Bilious Headache.- Dr. Eccles, an English surgeon, recently read before the British Medical Association an able paper on the treatment of what is commonly known as bilious or nervous headache, in which he called attention to the fact that the locality of the headache appears to be identical with a distribution of the nerves connected with Arnold's branch of the pneumogastric. In the words of the author, "The irritation of the gastric fibers is reflected or referred to the sensory fibers of the pneumogastric in the head (auditory branch). In the treatment of a large number of cases of this sort, we have observed, on examination, tenderness of the pneumogastric in the neck, invariably in the side affected the most frequently, and there is usually corresponding tenderness in the region of the solar plexus, or in one or both lumbar ganglia of the sympathetic. Massage is recommended by Dr. Eccles as a salutary remedy in these cases, as he has uniformly observed dilatation of the stomach and deficient peristalsis of the stomach and intestines."

Our observations respecting the frequency of dilatation of the stomach agree very closely with those of Dr. Eccles. We have found, however, the quickest means of relieving nervous or sick headache is lavage to the stomach, which acts with unfailing and almost instantaneous certainty. The majority of patients declare themselves feeling better by the time the stomach washing is fairly completed, and in a few hours are fairly restored to their usual health, although accustomed to suffer many hours, or sometimes days, with the headache, when treated in the ordinary way. J. H. K.

Therapeutic Results of Massage in Structural Disease.- Merck's Bulletin sums up the effects of massage in bruises and other traumatic tissue injuries, as follows:

In simple contusions, it brings about the

rapid disappearance of divers disturbances, especially pain.

In contusions of the joints, it dissipates the muscular reflex contractures or the pareses, but above all it prevents obstinate amyotrophy, which is the most serious of complications.

Applied to sprains, it is remarkable for the rapidity of its good effects; the looked-for result is obtained in three or four days.

In dislocations, recourse must be had to it as soon as the reduction is assured, as it reduces, in the shortest time, the swelling, ecchymosis, and pain; it arouses. the muscular fiber from that local stupor into which it is plunged by the traumatism; and it prevents atrophy and lingering stiffness.

Applied to juxta-articular fractures, it soon subdues both pain and swelling; if recourse is had to it after the removal of apparatus, it limbers up the parts and dissipates the cedema. A simple fracture, without deformation of the lower end of the radius, is cured in a fortnight, whereas at least forty days are necessary when immobilization with plaster dressings is resorted to.

Against acquired amyotrophy, massage shows itself powerless; if applied in the earliest stages, it may prevent the further progress of the affection.

The clinical conclusions are based on the histological results; a wounded muscle to which massage is not applied presents a diffuse sclerosis, with hypertrophy of the adjoining connective tissue in the various parts, interstitial hemorrhages, engorgement of blood vessels, and hypertrophy of their outer coat; whereas a wounded muscle, treated with massage, offers a normal histology. This is restitutio ad integrum.

The bloodvessels are normal in the muscle to which massage has been applied; in the muscle not so treated, they present a hyperplasia of the external tunic. The nerve filaments, normal in the muscle to

which massage has been applied, show signs of perineuritis and interstitial neuritis in the muscle not treated with massage.

The lesion of the nerves is more marked than that of the bloodvessels.

Upon the whole, according to the researches made by the author, it is proven, de visu, that massage acts by deterging a part of the variously noxious substances which the traumatism has introduced, by bringing the affected part back to its normal state, and by so preventing the process of diffuse sclerosis which would otherwise result.

When the

Abdominal Massage. writer first began the employment of abdominal massage, nearly twenty years ago, this procedure was looked upon with disfavor by the medical profession, who regarded hygienic appliances of all sorts as belonging to the domain of quackery. This excellent mode of treatment, however, has won its way into favor with scientific physicians in all parts of the world, and at the present time no one would think of denying its great value in certain forms of abdominal disorders, particularly those of the bowels and visceral prolapse.

A great variety of procedures have been proposed for the application of massage to this portion of the body, one of the most recent of which is what is known as Sahli's method, which consists of the application to the abdominal walls of a cannon ball with a rolling movement, the patient lying upon the back. Ivanoff has suggested the employment, as a substitute for the cannon ball, of a hollow wooden or celloidine globe partially filled with shot. The use of bags partly filled with shot has also been suggested, and the writer has made extensive use of both the cannon ball and the shot-bag with excellent results. The advantage of this method is, that the patient can use it himself, although of course it can be more advantageously employed by an attendant.

The cannon ball and shot-bag are of special service in cases of atony of the stom ach and bowels. For the relief of the last-named condition, the most prominent symptom of which is constipation, due to the lack of ability of the muscles of the colon to contract upon the contents of the bowels, the ball or bag should be applied first to the lower part of the abdomen on the right side. It should be rolled upward to the ribs, then across the body, then down upon the opposite side, continuing on in a nearly circular movement. application is best made before breakfast or half an hour after breakfast.

The

In cases of dilatation of, the stomach, or gastric insufficiency, in which the muscular structures of the walls of the stomach are unable to expel the contents of the organ at the proper time, so that the food, being too long retained, undergoes fermentation, the movement should be similar, but in the opposite direction. The ball, being applied first upon the left side, upon a level with the umbilicus, is moved upward close under the ribs of the left side to the epigastrium, and down upon the opposite side on a level with the umbilicus, continuing the movement as before. To aid the stomach in ridding itself of its contents, the application should be made about three hours after The writer has found this an exeating. cellent means of relief in cases in which gastric insufficiency is a marked feature. The shot-bag may be used precisely in the same way as the cannon ball or the hollow globe filled with shot. Manipulations may be made with the hands in such a way as to accomplish the same purposes. For manual massage, however, an attendant is, of course, indispensable.

