313 white specks, punctate in character, situated in the centre of the reddish areas which cover the mucous membrane of the cheeks and lips in the beginning of the disease. As the exanthem appears and spreads on the skin, the eruption on the mucous membrane of the lips and cheeks becomes diffuse, losing the characters of a discreet eruption, and we have an intense general redness which is simply dusted over by myriads of these bluish-white specks. When the exanthem is at its heigt the buccal eruption begins to fade, and in the latter stages of the fading of the skin eruption the phenomena, described above, entirely disappear. In order to recognize and properly appreciate the above sign the patient must be examined in the strongest day light, and the mucous membrane of the cheek everted so as to expose it thoroughly to the light. Then we see a minute bluish-white spot situated in the centre of the irregular reddish spots which cover the mucous membrane of the cheeks and lips, and doe not occur elsewhere. He says they cannot be mistaken for sprue, as they are not so deeply white, nor are they as large, nor do they coalesce to become plaque-like in form, and they always retain punctate form. The value of this sign seems to lie in the fact that an early diagnosis of measles can be absolutely made, and isolation perfected before exposure is great, and it ought to be sought for by all physicians when they are called to cases that do not admit of an easy diagnosis. J. W. P. S. A CONTRIBUTION TO THE THERAPEUTICS OF ENURESIS:-An accidental discovery was made in the treatment of this trouble by Dr. Alfred Hand, Jr., (Pediartics, Vol. 5, No 7), He prescribed pills of following composition: Ext. Cannab. Ind. Hyoscyam.. Zinc. Phosphid. gr. 1-8 gr. 1-400 for the mother who was suffering from nervousness incident to the care of the child. She misunderstood the directions and gave them to her child with the result that the enuresis ceased in two days, and had not returned at the end of six weeks, the time of the writing. TREATMENT OF INGUINAL HERNIA BY INJECTION.-Dr. Theo, Griffin (Int. Jour. Surg.)claims to have produced some very successful cures in the treatment of inguinal hernia by injection. The following 314 is his method in detail:--I prepare my patient by first seeing that he has a truss that retains the gut perfectly. It must not be allowed to rest within the inguinal canal, but must be held out of it by the pad of a truss that fits firmly over the internal abdominal ring. Having acertained that this is well done, after two or three days' observation, we are now ready to proceed with the injection. I desire to state here that, in a majority of cases, during the treatment the patient can remove the truss at night, taking it off and putting it on while in a reclining posture, but under no circumstances must the gut be alowed to come down. The patient now lies down upon the table, and we scrub the parts thoroughly with warm water and soap, dry well, and finally bathe with a 2 per. cent solution of bichloride of mercury, cutting the hair short over the seat of the proposed puncture. I now inject hypodermically a 5 per. cent solution eucaine, about one-half to the inside and a little below the external abdominal ring. Wait now two or three minutes for the local action of the anesthetic, during which time a syringe is charged with 10 to 15 minims of the injection fluid mentioned in my previous article, or the following which I sometimes use. M. Sig. -Inject 10 to 15 minims as directed. This syringe is furnis led with a silver probe, known as a cocaine applicator, which can be obtained of any instrument seller, and can be screwed on the syringe in the place of the hypodermic needle. Have this in readiness for the purpose of placing the fluid into and along the inguinal canal. I now take a small trocar and canula-I use one which I found in a veterinary hypodermic case-and plunge it into the tissue at the point where the local anesthetic was injected; direct the point of the trocar towards the external abdominal ring, pushing it up to the ring if possible. Now withdraw the trocar and invaginate the index finger in the loose folds of the scrotum, and push it up to and into the external abdominal ring. As the finger reaches the ring it will come in contact with the canula, which has been left in the tissues. With the free hand guide the point of the canula into the ring, aided by the invaginated finger. As soon as the point of the canula is engaged in the ring, depress the free extremity, bringing the canula almost parallel with Poupart's ligament, and force the canula gently into inguinal canal. It should be passed the full length of the canal, if possible. This being done I take up the syringe with the silver probe attachment, containing the injection fluid, and pass the probe point through the canula to the internal abdominal ring. The point should project a little beyond the end of the canula, so that none of the injected fluid will run back through the canula. Having done this, slowly inject the fluid, at the same time kneading the tissue over the canal with the fingers, gradually withdrawing the canula and syringe point. In this manner we surely get the fluid where we want it. It is, how ever, sometimes difficult for me to get into the inguinal canal, but perseverance usually results in success. The external ring is rendered more open and is more accessible by having the leg flexed upon the thigh. There is usually some swelling, but little pain or inconvenience results; so far I have had no abscess or suppuration of any