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soft palate looks thick and seems bulged forward and immovable. The faucial tonsils are apt to be simultaneously hypertrophied, and the symptoms which are really peculiar to the adenoid. vegetations have been wrongly attributed to the enlarged faucial tonsils. To be certain of the presence of adenoid growths, when posterior rhinoscopy is not practicable, the left forefinger should be passed gently behind the soft palate. The growths will be felt on the posterior wall and vault of the pharynx as soft velvety masses, bleeding readily on touch. The difference

between the smooth walls of a normal cavity, and one blocked with vegetations, is marked, but some children contract their soft palate with such force as to impede the movements of the finger, and the contraction of the muscular fibres of the palate itself may feel like a circumscribed tumour. Dr. Hooper considers it a waste of time to attempt to reduce these growths by local applications, but advises that they should be at once removed. To do this he prefers to anaesthetize the child and remove the growths with post-nasal forceps, supplemented, when necessary, with a post-nasal curette or steel finger nail. The improvement in the child on the removal of the growths is most striking, especially as regards the character of the breathing, quality of voice, hearing, and intelligence.

Treatment of Congenital Hernia. By Lewis W. Marshall, M.D. (Brit. Med. Jour., May 19, 1888.) -Dr. Marshall treated fortyone cases of congenital hernia during 1887 by the wool-truss first suggested by Mr. Coates of Salisbury. In every case he found congenital phimosis or imperfect urethral opening coexisted. Of the forty-one cases, twenty were cured at the end of the year, twelve were not well, and nine lost sight of. In all the twelve cases not well, the urinary condition had not been efficiently dealt with, in one case pertusis was also present, in another obstinate constipation, and in several general malnutrition. Dr. Marshall considers that this set of cases shows that the urinary difficulty is the primary factor in the production of congenital hernia in the male, and that if it is duly recognised and corrected, the pressure of the wool-truss is ample to ensure

closure of the canal in all cases in which nutrition is well maintained.

Jeffries on the Sterilization of Milk and Foods for Infants. (Amer. Jour. Med. Scien., May, 1888.)-Dr Jeffries' attention was called to the state of the milk supply of Boston, by the severity and prevalence of summer diarrhoea among infants. He found that though "fresh each day" the milk was decidedly acid, and by the time it was given to the infant, curdled when heated. He proceeded to make a series of experiments on the sterilization of milk and other infants' foods, and found that milk was efficiently sterilized by steaming for fifteen minutes, whilst steaming changed the milk less than boiling. He therefore, directed that all milk used for the infants should on receipt be steamed in a skillet set into the top of a teakettle, after this it was to be kept covered, and when possible on ice. The result was that instead of staying at the point of death, the little patient's began to pick up and were soon well, the stools first becoming light and then yellow in colour.

On the Treatment of Habitual Constipation in Infants.- By Eustace Smith (Brit. Med. Jour., July 7th, 1888) Habitual constipation in infants at the breast is sometimes due to a deficiency of sugar in the breast milk; at others, to a milk the curd of which is firmer than is common in human milk. In hand-fed children an excess of starch in the diet, or any food which overtaxes the child's digestive power and thus burdens the alimentary canal with a large undigested residue, may set up the costive habit. A mild catarrh of the intestinal mucous membrane results, and the fæcal masses, rendered slimy by the secretion, afford no sufficient resistance to the contractions of the muscular coat of the intestine, which slips ineffectually over their surface. Another cause of constipation is dryness of the stools, generally due to insufficiency of fluid taken. Constipation is often made more obstinate by an infant's own effort to delay relief, because of the suffering caused by the undue distension of the sphincter by the hard, costive motions. Torpidity of the bowels due to the use of opium must not be

forgotten. Dr. Smith says that an infant whose bowels are habitually costive is not necessarily injured by the want of a daily relief, but often it will cause flatulent distension, colicky pain, restless sleep, furred tongue, and loss of appetite; whilst the straining may prolapse the bowel or cause the navel to

start.

