bowels gently kneaded with the thumbs placed side by side; but in this case, too, the movements should follow the course of the larger bowel. In addition to the above treatment, more special measures have often to be employed. These may be divided into two classes: the class of suppositories and injections, and that of remedies given by the mouth. The class of suppositories and injections aims at producing an immediate evacuation of the bowel, and in no way tends to promote more regular action in the future. These remedies are, therefore, useful in clearing the way for further treatment, but there their value ends. A suppository of Castile soap introduced into the rectum is a timehonoured method of inciting an evacuation in the child. Another old-fashioned plan has lately been revived, which consists in the injection of forty or sixty drops of pure glycerine into the lower bowel. In each case energetici peristaltic action of the alimentary canal is induced, and the bowel is thoroughly emptied of its contents. Of these applications the action of the glycerine is very rapid, and in a few minutes the effect of the injection is seen. The soap suppository acts more slowly. Injections of soap and water, or other liquid, have an entirely mechanical action in relieving the patient. To be effectual such injections must be large, consisting of at least half a pint of fluid and should be thrown very slowly into the bowel. Still, although of service when given only occasionally, the frequent use of large injections is not to be recommended; indeed, this method of treatment is distinctly hurtful in cases where the costiveness has become a habit. Even in young babies great dilatation of the bowel and serious weakening of its muscular coat have often followed the daily use of the enema pump. For the permanent cure of habitual constipation remedies given by the mouth are greatly to be preferred, but, at the same time, strongly acting purgatives are worse than useless. Our aim should be to find the smallest dose which will awaken a normal degree of energy of peristaltic action, and to give this dose regularly so as to induce a habit of daily evacuation. The daily dose is most efficacious when combined with a remedy which tends to give tone to the muscular coat of the bowel. For this purpose a useful draught is composed of half a drop of tincture of nux vomica combined with ten drops of tincture of belladonna and twenty of infusion of senna, made up to a fluid drachm with infusion of calumba. This draught should be given at first three times a day before food, but soon two doses in the day will be sufficient, and it is rarely long before one dose given at bedtime has a sufficiently laxative effect. Our object is not to excite watery evacuations, but to induce as faithful imitation as possible of a normal action of the bowels. The liquid extract of cascara is useful in many cases, especially if combined with tincture of belladonna. Twenty, thirty, or more drops of cascara extract with ten of the belladonna tincture, may be given with a few drops of glycerine in a little water every night. In the west of England a remedy held in high esteem consists of half a grain of sulphur colored red with cochineal. That this apparently insignificant dose is often efficacious when given regularly every night I can testify from my own experience. In cases where the motions are drier than natural, as if from imperfect secretion of the intestinal glands, the addition of liquid to the diet, already recommended, may be supplemented by the administration of some saline aperient two or three times a day. This treatment is made more effectual when the saline is combined with small doses of nux vomica and quinine. For a baby of six months old, five to ten grains of sulphate of soda may be given with one quarter of a grain of quinine, half a drop of tincture of nux vomica, and a minim of aromatic sulphuric acid, in a teaspoonful of water three times a day before food. As in all cases where the remedy prescribed has been chosen with judgment and given in appropriate quantity, the continued administration of this draught, so far from rendering the bowel dependent upon the medicine, stimulates it to act spontaneously, so that the dose has soon to be given less frequently, and in no long time can be discontinued altogether. By means such as the above the most obstinate case of constipation in the infant can be cured with little difficulty, but to be successful the treatment must not be restricted to mere drug-giving. The food of the child must be regulated with care, his clothing must be inquired into, and his general management passed under review Where this is done, drugs given in comparatively small doses will act with sufficient energy, and will soon restore their normal regularity to the bowels.