Local Treatment of Chronic Gastric Catarrh. In an interesting clinical lecture on this subject, Dr. T. M. G. Carter says the following concerning the third stage:

The condition referred to here is one of atrophy. The functions of absorption and motion may be fairly well performed. The chief difficulty then is with the digestion of proteids. The local treatment has two objects, mainly, although a third is sometimes in mind. The first object is the removal of debris and foreign material. The second is the cleansing of the mucous membrane and the destruction of micro-organisms and their removal in order that the intestines may not receive bacterial products from the stomach. The third object sometimes kept in view in the local treatment by douching is a degree of stimulation of the functions of motion and absorption, and the tonic effect to the gastric walls which follows those washings. The first object is accomplished by the use of sterilized water or a 3 per cent. solution of sodium bicarbonate. Either tube may be used. The second object is effected by douching the walls with a green soap solution or a solution of Hydrozone. The latter agent in 5 per cent. solution as directed above gives very pleasing results. The third object may be secured by using hot or cold water for the douche.-American Therapist.

Digitoxin.-V. Starck (Münch. med. Woch., January 26th, 1897) draws attention to the disadvantages attending the use of the ordinary preparations of digitalis leaves. Merck has introduced a crystalline digitoxin which acts promptly, has no unpleasant by-effects, and lends itself easily to the requirements of dosage. Unverricht has administered this preparation per rectum, by the mouth, and sub-cutaneously. The author has used

Merck's digitoxin in tablet form in fourteen cases of cardiac disease, namely: ten of valvular disease, one of fatty deposit on the heart, two of myocarditis, and one of arterio-sclerosis with renal complications. The tablets were well taken, and did not exercise any appreciable irritant effects on the stomach. The digitoxin was without effect in the case of fatty deposit on the heart and of only passing benefit in one case of myocarditis, but of marked value in the second case of myocarditis. In the cases of valvular disease with severe disturbance of compensation the beneficial effects belonging to digitalis leaves appeared. The re

sult was obtained, on an average, in about twelve hours. In the case of antero-sclerosis a more distinct diuretic action was ob

served under digitoxin than digitalis infusion. In three cases digitoxin had to be given on subsequent occasions, and always with good results. In one case symptoms of digitalis intoxication arose after the digitoxin had been given during three days, but these disappeared under camphor injections in four days' time. At the end of this time the cardiac symptoms were improved, notwithstanding the intoxication. The dose was here, perhaps, too large, as eight doses of mg. were given in the three days. Usually the dose employed was mg. twice a day, ten such doses being sufficient. Wenzel and Unverricht have employed rather larger doses. Thus Merck's crystalline digitoxin may take the place of the usual preparations of digitalis leaves. The use of digitoxin requires much care, the pulse being especially watched. As to whether the addition to the digitoxin of other isolated and pure constituents of digitalis leaves would increase the therapeutie effect must be left to future investigation to determine.

MEDICINE.

Sleeplessness in Typhoid Patients.-One of the most distressing symptoms, especially in the early stages of typhoid fever, is the existence of a condition of restlessness which prevents the patient from obtaining the sleep so necessary to restore his exhausted vital powers. This wakefulness may be due to the presence of high fever, and if this be the case it will speedily vanish when the proper measures for reducing the temperature have been instituted. On the other hand, if it be caused by the presence of severe pains it will cease with their removal. Again, if dependent upon the absorption of toxines from the intestinal canal, it will disappear when attention has been paid to the condition of the primæ viæ. In some cases, however, it will be necessary to resort to the use of a hypnotic, and of these trional is considered by many authors as the safest and most efficient agent of this class. Dr. F. Gordon Morrill, visiting physician to the Children's Hospital of Boston (Archives of Pediatrics, March, 1897), in writing about the treatment of enteric fever in children, states that when disturbed sleep is not due to a high temperature a five-grain dose of trional acts admirably well as a

hypnotic. Dr. J. P. Thornley, assistant attending physician and registrar to the Presbyterian Hospital of New York, who has recently contributed a most interesting description of the methods employed at this hospital in the treatment of typhoid fever, in the New York Medical Journal, writes as follows of the management of sleeplessness: "During the first ten days when the patient is kept awake by the headache, or by pure nervousness, fifteen grains of trional and one-quarter grain of codeine usually produce sleep. Such sleep is of genuine benefit and comfort to the patient, and there is no hesitation in so procuring it. When the sleeplessness is due to the pain of complications, morphine is administered hypodermically in sufficient doses to give relief."

Boat-shaped Thorax in Myelosyringosis. At a recent meeting of the Société médicale des hôpiteaux, a report of which appears in the Journal des praticiens for February 27th, M. Marie and M. Astié called attention to a very peculiar thoracic deformity which they had observed several times, which seemed characteristic of myelosyringosis, for they had never seen it in any other affection. This deformity was characterized by a depression which was to some degree formed in the upper and median part of the anterior thoracic wall; it was completed by the forward projection of the shoulders and by the obliquity of the anterior thoracic wall, which seemed to approach more and more to the spine in proportion from below upward toward the cervical region.

