that a dilution of two-thirds may be too great.

When infants grow rapidly and do nicely, cream may be added, or the amount of milk increased. Sugar of milk is the proper substance to sweeten the mixture with, for it is not apt to cause fermentation; it is slightly laxative, and when lime water is used with the mixture to make it alkaline, the sugar of milk makes the lime more soluble, and therefore the more readily goes to form bone tissue.

A good way is to add the sugar of milk to the barley water when made, and put it into a clean bottle. It is best to make only enough for the day. When the barley water and milk have been mixed, it remains to see if the mixture is alkaline; if not, to use lime water or soda bicarbonate until it is.

Phosphate of soda has been recommended, but I have never used it. It will be necessary to provide the nurse with litmus paper. After four years use of this food in a country practice, where I have had every chance to know when it agreed or when disagreed, and how, enables me to urge you to give it a thorough and impartial trial. I have never found it to fail. Sometimes failures result in not correcting dyspepsia when existing, or the results of improper feeding or improper food.

In the majority of cases in which the subject of the infant's food comes to our notice, we are called in to treat the child for some sickness. When an infant has been for a long time fed improperly, and the mucous membrane of bowels and stomach is out of order, the condition needs to be corrected, else the food will fail. It will not be enough to give the proper food and say the child is not sick. Bromides, with soda and chloral, or hyoscyamus, are needed just as much as proper food.

Unless this is attended to, the nurse will surely give it soothing syrups, and you will fail, and very likely lay it to the mixture. It is necessary to mention this source of failure for the benefit of the younger prac.

titioners.

In conclusion, I will say that my experience

with this mixture has been that it is perfect. It can be used when the mother does not furnish sufficient food herself, and the infant does just as well as if it was all her own. It only remains to say that after the age of three months it should be diluted about half for about six months, for eight months one-third, and when it is ten or twelve months old, it can be given clear milk.

Offensive Diarrhea in Children.

There is a form of diarrhea in children,usually occurring after weaning, and from that period to four or five years of age, which is characterized by the most horrible offensiveness of the motions. This is so marked that it is generally at once mentioned by the parents. It is commonly met with in summer, but is not strictly what is known as infantile diarrhea, in which disease the stools are sour, but not necessarily fetid. Probably this form of diarrhea differs from the diarrhea of younger infants in being caused by the growth of the ordinary bacteria of putrefaction. It is not amenable to treatment by any astringent, nor has any alteration of diet much effect upon it.

Dr. James Braithwaite (Brit. Med. Jour., July 17, 1886), however, thinks that it may be successfully treated by disinfecting the bowel contents by means of salicylate of iron, as in the following prescription, which is suit able for a child two years of age: Sulphate of iron, Di; salicylate of sodium, Di; glycerin, 3iij; water to three ounces. The iron and salicylate should be dissolved separately, and the solutions mixed. The color is darker than port wine, and the taste not unpleasant. One teaspoonful must be given every hour, until the stools become well blackened, which happens in about twenty-four hours; or a larger dose may be administered at longer intervals. The medicine should then be given every three or four hours, and occasionally a small dose of castor oil, to clean the bowels well out, and to get the secondary constipating ef

fect of the oil.

In hospital practice, and amongst the poor,

it is not so successful as it would be if it were possible to remove the child from the family living room, the air of which is usually very impure, and is made worse by the smells incidental to cooking, and the presence of a sink.

[As a corrective of this condition, nothing is more satisfactory and efficient than infinitisimal doses of that most reliable antiseptic and germicide, viz., bichloride of mercury in doses of 1-100 of a grain every two or three hours, largely diluted with water. The sali cylate of iron is a very disagreeable mixture to most children, whereas the bichloride solution is not.

ulous, and hemorrhage continuing, a prescription of ergotine, nux vomica and cit. ferr. et quinia was given in capsules, each containing two and one-half grains cit. ferr. et quiniæ, one to be taken every four hours. After the third had been taken, the patient became covered with an erythematous eruption over the whole body. The itching was intense. The patient at once inquired if she had been taking quinine, and explained that on severa previous occasions she had taken the drug with identically the same effect. The erup tion on the body was scarlatiniform, while that of face and hands was morbilliform. The acute symptoms continued for four days being followed by a very free desquamation"flakes of skin, 2x4 inches, being cast off, re

