membrane is of a wine - red color, injected, and studded with granulations; the vocal cords are of a pale red, but always colored, contrary to their normal state, and their surfaces coated with somewhat tenacious mucus.

It is easy to understand the mechanism of these changes. All these young people (18 to 27 years, nine cases), were in excellent health; lungs absolutely sound. One only of the nine presented a slight amount of pulmonary emphysema; no hereditary disease.

All who have employed the means of locomotion above described know that it is necessary to use much force in ascending grades, and in maintaining a certain degree of speed on ordinary roads; and it is precisely this effort that is the cause of these disorders. The velocipedist inclines his body forward, a position that hinders free respiration. Then the force required for the propulsion of the bicycle augments the demand for air, and necessitates buccal respiration, that by the nose being insufficient. Finally, to complete the picture, the velocity of locomotion causes a large amount of air to enter the larynx and the lungs with enormous rapidity, and, consequently, with a degree of pressure proportionately high.

These conditions expose the traveler to the dangers of buccal respiration,augmented by excessive pressure of the air inspired; expiration is also forcibly increased, and this exaggerated physiological activity finally produces the pathological condition above described.

The removal of the cause and appropriate treatment brought about rapid recovery in the nine cases met with in my practice.

Bequests to New York Hospitals.

Under the will of the late Mrs. Mary Stuart about $800,000 is donated to twelve medical institutions in New York and vicinity. The Presbyterian Hospital receives a sum estimated at not less than $310,000. The Woman's Hospital and four others will receive upward of $80,000, while a few dispensaries are remembered to the extent of $5000. During her lifetime, also, Mrs. Stuart had given liberally to these same charities; in no year, for many years past, falling below $100,000 per year for these and other selected objects. Her will disposes of a total of $4,000,000 for religious and other purposes.

Miscellaneous Selections,

The Treatment of Abdominal Wounds.

Michel Wassilieff, discussing the treatment of these wounds (Revue de Chirurgie), says: "The position of the surgeon is very difficult in doubtful cases. How shall he act when he is ignorant of the condition of the viscera? To make a laparotomy immediately is a serious step, perhaps useless, for the viscera may not be injured. On the other hand, to postpone operation and wait for more serious symptoms, is to endanger the life of the patient." He then quotes Augagneur, who claims that the three dangers to life-internal hemorrhage, shock, and peritonitis-do not justify laparotomy, the first and second because they may of themselves cease, and the third because it has no definite symptoms, for those usually ascribed to it may be due to shock. The grounds on which Reclus and Nogues justify operative interference are as follows: Internal hemorrhage; issue of fecal matter and gas from the wound or the distending of the abdomen by gas; and symptoms of peritonitis. They would prefer systematically no operation to always operating immediately, supporting their opinion by statistics. With no operation they find a mortality of 12 per cent. in punctured wounds and 25 per cent. in gunshot wounds, against 24 and 63 per cent., respectively, where there was operative interference. Wassilieff says, however, that the majority of surgeons prefer operating, and that promptness has much to do with success. He cites six cases of his own, four of which recovered without fever after laparotomy, washing with a 1:8000 sublimate solution, and tamponing with iodoform gauze. All were punctured wounds, with injuries of the viscera. The fifth and sixth cases-both without early dangerous symptoms, one a punctured wound, the other a contusion-died without operation, and section showed peritonitis due to wounds of the viscera. These cases lead him to believe that in all cases where there is a perforating wound-or, as he puts it, where a laparotomy has been begun-it should be completed; but he finds it difficult to decide the question in cases of contusion such as the last.

Where there exists the least suspicion of a visceral wound, he advises immediate operation. He says: "Certainly we would have obtained better results in these last two cases by operating, and therefore my advice is, that it is better to operate without finding visceral lesions rather than commit the fault of neglecting a case that has internal injuries."

He discredits the authority of the statistics quoted, both on the ground of the period that they cover, and also the unwillingness of operators to report unfavorable cases.

Hygiene and Dietetics of the Arthritic.

