When the labors are continued until midnight, and the hour for resting is after this time, a light meal should be taken at eleven o'clock.

In either instance cited, if the food-stuffs taken have been easy of digestion, rapidly absorbed and oxidized, the fires will naturally burn low after several hours sleep and abstinence from food. On the other hand, if the food-stuffs taken require considerable time for their digestion, and are slowly absorbed and oxidized, the heat-producing supply may not be exhausted completely during a somewhat prolonged abstinence from food, or during the hours usually spent for sleeping. In the former instances, the demand for hot stimulating drinks before the morning meal is justified, in order to excite the reflex nervous mechanism to start the chemico-physiological processes of digestion, until heat can be developed by nature's inherent process to carry on the work. In the other class of cases this extraneous heat supply may not be needed. In the former, they are absolutely demanded, to maintain a perfect state of health; while in the latter perfect health may be sustained without their aid.

In neither instance can it be said that an unhealthy state exists; but in the one, the fires are allowed to burn very low, and consequently require a little more effort to get them in motion again,-which is not the rule in the other class.

Thus, the time for the principal meal and its composition must be governed entirely by the chemico-physiological laws which determine the development, growth and maintenance of animal life;-taking into due consideration the amount and kind of work to be performed, and the period of the twenty-four hours at which the labor is to be done.

The need for special stimulation before the first meal of the day will also be governed by the composition and quantity of the last meal taken before the night's sleep, and by the amount of work performed after the last meal, and the duration of the somnolent period.

In using the word stimulation, alcoholics are not necessarily intended; although, if scientifically and judiciously used, they can be made to serve a valuable purpose in the advancing years of life.

Much better and less dangerous agents, however, are at our command for starting the digestive process during adolescence and the adult period of life,such as hot broths, coffee, tea, et cetera.-American Medico-Surgical Bulletin.

THE PSYCHICAL SEQUELS OF GASTRIC DILATATION.

DR. DEVAY, as reported in the Journal de Medecine et de Chirurgie, of Paris, instituted during his stay at the Asylum at Brow, a great number of observations with regard to the influence of gastric dilatation on the nervous system. He demonstates that in those predisposed to mental alienation, dilatation may directly cause insanity, and that in the previously insane it is apt to most peculiarly modify the form of their mental disease. Just as the septic uterus, after an accouchement, may poison the entire system, and superinduce puerperal insanity, so the dilated stomach may produce a toxic condition with a strong tendency to melancholia. Bayle and Maury have already pointed out the relation existing between gastro-enteric disease and some forms of melancholia, but they interpreted the latter as a sympathetic phenomenon. It rested with Dr. Devay to demonstate

the process to be one of genuine intoxication. The manner in which dilatation of the stomach produces its psychical effects is simply this: The activity of the gastric juice being markedly diminished in a dilated stomach, bacterial fermentation is set up, the toxic products of which profoundly effects the central nervous system, calling forth phenomena of either a depressive or convulsive nature. M. M. Bauveret and Devic have shown how changes of character were wrought by dyspeptic troubles, and how in the predisposed the latter may prove the stepping stone to mental alienation. Individuals afflicted with gastric dilatation present a state of mental depression manifested by premature weakening of all intellectual faculties as of memory, concentration, will-power, judgment and of recaptivity for moral impressions. The influence exerted by gastric dilatation in the insane is also well illustrated by the modification which the preexisting form of insanity undergoes when from derangement of the digestive function the mental disease lapses into its previous form. Dr. Devay recommends in all of these cases the institution of an active gastric and intestinal treatment. The asepsis of the alimentary tract should be insured with all means at our command. A free evacuation of the bowels is to be induced regularly. If feasible, the stomach is to be subjected to frequent lavage with a fifty per cent. naphthol solution, while internally preparations of naphthol combined with English magnesia are to be administered. This course of treatment has often produced most happy results.-Medical Review.

THE ETIOLOGY OF ACUTE ARTICULAR RHEUMATISM.

