The New Drug Heroin. Tausyk (Vienna Cor. Med. Press & Cir.) has been experimenting with this new sedative for some time past, and has now ventured on a report of sixteen cases. Among these are eight suffering from phthisis pulmonalis, one of croupous pneumonia, one of pleuritis, and four of bronchitis. In all these cases treated with heroin the cough was immediately checked, or greatly modified, as the action of the drug is rapid and potent in its effects. The subjective symptoms are speedy relief and perfect comfort. In one case of bronchial asthma 0.003 of heroin relieved great dyspnoeal distress, which has not since returned. In other experiments he tabulates the comparative values of heroin and morphia. In cases of chronic cough which have lasted for weeks he has repeatedly given 0.003 gram (0.046 of a grain) of morphia without the slightest amelioration, while the same quantity of heroin checked it instantly, and left the patient in a vastly improved state of health after its effects had passed off. In other cases 0.06 to 0.10 gram (0.9259 to 1.543 grains) of codeia was given with little or no effect, while 0.003 gram (0.046 grain) of heroin gave perfect relief. Similar success attended a case of phthisis treated with codeia, extract of opium, hyoscyamus and morphia. Heroin is also potent as an anodyne in cases of neuralgia in the trigemini, enteralgia, and hemicrania, while its efficacy in diabetes is undoubted. After long use the dose requires to be increased to 0.005 gram, owing to the peculiarity of habit. There is only one case where stupor or giddiness was observed from the long and repeated use of the drug. Tausyk prefers giving it in powder form with soda bicarb., etc., one hour and a half before food. He commends that the quantity taken daily should not exceed 0.01 gram, or 0.15,432 of a grain, which might be increased in extreme cases to 0.03 gram, or 0.4,629 grain. Its greatest virtue, however, is in the relief of cough, which renders it invaluable in phthisical coughs. SURGERY. UNDER CHARGE OF W. B. ROGERS, M.D. Professor of the Principles and Practice of Surgery and Clinical Surgery, Some Points in the Surgery of the Paralysis of Children. At a recent meeting of the Liverpool Medical Institution (British Med. Jour., no. 1988), Mr. Robert Jones, in a paper on this subject, deplored the lack of interest displayed by the profession in the treatment of these affections. This was due to the pessimism derived from the pathology. It was essential there should be surgical supervision almost from the onset, as without mechanical and operative help the physician was powerless. The pathology required working up and further experiments made. These should consist of inoculations at an early stage, and of a search for the microbe. In view of recent experiments of his own, of outbreaks of an epidemic character at Stockholm, in America, and in Australia, there was strong evidence of the influence of infection. With care, most of the deformities of poliomyelitis might be avoided, more especially those due to contractures, and by mechanism, so applied as to equalize groups of antagonistic muscles, apparently very old paralysis could be remedied. A diagnosis, often difficult, should be made between a paralyzed group of muscles and a group merely rendered useless by the uncontrolled action of opponents. Mr. Jones discussed the question of tendon grafting, and the conditions suitable for it. He thought the operation likely to prove very valuable in a number of cases. He had operated upon seven cases. In two he had inserted the sartorius into the tendon of the paralyzed quadriceps. In two cases he had inserted the peronei into the paralyzed tendo Achillis for talipes calcaneus. In one case he reinforced the tibialis anticus by means of the peroneus longus. In a case of talipes equino-valgus the peroneus longus might be inserted into the tibialis posticus, or instead of the peroneus longus a strip of the tendo Achillis. Mr. Jones had operated upon over sixty cases of flail joints in accordance with the rules he laid down in 1894. Suppuration only occurred in one case. No matter what the trophic changes, healing seemed to occur without hindrance. He often ankylosed both knee and ankle at the same operation. In talipes calcaneus a good view of the joint might be got from behind, the cartilage freshened, and the tendo Achillis could be at the same time shortened. This operation he substituted for Willett's. After obtaining short fibrous or bony ankylosis in knee and ankle, the psoas and iliacus muscle moved the limb in one piece, and so expensive and troublesome appliances could be dispensed with. In dealing with spastic paraplegia, Mr. Jones combated the dicta of neurologists in regard to tenotomies. He divided the tendo Achillis and any other tendons which were tense, and in obstinate cases exsected portions of the adductors. Both limbs were then kept in extreme adduction for several weeks. Very fair walking results were obtained. In very spasmodic cases he strongly urged arthrodesis. Mr. Paul quoted in support of tendon grafting the result obtained in a case in which the distal