-Brit. Med. Jour. RECENT ADVANCES IN THE PHYSIOLOGY AND PATHOLOGY OF INFANT DIGESTION. Recent investigations undertaken by two French physicians, Drs. Hayem and Lesage, of the stools of children suffering from green diarrhea, revealed the presence of large quantities of a short, sporeforming bacillus, which, cultivated on potato or meat peptone gelatine, gave origin to a spinachgreen pigment. The bacillus grows freely in neutral or alkaline media; lactic, hydrochloric or citric acids arrest its development. The addition of a few drops of lactic acid to the gelatine prevents the development of the microbe. The injection of a cubic centimetre of the pure cultivation of the bacillus into the veins of young rabbits, caused green colored stools that contained the characteristic green color bacteria. Lesage declares the green diarrhoea of dyspeptic children to be a contagious bacillary disease. Assuming the clinical and bacteriological facts to be correctly stated, one point stands prominently out, and in fact, dominates the rest. It is that, before these microbes can develop in the intestinal tracts of children, and give rise to their green-colored diarrhea stools, there must have been an alkaline reaction at some portion of the tract, for it has been shown that they cannot grow in any part where the reaction is acid. The bearing of what has been stated on treatment, both prophylactic and remedial, is self-evident. In the first place food must be given, at least when the disposition to dyspepsia shows itself, in a perfectly sterile form, and in the second, remedial treatment will naturally fall into a disinfectant groove. The author recommends the Soxhlet milkcooking process as admirably answering all the requirements as regards prophylaxis. This is shortly as follows: Bottles are used that contain just the quantity required for one meal, so that none is left over when once the bottle has been opened. The bottles are provided with a well fitting india-rubber cap, in the centre of which is fitted a solid glass rod. When the feeding time arrives this rod is exchanged for a glass tube to which the teat is attached. The sterilising takes place in a water bath, by continued boiling for forty minutes. The that are generally the cause of the disease. immediate and visible effects of the washing out are the immediate cessation of the vomiting, and an increased tolerance of fluid food, which, as Epstein recommends, should consist exclusively of white-of-egg water until the diarrhoea is stopped. The washing out has to be repeated once or twice a day until the cure is complete-washing out of the large intestine, again using Nélaton's catheter, for the intestinal tube has already gained too firm a footing in Germany to require any further recommendation for German readers. The stomach and large intestine have now, we will suppose, been washed out and thoroughly disinfected, but the small intestine still remains in an unsanitary condition. What is to be done with it? It cannot well be washed out, and the only way out of the difficulty is, if possible, to give only such food as is not subject to fermentation. Hirschler has ascertained by experiment, as has already been pointed out, that in the small intestine it is principally the saccharolytic kinds of bacteria that are active. Escherich therefore pleads for the absolute exclusion of sugar from the dietary of children whilst under treatment for affections of the small intestine. A diet consisting of albumen and peptones he believes to be an unfailing means of avoiding the noxious fermentation processes. We may be permitted to point out that the dietary now recommended by Escherich, as the latest outcome of physiolgical investigation, is singularly like that recommended by the father of modern medicine, the British Sydenham, 200 years ago, who enjoined an exclusive dietary of weak chicken broth in summer diarrhoea.-Med. Press and Circular. SIMPLE AND RAPID STAINING OF THE Although the causal relation of the tubercle bacilli to pulmonary phthisis may be questioned by some, no one, we think, can deny the diagnostic importance of their presence in the sputum. As regards therapeutics, mechanical flushing is placed in the front rank. As the author remarks, the bodily removal of fermenting and decomposing intestinal contents by washing out of the stomach and large intestine is a more efficient therapeutical process than internal administration of any antiseptics, concerning which-with the solitary exception of calomel-it is not certain whether they can be given in doses large enough to be effective. That washing out of the stomach after Kussmaul's method is practicable and useful in children, is shown by the writings of such practitioners as Lorey, Friedlander, Epstein, Biedert, Ranke, Thomas, Escherich, Hirschsprung, and Ehring, all of whom have reported favorably of it. The apparatus recommended for the purpose by Epstein is a sort of douche, with tubing of suitable size, a Nélaton catheter, Nos. 8 or 10 serving as œsophageal tube. Washing out the stomach is indicated, according to our author, in both acute and chronic dyspepsia, in dys peptic intestinal catarrh, and in Brechdurchfall (vomiting and purging). Regarding the lastnamed affection, it is to be noted that from a therapeutical point of view it is of the greatest importance to empty the stomach of the remnants The methods at present generally adopted in of food and the poisonous products of decomposition the laboratories-the Koch-Ehrlich method-is a The ability to recognize them enables the physician to diagnose the character of pulmonary disturbances earlier than he can possibly do it either by physical signs or any other symptoms. If the technique of the staining of the tubercle bacilli can be reduced to a simple form, so simple that no special technical training is necessary, then I believe that this most important aid to diagnosis would be as constantly employed by the practitioner as the chemical and microscopical examination of the urine in suspected cases of Bright's