get more oxygen. This practice of lung gymnastics does not tend to cause hæmorrhages. With care the lung expansion can be greatly increased. When the lungs are seriously impaired special efforts must be made to secure sufficient lung capacity to obtain the oxygen requisite for a cure. The ordinary breathing of the patient in the open air will not do. A strong protest is entered against the custom of stuffing the patient with nourishment. Not one mouthful more should be given than can be digested and made into blood. In addition to beef, eggs, milk, etc., praise is given to sanguis boum, a mixture of ox blood and Malaga wine. When the pulse is over 100 very little exercise should be permitted. The patient should then lie or sit in the sunshine. The skin may be rubbed at night with cod liver oil to which may be added creosote, and a morning bath given. Inunctions of sulphur or iodine compounds over the diseased lung are useful. The only remedy for the cough is cool, pure, or cold fresh air day and night. The cough may be relieved by inhaling menthol or camphor in eucalyptus oil, to which may be added ammonia or potash, or an astrin-' gent inhalation if the mucous is copious. He has had a special inhaler constructed by which the patient may constantly inhale the fresh air without too great exposure by means of open windows.

The Montreal Medical Journal, January.

HEALTH RESORTS IN ARIZONA.

Wm. Vaughan gives a very good account of the climate of Arizona and the cost of living in the various towns and their respective advantages. He speaks more particularly with regard to tuberculosis. Phoenix has

There are The country

an altitude of 1,180 feet and contains about 12,000 people. a sanatorium, a hospital, hotels and boarding houses. around is fine and the roads are good. February has a mean temperature of 54 degrees, varying from 43 degrees to 75 degrees. From October to April the weather is delightfully sunny. The rain fall is about 7 inches. In 1903 there were 266 clear days, 60 partly cloudy, and 32 cloudy. From May to December it is very hot, and the thermometer may go above 100 degrees. There are frequent sand storms. Tucson is elevated 2,400 feet, has a temperature about 2 degrees lower than Phonix. It has a population of 7,500, and has hotels and boarding houses. The roads around are good. The rainfall is 8 inches. The means of entertainment for invalids are not good. Oracle is 4,500 above sea level. It is a rather rough place. The roads are fairly good, but the hotels poor. The patients find accommodation in tents. The mean temperature for the winter months in 46 degrees and for the summer months 79 degrees. The rainfall is about 16 inches, and the snowfall is 12 inches. There is a high degree of sunshine, about 85 per cent. of the days.

Cas

tle Creek hot springs is noted for its hot springs. The accommodation at the hotel which remains open from November to April. It is surrounded by hills and is free from sand storms. It is very dry and sunny. The horseback riding is excellent. Prescott is elevated 5,300 feet and contains 5,000 persons. It is a bright, well-built town, and has a hospital. The accommodation is scanty for invalids. A young Canadian, Dr. J. W. Flinn, has started a camp for the open air treatment of tuberculosis. The temperature for July and August is 95 degrees, and for January and February an average of 38 degrees. There is a maximum of sunshine, the rainfall is 16 inches, there are sharp thunuerstorms, and about 18 inches of snow fall. It is considered superior to Denver or Colorado Springs. Flagstaff is 6,800 above sea level, but it has poor The winter is severe and the altitude is too great for consumptives. The cost of living in all these places is high.

accommodation.

PLACING PERINEAL SUTURES PRIOR TO LACERATION.

Dr. A. Lapthorne Smith, Montreal, calls attention to the advantages of placing sutures in the perineum when it appears that laceration is inevitable. He recommends three. His method is to sterilize the parts, anaesthetize the patient, and place the anterior suture first. The anterior suture is entered at the base of the lesser lip. The second one an inch farther back and the third still farther towards the anus. The thumb is placed in the rectum as a guide and the finger in the vagina. The ends of the sutures are held by a haemostat. The advantages are that there is perfect apposition of the parts and that the muscles are secured. This avoids what too often happens of only securing a skin perineum. Once in a while the sutures may not be required, but this is a small matter. The sutures recommended are silk worm gut, and should be inserted with a curved perineal needle which is inserted on one side, made to travel across the vagina and out on the other side. The needle is then threaded and withdrawn. No doubt this original method of Dr. Smith will prove of much value.

DIAGNOSIS AND TREATMENT OF METRORRHAGIA.

Dr. F. Monod of Paris, read at the Montreal Medical Society a paper on this subject. He drew attention to the fact that the uterus is an organ that for many years bleeds regularly. He set aside menstruation and bleeding from the gravid uterus. Haemorrhage may be caused by fibroma, cancer, or a polypus; or again from some condition of the uterus

not marked by any acute or chronic affection, or from acute or chronic metritis, from a miscarriage or confinement. There may be a metrorrhagia at the menopause, or connected with lesions of the adnexa, or from an angioma of the mucosa. In some cases metrorrhagia is caused by an infection metritis. There is an essential metrorrhagia from general disturbance or anæmia. At the menopause the bleeding inay be caused by some senile change in the uterine tissue or by vascular changes due to the cessation of the menses. In diseases of the tubes and ovaries, as cystic tumors or inflammations, there may be excessive flow from the uterus. Following the expulsion of the ovum there may be a chronic metritis, a portion of retained placenta, or a fungous condition. In the treatment of these cases resort may be had to hot douches. Rest in bed with feet elevated, and vaginal packing. A two per cent. solution of gelatine may be injected into the uterine cavity. This is useful in uterine atony, fibroma or fungoids. Normal saline may be required subcutaneously. Ergot and digitalis cannot be depended upon. Ligature of the uterine arteries should not be performed, as it is better to curette or remove the uterus. In some instances the mucosa may be modified sufficiently by the cautery or by electricity. In some cases the disease in the ovaries and tubes may require their removal. Haemorrhage in old women may call for hysterectomy. The uterine caustics may be tried, such as creosote, camphor, napthol, tincture of iodine, silver nitrate, and chloride of zinc. The lecturer spoke well of the use of electricity as a uterine stimulant, the galvanic to be preferred. The positive electrode being placed in the uterine cavity and the negative over the abdomen. Vaginal hysterectomy must be resorted to for angiomatous metritis, deciduoma malignum and in metrorrhagia in old women.

