The Secretary, Dr. Bryce, read the report of the Special Committee appointed to visit the Boards of Health of Boston, New York, and Albany to inquire into the details of the modes of working of Boards of Health at those places.

Dr. CASSIDY read the concluding part of the report of his recent investigation into the outbreak of typhoid fever at Stratford in the form of a letter which he had forwarded to the Chairman of the Board of Health at that place. After explaining that the fever had been contracted by impure water, which contained sewage matter he made the following suggestions :-"That pure water be obtain

honorary except when engaged in attendance upon the meetings of the Board or any of its Coramittees, when they shall be allowed such per diem as shall from time to time be determined and their travelling and other necessary expenses when so occupied; that the Act of 1882 be amended as follows: -The Lieutenant-Governor in Council may appoint a competent and suitable person as Secretary of the Board, who shall hold office during pleasure and who shall be the chief health officer of the Province; that such legislation be adopted as shall give the local Boards of Health the power of ordering an examination to be made of the water or waters used by any of the inhabitants for their re-ed for drinking purposes: that until it can be obspective municipalities and of regulating the construction and cleansing of wells, and for closing wells or other sources of water supply the water of which shall be found unfit for use; that the Registration Act be amended by the addition of the following clause :-"The public carrier or other persons shall not remove the dead bodies out of any municipality without first having obtained a certificate from the Divisional Registrar that the particulars relating to the death of such persons have been duly registered with him under the provisions of said Act, and said certificate shall be known as a transient burial permit." The above clauses of the report was adopted.

It was moved that a committee consisting of Dr. Oldright and Prof. Galbraith be authorized to issue a circular to Municipal Councils and local Boards of Health setting forth the evils of the privy-pit and cess-pool systems, and endeavouring to induce them to adopt such systems of disposal of sewage as shall be best adapted to the preservation of health and the circumstances of their respective municipalities, and explaining these various methods.

It was stated that a number of cases of remittent and intermittent fever at Madoc and Wingham were attributed to the unsanitary conditions which prevailed in the vicinity of these places caused by the overflow of certain dams. It was decided that the Board of Health represent the matter to the Provincial Secretary, that it might be remedied according to the Public Works Act.

DR. COVERNTON read an interesting report of his visit to England, and his inspection of the systein of the Health Boards there. The report stated that during the five years preceding the introduction of an Act in England regarding infectious diseases, which provided for disinfection and isolation, the annual average of deaths from contagious diseases was as follows :-Scarlet fever, 92; smallpox, 55; measles, 50; typhus, 29; enteric or typhoid fever, 36. During the five years following the introduction of the Act the number of deaths from these diseases was reduced to the following annual average :-Scarlet fever, 64; Smallpox, 28; measles, 22; typhus, 12; and typhoid to 19. The effect of the introduction of the Act was a reduction of eleven deaths per thousand inhabitants.

tained the water used for drinking purposes be boiled and filtered; that privy pits and cesspools be discarded for the earth closet or some similar inexpensive plan; that house drains be properly trapped and ventilated." The report was adopted. In the evening session the report of the Convention at St. Thomas was read and adopted; also Dr. Covernton's report of the International Congress at Geneva was received.

A report of the outbreak of Enteric Fever at Lambton Mills was read. The probabilities with regard to the spread of the epidemic are that it was caused by infected linen thrown from the houses, and that the presence of a slaughter-house in rear of the houses where the disease broke out, contributed to give to the fever a malignant and fatal character.

It was moved by Dr. Cassidy, seconded by Dr. Covernton, that "Whereas typhoid fever and scarlet fever have been clearly traced, both in Europe and America, to the adulteration of the milk with water contaminated with sewage, and in other instances to the washing of the milk cans with water similarly contaminated, and the direct absorption of germs by the milk, and where other diseases such as milk sickness and ulcerative stomatitis have been traced to the use of milk from cows infected either with milk sickness or foot and mouth disease, this Board would recommend the local boards of health that a proper inspection of dairies should be made in order to prevent the occurrence or continuation of such evils."-Carried.

Selected Articles.

CHRONIC ALCOHOLISM.

Its Pathological Aspects.-Excerpts from an article by G. K. Sabine, M. D., in Boston Medical and Surgical Journal:

Changes in the Skin: In the early stages of this affection the skin is remarkably smooth and soft, owing to an increase in the fatty tissue. Later on the skin becomes dry and on the extremeties hard and inelastic.

The Blood: The most striking change in the

Cerebral Apoplexy: An effusion of blood into the brain substance frequently occurs in drunkards. All conditions brought about by the intemperate use of alcohol which tend to produce cerebral hyperemia favor, in a marked degree, the occurrence of either large or capillary effusions.

