the caption of "Some Therapuetic Possibilities of Biliary Fistulas," he says:

"In practically every operation for gall stones the operator establishes a temporary biliary fistula-either of the gall bladder or common duct-the purpose being to relieve cholemia, cholecystitis or cholangitis by continuous drainage in much the same way as urinary cystitis is relieved. Such treatment has proved to be the most efficient yet devised. To hasten this cure some have added to this simple drainage a daily lavage of the gall bladder with an alkaline mildly antiseptic solution. The loss of much of the fluid used for irrigation-frequently observed during such a lavage, naturally suggested the idea of studying the effects of various fluids introduced thus into the duodenum. So striking have some of these been that I desire to call attention to them--as well as to urge further study by the members of this section."

"First, as a means of deluging the system with water, the temporary fistula many times can be utilized with surprising advantage. I have repeatedly injected in such cases by continuous irrigation of warm, sterile normal salt solution, 500 to 1,000 up to 3,000, cc of fluid first as an experimental observation, then as a means of flushing out the kidneys, or clearing up a jaundice, or filling up the blood vessels-and in one case even added dextrose as supplying the calories most easily assimilable."

The giving of saline through a biliary fisture appeared to me as being a step in advance of our treatment of septic gall bladder and I concluded should the opportunity present itself I would try it.

The following is a report of a case where two pints of normal saline were given every day for a week through a biliary fistula.

Family History-Father died of cancer of spine. Mother living and in good health. Three brothers and two sisters living, in good health.

Early History-At thirteen had scarlet fever-and the usual diseases of childhood, menstruated at fourteen-was never regular and had considerable pain. Married at nineteen-fifteen months later gave birth to a child, the delivery was normal. After childbirth her menses were more regular but complained of being weak. She had leucorrhea and a continuous bearing down sensation. At the age of twenty-two, was operated on for torn cervix and perineum. Six years ago had left ovary and part of right ovary removed-and two years after this the

appendix was removed, but still she continued to suffer with pain in upper right quadrant of abdomen, which was more severe at times and was referred to right shoulder blade being crampy in character. During these seizures she would become nauseated but did not vomit. She was constipated and it was necessary for her at times to take enemas in order to have her bowels move.

Physical Examination-Inspection, skin slightly jaundiced, more of a muddy color, facial expression denoted pain, tongue heavily coated. Palpation, muscles of right upper quadrant of abdomen rigid, very tender over region of gall bladder, pressure here would cause pain in back near shoulder. Temperature 102.8. Pulse 102. Diagnosis of gall bladder disease was made from the above findings. I operated the following morning, March 24, 1910-opened through the usual incision for gall bladder and found some slight adhesions which were easily broken up. The gall bladder was distended to twice its usual size and upon opening it I found, about one inch from the fundus, what appeared to be sort of a diaphragm of very thick adhesions-the trocar would not go through without using considerable force-so after thoroughly protecting the field with gauze packs I cut down through the adhesions. I was unable to find any gall stones, but found the gall bladder to be full of black, tarry, ropey bile. I curetted the gall bladder-put in a rubber tube drain and ordered her put to bed in Fowlers position and given normal saline per rectum. There was practically no drainage, just a little bloody pus. Patient grew weaker and weakercould not retain saline by bowels which were moving involuntarily. She refused to take nourishment-her condition was alarming-morphine had to be given at intervals to relieve pain. March 28th-four days after the operation-I started to give the patient saline solution through the drainage tube in the gall bladder. This was done by clamping off the tube leading from the irrigator with haemostats so that the flow was reduced t oa drop at a time. It took three hours for the pint of normal saline to run in. Some time later she had considerable distress in the stomach which I was able to relieve by washing out with a solution of sodium bicarbonate. The following day I had administered to her two pints of saline solution through the tube into the gall bladder-one in the morning and one in the afternoon and washed out her stomach after each time. She continued to improve from the first time the saline was given by the biliary fistula. The improvement was continuous and as she gained in strength the bile began to flow through the fistulous opening and continued for about four weeks when the fistula

closed of its own accord. In order to find out her condition at the present time before reporting the case-I called upon her December 16th and found her at work. She has gained in health and strength and is now free from pain and has gained twentyone pounds in weight. It is my opinion that the normal saline solution through the gall bladder saved her life and I can recommend it as a safe procedure in any emergency such as I have described where the gall bladder will not drain-it should always be resorted to.

ABSTRACTS.

The Local Use of Powdered Silver Nitrate.

Baruch (Muench. med. Wochenschr., 1910, N. 35). Kaolin is heated to 100 to 150 degrees C., which renders it not only sterile but finer and more hygroscopic. To it is added 1 per cent. powdered silver nitrate. The miture forms, according to Baruch. an ideal dressing for suppurating and gangrenous wounds. The odor ceases, the granulations become firm and the growth of epithelium is stimulated. In the surgical clinic of the Berlin University, this powder has proven itself superior to all others for dirty and foul-smelling words. Its cheapness and its lack of odor are additional merits.

