are receiving in the modern maternity hospital, an advance will be made which will rank with vaccination, anesthesia and asepsis.

OPERATIONS UPON THE UTERINE APPENDAGES FOR STERILITY.Dr. W. M. Polk (Medical Record, December, 1902), a pioneer in conservative surgery of the appendages, attempts to answer the following questions: Shall we operate upon the uterine appendages primarily for the cure of sterility? Are we warranted in advising such a procedure for such a complaint? Is it too dangerous to be applied to a state which does not involve life? An answer, and perhaps a sufficient one, can be found in the history of operations for sterility done in the past upon other sections of the genital canal. Thirty years ago operations upon the uterus for sterility were common. Women then faced a mortality, in the best hands, which placed the recognized operations upon the several parts of the uterus for sterility upon a footing with which the operation upon the appendages compare favorably.

In fact the mortality rate is even in favor of operations upon. the appendages. He therefore thinks that we can affirm that the operation in question is no more dangerous than was the accepted operations upon the uterus thirty years ago.

A list of cases, personal, and gathered from literature, indicates the directions such operations should take. The mere freeing of these organs from adhesions, so as to restore them as far as possible to their normal position, seems all that is needed in many instances, care being taken to open up the fimbriated ends when closed, or partially closed. But if pyosalpinx, hydrosalpinx, or hemato-salpinx, be present, then it seems proper to remove all the dilated portion, leaving the cut end of the tube free. The mucous membrane of the tube in such cases always protrudes, a fact which accounts for the continued potency which prevailed in some of the cases cited.

Some operators stitch the open infundibula to the surface of the ovary, but this is hardly necessary if the normal connections between these organs are intact. If not, the cut end of the tube must be brought close to the ovary by shortening the mesosalpinx.

In dealing with the ovaries it is sufficient to act upon the principle that as much normal ovarian tissue is to be left as diseased

conditions will warrant. Just here it is pertinent to say that, so far, we are unable to determine in all cases the appearances which indicate the certain subsequent development of the more serious diseases of this organ, such as papilloma or large cysts. When this can be attained our choice of dealing with ovarian tissue will be more definite.

The paper was intended to draw special attention to that class of cases in which sterility is the leading complaint; perhaps the only one the patient considers, on which our best endeavors show the difficulty lies in the appendages. Great difficulties beset the conclusions in such work; but a correct conclusion can be reached even though it involves the comparatively harmless measure of vaginal incision for actual palpation of the suspected

organs.

Department of Cherapeutics.

In charge of DR. J. A. STORCK, New Orleans.

IS ADRENALIN THE ACTIVE PRINCPILE OF THE SUPRARENAL GLAND?

Aldrich, who has done so much excellent work upon this subject, reaches in the American Journal of Physiology for July the following conclusions:

1. All concentrated aqueous extracts of the suprarenal gland reduce Fehling's solution on boiling.

2. The adrenalin obtained from a certain amount of the aqueous extract reduces Fehling's solution approximately in the same proportion as the original extract from which it was obtained.

3. The mother liquor after removal of the greater part of the adrenalin, except in comparatively large amounts, does not reduce Fehling's solution.

4. Adrenalin is not a reduced form of the native principle, since it was obtained without the use of a reducing agent, such as hydrogen sulphide.

5. Adrenalin is the same whether obtained by using sodium carbonate solution or ammonium hydrate as a precipitant.

6. Epinephrin, and the other questionable products obtained from the gland must be oxidized, or, at least, a changed form of

adrenalin, the active principle, since they do not reduce Fehling's solution.

7. Adrenalin is identical with the copper-sulphate-reducing body, the blood-pressure-raising substances, as found in the gland, and is therefore the active principle of the same, and not a modified or changed form, as Abel contends.-The Therapeutic Gazette.

THE FEEDING OF CHILDREN IN THE SECOND YEAR.-At a recent meeting of the New York Academy of Medicine, T. S. Southworth (Pediatrics, June 15, 1902), read a paper on this subject.