Serous Apoplexy: An acute or chronic serous effusion into the cavity of the skull, into the brain substance, or into the membranes of the brain,and into the cavity of the arachnoid, may result from the abuse of alcohol. In alcoholism the blood is poor in plastic material, and as a consequence the transudation is favored. Either an acute or chronic collection of fluid in the ventricles of the brain is not an infrequent result of drunkenness.

Pachymeningitis Interna Chronica : This inflammation of the inner surface of the dura mater consists at first of a very slight layer of fibrine on the surface of the dura, from which a thin layer of connective tissue is afterward developed, which adheres to the surface of the membrane. A second and third layer of inflammatory exudation is then formed, and so on until there are many layers. The dura mater thus becomes materially thickened. Each one of these layers is vascular, and occasionally one of these vessels ruptures, resulting in a hemorrhage between two of the layers.-Louisville Med. News.

CANCER OF THE STOMACH.

(Clinic by DR. PEPPER OF Philadelphia.)

I had until recently under my care a lady of about middle age, suffering from tinnitus in the left ear, evidently depending upon some subacute inflammatory change in the middle ear. At times, it seemed to threaten development into Meniere's disease, i, e., attacks of vertigo associated with tinnitus, but I cannot say that it ever fully assumed this character. She appeared to be benefited by a course of treatment which consisted in careful attention to hygiene and diet, the prolonged use of quinia with iodide of potassium and counter-irritation over the mastoid process and the nape of the neck.

prove to be a case of gastralgia, which her anæmic condition rendered not improbable. I had, however, observed that it differed from a gastralgia in two particulars. In the first place the taking of food, instead of affording relief, increased the distress. In simple neuralgia of the stomach, we generally find that the ingestion of food relieves the pain, which again appears as the stomach becomes empty. In the second place, the pain was constant, instead of being paroxysmal, as is usual in gastralgia. I therefore suspected the existence of a gastric ulcer. There was, however, no vomiting, the amount of tenderness was not extreme and the occurrence of simple gastric ulcer in a woman whose surroundings were favorable, who had good food, and who was free from all care, is unusual.

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As the spring went on, finding my attemps to relieve this pain were unsuccessful, I put the patient to bed and gave her an exclusive diet of milk, in small quantities at short intervals. I also gave her alteratives, such as bismuth, nitrate of silver, minute doses of carbolic acid, with soda, valerianate of zinc and various other preparations, hoping to relieve the gastric distress; but nothing afforded relief, and she became thinner and thinner. About the middle of June I went away, leaving her under the care of Dr. James Tyson and Dr. Judson Daland. When I returned I found that she had died, and that an autopsy had been held, and that the specimen now before you had been removed.

I propose to examine this with you to-day. The case, as you will have inferred, proved to be one of malignant disease of the stomach. On examining the stomach, I find a number of ovoid masses. I wet one of these and it presents the appearance of a round-cell sarcoma, but a naked eye is not sufficient to decide this point. It is, however, some form of neoplasm. I may as well say here that you will often be struck, no doubt, with the laxity with which I use the terms sarcoma and carcinoma in my clinical lectures. The truth is, the difference between these growths and their minute sub-divisions, as they affect internal organs, is a matter of far greater consequence to you as microscopists and pathologists, than it is to you as physician. You have a patient in whom the symptoms and the progress of the case show conclusively that some neoplasm has developed in the stomach. The growth is going to kill the patient. The question whether it is an epithelioma, a cylindroma, a

Last spring, while feeling unusually well, she began to complain of a great deal of gastric distress. This was most marked after eating. It appeared to be relieved by a prescription containing pepsin, and the omission of all other remedies, but it soon returned. There was never any vomiting. Exam-carcinoma, or a sarcoma, while of interest in the ination of the abdomen showed tenderness, but no thickening or hardening could be detected. She came of a healthy family, her mother living to the age of 82, and as far as could be discovered, no member of the family had suffered from malignant disease. There has been no sufficient cause to explain the development of gastric pain; and I have therefore, for a time, hoped that it might

subsequent microscopical examination, does not alter the prognosis or influence the treatment. I do not use these terms in this manner because I disregard the importance of the study of these minute distinctions between the different forms of tumors; for these distinctions are of extreme importance when we come to consider tumors involv ing the superficial parts where they are open to

