allowed in these cases, excluding only such foods as produce substances difficult of elimination by or irritating to the kidneys. A milk diet also is good in the acute disease, but injurious in the chronic cases, and the excessive water drinking so often advised, he states, is irritating to the kidneys and injurious to the overtaxed cardiovascular apparatus. Sweating a nephritic patient may be of some value in relieving the patient of excess of water which the kidneys cannot dispose of, but giving much. water at the same time is irrational. The restriction or withdrawal of chlorides, on the other hand, is both practically and theoretically useful.

Hyperplasia of the Hypophysis, Thyroid,

and Suprarenals in a Case
of Acromegaly.

The lesion of the hypophysis in acromegaly is generally considered as destructive, whether or not it is of neoplastic origin. MM. Ballet and Laignel-Lavastine, however, have reported a case of acromegaly in which the gland presented the lesions of hyperplasia. The thyroid and the suprarenals were equally hypertrophied macroscopically and histologically. The parallel evolution of the three antitoxic glands is worthy of note.-La Tribune Médicale.

Anæsthesia in Rectal Diseases.

J. P. Tuttle says that simple fissures; small, straight, uncomplicated fistulas; ordinary skin tabs; isolated, prolapsing internal hæmorrhoids in patients with stable organisms, may all be satisfactorily operated on with local anesthetics, of which cocaine and eucaine are the best. In all other conditions, including extensive hæmorrhoids, complicated fissures and fistulas, and always in neurotic hyperæsthetic individuals, we should resort to general anaesthesia.-New York Medical Journal, June 17.

Therapeutic Notes.

Chronic Cystitis.

The following formula is highly recommended in the treatment of this condition:

B Venice turpentine, 5 grams.
Castoreum,

Camphor, of each, 2 grams.
Calcined magnesia, q. s. 4 grams.

M. et ft. pil no. xl.

Sig. One or two pills three times a day. -Medical Summary.

Whooping-cough.

Thiocol (Bull. Gen. de Therap., March 8, 1905) has given good results in the treatment of whooping-cough in doses for an infant 1 year old 0.5 gram (8 grains); for 3 years, 1 to 1.5 grams (15 to 23 grains); for 3 to 6 years, 2 to 3 grams (30 to 45 grains); for 10 years, 4 grams (1 drachm); and for adults, 5 grams (75 grains) in twenty-four hours. A combination frequently given was:

R Infus. polyg. senegæ, fiiss.
Liq. ammon. anis., mxv.
Thiocol, gr. xv.

Syr. aurant. amar., fɔ̃ss.

M. Sig. A teaspoonful every hour for infant of two years.

-Merck's Archives.

Cystitis.

E. G. Ballenger (Atlanta Journal-Record of Medicine, July, 1905) recommends the following treatment in this condition: In acute cystitis the chief indications are rest in bed, light diet, bowels kept open, urine rendered bland and unirritating by copious draughts of water, milk, buttermilk, whey, and lithia water. Hot fomentations to the pelvis or hot sitz baths lessen the congestion and relieve the pain. In

women hot vaginal douches should be given once or twice daily. These, as a rule, are sufficient to make the patient comfortable; if not, suppositories may be given.

B Morphineæ sulphat., gr. 1/12.
Ext. belladonn.,

Ext. hyosciam., of each, gr. 1⁄4.
Ol. theobrom., gr. xij.

M. et ft. suppos. no. j.

Sig. One such introduced into the rectum every few hours as required for the pain.

Urotropin or cystogen in 5 to 10-grain doses are valuable to make the urine antiseptic, but are particularly indicated when the urine is alkaline. The author states that irrigations should not be given in hyperacute cystitis or if there is an acute urethritis or nephritis, but may be used with decided benefit in the subsiding stage to prevent the cystitis from becoming chronic. The fluid should have about the same specific gravity as the urine. The following has given very satisfactory results:—

R Acidi borici,

Sodii biboratis, of each, 3j.
Sodii chloridi, gr. xxx.

M. Sig. Dissolve in a quart of hot water and use as irrigation.

As the disease becomes chronic the irrigations should be made more stimulating, as mercuric chloride, 1-5000 to 1-800; potassium permanganate, 1-12,000 to 1-1000, or nitrate of silver, 1-4000 to 1-800.

Furuncles in the Ear.

The Medical Record publishes the following for local use for the excruciating pain and earache:

R Zinci oxidi, 3j.

Acidi carbol., gr. x.

Vaselini albi, 3j.

M. et ft. ungt.

Sig. Insert a cylindrical tampon of cotton wool, covered with the ointment, into the canal.

This tampon should be large enough to produce considerable pressure. The greater the swelling the greater should be the pressure made by the tampon. The pain is at first severe, but disappears after tamponing. Before tamponing, use an antiseptic and repeat daily. Journal of the American Medical Association.

