lected in an hour or two, the time has come to remove it, unless this small amount of fluid is purulent or offensive. Ordinarily the tube can be removed on the second to the sixth day with safety. The opening soon closes, and there is no more danger of a ventral hernia than if drainage had not been used.

Gauze is a very good protector against the invasion of septic germs in new territories, and this is exactly what it does when it is used to drain the bottom of the pelvis. It fails to remove débris and micro-organisms. The gauze may be used where it is of greatest import to protect the upper peritoneum from invasion, in cases where there is a danger of this nature anticipated; as where a pus sac has been stripped from a bowel or where the development of a fecal fistula is feared, but even here a glass tube should be inserted to the bottom of the pelvis. I never use the Trendelenburg position. The pelvic cavity in pus cases has, by a slow process of inoculation, developed more or less of an immunity, the extent of which no one can foretell in a given case. The upper or susceptible peritoneum may be said to exist above the pelvic brim. Any position of the patient during an operation that favors the infection of this very susceptible area must, of necessity, increase the dangers from the operative procedure by this new infection. The upper peritoneum cannot be drained as thoroughly as the pelvic cavity. I believe bilateral dorsal drainage should be resorted to in general peritonitis.

Some decry the use of the drainage tube in the abdomen lest infection occur, and within a few lines recommend draining through the vagina, a cavity the normal habitat of a host of fermentative and pyogenic micro-organisms.

DEDUCTIONS.

Drainage is a life-saving process when used properly.

To use it is not an admission on the part of the surgeon that his work during the operation was imperfect.

The use of the tube alone does not produce or leave any condition that favors the development of hernia.

The omentum or other structures do not become entangled in the openings of the tube.

A small size flint-glass tube with small openings and open end should always be selected for pelvic drainage.

The tube does not produce fecal fistulæ.

The tube should be used when in doubt as to the absence or presence of drainage indications.

To depend upon the microscopic findings as to whether a given case should or should not be drained is seemingly scientific, but is neither necessary nor practicable.

Gauze drains should rarely be used, and should always be sup plemented by a glass drain.

There is no danger of infecting the patient through the tube if the attendant is properly instructed.

Where irrigation is indicated drainage should be used. Many cases will require drainage where irrigation was not indicated. The emptying of the tube and the time of its removal must be governed by the indications and progress of individual cases. Irrigation with a normal saline solution cleanses more quickly and effectively than the most thorough sponging.

The irrigating fluid should not be too hot to be comfortably borne by the operator's hands.

Kansas City, Mo.

GOUTY DIABETES AND ITS TREATMENT.

DR. DEBOUT D'ESTREE.

Of the various diseases whose very names are equivalent, in the opinion of ordinary people, to a sentence of death, diabetes takes a prominent place. Certainly there is a kind of diabetes called consumptive, that is uniformly fatal, and is distinguished by a frothy saliva that reddens litmus paper and eats into the teeth and injures the gums. The patient complains of an insipid, sweetish taste in the The tongue is red, often covered with a whitish or more rarely black, fur; the gums become soft and bleeding, the teeth loosen and decay, while the breath, which at first was tainted, now becomes fetid. The appetite becomes capricious and excessive, the sufferer being oftentimes morbidly hungry, although the latter symptom is sometimes absent, and we find instead alternations of ravenous hunger, followed by disgust at the idea of food. Later on the skin becomes dry and rough, and is liable to various kinds of eruptions, while its sensitiveness

diminishes. There is a marked diminution of vision and often loss of hearing, even to complete deafness. Impotence is always present. Local gangrene is not unfrequent, generally of the extremities, particularly the feet. Finally tuberculosis sets in, with its accompaniments: fever, diarrhoea, extreme debility, etc. The limbs are infiltrated; the urinary meatus and the prepuce become red and cedematous, and death follows. Such, in brief, is the story of the sufferer from consumptive diabetes.

