Bennett, in The Lancet of June 3, calls attention to the frequency with which pruritus ani is caused by an irritating discharge from the rectum. Superheated fat, or fried bacon, always induced an attack. He does not appear to have suspected that the pruritus was caused by a discharge from retained and decomposing feces.

HEPATIC ABSCESS

An observation of importance was made by Basseres: After an operation for hepatic absecss the skin about the wound ulcerated, and amoeba were found in the serum. Ordinary antiseptic dressings failed but the ulcers improved under Labarraque's solution. This might be tried as a remedy in amoeboid dysentery.-Arch. de Med. et de Pharm. Militaires, April, 1911.

ENLARGED PROSTATE AND CHRONIC DIARRHEA

Dr. E. A. Edwards, of South Carolina, reports the case of a patient, aged sixtyfour years, who returned from the Civil War with chronic diarrhea, from which he has suffered ever since. He had also an enlarged prostate, which interfered with defecation, the stools being ribbon-like. Under the use of chromium sulphate the gland was reduced at least three-fourths,

and the bowel trouble so completely cured that means have to be taken to keep the bowels regular. Previous to taking this. remedy he was accustomed to go to the toilet from three to six times during the day and three times every night; now his bowels move once a day. The masses are quite round, not compressed at all. Three tablets chromium sulphate, 4 grains each, per diem, checked the bowels more than was desirable.

THE ARYLARSENATES IN MALARIA

Pierpont and Acton (Indian Medical Gazette) have studied the malarial cachexias

presented in India, and sum up the following treatment: (1) Get rid of all parasites by the use of enough quinine. (2) Stimulate the hemopoietic organs by intramuscular injections of soamin. Of this 5 grains are injected on alternate days for six times, then suspended for ten days, and then six more injections given likewise. The total dosage must never exceed 100 grains. All cases in the first or second stage respond.

RHUS POISONING

Dr. C. H. Gardner says. (Med. Record) that after cleansing with a 1:40 solution of carbolic acid and soap, water is not used. If the parts have to be cleansed, carbolized oil is used, on absorbent cotton. Apply lead and morphine lotion on antiseptic gauze and dust with camphorated stearate of zinc. At bedtime advise to wear loose cotton gloves. This will prevent spreading to the eyes and genital organs.

"Internally I use aconite and gelsemium, for the fever and nervous disturbance, and

A writer in The Christian Advocate is quoted by The Texas Courier-Record of Medicine (Aug., 1910), who suggests that hop vines may be objectionable to flies. Living in a town in Bulgaria, a land where filth and rubbish abound as almost nowhere in America, this writer holds that her house may be considered a fair testing place for the efficacy of hop vines in keeping out flies. The vines run over the porch and over the windows. There are no screens, but no flies enter the kitchen, no matter what cooking is being done there. When

the vines were laid on the ground so that the house could be whitewashed, the flies swarmed into the kitchen; on replacing the vines, freedom from flies was again enjoyed.

Although we depend so much on screens in the United States, The Courier-Record comments, this information may interest many, because screens can seldom be perfectly effective. It may be a question whether the flies are actually kept out of the room because the hop vine is objectionable to the insects or because the room is darkened by the vines over the windows. Any room that is kept fairly dark has no attraction for flies.

INFLUENCE OF AGE AND TEMPERATURE ON DIPHTHERIA ANTITOXIN

Anderson reports that the average yearly loss of activity at the temperature of the room is about 20 percent; at 15° C. (59° F.) about 6 percent. Dry diphtheria antitoxin retains, in the dark at 5° C. (41° F.), its effectiveness for at least five and onehalf years. Old serums are as effective as fresh ones corresponding to their unitcontents. Zeitschr. des Allgemein. Oesterr. Apoth. Ver.

DEATH FROM COCAINE

The Therapeutic Gazette records a case of death following the injection of a 10percent solution of cocaine into the urethra. The patient was a soldier, with urethral fistula secondary to a stricture. The quantity of cocaine absorbed was exceedingly small.

VERONAL FOR COUNTERACTING DISAGREEABLE EFFECTS OF MORPHINE

The disagreeable effects of morphine can be obviated by combining it with diethylbarbituric acid or its salts (veronal, medinal), according to Wolfram (quoted in Skutetzky's "Neuere Arzneimittel," 1908). He does not give the remedies together, but lets the patient take the veronal by mouth, then half an hour later administers the morphine hypodermically. In this way, it is claimed, 0.5 Gram is

capable of preventing the bad side-effects of a dose of 0.03 Gram morphine without in the least diminishing its pain-relieving action.