INTESTINAL OBSTRUCTION AFTER LABOR FROM A HAEMORRHAGIC CYST.

Dr. T. P. Shaw, Kingston, reports a case where there was acute obstruction of the bowels from a haemorrhagic cyst. On the fourth day after the confinement, she was seized with violent pain in the lower half of the left side and the left iliac fossa. Very tender on palpation. On fifth day, there were tympanites and elevated temperature. In response to the use of enemata and the rectal tube the boweis did not move nor was there any passage of flatus. The temperature rose to 102 degrees.

upon.

The patient was removed to the Kingston Hospital and operated Here temperature was 102 degrees, pulse 130, and respirations were 22. A tumor could be made out in the median line. On opening the abdomen a dark blue tumor was seen, very tense and the size of an adult head, which was found to be a large, unilocular blood cyst of the

left ovary.

The pedicle was twisted. The tumor was delivered through the opening and the pedicle tied with a chain of ligatures of heavy silk.

The large vessels were secured by catgut.

and the patient recovered.

The obstruction was relieved

QUININE AMAUROSIS.

Dr. G. H. Mathewson, Montreal, gives an account or a patient who suffered from amaurosis caused by about 180 grains of quinine taken during a period of eight days by a patient who was ill with puerperal sepsis. The pupils were widely dilated, the tension was normal, vision-P.L., the optic disc was extremely pale with dull surface, and some haziness of the fundus. The arteries were bloodless and the veins paler than normal. She improved up to 6-36, but the field was very constricted. He refers to some of the recorded cases and discusses the literature of the subject from the first cases reported in 1841. The article is a very important contribution to the subject.

to.

THE PRIVILEGES OF MEDICINE.

John McCrae, M.D., L.R.C.P., Montreal, delivered the opening address on the above topic at the Medical Faculty, University of Vermont. In his address he referred to the brotherhood of the profession. He then pointed out that we were apt now to drift away into theory and not acquire such an intimate knowledge of the patient as our forefathers had to acquire. The advance in our knowledge of tropical diseases was referred He urged that, while enthusiastic over one's own college, he should be liberal minded towards others, and spoke of the great advantages coming to one from travel, and visiting other seats of learning. Emphasis was laid upon the fact that college days were full of good things, and it behooved students to spend their time well and not upon things that are "not worth the candle." It was well for every student to have high ideals. These may not be all realized, nevertheless, good comes from them. They stimulate towards great things. When college days are over and practice is entered upon many problems come up for study; and none are old problems, as every case has the disease and the patient as two elements in the equation-the latter element ever varying. It is by this searching for the solution of problems and the discovery of truth that the best in the profession can be attained. The monetary object should be secondary, and if the only object must lead to disappointment. One of the great features of the profession is the opportunities for doing good. Some of these may be paid in money, some in gratitude, and neither. He quoted the legend: "What I spent I had; what I saved I lost; what I gave I have."

GUNSHOT INJURY AND LARGE GRANULATING Surface. Arthur Kendall, M. D., Cloverdale, B.C., reports a case of injury by a gunshot to the anterior and inner aspect of the right thigh. The skin, subcutaneous tissue and adductor muscles over an area of 14 inches were carried away. The patient was sent to the Royal Columbian Hospital, New Westminster. The wounds had assumed a greenish-black hue. It was necessary to remove both testicles, four inches of the speranatic cords, and the entire scrotum. The wound in the thigh was treated with wet boric acid compresses. The patient made a good recovery. At the end of four weeks the granulation tissue was dissected away down to the muscle. The healthy skin was raised to a distance of two or three inches from the wound. This permitted the wound to be covered with integument without too much tension. Six incisions were made through the skin for drainage. Gauze drains were introduced. In one week the

sutures were removed.

The Maritime Medical News, January.

ELECTRO-THERAPY.

This is the title of the paper by Dr. G. G. Corbet of St. John, N. B. He refers to some facts in the history of the subject, and gives a succinct definition of the terms most commonly in use. He then mentions the kinds of electricity, as the animal, thermal, frictional or static, chemical and induced. Mention is made of the important place occupied by the x-rays, and explained the tubes of high frequency as those where the vacuum is rendered very complete, and those of low frequency as examples where the vacuum is not very complete. He calls attention to the fact that matter exists in the solid, liquid, gaseous, and a fourth the radiant form. Some remarks are made on the diagnostic value of the xrays, and list of diseases given for which the various kinds of electricity are most useful.

RECURRENT DISPLACEMENT OF THE PATELLA.

Dr. R. A. H. MacKeen, of Glace Bay, reports a case where the patella constantly slipped outwards. This condition is due to an unduly long patellar tendon, or to a condition of genu valgum. His method of treatment was the same as that described by Dr. Goldthwait of Boston. A long incision of at least four inches is made over the patellar tendon from the tibial tubercle upwards. The tendon is split longitudinally and the outer half cut off at the tibia. This portion is then passed under the other undivided half. The cut end is then securely fastened to the periosteum of the tibia and the insertion of the sartorius muscle. This gives the patella an inward traction and prevents it from slipping over the outer condyle. The treatment is both simple and effective.