Sixty-four per cent. of the patients in the emulsion cases were suppurating, and several were in a desperate condition. Of these, seventy-five per cent. improved. Of the oil cases, in which twenty per cent. of the patients only were suppurating and none were in a serious condition, fifty per cent. improved.

The weights, though continued through the whole experiment, were neither satisfactory nor conclusive, for reasons mentioned, with the exception of those for the first five weeks. These show the gains on the emulsion side to be nearly double and the losses about two-thirds those on the side of the oil.

In color, sixty-five per cent. of the patients in the emulsion cases were improved, to be compared with thirty-one per cent. of those in the oil cases.

Under general improvement, sixty-eight per cent. of those in the emulsion group, against forty-eight per cent. of those in the oil group, showed a gain, in spite of the much more serious condition of the former.

In conclusion, it may be said that there seems to be a certain better appearance, impossible to classify, about the patients in the emulsion group, which is in advance of that which may be deduced from the notes, though they show a striking gain over those in the oil group.

Thyroid Pathology and Therapeutics.

At the meeting of the Berlin Medical Association, June 27, 1899, Blum (Med. Press & Cir., vol. 68, no. 3142), read a paper on thyroid pathology and therapeutics. He urged that the thyroid should be removed from the list of glandular organs; it elaborated no physiologically active secretion, but seized upon a poison continually secreted in the system by means of some capturing substance. The tissue of the thyroid thus served for the arrest of some poisonous material produced by the action of the vital processes. The activity of the fettered virus was different from that of the free toxins. By the iodizing process taking place in the thyroid, the harmful agent deposited there as a toxalbumin was weakened. By perfect saturation with iodine it lost its poisonous properties. The free poison caused severe and frequent epileptiform convulsions, very frequently cachexia, and sometimes distinct psychical disturbances. Examination of a dog destroyed by thyroidectomy showed changes in the ganglionic cells of the cord and brain which could be identified by Nissl's method. The disturbances when the poison was passed into the system by inunction were of another kind; they consisted chiefly in alteration in tissue changes (emaciation, decomposition of albumin and nuclei, and liquefaction of the fat), restlessness, and palpitation of the heart. Convulsive conditions had never been observed. The quantity of thyroid substance absorbed could not be determined by the administration of iodine. The iodine of the iodine-containing substance was estimated quantitatively. In many days the toxic effect of the thyroid substance administered still acted alternatively on the tissue change, when all the iodine given had been again passed off. Such an animal when given thyroid, besides the symptoms mentioned, always had a long-continuing glycosuria, and when cane sugar was given it excreted levulose. The same animal, when phlorizin was given with the same diet, excreted dextrose.

As regarded the so-called thyroid therapeutics in myxedema, thyroid extract might act in two different ways—in the one, it could relieve the organs of abnormal deposits; further, the capturing substance contained in the thyroid

body could fix the freely-circulating toxin in the myxedematous individual, and at last, in part, render it harmless. In struma and obesity the administration of thyroid was best abstained from, because, while the substance was incorporated, which must be determined by the excretion of iodine in the urine, symptoms of poisoning could not be excluded. In cases of goiter other preparations of iodine, especially the non-poisonous iodine albumin (iodalbacid), should be first tried. In obesity the proper dietetic measures should have the preference. Gastric Ulcer at the Massachusetts General Hospital, 1888-1898. Greenough and Joslin (Amer. Jour. Med. Sciences, vol. 118, no. 2) present an elaborate article which terminates with these conclusions, based on the study of one hundred and eighty-seven cases of gastric ulcer occurring at the Massachu setts General Hospital, 1888-1898:

1. Gastric ulcer is more frequent in Boston than in Chicago, Baltimore, San Francisco or Denver.

2. It is five times as common in women as in men.

3. The average age in men is thirty-seven years; in women twenty-seven. 4. Hemorrhage was present in 81 per cent. of the cases. It caused the death of 17 per cent. of the male patients, but only 1.27 per cent. of the females. No woman under 30 died of hemorrhage from gastric ulcer during this period.

5. The blood was that of a chlorotic type of anemia.

6. Perforation occurred in 3.2 per cent. of the cases, and none of these patients left the hospital alive.

7. Of 114 patients 80 per cent. were discharged cured or relieved, but at the end of an average period of five years only 40 per cent. remained well. The mortality at the same time (due to gastric disease) was 20 per cent. Among the males it was 30 per cent., with the females 9 per cent

8. The excessive mortality of ulcer among men, its occurrence in life a decade later than in women, and the absence of fatal cases of hemorrhage in females, point to a difference of the ulcer in the two sexes.

