inhalation consists of two parts of pure oxygen, one of nitrous monoxide and 1 per cent. of ozone. The ice-bag should be employed for forty minutes three times a day one hour after meals. The oxygen is best taken standing and before meals, so that there may be no interference with deep inspiration. The writer advises two long inhalations from the cylinder at each treatment with an interval of two minutes between them.

High Specific Gravity of Urine.

Ordinarily a specific gravity above 1.025 is due to sugar or relative or absolute excess of urea. That the chlorides may be the cause

of the abnormal density is shown by a case reported by Dr. M. D. Hoge in the Virginia Medical Semi-Monthly for May 27th. His patient, a woman, passed in 24 hours 700 c. c. of urine with the extraordinary specific gravity of 1.120. There was no sugar or albumin present, and all the normal ingredients were in usual amount except the chlorides, which were doubled (27.6 grammes), while the urine was diminished one-half in quantity. By way of explanation it was learned that the woman ate largely of salt pork, ham and mackerel, and seasoned her other food with a considerable amount of salt. She rarely drank water, but used tea and coffee.

The Importance of In his introduction to a projected series of Urinalysis. lectures on urinary analysis (St. Louis Medical Gazette, June) Dr. Hugo Summa, Professor of Medicine in the Marion-Sims College, lays down the principles which have for years governed his practice in these respects:

1. Every treatment (even hygienic recommendations, such as cold baths) should be preceded by urinalysis.

2. When in the course of treatment specific medicines are used, urinalysis is required again and again.

3. As soon as the patient has reached the period of convalescence, especially before he is dismissed from regular medical attendance, urinalysis is absolutely necessary. (Remember, for instance, pyelitis after typhoid fever; suppurative nephritis after vaccination, or some weeks after osteomyelitis.)

4. The treatment of the various forms of nephritis, especially those most commonly associated with uremia, require urinalysis, partly to prevent uremic attacks, partly to control the therapeutic

measures.

5. In all chronic cases the determination of nitrogen is necessary from time to time in order to investigate the nitrogen-balance as to nutrition.

6. All operative procedures requiring the use of chloroform necessitate the most careful urinalysis, not only for the detection of some form of nephritis or diabetes mellitus, but also of temporary insufficiency of the kidneys.

St. Louis Medical Gazette. A new comer into medical journalism bears this name. The editorial staff includes Martin F. Engman, Charles G. Chaddock, George C. Crandall, Carl Fisch, Frank L. Henderson, Phillip Hoffman, Bransford Lewis, Hanau W. Loeb, Norvelle W. Sharp, Albert S. J. Smith and George M. Tuttle. The first number is strong in original articles and department work. May the Gazette prosper as it

deserves.

Examination for Gonococci. To prepare a specimen of urethral discharge for microscopic examination, Valentine, in the April Clinical Record, repeats directions for a common and reliable method.

1. Spread the discharge, filament or sediment as thinly as possible over the cover glass.

2. Let it dry under a bell-glass, to protect it from dust or air-microbes. This usually requires about three minutes.

3. Pass it three times through the opened Bunsen flame, with an even motion, to "fix" it.

4. Drop eosin (saturated solution in alcohol) upon the coverglass and hold it over the closed Bunsen jet until a slight, visible evaporation results.

5. Hold it under a stream of water until all the eosin that can be washed away is carried off. If the cover glass stood on edge over filter paper gives it ever so slight a tinge, the washing has been insufficient and must be repeated until nothing but clear water comes from the glass.

6. Drop 2 per cent. methylene blue upon the glass, and let it rest so covered for five minutes.

7. Wash as described under No. 5, and mount for examination.

Diagnosis of Tuberculosis Hegar is quoted in Pediatrics as recomPeritonitis mending bimanual vaginal or rectal examination. In this way, he says, small, often multiple nodules, the size of a hempseed, pea, bean or larger, can often be felt on the posterior surface of the uterus, in the cul-de-sac

DENVER MEDICAL TIMES.

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and along Douglas fold, at the sacroiliac articulation and in the paravaginal tissues. These nodules are frequently somewhat movable and are either attached to the peritoneum or embedded in the connective tissue in the form of enlarged lymphatic glands.

The Infectious Period of Dr. J. W. Washbourn, a prominent London Scarlet Fever. bacteriologist, is credited by the New York Medical Journal as saying: "There is a general belief that the skin contains the virus, and it has indeed. been stated that the patient is most infectious during the stage of desquamation. This latter statement is, however, incorrect, for there is evidence that patients are more infectious during the early stages than at a later period. While in some cases patients remain infectious for some time after desquamation has ceased, in many they are quite free from infectiousness during desquamation."

