plex mixtures. The percentage method is based practically on the idea that the proteid of cow's milk is the only food element that is difficult to digest, and that fat is comparatively harmless and easy to digest. It further assumes that the important thing in modifying the infant's food is to give the baby a certain percentage of each food element rather than to give it a certain amount of food. That the proteid of cow's milk is difficult to digest seems to Brennemann to lack any positive evidence, and is disbelieved by most European writers. For a number of years some pædiatrists have been looking in vain for any clinical picture that can be thus designated. The purely theoretical idea that casein is difficult of digestion has no standing when it can be practically shown that nearly every baby can digest a high percentage of casein in suspension or in skimmed milk, provided it can stand that amount of sugar, and that curds never appear in the stools, provided the food is fat-free. It seems doubtful whether there is harm in feeding proteid freely, though the small amount in mother's milk would make one hesitate to use a large amount. It seems equally doubtful that fat is easy to digest and metabolize, and he reports an instructive case showing its bad effects. Other objections to the percentage method are the danger of overfeeding, especially of fat overfeeding, and the fact that it has always seemed particularly complicated to most physicians, a majority of whom do not employ it as taught by its advocates. Improperly used, there is every chance of error. It is no wonder, then, that a majority of physicians finally use the simple modifications recommended by the "baby

food" men, and this alone is a serious arraignment.

Sodium Citrate in the Miserocchi (Gazz. Gastro-Intestinal Af degli Orpedali, No. fections of Infants.

30, 1907). In conformity with the recommendations of English and French clinicians, the author employed sodium citrate in the treatment of the gastro-intestinal affections of infancy. The remedy was prescribed for altogether 67 children, between 1 and 13 months of age, including 6 breast-fed babies, 42 with artificial nourishment and 19 who received mixed food. Among these children 17 suffered from gastric dyspepsia, 36 from gastro-intestinal dyspepsia, 9 from acute gastro-enteritis and fants were given, immediately after nurs5 from malnutrition. The breast-fed ining, a tablespoonful of a solution of 5.0 natr. citr. in 300.0 sweetened and sterilized water. In the cases of artificial nutrition the solution was added directly to the milk. An attempt was made in the case of 9 infants to administer the citrate without regulating the diet, but in these the improvement in regard to the vomiting and the stools was very inconsiderable. In the remaining 58 cases the necessary hygienic and dietetic restrictionwere applied, together with the adminis tration of sodium citrate, with very favorable results in 40 cases. No special effect of the citrate could be demonstrated in the remaining 18 cases. The remedy had a very prompt action in dyspepsia. and malnutrition; the vomiting subsided after a day or two, the stools became normal and the meteorism disappeared. The effect was not nearly as prompt in gastroenteritic disease. In a general way the action of the remedy is regarded as very favorable by the author, especially because sodium citrate is entirely harmless.

F. R.

Some Lesions of the Spinal Cord Produced by Experimental Caisson Disease.

A.

E. Boycott and G. C. C. Damont (Journal of Pathology and Bacteriology, April, 1908) report their experiments in animals killed by experimental caisson disease.

Bubbles of air were found most numerous in those parts with a sluggish circulation and less common in organs with an abundant blood supply. Bubbles were most frequent in the bodily fluids, such as blood or bile; also in fat.

In the spinal cord bubbles were much more abundant in the white than the gray matter, and especially abundant in the antero-lateral columns.

As regards different segments, bubbles were most abundant in the dorsal and upper lumbar cord.

Paralysis, especially paraplegia, is a common symptom of caisson disease, and in the experiments on goats seemed to be due to softening of the cord, especially of the lower dorsal and upper lumbar cord.

Evidence was obtained that attacks of temporary paralysis do not necessarily leave any traces of injury to the cord. Some animals who had had "bends" frequently showed no change of any kind.

Some Points in the His- David Orr and R. C. tology of Lymphogen- Rows (Journal of ous and Hæmatogenous Mental Science, July,

Toxic Lesions of the Spinal Cord.

1908) show the results of experiments upon the spinal cord and brain of rabbits, concluding that the central nervous system could be infected with toxins passing up the lymph channels of the perineural sheath. Capsules of a broth culture of an

organism were placed under the sciatic nerve, or under the skin of the cheek.

A resulting degeneration in the spinal cord or the brain was caused, closely resembling the changes in the cord of early tabes, or in the brain and cord of general paralysis of the nurone. The same results were obtained by injecting of colored pigment on the sciatic nerve.

The authors call attention to another mode of infection, by the circulation of toxine in the general blood stream. These two methods appear to produce a different appearance in the spinal cord. Lymphogenous infections affect the intra medullary portion of the infected nerves first, especially the entry zones, or postero-external fasiculus first, leaving the fibres near the median septum normal. In more toxic infections a more extensive change in the posterior columns of the cord took place.

In hæmatogenous lesions the result of a general intoxication, for example, cords taken from visceral cancer, the fibres around the median septum are first affected. The lesion is more marked in the cervical and upper dorsal cord.

The Surgical Treat- Pers (Dtsch. Med. ment of Sciatica. Wchschrft., No. 29. 1908). The author summarizes the outcome of his observations in the following statements: (1) Sciatica must be attributed to perineuritis or its sequelæ (adhesions); (2) The detachment and liberation of the affected nerve are followed by an arrest of the inflammatory process, the pain subsiding as soon as the adhesions are broken up; (3) The indications for operative interference are supplied by persistence of the disease, or con

vorable results were observed in lupus erythematosus treated with liquid air.

