-"Dr. William C. Wile, of New Town, Connecticut, who came to Paris representing the committee of Arrangements of the Ninth International Medical Congress, for the purpose of laying before the profession of France the exact status of the Congress, and to extend to them a most cordial invitation to attend, honored us with a visit the beginning of the month of August, and has given us the best of hopes for the success of this important gathering, where illustrious medical men from all over the world will be brought together. We earnestly desire to induce our confreres to take part in the great scientific undertaking, to which is added an agreeable and economical voyage.-"Gazette de Gynecologie," Paris.

-The "Virginia Medical Monthly," edited by Dr. Landon B. Edwards, is one of our most welcome exchanges. No one journal contains more original matter, and its selections and condensations are judicious and interesting.

-The gynecologist of one of the "centres" in the East, who carried his antagonism against the Ninth International Medical Congress (as reported by our London correspondent in a recent number of the REVIEW) to the extreme of going to Europe and making an effort to poison the minds of our trans-Atlantic brethren against the Congress, should have prefaced his remarks to the scientists abroad by announcing as his text the 16th verse of the 11th chapter of "Paul's" second epistle to the Corinthians, viz. "I say again, let no man think me a fool; if otherwise, yet as a fool receive me, that I may boast myself a little."

-Dr. Dudley S. Reynolds, of Louisville, editor of "Progress," is chairman of the Committee of Arrangements of the Mississippi Valley Medical Association which meets at Crab Orchard Springs, Ky., the second Tuesday in July, 1887. This fact alone assures us that the meeting will be a rousing one. All physicians in good standing, eligible to membership in the A. M. A. of the West and South are invited to become members.

1887 is the campaign year of the medical profession.

-To the members of our profession who work earnestly and honestly year after year towards the amelioration of human suffering, and whose principal gain is knowledge, experience, gratitude and fame, rather than wealth, we commend

it to get wisdom than gold! and to get understanding rather to be chosen than silver !

-We wonder if the numerous professors in medical colleges, great and small, scattered over our land in hamlet and city, realize the grave responsibility which rests upon them as teachers. They speak authoritatively to receptive minds, which, as Shakespeare says, "take suggestions as a cat laps milk." Ezra Michener, M. D., of Pennsylvania, who has been in practice over seventy years and is now ninety-two years old, in an article in the "Medical and Surgical Reporter" of Oct. 9, says: Errors taught in the schools, when innocently and confidingly carried home by their thousands of medical students, tend largely to people the tenement houses of the dead.

-The New York "Medical Record," announces in its issue of Oct. 9, that it has been "taken in," so to speak, by an "Irish girl about twenty years of age, dressed in well worn finery, black and white skirt, black Jersey, frayed under the right breast (this damage to the Jersey was probably gained in an affray with some companion in sin) so as to show corset beneath, whose plausible story about a child with paralysis, presents the weak point that her dress does not indicate, that she is a neice of a lady living in the best part of the city."

We regret exceedingly that this most interesting and valuable journal, so old and experienced in the ways of the world, should have been the victim of so youthful an offender. We suspect that the damaged Jersey and exposed corset were responsible for our worthy contemporary's error of judgment, for it admits that when it permitted its eyes to fall lower upon the weak points in the dress, it was able to see through the fraud. However, could not "a lady living in the best part of the city" be possessed of a poor relation in the form of a fascinating niece with weak points in her dress?

-Dr. Withers Moore has received a letter from a woman who read his address on the "Higher Education of Woman." She gives him the advice not to repeat the "disgusting, insulting and ignorant remarks on my sex," or the matter will be settled "by administering a sound chastisement on the offender, even though he may occupy the important position of President of the British Medical Association, or of any other ridiculous trumpery association."

In return the doctor should have quoted Shakespeare and said: "Let the galled jade wince; my Withers are unwrung."

BY WILLIAM PORTER, M. D.

I. TRACHEOTOMY in Membranous LARYN

GITIS.

II. IDENTITY OF CROUP AND DIPHTHERIA. III. QUININE IN THE TREATMENT OF WHOOPING COUGH.

IV. HAY FEVER EXPERIENCES.
V. LARYNGEAL VERTIGO.

VI. TUBERCULOSIS IN CHIldren-CongENITAL TUBERCULOSIS.

VII. HÆMOPTYSIS AND APEX PNEUMONIA. VIII. CAFFEINE IN HEART DISEASE.

edge of the trachea and hold it apart. They are held in position by a tape which goes round the neck. He had experimented with the clips on a number of dogs, and found that they held well and no ill results followed.

In speaking of the place of operation, Dr. Bell stated that he preferred the low operation because there was more room, and also because, by it, we get further away from the disease. In the after-treatment of cases in which the "clips" are used, he withdraws the mucus, etc., from the trachea by means of a glass pipette. He said he did not believe in the close camp bed which is now so often used, but preferred a free current of air. After operation he plugs the trachea or larynx

Dr. Jas. Bell of Montreal read a paper upon this subject before the surgical section of the Dominion Medical Association, which met in Quebec, August 18 and 19, 1886. After discussing early and late operations in diphtheria, and the question of diphtheria being primarily a local disease, he gave his reasons for not liking tracheotomy.-(Canadian Prac., Sept., 1886.)