9. The mortality of 8 per cent., and the failure of medical treatment to effect a lasting cure in 60 per cent. of the patients, indicate the need of surgical intervention in other than emergency cases of this disease.

SURGERY.

UNDER CHARGE OF W. B. ROGERS, M.D.

Professor of the Principles and Practice of Surgery and Clinical Surgery,
Memphis Hospital Medical College.

Surgical Procedure in Benign Diseases of the Stomach.

Petersen, of Heidelberg (Cor. Med. Press & Cir., vol. 68, no. 3140), at a recent meeting of the Königsberg Society for Scientific Medicine, read a paper on surgical procedure in benign diseases of the stomach. About 300 cases of surgical procedures in non-malignant diseases of the stomach had been recorded, and 77 such operations had been performed at the Heidelberg Klinik. The principal indications were: absolute stenosis of the pylorus, 57 cases. The stenosis was caused forty times by ulcer, eight times by cholelithiasis, four times by cauteri

zation, once by tuberculosis, etc.; two after failure of internal treatment, gastralgia, uncontrollable vomiting, the so-called rebellious forms of ulcer (five cases), and six times from dangerous hemorrhage. Eight of the 77 cases died, or 11 per cent. Advances in surgery shone out when the cases were divided into two periods - before 1895, 33 operations, with seven deaths 22 per cent.; since 1895, 44 cases, with one death-2.3 per cent. This striking advance was brought about by having the patients in a better state for operation and by increasing experience in the selection of cases, and, secondly, by improved technique, and, above all, by the introduction of Murphy's button; this reduced the length of an operation from three-quarters of an hour to one-quarter, permitted nourishment from the first, and avoided the so-much-dreaded spur formation between the upper and lower ends of the bowel. Trustworthy after-reports were available concerning forty patients who had been operated on over two years. In the cases of stenosis the reports were at first satisfactory in the better selected method of operation. In gastroenterostomy the permanent recoveries were 99 per cent. In the case of gastralgia 10 per cent. were improved, 90 were completely cured, either by gastroenterostomy or simply by the separation of adhesions. In six cases of hemorrhage recovery was complete, twice by excision and in the other case by gastroenterostomy. In one case of ulcer the bleeding was arrested by gastroenterostomy, although the ulcer itself was not treated. If such cases were reported it would place the treatment of ulcer of the stomach on a new basis.

The changes in the stomach after gastroenterostomy were important. Dilatation receded quickly, but rarely disappeared. The motor function was normal in nearly all cases. Lactic acid disappeared. After the operation bile was frequently found in the stomach. Neither the absence of gastric juice nor the presence of bile caused any visible disturbance. A functionizing sphincter gradually developed at the fistulous opening.

The total results of the period named were: Before 1895-Mortality, 25 per cent.; uncured, 15 per cent.; improved, 10 per cent.; permanently cured, 50 per cent. Since 1895-Mortality, 3 per cent.; uncured, 6 per cent.; improved, 10 per cent.; permanently cured, 80 per cent.

Appendicitis.

Means (Jour. Amer. Med. Assn., vol. 33, no. 6) concludes a very practical article thusly:

1. An early diagnosis of appendicitis is desirable, and possible if the few cardinal symptoms are understood, such as pain near the umbilicus, tenderness in the ilio-cecal region, tympanites, and rigidity of the muscles in the lower right quadrant of abdomen.

2. Too much significance should not be placed upon the presence or absence of pain, and high temperature. Both may be absent while grave pathologic conditions are going on. They may also be present to a high degree without determining the pathologic status.

3. Appendicitis is a surgical disease, and should be treated from a surgical standpoint.

4. From the nature and location of the disease, there are no known remedies given internally or applied externally that can remove the trouble.

5. The pathologic conditions of a diseased appendix cannot be definitely determined by external examination, or from the existing symptoms.

6. Early operations give the best results.

7. The time for operation is when a diagnosis has been made, providing the environments of the patient are favorable and there are no complications precluding the same.

8. The technique of the operation is governed largely by the taste of the operator and the pathologic conditions.

Intestinal Anastomosis.

