nal breathing we may advise; but all animal cells, whether single or united in tissues or in organs, consume a certain amount of matter, and those chemical changes by which material brought to the tissues and organs by the blood and transformed into other products through the activity of the living cells with liberation of life energy, must be maintained by a continued inherent thrill or respiratory rhythm and a constant supply of chemical products. This same chemical agent must not induct a destructive blood metamorphosis, but supply food for the debilitated vitality. For such action we must seek some combination of the old and well-tried remedies of ergot and apium, with acceptable hemagogues. The questionable action heretofore exhibited by various preparations of such remedies has been due, as clinically proven, to the component resinous compounds of the apium in the combination. In Ergoapiol (Smith) the active principles of apium have been isolated and with ergot made to form an acceptable and agreeable compound with invigorating hemagogues, proving of unquestionable benefit in such conditions as mentioned in this article. When the general practitioner awakens to his responsibility, we will have less of these conditions, a continuation of which invariably produces, a capillary varicosis, with its train of evils, manifested more frequently by copious and disagreeable discharges called leuchorrhea. But even as late as in this lastnamed condition the physician will learn that Ergoapiol (Smith) judiciously, consistently, and determinedly administered, will prevent much needless mutilation by effecting a cure. Pre-emption of space for case reports on this subject would scarcely be justifiable, when each reader may cluster the facts as herein stated around well-known principles and evolve therefrom a rational solution of treatment for diseases involving the female genitalia.- Jno. A. Hale, M. D., in Medical Herald. FORMALIN FOR INOPERABLE CANCER.- Seneca Powell recommends the treatment of inoperable cancer of soaking gauze in a 2-per-cent. formalin solution, and laying it on the tumor and cov ering with jaconet and cotton wool. By changing the dressing every six hours the discharge and fetor ceases, and the further progress is an aseptic one. The tumor loses its elasticity, and becomes friable and insensitive. Separation is accomplished without pain, though it is necessary to snip the fibrous bands passing into the deeper tissue. Courier of Medicine. HOT WATER IRRIGATION TREATMENT FOR THE RADICAL CURE OF HYDROCELE.- Griffith considers that the irrigation treatment produces most gratifying curative results, and eliminates the elements of danger to the patient, which accompany cutting operations and injections. His method of diagnosis is to press a metal cylinder, two inches in diameter and about nine inches long, against the scrotum; the contents of the cyst look translucent if the case is hydrocele, unless the fluid contents are bloodstained. The instrument recommended by Griffith for injecting hot water consists of two canulas fitted upon a single trocar, an eye being added to the upper canula for the securing of prompter drainage of the sac. The side selected for puncture is cocainized by a four per cent. cocaine hydrochlorate solution and the trocar inserted as for ordinary puncture. When the trocar has entered the cavity, a site free from vein markings is selected on the opposite side of the sac and the end of the trocar carried through it until it emerges from the skin. Before withdrawing the trocar, the upper canula is connected with the tube (fitted with a pinch-cock) of a two-quart fountain syringe suspended three or four feet above the patient's pelvis, and filled with water as hot as can be borne (120° to 160° F.). The two canulas now being in position, the one above attached to the hot water reservoir, the one below free, the trocar is withdrawn, and after the hydrocele fluid has stopped gushing, release the pinch-cock. Thoroughly flush the sac under some pressure to dilate and to present the surfaces of all folds of the tunic to the action of the hot water. Withdrawing the canulas and sealing the puncture sites with cotton wisps and collodion, followed by the application of gauze or a snug suspensory or T-bandage, completes the treatment. The patient may resume his daily occupation without hindrance, for the only reaction is slight swelling and tenderness, which pass away during the course of a week. It is rarely necessary to excise redundant scrotum, as the natural tonicity of the parts will assert itself after a few weeks and "take up the slack." - Frederic Griffith, M. D., in Am. Jour. of Dermatology, June, 1905. SOME REMARKS ON CASES INVOLVING OPERATIVE LOSS OF THE COMMON BILE DUCT.