selves, and consequently their action is not as intelligent as it might be. If given a rule to work by, they will apply it, not only in season but out of season, and will look amazed if one suggests that, under special circumstances, they should have varied their usual procedure. Every employer and overseer of labor knows to what an extent

this is the case. It is the exceptional workman who really thinks, and who can therefore be trusted to suit his action to circumstances. And so in nearly every sphere of life, a kind of automatism seems to be the rule, and intelligent self-direction, in the light of present facts, more or less the exception. One is, therefore, tempted to ask whether in connection with our system of education, some gymnastic might not be devised for the special purpose of teaching the rising generation to think. -Popular Science.

IS APOMORPHINE A SAFE EMETIC-Dr. John Brown, of Bacup, asks the important question : Is apomorphine a safe emetic? and gives a brief account of his further experience of this drug. There are few, if any, of the new remedies introduced into the Pharmacopoeia that in his opinion have sustained their reputation with such unvarying success, and with so few failures, as apomorphine. Dr. Brown prepares his own solution of apomorphine as follows: Apomorphine Hydrochlor. gr. i.; Sp. Vini Rect. m xx.; Aquæ m c. Each 10 minims equals one-twelfth of a grain of apomorphine. The average interval between the hypodermic injection and the emesis is about ten minutes. As a rule, the vomiting only occurs two or three times at short intervals. The depression is but what might be expected after or dinary vomiting. He has observed no case approaching fatal or even serious collapse. Only two of the cases were adults, the others were very young children. He believes that there is no emetic so safe, certain and quick for children. In adults ordinary emetics usually succeed; not so in children. The cases reported in which collapse occurred were adults.-Brit. Med. Jour.

CARBOLIC ACID AND IODINE IN WHOOPINGCOUGH. Dr. Rothe, having met with some unfortunate cases of whooping-cough treated with antipyrin, turned his attention to a combination of iodine with carbolic acid in the treatment of this affection, and with this combination he has obtained excellent results. He has, he says, treated hundreds of cases, and cannot remember one in which the affection lasted longer than four weeks, besides which no fatal case occurred. The mixture he employs is as follows: acid carbol. 15 gr.; sp. vin., 15 m.; tinct. iod., 10 gtt.; tinct. bellad., 30 m.; aq. menth. pip, 2 oz.; syr. opiat., 150 gr. A teaspoonful of this is given to children over two years of age every two hours. When this treat

Should this not relieve the condition, galvinism should be resorted to, the current being caused to pass along the tract of the nerve, by placing one pole at the spinal column and the other at the painful parts.

UTERINE STYPTIC.-John Adderley, M. D., Skibbereen, County Cork, Ireland, says: It gives me great pleasure to add my testimony to the great value of S. H. Kennedy's Extract of Pinus Canadensis, which I consider a most valuable uterine styptic, seeming not only to possess the power of arresting uterine hæmorrhage, but also to produce a healthy action of the parts. I used it with a patient who had been suffering for a number of years from menorrhagia, depending upon ulceration of the os and cervix uteri, with whom I had tried all other remedies for menorrhagia, lasting during a period of five months almost without intermission. Extract of Pinus Canadensis applied to the os uteri on cotton wool, and also used as a lotion arrested the hæmorrhage immediately, and the Aletris Cordial, which was taken internally, helped to invigorate the system and promote a cure which I had at one time considered incurable. I should not wish to be without these remedies in similar cases, and shall continue the use of them in my practice, as I consider they gave most satisfactory results.

THE POST-MORTEM WARTS, says Dr. Wm. Osler, are now pretty generally regarded as local tubercle, the result of inoculation. The presence of bacilli has been demonstrated in several instances. The tubercles consists chiefly of granulation tissue, occasionally with giant-cells, and with papillomatous outgrowths of the epidermis, which gives the tubercle the wart-like character. They are met with in persons who perform many post-mortems and in those whose business brings them into close

contact with animals and animal products. Their occurrence is by no means infrequent. In Germany it is quite common to see the hands of the demonstrators of pathology (and more especially the attendants in the autopsy rooms) disfigured by these structures. Mr. Hutchinson considers these warts a form of lupus.-Med. Rec.

