region, the dose being deeply injected. The skin, needles and syringe should be carefully sterilized. A glass syringe with asbestos packing, and platino-iridium needles are advised.

Methylene Blue.

Meillère (La Trib. Med.) states his conviction that methylene blue possesses analgesic, antipyretic, and cholagogue properties; that it is of value in malaria, gonorrhoea, rheumatism, and in inflammations of the genito-urinary tract. Good results have been claimed from its use in enemata for enterocolitis. Topically it may be used in inflammations of the naso-pharynx, middle ear, and eyelids, and in pruritis. The maximum dose is 25 centigrammes, for internal administratration,

Meillère states than an index of the functional condition tion of the kidneys is afforded by the facility of elimination of methylene blue by those organs. Five centigrammes injected into the tissues of a healthy person will appear in the urine in half an hour. The color is faint at first, and of a greenish tinge, reaches its deepest shade in from three to four hours, and disappears entirely in forty hours. Variations of this normal elimination may be classified as prolonged, delayed, or intermittent. Rapid elimination indicates defects in the continuity of the secreting structures. Prolonged or delayed elimination indicates renal impermeability, while intermittent elimination shows the presence of hepatic disease or of parenchymatous changes within the kidney itself.

Dysmenorrhea.

Hammond divides the medical treatment of dysmenorrhea into treatment before the attack, treatment of the attack, and treatment after the attack.

For the first he advises saline purgation the day before, or the day of the attack, if the latter be due to congestion. Ten drop doses of tincture of gelsemium three times daily for seven or ten days before the attack will often afford absolute

relief.

Apiol, cimicifuga, permanganate of potassium are worth a trial.

For the attack: rest, hot vaginal douches, hot rectal douches, heat to the abdomen. The fixed, boring pain due to myomas may be controlled with belladonna, hyoscyamin or antipyrin suppositories. Neuralgic pains are relieved by phenacetin, antipyrin and gelsemium. When inflammatory conditions are present hot sitz baths, free purgation, and hot vaginal douches are indicated. Tincture of piscidia erythrina and tincture of hydrastis are useful. When the flow is scanty, hot mustard sitz baths are indicated. If vaso-motor spasm is the cause, nitroglycerine in 1/100 grain doses repeated in an hour will give relief.

After the attacks the general health should be attended to. Strychnia to restore uterine tone, and possibly electricity. With demonstrable pelvic lesions surgical aid should be invoked.

Ichthyol in Bronchitis.

According to De Brun ichthyol is a valuable remedy in chronic bronchitis. There is relief of cough, expectoration, dyspnoea, and sleep is promoted. The following formula is recommended:

Sig. One-half to one teaspoonful in water several times

a day.

Iodide for Bronchitis.—

Shoemaker recommends the following formula for chronic bronchitis and pleurisy;

M.

Sig. One teaspoonful in water or milk after each meal.

Soft Chancre.

The following is recommended as a local application to soft chancres:

Bartrina has found that strictures that are so small as to prevent the passage even of a filiform instrument will allow, of the passage of a small instrument five or ten minutes after the instillation of a little of the following solution:

Ft. sol.

Adrenalin chloride,
Normal salt solution,
Chloretone,

I part. 1000 parts.

5 parts.

The chloretone is added to increase the anæsthetic effect. If protected from light the solution will keep indefinitely and can be sterilized by boiling without changing its physiologic properties.

For Chronic Ulcer of Leg.

Schulze advises the following formulæ for troublesome ulcers of the leg:

Chronicle and Comment.

By the latest returns there are 29,997 medical practitioners in Germany, an increase of 864 during the last year. Berlin has 2,572 physicians, being one to 734 inhabitants.

The actual test of a doctor's knowledge and powers of differentiation come into play in diagnosis, and this is largely the reason why hospital training and clinical experience are of such value. However well posted a physician may be in relation to all therapeutic measures, or however well-grounded in pathological and historical data, unless he be a good diagnostician his knowledge is without an "edge"-it is dull and all but indifferent.

Our English professional cousins have their troubles in a very prominent manner in connection with their obstetrical work—an unwelcome condition of affairs that prevails with us but little.

It seems that in England there is a very large class of registered midwives-a class of half-educated women who do very well, it may be, in the lying-in chamber so long as "everything goes right."

With us the midwife has but indifferent recognition and in reality, taking the country over, has comparatively little to do.

The more intelligent women want nothing to do with. their own sex when they reach the throes of child-birth. A strong, sympathetic yet nervy man is the one who appeals most to them, and especially is this the case in the first confinement, and having had Doctor So-and-So when her first child was born, few women thereafter have any desire to re

trograde to a midwife. On the other hand, it often occurs that a woman employing a midwife for her initial labor, will subsequently look forward to another trial with much more confidence if she can obtain the services of a "regular doctor." She commonly feels that much of her suffering was needless and would have been prevented had a doctor been present. She believes she received only about half the assistance it was possible for her to have.

Perhaps the poor training of midwives with us, together with the fact that they are mostly old women, very incompetent women, except in the matter of physical strength, and that they are very self-important, largely determines the question-as, indeed, it should.

However undesirable by itself obstetrical practice, as a rule, may be, still the family practitioner will not allow a woman to fall under poor, or perhaps perilous, service even if he has to ride half the night over the worst of roads and wait a year or two for the very nominal fee.

We doubt if it is generally known that a medical man in Germany may be fined about $225, and sentenced to three years' imprisonment, besides paying compensation to the patient, for neglecting to repair a ruptured perineum.

It should be strictly borne in mind that the practitioner is in no sense regarded in this connection as in the least responsible for the occurrence of the rupture; but he is held culpable if he neglects to discover the same and further neglects the taking of reasonable means for its repair.

Such a law cannot be held as unjust any more than in the case of the recognition and proper treatment of fractures of bones. It is purely a matter of neglect, entailing in its consequences a vast amount of suffering, which could have been prevented.

A recent authority gives some figures regarding the hospitals in the United States, indicating the very rapid increase