This depression extended from the sternal fourchette as far as the level of a horizontal line coincident with the inferior border of the pectoral muscles; it never went beyond this line below. Transversely, it was limited by the prominence of the shoulders. The long axis was directed from above downward, so that it might be considered as two abrupt lateral borders. These were the sides of the boat, one the upper or cervical extremity, or the prow, and the other the lower or abdominal extremity, or the stern, which gradually sloped upward. The bottom of the depression was flat and slightly irregular, so that the maximum of the depth was sometimes on the left and sometimes on the right of the median line; more frequently it was several centimetres below the sternal fourchette. The greatest depth observed by the authors was five centimetres and a half.

Since it was due to a bony deformity, this appearance of the thorax should not be attributed to the disposition of the pectoral muscles; it was not, either, a natural appearance consequent upon the projection of the shoulders. In fact, there had been very little atrophy of the pectoral muscles in the patients observed by M. Marie and M. Astié, and in those affected with myopathy, in whom the pectoral muscles had completely disappeared, the aspect of the thorax did not in any way resemble that of the boat-shaped form. It was unnecessary to add, the authors said, that scoliosis also, which existed in their patients, was not the cause; the thoracic costal deformities following scoliosis were entirely different from this one, which was not found in any form of scoliosis.

It was evidently a trophic lesion like other bony lesions of myelosyringosis, and one that occurred frequently, for the authors had observed it four times in ten cases of this disease, and they concluded, therefore, that a boat-shaped thorax might be an effectual aid in the diagnosis.-N. Y. Med. News.

Gonorrheal Endocarditis.-A case of endocarditis due to gonorrhea came under the observation of Michaelis. A man, twenty-five years of age, in the third week of an attack of acute gonorrhea, was seized with severe rheumatic pains in the finger joints. The metacarpal-phalangeal joints of the third and fourth fingers became much swollen; temperature, 102.4° F. After a few days a scraping, systolic murmur was heard in the aortic region, and on the twelfth day after admission to the hospital the patient, with but a moderate fever, succumbed to a fatal syncope. On section, a verrucose mass about the size of a hazel nut was found attached to the aortic valve, and beneath this was a rupture. Microscopic and bacteriologic examinations revealed the presence of gonococci.-Zeit. f. Klin. Med

Treatment of Chronic Empyema by Decortication of the Lung.-Delorme (Gazette Hebdom. de Méd. et de Chir.) reports nineteen cases of chronic empyema of from six months' to eleven years' duration, in nine of which the above-mentioned procedure effected either an entire obliteration of the cavity or greatly increased pulmonary expansion. Failure resulted from pulmonary tuberculosis, either unrecognized or following an

otherwise successful operation, or from inability to detach the fibrinous covering of the lung.

The cavity should be disinfected for several days before the operation. No special instruments are needed. Those used should be long and blunt. Most of the work can be done with the fingers. The presence of adhesions should be determined before opening the chest-wall, and to avoid shock the operation should be as rapid as possible, and the region of the pericardium and diaphragm avoided. Care should be taken not to penetrate the lung in the first incision through the membrane. Should this occur, a fresh incision should be made. Hemorrhage is slight, when neither parenchyma or visceral pleura is wounded.

In the after-treatment, exercise and pulmonary gymnastics are advisable. When decortication is impossible, the operation must be abandoned, and that of Estlander or Schede substituted.— Med. News.

PHYSIOLOGICAL AND PATHOLOGICAL NOTES.

The Absorption of Iron in the Intestine, and its Relation to the Blood.-In the Presse médicale for February 10th M. Chassevant states that M. Cloetta has made some experiments in regard to the elimination of iron in the economy (Archiv für experimentelle Pathologie und Pharmakologie, 1897). For this purpose he used ferratin, which exercises no caustic action on the tissues. His experiments demonstrated that in dogs which were subjected to a milk diet, the iron injected into the veins in the form of ferratin was eliminated by the large intestine. Quincke has also ascertained this by micro-chemical examination. The author also investigated the means of assimilation of this element when administered by the digestive tract, and he found that twenty per cent. of a dose of ferratin introduced into the stomach of a dog subjected to a milk diet was absorbed.

According to M. Cloetta, the organic combination of iron with albuminoid matter is necessary in order to insure its absorption. For instance, two dogs were experimented upon as follows: their food consisted of a soup made of starch, sugar, glucose, and distilled water. To the nourishment of the first dog a solution of iron chloride, representing sixty milligrams of iron, was added; to that of the second dog a solution of ferratin representing forty milligrammes of iron. The villosities of the dog