kind. I have been recently informed that two of the cases reported by me have relapsed-case No.4 with an omental hernia, and case No. 5 which at the time of my report I had just discharged from my treatment. Since then I have treated two other cases, the ultimate result of which it is to early too ascertain. The chief difficulty in the way of successful treatment is to get the injection properly into the inguinal canal. If this is well done the chances are good for a cure. The unsuccessful results are, no, doubt, in a marjority of cases due to the failure of the operator to do his work properly. Each patient shonld have at least three or four injections; this is an arbitrary rule, as there is nothing to guide you as to the exact number required. Notes and Items. DR. ROSCOE E. FRANKLIN, of Richmond, Virginia, has gone to seek his fortune in the Klondike gold fields. Dr. W. Clair Spruell has been reappointed resident physician at the University Hospital, Baltimore. A very richly deserved compliment. BOARD OF EXAMINERS.-There were upwards of eighty applicants before the Board at the Charlotte meeting, just closed. At time of going to press the number of successful applicants had not been determined upon. The Medical College of Virginia graduated 39 Doctors of Medicine April 21. The following North Carolenians are among the number-Dr. G. A. Caton, Greensboro; Dr. R. B. Miller, Goldsboro; Dr. R. J. Price, Wilmington. SURGEON-GENERAL VAN REYPEN, of the Navy, has received over three hundred offers from physicians of service as acting assistant surgeons in the Navy. These offers cannot be accepted until Congress authorizes the temporary appointment of acting. surgeons. There are about twenty vacancies in the regular service, for which there are few or no applications because of the humiliating treatment to which newly appointed assistant surgeons are subjected. If Congress will remove these objectioanble features and will authorize the appointment of acting assistant surgeons, there will be no lack of competent men for vacancies. -Medical Age. MEDICAL OFFICERS OF THE ARMY.-The House Committee on Military Affairs has made a favorable report on the House bill providing for the increase of the number of medical officers in the army by adding 15 assistant surgeons, with the rank of first lieutenant, and authorizing the surgeon-general of the army, with the approval of the Secretary of War, to appoint as many contract surgeons in emergencies as may be necessary, at not exceeding $150 per month.-Philadelphia Medical Journal. ACTING ASSISTANT SURGEONS.—Over eight hundred medical men have offered thir services to the army authorities and more than a thousand to the naval medical department. These are by no means all young men or recent graduates, for many offers are received daily from men, some of whom saw service in the civil war on one side or the other, and others who have come on the stage since that time but who stand in the front rank of the profession.-Medical Record. CARE OF THE SICK AND WOUNDED.-It has been decided that the naval ambulance ship Solace shall be used as a transport for the sick and wounded of both army and navy. She will carry men physicians disqualified for active service from the fleet or from Cuba to Key West and Tampa. A hospital train will run from Tampa to northern points, in order to give the sick a benfit of a change to the cooler climate of the middle and nor thern Atlantic seaboard. A general army and navy hospital will be established at Key West, and hospital tents will be sent there to accommodate any overflow of incapacitated seamen and soldiers. The selection of Key West for this general hospital is due chiefly to the fact that the island is more healthful than places on the mainland, in the event of a fever outbreak among the men in Cuba or on the warships, the treatment of the stricken there would lessen the danger of spread of the disease to the coast proper. Other hospitals are to be established in the department of the Gulf, but that at Key West will be the headquarters of the medical corps of both military services, in addition to the Marine Hospital service.-Medical Record. NORTH CAROLINA MEDICAL JOURNAL. A SEMI-MONTHLY JOURNAL OF MEDICINE AND BY AP. MORGAN VANCE, M. D., Louisville, Ky. IVE weeks ago FIVE I was called by doctor Henderson of this city to see a young woman who was in an extreme con dition; Dr. Cecil also saw her a few minutes afterwards. She was twenty-four years of age, the mother of one child four years old, and had a miscarriage the 29th of last August. Her pulse at the time of my visit was 150 to the minute, tempera ture 105° F. Her abdomen was considerably distended, about the size of a seven months pregnancy. Doctor Henderson had seen her in his office four days before; she was then able to walk about the house, and the day I saw her she had been up walking about. Her bowels had moved as a result of a dose of castor oil the night before. Her pulse at the time of my examination was very feeble. I could get no history at that time of ary former trouble, with the exception of the miscarriage referred to, followed by a curettment, which stopped a small amount of hemorrhage that had been going on, I thought at first that the woman probably had a hemorrhage that had gone on to degeneration and formation of a septic clot, and advised an operation. She was taken to St. Joseph's Infirmary. When the abdomen was opened I came down upon what looked like a gravid uterus; finally in feeling around this glistening, smooth surface, I *Reported to the Louisville Surgical Society. |