If this is true, the thought is suggested that the morphine-hyoscine narcosis might be improved by giving 5 to 7 grains of a diethylbarbituric preparation one or two hours before injecting the former-possibly in reduced dosage.

As bearing upon this suggestion, a statement of Reich and Herzfeld (Therapeut. Monatsh., 1908, No. 7) may be of interest. These authors recommend veronal in parturition when the first stage is protracted and a somnifacient seems indicated. They found that in doses of 4 to 7 grains it allays the uterine pain without diminishing the intensity of the contractions, labor proceeding with the patient in a dazed, dreamy condition. If subsequently a volatile anesthetic is resorted to, the amount required will then be comparatively small.

POSTOPERATIVE ACUTE GASTRIC

DILATATION

H. M. Hepperlin (Western Medical Review, Jan., 1911) has observed this condition in 3 cases out of 313 abdominal operations following upon the operation after from six to twenty-four hours. The first case terminated fatally, the other two in recovery, owing to the prompt use of gastric lavage, and the author believes that he could have saved the first patient if he had instituted the same treatment early enough.

The author is fully persuaded that strychnine, physostigmine, and the various other drugs recommended in this condition are, as a rule, far more injurious than beneficial, and he insists upon the prompt and thorough washing of the stomach, in acute gastric dilatation, as the safest and best method of procedure.

IRON HYPODERMICALLY

R. M. Niles recommends, in The Medical Council for February, the hypodermic administration of iron wherever this remedy may be indicated, and claims to have seen

excellent results from its use in this manner. His technic is as follows:

The solution is prepared by adding 2 Grams of iron and ammonium citrate to 8 Cc. of boiling distilled water in a sterile vial. The solution is corked with a sterile stopper and heated in a water-bath each time before using. From 2 to 8 minims of the solution are used for a single injection. The injection is made deeply into the muscular tissue of the thigh, shoulder or arm, care being taken to have the skin, as well as the syringe and needle, surgically clean.

Slight pain is experienced at the time of injection. But little local reaction takes place. Later a hard nodule may be felt at the site of injection, which soon disappears.

THE EFFECTS OF LIGHT AND SHADE, COLOR, AND TONE UPON NERVOUS PATIENTS

Many patients, says a writer in The Medical Times for July, 1910, will complain of the unpleasant or irritating effects of their surroundings. They say that going to a certain person's house or being in a certain place aggravates them. An analysis of mental states may reveal some experience whose association is concealed, or subconscious. If no such experience can be found upon which to base the psychic reaction, some condition inherent to the particular place or environment may be discoverable.

Among the principal effects of environment, that of color, light, and shade should be thought of. The singular psychoses known as agoraphobia, claustrophobia, and related states of fear arising in hitherto unexplained causes may be due to optic or psychosensory deviations from the normal. Many people who may be classified as normal object to dark paper upon ceilings alone and wish this light-effect continued down as far as the border. To some such people, a room with a deep color upon the ceiling and a very light tone on the walls would be unpleasant, irritating, and aggravating. The reverse, then, will be all these disagreeable qualities to people reversely constituted.

E

II INTEROPTOSIS is frequently observed in nervous dyspeptics. I even think that there can be no true intestinal displacement except in manifest neuropathic cases. Be this as it may, yet ptosis shows itself ordinarily by a feeling of abdominal weakness, shattered state of the stomach, or more exactly, by a dragging at the mesogastrium, oppression at the pit of the stomach, smothering, gases, tightness around the head, spells of anguish, vertigo, weakness of the loins, and cramps of the legs. Lying on the back at night and strapping of the abdomen during the day allay these symptoms. It is when the stomach is empty that the wearing of a well-tightened abdominal girdle, which lifts up the prolapsed belly at its most dependent part, is the best treatment.

The abdominal girdle is as necessary for the lean person as for the fat. Both of these have their belly like a wallet, only that the lean person has it inside. (Ewald.) Since the enteroptosics tolerate better the dinner and even the supper than two luncheons, it will be best in a certain measure to have them feed most at these meals, remembering that their fattening is a necessary condition of their cure. It It goes without saying that they should use a diluent diet, yet I would warn against the abuse of pap, purees, pastry, compots, and other mashed aliments, since by the disuse of mastication we favor that fatal tachyphagia (hasty eating) which every neuropathic should avoid.

For exercise, the Germans prefer, for patients with intestinal ptosis, walking on

all fours without bending the knees, and I was able to convince myself that this singularly strengthens the natural abdominal musculature. Mountain climbing, riding the tricycle, regular abdominal massage, static electricity and the high-frequency current (the latter reserved especially for the presclerotics) is also recommended. Tepid douches will remedy the nervous instability, as well as keep off pruritus and urticaria, which are frequent complications in the case of neurodyspeptics. As to medicaments for ptosis, strychnine ahd ergotin granules (two of each, three times a day) have given me real good service, especially in female patients.

