the idea of rectal feeding. But the rectum does take on this vicarious function and absorbs some substances not previously digested. The technique of the process is important. The left recumbent position is more advantageous, as it will not require such frequent flushing. We might use enemata twice in the interval of flushing, although the latter stimulates the bowel to absorption. In 1879 I saw a case in Bellevue, in charge of the elder Flint, with stricture of the cardiac end of the stomach, who was fed entirely be rectum for six weeks, and who in that time gained from sixteen to twenty pounds.

so.

Dr. H. Bert Ellis said: Formerly, many kinds of undigested food were introduced into the rectum; so there were good reasons for unsatisfactory results, for the rectum is not a digestive organ, therefore whatever food is injected should be predigested or partially Is there reversed peristalsis so that absorption takes place in the small intestines, where there is a special absorbing apparatus? Dr. Miller speaks of absorption in the rectum as a vicarious function; but this is not necessarily so, for indeed it performs this function regularly in the absorption of the watery portion of the waste products.

Dr. Albert J. Scholl said: In a phthisical patient with esophageal stricture, I used milk peptonized with Fairchild's tubes, one pint at a time, strained. This was easily retained. I believe the injection of solid substances is a frequent cause of irritation and consequent expulsion of the enemata.

Dr. J. H. Davisson said: In my practice I have restricted this method of feeding to hopeful cases, such as the vomiting of pregnancy, where we can tide them over for five or six weeks. I wouldn't care to employ it in hopeless cases of phthisis or carcinoma. I prefer a liquid form, and can see no advantage in emulsion or in egg. I use predigested preparations of beef and think pure pepsin necessary to insure digestion. Beef juice, or essence of beef, with brandy or milk, four to eight ounces at a time, every six to eight hours are best. In using liquids so much flushing is not necessary, and there will be less irritation and less residue. I prefer the left recumbent position and fountain syringe, and am careful to have the food at the proper temperature.

Dr. T. J. McCoy said the discussion recalls a case of stricture of the esophagus; for two months the patient took liquid; later he was fed per rectum for nearly two months, twice daily--4 to 6 ounces of milk, beef tea, whiskey, with extract of pancreatin; a Davidson's syringe was used; the body was well nourished at death. The bowel was flushed ten to fifteen minutes before the enemata. Morphine was needed to allay the pain of cancer. This method is very important in the vomiting of pregnancy. The recumbent position is necessary. Rectal medication is important.

Dr. Fitzgerald closed the discussion: In flushing we are not aiming to wash out the entire canal, but only to clean out the rectum; hence the sitting posture is preferred. My idea has not been to obtain. absorption in the colon or higher up the besetting sin has been to use too much material in the injection. It is a good thing in pregnancy, but our duty as humanitarians is to prolong life, even in hopeless cases; we cannot always decide whether an ulcer or malignant growth is present; we must give the patient a chance.

Literary Notes.

A Treatise on Disease of the Nose and Throat, in two volumes, by Francke H. Bosworts, M.D., Professor of Diseases of the Throat, in the Bellevue Hospital Medical College, New York, etc. Volume 2, Disease of the Throat. With 3 Colored Plates and 125 Woodcuts. Octavo, Pages 833. New York: Wm. New & Co., 1892.

With the completion of the second volume, Dr. Bosworts has erected a landmark in American RhinoLauryology, to which we may "point with pride." The amount of labor bestowed upon these two vol umes, as evidenced by the exhaustive text and literary references, is simply stupendous. Every branch of the subject is treated in the utmost practical manThere are many points upon which we are tempted to linger in reviewing the treatise, but lack of space forbids us confine.

ner.

From an elaborate resume of the cases of hemorrhage, in that very common and exceedingly useful operation tonsilotomy, we learn that this dangerous sequel is almost invariably met with in adults, there being only one case recorded in childhood, and in this case a galvanic cautery loop was used on a child eight years old. The author never undertakes the operation in adult life without apprehension and preparation for emergencies. He claims, however, that no well authenticated fatal case is on record.

Tying the bleeding vessel, a pressure on the only efficient halmestatics. The subject of diphtheria is treated in a masterly manner in the 60 pages devoted

to it.