The patient stated her inability to take Brown's Iron Bitters, as it contained quinine. According to Dr. Wilkinson, each dose of this bitters contains only about one-fifth grain of quinine. That so minute a quantity of quinine could produce such symptoms is indeed the strangest feature of this very interesting case. But I feel sure that no false conclusions were reached in this case, since the patient stated that five times the same thing had occurred when she had been taking quinine. The doctor supplements his report by giving the details of a sixth attack suffered by this lady about one month later than the one described. A physician who did not. know her idiosyncracy, was called in and gave a moderate dose of quinine; all of the above symptoms were gone over, with a very great increase in the amount of exfoliation. On this occasion a cast of the whole foot came away, which was preserved and exhibited to the medical society.

A HAPPY RESULT IN A CASE OF ECZEMA.

When one has practiced medicine a few years, he has generally found out the intractable nature of chronic eczema, and feels but little confidence at best in giving any but a very guarded prognosis, and even then always allows himself an abundance of time to carry

out his treatment before favorable results can be expected. It was with these misgivings and careful prognostications that I undertook the treatment of Mrs. S., a lady about 50 years old, in general good health and the mother of a family.

con

She gave a history of eczema for nearly a year, during which the disease had steadily grown worse and the affected area was stantly extending. The lesion was on the foot and leg, extending almost to the knee. The skin was much thickened, indurated and fissured. The itching was distressing in the extreme, the patient remarking if it could not be relieved, it would run her crazy.

The following treatment was ordered: A teaspoonful of crab orchard salts in large glass of cold water on rising in the morning; seven to ten drops of Fowler's solution after meals, and the ointment for local application consisted:

that the internal treatment of acne will henceforth be a thing of the past, if future experiment continues to approve the method of passing cold steel sounds into the urethra, as advocated by Dr. Sherwell in his paper before the American Dermatological Society. Sev eral observers have confirmed the value of this treatment, the last of whom, Dr. Hutchinson, of Chicago, has reported the cure of thirteen cases in the male sex, the majority of whom had no symptoms pointing to the urethra, nevertheless, the treatment was based upon the idea that there were hyperemia and irri tability present. Having found the value of cold sounds in men, he has treated six out of seven cases in women successfully by the use of hot injections. The analogy would have been better sustained had he used cold injections. This is also upon the theory that acne in women is due to hyperemia and irritability of the uterus and the appendages. We see in this an opportunity gynecologist and dermatologist, and another confirmation in favor of the scientific general practitioner, so opposed to the myopic spe cialist.

a clash between the

as matter upon the clothes will reinoculate and continue the case indefinitely."

We have never tried these remedies compounded as they are in this prescription, but all of them are familiar to most physicians as remedies for gonorrhea. We feel safe in asserting, however, that when tried under the most favorable circumstances, it will not cure ten per cent of cases in ten days much less three. Should any of our scribers feel inclined to try the prescriptions here given, we would feel obliged if they would send us the results of their experi

ment.

Dr.

THE INTERNAL TREATMENT OF GONORRHEA.

At a meeting of the Berlin Society of Internal Medicine held June 21, a discussion arose upon the treatment of gonorrhea by medicines. Dr. Posner stated that what had been learned about the gonococcus was interesting: it had not given us much that was practical so far as treatment was concerned. Antibacterium treatment had not given us brilliant results, and to-day we treat gonorrhea with well known remedies, and combat it chiefly with various forms of injections. The value of these injections depend upon their curative influences upon the mucous membrane rather than their destructive power on the gonococcus. Internal remedies act beneficially by passing through and cleaning out the urethra in an opposite direction from that produced by the injections. Posner speaks highly of the sandal wood oil, which has such a reputation in France, which he has used much because injections are frequently not well borne, and indeed are often capable of doing harm. The speaker believed that many cases that would get well spontaneously were often kept up artificially. He has used sandal wood oil in all stages of gonorrhea and has found it always better borne than any of the other balsams, and under all conditions exerted a better influence on the disease. In those cases of gonorrhea where we have to cease injections on account of epididymitis, cystitis, prostatis, etc., this