ETIOLOGY OF CANCER.-The first long address in this year's Surgical Congress at Berlin was delivered by Professor von Esmarch, of Kiel, on the subject of the Etiology and Diagnosis of Carcinoma, more particularly of the Tongue and Lip. The speaker pointed out that in all parts of the body, but with especial frequency on the tongue and lip, there occurred ulcerating tumors resembling cancer (syphilomata, tubercles, and actinomycotic masses), which naturally required different treatment from that used in cancer. As the latter should always be removed as early and as thoroughly as possible, and severe mutilating operations are often necessary for that purpose, it is of the utmost importance that an anatomical diagno sis should be made before operating. In most cases this can be done with certainty by microscopic examination. In order to procure the necessary material for examination, the surgeon should not recoil even from severe operations. Exploratory puncture, scraping, excision of large pieces, laryngotomy, laparotomy, trephining, suprapubic cystotomy, forcible dilatation of the rectum or urethra, belong to this category. Syphilomata are most frequently the occasion of error. They occur frequently on the tongue and also on the lips. Their late appearance, often after a period of latency extending to many years, makes the diagnosis difficult. If, in such cases, the anatomical examination supplies no positive proof that the disease is cancerous, and if, at the same time, there is no evidence of tubercle or actinomycosis, a diagnosis of syphiloma must be made in the first place, even if no other signs of inherited or acquired syphilis are present. These are the cases in which diagnostic inferences may be drawn from the success or failure of treatment. Antisyphilitic treatment must be energetically carried out. cases of tuberculosis and actinomycosis, the diagnosis will be confirmed by means of the microscope. With regard to causation, in the case of carcinoma, some sources of irritation may be discovered; these may have occurred but once, as in injuries, or may be persistent, such as foreign bodies, soot, tobacco, paraffin, etc. It is well known that malignant tumors originate in scars; old ulcers of the leg, or stomach, and syphilitic sores may degenerate later on. Benign growths may also become transformed into malignant tumors, for example, warts, nævi, etc. Chronic conditions causing irritation of the mucous membrane, or of the skin may give rise to the devolopment of ma

lignant growths, for example, leukoplakia, eczema, etc. With regard to the theory of their origin, Cohnheim's hypothesis, that it is due to the persistence of embryonic germs, is untenable. There is as yet no proof that cancer is an infective disease, and it is by no means probable that it is so. One has always to come back to the assumption that a certain predisposition, some diminution in the power of resistance of the tissues, is a ne C sary factor. Without this, it is impossible to explain how it is that in the great majority of cases in which causes of irritation exist, cancer does not become developed. One is inclined to look upon the predisposition as inherited, without being able to get any further. It may also be said that the tendency to the formation of tumors depends on the tendency of certain tissues to become thickened. Dy thickening of the connective tissue, especially of that of the vessel walls, sarcomata are produced; whilst carcinomata arise from thickening of the epithelium. The extension of this thickening into the neighboring tissues seems to be dependent on weakness of the latter. Cancer originates in overgrowth of the epithelium in the connective tissue inflamed, and thereby weakened. Perhaps the development of sarcoma on a syphilitic basis may serve to elucidate the origin of malignant tumors in general. Old, badly-treated syphilis leaves behind a tendency to thickening of the connective tissue. As the result of irritation of any kind, tumors such as sarcoma, fibrona, etc., may become developed in this thickening. These frequently disappear spontaneously, and are often curable by internal medication. Most of them, however, recur after extirpation, and they may also become generalized by metastasis, like the most malignant cancers. Such tumors, really dependent on syphilis, often first appear after long years of complete latency. In many other cases, in which infection can be excluded with certainty, the possibility of inherited syphilis must be borne in mind. The patient's ancestors must also be proved to have been free from syphilis. It is well known that many morbid tendencies which are inherited skip one or two generations in transmission, as, for example, gout, hæmophilia, etc. In the same way, syphilis may also skip one or more generations. It must be borne in mind that syphilis is extremely diffused. A large number of familiar diseases, all of which had this characteristic in common that they produced destructive ulcers in the skin by the breaking down of thickened connective tissue, disappeared before their syphilitic nature was recognized and appropriate treatment could be applied. It is, therefore, not beyond the limits of possibility that even among men now living there may be a tendency to thickening of connective tissue which has been handed down from bygone generations. Whether the tendency to epithelial thickening is to be explained in the

same way, more extensive investigation is required to show. One can only agree with Billroth that, up to the present, the most laborious statistics have thrown no light on its etiology.

IRRIGATION OF THE PUERPERAL UTERUS.-Dr. Haynes concludes a discussion of this subject thus: 1. Where intra-uterine irrigation is used in the absence of sepsis, use no sublimate, but plain hot water, or salt and water.

