first directed to it by advertisements of a cleansing solution for taking grease spots from clothes, advertised under a trade name which is a corruption of the first part of its name, and as a substitute for explosive benzine.

The advantages of the carbon tetrachloride-iodine mixture are its simplicity and fat-dissolving properties. If used repeatedly upon the hands, the skin will become dry and peel off, but this will not happen unless there is repeated application, and McDonald uses it after his hands have been in pus, or after a pus case has been operated upon, to be sure of complete sterilization. For constant use as a hand disinfectant, the iodine must be reduced and some lotion or oily substance, as lanolin or cold cream, rubbed into the skin of the hands after operating. Carbon tetrachloride is not expensive and costs in the neighborhood of two dollars a gallon, and three ounces is sufficient to prepare the abdomen for operation.

NITROUS OXIDE AND OXYGEN. Williams, in the California State Journal of Medicine, thus sets forth the advantages and disadvantages of this mode of anesthesia for prolonged operations: Advantages.

There is a great decrease in postoperative nausea and vomiting. Teter had in 13,000 cases only five who vomited continuously after nitrous oxide, the longest case lasting only six hours.

Surgical anesthesia is attained in from two and a half to four minutes.

There is almost immediate recovery after the gas is discontinued.

During the operation the patient has no mucus, rarely vomits, and the tongue never falls back.

It is ideal in obstetrical work, as it causes analgesia or even anesthesia, without muscular relaxation. It acts rapidly and is eliminated rapidly.

It will probably be a great advantage

in thoracic surgery, as it has been used with success experimentally on animals.

Nitrous oxide and oxygen is the safest known anesthetic. Bevan estimates the death rate to be one in 50,000, while the death rate from other anesthetics ranges from one in 10,000 to one in 15,000.

Disadvantages.

It is expensive, costing from $6 to $9 per hour for material. The rebreathing method used in 700 cases recently at Johns Hopkins Hospital greatly reduces

the cost.

It requires a special apparatus.

There is much more muscular rigidity than with ether, but morphine and small amounts of ether overcome it when present. Some surgeons learn to accustom themselves to it on account of the improved condition of their patients.

There is some danger from suboxidation, and venous congestion in certain cases, as in alcoholics and obese men.

It is contraindicated in serious heart conditions on account of the increased work put on the right heart from venous engorgement if any cyanosis is present.

It requires more skill to administer than other anesthetics. To quote from Crile: "It has certain dangers which are almost wholly in the hands of the skilled anesthetist; it is not the anesthetic of choice for the unitiated, but only for the highly trained anesthetist."

GETTING PURE MILK.

John Lee Coulter, in the Northwestern Lancet, points out that the dairymen who wish to do what is right must be helped; the same as a child who wants to learn to write must be shown how. Education for the mass of sensible producers must be supplemented by laws for the prosecution of those who refuse to live up to a certain standard, the same as in the case of our pure-food law.

If good milk is produced, the rest is comparatively easy. But the writer, be

cause he has lived for many years on Minnesota farms, because during the last year he visited the barns of a great number of farmers and dairymen and discussed the question with the producers, and because he has made a series of every careful estimates of the cost, is confirmed in these views: first, that the consumers must make insistent demand for a better product or they will not soon get it; second, that they must show their desire for it by being willing (by passing laws and by being taxed to supply the money) to help to get rid of the undesirable cows; third, that they must show their desire by carrying on a movement of education among the producers who do not understand, and by prosecuting those who persist in dirty methods.

If consumers really want sanitary milk, one of the first moves would be to see that the stables kept by hospitals are sanitary. This is surely as important as carrying flowers to the patients; yet the writer has visited such stables and has found some as bad as that of many dairymen.

If they really want sanitary milk, another early step is to clean up the stables behind their own houses in the cities. As a general thing these stables, with one, two or three cows, are in a worse condition than is found in the average dairy or farm.

If those who do not keep cows want sanitary milk, let groups of twenty-five or fifty in a locality agree to pay a cent a quart higher to some dairyman if he will improve his quality, and let them send their own inspector out from time to time. A few months would show the wisdom of this step. Or, again, if they want this good milk, let one hundred families purchase or establish a small dairy to supply their needs. If they would establish a clean dairy they could easily dispose of the surplus milk at a profit. When consumers get rid of their false notions of economy, when

they demand sanitary milk, they can get it for what it costs, including such a profit as is now added.

Many farmers would be glad to produce more sanitary milk, to introduce cleaner methods, and to be surer of the health of their cows, if the consumers only appreciated what it meant. But the consumer must be willing to pay for a better product. No farmer or dairyman can introduce these reforms and compete with another who does not go to any extra expense.

In conclusion, the author urges that the demand must come from those who use the dairy products. Just as they have demanded pure-food laws and other reforms and have commenced to get results and are paying for them, so, too, they must demand not only good weight and measure, and no adulteration, but also a product from a healthy cow secured according to good rules of cleanliness.