On the subject of croup, the author is a dualist. He seriously questions whether a case of larnyxtracheal diphtheria, so called, ever occurs without a diphtherites inflammation in the fauces. Sixty pages are devoted to that most interesting subject," Neurose of the Larnyx," which is treated in a practical and comprehensive manner.

We cannot close this brief notice without commending the mechanical execution of the work, which renders it so attractive to the eye that it invites to perusal.

KEEPING IN STEP WITH NATURE. Under this caption, our colleague of the New Eng land Gazette, offers the following crisp and practical ideas:

"More and more we realize that this is the secret of bringing the sick to health, and we earlier recognized it to be the secret of keeping the healthy healthy. Time was when there was uncommonly little recognition paid to nature, still less consultation with her, on the part either of theology or of medicine. The former pronounced human nature to be deceitful and desperately wicked, until made over into something quite unrecognizable, by some patent theological process or other. The latter tacitly declared that nature was altogether powerless to make repairs in the organisms, it is her business to keep in order, and proceeded to outrage, defy and overthrow her by every diabolic device known to ancient medical ingenuity. But modern theology has decided that work along the lines of unalterably established human needs and impulses is the only effective work; and modern medicine is learning, in wholesome humility, to stand with bared head before Mother Nature, only too gratefully profiting by her lightest hint. A very great theologian once said that righteousness was only in keeping in the current of divine Providence. The correlative medical axiom might be, that health is only keeping in step with

The old-fashioned doctor, called to a sick bed, was wont to mount some hobby of theory whose gallop too often ended by the patient's open grave. The new-fashioned doctor follows respectfully, on foot, the silent couriers of sign or symptom that nature sends out for his guidance. Instead of drastic dosing with purgatives for constipation, today's doctor orders free of drinking water; instead of perilous anodynes for out-crying nerves, he feeds them with the fats, their natural and too-long denied foods, for which they were crying; instead of whip and chain for the mentally diseased, he gives them long rest, full nourishment, the books, the society, the out-door work which, as best suited to the individual case, shall restore with healing, gentle touch the lost. balance. Instead of exhausting bleeding in febrile conditions, continual and refreshing applications of cooling water and ice. Assiduous search to discover just where nature, through hereditary defect or otherwise, is unable quite to have her way, and to aid her, judiciously and gently, in getting her way; this is the rational, the merciful tendency of modern medicine. To do this with the least expenditure of force, and along the simplest and most obvious lines, is to be the most progressive and the most certainly successful of practitioners. Not to scorn nature, but to keep in step with her, that is the secret of medical advance to-day and forever.”

Modern medicine doubtless owes its best, its most valued achievements to the recognition of what years ago was aptly termed as "medicatrix naturæ." The more clearly the conservative tendency of the human organism shall be recognized, the more closely these elements of the machinery shall be studied; the more accurately its aims shall be followed, the more grand will be the results for human weal. It does not follow that the physician shall be an idle spectator of the battle between the human organism and the disease which is attacking it. On the contrary, having studied and mastered the capabilities of the human organism, and the forces which disease has marshalled against it, he is in a favorable position to aid the former by sustaining and guiding its conservative powers, and to cripple and rout the latter by neutralizing its lethal factors.

The modern physician no longer pursues the practice of his ancient predecessors; he no longer fights the disease with powerful remedies, whose debilitating effects upon the patient counteract any possible effect upon the disease. In short, we have been taught by irrefutable evidence, that while the contest is waged between the disease and the remedy, the poor patient is the battlefield, which suffers alike from friend and foe.

As a watchful pilot, the physician now stands at the helm; as the former utilizes steam, tide and wind

to land his valued freight into a safe harbor, so does the latter utilize the conservative tendencies of the system to the same end.

In surgery the need of the physician's functions has long been recognized and established as a line of practice in the most varied cases. The cautery irons unguents, and lotions of a past era have given way to the more simple, hence scientific rest treatment, which enables the wounded part to be restored by its own inherent forces. When the same principle shall be recognized and practiced in medical cases, the death rate and the duration of diseases will be diminished.

To this end the simplification of therapeutics, which is the guiding star of the Gazette, must contribute materially. The utilization of natural remedies, light, heat and exercise, electricity, massage, water, diet and other hygienic agencies, aided by medicinal agents, whose mode of action has been clearly demonstrated, will aid the physician to accomplish real marvels of recovery in serious and desperate forms of disease, as we are told by that accomplished clinician, Semmola.

