slight trauma to the skull that is hardly noticeable. With such an injury the patient becomes gradually unconscious and the pulse is very slow. Shock is followed by fever if infection takes place.

No scalp wound should be hurriedly closed; all possibly infected material should be removed first. Scalp wounds, owing to the hairy covering, are more subject to infection than similar wounds on any other portion of the body, excepting perhaps dirty hands and feet. The staphylococcus pyogenes and streptococci are often found upon the dirty scalps of those who work among horses and cattle, street cleaners and laboring people generally, necessitating, to our mind, the use of clippers or the razor to remove all possibility of infection if there has been any extensive injury to the scalp. Scalp wounds in the spring time are very likely to become attacked by erysipelas unless the strictest precaution against this has been taken. To prevent such infection application of a ten per cent solution of tincture of iodine or of an equally effective antiseptic should be made. The hemorrhage in such injuries can easily be controlled by direct pressure upon the bleeding vessel. The edges of the wound should be lifted and all foreign substances removed from under the scalp by injections of one to two thousand sublimate solution. Never sew up or approximate such a wound until all blood clots and foreign substances have been removed. A small drain should be left in the most dependent portion of the wound. From one to three thousand units of anti-tetanus serum should be used as a precaution against tetanus. If the wound should be in close proximity to the ear, mop out the auditory canal with ten per cent carbolic acid in glycerin, then pack the ear with sterile gauze.

Effects of Injuries upon Certain Centers.-If the left frontal lobe (upper or middle convolutions) is involved, there is no immediate effect upon sensation or motion, but more or less irritability and impairment of mental acumen. Injury of the right frontal lobe has but little effect upon a right-handed man. The power of speech is lost if the left third frontal convolution is damaged in a right-handed person. We recently had such a case-a pistol ball injury in which the patient could not speak, but wrote his statements to me on a card; four hours later he lapsed into unconsciousness. It should be remembered that the right third frontal convolution is the speech center in left-handed people, and that if

only one side is damaged the other gradually takes up the lost power of speech. Paralysis or loss of motion follows injury to the ascending frontal or parietal convolution just in front of and behind the fissure of Rolando. The leg motor center embraces the top of the ascending frontal with the entire parietal lobe. The motor arm centers are located on either side of the middle fissure of Rolando. Damage to any of these points results either in spasm or paralysis to the area they control on the opposite side of the body.

NOTE: We recently had a splendid recovery from a compound gunshot fracture which passed through the left anterior frontal lobe, producing aphasia within a few hours after the injury. The case was treated by raising the depressed fracture, instituting drainage, with ice to the shaved head; and though he suffered the loss of at least an ounce of brain matter he made an uneventful recovery. He has since taken a civil service examination successfully and is now in a good state of health and intellect, though a little shy on gray matter.-International Journal of Surgery.

SANGUINARIA CANADENSIS.

BY A. F. STEPHENS, M. D., ST. LOUIS, MO.

Regular medicine never got further in the investigation of the medicinal properties of sanguinaria than this: "Sanguinaria is an acrid emetic, with stimulant narcotic powers. It is an expectorant, and is said to be an emmenagogue. An infusion in vinegar has been employed advantageously as a local application in obstinate cutaneous affections."

Forty years ago Prof. John M. Scudder said of sanguinaria: "In full doses we employ sanguinaria as a stimulant to the mucous membrane. This use is valuable in bronchitis with increased secretion, and in atonic conditions of the stomach and bowels with increased secretion of mucus. In minute doses we employ it in cases of cough with dryness of the throat and air passages, feeling of constriction in the chest, difficult and asthmatic breathing, with sensation of pressure. It is stimulant to the vegetative system of nerves, and under its use there is an improvement in the circulation, in nutrition and secretion." This verdict has stood for forty years. It was true then, it is true to-day. But since that time

further investigation has added a little here and there, as experience has taught us, until we can now paint the following picture, which is comprehensible by any intelligent person, and which predicates the successful use of sanguinaria: Tickling sensation in the throat; irritation of the throat with dry, hard cough; throat and air-passages dry, hot, and swollen; dry cough; laryngitis with dry, hoarse cough and a sense of choking or constriction in the larynx; difficult respiration, when the mucous membrane is dry and swollen, and the parts seem hot, and the patient complains of difficulty in swallowing; bronchitis with increased secretion of mucus; atonic conditions of the stomach and bowels with increased secretions of mucus; sense of uneasiness and burning in the stomach with nerv

ousness.

Having the above clinical picture firmly fixed in our minds, there will be no difficulty in finding a place for sanguinaria in many cases of inflammation of the throat (pharynx, larynx), trachea and bronchial tubes; likewise in the treatment of diseases of the gastro-intestinal tract when there is evidence of a lack of secretion, and where digestion is not completed because of a failure to furnish a sufficient amount of gastric fluid. In cases of torpid bowel, when the stools are dry and difficult to expel, with a sense of constriction at the anus. In cases of this character the remedy may be combined with collinsonia to good advantage.