end of the tendon of the long flexor of the thumb was grafted on to that of the index finger. The boy ultimately became a fair pianist, and could flex either digit independently, presumably by automatic action of opposing muscles. Radical Cure of Scrotal Hernia. Croly, of Dublin, operates for hernia in the manner described in the following report: H. H., æt. 45 years, sailor aboard H. M. S. "Melampus," was admitted, suffering from hernial symptoms bordering on strangulation. He had worn a truss, but it failed latterly to keep the intestine up. With some difficulty reduction was effected, and the patient was kept in bed and bowels acted on. He was most anxious to be operated on. Mr. Croly performed the radical cure by the displacement method. The patient made an uninterrupted and excellent recovery. Mr. Croly made some remarks on the great advantages of the operation which he first termed the "operation by dissection," and though, in his early operations (more than sixteen years ago), he did not displace the sac, he has now given up all other methods in favor of the "Verlagerungs method" or displacement operation. Mr. Croly, in his earliest operations, slit up the inguinal canal, a plan since adopted by Bassini, and much favored by some surgeons. Mr. Croly warns his pupils against sac twisting introduced by Kocher, but abandoned by him in consequence of necrosis of sac. Mr. Croly mentioned two cases which he saw in England in which urinary fistulæ followed the twisting method of operating. Since Mr. Croly introduced the "displacement operation" he has performed it with great success in the City of Dublin Hospital, and in private practice. A large number of his cases have been exhibited at the Surgical Section of the Royal Academy of Medicine. The displacement operation in femoral hernia gives equally excellent results.-Med. Press & Cir., vol. 66, no. 3087. Subcutaneous Injections of Solutions of Gelatin in Aneurism. Moyer (Medicine, vol. 5, no. 3) reviews a number of cases of aneurism treated by subcutaneous injections of solutions of gelatin. He arrives at the following conclusions: 1. Gelatin solutions are of some value in the treatment of saccular aneurism. 2. They are of no value in diffuse enlargements of a vessel. 3. The remedy is used empirically, the experimental work affording little or no basis for the treatment. 4. Solutions not stronger than 1 per cent. should be used. 5. Great care should be exercised in technique; failures in asepsis are easily made, as the solution is a good culture medium. The solutions should be kept in a brood oven to determine bacterial growth. 6. There may be dangers in the treatment, but the observations heretofore made are insufficient to indicate what they are. 7. Absolute rest in bed should be enjoined, and other remedies suitable for these cases may be given at the same time. 8. It is not a cure for aneurism, but may rank in the future as a treatment. 9. The method is worthy of more extended trial. OPHTHALMOLOGY. UNDER CHARGE OF A. G. SINCLAIR, M.D. Professor of Ophthalmology, Otology and Laryngology, Memphis Hospital Medical College; Ophthalmic, Aural and Laryngeal Surgeon to St. Joseph's Hospital. Modern Views on Trachoma. Schulhof (Wien. Med. Presse, nos. 24 and 25, 1898) gives a very complete summary of recent work on the etiology, pathology and treatment of trachoma. He quotes some striking figures as to its prevalence. In thirty Austrian counties there were in 1895 nearly 30,000 sufferers, while in the Russian Army in 1896 the number of victims reached the almost incredible proportion of 62 per cent. The author summarizes the results of his investigations in the following conclusions: Its appearance is favored to a great extent by special conditions, such as race, locality, general nutrition and occupation. The actual natural history is not yet established; experiments and inoculations into animals have so far failed. The hypertrophy of the conjunctiva (granulation) is pathologically and histologically the principal characteristic of the morbid process. Hitherto the following have been generally accepted as the best means of treatment: Solution of silver nitrate and its substitute, argentamin, touching with copper sulphate, washing out with sublimate, the galvano-cautery, and in very obstinate cases more extreme measures, such as the use of jequirity, peritomy, and the removal of the hypertrophic folds. Among the newer remedies the following deserve a trial: guaiacol-glycerine, ichthyol, sozo-iodol preparations, and electrolysis. But the most important measure by far is prophylaxis, by means of regulation of the sanitary conditions and prevention of the spread from patient to patient.