Barbat (Jour. Amer. Med. Assn., vol. 33, no. 3) gives the result of experimental research, done in the medical department of the University of California, as to the value of the various methods of intestinal anastomosis. It is interesting to note the conclusions which he has deduced from his experiments. They are: 1. It is possible to make a safe and satisfactory end-to-end anastomosis.

2. With practice a surgeon can, with nothing but a needle and thread, sew a divided bowel together and obtain a result which will almost equal that obtained by the use of the Murphy button.

3. The result obtained by the Murphy button is superior to that of any suture method yet devised.

4. The Murphy button and Frank coupler give the same anatomic result. 5. Contraction following end-to-end anastomosis is usually due to faulty technique.

6. The Murphy button is much safer and more reliable than the Frank coupler. 7. A perfect Murphy button, properly introduced, is the quickest, safest and most reliable means of obtaining an anastomosis between any two viscera.

8. All devices which are used to support the gut in suture operations are unnecessary; and as good, if not better, results may be obtained without them.

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; Ophthalmic and Aural Surgeon to the City Hospital.

The Curative Value of Mechanical Methods in the Treatment of Granular Conjunctivitis.

Kuhnt (Zeitschr. für Augenheilk.) discusses, in an interesting manner, the mechanical treatment of trachoma. The advantages and disadvantages of the different methods of removing the granules are considered, and the various instruments which are used for this purpose are described, among others more than one devised by Kuhnt himself. He sums up his observations as follow:

It goes without saying that certain cases demand certain lines of treatment. We must, in other words, individualize. If we are dealing with light cases in a region which is usually free of epidemics of trachoma, we should always try the various medicinal means first. Even if the disease has existed for quite a time, these remedies should be tried. We should not, however, persist with

this method of treatment long, especially if the cornea seems in danger and improvement does not show itself, in which case we should at once resort to the galvano-cautery or expression, even in localities which are immune, so far as epidemics are concerned. The removal of the granules in such a case will certainly shorten the process and render safer the cornea. In regions where epidemics prevail, the mechanical methods are only to be recommended as a general thing for the intelligent and better class of population-in short, for those who know what cleanliness means, and are in the habit of practicing it. In those cases where repeated expression has failed, excision should be tried.-[Ann. Oph.

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Blepharitis Acaria A Disease of the Eyelashes and Borders of the Lids-Caused by Parasites (Demodex Follicularum) in the Hair Follicles.

Rachlmann (Klin. Monatsbl. fur Augenheilk.) describes this variety of lid affection, and refers to the only other contribution in this connection, that of Stieda in 1893 (Centralbl. f. Prakt. Augenheilk.) In looking for the parasites, one must put the freshly epilated hair on a slide and examine with a low power in water. One will find in the hair follicle not only the male and female parasite, but also the larvæ, the embryos and eggs, proving that the entire process of generation takes place in the hair follicle. In addition to the living parasites there will be found also the metabolic products, the excrement, etc., either sticking close to the shaft of the hair or lying next to it. When objective symptoms are absent, the patients usually complain of the eyelashes dropping out and of great itching of the lids. In most cases, however, there is marked hyperemia of the inner zone of the lid border and also of the outer or anterior border of the lid. Usually there is marked hyperemia of the conjunctiva in this vicinity. There is often present a sticky secretion, like thick honey or impure vaseline, which hangs to the base of the hair in clumps. Sometimes only points of the lids seem involved, while in other cases the redness and hyperemia extend along the entire intermarginal border of the lid. In many cases the changes described coexist with diseases of the cornea or of the conjunctiva. This condition is seen in twenty-five per cent. of trachomatous eyes. The most effective treatment is the application of an ointment consisting of balsam of Peru, one part, and three parts of lanolin. Rapid improvement generally follows this treatment, and the subjective symptoms disappear in twenty-four hours.-[Ann. Oph.

NOSE, THROAT AND EAR.

UNDER CHARGE OF RICHMOND MCKINNEY, M.D., MEMPHIS.
Laryngologist to the East End Dispensary.

Reflex Cough.

Richards (Medical Record, vol. 56, no. 6) writes interestingly of the subject of coughs of reflex nature. Reflex and nervous cough is characterized by some or all of the following: Sudden appearance; rhythmical character; free intervals when no signs of cough are present; expectoration absent or slight in amount; no fever or marked constitutional disturbance; may continue for years or stop at any time, or eventuate in other symptoms; may come at regular intervals;