disease. complicated process requiring much practice and judgment, especially in the decolorization of nitric acid; it is not consequently adapted to the general practitioner's use, and will yield reliable results only in the hands of experts. The belief that any technique which is simple and rapid, and reduces the staining of the tubercle bacilli to a mechanical basis, would be of use to the general practitioner is my reason for presenting the following method, which I have used for some time with uniformly satisfactory results. While working with Professor Koch last spring, I found that in his personal examinations he made use of a solution of fuchsine known as Ziehl's solution, and hardly ever had recourse to a double staining. To an expert, this gives without doubt the quickest staining possible, but because of the weakness of the solution, if made according to Ziehl's formula with the ordinary fachsine purchased in this country. and of the lack of a contrast color, it does not yield satisfactory results to others. Mak ing use of the principle which Ziehl has incorporated in his solution, viz., that carbolic acid can be substituted for aniline oil, I first stain the bacilli with a very strong solution of carbolic fuchsine, and then make the contrast staining by what is known as Fraenkel's solution, which combines the decolorizing and dyeing in one process. This furnishes a specific staining for the tubercle bacillia deep-red color; the other elements in the sputum, the putrefactive bacteria, the puscells, the epithelium, taking the second color blue. The advantages of the method which I propose are these: 1. Simplicity; one solution is poured on the sputum and then the other, with no judgment necessary as to the amount of staining or to the decoloration; this makes the process simply a mechanical one. 2 Quickness and precision; the whole process occupying but two minutes. 3. The great intensity of color with which the tubercle bacilli are stained. 4. The solutions keep indefinitely, especially the carbolic solution, which cannot decompose like the aniline water solution of fuchsine; they are therefore always ready for use. ten or fifteen cubic centimetres-the exact amount is not important. 4. Shake a few times and set aside for twenty-four hours. This is the carbolic solution of fuchsine to be used. Second The Methylene-blue Solution. into a four-ounce bottle, Alcohol. 30 parts. Distilled water Nitric acid. 50 20 Put and add methylene-blue until the solution is more than saturated. The Method of Staining the Sputum.-1. Pre pare two cover-glasses in the ordinary way, by placing a small portion of the suspected sputum on one cover-glass and, by means of the other, pressing it out between them into a thin layer; on sliding the cover-glasses apart, a thin film of sputum will be left on each cover-glass. Allow the cover-glass to dry, and then, holding them firmly with a pair of forceps, prepared side uppermost, pass them rapidly three times through the flame of a spirit-lamp. 2. Hold cover glass as before, and pour on it a few drops of the fuchsine solution. Then warm the cover-glass over a spirit-lamp until steam rises, being careful not to allow the fluid to boil; now let the solution on the cover-glass cool. 3. Pour off the fuchsine solution. 4. Pour on the cover-glass the methylene-blue solution, and after half a minute or so, the exact time is not important-5. Wash off the stain carefully with running water (a wash-bottle is convenient). 6. Dry the surface of the cover-glass which does not contain the sputum. 7. Mount on a slide in water and examine. A little practice will enable one to carry out this simple technique with great rapidity; the only difficulty is in preparing the solution at first, but, as they will keep for months and are always ready for use, this is not of much moment. One great advantage to the practitioner will be the doing away with all dishes, acids, etc. The two bottles always stand ready, and when necessary the sputum can be examined while the patient is in your office. To emphasize the quickness of the process, the whole formula can be stated in four lines. 1. Pour your fuchsine solution on prepared cover-glass. 2. Heat and then allow to cool. 3. Pour off solution and pour on methylene-blue solution 4. Pour, wash this off, dry, and mount in water. -H. P. Loomis, M.D., in Med. Rec. The Method of Preparing the Solutions.-First: The Fuchsine Solution. 1. Pour into a small bottle of alcohol, say a four ounce bottle, enough fuchsine to form a well-marked layer over the bottom of the bottle, or, in other words, more than THE CHIAN TURPENTINE TREATMENT enough for a saturated solution. 