Dr. Southworth outlined the following general plan of feeding as appropriate to children of this age: 7:30 A. M., breakfast, including a bottle of milk, 12 ounces; 11 A. M., bottle of milk with a crust of stale bread or a piece of zwieback; 2 P. M., dinner, with less milk as other food is increased; 6 P. M., supper, including a bottle of milk; 10 P. M., a bottle of milk. About the middle of the second year the bottle should be replaced by the cup except at the ten o'clock feeding at night. Soft-boiled eggs might be allowed every second day for breakfast, and the diet should be varied by mixing bread crumbs with egg, or with milk, or by giving crackers, broths and meat juices. Orange juice, if carefully freed from the pulp, and two or three prunes, freed from the skin, are useful additions to the diet. A mealy potato, baked, should be the first vegetable. Stewed celery and tender boiled onions might be given toward the end of the second year. Beef juice expressed from lightly cooked steak, Dr. Southworth considers very useful, even before the end of the first year, particularly in anemic babies. From one to three ounces should be given daily, but in children of nervous, rheumatic, or gouty parents, beef juice and broths must be used with caution. Toward the middle of the second year the fine white meat of poultry and scraped steak or mutton chop may be given. These young children should not be allowed to come to the family table, for the longer they can be kept from desserts and sweets generally the better. It is necessary to specifically warn the ignorant against giving their children tea, coffee and beer.The Dietetic and Hygienic Gazette.

TETANUS FOLLOWING GELATIN INJECTIONS.-Margonnier and Hirsch (Therap. Monatsch.) utter a note of warning concerning the hypodermic administration of gelatin as an antihemorrhagic.

They have collected seven cases of tetanus, including two of their own, following the injections. In several of these cases abscesses had developed at the seat of injection. They conclude that the methods ordinarily employed for the sterilization of gelatin solutions are inefficient. Their method is to dissolve the gelatin in warm water, and steam at 100 deg. C. is forced through the solution for an hour. Even after this process they had several abscesses to occur at the point of injection. Dr. H. C. Wood, Jr., thinks that three repeated boilings would be a far simpler and more effective means of sterilizing gelatin solutions.

PROPHYLAXIS AGAINST NICOTIN POISONING.-Among the processes to render tobacco inoffensive to the nervous and cardiovascular systems, that of Gerold (Bulletin de Therap.) has given the best results. Gerold macerates tobacco leaves in a solution of tannic acid, which neutralizes the nicotin and other injurious active principles contained in the plant. In order then to restore the perfume of the tobacco, which is spoiled by the tannin, it is dipped in a decoction of origanum vulgare. Experience is said to prove that the toxic action of the tobacco has really been decreased by this means and that its use and even abuse is rendered almost innocuous.-American Medicine.

Department of the Ear, Nose and Throat.

In charge of A. W. DEROALDES, M. D., and GORDON KING, M. D., New Orleans.

PRIMARY GANGRENE OF THE TONSILS.-Two cases of this unusual affection are described by Dr. Robert Fullerton, of Glasgow. The first was that of a physician who had become very much run down in health and who, after recovering from a very severe cold in the head, had an acute tonsillitis with temperature at 103. The appearance of the throat was that of acute follicular tonsillitis in the beginning, but after several days sloughs appeared on both tonsils and spread rapidly, accompanied by great painfulness of the parts. Swallowing was very difficult, the voice husky and nasal and breath fetid. A shallow

ulcerated patch was present on the upper lips. Lymphatic glands of the neck enlarged and tender. There was no history or proof of syphilis. Treatment consisted in removal of sloughs, application to the ulcerations of strong solution of carbolic acid and silver nitrate, frequent cleansing of the mouth and the administration internally of perchloride of iron, about six drops four times a day in glycerin. After a considerable length of time the parts healed, leaving behind distinct scars where the loss of tissue had occurred.

The second case was that of a girl 23 years of age which showed much the same local characteristics as the first. Bacteriologic examination of swabbings from the ulcerated surfaces showed at first staphylococci and diplococci, and later an almost pure culture of pneumococci. Patient was cured after four months, but a year later had a recurrence and tubercle bacilli were found in the sputum. Death occurred and the autopsy revealed pulmonary tuberculosis.

The author considers both cases as examples of primary gangrene of the tonsils.-The Lancet, June 7, 1902.

ANESTHESIA OF THE DRUM MEMBRANES.-Geo. B. McAuliffe, M. D., gives the results of his observations on anesthesia of the tympanum in a paper read before the American Otological Society, July 7, 1902. Basing his experiments on the fact that the Eustachian tube and the tympanic cavity receive their sensory nerve supply from same source-the glosso-pharyngeal-the author considers that the best method of producing anesthesia of the tympanum is by the use of cocain injected in the Eustachian tube. The external dermal layer of the tympanic membrane opposes the absorption of liquids brought into contact with it through the external auditory canal. Better osmosis may be obtained by the preliminary application of hydrozone to this surface. The use of the cocain-alcohol-aniline oil mixture gives partial anesthesia, but there is danger of toxic effect. Cocain injected into the Eustachian tube produces some complete anesthesia by deadening the nerve trunks that supply the tympanums. The knife used should be as thin and sharp as prac

ticable.