PROTEID IN INFANT FEEDING.

D. J. Milton Miller, in the Interstate Medical Journal, emphasizes the great importance of a sufficiency of proteids in the infant's dietary; to show how frequently infants suffer from a want of this element, because of the misconception (still prevalent) that it is the casein of cow's milk which is the most injurious to, and difficult to digest by,. the human baby; that this idea had its origin in the belief that the curds commonly seen in the infant's stool were undigested casein, while, in reality, in the majority of cases, they are composed of fat-although casein curds do occur; that this belief has led physicians in the past, and is still leading them, to feed babies with low proteids or upon proprietary foods deficient in this element; that fat is better tolerated before the sixth month than after, in winter than in summer, is the cause of a peculiar form of constipation, and is partic

ularly obnoxious in all acute digestive disturbances, and may provoke a definite and often severe train of symptoms due to acidosis; that a deficiency in proteids is a common cause of mal-nutrition, rickets, scurvy, anemia, feeble circulatory, digestive and assimilative powers and constipation; that normal or increasing weight may occur with deficient proteids, and, with constipation, is frequently an early sign of rickets; that when these symptoms occur, the proteids should be increased, often with. diminution of the fat, especially if there is constipation, or if there is diarrhea. with fatty curds; that when increased amount of proteids are indicated, but apparently not tolerated, even though the fat be reduced, resort should be had to peptonization and digestive tonics,-although it will repeatedly be found that perseverance in the increased proteids will frequently cause the apparent evidences of their injurious influence to disappear; that buttermilk is a convenient medium for exhibiting the proteids; when they are otherwise not well tolerated; that the stools may be practically disregarded, so long as the infant is gaining regularly and developing naturally; and, finally, as will have been observed by those who have grasped the full significance of these remarks, that simple dilutions of whole milk with cereal decoctions, and the addition of sugar, are sufficient, in very many cases, for the successful nourishment of infants.

GONORRHEA IN WOMEN.

J. L. Peck, in the Hahnemanian Monthly, admonishes that instrumentation should not be resorted to for fear of carrying the infection higher up into the cervix, endometrium and tubes, and producing serious extension of the disease into these and other parts. Coitus should be prohibited, and the patient instructed as to the manner of preventing the conveyance of the disease to other parts and persons. Such internal medi

cation as required to relieve the pain and irritation of the parts affected should be prescribed. The external parts should be bathed two or three times daily with a boracic acid solution, or other mild antiseptic, and clean pads applied frequently.

In sub-acute and chronic cases the most effective treatment is the local application of silver nitrate, ten per cent solution. Great care should be taken to see that all the folds and crevices of the vagina are thoroughly treated, and if the cervical canal has been infected, applications of silver nitrate should be made within the canal. Following this treatment the vagina should be well smeared with vaseline and packed with cotton or gauze, or a tampon medicated with ichthyol and vaseline, or ichthyol and glycerine, ten per cent. is placed in the vagina. The packing or tampon is removed in forty-eight hours and douches of permanganate of potassium one to five hundred, or creolin, or bichloride of mercury one to four thousand. The local treatments should be applied two or three times a week with the daily use of antiseptic douches when the tampons are not in use. Protargol ten per cent, or argyrol twentyfive per cent may be substituted for the silver nitrate, but the latter are not as effective in destroying the bacteria. Where the urethra is involved a Kelly's urethrascope should be introduced to within a short distance of the bladder and application of solution of silver salts applied the entire length of the urethral canal. It may be advisable to use ten per cent applications of cocaine in the urethra in painful cases prior to these applications. The ducts of Skeenes or para urethral ducts, and Bartholinian ducts, if involved, are treated by pressing out the purulent discharge and using injections of silver salts with the aid of a blunt pointed syringe. In obstinate cases these ducts should be incised freely under local anaesthesia and thoroughly cauterized.

"DONT'S" IN THE USE OF 606.

The Journal of the A. M. A. offers the following advice in the use of salvarsan:

The most recent advice from authoritative sources as well as our own experience, favors, in general, the employment of salvarsan by intravenous injection.

1. Don't use salvarsan in myocarditis, in advanced cases of tabes dorsalis and

general paresis, in nerve syphilis affecting vital centers, in grave kidney disease, in cachectic and debilitated persons (unless the condition is due to syphilis), in aneurysm, in optic neuritis, and in persons with lesion (such as gastric ulcer) in whom increased blood-pressure may produce hemorrhage.

2. Don't use intravenous injections of salvarsan until you have fully qualified yourself and possess a detailed knowledge of the technic. Deaths have occurred and more will occur from unskilful administration.