Liquid carbonic acid is analgous to liquid air in many ways and can be procured without difficulty anywhere. The results obtained from its use by the author in the last eight months were most satisfactory. It comes in long iron cylinders, the price of a container holding 10-12 litres being $2. This quantity suffices for a large number of treatments. The cylinder should be kept slightly inclined, stopcock downward, in order to facilitate the escape of the fluid. In its natural shape, or in form of a spray, liquid carbonic acid gas has not been found of practical usefulness. The liquid, as it escapes, is received in a piece of leather or other strong material, the rapidly evaporating acid becoming at once concentrated into a kind of snow. The main valve must be widely opened, and the bag destined for the reception of the gas be held close to the orifice, after which the liquid is allowed to flow for 5.10 seconds, this being usually sufficient to obtain a snowball of the size of a hen's egg. It is easily ascertained by feeling the bag, if it is filled with the frozen mass. The remedy having thus been obtained in applicable shape, the snow must be molded according to requirements, to suit the circumference and surface of the affected spot. It is easily compressed into a solid ball, inside of a piece of soft leather, and then shaped to suit the purpose by scraping the surface with the penknife or scalpel. The surface to be treated must be perfectly smooth, and when a large area is involved the frozen plane should have the shape of a square, so that new parts may be successively attached without retouching at point which has already been frozen. The snow may be pressed into short cylinders. made of hard rubber and the solidly adhesive cone be trimmed at the margins to

suit requirements. It is desirable that a certain experience be acquired with the preparation of the necessary applicators before the new remedy is tried upon the patient. The snow may be grasped through a piece of leather and pressed upon the affected surface. The temperature of this snow is estimated at 90 degrees Celsius, whereas that of liquid air is 180 degrees Celsius. When frozen for several seconds under slight pressure the skin becomes a hard white mass. The thawing of the frozen portions requires about twice as much time as that needed for the freezing process. Over-energetic application up to a minute is apt to induce necrosis of the part.

The first visible effect, after the thawing of the frozen portions, is a slight redness, followed within a few minutes by the formation of wheals. Sometimes vesicles form in the course of a few hours. The gradually developing scab persists for a few days up to more than two weeks, according to the depth of the action, and should not be removed prematurely. The pain caused by the applica tion of this remedy is very inconsiderable, as was repeatedly noted by the author in the treatment of children. The scar formation is remarkably smooth, even after deep freezing; there is no actual cicatrix after superficial action. Whether to aim at the coveted result in one or several sittings depends on the judgment and experience of the operator. In those cases where cosmetic factors enter into consideration it is probably advisable not to freeze deeply in one session and to obtain the result in a more gradual fashion in two or more sessions. The author, however, often achieved all that could be desired by means of a single application.

The indications for this new remedy are approximately the same as for liquid air. While not very wide, they concern

numerous anomalies of the skin, in which it fills a long-felt gap. Pusey originally recommended it, especially for various forms of nævi, warts and callus formations. The author found it an excellent

remedy in the treatment of lupus erythematosus and perfectly safe in cases of epithelioma. Very favorable results from liquid carbonic acid are obtained in the vascular, and even the cavernous, forms of nævi. The treatment is practically painless and produces no actual scars. Concerning the terminal results of epithelioma treatment with this remedy, no definite statements are as yet possible, but since recurrence has been observed, even after thorough surgical intervention, Xray treatment and various cauterizing agents, it is safe to regard liquid carbonic acid simply as a rapidly acting, almost painless and very convenient addition to our stock of remedies.

The carbonic acid snow is especially well adapted to the rapid removal of senile keratosis, where it is distinctly preferable to curetting followed by cauterization. It goes without saying that it is far more convenient than X-ray treatment. The same remark applies to all kinds of warts. In certain cases of In certain cases of callus on the sole of the foot the effect of the snow was found to be merely moderate.

In lupus erythematosus the application of carbonic acid snow, as well as of liquid air, appears to be a valuable addition to other methods of treatment, the results of which, including the Finsen treatment, are in a general way rather unsatisfactory. So far notable results have not been achieved by either liquid carbonic acid or liquid air in lupus vulgaris, but a favorable effect does not seem to be excluded under proper application of the remedy.

F. R.

Raynaud's Disease and Angelo (Il PoliclinExophthalmic Goitre. ico. May, 1908). The author reports an interesting case which came under observation in the clinics of Rome, Italy, and points out the association of the two diseases in connection with their as yet obscure ætiology. Similar associations are found to occur with especial frequency among neuropathic individuals (tabes dorsalis and paralytic dementia, hysteria and epilepsy, or hysteria and neurasthenia).

The patient was a young woman 22 years of age, who, at the age of six years,

had suffered from an affection of the hands, with a change of the color of the skin, from red to purple and grayisn blue; a sensation of cold, up to impossibility of moving the extremities; "dead" fingers alternating with local cyanosis; constant pain, with nocturnal exacerbations, first in the middle finger of the right hand, then gradually involving the other fingers of the right and left hand, followed by ulceration with a very sluggish course, disfiguring cicatrization, and deformity of the nails. In addition to these slowly and steadily developing affections, there appeared another series of disturbances when the patient was about 12 years old, consisting in headache, constant palpitation, with sudden exacerbations of great severity, a sensation of pain and distress in the cardiac region, anorexia, irritability, bad dreams, perversities of taste and smell (the patient would eat soap, wood or rubber, and complained of smelling kerosene everywhere), profuse intermittent perspiration, general crises of tremor, attacks of sudden diarrhoea, vertigo, hallucinations of sight and sound, considerable emaciation. There was a swelling of the thyroid gland, but no actual goitre. The heart dullness was increased; exophthalmos was more marked on the right