Iodine Treatment of Typhoid Fever.

A. Ceriolo (Gazz. degli Ospedali, xxv, No. 151) reports the successful treatment of typhoid fever, which is endemic in his locality and always severe, with iodine, since using which his cases have all run a mild course, even following a violent onset. His method is to give 0.07 grams (1 grain) of iodine and 0.07 gram (10 grains) of potassium iodide during the day, fractioned, with a quantity of water. He also gave 0.15 to 0.2 gram (2 to 3 grains) of quinine and 0.5 gram (8 grains) of sodium benzoate.-Merck's Archives.

Sodium Cacodylate in Ocular Affections.

This salt has been employed internally in the treatment of various ocular affections with good results, particularly in rebellious herpetic keratitis. Galezowski has employed it locally in the eye in the form of an oily or aqueous collyrium as fol

lows:

R Cocaina hydrochloratis, gr. iv.
Liquid vaselini, 3iv.

Sodii cacodylatis, gr. ij.

M. Sig. A few drops in the eye two or three times daily.

-Merck's Archives.

Mucous Colic.

Robert Coleman Kemp discusses thoroughly the treatment of this condition in American Medicine, of March 4, 1905. The author states that he has obtained the greatest relief from cramps and bearing

down pains by enteroclysis with normal salt solution at 110° to 120° F. with oil of peppermint, .3 to 1 cubic centimeter (5) to 15 minims) to the quart. Several gallons should be employed once or twice in twenty-four hours, and no fluid should be left in the bowel after irrigation, lest further cramps ensue. High enemas of warm olive-oil-a pint to a quart-are also of service, as they would aid in relieving spasm. Hot saline injections containing 60 to 120 cubic centimeters (2 to 4 ounces) of milk asafoetida may also be employed.

Tincture of belladonna, in doses of 10 drops every three or four hours, and pushing even to physiological effects, has given

the author the best results in the treatment of the spasm. Occasionally it may be necessary to employ codeine in .02 to .03 gram (1/4 to 1/2 grains) doses, or even morphine, S milligrams to .02 grams (% to 14 grain) in conditions of extreme pain.

Proper abdominal support, an upward and backward pressure from the symphysis to the umbilicus is given between the attacks. For this purpose may be employed an elastic supporter or Rose's adhesive plaster belt. Before applying the plaster the surface should be shaved and cleaned with alcohol or ether; and removed every four to six weeks.

Nux vomica or strychnine is of service in increasing the tone of the gastro-intestinal tract and the general muscular system. Resorcin, 5 grains, or sodium benzoate, 5 to 10 grains, or bismuth salicylate, 5 to 10 grains, should be given if there is much fermentation. The use of the following, recommended by Dr. William H. Thomson, in the treatment of catarrhal colitis with a mucous colic, gives good results:—

R Silver nitrate, gr. v.

Resin of turpentine, 3iij.

Potash solution, 3j..

Copper sulphate, .02 gram (1/ grain), three times daily, may be substituted later. Fowler's solution of arsenic, in .06 cubic centimeter (1 minim); dose, three times daily, has also been useful in these cases.

Constipation, diet, and general treatment, including tonics, were also dwelt upon.

Alopecia.

Walsh has used the following with gratifying success in preventing that condition. so annoying to humanity which is described by the patient as "My hair is falling out":

R Acidi salicylici, 3iij.
Acidi carbolici, 3j.
Olei recini, f3ij.
Alcohol, q. s. ad fzvj.

M. Sig. Apply freely to scalp once or twice daily.

-Journal of Medicine and Science.

Raynaud's Anti-Malaria Mixture.

The following is the formula of this mixture according to the Medical Summary:— R Tinct. iodine,

Potassii iodidi, of each, 3iss.
Aquæ dist., fv.

M. Sig. One teaspoonful in water given in the beginning of the paroxysm and repeated in about fifteen minutes, if needed. This is supposed to be of special value in cases where the chill comes at

irregular intervals.

Pruritus Ani.

to make pills soft.

Divide into sixty pills.

Dose: Three pills three times a day.

events, the patient should be seen, daily for a time, and an injection into the cavity of the rectum of from 1 to 2 or 2 1/2 drachms

of the following prescription should be employed :

R Fluid extract of hamamelis, fzij.
Fluid extract of ergot,

Fluid extract of hydrastis,

each, fōij.

M. Shake well before using.

The patient should be advised, prior to using this injection, that a desire to evacuate the bowels will occur as a result of its use, but that if he will remain quiet upon the examining table the sensation will quickly disappear.