2. Let it stand for twenty-four hours, shaking the bottle from time to time. 3. Into a four-ounce bottle, containing a five per cent. aqueous solution of carbolic acid, pour enough of the first solution to produce a distinct precipitation of the fuchsine, say, about OF CANCER. Chian turpentine, the internal administration of which as a remedy for cancer has been recently recommended anew by Professor John Clay, obstetric surgeon to the Queen's Hospital, Birming ham, England, is a product of the Pistacia terebin thus, a tree which in its native island of Scio, in the Mediterranean, grows to the height of thirty or forty feet. The gum is obtained from incisions into the bark, and the many impurities which it contains are composed of sand, leaves, straw, and particles of bark and fruit. As Professor Clay insists that its efficiency depends upon the genuineness of the drug, it is well to carefully consider the following discription from Flückiger and Hanbury's "Pharmacographia.": "Chian turpentine, as found in commerce and believed to be genuine, is a soft solid, becoming brittle by exposure to the air; viewed in mass, it appears opaque and of a dull brown hue. If pressed while warm between two slips of glass, it is seen to be transparent, of a yellowish brown, and much contaminated by various impurities in a state of fine division. It has an agreeable, mild terebinthinous odor, and very little taste. The whitish powder with which old Chian turpentine becomes covered shows no trace of crystalline structures when examined under the microscope." It is believed that Strassburg and Venice turpentine and Canada balsam are often substituted for it, which can usually be easily detected by applying the tests as to taste, odor, and appearance given above. The turpentine, as used by Clay in the first reported case (Lancet, March 27, 1880), was given in the form of a pill, containing three grains, combined with two grains of flowers of sulphur. Two of these pills were given every four hours for many weeks, and some cases for nearly a year. It was found that in some instances the turpentine in the pill form was not well digested, and the latest recommendation of Professor Clay is to administer it in an emulsion made as follows: One ounce of the Chian turpentine is to be dissolved in two ounces of pure sulphuric ether. This solution has been termed the turpentine essence, and the emulsion is made by adding one ounce of this essence to a mucilage of acacia (one ounce and a half of powdered gum arabic and water to nine ounces), making a ten-ounce mixture, a teaspoonful of which contains about three grains of the drug. A dessertspoonful, it will be observed, contains the same amount of turpentine as the two pills which were previously recommended. In some cases resorcin has been added in doses of a grain. This emulsion is not of a disagreeable taste, as nearly all my patients who are under the treatment testify. Tonics have been used when indicated. In some instances local applications have been made, in others this internal remedy alone has been employed. When it has been taken for about three months it should be omitted three days in every fortnight. The sulphur is often given in a separate pill, especially in cancer of the uterus and rectum. I have given this description of the plan and exhibited the preparations in order that we may have an accurate knowledge of of what this China turpentine treatment really is. We are all familiar with the statements which Professor Clay has repeatedly made concerning its efficacy. He has seen a number of complete cures, not only of uterine cancer in advanced stages, but also of cancer of the rectum and surface epitheliomata. In cancer of the breast he reports marked improvement of symptoms and complete arrest of the new growth. No report has yet been pubiished, as far as I can learn, stating the precise changes in the tumor, but he maintains that the primary action is upon the periphery of the growth. The plan has been tested in the London Cancer Hospital, and, after a tolerably thorough trial, condemned by Dr. Marsden and Mr. Purcell. Another trial has recently been made, however, and one of the surgeons of the same hospital declairs the Chian turpentine to be a very useful remedy in many cases. In the Lancet for November 22, 1887, the editor says there can be no doubt that Professor Clay's report of cures are trustworthy, and that it can hardly be possible, with a man of his large experience, that they were all cases of mistaken diagnosis. He advised a continued trial of the remedy. The drift of pathological research is now strong in the direction of a specific origin of the disease, to which theory Sir James Paget expressed a qualified preference in his recent "Morton Lecture." cure by internal treatment may, in the next decade, become as possible in cancer cases as it has long since become in syphilis. To My own experience is still too limited to be of much value. Several patients in my service at the Skin and Cancer Hospital have been under the treatment of varying periods-from one to six and eight months. All take the remedy well, by giving them a brief rest occasionally. A cancer of the uterus has been greatly benefited; pain has decreased, hæmorrhage has ceased, and granulations have become healthy. A large epithelioma of the face has decidedly changed in character. In some no effect whatever has yet been noted. We shall watch the cases with great interest, and give a full report to the profession.