work. Dr. Goodell prefers other sutures in complete tears of the perineum, although, since seeing catgut so generally used by Martin, Mackenrodt, and Winter, in their abdominal operations, he has adopted it and advocates it in all septic abdominal cases and those in which drainage is needed. In removal of fibroid tumors of the womb by the operation of supravaginal hysterectomy, the broad ligaments may with safety be ligated wholly with catgut. Where broad vascular regions have to be tied off, overlapping, quilted sutures are used, and in tying large pedicles, as in ovarian tumors, two or three separate ligatures should be applied in place of the single Staffordshire knot. In vaginal hysterectomy for cancer, catgut may be used exclusively, the ligatures on the broad ligaments being drawn down, and treated by the extraperitoneal method. Nos. 3 and 4 of the German gut should be used, having been previously prepared in the following manner: To dissolve out the fat it is first placed in commercial ether for from twenty-four to forty-eight hours, according to the size of the gut, and if it is of the larger size the ether is changed once. The gut is now immersed for forty-eight hours in a 1:1000 alcoholic solution of corrosive sublimate. It is then wound on glass spools by surgically clean hands, and kept permanently for use in a mixture of two parts of oil of juniper to one of alcohol, which is occasionally changed. When needed for an operation, he transfers the requisite number of spools to a mixture of one part of glycerin, which has been sterilized by heat, to nine of alcohol. This gives the gut greater smoothness and pliability. Thus prepared, it will last in the tissues of the body a week to ten days.-W. Goodell, in Ther. Gaz.

Uncured Gonorrhea.

The more one studies the minute anatomy of that sensitive and indispensable canal, the modern urethra, the less is the surprise excited by the slowness with which the intense inflammation characteristic of the blenorrhagic process is recovered from. Ricord once observed that when old man Weller, of Pickwickian fame, advised Sam to "bevare of the vidders," it was because he had preserved a lively recollection of the sexual vicissitudes of his youth. In any event,

the more one learns of the immediate and distant effects of gonorrhea in a certain proportion of cases, the more fully does one appreciate the fact that this malady is by no means the insignificant and securely localized ailment that it is popularly conceived to be. The spongy portion of the urethra is richly studded with glands and sinuses which participate in the inflammation and afford the materies morbi a hiding place and a nursery ground, safe from the salutary influence of injections. The discharge from the mucous surface may have ceased, but the disease still lurks unsuppressed in the recondite corners of the membrane, and returns again and again till the microbite fury is spent. Still more important is the prolonged infectivity of the disorder, due to the special anatomical structure of the parts affected. It is only since the last few years that the scope of gonorrheal inflammation in the female has been more accurately mapped out. We know at present that its invasion of the uterus and its propagation along the Fallopian tubes paves the way to life-long invalidism on the part of the innocent victim, and this knowledge must materially increase the practitioner's sense of responsibility in declaring this or that case to be "cured."-Med. Press and Circular.

The Value of Bichloride of Mercury in the Treatment of Urethritis. Brewer (Internat. Jour. of Surg.) reiterates his confidence in the efficacy of bichloride of mercury in the treatment of urethritis. His method was as follows: At the first visit the patient was instructed in the proper use of a syringe, and was given a large amount of a solution of bichloride of mercury, varying in strength from 1:16,000 to 1:50,000, according to the sensitiveness of his urethra and the stage of the disease. This he was instructed to use twice daily, by taking ten injections in the morning and ten at night, holding each one in the urethra one minute, to imitate as nearly as possible the result of irrigation. The patient was seen three times a week. As soon as the discharge lost its purulent character, bichloride was suspended and a mild astringent was substituted, preferably bismuth suspended in water. In the fifty-five cases treated in this way, five were not benefited, after an

average employment of the method for seven days. In the remaining fifty cases, the average length of time necessary to effect a change in the discharge from pus to thin watery secretion was a fraction over eight days. The discharge entirely disappeared on an average of twenty-one days. Epididymitis occurred in three of these cases, and posterior urethritis was developed in two. The reporter fairly states that these statistics are of little value from a scientific point of view, since the cessation of the discharge can by no means be considered as an index that the disease has been cured. He offers his conclusions, not so much on the basis of these cases as upon a very large personal experience, and states positively that the judicious use of bichloride of mercury in cases of acute gonorrheal urethritis is attended with better results in subduing the painful and disagreeable features of the disease than is any other agent. The recovery is more rapid and permanent, and the frequency of inflammatory complications is very greatly reduced.-Therapeutic Gazette.