2. If the urine is albuminous and scanty, use no mercury.

3. If the urine is slightly albuminous and copious, or if the patient is profoundly anemic, do not use more than a pint of a solution of 1:8,000. 、

4. Always use tartaric acid and sublimate lablets or powders; dissolve thoroughly in a small quantity of water and mix carefully with a definite quantity of hot water in a pitcher, from which pour into the irrigator.

5. Always use fountain syringe, and for the uterus a double table, so as to insure the return of the solution. If for any reason the fluid fails to run out as fast as it flows in (if not through the reflex tube, by way of the channels at its sides), shut off the flow. The irrigator should not be raised more than three feet.

6. Precede by copious irrigation with hot water to wash out blood, etc., which may form with sublimate adhesive albuminous compounds, which may in time be absorbed. Follow by a quart or two of hot water to insure the evacuation of all the sublimate solution.

7. For the uterus use a solution not stronger than 1:8,000 and not more than a quart daily.

8. For the vagina use a solution not stronger than 1:4,000 and not more than a quart twice daily.

Irrigation used in the above way is, we believe, a practice almost devoid of danger. We have made more than one hundred and seventy-five irrigations with the double tube and fountain syringe, with no untoward results except in two cases an unimportant rise of temperature, and in one a severe but harmless chill, and even these slight accidents we feel certain might have been avoided by greater care. Yet irrigation of the puerperal uterus will always be a procedure requiring great care and judgment, and some skill.

Enough has been said to make it evident that our opinion coincides with that of Crede and Fehing, that both vaginal and uterine irrigation are attended with undoubted dangers, and should never be employed in the puerperal state unless to meet definite indications.-Amer. Jour. Obstet.

THE NATURE OF TETANUS.-The prolonged reading of the subject introduced by Professor Verneuil at the Academy of Medicine, on the nature of tetanus, has been brought to a close. Be

As

sides the equine and telluric origin of tetanus, M. Verneuil believes also in the contagiousness of this malady, which may be effected by the dust floating in the air, or even by flies, as in the case of charbon. He cited a case in support of this last conjecture, without pretending, however, to arrive at a positive conclusion. In fact, M. Verneuil gives the preference to the equine origin of tetanus. In support of his thesis, he cites a statistic of about 380 cases. Of this number, 222 relate to individuals whose profession put them in constant relation with the horse (farmers, coachmen, stablemen, etc.), or fifty-eight per cent. for the other cases, the equine origin of the malady, which may not appear so evident, is none the less real. For instance, three medical men, who died from tetanus, had horses which they looked after themselves, and a beadle, whose profession has nothing in common with that of the stableman, contracted the disease after having during a whole day, with a wound in the hand, transported manure from one place to another. As regards the telluric origin of tetanus, M. Verneuil sees in the earth only an intermediate agent between the horse and man. The soil impregnated with the dejections of the horse would be noxious; ordinary soil would not be so. Thus it was that in the extensive works executed at the port of Boulogne, and where not a single horse was employed, not one case of tetanus was observed, although the wounds incurred by the workmen were numerous. Professor Verneuil concluded his communication by insisting on the means that should be taken to prevent the development of this malady. As it is now admitted to be contagious and microbian, all the articles that have been in contact with tetanic patients should be completely disinfected. A person wounded should never sleep in the bed previously occupied by a tetanic patient, without disinfection having been absolutely carried out. equine origin of the malady being also established, the prophylactic measures should not be confined to man, but they should be applied also to horses. He recommends that the most energetic means should be employed, and he proposes not only the disinfection, but also the destruction of objects which, like the harness for instance, that had been used on tetanic horses, might contain the microbe of tetanus.-Paris Correspondent Med. Rec.

The

CEREBRO-SPINAL MENINGITIS.-Cases of cerebrospinal meningitis, which used to be quite rare here, have become much more numerous of late; and, as this generally fatal disease is now understood to be infectious, the Berlin police are about to take measures to prevent it from spreading. On and after May 1st next, every physician will be required to report any case occurring in his prac

tice without delay to the Royal Sanitary Commission. So far as possible patients are to be isolated. Children of families in which there are cases, are to be kept from school till the danger of infection be medically certified as past. The sick-rooms, the linen and cotton articles, especially the handkerchiefs used by the patients, their clothes, etc., are to be thoroughly cleansed and disinfected. These regulations will be enforced by penalties.