9 its

Dr. Lublinksi had used sandal-wood oil for about four years-since his attention was called to it by some English authorities—and he confirms Dr. Posner's statement as value. It does not offend the stomach near so quickly as the old balsam copaiba, but its action is not so strong as the latter drug. He has increased the dose to twenty drops, in conjunction with peppermint tablets. In severe tenesmus, even when the bladder is affected, he has seen it act admirably. Dr. Rosenthal had also used sandal-wood-oil, but when a decided result was not obtained, he was better satisfied with the balsam copaiba. When the disease is in the posterior part of the urethra, in the neighborhood of the neck of the bladder, balsam of copaiba has an especially favorable action, but if the disease is in the first stage, it is not so good. not altogether agree with Dr. Posner that no injections are necessary. That balsam copaiba has an action on the gonococci is shown by a recent work of Oppenheimer. The gonoccoccus does not grow when placed in the urine of a man taking the balsam. When the inflammation reaches the neck of the bladder, all injections should be withheld-and it is

He does

then at balsam copaiba has its best effect. Dr. Caspar also affirmed the essentials as announced by Dr. Posner. He had first learned of the use of oil sandal wood in England two years ago, and had made frequent use of it. He thinks the dose given by Dr. Posner rather high, and gives himself about ten drops three times a day. The East India sandal-wood is to be preferred.-(Jour. Cut. and Ven. Diseases) (The Am. Pract. and News).

The above, emphasizes the fact to which attention was called but a short time since, viz., that in reality very little advance has been made in the treatment of this--one of the very commonest diseases we are called upon to treat. The discovery of the germ (gonococcus) and our knowledge of germicides, has not shortened the duration of gonorrhea one whit. It also emphasizes the additional fact that so far as the lessening or mitigation of disease is concerned, the germ theory so far has been a failure.

SIMPLE METHOD OF ARTIFICIAL RESPIRA TION.-In the Brit. Med. Jour., (London Med. Record), Mr. J. A. Francis describes a simple method of artificial respiration which he alleges, combines all the advantages of the Marshall Hall, Sylvester, and Howard methods, without any of their disadvantages. The of their disadvantages. The plan is as follows: The body of the patient is laid on the back, with clothes loosened, and the mouth and nose wiped; two bystanders pass their right hands under the body at the level of the waist, and grasp each other's hands, then raise the body until the tips of the fingers and the toes of the subject alone touch the ground; count fifteen rapidly; then lower the body flat to the ground, and press the elbows to the sides hard; count fifteen again; then raise the body again for the same length of time; and so on, alternately raising and lowering. The head,arms and legs are to be allowed to dangle down quite freely when the body is raised. The author alleges that this method is most successful, and it is so simple that anyone can perform it without any teach

ing.

SELECTION.

THE MEDICAL ASPECT OF SURGERY.

BY FREDERICK ABELL HUMPHRY, F. R. C. S., Surgeon to the Sussex County Hospital.

Address in Surgery before the British Medical Association.

MR. PRESIDENT AND GENTLEMEN: — In former years, your visits have been meat made to great centers of industry, and gr centers of intellectual and professional activ ity and vigor. Your visit this year is to a town probably quite as large as many at which you have held your meetings, but it is a special manufacture, no definite industry of town of a peculiar character. Having no its own, it is wanting in many causes of those great surgical injuries and surgical diseases that form the fruitful subject of such a paper as this. In fact, it is a town where not disease, but recovery from disease is, medically speaking, its great characteristic. And so, in the wards of our hospital, the numbers of serious and acute diseases do not hold the ordinary proportion to the chronic and stru mous cases; hip joint disease, necrosis, and rounding country districts. similar affections that abound in the sur

In casting about, then, for a fit subject for these remarks, I have not chosen to bring be fore you any gorup of cases from my own experience, or any special form of treatment wider, and, I trust, as interesting, a subject for any special disease, but rather to take a for consideration.

Looking back over the last half century, I suppose the greatest change that has occurred in the practice of surgery, has been the dedevelopment is cause and consequence, too, velopment of the so-called specialties. This of the enormous increase in the knowledge of the art and science of surgery that has oc curred during that period; with that increased knowledge have come increased facilities for investigation of disease, and much improved methods of treatment. But, while fully recognizing and valuing these great and rapid advances in different directions, it may be worth while to pause as it were, to take breath-and even look back on the ground already covered. Are we going too fast? Old theories, old opinions, old treatment, old books, are they sufficiently studied and considered? Are the old relations between medMedical Side of Surgery (if I may so speak) icine and surgery still maintained? Is the holding its ground, and making the same ad