Abdominal massage is beneficial in a great number of other conditions besides those mentioned. The following are some of the leading therapeutic effects which have been demonstrated as resulting from the proper application of the abdominal massage:

1. The contents of the alimentary canal are moved onward.

2. The portal circulation is accelerated, and also the circulation of the lymph in the lymphatic channels.

3. Absorption is stimulated by the increased activity in the portal circulation. 4. The production of gas is diminished, and its expulsion encouraged.

5. The respiratory movements are increased, thus relieving hepatic congestion, and general visceral congestion in the abdomen.

6. The nerves and nerve-centers of the abdominal sympathetic are stimulated, and thus the vital activity of all the abdominal viscera is accelerated.

J. H. K.

Treatment of Myxedema. — This unfortunate but comparatively rare disease has recently received considerable attention by the discovery of the relation sustained to it by the thyroid gland. Dr. Murray reported recently in the British Medical Journal a typical case of this disease, in which almost complete recovery has been secured by hypodermic injections of an extract of the thyroid gland of a sheep. The gland-extract was prepared as follows: Taking the thyroid gland of a sheep just killed, and carefully removing all the fat and cellular tissue, the gland is divided into small morsels. One c.c. of pure glycerine and an equal quantity of a two-per-cent solution of phenic acid are then added. The mixture is then placed for twenty-four hours in a glass vessel closed with sterilized cot

Association.—

An Anti-spitting Spitting, except in a proper receptacle, should be prohibited by law in all public buildings and such public carriages as omnibuses, street-cars, railroad-cars, steamboats, etc. Modern science has shown that sometimes potent causes of disease and death are communicated by germs which are found in the expectorated matter of persons suffering from infectious maladies. For example, pneumonia, diphtheria, and consumption, three of the most deadly diseases, which are responsible for fully one fourth of the deaths that occur in thickly settled districts of civilized countries, are always communicated by germs found in the sputum of patients suffering from these diseases, and are doubtless communicated through the diffusion of the particles of dried sputa, which, being deposited upon the floors of lecture rooms, churches, street-cars, and omnibuses, and upon the street pavements, become dried, and are ground to dust, and then whirled into the air as minute motes, which dance in the sunbeam and carry disease and death to those who unsuspectingly inhale. inhale the germ-laden air. These deadly germs can be found in the air of almost every church, opera house, or lecture room, and their presence has also been demonstrated in the air of sleeping-cars. The State of Pennsylvania has prepared and widely circulated a little notice setting forth the dangers of spitting, which has been posted in every schoolhouse in each city, and the teacher requested to call attention to the evils which it points out, at least once a week. The example is a good one, and ought to be imitated in every city in the land.

The measure taken for the suppression of the spitting nuisance above referred to, was the result of the active effort of an association formed by the ladies of Pittsburg, under the leadership of Mrs. J. M. Oakley. It might be called the Antispitting Association, as it is giving special

attention to the suppression of this public evil, the dangers of which are yearly becoming more conspicuous.

WE are glad to announce the addition to our list of distinguished collaborators, of the name of Prof. E. Meinert, M. D., of Dresden, who will contribute at an early date, a very valuable and interesting article on the Anatomy, Methods of Investigation, and Etiology of Enteroptosis. The subject is one of very great interest, especially to American readers, to whom it is comparatively new, and we are glad to be able to present the subject to our readers from the pen of so able and original an investigator as Dr. Meinert. It is also a pleasure to us to know that the results of the interesting studies made by Dr. Meinert within the last few years, relating to this important question, agree entirely with our own results, which have already been published. There is, perhaps, no question relating to practical therapeutics which has a more vital and direct bearing upon the every-day work of the physician than this.

REVIEWS.

J. H. K.

Eighth Biennial Report of the Illinois Eastern Hospital for the Insane, Kankakee. This volume, the chief part of which consists of the biennial statement of the medical superintendent, presents a model report of a model asylum for the insane. Dr. Richard Dewey, the well-known medical superintendent, has in its organization erected a monument to himself in this model institution for the treatment of the insane. Instead of massing patients together in one large building, and subjecting them to a course of treatment which might fairly be termed "meditation on death or on chronic lunacy, the Kankakee asylum is organized on the cottage plan, the patients being gathered in

families of from forty to sixty and classified as far as possible. Here they receive the benefit of the most advanced rational methods for the treatment of the various forms of nervous and mental maladies from which they are suffering.

The great State of Illinois has reason to be proud of the grand Hospital for the Insane, at Kankakee, and it is to be hoped that the labors of the man who has been chiefly instrumental in creating this admirable institution, are sufficiently well appreciated by his fellow-citizens, and especially those who have recently assumed the reins of government, to enable them to disregard the opportunity for displacing him by a man of lesser worth and ability. Nothing could be more antagonistic to all ideas of propriety and justice than the removal of so efficient a public officer, simply for the purpose of filling his place by a man of political affiliations. Such a man as Dr. Dewey is above politics, a fact which it is to be hoped the new democratic governor of the State of Illinois will recognize.

Uber Enteroptose.- Concerning enteroptosis, or intestinal prolapse. By E. Meinert, M. D., Dresden. This brief paper consists of a note communicated to Der Gesellschaft fur Natur und Heilkunde. Dr. Meinert has made extensive investigations upon the subject of enteroptosis, or intestinal and visceral prolapse, and published in connection with his note a large number of interesting observations, which will be given to the profession in the near future. The subject is one that has been greatly neglected, and the thanks of the profession are certainly due to Dr. Meinert for his painstaking investigations.

A National System of Sanatoria: A Plea and a Prophecy.- By Samuel S. Wallian, A. M., M. D., of New York. The author has evidently had no great experience in the management of Sanitariums.