INFECTION OF AN INFANT THROUGH THE MILK OF A TUBERCULOUS NURSE.-Dr. Steigenberger, of Buda Pesth, has recorded a case of tubercular infection through the nurse's milk in the Pesther medicinisch-chirurgische Presse. The facts of this interesting case are summarized as follows: An infant, aged five months, of healthy parentage, developed caseating cervical, glandular abscesses, of a distinctly tubercular kind. Microscopical examination verified the macroscopical diagnosis. Inquiry elicited the fact that the infant had been nursed, for a period of four weeks, by a woman who had to be discharged on account of phthisis, with abundant expectoration. The etiological relationship was thus clearly established.

The infection of human beings through the milk of tuberculous animals has been repeatedly shown, and there is, of course, no reason why the human milk should not carry with it the same pathogenetic power. But, so far as we are aware, the above case is the first instance in which this method of transmission has been actually observed to occur. The inference is obvious, namely to exercise the greatest possible amount of care in the selection of wet-nurses.-Med. Rec.

DIGITALIS IN THE TREATMENT OF PNEUMONIA. In this disease digitalis acts on the factor of fever, which in pneumonia is often the most prominent symptom. It also circumscribes the area of disease in the lungs, but the main indications for its use are to be found in the constitutional disturbance. In an uncomplicated case of pneumonia, it should be given whenever the pulse exceeds one hundred, irrespective of the extent of the pulmonary lesion. It should be borne in mind that in fatal cases death supervenes between the eighth and tenth day, and digitalis attains its maximum effect from the seventh to the tenth day. It is therefore necessary to prescribe the drug not later than the third day.—Cincinatti Lancet-Clinic.

MUST NOT HAVE SPECIALTY ON CARD.-The American Association of Genito-Urinary Surgeons says that it will not consider the application for membership from one who on his card states that he is a Genito-Urinary Surgeon. He can do this in connection with his papers in the medical journals, and with the reprints of the same, in the announcements of the dispensaries, etc., with

which he is connected. By these means he can advertise his specialty among the people and the profession, but he must not do the same thing with his cards.—Med. Rec.

A JUDGE'S OPINION ON THE USE OF THE TITLE HOMEOPATHIST.-Judge George C. Barrett, of the Supreme Court of this city, sends to the New York Medical Times, an opinion which will be read with much interest. He was asked to give a reply to the question: "Has a physician designating himself an Homopathist and called as such to a patient, any legal or moral right to adopt other than homœepathic means in the treatment of the case?" To this Judge Barrett answers: "I have your note of the 11th inst., asking my opinion upon a question of professional ethics. In may judgment there can be but one answer to your question, and that is in the negative. If I call in a medical man who designates himself a 'homœopathic physician,' it is because I do not wish to be treated allopathically, or eclectically, or otherwise than homoeopathically. There is an implied understanding between myself and the homœopathist that I shall receive the treatment which, by tradition and a general consensus of opinion, means small doses of a single drug administered upon the principle of similia similibus curantur. If there is to be any variation from that method I have a right to be informed of it and to be given an opportunity to decide. Common honesty demands that before a confiding patient is to be drugged with quinine, iron, morphine, or other medicaments, either singly or in combination, he should be told that the homeopathist' has failed and that relief can only be afforded by a change of system. An honest homoeopath,' who has not succeeded, after doing his best with the appropriate homopathic remedies administered on homeopathic principles, should undoubtedly try anything else which he believes may save or relieve his patient. But when he reaches that point the duty of taking the patient into his confidence becomes imperative. The patient may refuse to submit to the other system or he may agree, but prefers a physician whose life has been specially devoted to practice under that other system. He may say to the

homœopathist;' You have failed, but I prefer to try anather gentleman of your own school, before resorting to a system that I have long since turned my back upon. Or he may say, Well, if homeopathy cannot save me I prefer to go to headquarters for allopathic treatment. All this, gentlemen, is the logical sequence of the particular designation Homopathist.'"

