12-YEAR OLD ULCER HEALED WITH APPLIED BLOOD, WITHOUT SKIN GRAFTING.

Mike L.; age 57, Irish. Diagnosis, ulcer of left leg. Admitted to hospital March 3, 1902. This condition was of about 12 years standing, and during that time had never entirely healed. He has been treated at various hospitals and at various clinics. and by private physicians, but said that he got no special relief. The ulcer was a large one situated on the calf of the leg, being 4 by 34 inches. It was covered with unhealthy granulations which exuded a foul-smelling purulent discharge. The surface of the ulcer was thoroughly cleaned up with a dermal curette, and dressed with a wet Thiersch pack. This was kept wet and not changed in 24 hours. At the end of the 24 hours this dressing was removed, the wound thoroughly cleansed with bovinine and hydrozone reaction, followed by Thiersch irrigation, and dressed with bovinine pure. The bovinine dressings were changed twice in 24 hours, and the patient got a wineglassful of bovinine internally, every three hours. March 23d, the ulcer had healed with the exception of a small space at the upper periphery. This was touched up with a 25 per cent. solution of pyrozone, and dressed with bovinine pure; the dressings being renewed twice in 24 hours. March 30th, the patient was discharged cured; the ulcer having become covered with healthy skin, and no scar tissue, it being almost impossible to tell it from the surrounding skin, the only difference being that it was a little redder.

MARSYLE CLIN-SOLUTION FOR INJECTION IN STERILIZED TUBES.

The hypodermic injection of the salts of iron is not generally advised. Certain authors believe them useless; others regard them as painful, and the cause of a strong local reaction. The result thus far with the injection of Marsyle Clin solution shows that it is rarely painful, and is not accompanied by any irritation.

Injection should be deeply made in the gluteral muscles. The hypodermic method may be employed when the oral method is contra-indicated. The solution for injection is sterilized, and contains exactly five centrigrammes of Marsyle to the cubic centimetre.

It is furnished in sterilized tubes, the contents of which always slightly exceed a cubic centimetre, to permit of completely filling the syringe.

Note. After injecting the solution, carefully wash the needle and syringe in boiling water, to avoid oxydation.

Doses.--At the outset, one injection every two days, of onehalf to one cubic centimetre. After the susceptibility of the patient has been tested, daily treatment may be instituted.

EDITORIAL ITEMS.-Continued.

there is less prostration and the membrane is more apt to remain limited to the tonsils.

Inflenza. Kolipinski has described what he considers an early pathognomonic sign of this disease, in the presence on the soft palate of numerous, small, convex, transparent, pearly white projections about the size of a grain of sand, and giving a rough sensation on rubbing with a spatula.

To examine for influenza bacilli, have the patient expectorate sputum from the lungs into a wide-mouthed bottle containing boiled water. Decant and wash with water several times. Then remove the mass of muco-pus, open with scissors and take up a pea-sized piece with the platinum loop, fixing in the ordinary manner and using any of the common anilin stains. The epidemic nature of influenza should be given due weight in diagnosis. It is well to bear in mind that, besides the ordinary rheumatoid and respiratory forms of the disease, we at times encounter cardiac, gastro-intestinal and typhoid types. When grippal pulmonary symptoms do not clear up quickly, repeated examinations of the sputa should be made for tubercle bacilli.

Malaria.-The differentiation of malaria from other causes of chills and fever presents no difficulties to physicians familiar with the use of the microscope. The finding of the hematozoa malariae in the red blood corpuscles, and to a less extent the leucocytes, with the resulting pigment, is absolute evidence of malarial infection. The blood for examination is best drawn during the latter part or shortly after one of the periodic paroxysms. Malaria differs from septic conditions in the absence of hyperleucocytosis. The sign of enlarged spleen and the therapeutic test with quinine are of some diagnostic value.

Typhoid Fever.-To distinguish typhoid states of varied origin from the true specific infection frequently requires a resort to the Widal agglutination test. This reaction is seldom obtained before the end of the first week or later, and may be a residue of immunity from a former attack. The Ehrlich urinary diazo reaction appears usually from the fourth to the seventh day, but may be wanting in mild cases, and is occasionally observed with other infections. Hypoleucocytosis serves to differentiate enteric from septic fevers. The prodromal headache, lassitude, muscu

lar and nervous pains of typhoid should be kept in mind. Paratyphoid bacilli may cause the clinical symptoms and signs of typhoid fever, but the subject is negative to Widal's and Ehrlich's tests. Miliary tuberculosis and some cases of meningitis cannot be distinguished from enteric fever except by careful bacteriologic examination.

Rheumatism.-Rheumatism in children is often mistaken for "growing pains," and sometimes for tubercular disease of the hip or abdominal inflammations. In addition to the joint pain and stiffness, which are often insignificant, there may be present headache, stiff-neck, epigastric pain, habit spasms, night terrors and somnambulism. Chorea complicates over 50 per cent. of these cases of puerile rheumatism. There is commonly an excess of uric acid in the blood and urine.

Epidemic Meningitis.-The specific diplococci are present early in the spinal exudate obtained by lumbar puncture. Typical cerebrospinal meningitis of sporadic occurrence may be due to streptococci pyogenes, pneumococci or tubercle bacilli, migrating from foci in various parts of the body.