Lettuce.

Although preparations of lettuce have from very early times had a reputation in medicine for their soporific properties, the narcotic constituent of the plant has never been ascertained with any certainty. Various neutral, fatty and waxy bodies, separated from the milky sap of different species of Lactuca, have been from time to time described as compounds of medicinal value, but on the other hand it has been denied that the dried milk-sap, lactucarium, in spite of its narcotic odor, possesses any sedative action, and in fact this preparation is no longer officinal in England or the United States. It is therefore interesting to learn in a communication from the Research Laboratory of the Pharmaceutical Society, read recently before the Clinical Society, that Mr. T. S. Dymond has established beyond doubt the presence of hyoscyamine, the principal alkaloid of belladonna and henbane, not only in the cabbage and Cos varieties of the common lettuce, L. sativa, but also in the wild lettuce, L. virosa. The amount in the young plants is certainly very minute, but in the officinal green extract, which, according to the direc

tions of the British Pharmacopoeia, is to be prepared from the flowering herb of L. virosa, the mydriatic alkaloid occurs to the extent of 0.02 per cent.-Science.

Opium Disease.

The paper, which opens with a protest against the use of the word habit in describing the opium disease, discusses some recent facts which throw light on its etiology. Clnical studies have insufficiently investigated the question of etiology.

A large proportion of opium cases have inherited a neurotic diathesis. In some cases there is present an opium diathesis, or a special inherited tendency to use opium. In all neurotic cases the use of opium, when given, should be concealed and watched with care.

In another class of cases abnormal nutrition seems to be the most active etiological factor. Imperfections of digestion, assimilation and elimination of waste products, and the resulting auto-intoxication, produce an array of mental, nervous and digestive suffering, for which opium is a specific paralysant. In a third class the use of opium may be dated from an injury or disease.

Routine treatment, either by slow or rapid reduction of opium, is not wise. The removal of opium is not the cure. The substitution of other narcotics is unwise. Where an opium or neurotic diathesis exists the opium should be withdrawn very gradually. Rapid reduction and heroic treatment are never permanently successful. Attention should be given to brain and nerve nutrition. Great care is needful in using other narcotics to lessen irritation during withdrawal of this drug. Foods and tonics should be given. The same general treatment as for neurasthenia is required.

In the second class of cases treatment is very hopeful. A long preliminary course of baths, mineral waters and tonics should precede the removal of the opium. Then the opium may be removed at once without the knowledge of the patient. In the third class the opium may be removed rapidly or diminished slowly and discontinued, or, in some cases, should not be altogether removed.-T. D. Crothers, in Jour. A. M. A.

Treatment of Hemorrhage in Typhoid Fever.

I wish to enter a protest against the usual and generally accepted treatment of intestinal hemorrhage in typhoid fever. My last few cases having ended in recovery, without medication, encourage me to believe that my previous results (about 50 per cent. mortality) in this alarming accident were due to hypermedication. The hemorrhage has usually ceased by the time that its occurrence is recognized.

The remedial agents usually employed are ergotin, tannic acid, plumbic acetate, and opium. The hypodermic injection of ergotin causes, first, a lowering of the arterial pressure, which is soon followed by an increase of pressure, so that ergot, if not harmful, is at least of doubtful utility. I have seen two cases of gangrene of the toes in the course of typhoid fever in which ergot had been administered.

A popular and favorite prescription for intestinal hemorrhage in typhoid fever contains tannic acid, tincture of opium, turpentine, and chloroform. The tannic acid is presumably selected for its local effect in traversing the intestine, or for its conversion into gallic acid in the circulation. The astringent effect can at best be but slight. The tincture of opium is anti-peristaltic, but it is questionable whether muscular paralysis is desirable. Should one administer opium after labor or abortion when the uterus is full of clots which may become septic? In typhoid fever the putrid sloughs in the intestine are a source of hemorrhage.-J. Rodman, M.D., in Phil. Med. News.

WITH the deepest regret we learn that the doors of the insane asylum have closed upon Roberts Bartholow. What an ending for such a life! To the very last no evidence of mental alienation appeared in his lectures or his writings. The habit of a lifetime's assiduous labor carried him along in the well-worn grooves, although outside of them his malady was easily discernible. Hard work, no rest, no Sabbath, no vacation-by such means his powerful intellect carried him to the forefront of his profession; but at last outraged Nature reached her limit of endurance, and the break-down was complete.-Med. Times and Reg.