When there is a clearly defined complication of hypochondria, nothing is so much contraindicated as a milk regimen, which only accentuates the paresis of the stomach and the inertia of the bowels, diminishes the peptic secretions and the work of the hepatic cells, exaggerates the vice of fermentation, and annihilates all effort at digestive stimulation. Milk, moreover, is but a sub-aliment, still, if it would be always tolerated, its tendency to enfeeble the body might be endured for the sake of resting the stomach. The lactic diet of the neurodyspeptic must consist of kephyr, kumiss, and yoghurt. These fermented milks cause neither ballooning, heaviness or somnolency. Bouillon, hot and with the fat well removed, taken with some granules of pepsin, papaine, pancreatin, or diastase, is also a drink which incites to increased activity the gastric peptogenic glands. I look with pleasure at the return of clinicians to the use of this agent for restoring

the stomach, an agent I never left off from utilizing in my own practice.

Some hypochondriacs are afflicted with merycism, which is a sort of rumination and at first is involuntary, but little by little becomes transformed into a veritable conscious tic, thanks to neuropathic influences. We meet also in these cases with chronic diarrhea and cardiac troubles, owing to an upward pressure of the diaphragm by intestinal gases. To prevent this complication, I give, after meals, 30 drops of a mixture of equal parts of peppermint water, tincture of anise (green), eau de Rabel (alcoholate of sulphuric acid of the French Codex), and the official phosphoric acid. This treatment ameliorates the hypopepsia and clears up the milky and putrifiable urine, which is full of phosphatic ammoniamagnesia. Salt baths, very warm clothing, friction and compresses with alcohol over the stomach are good for the hypochondriacs, and so, too, is vibratory massage. Apropos of the last, it is to be said that our Gascon confrère, Sabrazes, affirms that a purring cat in the lap makes the best gastrointestinal vibratory massage. Here you have zootherapy indeed!

When the gastric atony is refractory, then lavage of the stomach may at times come into use advantageously. It is detergent and aseptic, stimulates the motility of the organ whose secretion it wakes up, and quiets its irritability. It acts also much, we would say, by way of suggestion, modifying the depressed psychic condition of the subject. But we make use of this expedient exceptionally only, as we should of an emetic for a rapid cleansing of the stomach. In certain cases of obstinate anorexia and also in uncontrollable vomiting, gavage (feeding by stomach-tube) is to be followed by lavage of the stomach.

In dealing with hyposthenic patients, we must guard against optimism to the uttermost; for if we should nourish the patient insufficiently, then dyspepsia, especially in the young, favors tuberculous infection, while, on the other hand, every attempt at superalimentation carries the risk, ordinarily, of inducing toxic troubles in the intestines, the liver, and the kidneys. We must also avoid alarming nervous indi

viduals by frequent examinations and pro longed questions or by a too closely regulated diet and thus inaugurate promptly in the emotional individual an alimentary phobia by autosuggestion.

Gastric psychoses, hypochondriac obsessions, prepare the patient for nausea, vomiting, and intolerance of nutrition. On the other hand, there will result aggravation of amyosthenia, lassitude, and inaptitude to work, and from these arises deleterious interlinking of troubles between the stomach and the nervous system. We must also be able to ferret out cases of inanition, by a progressive restriction of the ration we allow, for a sufficient and well-tolerated regimen accomplishes at times, in these cases, the very miracle of a resurrection.

Prolonged rest in bed, also, is often enough necessary to calm the irritation (dizziness) which very lean ptosic patients feel when in the vertical position. These patients must avoid all excess in venery, which would render them incurable, and they should guard against idleness, which favors unhealthy autocontemplation. The distraction of travel and a well-directed water-cure at times will benefit these patients, when neither rest nor diet do them any good.

Quassin and strychnine as digestive stimuli are of no value when swallowed in the form of granules, but as gustation is, to put it in a word, the point of departure of gastric reflexes, I think that we ought to act upon the nerves of taste and therefore recommend that, in spite of the bitterness, these granules be masticated. Strychnine, above all, acts on the medullary centers, while as to quassin, we all know that the late lamented Laura considered the granules of quassin as the most powerful galvanizers of the depressed stomach and at the same time as a precious peristaltic tonic of the intestines and as an indirect sedative of the nervous apparatus. Quassin, especially when chewed, increases eupeptic salivation sensibly and incites also a good quality of appetite.

Emetine is, at times, needful for exciting the too torpid gastric muscle. Cannabin and cocaine relieve the distressing heaviness