The pulse now gradually improved, and the dressings were found to be bile-stained. On the following morning he was much better. Subsequently the discharge was copious, bile-stained, and smelt strongly ammoniacal like urine. The gauze was removed at the end of a week and a temporary drain established in the right loin. Recovery followed.

The writer has been able to find recorded only three severe cases with collapse in which a successful primary operation was done. This fourth case is conspicuous by the early period at which operating became necessary, and by the fact of recovery from such grave anemia.-The PostGraduate.

ACUTE NON-TUBERCULOUS MENINGITIS.-Netter. (Rev. Mens. des Mal. de l'Enf. Vol. viii, Nos. 8 and 9: Thirteenth International Congress of Medicine.)

Non-tuberculous meningitis may be primary (epidemic or sporadic), or secondary to otitis, to various suppurations, or to an acute local or general disease. In connection with otitis it must be remembered that phlebitis, sinus thrombosis, and cerebral abscess may occur as complications as well as meningitis, and that the nervous symptoms are analogous in all. The symptoms of meningitis in the course of acute diseases, and especially in the beginning of a pneumonia, may be due to serous, and not necessarily to suppurative, meningitis. There does not seem to be any hard and fast line which can be drawn between the epidemic and the sporadic form of the disease. The value of Kernig's sign must not be insisted upon too strongly, for while it is almost constantly found in non-tuberculous cases, it is also present in the majority of the tuberculous ones, therefore it can not be , relied upon in differentiating the nature of a meningitis. Quincke's method of lumbar puncture is of invaluable aid in diagnosing meningitis, the physical, microscopical, and bacteriological examination of the fluid. withdrawn determining the nature and cause of the process. In cases of suppurative meningitis repeated lumbar punctures may be of service in treating the disease, and warm baths according to the method of Aufrecht are of great value.-Archives of Pediatrics.

THE TECHNIQUE IN OPERATIONS FOR INTRALIGAMENTARY, CYSTIC, AND SOLID TUMORS.-Wathen, of Louisville, advises the removal of all tumors not larger than a fetal head per vaginam, either through the pouch of Douglas, leaving the uterus intact; or, where this can not be done, he performs hysterectomy, and never operates upon any patient who is not prepared for both the vaginal and abdominal methods, for complications may arise in any case that will promptly indicate the necessity for abdominal celiotomy.

In cases where the tumors are too large to be removed per vaginam, he begins the operation through the vagina by ligating or clamping one or both of the uterine arteries, as may be indicated-preferably between the

ureter and the internal iliac; and when the abdomen is then opened, he controls the ovarian arteries before he begins enucleation, thereby making practically a bloodless operation. In all cases in the abdominal part of the operation, he advises the application of forceps if possible during the enucleation, because this facilitates the work, and the ligatures can be much better applied after the tumor has been removed. He claims that we can much better avoid injury to vital structures if we primarily control hemorrhage, because the blood obscures the structures, and the surgeon, because of hemorrhage, may become confused in his work and hurries in a degree not consistent with good surgery. He believes that pathogenetic germs do not pass through a healthy peritoneum, and the reason why so many intraligamentary cysts suppurate is because of the unfolding of the mesentery, bringing the cystic wall in direct contact with the muscularis of the bowel, with no intervening peritoneum. As there is always danger of secondary giving way of the bowel where the mesentery has been unfolded, he advises in such cases to either preserve the capsule intact and suture it in the lower angle of the abdominal wound, or to remove superfluous parts, suture carefully and drain into the vagina through a tube introduced through an opening through the Douglas pouch. By this means the peritoneal cavity is entirely protected from bowel rupture or from any sort of infection from the capsule cavity; in the first instance, the drainage being through the abdominal wound, and the second, through the vagina.—St. Louis Courier of Medicine.