-Dr. Daniel Lewis, in N. Y. Med. Jour. THE TREATMENT OF BRONCHO-PNEUMONIA IN CHILDREN BY APPLICATION OF ICE. Having now treated many cases of severe bronchopneumonia in children and infants by means of ice-bags, it seems desirable, owing to the success attending such treatment to urge the profession to consider its more general adoption. The cause of the broncho-pneumonia does not, in my ex perience, influence the employment of the ice-bag. It may be used with much success even in cases of broncho-pneumonia secondary to tracheotomy, but still more favorably in cases of influenza and measles. The smaller the child the more marked are its effects. In very small infants under one year of age the ice bag may be placed on the head, the hair having previously been thinned and shortened if necessary. The treatment to be successful must be carried out with a will and systematically. As heart and circulation the influence is also decided, but this influence is probably exercised directly and indirectly; for not only does the cold directly quiet the heart and steady the circulation, but the calming of the nervous system also acts indirectly in the same direction. The respiratory centres are similarly beneficially affected.. The heartregulating apparatus manifests most clearly the same beneficent action, and the temperature chart shows a similar harmonious effect. It is curious to observe the almost immediate cooling of the whole surface of the body soon after the application of ice to any part, this cooling effect being perhaps best marked when the ice is applied to the head; the hands, previously red and hot, become cool and slightly blue. The change is decidedly favor of feeble circulation in the exposed parts of the skin. Vomiting and diarrhea, alone or in combination, may require treatment in the cases under consideration; the cold method does not increase diarrhoea, and it certainly tends to stave off vomiting. The employment of cold does not obviate the necessity of using stimulants, either of the ordinary sort or such as act more especially on the heart and respiration. But cold renders them less nceessary, and when they are required smaller doses are sufficient. There is, indeed, a saving of expenditure all round: the cost of the illness is lessened, and the illness costs the child less expenditure of reserve strength.-Angel Money, M.D. in Lancet. a general rule, the rectal temperature affords the best guide to the application of cold, and those acquainted with broncho-pneumonia well know the highly marked remittent or almost intermittent character of those affections. Ice-bags have the drawback that they often give rise to a little wetting of the child, but this has not, in my ex-able, notwithstanding the supervention of the signs perience, proved injurious to the patient. Leiter's tubes have been tried, and have some advantages, being especially valuable when an intelligent nurse is in attendance. The condensation of moisture caused by the cold is of course inevitable, but this wetting may be rendered harmless by covering the ice-bag or Leiter's tubing with a layer of Hartmann's wood wool or the compressed moss sphagnum. In severe cases, where a rapid effect is required, two ice-bags have been placed on the head, and one over the chief seat of consolidation in the lungs. With a little management it is not difficult to keep these in place; certainly not when the neuromuscular prostration is marked, as it almost always is in severe cases. The chief merits of this treatment consist in the maintenance of the strength, not only of the heart, but also of the respiratory centres and of the nervous and muscular systems. Although otitis media occasionally occurred, yet this has not been more frequent than in cases treated without cold. Albuminuria is not rendered worse by the cold, nor have any cases of hæmaturia been observed. The urine has, at some trouble been specially collected and tested in small infants. The duration of the disease is, on the whole, shortened. Convalescence is almost invariably rendered more rapid, doubtless because of the conservation of the child's energy. ECLAMPSIA, WITH ALBUMINURIA. Dr. J. H. Bennett, in the Jour. Amer. Med. Assn.—Mrs. H., aged thirty-five, multipara, was taken with convulsions at end of eighth month of pregnancy. At 4 o'clock in the morning of Sept. 28, I was called and found patient in a comatose state; face and hands, and, in fact, the whole body, cedematous to an uncommon extent. Being naturally plethoric, sixteen ounces of blood were taken from the arm, followed by ten grs. of calomel combined with 4 gr. of elaterium. This procedure and treatment had a very happy effect in controlling the alarming symptoms. Elaterium was continued in gr. doses administered every three hours, with sixty grs. of cream of tartar, until thoroughly watery stools were secured, which reduced the oedematous condition almost entirely. It is superfluous to assert that ice does not merely act by stealing heat; its action is almost exclusively sedative. Physiologists would aver that it increased inhibition, and in that way made wrong right; because disease simply lowers resistance in the vital processes, and curative measures Believing that urea decomposing in the blood raise it. Ice influences different organs differently, causes the phenomena of eclampsia, benzoic acid and this is most noticeable in the various parts of was administered (after the thorough watery evacthe nervous system. Its action on the cortex cf uations were brought about) in eight gr. doses the brain is, perhaps, most evident in the pro- every three hours until the patient became conduction of sleep, restless movements rapidly sub-scious, after which the same treatment was considing if the cold be efficiently applied; probably, therefore, the whole system of motor centres and sensory centres is soothed, because morbid sensa tions and morbid motions tend to cease. On the tinued, with the addition of wine of colchicum and guaiacum. As soon as the patient was able to do so, the knee and chest position was adopted and maintained at times when her strength would |