out with saline solution. A pint of saline fluid was introduced into a vein in the arm, and strychnine given hypodermatically. The patient gradually improved and ultimately recovered. In the second case, the patient was a primipara and had always been delicate. Delivery was accomplished under chloroform by forceps, the perineum being somewhat torn.

After the child was born the uterine contractions produced spasm, with air hunger, and frequency and irregularity of the pulse. Attempts to express the placenta caused uterine contractions and a return of the spasms. The patient's heart became markedly dilated. The placenta was removed by hand and the uterus irrigated with salt solution. No further spasmodic attacks occurred, and the patient slowly recovered.

THE BLOOD IN TUBERCULOSIS. Wright and King, in the American Journal of the Medical Sciences, presents the following conclusions:

1. In uncomplicated cases of tuberculosis the average number of red cells is normal or above excepting during a short time prior to death.

2. The hemoglobin percentage averages about 85 per cent. excepting dura short time prior to death.

3. The red cells exhibit an increased resistance to the hemolytic action of salt solutions, this resistance, as a rule, being increased directly as the progress of the disease.

4. Resistance to hemolysis will probably be found of diagnostic value.

5. The prognosis becomes less and less favorable as the hemolytic index falls.

6. The hemolytic index and Imyphocyte percentage bear a direct relationship in prognosis.

7. The total white count increases directly as the disease progresses.

8. In most instances the stage of the disease, in uncomplicated cases, can be more or less accurately determined by the total white count.

neutro

polymorphonuclear

9. The philes have but little if any phagocytic action in this disease.

10. A high polymorphonuclear percentage makes a bad prognosis.

11. It is strongly probable that the lympocytes are markedly phagocytic in tuberculosis.

12. A high percentage of lymphocytes is a very favorable prognostic index.

13. The following blood findings are positive proof of improvement in any given case: (a) Decreasing white count; (b) falling polymorphonuclear percentage; (c) rising hemolytic index; (d) rising lymphocyte percentage.

14. Blood examinations should be made coincident with every physical examination, otherwise the physician misses most valuable information relative to his patient's condition.

BURNS OF SECOND DEGREE.

Let us suppose, says Colcord, in the International Journal of Surgery, that we are called to treat a severe burn of the second degree. We find the patient suffering agonizing pain with oncoming shock and a chill. We at once administer a hypodermic of 4 to 1⁄2 grain of morphia, 1-40 to 1-20 gr. of strychnia, and 1-100 to 1-50 gr. of atropin, to stop his pain and apprehension and combat the shock. We then see that the room is warm-80 to 85 degrees-clear it of unnecessary furniture and by-standers and order hot water bottles, or hot bricks, gotten ready. The bed should also be prepared. If we have a nurse or assistant at hand, we can order her to prepare the necessary things for a hypodermoclysis or a Murphy enema.

We must bear in mind that in every bad burn three things are more important than the local treatment:

1. Stop pain.

2. Combat shock.

3. Provide for dilution and elimination of the toxins, which at once are thrown into the blood.

Having gotten thus far with our work, we can proceed to do the local dressing. The clothing should be carefully cut away-never pulled off or dragged over the burned area. We must remember that a burn is, at first, sterile and we must try to keep it so. Unless we believe that it has become infected through dirty handling, dirty clothing dragged over it, or a dirty blanket laid on it, it is best not to wash the burn. Estes washes the surrounding skin with 5 per cent. carbolic solution, protecting the burn with pledgets of wet gauze. With our burn ointment we have not found this necessary.

Pieces of gauze of convenient size are now spread thickly with the ointment and applied somewhat beyond the burned areas. Over this cotton and over all a bandage is placed. The patient is now put to bed, and if shock continues the normal salt solution is repeated every eight hours, giving plenty of water to drink. Nourishment for the first three days should be liquid on account of the intense congestion of the alimentary tract. There we may gradually feed according to conditions.

There should be the usual care of the bowels, skin, kidneys, etc., not forgetting, in our zeal over the local treatment, that we have on our hands a sick man with blood loaded with toxins, with meninges, lungs, stomach, kidneys and other organs congested and filled with cmboli.

We re-dress our burns daily, gently wiping away the discharge of serum and broken down cells, which is poisonous and irritating, with dry gauze or cotton. Blisters are opened and pieces of loose skin removed with sterile scissors or forceps, but all skin is left in place as long as possible to protect the underlying, new-forming skin.

Every dressing should be made with. aseptic care, clean hands, clean gauze and clean instruments.

As the old epidermis is she we have

a red raw irritable surface, and we must reduce our ointment to one-half or even cne-fourth strength. In an occasional case even this is too irritating and we change to oxide of zinc ointment or, better, to strips of gutta-percha tissue wet in normal salt solution. Over this are applied the gauze and one-fourth strength ointment, or zinc ointment, cotton and bandages. When the islands of epidermis have coalesced, we can change to aristol or any dusting powder.

