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pulse is a safe pulse; a rapid pulse requires purging, cupping, or blood letting. A soft, rapid, compressible pulse requires digitalis and strychnine. Nitroglycerine is dangerous. Camphor is to be used in two grain powders with sugar or milk. Cyanosis calls for atropine. A fast struggling heart in the early stage may be quieted with a few drops of tr. aconite, veratrum viride, or hyoscyamus.

The fever should be kept below 103° F. by sponging or ice bag to the head. High, cool, rectal enemas are of value. Coaltar products are to be avoided. Pain in the first stage is to be controlled by strapping, mustard plaster, or turpentine stupe. In children redden the skin with the mustard plaster and then apply some of the clay poultices covered with cotton; or apply a flaxseed poultice covered with oiled silk jacket. Dover's powder or codeine may be used to control cough and pain, if necessary.

Elimination must be stimulated.

Give a calomel purge and

a hot mustard foot bath. Keep covered and give plenty of water, vichy, or seltzer. High rectal saline injections at a temperature of 80° to 98° F. are of value as an eliminator and temperature reducer.

Potassium iodide and the ammonium salts are of service in the third stage. Creosote carbonate may be used as an inhalation and internally. Blood-letting is of value in cyanosis of the second stage. Plenty of fresh air, clean linen, and a careful disposal of the sputum should be insisted upon. The mortality of nearly two hundred cases treated in this plan was 18 per cent.

FRACTURE OF THE PATELLA.-J. B. Cutter, Albuquerque, New Mexico (Jour. A. M. A., August 5), reports a case of fracture of the patella in which the patient refused treatment and precipitately left the hospital as soon as he learned the time and confinement it would require. About three weeks later he returned to obtain a certificate of discharge, having used his leg constantly during the interim, no attempt at treatment or immobilization having been made. There was ligamentous union apparently, the separation of the fragments being three-quarters of an inch.

The functional result was remarkably good, there being almost complete extension and no inconvenience in walking. The separation case suggests to Cutter the question how much or how little advantage is gained by the conventional periods of rest in the recumbent position in cases of fracture of the patella?

RAPID TREATMENT OF VAGINAL GONORRHEA.-C. Daniels thinks that gonorrhea is the most common type of vaginitis. The lesions are located especially in the cul-de-sacs. The writer describes the following method of treatment, which is advocated by Tuffier as being the most rapid: The vagina is first carefully cleansed with a sterilized compress or a soft brush. It is then rinsed with plain boiled water. Injections are then given of six liters of a 1 to 4,000 solution of permanganate at 35 to 50 degrees. The vagina is then tamponed with five or six large wicks of sterilized gauze, soaked with the same solution of permanganate. After twenty-four hours the wicks are withdrawn and new ones are inserted. After from twelve to twenty-four hours this treatment is completed. The patient is carefully looked after for about two weeks, although after the second day there are no more gonococci. The cul-de-sacs are painted with tincture of iodine, which is also used to disinfect the cervicouterine cavity. Daniels approves of introducing a stick of nitrate of silver into the urethra. This is immediately withdrawn. Three or four treatments, eight days apart, will effect a complete cure of the urethral infecton.- Revue Francaise de Medecine et de Chirurgie.

SPRAINS. Dr. Britton recommends that the limb be put into a vessel of very hot water immediately, boiling water being added as it can be borne, and kept immersed for twenty minutes, or until the pain ceases. Then put on a pretty tight bandage and order rest. Sometimes the joint can be used in twelve hours. If the trouble is more chronic, apply a silicate of sodium dressing, and let the patient walk with a cane, if the ankle be the joint affected.- Atlanta Journal-Record of Medicine.

PROSTATECTOMY.-R. Harrison says of perineal prostatectomy that he believes it of limited applicability adapted principally to partial removals of the gland. Freyer's operation of

supraprostatectomy is considered the operation of choice in the majority of cases, some of its advantages being that it may be completed with a knife aided by the fingers in a very few minutes, and that the bladder and prostate are approached from their most accessible position where there is little or no danger of encountering hemorrhage or of permanently damaging the sphincter or retentive apparatus of the bladder. The drainage provided is free so that secondary strictures need not be feared, and any calculi present are sure to be detected and removed. Partial supraprostatectomies have not proved, on the whole, successful. In regard to the mortality attendant upon the two types of operation the author believes there is not much difference between them, and he puts it, including all causes of death, at about ten per cent. Medical Record, May, 13, 1905.

