It must be admitted, therefore, that the results hitherto have been brilliant; and yet, when we remember that the disease from which most of the patients suffered was certain otherwise to terminate fatally, it is some consolation to know that even a small proportion of them were restored to health by operative interference; and there is little reason to doubt that just as in the case of ovariotomy-when the rules for carrying out the operation are more thoroughly understood, and further experience has been accumulated, the death-rate will be materially lowered,

The operation is specially to be recommended where there is reason to believe that the obstruction is not of a malignant nature, or, if malignant, that the cancer of the pylorus has not seriously encroached upon the pancreas or other structures in the vicinity; and it is probable that earlier resort to the kuifǝ, and before exhaustion is extreme, may lead to a greater success.

I cannot conclude without referring for a moment to the operation devised by Dr. Loreta, of Bologna, for cases of non-malignant contraction of pyloric and cardiac orifices. This consists in opening the abdomen, and making an incision into the stomach, through which the index finger of the right hand is introduced, and with which the orifice is forcibly dilated. The cardiac orifice cannot be reached with the finger, so that a metallic dilator is used instead. In a letter from Dr. Pedrazzoli, we are told that up to July 15, 1883, Dr. Loreta has in this way forcibly dilated the pylorus four times, and the cardiac orifice once. All of these operations were successful, although one patient it is said to have died 36 hours after the operation "from causes entirely independent of the operation," and the evidence is in favor of the permanency of the cures. We may, therefore, look foreward with confidence to the results of subsequent attempts in the same direction.

In cases of malignant obstruction at the cardiac orifice, we may sometimes prolong life by the formation of fistula, or by introducing food with the aid of a narrow gum elastic tube. - Glasgow Medical Journal, March.

Dr. W. G. Bullock, of Savannah, Ga., born in 1811, a graduate of Yale College and of the University of Pennsylvania, Class of '33, is dead. He was frequently President of the Georgia Medical Associa tion, and was corresponding member of medical bodies.

OVER-STUDY AND THE TEETH.-The latest fad among Parisian physicians who are worried about the over-education of children, is that it causes a deterioration of the teeth.

ANTIPYRIN AND KAIRIN.

Dr. John S. Lynch reported his experience with antipyrin in fevers at the Maryland meeting. His attention had been called to this drug during the past year. He regards it as one of the most important therapeutic agents recently given to the profession, almost equal to quinine in its value. Its chief action is upon the temperature of the body, and this action is almost certain. His first trial of it was in the case of one of our colleagues, Dr. Kinnemon, whose death occurred during the latter part of last year. He was suffering from phthisis, and all the usual medicines employed to check the rise in the temperature had proved unavailing. After a great deal of difficulty he procured some antipyrin and tried it on him with the result of at once lowering the temperature and improving the condition of the patient. He has no doubt that had he been able to obtain antipyrin longer this patient's life would have been much prolonged. He said he had used it in a number of similar cases with constant effect. In rheumatism it is fully as efficacious in his hands as salicylic acid; he had used it in dysentary and in a great number of febrile affections. He regards it as a perfectly safe remedy. The only disagreeable effects which he has noticed are that it sometimes causes nausea, and that the first dose will sometimes give rise to profuse sweating. The former is readily controlled by suspending the drug, and it is a curious fact in regard to the latter that the sweating is only brought on by the first dose. The subsequent doses are fully as effective in lowering the temperature but they do not cause the sweating. He was more ready to call attention to this drug, as he believed it was not in general use among the profession. The chief objection to the drug is its expense. As it is a product of coal-tar, and made from what was formerly considered to be refuse matter, there is no doubt that it will come down in price after a while. The dose of the drug is about seven and a half grains, and may be increased to fifteen grains.

Dr. R. H. Thomas said that his experience with antipyrin was very limited, but he had for about eighteen months been using kairin in cases similar to those mentioned by Dr. Lynch. Kairin acted well in much smaller doses than was recommended by European journals. He has found five to ten grains sufficient if given hourly. Kairin is a drug that must be carefully watched, as if continued too long it will cause too great depression of the system. His rule is to give it in five to ten grain doses every hour, having the temperature watched, and to stop it as soon as the temperature reaches 99°. This can be done even when quinine has failed to produce effect before. If used in this way with care, he has learned to regard it as a valuable and reliable antipyretic.-Medical News.

RECTAL MEDICATION.