You see how they account for the symptoms de- UNUSUAL AND COMPLICATED CASE OF scribed. There was no pyloric obstruction, and there was, therefore, no vomiting. Vomiting, in cancer of the stomach, occurs most commonly as the result of the attempt of the organ to propel its A. B. æt. 26, admitted Oct. 5th, a powerful, contents through an obstructed pylorus. This is active, and very muscular policeman, amused himthe reason why the vomiting presents the peculiari- self by leaping over a bar, on coming down discovties of coming on a certain interval after the inges-ered that he had strained himself, and found a tion of food, of occurring when the food has reached a certain stage of digestion, and of being followed by complete relief. In other cases of gastric cancer, there is an ulcerated, irritable surface, and the contact of the food against this surface excites vomiting. In such case, the vomiting resembles that which ordinarily occurs in simple gastric ulcer. There was here neither pyloric obstruction nor ulceration of the mucous membrane. Again, I never

chloroform and shaved the parts, I made a free 1. The large size of hernial contents when comincision along the long axis of the tumour, and pared with the unusually small opening in internal found an exceedingly thin, transparent sac, tensely ring. 2. The dilated canal and external ring by filled, and containing a teaspoonful of transparent presence of testicle. 3. The rapid injury to serum. On opening the sac at its upper surface, omentum, and risk to life of bowel, and after only about 18 inches of bowel were seen, of a very dark three and a half hours' strangulation.-Edin. Med. colour, and full of serum, but retaining lustre, polish | Jour., Dec.

and tension. In addition to this, a large piece of omentum was also in the sac, swollen, engorged, but non-adherent, lying like an apron over the upper half of the coil; and behind the bowel was the testicle not larger than a small walnut. The cord was also exceedingly thick and full of serum. The external inguinal ring was fairly open and easily dilatable, not requiring division; and at first it seemed as if the bowel was to be easily emptied and returned to the abdomen, as with gentle pressure nearly the whole coil at once retired from view. It was obvious, however, that it was not relieved, and that it only was returned into a largely dilated and broad inguinal canal; so I again pulled the coil fairly out, making traction on its neck which was very tightly held. I then raised the piece of omentum, which unfolded to quite the size of the palm of the hand, and, gently pulling upon it, found that it was also tightly held, and at the constriction was already black in colour, and apparently dead. Pulling the testicle also down, we found the cord also held as in a vice. The constricting point was the internal ring; and the canal being of its full normal length, this could barely be reached by the tip of my forefinger, and the tip could not be got through it.

With care, however, I guided a long, curved, probe-pointed bistoury on the point of my finger, and with great caution nicked the ring upwards till the finger could be got through it, and then, feeling no pulsation, and guiding the knife, divided it freely. This being safely accomplished, it was then easy enough to empty the bowel of flatus and gradually reduce the coils into the abdomen. The question then arose what to do with the omentum. It was difficult to believe that such a large piece could have been driven at once through such a small aperture; but there it was, and the restriction was so tight that it was almost certain to die, or at least to suppurate. So I ligatured it with thick catgut in four positions, and divided each separ-j ately, leaving the catgut ends long, to act as a drain. I then pulled the testicie and cord as far down as possible into the scrotum, and, leaving the catgut hanging out, stitched up the deep parts first, and then the edges, with strong catgut, and dressed the wound with carbolized wool. Patient was kept under opium for first few days, and on milk diet. Neither pulse nor temp. ever rose. Bowels were opened with enemata on sixth and eighth days, and cure has been most complete. Not a drop of pus formed. The points of interest this case has to practical surgeons are :

INDICATIONS FOR THE USE OF
DIGITALIS.

BY J. MILNER FOTHERGILL, M. D. EDIN. The correct use of this potent remedy-invaluable in certain cases of lack of power in the heart is scarcely as yet general. Old established views take a great deal of uprooting; and yet they must be uprooted before new views can be built up in their place on the same ground. Digitalis was long regarded as a cardiac sedative-" the opium of the heart;" because it rendered the heart's action slower, or less tumultuous. Slower, certainly, in those cases where the rapidity is due to the action of an irritable muscle; irritable, because becoming exhausted. But when the rapidity of the heart's action is due to nervous disturbances digitalis is useless, or very nearly so. Digitalis, then, is not useful" because it slows the action of the heart." This is an error. In many cases it exercises no action worth estimating upon the rapidity of the heart's contractions. While in others it is of the greatest service when the action of the heart is not accelerated before its administration, nor slowed while the good effects are being felt. "Less tumultuous," most certainly in many cases. Where a heart is labouring hard, yet accomplishing very little; when the muscle is doing its best to the utmost of its power, but is heavily handicapped; then digitalis will usually calm its action, not, however, by any sedative effect, but by increasing the vigor of the cardiac contractions. In other words, it may be said that the digitalis achieves the more complete emptying of the ventricle at each systole ; and that is what is wanted in these cases.

Now, sometimes digitalis will both slow the heart's action and do away with palpitation, at one and the same time. This is most commonly seen in simple dilatation of the left ventricle, without necessarily any valvular lesion; the mitral valve may leak, but not as the result of any distortion of the valve curtains, but rather the ostium has stretched with the yielding of the heart muscle, and the valve curtains become insufficient to close the ostium completely on the contraction of the ventricle. Such a condition is common where the dilatation has taken place too swiftly for the valve curtains to stretch pari passu with the yielding of the muscle. Here digitalis is usually of the most priceless value. But its utility will be greatly enhanced here by putting the patient at complete