SAHLI (Deutsche Archiv für klinische Medicin, Bd. H. li., 4 u. 5, page 451) contends that although the infectious nature of acute articular rheumatism has not yet been demonstrated, such an etiology is highly probable from the point of view of modern general pathology. In favor of such a causation are the acute febrile course, the local involvement of the joints, and the tendency to complication by endocarditis and inflammation of serous membranes. Sahli reports the case of a girl, sixteen years old, with a second attack of acute articular rheumatism, complicated by endocarditis, pericarditis, bilateral pleurisy, and, finally, left-sided pneumonia, death suddenly taking place with cyanosis, perspiration, and heart-failure. At the post-mortem examination vegetations were found not only upon the leaflets of the mitral valves but also upon the aortic semilunar segments and upon the lateral leaflet of the tricuspid valve; the pulmonary leaflets were free. Inoculations were made upon agar and gelatin from the endocarditic excrescences, from the enlarged bronchial glands, the synovial membrane and the contents of an affected knee-joint, the thickened pericardium, the inflamed pleura, and from blood from the heart. In almost all instances pure cultures of a single organism developed, which corresponded in all essential characters with the staphylococcus pyogenes citreus. Animal inoculations yielded negative results. The conclusion is expressed that the organism found is to be looked upon as the cause of the disease. It remains to be determined whether this organism is a distinct one or a modified form of the staphylococcus pyogenes citreus. It seems possible (and the possibility is supported by evidence) that acute articular rheumatism may be caused by attenuated pyogenic cocci, and future investigation must determine whether a single or several species

of organisms have an etiologic relation to the disease. The bacteriologic examination in the case reported indicates that the so-called complications of acute articular rheumatism (endocarditis, pericarditis, pleuritis) were etiologically related to the primary disease, of which they were thus not complications but merely localizations. In numerous other cases of acute rheumatism subsequently examined, staphylococci were also found in the contents of affected joints and in the blood.-American Journal of the Medcial Sciences.

THE GENTLE TOUCH.

MR. BILTON POLLARD, in his address before the University College, London, gave a very timely and practical hint regarding the kindly treatment of hospital patients by internes. We regret to say that such a lesson is occasionally much needed in many of our public institutions, and the heeding of it will give that necessary exercise of the finer humanities which fits the graduates for the higher grades of successful practice among the so-called cultivated classes. The lecturer very properly maintains that an interne who can, by his gentle methods and appreciative sympathy, win the love and friendship of his poor and dependent patients, has gained as important an experience as any he can obtain in the hospital ward. Not that the ordinary hospital attendant intends any wrong, but there is, in some instances, a sudden inflation of his importance which invites dictatorial brusqueness, and an indisposition, in the exercise of duties supposed to be more important, to give time and thought to the exercise of the better elements of his manliness, by a compassionate consideration for the sufferings of such as are at his mercy. The cry of agony is never necessary for a diagnosis when the surgeon is the active agent of its production. The man who inflicts. unnecessary pain in handling an injured limb is either a bungler or a brute.

The difference between the one who considers the feelings of his patients and the other, who does not, is very apparent in the examination of a wound or the manipulation of a fracture. In the former the practised delicacy of touch. discovers all that is necessary to know concerning the extent or character of the wound, without a sign of pain from the patient; while the latter, by the pressure and twist in the wrong place and at the wrong time, transforms the patient from a quiet, helpful, and submissive subject, to a shrieking and horrified sufferer. Even the most ignorant patient takes such lessons to heart. With a rich patron the question of choice could very easily be settled, but usually the sick or injurd pauper must submit to the inevitable. When we consider that the highest science. aims to mitigate pain, we can hardly claim superior accomplishments or greater depth of learning for the man whose very touch is signalized by a howl.

While it may not be possible for everyone to obtain this refinement of manipulation, there is no excuse for not cultivating it in every instance. Scientifically speaking, a sick beggar is the same as a sick king. Their nervous systems are made alike, their reflexes are similar, and their pain-centres are equally responsive. The one who can learn early to treat them from the same stand-point of appreciation becomes the sympathizing friend of both, and will be as welcome in the palace as in the hovel. There may be a reason why all cannot be great physicians, but we all can be gentle ones. Even in our most desperate cases when all other remedies fail, the very last to lose its influence is the kind word, fitly spoken.-- Medical Record.

THE DIAGNOSTIC SIGNIFICANCE OF HERPES LABIALIS.

FELIX KLEMPERER (Berliner klinische Wochenschrift, 1893, Number XXIX, page 694) has made an interesting clinical and bacteriological contribution to the subject of the significance of herpes labialis in the differentiation of tuberculous from epidemic cerebro-spinal meningitis. He reports at length three cases of cerebro-spinal meningitis in which the possibility of a tuberculous origin had to be considered. Two presented a family history of tuberculosis. One was complicated by pluerisy with effusion. All presented herpes labialis. One terminated fatally; the post-mortem examination showed the condition to be nontuberculous. In the other two recovery took place. In one of these only pneumonia cocci were found in the fluid of the vesicles; while in the fatal case uncapsulated diplococci were found that in bouillon culture formed chains. The results are also reported of examinations of the contents of herpetic vesicles of the lip in nineteen other cases. In fourteen cases pneumonia cocci, staphylococci, and streptococci were variously found, but in every instance only one form. In five cases in which the contents of the vesicles had already become turbid, streptococci and staphylococci were found. The conclusion is reached that the microorganisms found in the fluid of the vesicles must be considered as the cause of the eruption, and, further, that they are the same as those causative of the primary disease. It is pointed out that herpes occurs commonly in the course of diseases (such as pneumonia and angina) caused by micrococci, or (such as rheumatism and endocarditis) in which micrococci cause secondary infection, and with but extreme rarity in the course of diseases (such as typhoid, diphtheria, and tuberculosis) that are dependent upon specific microorganisms. The deduction is thus reached that the appearance of herpes labialis, in the course of an attack of cerebro-spinal meningitis, may be considered as indicating a non-tuberculous origin.-American Journal of the Medical Sciences.