SOME EXPERIENCES WITH THE Schleich MIXTURE.-P. Ilyn (Klin. therap. Woch., July 20, 1900) has employed the Schleich solutions in 135 cases, and is well satisfied with the results. All disagreeable symptoms of ether narcosis, such as salivation and bronchitis, were but rarely noticed, and as long as respiration was active, sudden death, which is liable to occur after chloroform administration, seemed to be impossible. Depending upon the age, from 0.98 to 2.70 cubic centimeters of the mixture were found necessary per minute to keep the patients under. Excitation was noticed in twenty-five cases, nausea in nineteen, convulsive movements in three, trismus in two, and temporary cessation of respiration in two, one of which was an extremely weak child suffering from post-scarlatinal osteomyelitis. Respiration becomes more frequent and deep, and is most rapid when complete narcosis has set in, unless dyspnea is present, when an increased rate is not observed. There seems to be a close association between the degree to which the patient is anesthetized and the number of respirations, for when the patient is allowed to come out the normal rate gradually returns. The pulse is full and not rapid; as consciousness returns it becomes more frequent and weak. The author believes that, owing to the physical properties of the mixture, one can regulate the amount within perfectly safe limits by carefully and constantly watching the respiration and circulation.-New York Medical News.

TRAUMATIC PERFORATIONS OF THE MEMBRANA TYMPANI.-Francis Packard (J. A. M. A.) reports eleven cases of perforation of the tympanic membrane due to traumatism. Of 1,500 consecutive cases of membrane rupture taken from the record book of the Pennsylvania Hospital, these were the only ones attributable to injury. This showing, coupled with the statistics of other authorities quoted by the author, tends to demonstrate that traumatic perforations are not relatively frequent.

Traumatic lesions of the drum may be produced, according to Politzer, 1, by direct penetration of a foreign body into the membrana tympani; 2, by the extension of a fracture of the cranial bones to the membrane; 3, by a sudden condensation of the air in the external meatus or in the tympanic cavity, more rarely by a rapid rarefaction of the external air.

Packard's eleven cases were the result of: Struck by weight falling from a height, two; fall upon the head, two; introducing a foreign body, one; struck by wave while bathing, one; blow on ear (fist), two; working in caisson, one; struck with weapon, one; blow on head, but from what not ascertainable, one.

The medico-legal aspect of traumatic perforation is discussed by the author, and the ultimate termination of such injuries, when uncomplicated with damage to the ossicles or labyrinth, he says, is usually healing of the perforation.

Little treatment is required, the handling of the case being left to nature as far as possible. A little clean, dry cotton may be kept constantly in the external auditory meatus, and if there be much discharge the gentlest possible cleansing will suffice.-The Chicago Clinic.

CEREBRAL ABSCESS SECONDARY, TO TYPHOID.-A. C. Brown (Edinb. Med. Jour.) reports a case which is interesting on account of its etiology, the difficulties in the way of diagnosis, and the success of the treatment. No instance has yet been recorded in which pyogenic organisms gaining access to the circulation from the intestinal ulcerations of typhoid have been deposited in the brain with the production of a suppurative focus. In this case the patient, a girl of nineteen, developed the symptoms of Jacksonian epilepsy shortly after discharge from the hospital, where she had been treated for a moderately severe attack of typhoid fever. The nervous disturbances were purely motor in character, sensory symptoms and cerebral derangement being entirely absent, so that the focal lesion could be definitely located in the right Rolandic area, as the convulsions affected the left arm and leg. The nature of the lesion was more difficult to determine; functional disturbance of the cerebral centers, abscess, tubercle, and syphilis were one by one considered and rejected. Against abscess were the position of the lesion, the absence of any exciting cause or rise of temperature (a blood examination was not made), and a provisional diagnosis of a rapidly growing gliomatous tumor was made. On operation, however, the error was recognized and three ounces of pus evacuated, after which the patient made a complete and uneventful recovery.-Medical News,

Special Notices.

THE preparations of "PEPSIN" made by Robinson-Pettet Co. are endorsed by many prominent physicians. We recommend a careful perusal of the advertisement of this well-known manufacturing house. (See advertising pages.)

SANMETTO IN ENLARGED OR ATROPHIED Prostate WITH URINARY DIFFICULTIES.-The cases in which I have had occasion to use Sanmetto are quiet numerous and varied, both acute and chronic, and when indicated have produced very satisfactory results, both to me as well as to the patient. For a period of three years Sanmetto has been my sheet-anchor in the large majority of cases of prostatic and urinary difficulties, both in enlarged prostate as well as atrophied conditions. I may sum up the whole category of prostatic and urinary ailments, and say in my experience that Sanmetto covers more general indications and is more reliable in my hands than any other remedy. I use and have great confidence in Sanmetto. Toledo, O.

