baccelli also claims to have never seen the two infections together; while Osler publishes the cases of Thayer and Barker, where both diseases were present, consequently we must admit the possibility of the coexistence of the two infections and at the same time recognize its rarity. The similarity between Baccelli's sub-continuous and typhoid fever is so close that only a microscopical examination should be taken as final, for even the administration of quinine will not make the differentiation. In my observation, where Widal's reaction was affirmative, the renal complications were much more rare than when the estivoautumnal parasite was found. The percentage being as one to sixteen in typhoid, while, in my series of one hundred and fifty cases of malarial infection, kidney complications were shown in 42 per cent. In the experience of Dr. W. Britt Burns, of Memphis, Tenn., with the nephritis following malaria the urine clears under large doses of quinine. This has not been my experience. He reports a necropsy in which the gross pathology showed a large and a small white kidney, with marked hepatic and splenic changes. In my experience the large white kidney is the more common, and congested, granular, pigmented glomeruli are found, and glandular degeneration is noted along the tracts of the tubuli uriniferi, and especially about the loop of Henle, eight-tenths of all the granular epithelial and blood casts having come from the ascending limb. After a few days, according to Dr. Moore, of Galveston, Tex., of single tertian infection there are liable to be manifest certain renal changes; that doubtful tertian infection will produce a nephritis in a large proportion of cases, even though it runs only a short time. The more chronic the case becomes the more probable will be the kidney complications. He claims to have found renal complications in 68 per cent. in estivo-autumnal fever. I think this percentage is rather high, and that perhaps there were some pre-existing lesions in some of his cases. In his observations the age of the patient, the height of the fever and the specific gravity of the urine show no relation to the presence of albumin and casts. This is in line with my observations, but I have noticed a relation between the number of parasites and the amount of pigment found in the blood and the rapidity with which the kidney disturbances appear; also a relation between the hepatic congestion and the disturbance of the urinary equilibrium. Rosenstein recognizes an acute nephritis as a result of malaria, and finds the support for his opinion in the albuminuria which occurs during the febrile attack. There is no doubt whatever but that an acute nephritis (diminished urine, blood, casts, edema and mucus) may develop during the course of an attack of an intermittent quotidian fever, whatever the original type may have been. Bignami claims that this condition is generally relieved by quinin. But in my experience, in cases where the free pigment was excessive, I have had black fever following the administration of quinin in three instances, with death in two, hence I am of the opinion and follow the rule of using quinin with extreme caution in cases of over five or six days' standing, where the infection is virulent, but rather follow the treatment used by the practitioners of the Yazoo and Red river valleys in cases of pernicious malaria, namely the use of hyposulphite of soda in 10 to 12 gr. doses. Dr. J. B. Elliott, Sr., of New Orleans, La., recommends this treatment, and it certainly is efficient. However, where there is a profuse medication displayed, and blackwater fever develops, quinin may not be held entirely responsible, for Dr. C. W. Schlayer reports a case of black water fever complicating malaria in a patient who recently returned to Germany from Africa, in which country he was free from malaria, owing to quinin prophylaxis. The blackwater complication followed the administration of a .75 gm. dose of phenacetine. I have had a case of blackwater fever follow the giving of a .4 gm. dose of phenacetine. Reinhold Ruge (Deutche Medicinische Wochenschrift July 10th, '02), reports a case where the blackwater fever followed the administration of a .3 gm. dose of quinin, and concludes from a large experience that quinin prophylaxis is not, in all cases to be relied upon. However, he thinks that the method recommended by Kleine of the use of quinin enema during an attack is of benefit. He urges the microscopical examination of the urine, and claims that the blackwater complication can be detected for twenty-four hours before the appearance of the clinical signs, as polychromatophilic degeneration may be observed together with numerous macrocytes, microcytes and blood shadows. According to Rosenstein, even chronic parenchymatous nephritismay be the result of malaria, and is developed either during the attack (especially if the sweating stage be absent) or at varying periods after the fever has subsided, even when the patient is sufficiently recovered to think himself able to return to work. From Bartel's observations on patients in Kiel, who came from the plains of Schleswig Holstein, he draws the conclusion that malarial fever is one of the most active causes of chronic parenchymatous nephritis. Senator gives malaria as a factor in nephritis. Theyer and Hewetson, after observing 250 cases of malaria, place the percentage of kidney complications at 50 per cent; Thayer claims that he can trace the origin of chronic nephritis to malaria, and I have to believe that in one of my cases the only cause for the fatal nephritis was malaria. In the Roman Clinique, Rempicci made a study of 350 cases of malaria and takes into account all forms of kidney complications, from the simple to the graver forms, and says that out of the 350 cases 80 were of strictly malarial origin or about 23 per cent in his work at the hospital at San Spirito he found that acute and chronic nephritis may develop from malarial infection. In his collection there can be no doubt of the etiology. Kelsch and Keiner give a 20 per cent nephritic complication in their malarial cases. There is still some doubt as to the cause of this common complica |