daily. Vaginal tamponage for uterine hemorrhage has two cardinal disadvantages-inefficiency and cumbersomeness. Intrauterine tamponage is a better treatment; it should be in the form of a continuous strip of aseptic or antiseptic gauze about two inches wide. It must be renewed daily.

Concerning intrauterine applications, the writer concludes that the treatment, as ordinarily applied, does not reach the disease, because of thick, protective coating of uterine secretions over the mucosa. Furthermore, he says, in the vast majority of cases for which it is used it is not only not indicated, but may even be injurious, through slight trauma setting up pelvic infection. The milder intrauterine treatment is long, tedious and useless. Caustics, including electricity, may stop the discharge, but at the same time inaugurate cicatricial changes resulting in stenosis or septic sloughing. Gradual dilation with the intrauterine gauze tamponade has been occasionally successful in the writer's experience, but great care is necessary lest the gauze, instead of carrying out septic matter, carry it in.

Curettage affords both a symptomatic and histological cure for the simple glandular forms of mildly infectious endometritis, providing, of course, that the disease has not progressed to the atrophic stage. The danger and uselessness of topical treatment in strongly infectious cases, says the writer, is so manifest that such treatment is not liable to remain common.

When the catarrhal condition is a general one dependent on a general infection, as after scarlet or typhoid fever, or on circulatory stagnation from disorders of the vital organs, or upon the various diatheses, uricemia, anemia, leukemia, chlorosis, diabetes, gout, rheumatism, or upon deficient function of the bowel or kidney— clearly in such cases topical treatment of the vagina or uterus are of no possible value. In such cases the rational treatment is purely a systemic one, for, as the writer remarks, if in a given case the whole intestinal canal and bladder and endometrium were catarrhal, it might be quite as logical to apply fuming nitric acid to all as to one-a reductio ad absurdum. The late Dr. Byford gave for many years as a routine remedy 1-20 grain of calomel thrice a day with enough mild saline to keep the bowels regular-to which simple plan of treatment it is not unlikely his pre-eminent success was largely due.

The writer concludes with the following italicized deductions: "If the above premises are true, it follows that a very large proportion of the women who formerly crowded the reception rooms

of the gynecologist for intrauterine and other local treatment should. be treated by medical or surgical means or by both combined. If they do not present well defined indications for surgical treatment they should generally be referred to the field of internal medicine. The legitimate field for routine topical applications in gynecology is limited."

To Prevent X-Ray Burns. Charles L. Leonard (New York Medical Journal, July 2d) affirms that the patient may be absolutely protected from the harmful effects of the static. charge by the interposition between the tube and the patient of a grounded sheet of conducting material that is readily penetrable by the X-Ray, such as a thin sheet of aluminum or gold leaf spread upon cardboard. In other words, so-called X-Ray burns are not due to the rays themselves, but to the ordinary electric discharge.

Electricity for Uterine Fibroids. Electrical treatment is specially indicated in the following classes of cases, says Franklin H. Martin (Medical Fortnightly, June 15th): 1. In bleeding fibroids in women approaching the menopause. 2. In all inoperable cases.

I.

3. In incipient fibroids in women over 40 years of age.

4.

In all bleeding fibroids of the smooth interstiral variety which have no symptoms but hemorrhage.

5. In all cases (not accompanied with pelvic pus accumulation) which refuse to have an operation.

The Tongue as an Index of Disease.

Changes in the appearance of the tongue may be due to general or local causes, particularly mouth breathing and ragged teeth. There is a tendency of late to neglect the tongue as a diagnostic factor, which is to be regretted. The following observations, which appeared in a recent number of the Indiana Medical Record, afford a practical summary of the clinical phases of this organ:

A broad, pallid tongue, with a loaded base, says atony and refers you to a want of action of the entire viscera below. The remedial agents would be cathartics and tonics, especially those mild, but effectual in character.

A shrunken tongue, pinched in expression, indicates functional inactivity of digestion, and requires great care in choice of food, as well as quantity. In this condition of the tongue we have atony also. It is the tongue of advanced fevers, inflammations of the

mucous membrane and want of assimilation; hence great caution both as to remedies and food. Here we must not use cathartics, through mild aperients may be carefully employed.

A contracted, pointed tongue, with dryness and dark fur, is the usual tongue of typhoid and other low grades of fever, when all thinking minds would use great care in the treatment and food. The dryness or moisture of the tongue denotes the extent of the disease of the intestines.

A fissured tongue points to the kidneys, either nephritis or insufficiency.

Yellow coatings are usually associated with morbid liver and want of biliary secretions and indicate mild hepatics and tonics.

Raised, bright red papillae denote irritation of stomach and of ganglionic nerves. They show exhaustion, no digestion and need of rest. We may give nux vomica, in 20-drop doses, and bismuth and pepsin after food, which should be warm and taken in small quantities.

A broad, thick, raw-looking tongue denotes a septic condition and favors typhoid fever. If deep red, sulphuric acid is indicated; if pale, sulphite of sodium. The food should be liquid and supped warm in small quantities. A septic state of the blood is indicated also by the dark red tongue and dark coating, by shades of dark brown and black, and by a pale dirty fur.