Dr. D. W. Cathell read a paper at the meeting of Medical and Chirurgical Faculty of Maryland on Rectal Medication. He spoke first on the rectum as an absorbing cavity and then said that he would confine his remarks to the use of morphia and belladonna in this way. He does not use medication per rectum in preference to the usual method by the mouth, but a number of cases arise where the stomach should be left at rest to perform its proper digestive functions, and yet where drugs are needed by the system. His favorite method of administering the drugs in question is to give them combined. The combination seems to unite all the good qualities of the two drugs and to lessen the unpleasant effects of each. He referred to a number of cases in which he had used these remedies together in this way, such as "ulceration of the prostrate gland," where after long agony the relief under this method began to be observed at once; vesical tenesmus; senile hypertrophy of the prostrate gland, when the patient from being obliged to rise every hour during the night for micturation was enabled to sleep all night without disturbance; encysted renal calculus; vaginismus: subacute sciatica: dysentary and irritable rectum, etc. In order for the suppositories to have effect, they must be prepared carefully and accurately. The excipient preferred by himself is glycerine jelly. But where the suppositories are apt to be kept for a considerable time he used oleum theobromæ. This last keeps fresh for a very long time and does not grease. It is often adulterated with which renders the medicines contained in the suppository inefficacious. The fact, however, that the suppository is found in the dejections undissolved, provided it has been made of cocoa butter, does not mean that it has not yielded its contained medicine, as, since it is a vegetable fat, it is able to do this without being dissolved. His own experience had shown him the truth of this. The size of the suppositories he uses is fifteen grains. The question arises whether medicine administered per rectum in capsules would not be better. He is rather inclined to favor them, as there are manifest advantages in favor of the capsule, such as cheapness, accuracy, and the exclusion of air from the drug. He generally gives the medicine once in six hours. He prefers morphia to opium and the watery extract of belladonna to the alcoholic, the usual dose being one-fourth to one-sixth of a grain of morphia and one-half of a grain of belladona.-Med. News.

A glass of beer three times a day, with meals, is highly spoken of in the treatment of severe vomiting of pregnancy.

REPORT ON THE NERVOUS SYSTFM.

BY DR. W. C. PEASLEE, DENVER, COLO.

SOME OF THE Neglected or UNDULY APPRECIATED PSYCHICAL PREcursors of Brain Disease.*-Dr. C. H. Hughes (Weekly Medical Review, St. Louis, June 27, 1885) asserts that the precedent of all grave cerebral disease is neurothopia, or defective nerve nutrition disturbing the quality and constitutional molecular relations of the cerebral cells and their reciprocal physiological conditions of waste and repair.

Neurothopia may be considered as functional, to distinguish it from organic disease, i. e. it may be so slightly organic as to not necessarily excite alarm. Strictly speaking there can be no functional derangement without structural disorder, either in molecule or mass.

The physical symptoms of general functional neurothopia, which are precursory of brain breakdown, if unrelieved by curative treatment, often ultimate in hopeless irremediable destructive conditions.

One of the strangest inconsistencies of sagacious business men, is their proneness to lightly estimate or ignore symptoms which, even in the uninformed laity, are significant of something, a something which they persist in deciding (without medical data) as of but little consequence. A fire of unrest is kindled in their brain, a little flaw in the working of their physical machinery is noticed, but unless of such a painful and incapacitating character as to entirely stop or completely derange all function, they persist in goading their mental machinery to further movement until the completion of some cherished project, when, if convenient, they intend to call in the physician, when lo! the undertaker comes in his stead, or comes with or soon after him! A sort of remorse comes over those persons over duty to self undone, and at last, when the mental machinery can by no possibility be longer used, the physician is called to watch over morbid conditions he cannot change and to certify as best he can to the cause of death, and thus keep the coroner out and let the undertaker in. The verdict of the fraternity, if asked, would be, "death inadvertently induced by his own head." These overworked and overworried men of business, who would stop a fire or a leak in a roof, will neglect a flaw, a leak or a fire in their own organisms until the process of destruction has gone on beyond all possible repair. The business man counsels his attorney when even a suspicion crosses his mind as to the possible existence of a flaw in the title of any property in which *Read before the Missouri State Medical Association, at St. Joseph, May,

1885.

he is concerned, yet this man usually postpones the services of the physition to the very last moment, or casually asks some passing physician (most likely to be one who has sugared him over with a small fee or rendered him services as a commission for his influence and in thus asking in this want-something give-nothing manner, gets a diagnosis of simular value), or making the astute diagnosis from his own imaginary knowledge of disease, he asks the physician what medicine is good for such a disease. Or he has learned from some late medicine almanac which has made symptoms so plain that the "way-faring man though a fool" may see them? or at least the remedy so reliable? that will relieve them? which together with certificates to dovetail with scientific exactness and pecuniary certainty with the causes, the conditions and cure, stimulate the purchase and use of patient medicine, which in the mass of cases fans the fire already kindled within our organism.

What a blessing pain is, and what a pity the lighter shades of psychical pain and unrest are not sooner regarded and timely counsel taken.

Many of us are guilty of viewing symptoms which have been sufficient to induce the patient to counsel us, as insignificant, and thus dismiss him with a placebo and the advice to come again when something definite has developed.

The psychical symptoms of cerebral neurasthenia are too numerous to be mentioned here. But when the nutrition of a sentient motor or ideational brain cell or group of cells fails to furnish the pabulum of force demanded of it in ever so minute a degree, some change in the tonicity of its functionation takes place and we have the phenomena of nerve impairment manifested in indisposition, transient feelings of depression, and great languor. Neurothopia and debility of function go together. A brain, nerve centre or ganglion that cannot appropriate an adequate nutrition to supply it becomes starved and responds abnormally.

Impending brain failure may be discovered by comparison of the patients previous with his present history. A once bold business character becomes timid and over-cautious, timidity and morbid fears of im spending calamity, a general dread takes possession of the sufferer. The mental preceptions of the individual are morbidly colored. The patient feels weary and misjudges the conduct or speech of those about him. Irresolution and irritability of manner of speech are always symptoms of significance. These morbid symptoms cast before them the graver coming event-insanity.