In the December number of The Physician and Surgeon, Dr. Lucas Championniere, in the course of an able article upon this subject, deduces the following rules as to the best diet to be ordered for the patient. The author says that for those suffering from pronounced arthritis who are very lithemic, preference should be given to white meats, veal and young animals, mutton, and lastly, beef. In some cases, however, game or venison should be denied. If fish be ordered, the whitemeated is best, as we find it in the sole, haddock, or codfish, while such colored or oily flesh as in the salmon, eel, mackerel, or sturgeon had best be avoided. Shellfish and crustacea, while nutritious, the author considers as too compact in their tissues, and hence indigestible, and on this account inadvisable for the arthritic.

Peas and beans yield a considerable amount of nitrogenous matter, but strange to say, do not seem to form uric acid. The fruit-acids become alkaline in the system, and these two classes the author advises in the diet table.

As to liquids, Dr. Championniere considers water especially good for the gouty. Some writers have gone so far as to say that this article alone is sufficient for a cure. Water increases the excretion of urea, and it is proven that the production of uric acid is in indirect ratio to the formation of urea; hence, the more water the patient consumes the less uric acid is formed. Finally, water aids in the elimination of all waste organic products, and in the dissolution of the fatty acids which constitute gall stones. A dry diet, it is thus seen, is rather a dangerous one for the arthritic.

As to wines, the author advises very light varieties. Alcoholic wines and champagne especially are most injurious.

The following rules are held to be applicable in every case : See that the arthritic patient produces and absorbs the least possible amount of organic poison which, by irritating the less resisting connective tissue, would cause arthritic manifestations.

Modify the arthritic diathesis as far as possible by means of exercise, gymnastics, hydrotherapy, massage, etc.

Attend to the amount and quality of the food; hasten nutritive changes; facilitate elimination of all organic waste and toxines by stimulation of the emunctories, which are usually unreliable in arthritic patients.

Professor Pancoast on Influenza.

"La Grippe" is not a proper name for the disease, as that is simply the name of influenza in France, and especially in Paris, where the name originated; it is more than influenza, it is a malarial break-bone fever. It is called "la grippe because, like the influenza, it takes one suddenly; and it is a sort of blood-poisoning caused by malaria. The poison is a microcosm, which produces malaria; this microcosm is now frequently spoken of.

The great prostration and the pains in the extremities, in the limbs, deep-seated pains in the limbs and bones, make it resemble the malarial fever of the mountains of South Carolina, called the dengue, or break-bone fever, which, like this malarial influenza, leaves the patient very much prostrated. One of the great elements of the disease which we have to combat, is the prostration and consequent debility of the patient. In my surgical operations I have had to combat it, and many cases have been taken with the "grippe" in bed without any possibility of contagion. I do not believe that it is a contagious disease, but it is an epidemic simply; there must be a receptivity in the individual, an exhaustion or fatigue, which predisposes him to disease, and thus renders him liable to the action of the microcosm floating in the atmosphere. I feel fully persuaded that it is not a contagious disease, for some of my surgical patients have been taken suddenly in

bed with it, being confined there by an operation, and have not been exposed to it by contact with anyone suffering from the influenza.

In addition, I have noticed that while the influenza has been prevailing, the inflammatory and surgical diseases which I have been treating seemed to take on a low type of inflammation, and I have found it necessary, at these times more than usually, to give tonics to build up my patients, and to keep up their tone.

I am also in the habit of telling my patients who are able to walk about, to take good care of themselves, so that they would not catch the influenza, nor suffer from the epidemic. By making him take care of his health, by keeping up his health, by keeping up his strength, and taking a tonic if necessary, and attending to the secretions, and taking exercise in the open air, by keeping up his tone, the patient is able to resist the epidemic poison. By keeping up their strength and taking exercise in the open air and keeping their health in the best condition, they are able to resist the epidemic and are able to throw it off more easily if attacked; but if debilitated or run down, they develop a condition of receptivity for the poison which renders them easy victims.-Times & Reg.

Goiter.

Dr. Kapper, an Austrian military surgeon, has employed in fifteen cases, with invariable success, Mosetig's plan of injecting iodoform emulsion into soft thyroid tumors. In every instance there was a diminution of the circumference of the neck amounting to from to inch. Antiseptic precautions were employed, and in some cases where the tumor was of considerable dimensions, several syringefuls were injected into different parts of the parenchyma. In order to ascertain whether the needle has entered the gland, the patient is asked to swallow, when, if it has so entered, the downward movement of the syringe shows that the needle has been carried upward. In some cases the injections were repeated daily for several days, in others at intervals of a few days. In no cases were any untoward symptoms produced.