RIB RESECTION.-The Central/batt fur Chirurgie, No. 7, 1889, contains the report of a case in which Dr. Grünbaum, of Warsaw, removed with success

the whole of the tenth rib on the right side, together with the corresponding transverse and articular processes of the tenth dorsal vertebra, for necrosis. The patient, a young man, aged 23, when first seen by Dr. Grünbaum, presented an open sore, about two inches in length, over the tenth rib in the axillary line on the right side. This sore was lined by unhealthy granulations, and at the bottom of it was exposed bare bone. Pressure along the posterior part of the rib and over the spinous process of the tenth dorsal vertebra caused much pain. The patient having been put under the influence of an anæsthetic, the rib was exposed by incision of the soft parts as far as the angle. The posterior part of this incision laid open a cavity, of the size of an apple, which contained thin, ill-smelling pus, and surrounded the head and neck of the rib and the transverse process of the tenth dorsal vertebra. The head and neck of the diseased rib having been carefully dissected away from the adherent pleura, the whole of the bone, together with adherent vertebral process, was removed without any wounding of this membrane. A cavity was now discovered in the body of the tenth dorsal vertebra, which was occupied partly by yellow tuberculous material, partly by vascular granulations. The contents of this cavity and also the granulations on the inner surface of the abcess cavity, together with shreds of tissue and purulent clots, were then removed with a sharp spoon. Although the wound healed favorably and with but little discharge of thin fluid, the patient remained feverish for a long time after the operation, but he ultimately made a complete recovery. This case, Dr. Grünbaum states, was certainly one of an acute form of osteomyelitis granulosa with suppuration, and caries of a part of the tenth dorsal vertebra, and of the whole of the tenth rib on the right side.-London Med. Recorder.

GENEROUS GIFT TO THE EPISCOPAL HOSPITAL OF PHILADELPHIA.-The family of the late George L. Harrison, of Philadelphia, has offered $200,000 to the board of trustees of the Protestant Episcopal Hospital, to found and to endow a building

for incurables in connection with that institution.

Some years ago Bishop Stevens submitted to the Convention of the Diocese suggestions in reference to such an addition to the hospital. He wanted an endowment for a ward of such a character.

The trustees of the hospital took the matter in hand, and some measures were adopted which brought a response, and a nucleus was formed by donations until the total, some of it given for building and some for an endowment, amounted to something less than $10,000. Now, Mrs. Harrison has joined with the four sons of her late husband, Charles C., William W., Alfred C-, and Mitchell Harrison, in making the gift to perpet

uate the memory of George L. Harrison, one of the best and most generous friends the hospital ever had. It is almost unnecessary to add that the board of trustees has accepted the offer. It is seldom that money is given so generously and so wisely as in the present instance; for instead of expending the whole sum in a building, one-half of the amount is to be reserved as an endowment, so that the building when erected will have ready to its hand the money necessary for accomplishing the good work for which it is intended.

HYPERIDROSIS AMONG SOLDIERS.-An official circular, addressed to Prussian army surgeons respecting excessive sweating of the feet and other parts among the soldiers as an affection demanding treatment, advises the use of chromic acid as an efficient and economical application; of the strength of one part in ten of water. In cases of hyperidrosis of the feet such a ten-per-cent. solution, applied at intervals of three, four, or six weeks, has proved sufficiently strong to remedy this sort of disability. From the point of view of military hygiene, the prophylaxis of this affection is not merely a question of discomfort and inconvenience, but has its relations to the efficiency of the service, since all soldiers having hyperidrosis will be more or less prone to recurrent catarrhal troubles and to the evils attendant thereon. Hyperidrosis of the feet, moreover, will impair the marching capabilities of the men having that infirmity.

BALDNESS AND Dandruff.—A solution of chloral hydrate, five grains to the ounce of water, will clear the hair of dandruff, and prevent its falling out from that cause. In many instances where the patient is nearly bald, the application of the above-mentioned solution will restore the hair. Arnica oil is also an admirable remedy to promote the growth of hair. A small quantity well rubbed into the scalp three or four times a week can be tried with expectations of benefit.

THE PEANUT IN THERAPEUTICS.-The peanut, beloved of the gods of the gallery, may possibly vindicate its claims to popularity, as it is recommended as a remedy for insomnia. It is said to be quite efficacious when taken ad lib., freshly roasted before retiring. It is true the recommendation is made by a clergyman, but as it is not a new tonic made from bad whiskey, an opium cure containing morphine, or any of the other blessings to humanity usually floated on clergymen's endorsements, we need not condemn the peanut

without a trial. It is certain that the free use of

this nut sometimes produces vertigo and slight mental exhilaration.-Philadelphia Medical Times.

THE Homœopaths are to hold a Congress in Paris this year.