A tongue pointed, contracted, always moving and drawn to one side of the mouth denotes trouble with the nerves and perhaps the brain, especially congestion at its base. The tongue is likewise pointed and narrow in sluggish digestion and disassimilation from any cause.

Dry tongue denotes fever or imflammation, or an affection of the nerve centers of the ganglia. A thick tongue with edges turned upward, signifies atony of nervous ganglia, requiring stimulants, nux vomica or strychnine and quinine.

Differentation Between False and True Albuminuria.

In cases of pyuria to determine whether the albumin reaction depends solely upon the pus or partly upon a renal disorder, Martin and Taylor, in the American Text Book of GenitoUrinary Diseases, advise to take a small portion of the 24 hours' urine into which the pus has been intimately mixed, combine with an equal volume of 1⁄2 per cent. solution of acetic acid colored with methyl-violet, and count the stained pus cells with the Thoma-Zeiss hemacytometer. With another specimen of the filtered

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urine the albumin is estimated volumetrically in Esbach's albuminometer. One hundred thousand pus cells per c. m.m. corresponds to I per cent. of albumin, and a relative excess of albumin would imply a renal albuminuria.

In regard to blood, when the red cells in a well mixed daily specimen of urine do not exceed 3,000 per c. m.m., any albuminuria shown by the nitric acid contact test must be of renal origin. Another method is based upon the changed ratio of serum-albumin and globulin, which in renal albuminuria is 12 to 18:1. If amyloid kidney is excluded and the ratio is much lowered, as 2 to 5:1, a mixed albuminuria would be suggested. Should the proportion of globulin equal or exceed that of serum-albumin, the diagnosis of a blood-albuminuria is almost positive.

Death of Dr. Murrell. Dr. T. E. Murrell was in every sense a physician. Skillful and enthusiastic, far

above the average. He early made an impress in the profession, and won a recognized place among the neurologists of America. He was, at the time of his death, professor of ophthalmology in the Barnes Medical College, of St. Louis, a chair he adorned with rare ability as a lecturer and teacher. He was clear, ready and full; always instructive and impressive, idolized by his class and esteemed by his colleagues. He enriched the literature of his department by many valuable contributions on diseases of the eye and had won, at the time of his death, an enviable place among his professional conferees.

He had come to Denver hoping to recruit his health, but his energetic spirit and indefatigable ambition to continue at work in his profession permitted him no opportunity for that rest of mind and nervous system so essential to recuperation and recovery.

On his first arrival in Denver he improved much and continued to improve for the first six months, but heedless of the necessity of rest, in order that he might accomplish this necessary repair his system needed, he continued his professional work; one of the common fatal errors of conduct with victims of tuberculosis in this climate, bringing with them the energies and aptitudes of the lower altitudes, and continuing the nerve strain habits of their former homes, they overdo themselves and die. Those who recover of phthisis pulmonalis in Colorado and most of those who make pilgrimages to this altitude for their health and succeed in getting well, adapt their habits to their new environments, abandoning or moderating their strains of business, vicious indulgence or depressing habits which made tuberculosis a possibility.

In the death of Dr. Murrell the profession has lost one of its most zealous and eminent men, cut off in the prime of life. He will be missed by a profession which can illy spare such ardent workers. and mourned by a host of friends.

He was a frequent contributor to the columns of the DENVER MEDICAL TIMES, and the editors of this journal extend to his bereaved family and his many friends their profound sympathy.

Gunshots Wounds of the Abdomen.

Dr. J. C. Oliver, of Cincinnati, makes an important contribution to the literature of this subject in the Lancet-Clinic for May 7th. Of 58 cases there reported, 22 were operated upon because of penetrating wounds, and of these five recovered and the remainder died. It is a curious fact, says the writer, that all the cases corresponding to those which recovered with operation died. when no operation was performed and similar cases to those which recovered without operation were attended with a mortality of 100 per cent. when subjected to operation. The conclusions of the author, from analysis of his own experience are as follows:

1. When in doubt as to whether a wound is penetrating or not, one is justified in enlarging the wound and following the track of the bullet in order to be certain upon this point.

2. When a wound is in a location where multiple injuries are apt to be inflicted upon the viscera, immediate operation is indicated.

3. In all cases of continuing hemorrhage after a gunshot wound of the abdomen, exploration should be made unless the patient is in extremis.

4. Gunshot wounds of the stomach, liver or kidney, in the absence of the signs of continuing hemorrhage, are more apt to get well without operation than with it.

5. A large proportion of these cases has no chance of recovery either with or without an operation, because of the nature of the injury inflicted.

The main point in the medical treatment of gunshot perforation of the stomach is to keep that organ absolutely empty, not allowing water to be taken.

An American Honored. Prof. C. H. Hughes, of St. Louis, who came out for the meeting of the American Medical Association as president of the section of Neurology and Psychology, and detained at the residence of his sister, Mrs. T. A. Hughes, on