- In the Annals of Surgery, July number, W. J. Mayo gives an account of a case of anastomosis between the hepatic duct and duodenum. Out of 159 cases of operation on the common duct of the liver, there was a loss of continuity of the duct in seven cases, five intentionally produced in operating for removal of malignant neoplasms, and two accidentally, one of these following an extensive operation for gall-stones, this case forming the basis for the following described operative procedure, the various steps of the latter being neatly and accurately illustrated. Relief of fistula was the occasion for the operation. An incision through the upper rectus exposed a mass of adhesions with the liver and hepatic duct on the one side and the stomach, transverse colon and duodenum on the other. The original drainage opening at the site of the cystic duct was discovered, the hepatic duct found dilated and the common duct obliterated and converted into a fibrous cord, the duodenum overlapping the remains of the latter forming one of the walls of the fistulous tract. The external incision was enlarged and the liver turned and held upward, the duodenum being immobilized. The hepatic duct was then freed from its adhesions and the duodenum fastened to the adhesions about the duct with three catgut sutures placed about three inches from the pylorus. A small elliptical portion of the duodenum was then excised at the point of contact of the latter with the end of the hepatic duct and the latter sutured to the edges of the former openng with throughand-through catgut sutures. The duodenum was still further anchored, laterally and anteriorly, to the under surface of the liver and to the surrounding scar tissue, thus affording a broad area of attachment of the duodenum to prevent undue traction upon the hepatic duct. The patient made a rapid and uninterrupted recovery and remained free from trouble, gained thirty-one pounds and resumed her former state of excellent health. The above report proves two things: First, that drainage is unnecessary in certain instances, and that sutures penetrate all the coats of the duct and duodenum and produce no complications.— E. H., in Lancet-Clinic. THE IMPORTANCE OF EARLY RECOGNITION OF SUPPURATIVE Ear Disease.—A. G. Bryant, in a long article on this subject, contributes a very full discussion of midde ear disease, its etiology, symptomatology and sequelæ, together with the diagnosis and treatment of the various phases of the malady. The disease is so common an accompaniment of the ordinary diseases of childhood that the practitioner should be as familiar with the ear speculum and probe as with the stethoscope, and it should be remembered that it is often the objective examination that gives the first clue as to the existence of middle ear trouble in small children. The following plan of treatment is outlined for early cases: Douche the ear gently every two hours with one or two quarts of a sterile normal salt solution as warm as can be borne, to be followed by a hot water bag or a hot salt bag. Give one grain of calomel in 1-10 grain doses and repeat as necessary. Use cleansing and astringent washes for the throat and cleansing sprays for the nose. Caution against too forcible blowing of the nose, or blowing both sides of the nose at once. Have the patient remain in bed until the acute symptoms have abated. The bromides or phenacetine may be given, but with caution, and only for a few days. Avoid all opiates, as they mask the symptoms. Early paracentesis is urged, especially in influenza cases, and the technique of the operation and the after treatment are described. Mastoid involvement and the treatment of chronic suppuration are also discussed.- Medical Record, May 13, 1905. CLINICAL FEATURES OF THYROID HYPERTROPHY.- Dr. Halsted, at the May meeting of the Johns Hopkins Hospital Medical Society, said that one or more of the symptoms usually known as exophthalmic goitre" might occur with various pathological conditions in the thyroid. Cysts, adenomata, carcinomata, and even "normal" thyroids had given such symptoms. No sharp line could, indeed, be drawn between perfectly normal people and those with extreme hypertrophy. The well-known symptomcomplex is sometimes present without hypertrophy of the gland. The condition is more frequent in females (4.6 to 1) though late in life the proportion is smaller. The prognosis is bad and it is doubtful if complete recovery has ever occurred. Twenty-five per cent. of all the patients die within a short time and the rest remain in a state of labile equilibrium. Acute cases occur -one, reported in Nothnagel, appeared in two days and disappeared in eight. The mild form of the disease has been particularly studied by the French; and all observers have noticed that there is no sharp line of demarcation between normal patients and those with mild goitre. In the cystic cases there has usually been no hypertrophy of the non-cystic portions of the thyroid. In the Johns Hopkins Hospital there have been 46 cases of goitre with symptoms operated upon. The majority of these were mild but a few were severe. There was one death in the series. And in this case nearly three fourths of the gland was removed. At present non-operative treatment is being tried, and the X-ray is being used instead. The influence of this agent has been marked in certain of the reported cases but it is not prompt.Johns Hopkins Bulletin. ACUTE PNEUMONIA AND ITS MODERN TREATMENT.-L. G. LeBeuf (New Orleans Medical and Surgical Journal, August, 1905) discusses this subject and points out its treatment. Diet is of prime importance, milk fresh or peptonized, peptonoid, panopepton, soft boiled eggs, raw eggs, bouillon, and gruels are applicable. Feed every hour. Give water freely, fruits, grapes, oranges, etc. general diet. Wait till fever is all gone before returning to |