Annotations.

How to Sterilize Milk.-Since the subject of the sterilization of milk has been agitated, the question is often asked, "What is the best method of sterilizing milk" that is, destroying the germs of disease or fermentation which it may contain. We have made many experiments, and from our experience can confirm the results of many observers who have given attention to this subject, that the complete sterilization of milk is a matter of no small difficulty. Milk which has been boiled for half an hour once or twice

each day for several days in succession, will keep for a number of days, but ultimately sours. This is due to the fact that some of the germs contained in milk are particularly hard to kill, and require a temperature above that of boiling milk.

We have recently been conducting some experiments upon this subject, with results so satisfactory that we are glad to be able to communicate them to the readers of the Bacteriological World and Modern Medicine. The first experiments were made with a tin receptacle capable of resisting a pressure of twentyfive pounds. This was partly filled with water and placed in boiling water, to the action of which it was exposed for half an hour. The pressure indicator showed no very considerable increase in pressure within the closed receptacle. We then tried boiling the tin vessel in a saturated solution of salt in water, when the pressure, as indicated by the pressure gauge, rose to four pounds. This was the result which we

expected. We accordingly proceeded to a further experiment, which consisted in boiling milk tightly sealed in strong bottles, in a saturated solution of salt. Milk sterilized in this way, by boiling in the salt solution for half an hour, will keep perfectly for an indefinite length of time. We opened, a few days ago, a bottle of milk which had thus been sterilized last June (1891), and found it to be as fresh as when placed in the bottle. It is only necessary to take the precaution to allow the solution of salt in which the bottles are boiled, to cool before removing the bottles. If the bottles are removed from the solution while hot, they will almost instantly burst. The vessel containing the bottles of boiling milk should be set aside and allowed to cool gradually, when the bottles should be removed and placed in an ice chest or an ordinary refrigerator. Ordinary soda-water or beer bottles are excellent for the purpose; or beer bottles may be used. Ordinary corks may be used for the purpose, but they should be previously boiled for half an hour. They should be pressed in tightly, and fastened with wire or with a patent fastener. After the bottles have been cooled and removed from the boiling kettle, the tops should be carefully dried, and if corks. are used, covered with sealing wax, such as is ordinarily used for canning purposes.

The efficiency of the salt solution is due to the fact that its boiling point is 227° F., while that of boiling milk is less than 200° F. By using different salts, a still higher temperature may be attained. For example, a saturated solution of carbonate of potash, or saleratus, boils at a temperature of 275° F., while a saturated solution of chloride of calcium boils at 355° F. These high temperatures are, however, unnecessary.-Bact. World.

The Ordinary Water-Bed as a Means of Affecting the Temperature of the Body.--I have for some years used the water-bed as a means of heating the human body during collapse, with such extraordinarily good results that I venture to call the attention of the profession to it, without claiming that no one else has done the same thing.

In cases of collapse and subnormal temperature occurring during advanced stage of typhoid fever, the severe forms of bronchitis, etc., etc., I have been accustomed to employ an india-rubber water-bed, about half the width of the ordinary mattress. It is placed upon the bed, alongside of the patient, partially filled with water at a temperature of 140° to 150° F., and covered with blankets, upon which the patient is laid. The weight of the body carries it down and forces. the water up at the sides, so that the person is partially surrounded by the heated water. The mass of the water, and the protection of the blankets, prevent

the loss of heat, so that the mattress keeps hot for many hours. Within a few days I have had an example of the power of the hot-water mattress. The patient, in the early part of the fourth week of a typhoid, went into a collapse, with subnormal temperature and profuse sweating. At the time when the water-bed was put on his mattress his temperature was 97° F. There was some delay in getting the hot water; probably three-quarters of an hour elapsed before the man was put on the bed, and his temperature had fallen to 95.2° F. Within twenty minutes the temperature had gone up to 97.5° F., and not long afterward was normal. When the heat of the body has reached 98.5° F., the patient may be lifted off and laid alongside of the water-bed, which being covered by the same blankets as are over him will keep the temperature up to the normal.