Melancholia and the Blood. An important practical contribution to

the study of melancholia is that by Dr. B. C. Loveland (New York Medical Journal, June 25th) in which he gives the results of a blood examination of fifty-seven cases in the early stage. In nearly every instance the blood was unduly concentrated, ranging up to as high as 8,760,000 red corpuscles per cubic millimetre. The hemoglobin was also above the average-as high as 128 G. The rational treatment deduced from such findings is to promote elimination by every possible avenue "Not forgetting that water is nature's solvent, and the most powerful aid in cleansing the system, and exercise its strongest ally." The patient should be fed according to the requirements of the body, as shown by clinical examinations. Lastly, only such medicines as are needed to complement the dietary and hygienic methods in securing sleep and promoting elimination should be employed. The results in the author's practice were that of forty-five patients thus treated, thirtyfive recovered, eight were improved and only two received no benefit. The following is an illustrative case:

"Mrs. B., a widow, 52 years of age, came under my care on March 4, 1896. She was not very thin, though she had lost some flesh since she began to run down. Diagnosis was confirmed by a noted specialist. Melancholia began a year before she was sent to me. General characteristics conform to the description in the early part of this paper. Blood examination at the time of admission: Hemoglobin, 100 per cent. (Fleischl); red corpuscles, 5,780,000 to the cubic millimetre.

"Treatment directed was a diet mainly of milk and vegetable food, and phosphate of sodium, 15 grains in a glass of hot water, before each regular meal time, and two quarts of water to be drank during each day. Improvement was gradual but continuous, till she was quite recovered, and went home on July 5, 1896. At that time her blood examination showed as follows: Hemoglobin, 80 per cent. (Fleischl); red corpuscles, 4,920,000 per cubic millimetre. She came to see me in May, 1897, to show me how well she was, and up to the present reports still come of her continued good health."

It is a noteworthy and not contradictory fact that in the later stages of melancholia, so commonly seen in asylums, the long standing anorexia may greatly reduce the proteid elements of the blood as well as of the solid tissues, and in these cases iron, quinine and strychnine serve as useful adjuvants to forced fluid feeding. The writer calls particular attention to the constant difference in estimation by the Gowers and the Fleischl hemoglobinometer, the latter showing 85 per cent. when the former is 100.

Normal Salt Solution in
Abdominal Surgery.

Hunter Robb (Columbus Medical Journal, June 7th) has for the past eight years used salt solution for irrigating the abdominal cavity, and during the past three years has made a practice of leaving in this cavity from 300 c. c. to several litres of the hot normal solution, when not employing drainage. He is convinced that this procedure undoubtedly diminishes shock as well as the thirst of which patients so frequently complain after such operations.

The Blood Changes Induced In a recent address before the Philadelby Altitude. phia County Medical Society, Solly (Philadelphia Polyclinic) reviewed the essential facts of the subject. Mountain sickness has now been proved, he says, to be due not directly to lack of oxygen, but to diminished oxygen tension. It is also well established that when the oxygen tension diminishes the number of red corpuscles and the percentage of hemoglobin proportionately increase; such increase may be greater in an unhealthy than in a healthy person. At Colorado Springs the normal blood count is about 6,000,000. This gain is more than ccmpensatory, as is shown by the fact that an individual after residing at a high altitude, on removing to sealevel, does not decline to his former subnormal blood count. Appetite and digestion are increased commensurately with the enhanced

power of the blood.

In comparison with the blood changes the therapeutic effects of dryness, increased sunshine and lower temperature are of minor importance. The diminished blood pressure consequent upon a low barometer tends to relieve internal congestions and to mitigate, under certain conditions, aneurysms and heart lesions. It also accounts for the well attested clinical fact that hemoptysis is less apt to occur in a high than in a low country. With respect to the necessary length of residence at a high altitude for a consumptive, the writer concludes that, as a rule, sufficient. length of time is not allowed. An interval of six months to a year is advisable, after all active disease process has ceased before the patient can return with safety for a permanent residence at his old home. Dr. Solly thinks, however, that when a patient is doing well, even though the disease may not be fully arrested, it is often of advantage to let him go home for a month-not longer, since after this period the increased blood power begins to decline. He is of the opinion that the permanency of cure at high altitudes is probably greater than when the disease is arrested at lower elevations.

The Value, Limitations and Alternatives of

Topical Applications in Gynecology.

Under the above caption,
Prof. E. C. Dudley, of the
Northwestern University

Medical School (Philadelphia Medical Journal, June 18th), freely criticises the principal procedures in local treatment, namely, the hot water vaginal douche, the tamponade and intrauterine applications. The douche acts in a two-fold way; as a vasometer stimulant lessening congestion, and as a cleansing agent to remove pathologic secretions. Its principal indications are in chronic pelvic inflammations and uterine hemorrhages. The indiscriminate routine use of the douche is of questionable propriety, on account of the washing away of the normal lactic acid germs, which render the vaginal secretion acid and thereby make it unfit culture ground for about 90 per cent. of all pathogenic bacteria. If the douche is employed at all, the rules of Emmet as to administration should be observed in every detail.

The vaginal tampon in the treatment of inflammation is designed to fulfill one or more of three purposes, namely, pressure, medicinal vehicle and drainage. The writer asserts that the pressure effect of the tamponage in displacements is better accomplished by massage, after Brandt's method. As a vehicle for glycerin or other depletant drugs, Dr. Dudley holds that the therapeutic value of the tampon has been much overestimated. If used at all, it should be