Trypanosomiasis in Plants.

An interesting contribution to comparative pathology has been made by Lafont (Abst, in Centralblatt f. Bacteriologie 47, 10-11, 310) who has found that in the Island of Mauritius certain species of Euphorbia harbor in their juices a parasite closely resembling the trypanosomes. The attempt to cultivate it, or to infect mice and sparrows with it failed, but on examining the insects that suck the juices of these Euphorbias, he has found the parasite in Nysius Euphorbiae, a relative of the bed-bug.-Gifford (Omaha).

An Important Court Decision.

Holding that municipalities have no right to pollute public water-courses through their sewage systems the supreme court has granted an injunction restraining the village of Sharon Springs from polluting the waters of Brimstone Creek, the waters of which are used by property owners along its course

for dairy purposes. The defense of the village was that the state had approved the plans of its sewage system. This was a test case, there being fifty similar suits pending. The court held that it was the policy of the state that water-courses be maintained in a pure and wholesome condition, and that in granting aid to municipal corporations to install sewer systems, the right to maintain a public nuisance was not conferred.

Treatment of Erysipelas with Anti-Diphtheria Serum.

Rehak (Abst. in Fortschritte der Med. Nov. 17, 1910, p. 1547) reports the most brilliant results from the above treatment. After treating 13 cases with anti-diphtheria serum with (diphtheria antitoxin probably) he concludes that all cases of erysipelas, except where general sepsis has supervened, react within 24 hours after the injection with a fall of temperature, followed quickly by an improvement in all the subjective and objective signs of the disease, and the case goes on to complete recovery without any serious complications. So far as observed, no relapses occur. In one case with general sepsis, no reaction to the serum injection occurred. Encouraged by Rehak's report, Barannikov (ibid) has tried the same treatment in 3 cases of severe erysipelas and has obtained results that surpassed anything previously seen in his 24 years of practice.-Gifford, (Omaha).

Puerperal State.

(By Archibald Church, M. D.)

Pregnancy, parturition, and lactation diminish the vitality of woman, debilitate and weaken her entire organism, induce a species of physiological commotion in her nervous system, and, in short bring to bear a strain upon her which is, even under normal conditions, attended by emotional irritability, depression, morbid yearnings, etc. It is not strange, therefore, that the puerperal period in women with unstable nervous systems should often be an exciting factor in the development of psychoses of various kinds. In about 10% of insane women the insanity has its origin at the epoch of reproduction. The majority of these cases are parturitional (seven and a half per cent), while about a fourth are lactational and a tenth pregnaney cases. It is perhaps true that there are many cases of parturitional psychoses in which the insanity is not so much due to the stress of labor as to possible auto-intoxications from poisonous substances absorbed during the catabolic changes

incident to subinvolution of the enlarged uterus.-Aikin, Joseph M. (Omaha).

The Effect of Tobacco On Body and Mind. (Journal of American Medical Assn. Editorial October 1, 1910.) Dr. George L. Meylan, of Columbia University, in a study of 224 college students from two classes found that 115 were smokers and 108 non-smokers. He makes the following conclusions:

The use of tobacco by adolescents is injurious; there is no scientific evidence that the moderate use of tobacco by healthy, mature men produces any beneficial or injurious physical effects that can be measured; there is an abundance of evidence that tobacco produces injurious effects in (a) certain individuals suffering from various nervous affections, (b) persons with an idiosyncrasy with respect to tobacco, (c) persons who use it excessively. It is generally conceded that the use of tobacco by college students is closely associated with idleness, lack of ambition, lack of application and low scholarship, though these may not be due entirely to the tobacco.-Aikin, Joseph M. (Omaha).

Example of the Danger of Some Forms of Immunity.

That an immune animal may be killed by a dose of a pathogenic germ which would injure but not kill a non-immune animal is well illustrated by Much (Abst. in Fortschritte der Medizin Oct. 6, 1910, P. 1255). If one injects into a highly immunized animal a small dose of a highly pathogenic race of the colon bacillus, the animal is not injured; the germs are immediately killed. A non-immune animal also remains alive after a similar dose. In the second animal, the germs are not killed at once, but are gradually put out of commission by the normal antibodies and by those which develop under the influence of the germ; but if one takes a dose of the same germ sufficient to make a non-immune animal very sick, but still not sufficient to kill it, the same dose injected into the immune animal will produce a fatal result. The explanation is that in the immune animal, so many germs are so suddenly killed that the organism is overwhelmed by the amount of bacterio-toxins liberated from the dead germs; in other words, with a large dose of an extremely pathogenic germ, the immune animal is worse off than the non-immune, but luckily such conditions are seldom found in practice.-H. Gifford (Omaha).