"(1 The tube never accurately fits; (2) When the tube is in place, the incisions into the trachea cannot be kept under observation; (3) Occasionally the tube from not being in the middle line, and being left too long in the trachea, ulcerates through, and an artery may be opened; (4) When the tube is in the trachea, there is difficulty in expelling through it pieces of membrane; (5) The tube causes sometimes exuberant granulations and warty growths. In place of the tube, Dr. Bell has

absorbs the discharges and helps to localize the membrane. Over the wound he keeps a piece of gauze, and he occasionally introduces vaseline into the trachea. When the tube is used after two or three days the breathing becomes dry, and the end of the tube becomes coated with inspissated mucus; below this, in the trachea, is a cone of dried exudation, which helps to block up the passage.

Dr. Bell gave the histories of two cases of diphtheria in which he had operated and used his "clips." One case died, and the otheraged twenty-five months-recovered. In nine cases of tracheotomy in which he has used the tube, all, with one exception, died.

He summed up by saying that the excessive mortality after diphtheria was due to defects in the after-treatment. The presence of a tube is a source of irritation, and prevents the application of remedies to the trachea itself." [The favor which this substitute for the

tracheotomy tube met with in the section is another indication that thoughtful men are looking for something better than old methods in this direction. In a recent number of the REVIEW mention was made of an instrument invented by Dr. Briggs, of this city, for the purpose of keeping open the tracheal in

cision.

Dr. O'Dwyer's method of intubation is also favored by some though not as yet sufficiently well-known to have been generally appreciated. I believe that tracheotomy will survive, but that the tube will sooner or latter be a thing of the past. It is wonderful to note that as an operation of any kind becomes more frequent, the manner of performing it becomes more simple.]

IDENTITY OF DIPHTHERIA and Croup.

The arguments of the dualists have been again very clearly and forcibly stated by Dr. J. M. Clemens, of Louisville, in a paper read before the Medico-Chirurgical Society of that city, and published in the first number of Progress for July, 1886. The author seems to think that what he regards as the error of the upholders of the unity theory is to be ex plained by the fact that they wholly ignore the existence of a non-specific, non-contagious, idiopathic membranous croup, and he maintains that such a disease does certainly exist, and that it is perfectly distinct and distinguishable from diphtheritic laryngitis. In support of his view he enumerates the points of difference between the two affections, which we reproduce in parallel columns for facility of comparison:

In addition to the signs above enumerated the author adds that diphtheritic croup is a general disease of markedly asthenic character, while true, or pseudo-membranous croup, is a local affection of sthenic type.

The importance of this question is most certainly one which can hardly be overestimated. For it has a bearing not only on the therapeutic management, but upon the prognosis and the prophylaxis as well. But, while in the abstract an error is always wrong and to be avoided if possible, yet, unless the physician can persuade himself absolutely that he has to do only with a local, non-contagious, membranous laryngitis, he would do well, in the present state of our knowledge, to regard every case of membranous croup as diphtheritic in character, and to take his precautions accordingly. If err we must, it is better to err on the safer side.-Med. Record. [The position of the Record is the only safe one, whatever may be our opinion on the question of "identity." In truth we should be on our guard in any case with exudation upon the pharyngeal or laryngeal surface. We have ridiculed those pretenders who call every follicular patch diphtheria, but on the

other hand I have seen serious mistakes made by physicians who feared the charge of sensationalism, and failed to remember that a seemingly innocent looking point of exudation might be a diphtheritic invasion. I have never regretted watching all such cases till the patch had disappeared. Within the last week a small deposit upon the tonsil had ev. ery appearance of follicular origin, but the next day had all the characteristics of the diphtheritic exudation, extending over the pharyngeal wall and upon the velum.

Those who maintain that they can at once determine the nature of a pharyngeal or laryngeal exudation may believe the proposition, but had best not attempt to sustain it in practice.]

PARKER (W T.) ON QUININE IN THE TREAT MENT OF WHOOPING COUgh.

Dr. Dawson introduced this treatment from Germany, and first used it in the wards of the Hospital for Children, in New York City, then under his care. He met with great success. In 1880 I employed this treatment in many cases in private practice. I was so much pleased with its workings, and the almost immediate relief afforded, that I have used it and recommended it ever since. The treatment which I follow is to expose the patient as much as possible to the open air, and, if practicable, at our mountain or ocean resorts, paying particular attention to food and clothing and general hygienic conditions. Every two hours I give a teaspoonful of a solution of sulphate of quinine, four, six, eight, or even ten grains to the ounce. This remedy does not disappoint in many cases in controlling the disease, and, if properly used, and with perseverance, in actually curing it, or at least shortening its course very decidedly. It seems to act as a sedative on the inflamed mucous membrane, and has also the valuable properties of a tonic. Unlike many of the other remedies which are so unsuccessfully exhibited in this disease, it has absolutely no injurious effects. The little patients begin to improve very shortly after the

first two or three doses. I am fully convinced that a trial should always be made of the solution of sulphate of quinine, in the strength and in the doses indicated, according to the age of the patient and the severity of the case; and after a few faithful experiments in this direction, I believe that no one will be able to say with truth that "the course of the disease could not be controlled by treatment."-Phil. Med. Times, June 26,

1886.