ENDOCARDITIS GONORRHOICA.

LEYDEN (Deutsche medicinische Wochenschrift, September 21, 1893) relates the following case in a man, aged twenty-two. In April he had swelling of one knee and both ankle-joints, and when admitted a month later the knee and left anklejoints were still swollen. The clinical picture was characterized by (1) the presence of aortic and mitral disease; (2) irregular temperature with rigors; (3) repeated vomiting; (4) the development of acute nephritis; and (5) the malignant course of the disease. The patient died in three weeks' time. One of the aortic cusps was destroyed by ulceration and covered with vegetations. There was a large mass of vegetations on one of the mitral cusps. There was only one breaking down infarct, and that in the spleen. The kidneys were swollen, hyperemic, and contained microscopic foci of softening. The myocardium also contained similar foci. From the literature of the subject here detailed it appears that (1) the relation of gonorrhea to endocarditis is established; (2) a portion of such cases have a chronic course, and some even tend to recover; and (3) others have a malignant course. The bacteriological problem in gonorrheal endocarditis has hitherto been unsolved. Some investigations have shown that the streptococcus was present in the valves, but generally they have been inconclusive. This case thus provided the opportunity of settling the question

of the pathogeny of this endocarditis. The blood examined during life gave negative results, as also that taken from the auricle after death. The fibrinous deposits were examined bacteriologically by Michaelis. Gonococci were demonstrated (1) by their shape; (2) by their presence within the cells; and (3) by the facts that they were decolorized by Gram's method, and very easily by alcohol and lavender oil. No other microorganisms were found. That no cultiva-. tion experiments were made is not looked upon by the author as any real objection, as the above-named characteristics are sufficient. Although the settling down of the gonococci upon the endocardium is remarkable, it is not very surprising, as blood serum is a medium well suited to these microorganisms.

THE TREATMENT OF EPILEPSY.

FLECHSIG (Nourol. Centralbl., Number VII, 1893) gives a preliminary account of a new mode of treating epilepsy lately originated by him, which he found to be more effectual than methods previously used. His plan consists in giving small but increasing doses of opium for about six weeks then discontinuing the opium and substituting large doses of bromide (about seven and five-tenths grammes daily). After continuing these for two or three months the dose was gradually brought down to two grammes daily. The result usually obtained was cessation of fits as soon as the bromide was commenced; the observations, however, did not cover any great number of cases or period of time. Stein (ibid., October 1, 1893) has used the method in several cases, of which he specially refers to six. In three of these patients the fits stopped shortly after beginning the course of bromide; the patients then passed from under observation. Two of the remaining patients had no fit from the time that the bromide was substituted for the opium until the date of report (early part of July to September 15), their general health improved, and their body weight increased. The last case was a boy in whom the fits were arrested for only a few weeks. Prior to the opium treatment this patient had been intolerant of bromide; but after it he could take five grammes daily. In general Stein thinks favorably of the method, and recommends. it especally for children.-British Medical Journal.

SURGERY.

TREATMENT OF SOFT CHANCRES BY HEAT.

LORAND (Wiener medicinische Wochenschrift, Number XL, 1893) describes this mode of treatment, which he saw carried out by Welander at Stockholm. It is based on the observations of W. Boek and of Aubert, the latter of whom found that chancrous pus heated to 40° centigrade became non-inoculable. Welander's method is as follows: Water is conducted by two pipes, one carrying hot and the other cold water, to a copper reservoir, and is there kept at a temperature of 50° centigrade by means of a gas jet. From the reservoir the water is carried by rubber pipe to a coil of lead tubing through which it circulates, and then escapes by another rubber pipe. If the reservoir is kept at 50° centigrade it is found that when it reaches the coil it has a temperature of about 41° centigrade, below which it must not be allowed to fall. The ulcers are dressed with pledgets