J. S. FISHER, M. D.,

1876 Pulte Med. Col., Mem. Nat. Homeo. Med. Ass'n, Mem. Ohio State Med. Soc., and N. W. Ohio Med. Soc., and Toledo Med. Soc.

The Anodyne Treatment of ACUTE PERITONITIS.-McCaffery (“The Etiology, Pathology, and Treatment of Acute Peritonitis") observes that the most pronounced indication for treatment in peritonitis is that for the relief of pain. Blisters and counter-irritation, the older resorts, are practically useless. Hot-water bags and poultices are far superior, but the relief they afford is only temporary. In some cases the ice-bag is more grateful than hot applications. But whether hot or cold is employed, it should be relied upon only until other lines of treatment can be instituted. Papine should be given in teaspoonful doses every hour, and the doses repeated frequently enough to afford the desired results. Relief from pain, short of narcosis, should be sought, and this is generally easily obtained by proper dosage. Papine does not produce nausea, but rather prevents this syptom. In the event of the development of more or less prostration, a proper stimulant, such as strychnine or nitro-glycerine, should be judiciously employed.-Medical News.

THE EARLY DIAGNOSIS OF LOCOMOTOR ATAXIA.-The poor results derived from the treatment of tabes are often due to the fact that an early diagnosis has not been made, or that patients do not apply for treatment in the early stages of the disease. Erb (Med. Wochenschr.) details a series of cases which had all been preceded by symptoms of secondary syphilis, some as far back as twenty-four years. In one group of cases the tendon reflexes were normal even after four to seven years' duration of slight lancinating pain, bladder insufficiency, sensory disturbances, easy fatigue, slight pupillary sign, and " 'Rhomberg's symptom." A second group presented no subjective symptoms whatever, and but very few and almost unnoticeable objective symptoms. Still another group was attended by marked gastro-intestinal disturbances, not typical of tabes, and with bilateral paresis of the sixth nerve and pupil sign. Author insists on the necessity of always investigating the knee-jerk and pupil reflex in suspected cases. Tabetic symptoms with an antecedent syphilis are always serious. Absence of a syphilitic history does not establish the existence of tabes, even though some symptoms may exist. For the pains in tabes dorsalis, Antikamnia and Salol Tablets have been found most excellent when given in doses of two tablets every two or three hours. The antikamınia acts particularly upon the spinal cord and its sensory tracts, and consequently takes the place of opium and its alkaloids, so often used to relieve patients subject to these attacks. The favorable effect of salol in this and similar conditions is well known.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

THE CONDUCT OF THE SECOND STAGE OF LABOR IN
PRIVATE PRACTICE.*

BY EDWARD SPEIDEL, M. D.

Adjunct Professor of Obstetrics and Chief of the Gynecological Clinic, Hospital College of Medicine, Louisville, Ky.

Every one recognizes that the aseptic details possible in wellregulated hospitals and infirmaries can not be expected in private practice, especially among the poorer classes; but the physician should strive to conduct his work on the lines carried out in such institutions, and come as near that standard as his surroundings will permit. With the paraphernalia contained in this little package, which can be easily taken to every labor case, and with a few clean sheets and towels, hot water and soap, every reasonable demand of aseptic obstetrics can be complied with.

This package contains a hand brush, small package of sterilized gauze, two oz. powd. boric acid, two oz. lysol or other liquid antiseptic; scissors, linen tape or corded silk for the cord, chloroform, one half doz. five gr. quinine pills, sol. two per cent nitrate of silver, ergot, dropper, needles, silkworm gut, needle holder, perforated shot, and a soft rubber catheter.

The package is described in detail, together with instructions for the preparation of the patient for labor, in an article on "Asepsis in Labor" published in the Louisville Monthly Journal of Medicine and Surgery, November, 1900.

*Abstract of paper read before the Kentucky State Medical Society, May, 1901.