When, in diseases of the throat, the indications for sanguinaria are present, there is no remedy that will act more kindly and promptly. In sore throat, croup, diphtheria, etc., when the parts are dry and swollen, the cough dry and rasping, and the patient complains of tightness, as of choking, difficulty in swallowing, and much pain on motion of the parts, sanguinaria will give prompt and gratifying relief. Such symptoms are very frequently met with in croup and diphtheria. One may use the old acetous emetic tincture in these cases, if at hand.

In persistent, teasing coughs, with a feeling of tightness in the throat and chest, sanguinaria will loosen the constricting grip and relieve the cough.

In pneumonia, when the secretion is deficient and the cough is dry and harassing, and the patient complains of weight and compression in the thorax-a feeling of tightness-this remedy will do much to overcome the difficulty.

We find that the remedy is indicated in many cases of eruptive

diseases, especially in the early stage. In measles, when the cough is hard, dry, and persistent and painful, and the mouth and throat are parched, sanguinaria will prove very satisfactory, as through its action in relieving the conditions as indicated the eruption is determined more quickly to the surface. In scarlet fever when the throat is greatly swollen, deglutition difficult and painful, and the involvement of the larynx induces the characteristic cough, complains of a sensation of being gripped by the throat, and what secretion there may be is stringy and difficult to expel, sanguinaria will relieve the patient's suffering and work toward a cure.

In diseases of the eyes accompanied by dryness of the conjunctivæ, with a sensation of drawing, burning pain in the eyes, sanguinaria will aid in giving relief.

In catarrhal conditions of the nose, especially that designated as dry catarrh, will be favorably influenced by the remedy. Let us remember that there is one mucous membrane only, and that a remedy that will favorably affect one section of it will also just as favorably affect other portions if the same conditions exist.

Sanguinaria may be combined with other indicated remedies, and in many cases is joined to ipecac or lobelia to good advantage. I do not think that sanguinaria is estimated at its true value by most physicians, and for this reason I am calling attention to it

once more.

I have not discussed the properties of the alkaloidal fragments which can be broken out of the plant, viz., sanguinarine, porphyroxine, and puccine. I have simply tried to point out the uses of sanguinaria as represented in the whole drug. The fragments have their uses also, but they do not fill all the requirements of the parent.-Eclectic Medical Journal.

CLINICAL PATHOLOGY AS AN AID TO DIAGNOSIS.

BY DR. LEONARD G. J. MACKEY.

It is obvious that no busy practitioner can afford the time for making these investigations for himself; but there is no reason that he should not understand exactly how they are made, and appreciate both their uses and their limitations. With this knowledge he is in a better position to interpret the facts which the pathologist is able to lay before him, and better able to supply the pathologist with suitable material for examination; for example, a

catheterized specimen of urine should be provided if it is to be searched for tubercle bacilli, and something more than one drop of blood is necessary for the Widal test or estimation of the opsonic index.

THE EXAMINATION OF THE SPUTUM FOR TUBERCLE BACILLI.

Tubercle bacilli can often be detected in the sputum before we can detect physical signs in the chest, and before the symptoms of the patient would appear to justify a definite diagnosis, or to warrant us in asking him to undertake the arduous and prolonged treatment which is essential for the eradication of the disease.

Moreover, the detection of the bacillus in the sputum is more conclusive proof than our interpretation of symptoms and physical signs, however convincing they may appear to be.

The technique of the examination is simple, and I believe that a positive result is absolutely reliable. A single negative examination is practically valueless. If in a case where pulmonary tuberculosis is suspected the sputum is examined with a negative result, suspicion should not be in the least allayed; but the examination should be repeated several times, and the search should not be abandoned till five or six specimens of the sputum have been examined. An important factor is the length of time expended on the examination, and a negative report would be more valuable if the pathologist would state the number of minutes which had been. spent in the microscopical examination of the stained film.

A most important point is the selection of the particles of sputum from which the films are to be made. The common practice of taking a casual loopful from a specimen of sputum is a constant source of error; experience teaches that the little white. opaque particles often contain the bacilli, while the rest of the sputum contains none.

Sometimes the carbol-fuchsin solution, on which we rely for the staining of the tubercle bacillus, loses its staining properties after being kept for some time, and it is a good plan to test it on a specimen which is known to contain the bacilli in large numbers.

THE EXAMINATION OF THE URINE FOR TUBERCLE BACILLI.

This is not only very much more difficult than the examination of sputum, but also much less reliable. In the first place, the epithelial cells at the orifice of the urethra usually have attached