Attention to feeding and clothing is of as much moment as drugs. A teaspoonful of syrup three or four times a day will often correct constipation of a baby at the breast; or, if the motions are hard and dry, a little plain filtered water. Exposure of the limbs and belly may cause the constipation due to mild intestinal catarrh; in such a case the thighs and legs, as well as the belly, must be well covered with flannel. In the diet, excess of starch must be avoided. Mellin's food is useful as it has a gentle laxative effect, but it does not prevent the curding of milk in the stomach, this can be ensured by diluting the milk with barley-water. The peristaltic action of the bowels can be stimulated by friction and kneading of the abdomen in the direction of the colon. Suppositories and injections though useful in producing an immediate evacuation of the bowel in no way tend to promote regular action in the future, and large injections of fluid, if frequently given, are distinctly hurtful by dilating the bowel and weakening its muscular coat.

In remedies by the mouth, strongly-acting purgatives are worse than useless. The aim should be to find the smallest dose which will awaken a normal degree of energy of peristaltic action, and combine with it a remedy, which tends to give tone to the muscular coat of the bowel. A useful mixture of this kind is composed of half a drop of tinct. of nux vomica, ten drops of tinct. of belladonna, twenty drops of infusion of senna, made up to a fluid drachm with infusion of calumba. This, at first given three times a day before meals, will soon be only needed once at bed-time.

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The Kreuznach Mother-Liquor and Calcium Chloride in the Treatment of Skin Diseases.—Dr. E. Lier finds that the value of Kreuznach Mother-Liquor depends on chloride of calcium, of which it contains nearly 350 parts per thousand. He says it may exert primary or superficial, and secondary or deep effects. The first is procured by using for a short time baths of under 90°, with or without the addition of mother-liquor, and applications of a paste of oxide of zinc, and terrasilic, ãā 500, vaseline 1500, mother-liquor 2500. This treatment is useful in erythema, moist eczema, impetigo, psoriasis, and tubercular glands. The deeper effects are obtained by the use of warm baths, 93° to 99°, of longer duration, with the addition of a large quantity of mother-liquor, and also by using compresses of the same, either pure or slightly diluted. This treatment is indicated in pruriginous and keratoid eczema, icthyosis, scleroderma, and all forms of skin diseases in which there is much infiltration or induration of the cutis.-Centralblatt für die Gesammte Therapie, July, 1888.

Treatment of Callosities, Corns, and Warts.-Rosen has used with good results salicylic acid, in powder, covered with moistened bandages. He proceeds as follows: -He first moistens the diseased spot with an aseptic solution, and then covers it with a thick layer of salicylic acid. Over this he places some very fine borated lint in four thicknesses, and covers the whole with a piece of gutta percha. The dressing must be left for five days, and unless the patch be over indurated, it will probably be cured. Should this not be the case, the procedure must be repeated, and the dressing left undisturbed for a longer period.-Münschen Med. Wochens., No. 28, 1888.

Alterations of the Skin which are produced at the time of Puberty and at the Menopause.-A very interesting resumé of the

above conditions is published in the Journal of Cutaneous and Genito-Urinary Diseases, August, 1881. The most common affections are:-1. Hyperidrosis; 2. Erythema; 3. Eczema; 4. Acne; 5. Erysipelas; 6. Urticaria; 7. Pemphigus; 8. Pruritus; 9. Pigmentary Hypertrophies

Hyperidrosis.-This is frequent at the menopause, less common at puberty, and may be local or general. Local hyperidrosis is most commonly found upon the face, which becomes red, turgescent, and covered with a hot sweat, but it may occur anywhere. Generalized sweating is quite frequent, and its appearance is often preceded by a slight shivering and a sensation of swooning.

Erythema. This often follows hyperidrosis, and a transient form, erythema fugax, may be produced by moral emotion and vasomotor troubles.

Eczema. Hyperidrosis may set up eczema, but this often occurs independently, especially at the menopause. In the rheumatic diathesis it is not infrequent to find a history of an attack of eczema at puberty, and its reappearance at the menopause. It often attacks the ears, face, scalp, and feet, but eczema of the genitals is often observed at the critical age. It begins upon the labia majora, and spreads to the neighbouring parts, occasionally affecting the anterior part of the vagina. It is very severe on account of the great itching; it has evening exacerbations, and the itching is not less than in pruritus, an affection which it often succeeds.

Acne Rosacea.-Acne vulgaris and acne rosacea are very common at puberty, and according to Kaposi they are due to the increase of function of the sebaceous glands, coinciding with the active development of the hairy system. The small white pearly form of acne vulgaris is most common, but the indurated form is not infrequent. It often disappears after marriage, and Hardy suggests a connection between continence and the persistence of acne. The menopause is often associated with increase of pre-existing acne vulgaris and an outbreak of

rosacea.

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