PROGNOSIS IN BURNS.

A. W. Colcord, in the International Journal of Surgery, remarks that there has been much discussion about the cause of shock in burns. Some claim it to be mainly phychic. Others, as Crile, claim it to be due to nerve injury, while many investigators, notably among the Germans, ascribe it to the rapid and intense toxemia. Each man brings forth good experimental evidence for hist claim. In my opinion it is due to several factors, the most important being the following in the order named:

1. Psychic effect of a severe accident with added excitement from surrounding friends and bystanders.

2. Severe sudden pain.

3. Rapid toxemia from absorbed poisons in the sick area, partly from hemolysins and partly from chemically. changed lymph in the lymph spaces.

4. Reflex nerve phenomena from injury in the burned are of: (a) nerves of pain; (b) nerves of temperature; (c) vasomoter nerves.

5. Rapid congestion and embolism of vital organs. Autopsies on cases of death, apparently from shock in burns, even a few hours after the accident, show intense congestion of meninges, kidneys, lungs, stomach and intestines, with emboli of clumps of red blood corpuscles throughout these organs (Ravogli).

Ulceration of the duodenum, stomach and intestines following burns is prob

ably due to embolism. There were no gastric or intestinal ulcers in my series. There were, in 2,000 cases, eleven deaths, all but one during the period of shock. Among the symptoms of burns we find:

1. Pain.

2. Shock.

3. Chill.

4. Nausea and vomiting.

5. Delirium.

6. High toxic temperature.

7. Scarlatiniform rash (occasionally). 8. Suppression of urine.

9. Albumin or blood in the urine. 10. Septic temperature if infected. The causes of death are:

1. Shock, if within a few hours.

2. Toxemia, if between one and four days, from:

(a) Absorbed toxalbumins.

(b) Hemolysis.

(c) Arrested secretion.

3. Congestion of vital organs.

4. Embolism of lungs (Estes), brain kidneys or other vital organs.

5. Toxemia from slough in one or two weeks.

6. Toxemia from infection of burn. 7. Suppression of urine (early). 8. Ulcer of duodenum, stomach or intestines.

9. Exhaustion from long suffering, suppuration, etc.

10. Hemorrhage from sloughing of a large blood-vessel.

PRACTICAL POINTS ON FRACTURES. BY JOSEPH E. FULD, M. D., New York. (In the International Journal of

Surgery.)

With a history of a trivial injury, followed by a fracture, such as stubbing the toes in falling, or even sudden turning over in bed, always think of a pathological fracture. An X-ray picture may reveal a tumor, which may be a sarcoma, secondary carcinoma, gumma, cyst of bone, etc. These cases are frequently of medico-legal interest.

Always have a physician or nurse assist you in reducing and setting a fracture, who will share the responsibility and act as witness should suit be brought against you. If necessary, call in a consultant. Always give a guarded prognosis.

In fractures of the nasal septum, the interior of the nose should be inspected frequently after replacement of the fragments, as the hematoma, which generally follows the injury, often becomes infected and must be opened early.

In fracture of the spine and of the pelvic bones, it is important to catheterize the patient at regular intervals. In the latter condition this will aid in the diagnosis of rupture of the bladder, which is shown by the presence of blood or bloody urine. If necessary, the bladder should be irrigated.

Leave instructions that should a fractured limb become swollen, bluish or very painful, you be notified at once; and always respond to the call or send someone in your place. If there is much swelling, cut the plaster cast or loosen the dressing and reapply it less firmly.

In doubtful cases of fracture of the base of the skull, a lumbar puncture showing bloody fluid will give conclusive proof of its existence.

Bleeding from the nose and ear following head injuries does not, necessarily, mean fracture at the base of the skull. The hemorrhage may come from an abrasion of the auditory canal or the mucous membrane of the nose.

There are many cases of sprained, weak, rheumatic wrists that are instances of unrecognized fractures of the scaphoid bones. The X-ray will reveal the

true nature of the lesion.

Temporary splints may be improvised from all varieties of articles and materials-umbrellas, walking sticks, golf clubs, broom sticks, newspapers rolled up into narrow bands, old bandboxes, bed slats, cigar boxes.