DYNAMICS OF DREAMS.-A. E. Gibson presents an exhaustive analysis of the physical and psychical basis of dreams. He sums up his views in part as follows: To sum up the argument, dream and waking differ in degree and form of manifestation only, not in principle and essence. Like waking consciousness, dream reveals, but does not create. The same world that surrounds the waking individual surrounds the dreaming, only the viewpoints and media of observation are changed. As the life experience of an individual in his waking consciousness receives its character and value by and through his power of response to environment, so in a similar way the value of a dream depends upon the power of the Ego to respond to consciousness in its various forms of emotions, ideas, and feelings which constitute the environments of the subjective of a dream plane. Waking or dreaming, the individual is, or becomes, what he chooses to be at any given moment of his existence. The background for ordinary dreams consists of undigested remnants of waking life. Hence, ordinary dreams. are merely undigested life, being made up by longings, desires, anticipations, idle hopes, and miscarried realizations, which, oc

cupying the mind during the day, are overtaken by sleep before having reached their fruition. Hence the mixture, in most dreams, of the sane and the insane, of truth and delusion. On the other hand, the life lived out and assimilated in a purposeful existence becomes absorbed in the formation of character and leaves no residue to form the bizarre staging for the confused dream. And to such an individual the intuitions of dreamlife, with their dazzling imagery, will introduce symbols, which, properly interpreted, may carry the significance of prevision or prophecy. Therefore, to turn dreams into useful, intelligent, and intelligible factors, we must fill our waking life with deeds and thoughts of universal usefulness, and freight the train of events with an unflinching devotion to duty and virtue.— Medical Record, Aug. 12, 1905.

A CASE OF MENSTRUAL URTICARIA.— D. J. M. Miller epitomizes the literature of this condition and describes its occurrence in a girl of fifteen, who menstruates regularly and whose attacks of urticaria make their appearance seven or eight days before and cease two to three days before, each period. Occasionally the urticaria persists until the flow begins, rarely during the first day or two of its course. During the intervals between the periods the patient is quite free from attacks and she is perfectly healthy in other respects. The urticaria itself is of the ordinary type. - Medical Record, May 13, 1905.

LARGE DOSE OF QUININE IN PNEUMONIA.-F. H. Poole, Ross Fork, Idaho (Journal A. M. A., June 3), reports that he has recently treated thirteen consecutive cases of pneumonia among Indian school children with large doses of quinine, according to the method advocated by Galbraith (Journal A. M. A., Jan. 28. 1905, p. 291) without mortality. The initial symptoms common to all cases were intense frontal headache, epigastric distress and vomiting, and in eight cases epistaxis also occurred as an initial symptom. Three of the five boys had epistaxis at the onset and all had it repeatedly during the quinine treatment. Of the eight girls five had it as an initial symptom. Two of these had never

menstruated, but the menses appeared during the treatment; in the other three they also appeared, though not due, and in spite of the fact that the patients had always previously been regular in this respect. In none of the girls did epistaxis appear after the initial symptoms. Poole asks: Was this hemorrhagic tendency a part of the disease and peculiar to this epidemic, or were the epistaxes of the onset due to the infection and the later hemorrhages to the treatment? The minimum single dose of quinine given was fifteen grains, the largest thirty-six grains. These large doses proved a genuine stimulant to the heart and circulation, and appeared largely to allay the anxiety of the patient and to secure sleep.

INCONTINENCE OF URINE.-E. C. Dudley, Chicago (Journal A. M. A., June 3), describes a new operation for the relief of the urethrocele with imperfect urinary control, sometimes met with in multipata. It is based on the same principle as the operation of Albarran for the same purpose; the urethra however is not dissected free and the danger of sloughing is avoided. The first step consists in denuding a horseshoe-shape surface between the meatus and the clitorus, and to either side throughout its length. In the second step of the operation the meatus is drawn up to a point near the clitoris and secured there by means of two sutures. The lateral portions of the denuded surface are then closed. The first two sutures stretch the urethra upward toward the clitoris, and the lateral ones tend to hold it in its new position. The idea is to straighten the urethra by longitudinal tension and to collapse it and to hold together the dilated walls and to overcome the sacculation at the neck of the bladder by lateral traction. In many cases it may be necessary to operate at the same time for the associated cystocele, and in nearly all cases to perform perineorrhaphy for the relaxed posterior vaginal outlet. When there is very much relaxation of the tissues about the clitoris, and there is danger of it being pulled down, he would take a reef in the tissues above that organ, enough to keep it sufficiently high to hold the urethra taut. He has performed this operation five times since Jan. 1, 1905. In the first four, the relief was immediate, and, so far as known, continuous. The last case is still too recent to be correctly estimated.

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