Yellow Fever and Dengue.-The differentiation of these two diseases in the early stage is said to be difficult, though of the utmost importance, since one is commonly fatal and the other is not. In the second and third stages of yellow fever the marked jaundice, severe, often black, vomiting, albuminuria and ischuria. or anuria make its diagnosis assured. Dengue spreads in very rapid epidemics along the southern and southeastern coasts. During invasion there are intense, boring or breaking pains in the muscles, bones and joints, whereas in yellow fever there are severe headache, nephralgia and pain in the calves.

Cholera and Dysentery.-Microscopic and cultural examinations of the feces furnish definite diagnostic evidence at an early stage, showing the "comma bacillus," the bacillus dysenteriae (Shiga) or some one of the amebae.

Rabies. The old medical teaching that a dog suspected of madness should be killed the instant it has inflicted a bite, is still followed largely by the laity. The only evidence of human hydrophobia in the period of incubation is in the dog itself. Gibier recommends that the canine suspect be kept in confinement and carefully observed for at least one week. As soon as the animal dies, which it will surely do if afflicted with rabies, the head and neck

should be cut off near the shoulders and sent to the nearest laboratory for the crucial tests (microscope shows proliferation around nerve cells of vagi; confirmed by inoculation experiments) that will decide the diagnosis within 24 hours. If the whole caput cannot be sent in this way, portions of the brain and medulla should be placed in two clean bottles, one containing pure glycerin, and the other 95 per cent. alcohol. In cases of bites on the head, the dog may be killed as soon as it shows distinct symptoms of paralysis, and the brain and medulla extracted for examination, since a few days or even hours saved in dumb rabies is an item of great consequence.

Glanders.-Mallein, the filtered product of growth of bacilli mallei in fluid media, when injected into animals afflicted with this disease, causes a sudden, short fever. Strauss's diagnostic method is to introduce a bit of the suspected tissue or culture into the peritoneal cavity of a male guinea-pig. If the reaction is positive, the animal's testicles, within 30 hours, show inflammatory swelling, resulting in a purulent orchitis.

Gonorrhea. The fact of the decolorization of the diplococci by Gram's method, and their presence within the leucocytes, is general sufficient evidence of gonorrheal infection, but in case of doubt cultural tests should be employed. In the female gonorrheal pus for examination is readily expressed from the urethra by means of the finger in the vagina. The morning urine is most likely to show gonococci.

Pulsatilla for Intra-Pelvic Disease.-According to Leuf, the tincture of pulsatilla is one of the most efficient agents for the relief of aching ovarian pain. In the dose of one to five drops every hour, it soon gives complete relief, sometimes acting as promptly as an opiate, but without a single objectionable accompaniment or after effect.

Ipecac for Uterine Hemorrhage.-Leuf recommends 1-20 to 1-12 grain of the powdered drug in solution every half hour or hour. It may be associated with an opiate if there is much pain. Belladonna may be given for a like purpose in 2-drop doses of the fluid extract every hour or two.

Amennorrhea from Mental Depression.-When mental depression seems to be the cause of amenorrhea, Leuf states that the tincture of gelsemium (ten drops every three or four hours) is often very useful. Amenorrhea caused by sudden nervous

shock is best met with large, repeated doses of potassium bromide. High mental excitement is sometimes markedly relieved by hyoscyamine (gr. 1-100 every hour).

Oxaluria and Glycosuria.-Frieda Lippert (American Medicine) has made an extensive series of urinalyses, which appear to show that there is a definite relation between oxaluria and glycosuria. Abundant oxalates reduce copper solution on standing twelve or eighteen hours after boiling.

Borax for Obesity.-Gerhardt, quoted in Medical Record, has found that eight grains of borax three times a day reduces the excess of fat. Smaller doses have no appreciable effect.

For Rhinitis Sicca.-Schrotter (Medical Record) prescribes an application of three parts of iodin in 400 parts of glycerin.

Ointment for Adenitis.-Widerhofer (Medical Record) uses an emollient containing 1-60 part of potassium iodide and 1-600 part of iodine.

For Collapse.-Krafft-Ebbing (Medical Record) advises the hypodermic injection of one-half to a syringe full of a mixture of equal parts of camphor, ether and olive oil.

Neural Treatment of Rheumatoid Arthritis.-A case in a bedridden middle-aged woman was treated successfully by W. J. Middelton (British Medical Journal) by means of massage and blisters. The latter were first applied, one on each side of the tenth dorsal vertebra, and were kept open nearly two weeks with savin ointment. Others were applied about a month later on either side of the lower cervical and upper dorsal vertebrae. The patient improved so much that she could get about and do her house work.

Creosote Carbonate in Pneumonia.-This drug is claimed to cut short an attack of pneumonia, and to prevent relapses and sequelae. It should be administered every six hours, the daily dose being from two to four drams.

Ethyl Chloride as an Anesthetic.-One thousand personally conducted cases with this anesthetic without a death are reported by M. W. Ware in the Journal of the American Medical Associa tion. Altogether 13.246 cases are reported with but one fatality.

Prevention of Puerperal Mastitis.—Ahlfeld (quoted in Clinical Review) applies ice bags day and night to abort incipient mastitis. To prevent such inflammation, he uses a solution of one part tannin in ten parts alcohol. This is applied to the nipple every