3. In the preparation of the drug for intravenous use, don't use a solution made with common salt or undistilled water (such as is often supplied in hospitals), but use a specially prepared sterile physiologic salt solution made with chemically pure sodium chlorid; otherwise you may find it impossible to obtain a clear solution.

4. Don't under any circumstances inject into the veins a solution which is not perfectly clear; a flocculent or cloudy liquid may produce alarming symptoms of collapse or even death.

5. Don't use a solution any more alkaline than is absolutely necessary to secure a clear solution.

6. Don't inject the salvarsan into the veins without previously running in physiologic salt solution; if the needle. is not in the vein you will infiltrate the surrounding tissue with the salvarsan solution and cause subsequent inflammation and unnecessary pain.

7. Don't infuse the solution into the vein too rapidly; it is best to have a needle of such a caliber as will require eight minutes to introduce 200 c. c. of fluid. With the gravity apparatus, the rapidity of inflow can also be governed by the heights of the receptacle.

8. Don't infuse a cold solution; the liquid should be about the temperature of the blood.

9. Don't use "glass pearls" in the mixing jar, as is often recommended; we have found that minute particles of glass chip off, which might cause embolism.

10. Don't use a routine dosage of the drug; the dose should be gauged according to the weight of the patient and the character of the condition to be treated.

11. Don't employ intravenous injections in your office or in a dispensary. The patient should be treated in a hospital and put to bed and carefully observed for a period of not less than three days.

12. Don't persist in the intravenous injection if the patient should show signs of collapse during the administration, but stop at once.

ELIMINATING THE ANESTHETIC.

Blain, in the International Journal of Surgery, cannot understand why patients should not be allowed fluids after operation. It is merely one of the traditions which have been so long handed down. Yet we see nurses busily watching patients to see that they do not steal water from a hot-water bottle or bag, under the supposition that this would be very detrimental. When we consider that the mode of elimination of the anesthetic is to no small extent by way of the gastric mucous membrane, it is quite easy to understand that any means which aid in its removal will be of benefit. This end is accomplished by lukewarm water or a glass of water contain

ing ten grains of sodium bicarbonate, or a cup of black coffee administered shortly after the patient comes out of the anesthetic. As a rule, nausea and vomiting, which would ordinarily continue from twenty-four hours to two or three days, can be entirely done away with.

Some have advocated the washing out of the stomach at the completion of the operation by means of the lavage tube. This method is open to two objections: First, the danger in passing the tube with the patient anesthetized (the author has known of one death by this method), and, second, because it is best that a patient should be fairly out of the anesthetic at the completion of the operation. However, it is often necessary, in order to relax the jaws sufficient to permit the passage of the tube, to administer more ether.

In most cases where the pulse is weak, the best results are to be obtained by saline solution given by one of the several routes-subcutaneous, rectal or intravenous. This, coupled with heat externally and other mechanical means, will eventually supplant the giving of whisky, strychnine, -nitroglycerine, etc., under the guise of stimulating the heart. Saline solution is at present the best means at our command to replace the lost blood, combat shock and aid in diluting toxins and eliminating the waste products from the body. Its employment by the drop method is also advantageous after a large percentage of operations-even though shock is not extreme, and aside from its well-known use in peritonitis-to relieve the thirst. and aid in restoring the patient.

QUANTITY OF FOOD FOR INFANTS.

Copeland, in the Virginia Medical Semi-Monthly, sums up this question as follows:

A determination of the total amount of food required in a given case is of great importance, for the reason that in

depending upon clinical observation, the harm is oftentimes done before the error in diet is fully appreciated. Such a determination has been satisfactorily worked out for man, and owing to the balance between the protein intake and nitrogen excretion is not difficult. With the infant such work has been especially difficult, from the fact that the rapidly growing organism requires a supply of protein far above what is shown by its nitrogen excretion. Forty calories per pound of body weight for each twentyfour hours is the average need. Now, having prepared a food acceptable to the infant, with a proper nutritive ratio, the estimation of its caloric value is not troublesome. A comparison of such value with the infant's requirements is important in determining a minimum energy value, below which we may not safely continue for any length of time.

Having satisfied ourselves as to the amount of food required in twenty-four hours, it must then be determined what quantity is to be used at a feeding and what interval there must be between feedings. Conclusions must be based upon the character of the food, the age of the infant and the capacity and muscular tone of the stomach. The infant's stomach empties much more quickly af ter a feeding of human milk than after any other possible nourishment. The acidity of the gastric juice is largely dependent upon age, and the influence of acid in retaining food for gastric digestion has been pointed out. Stomachs deficient in motile power as the result of faulty feeding or disease require time to evacuate their contents.

Fortunately, the healthy infant, like all other healthy young animals, adapts itself readily to altered environment, including food, if due time is given; otherwise, our efforts could never meet with success. We must bear in mind that any artificial food, no matter how scientifically worked out, is essentially foreign and may give trouble. Finally, we must