For the pruritis the author states that if the skin has a very rough and dry appearance, the entire surface around the anus should be painted for several outwards with a concentrated solution of silver nitrate (960 grains per fluid ounce). If any break in the continuity of the skin exists as a result of previous scratching, a little of a 5 per cent. cocaine or eucaine solution, applied to the abrasions, will prevent the suffering incident to the use of the silver salt. This application may be required two or three times before the desired effect is obtained, not oftener, however, than every fourth day. On the days between the silver application the parts should be coated with full strength official citrine ointment, covered with cotton, and kept in place with a T-bandage. If the itching should be severe the parts may be bathed with hot water, and then apply either the official black wash, or calomel ointment.-New York and Philadelphia Medical Journal, July 29, 1905.

fever admitted to the St. Ladislang Infectionsspital in Budapest. Half of this number (600) was given 1 to 7 grains of urotropin three times daily for the first three days after admission, and again for a similar period, beginning with the fourteenth day. The other half was not subjected to this treatment. In the first group (treated) nephritis developed in 9.16 per cent.; in the second group in 13.66 per cent., the latter presenting a much greater number of severe cases. The difference becomes more striking when the percentages of nephritis in each group are compared according to the day of illness (i.e., scarlet fever) on which the administration of urotropin was begun. The percentages of nephritis in cases admitted on the second day of illness do not differ (9.8 per cent. in each group); on the third day 7.4 per cent. in the treated group; 13.6 per cent. in the untreated group; on the fourth day 10 per cent. as compared to 15 per cent.; on the fifth day 8.9 per cent. as compared to 25.6 per cent.; demonstrating that except in cases coming under efficient general treatment at the earliest moment, urotropin diminishes to a marked degree the effect on the kidneys of the scarlatinal toxæmia.

Helenin in Whooping-cough.

Helenin markedly diminishes laryngopharyngeal excitability; it is a moderator and sedative to the nervous system. These properties explain its action in whoopingcough. According to Valenzuela the effects of helenin are remarkable. It acts like an aromatic bitter in the stomach and opposes the vomiting, so frequent and distressing, which accompanies the attacks of cough.Le Progrès Médical.

THE

Medical Bulletin.

F. A. DAVIS COMPANY, Publishers.

President, F. A. DAVIS.

Editor, JOHN V. SHOEMAKER, M.D., LL.D. Business Manager, H. T. PEARCE.

from so-called "preventable diseases," that the present epidemic of yellow fever should have obtained such a strong foothold in New Orleans, the latest reports totaling more than 900 cases, with 154 deaths. The reason for the failure in preventing the rapid spread of the disease was its occurrence first in the foreign colony, among

GEORGE AYRES HEWITT, M.D. THE editor regrets to announce the death of Dr. George Ayres Hewitt, on Tuesday, August 1, 1905, at Cape May, N. J. Dr. Hewitt was well known to the medical profession as a writer and translator, being a noted linguist, speaking and talking fluently seven languages. He was a frequent contributor to the MEDICAL BULLETIN, and for a number of years had been associated with the editor in his work on the journal. He was a native of Philadelphia, the son of Capt. James S. Hewitt, and received his medical education at Jefferson Medical College, graduating in 1877. After his graduation he went to St. Paul, Minn., where he practiced for a number of years. He then returned to Philadelphia and continued in active practice until the early part of this year when, on account of failing health, he relinquished his work and went to the seashore, hoping that the climate and a care-free life might be beneficial; his death, which occurred at the full noon of his days, from chronic Bright's disease, saddened a wide circle of friends. Dr. Hewitt was singularly gentle and unpretentious, and possessed the noblest qualities of mind and heart, a man of high moral character, a scholar, and a sincere friend.

THE YELLOW FEVER EPIDEMIC.

IT is to be regretted that with our present knowledge of sanitation and methods of protecting individuals and communities

In

tary measures, but are particularly prone to conceal illnesses of a fever nature. order to prevent conflict of authority, the United States Public Health and Marine Hospital Service has been given absolute control, and those measures will be immediately enforced which in recent years have been found efficient-the prevention of the conveyance of the infection by the mosquito

though its rapid progress so long before the advent of cool weather makes its early abatement a hazardous prediction. That the stergomyia is an agency of transmission is an undisputable fact according to those who have made a careful study of the subject, yet a doubt still exists whether it is the sole means for the spread of the infection; it is to be hoped, however, that the opportunity afforded by the present epidemic for a careful study of this subject will prove to a certainty this vital point, for upon this decision the prevention and management of future epidemics will depend. Too much praise cannot be given to the inhabitants of this afflicted city for their liberality, individual work, and hearty co-operation with the physicians in carrying into effect those principles which the latter epidemics demonstrated to be of value in limiting the spread of the foci. Windows, cisterns, wells, and every place where there is a possibility of the mosquito finding a resting place have been screened, and the patients are conveyed to the hos pitals in screened ambulances. It is regrettable that the co-operation of physicians, health boards, and inhabitants has not been so harmonious in the outlying districts, and several of the Southern States, for many