—Annals of Ophthalmology. On the Prophylaxis Against Purulent Conjunctivitis of the New-Born. Pechin (Recuil d'Ophtalmologie) prefaces his article by the statement that Europe contains at least thirty thousand blind who have lost their sight through the ravages of this disease. He disparages the Credé method of prophylaxis on account of the danger which he considers that it possesses of clouding the cornea. In the first place, he recommends thorough cleansing of the vagina of the mother before confinement, and free washing of the eyes of the child after birth. The first care should be offered to the eyelids while waiting to tie the cord. This attention being given, the child is to be bathed, and the eyes are to be more carefully cleansed while the eyelids are kept open. For this purpose the author uses distilled sterilized water. A little soap may be added to the water, but nothing else should be used. He considers that this simple method of prophy laxis is sufficient.-Annals of Ophthalmology. Why the Proportion of Blind in Cities is Less than in the Country. Howe, Lucian, M.D., Buffalo, N. Y. (Amer. Jour. of Ophth., Oct., 1898). As a result of his investigations of this subject, Dr. Howe has come to the following conclusions: 1. Blindness is more frequent in the country than in the cities. 2. On examining the different factors in the production of blindness, we find that these are either the same or made practically the same in city and country, with one exception. This exception is ophthalmia in infancy. 3. A comparison of statements made by thirty-eight county almshouses and by thirty-five obstetricians in the most populous State in the Union, indicates that decidedly less attention is given to guarding against ophthalmia of infancy; especially is the silver nitrate used less as a prophylactic in the country than in the cities. 4. This tendency, on the one hand to habitual neglect, or on the other hand to habitual use of such prophylaxis, is not only the most apparent cause of such variation if, indeed, any other reasonable cause be discovered-but it probably accounts for the larger part of this difference in the distribution of the blind.— Annals of Ophthalmology. Metritic Iritis. Mazet, Marseilles (Annals d'Oculistique, November, 1898), gives the clinical history of two patients who were affected with an iritis, which he attributed to an endometritis. In each instance the inflammation of the iris declared itself within a few days after menstruation had commenced, and in each case the patient suffered from an endometritis, which periodically became aggravated during each menstrual epoch. In one case there was considerable pus in the anterior chamber. Both women were otherwise healthy, and in neither could any trace of any hereditary infection be found. The author agrees with de Wecker, that those cases were due to an absorption of toxic agents or principles by the denuded mucous membrane of the uterus, for some reason or other this situation being the point of least resistance. He says that if it be true, as Cohn claims to have observed, that the ciliary veins are congested at the menstrual epoch, this observation strengthens the theory. Both of Mazet's cases yielded readily to treatment of the eye and the uterine conditions.-Annals of Ophthalmology. NOSE, THROAT AND EAR. UNDER CHARGE OF RICHMOND MCKINNEY, M.D., MEMPHIS. Faucial Tumors. At a recent meeting of the Liverpool Medical Institution (British Med. Jour., no. 1988) Mr. Banks described three cases of removal of tumors lying external to and behind the tonsil, with lantern slide illustrations. The first case was that of a young man in whom the tumor had been growing for many years, and had attained such a size as to cause a marked projection behind the vertical ramus of the jaw. It was removed by the mouth, a vertical incision being made over it; it easily shelled out without hemorrhage, and was found to be an adeno-fibroma, as he had diagnosed. The second was a precisely similar case in a woman, aged 40, with a history of two years' growth of the tumor. As she was very stout and full-blooded, a preliminary laryngotomy was done, and the pharynx packed with sponge, but the bleeding was only trifling, and the tumor was easily shelled out with the finger. The third case was different, the patient being a small, thin, pale woman, about 20 years of age. A swelling had appeared behind the right tonsil about eight or ten weeks before admission, and had been steadily and rather rapidly increasing. There was a great deal of pain in it, and the swallowing was seriously interfered with. The swelling was very elastic and ill-defined, insomuch that there was a question as to whether it might not be inflammatory, having as a focus some small, very deep-seated collection of pus. Under chloroform an exploratory incision was made; through the thinned and flattened-out tonsil the finger came upon a distinct tumor, which felt as if it could be shelled out. In about a fortnight the patient's sufferings became extreme, and she was in danger of choking. A preliminary laryngotomy was done, and the pharynx plugged; then a free incision was made over the tumor, and enucleation effected. The tumor was found to be so adherent to bone at its furthest-off point that the cheek was slit up and the lower jaw rapidly divided. This gave a good view of the deep parts, and when the growth was finally torn away it was found to be adherent to the side of the body of the third cervical vertebra and to the base of the skull. Owing to the very little use of cutting instruments, the bleeding |