In

The success which I have had in heating the body with this contrivance suggests that the water-bed may also be used instead of the cold bath for reducing temperature. All that would be necessary would be to have the water-bed supplied with two nozzles, instead of the ordinary aperture, and an india-rubber tubing or hose fastened to the each nozzle, connecting the one with the spigot, the other with the outlet of the neighboring bathtub or stationary washstand. this way, without labor or trouble, water of a constant temperature of 40° to 50° F., at least in winter, could be kept in the bed, and it would be very easy to run the water through ice if it were necessary to get further lowering of the temperature. I have not tried this method of cooling the body; but my present hospital practice not affording me much opportunity to study typhoid or other fevers, I venture to call the attention of the profession to the matter.--Prof. H. C. Wood, M. D., Univ. Med. Mag.

The Scientific Study of Food.-Professor W. O. Atwater, in an instructive article in The Forum for June, points out the curious fact, that, in the extraordinary applications of science to practical problems in recent years, one of the most important fundamental problems has been strangely overlooked, viz., the scientific study of food. The coming man will avoid four mistakes that are now largely made: (1) he will not buy as expensive kinds of food as are now generally bought, because some of the least expensive foods are the most nutritive and palatable; (2) with further scientific information the coming man will value foods in proportion to their nutritive qualities; (3) if foods are bought and eaten with reference to their nutritive qualities, and not to mere fashion or habit, it would require a much less quantity to keep a man in his best working condition than is now generally consumed; (4) there will be a revolu tion wrought in the present way of cooking, which is

both wasteful and primitive and far behind our adProfessor vancement in almost every other art.

The

Atwater gives the results of practical studies in diets made to show these conclusions. And he asks: "Has man yet reached his highest development? poorer classes of people-and few of us realize how numerous they are-the world over are scantily nourished. The majority of mankind live on a nutritive plane far below that with which we are familiar. We may hope for the best culture, not of the intellectual powers, but of the higher Christian graces in the minds and hearts of men in proportion as the care of their bodies is provided for. Happily with advance of knowledge comes the improvement of man's conditions. May we not hope that the future development of their race will bring that provision for physical wants which is requisite for the best welfare of mind and soul?" President Dwight, in his article, also in the June Forum, on the recent action of Yale College in admitting women to its advanced courses, makes an eloquent discussion of the higher education of women in the United States.-(Science.)

The Bacteria of Cheese.-If bacteria are an aid to the butter-maker, they are absolutely indispensable to the cheese manufacturer. Some people do enjoy the taste of sweet cream butter, and there has been for some time an evident tendency toward a desire for less strongly tasting butter. But no one desires to eat fresh cheese. When first made, cheese is soft and tastes somewhat like milk curd. It has none of the palatable taste which we find in the cheese of our table. It is a long ripening which gives this taste to the cheese.

Here, again, the ripening process is one of bacteria growth. The millions of bacteria that were in the milk are stored away in the cheese, and instead of being killed here, as they are in the butter, they begin to multiply immediately. Here, too, there is a battle of bacteria, and now one species is in the ascendancy and now another. and now another. If the wrong species gets the upper hand, the cheese becomes bad, and cheese-makers have their greatest trouble from this source. The bacteria do not grow so rapidly as they do in cream, for the conditions are less favorable, but the ripening is kept up for months, and during the whole time the bacteria are growing. Under their action the character of the cheese slowly changes. Here, again, the decomposition products are responsible for the taste and odor. In some cases, such as Limburger cheese, the action is allowed to continue to the verge of putrefaction. Ordinarily it is not continued so far, but in all cases the cheese-maker favors the growth of certain forms of bacteria by regulating the temperature at which the ripening is carried on. As the ripening continues, certain parts of the cheese are digested and

decomposed by the bacteria growth, and, as the products of decomposition accumulate, the taste grows stronger. After a time it is considered fit for the market, but the longer the ripening continues the stronger the taste becomes.

Little is known yet as to the bacteriology of different kinds of cheeses. Whether the different tastes of Edam, Limburger, and other characteristic cheeses is largely due to the character of the bacteria ripening them can not be said. Cheese-makers do, however, have much trouble with various irregular forms of ripening, and a great drawback in this business is the lack of uniformity in this respect. Beyond doubt, this is due largely, perhaps chiefly, to the variety and number of bacteria which succeed in gaining a foothold in the cheese and contribute to its ripening.