Arthritic diabetes, or gouty diabetes, the form we wish to consider, is altogether different; so much so, both as to it symptoms, progress and termination, that it is well to be on one's guard in the differential diagnosis of these different kinds of glycosuria, one of which is inevitably fatal, while the other, infinitely more benign, is simply a transformation of gout, or rather one of its forms which frequently succeeds the articular type when the attack in the joints suddenly ceases at an advanced stage. It is often observed that a gouty father has diabetic children, and vice versa.

In arthritic diabetes, we find that the disease invades the system in an insidious, unobtrusive manner, with no other warning than an unusual weakness in the limbs and excessive and apparently causeless fatigue. In this case, there is no impotence, neither teeth or gums are attacked, no gangrene appears, the appetite continues good, and if the patient suffers from thirst at all it only lasts a week at most after the début of the glycosuria; there is no emaciation and rarely any increase in the urinary secretion. Anthrax may possibly supervene, however, with all its usual consequences.

Precisely because the system gives no particular indication of this affection, and because this special form of gout cames in such a mysterious manner, one should know its genesis and be able to recognize its presence at the outset; otherwise, in the absence of the classic symptoms, it may be many months before the physician's attention is arrested, and he remarks the presence of a new complication of gout, which, having no marked symptom, has escaped his recognition.

Therefore, whenever a gouty patient reports an improvement in the state of his joints, while at the same time he complains of extraordinary lassitude, without apparent reason, the physician should examine his urine. In eight cases out of ten, sugar will be found-20, 30, sometimes 60 grams per litre.

In proportion as sugar appears, the uric acid disappears from the urine. Any remedy that will increase the secretion of the uric acid will diminish the sugar in the urine, a fact which proves the intimate correlation between these affections apparently so different, but which in the presence of a gouty diathesis, alternate with each other.

In order to suppress the glucose and cause the elimination of the uric acid through the kidneys, I have found the Contrexéville-Pavillon water a very simple and effective remedy and preventative. It should be taken, in March, June and October, for instance, in the following manner: twenty bottles are to be drunk during each period, one daily, divided into four glasses that are drunk at intervals of half an hour, with an interval of one hour between the last glass and breakfast. The water should also be mixed with the drink taken at meals. The nature of the particu lar beverage is immaterial and no disagreeable taste is imparted to it by the water, which acts directly upon the liver, increasing its functional activity as well as the intestinal peristalsis, but without causing any marked looseness of the bowels or purging. Paris.

EDITORIALS.

AMERICAN MEDICAL ASSOCIATION, FORTY-NINTH ANNUAL MEETING, DENVER, COL.

THE meeting just closed was one of the most interesting and profitable and most largely attended in the history of the association. Fourteen hundred doctors were officially registered attendance which number was swelled to easily 2,000 by those

not registered.

as in

The local committee and profession had arranged commodious and convenient meeting places for the sections in the theatres and churches convenient to the hotels, and the programme of entertainments occupied every evening, and several days following the close of the meeting.

On Monday, June 6, the day previous to the regular work of the meeting, the medical publishers held their annual meeting and considered papers on "The Dignity of Advertising," "Prob

lems in Medical Journalism of Today," "Some Unique Features," and "Shadowy Ethics in Journalism."

The American Medical College Association also held its annual meeting. The object of this association is to regulate, maintain and raise the standard of education in every medical college in the United States. If a college fails in the requirements of this association, it is not recognized by this body and consequently not recognized as a standard school, either by students or by the state boards of medical examiners.

There has existed for some time a separate association called the Southern Association. The gratifying news was brought out

at this meeting, that the South has decided to amalgamate with the larger body at its next meeting. When this is accomplished, there will be a uniform course of not less than a four years' study in all the colleges that are parties to this organization.

There also was held the regular annual meeting of the American Medical Editors' Association.

In the evening the association of editors and publishers gave a banquet of about 400 covers in the banquet room of the Brown Palace Hotel. The war spirit seemed to be prevalent among the company and "America," the "Star Spangled Banner," "Away