IN

HARVEY AND BELL COMPARED. N A lecture on Charles Bell, printed in the Lancet, Arthur Keith calls attention to a remarkable similarity between the discoveries of Harvey and Bell. Monro, as we have seen, was puzzling over the meaning of spinal ganglia when Bell was a student in Edinburgh at the end of the eighteenth century. Fabricius was trying to explain the meaning and use of valves in the veins when Harvey was studying in Padua at the end of the sixteenth century. They were designed, Fabricius thought, to secure an even distribution of the blood during its reflux from the thorax to the extreme parts of the body. Harvey and Bell came to London to observe, reflect, and experiment, and teach and practice for a livelihood. Harvey brooded over his "new" idea from 1616 to 1628 before publishing; Bell over his from 1807 to 1821. Harvey found the arrangement of the valves could not be explained on the current teaching of the day. They allowed blood to pass only in one direction, and that was towards the thorax. The current teaching could offer no explanation of why the lungs required a special ventricle and an artery as big as that to the whole body for their special blood-supply. No explanation

was offered for the existence of the tricuspid valve, nor for the semilunar and mitral valves. Harvey was the first anatomist to formulate as a working principle for the investigator that the existence and form of every organ and part of the animal body is determined by function, and that by a study of form a key or guide may be obtained which will direct the inquirer as to the manner in which the function may be experimentally demonstrated. A rational study of

anatomy guided Harvey and Bell to their discoveries.

On whatever standard one proceeds to judge, Charles Bell must be assigned a first place amongst the world's anatomists. He did for the anatomy of the nervous system what Harvey did for the circulatory system-brought order out of chaos. John Hunter was probably a greater discoverer than either, but he was anatomist of life rather than of the human body. Harvey proved his thesis in every point; his demonstration was complete. His inclinations were under the sole guidance of his facts. Bell, as we have seen, sometimes allowed the facts to follow his inclinations. In Bell's favor we must take into consideration he was dealing with the most complex and elusive system of the body, one which can be interrogated with success only by the more delicate modern means which Bell had not at his command.

In conclusion, the author quotes a footnote from Sir Charles Bell's treatise on the "Nervous System of the Human Body": "In your department," Sir Humphry Davy said to him, “you can hope for nothing new. After so many men in a succession of ages have labored on your subject, no further discovery can be expected." "This," writes Bell, "shows great ignorance of anatomy since every improvement points to something new, and the higher we go the more is the field of view extended." Once a new path is found there is no telling the various discoveries it may lead to. The path discovered by Charles Bell is one which has carried his successors into new and and wide fields. Nor are the methods which Harvey and Bell employed to elucidate the human body exhausted; those who know the structure of man best

know how obscure are many parts and organs of the human body, and how indifferently they can be explained on the basis of our current teaching.

DO WE LIVE OUT HALF OUR DAYS. Life tables elaborated to demonstrate the average period of human existence show that pursuits and habits appreciably influence longevity, said Howe, in 1884.

A

The husbandman survives the mechanic, the merchant outlives the professional man, and the "commoner" attains the greatest average age. By the "commoner" is meant the one who leads a comfortable career, and never indulges in excesses. Utter laziness shortens life as much as a condition of hardship. The strong arm is possessed by him who puts forth strength-makes an effort. An unused brain leads to inanity and premature decay; and mental overwork hastens apoplexy and paralysis. The brain needs recreation, which means variety in kind of intellectual work. game of billiards will refresh a tired mind-the bookkeeper needs diverting exercises, and so does the overworked professional man. At the age of fifty the weary and worried lawyer, minister, or doctor should have a farm to look after he should hunt and fish, and row and ride. In the cultivation of choice fruits and fine stock the gentleman farmer wholesomely exercises both mind and body; but to retire from business and do nothing is exceedingly dangerous. It is safer to wear out than to rust out. Recreation does not mean stupor and idleness.

The average agriculturist has opportunities for diversion and recreation, yet he overworks in seed-time and harvest; he is careless about sitting in draughts of air when sweltering with heat; and he allows his stomach to be gnawed with hunger when he goes to town that he may save the expense of a lunch. In

that respect he cheats himself outrage ously.

Ponder over the vital depression produced by the indulgence of grief, envy, hate, revenge, jealousy, and needless fear. Think of the deadly effects of intemperance and unchastity. There are those who eat too much nutritious food, and who at the same time exercise too little, yet they are few in comparison with those who are doomed to drudgery and scanty diet. In large towns and cities there are numbers of pitiful women and children who are not well clothed and housed, to say nothing of the pangs of hunger that have to be endured.

Well, what is to be the remedy for such evils? Wisdom will cure a multitude of ills. Let the brain taxed take heed and rest; instruct the farmer to take half as good care of himself as he does of his stock; reason with the intemperate and the unchaste; and educate the poverty stricken to take hope and see how they may better their condition in life. Cultivate good cheer when de-. spair holds the gloomy in chains. "The world at best is not a dreary place." It is simply dreary to those who make it such, by those who hum deplorable songs written by pessimistic poets. Away with "solemncholy" hymns set to long meter, and sung in sepulchral tones. There may be melody in plaintive notes, but the heart grows heavy in listening at too many of them. If we could live out half our days we should look on the bright side of things-we should try to feel that this world at best is a beautiful place.

GERMAN MEDICAL PRACTITIONERS. An article in the German Medical Weekly gives a statistical survey of the medical profession for 1910. Those practicing numbered 32,449, or 5.01 doctors for each 10,000 of population, an increase of 480 over 1909.

A still further growth may be ex