Along the line of cheese manufacture our bacteri ologists are promising us help from their researches. Of course, the cheese-maker has never paid any attention to the sort of bacteria which he plants in his cheeses, for he has never heard of them. Sometimes he has unwittingly planted species which produce violent poisons, as is shown by the many instances of death from eating poisonous cheese. Now, our bacteriologists are suggesting that the ripening of cheese may be easily controlled. Artificial cultures of the proper sort may be furnished the cheese-maker, and if these are planted in the cheese not only will the danger from poisonous cheese be prevented, but at the same time the desired taste of the cheese be assured.-Prof. Conn, in Pop. Science Monthly.

The Treatment of Neurasthenia.-Dr. Petrina states that we have two objects to fulfil in the treatment of this condition-first, to remove the abnormal excitability, and second, to timulate the weakened innervation. An important part is played by the nutrition. In general a mixed, easily digested diet, with regular times of taking meals, is preferable to a rigidly fixed dietary, and individual idiosyncrasies must be respected. Beer, wine, tea, coffee and tobacco may be allowed in small quantities. Residence in the country is frequently sufficient to effect a cure; in severe cases a change of climate is indicated. A sea climate is indicated in cases of vigorous persons who have become exhausted from great mental exertion. On the other hand, very debilitated and excitable neurasthenics do badly in sea-air, for experience has shown that the sleeplessness and excitability are increased. For the majority of neurasthenics the climate of high altitudes is most suitable, and should always be first tried. The home treatment of neurasthenia is less effective, but also gives good results. It consists of physical influences, hydrotherapy, electricity, gymnastics, massage, regulation of the diet, work and sleep. The hydropathic measures comprise

the rubbing wet-pack or simple wet-pack, the full or sitz bath. The rubbing wet-pack should not have too low a temperature, nor be too prolonged. Cold river baths are frequently well borne even by delicate neurasthenics. The electrotherapy may consist of general faradization, the electric battery, and the local application of the galvanic current. Massage in conjunction with gymnastic exercises is of value; for young neurasthenics riding, fencing, swimming, etc., are indicated. The employment of digitalis for cardiac disturbances, of opium for gastro-intestinal pains, and of strong purgatives for the obstinate constipation which usually exists, requires the utmost caution. The application of an ice-bag over the heart, galvanization of the neck along the sympathetic, together with administration of bromides and the maintenance of rest, act as good cardiac sedatives, and enable us to dispense with digitalis. The use of a Priessnitz compress over the abdomen is serviceable, and constipation may be relieved by enemata. The dyspeptic symptoms may be relieved by drinking the lukewarm waters of Carlsbad, Mühl or Schlossbrunnen, to which, if necessary, some Carlsbad salts may be added.— Therapeu. Monatschrift.-Medic. Age.

Treatment of Typhoid Fever by Water Through Mouth and Rectum.-Experiment 1st.-I was called to see Mrs. M., who had been sick with typhoid fever for ten or twelve days, and under the treatment of a physician. The patient, when in health, is a very frail woman, and I found her extremely feeble and helpless, with all of the symptoms usually met in a severe case of this fever. Temperature range, morning 103°, to 104° in the evening. She informed me that she had, at best, an extremely delicate stomach, and that in her present condition she could not take any medicine, and very little food.

It occurred to me that this was a fit subject with which to utilize the suggestions of Dr. Debove and Prof. Cantani, in the use of internal water baths for reducing the temperature. I directed that an enema of half gallon of warm water be given every morning, and one gallon in the evening, and if the temperature was not sensibly reduced, to repeat in one hour. In addition to this, I had cold cloths placed over the bowels and renewed frequently. The nurse was directed to give all the cold water the patient could be prevailed on to drink. prevailed on to drink. Milk and whiskey were given as freely by the mouth as she could take, and beef extract by enema at intervals, day and night. This course was regularly carried out, and although there was an increase in daily temperature for several days, and aggravation of the symptoms, causing the case to look more unfavorable, the warm water flushings were repeated oftener, with the result of establishing copious diuresis, followed by diminution of tempera