[The treatment of whooping cough has been a fruitful field for therapeutic investigation of late. Not long ago, the REVIEW published the report of W. T. Green, of London, who used the ordinary illuminating gas by inhalation with good results. But we may have too much of treatment. Whooping cough is self limiting. Care for the general health of the little patient, keep up its strength and enforce good hygienic conditions for the average case. Severe cases may require special medication].

HAY-FEVER EXPERIENCES.

Despite cocaine and galvano-caustics, hayfever continues to flourish, and the Association of Hay-fever Sufferers, at its last annual meeting at Bethlehem, reports itself in an unusually flourishing condition. The meeting in question is made up of sufferers from hay asthma, who annually indulge in a sort of rhinopathic love feast, in which experiences in sternutation and allied phenomena are exchanged, and all the remedies heard of or tried during the year are reported upon. The meetings are, therefore, very suggestive, and have about them a picturesque and eye-suffusing interest. We chronicle some of the contributions.

Mr. Fassett stated that he had found relief for two years through the rubbing of a "magnetic physician;" another gentleman highly recommended the use of sanitary woolen clothing; a third believed in the value of strict diet. With great difficulty and after persistent urging the Association succeeded in securing the presence of a distinguished

microscopist of New York, whose name is more particularly associated with the Yeastplant and Hot-water School of Pathology and Therapeutics.

This gentleman gave a lecture on hay-fever, and stated that the morphology of the secretions in this disease and in asthma were identical, and we gather from a not very complete report that the doctor found "spiralis" and various yeasty germs in the sputa of both diseases. Professor Lockwood, in apt connection with this, stated that he had once magnified the discharges (whether under a microscope or by a dose of oil he does not say) of a child two years old, and found in them a perfect botanic garden.

The president very sensibly recommended that all hay-fever sufferers start for an exempt region before their attacks come on, and the ex-president advised sufferers who are compelled to travel to insert in the nose a small piece of sponge kept wet with water. After the transaction of business, the Association adjourned-just like any other one.Journal of the American Medical Association, Oct. 2, 1886.

[The above does not offer much comfort to the sufferer. Despite the rose-colored reports appearing from time to time there is, as yet, no known specific for hay fever, though many cases may be controlled and relieved, and some cured, especially those depending upon intra-nasal conditions. Dr. Beverly Robinson in a valuable paper (Medical News, July 17, 1886), takes a decided stand against the modern tendency to relegate all cases of hay fever to nasal obstruction. He believes that when hypertrophies of the nasal passages exist carbolic acid or chromic acid are generally quite as effective as the galvano-cautery. Sajous says that not one-half of his cases of hay fever treated by the galvano cautery the last year were relieved, and the second year his results were not as good as the first. A well written editorial in the Medical News for August, 1886, concludes by saying that the electric cautery sometimes does irreparable injury in the nares, and may convert a bearable into one that is

agreeable and mortifying. It has been my own experience, that, when carefully used, the chromic acid is the most reliable and efficient agent we have for the removal of hypertrophic tissues from the nasal passage. With a knowledge of the proper use of this, and a Jarvis snare, the practitioner can accomplish much. It remains a fact, however, that he who treats hay fever without considering the systemic influences and peculiarities will fail.]

LARYNGEAL VERTIGO.

Following an interesting paper before the American Laryngological Association, Dr. F. F. Knight, (New York Med. Jour., July 10, 1886,) recapitulates:

"It is admitted that we have uncomfor table sensations in the head, and sometimes loss of consciousness following cough. The simplest explanation of the symptoms would seem to be that there is a direct disturbance of the cerebral circulation by compression of the large blood-vessels, and even of the heart itself.

The mechanism of this is easily understood when there is forced expiration against a glottis closed by spasm. With cough there is a repeated, forced expiratory effort against an intermittently closed glottis, but,even without this, we know that there is sufficient disturbance of the cerebrum, through greatly increased rate of breathing, to cause very uncomfortable sensations in the head, and to produce momentary insensibility to pain.

In order to explain why one person should experience such disturbances from cough, and another not, is difficult, and we are obliged to resort to the old theory of idiosyncrasy. The fact that some of the patients had lost consciousness before, without cough, allows us to suppose that in case of predisposition to such condition the mode of excitation may be different in different attacks; that the tendency to lose consciousness may be acted upon in very different ways, just as a patient who is liable to syncope may faint from a variety of causes, e. g., exposure to bad air, loss of blood, or simple emotion."