in infant mortality is due to many agencies. The general adoption of Pasteurization and sterilization of milk for infant feeding is by far the most important of these, and applies to New York City and the whole of the United States. Other agencies in New York City are the improved city administration, the milk inspection of the Department of Health, the Strauss Milk Charity, the fresh air work of St. John's Guild and similar charities, cleaner streets and asphalt pavements, the new small parks, play grounds and recreation piers, the improved tenements, and the use of diphtheria antitoxin. (R. C. B.)

THERAPEUTICS.

Chas. H. Stoddard, M.D., B. L. Schuster, M.D.

Natural Albumen and Albumen Preparations as Diet for the Sick.— BERMBACK (Therap. Monatshefte, Aug., 1903) says that a diet consisting largely or exclusively of albuminous food is most often needed in cases requiring a special diet, but is only applicable for a very short time. Where there is loss of tissue albumen, and where fats and carbohydrates are contraindicated, such a diet should be used. The diet is indicated in pulmonary tuberculosis, myocarditis, obesity, chlorosis, essential anemia, diseases of the stomach, and hysteria.

The three most important means of giving albumen is by use of milk, eggs, and meat. Cow's milk is cheap and easily assimilated and has a high calorific value. In large quantities, however, it throws considerable work on the circulatory system. Eggs are easily digested and largely assimilated. Meat furnishes the largest amount of albumen and has the highest calorific value. The author supplements these articles by the use of Tropon and Eucian. (B. L. S.)

Dietetic Treatment of Chronic Nephritis.- ANDERS (Amer. Med., Oct. 31, 1903). This demands that we meet the requirements of nutrition plus the loss of albumen through the kidneys. Drugs are only of real value, in cases secondary to syphilis, malaria or chronic suppuration, etc.; usually they cause more harm than good. Hygienic measures such as warm baths, climatic change, muscular exercise, etc., are important adjuvants to the treatment.

Diet is of major importance and prevents or retards contracted kidney and anemia. Food must be digestible. Exclusive milk diet contains too little carbohydrate and iron. The usual prescription of milk diet and large quantities of fluid overburdens the already strained heart. Meats must be restricted. There is no evidence that red meats are more harmful than others. Give whole milk (not skim milk, as fat is essential) diluted, fruits, green vegetables and rice freely. Make diet conform nearly to patient's usual dietary and have meals small and given at three hour intervals.

Van Noorden finds that kidneys have less power of secreting foreign material such as potassium iodide, sodium salicylate and other drugs than for the products of metabolism Important diagnostically and in watching the progress of treatment, are cryoscopy of urine and of blood, careful record of the body weight and frequent blood examinations for the state of anemia.

(C. H. S.)

Acid Phosphate of Soda in Alkalinity of Urine.-R. HUTCHINSON (Brit. Med. Journal, May 30, 1903) says that acid sodium phosphate has greater acidifying effect on the urine than any other drug. It is especially of use as an adjuvant for urotropin, for the latter acts best in acid urine. It is soluble freely in water and is given in doses of 30 to 60 grains every three hours until the effect is shown by litmus paper when a smaller amount continues

the effect.

WHEELER (Med. Press, Sept. 9, 1903) details a case of cystitis, in an aged man, complicated with hemorrhages, which was successfully treated with adrenalin locally, and this drug internally. In three cases acidity was produced in twenty-four hours. He cautions prescribers to see that the chemist does not use the official sodium phosphate, but the acid salt, the normal urinary acidulant. (C. H. S.)

Cause and Prevention of lodism.- LESSER (Deutsche Med. Wochenschr., No. 46, 1903). It was formerly thought, and many believe to-day, that the iodides entering the system are decomposed and that the free iodine causes the intoxication. Lesser, by extensive experiments, shows that the iodides given internally circulate as iodin-alkaline salts and that the symptoms of iodism are really due to the rapid absorption of excessively large quantities of iodides into the circulation. It would be more correct to apply the term iodin-alkalism to this condition, for the prevention of which he recommends: (1) Administering iodides in mucilaginous substances, thus delaying their rapid entrance into the circulation. (2) The greater the idiosyncrasy the smaller should be the doses, frequently repeated. The rapid elimination will prevent intoxication and the amount of iodides circulating will remain fairly constant. (3) Administration of iodine preparations per rectum. Zeissl recommends: R. Natrii iodati 2.0; Aq. 30.0; Tinet. Opii. gtt. 5. Here also resorption is delayed. (4) Use of substitutes for the alkalies (iodin-albuminates and fats), which are gradually changed to alkalies, but contain proportionately less iodine. (5) Iodipin injections. Absorption is slow but continnous. These are especially indicated where there is a marked idiosyncrasy.

(B. L. S.)

Sodium Sulphanilate in Exophthalmic Goitre.- KIRNBERGER (Therap. der Gegenwart, Oct. 1903) starting from the hypothesis that the nervous phenomena presented by the subjects of Basedow's disease are due to iodic auto-intoxication caused by excessive production of iodothyelin by the hypertrophied thyroid gland, has recommended the use of sodium sulphanilate in these cases. Ehrlich and Kronig had previously recommended sulphanilic acid and its sodium salts for iodism. Kirnberger gives his patients 10 grammes (150 gr.) of sodium sulphanilate daily. It causes gain in flesh, gives restfulness and vigor, and a sense of well-being, and notably diminishes the tachycardia. But in most cases the remedy has no influence on either the hypertrophy or the tremor. The effects appear to be simply palliative. (C. H. S.)

Lactic Acid for Pruritus.-M. DE CASTLE (Jour. de Med. et de Chir. Pract.) uses the above drug for localized or general pruritus. One case of vulvar pruritus of four years' standing was promptly cured and others all non-glycosuric, showed equally gratifying improvement. (In the treatment of other itching affections of the skin, notably urticaria, acids both internally and externally are of marked service.)

(C. H. S.)

DISEASES OF THE EYE, EAR, NOSE AND THROAT.

C. Zimmermann, M.D., G. E. Seaman, M.D., H. B. Hitz, M.D., N. M. Black, M.D., J. S. Barnes, M.D.

Ocular Headache and other Ocular Reflexes.— M. W. ZIMMERMAN (N. Y. Med. Jour., March 21 and 28, 1903) presents a statistical study of 2,000 cases of ocular headache and other ocular reflexes in hospital and private practice in which the cases are studied from every possible standpoint. He says that the time at which an ocular headache appears, varies very much. It usually bears a direct relation to the eye work of the patient, appearing most frequently after the eyes have been used for some hours. Early morning headache from use of the eyes the previous evening is common. Intense watching of comparatively distant objects, attendance at the theater, etc., are frequent exciting causes.

The influence of ill Conditions of lowered lactation and post

Car sickness is often due to errors of refraction. health as a frequent predisposing cause is pointed out. resistance after severe illness, pregnancy, prolonged influenzal conditions are given as determining factors in many cases of ocular headache.

Regarding results, the author says that careful optical treatment of ametropia is the most satisfactory therapeutic measure in the whole field of medicine. 86.1 per cent. of the cases studied and followed to the end resulted in practical cure. (G. E. S.)

Brief Consideration of Prognosis in Chronic Suppurative Otitis.THOMAS J. HARRIS (Annals of Otology, Rhinology and Laryngology, March 1903) has for a period of eighteen months, tested the value of treatment in all the suppurative cases at the Manhattan Eye and Ear Hospital. All surgical measures indicated, such as removal of adenoids, extraction of polyps and granulation tissue, were at first performed. It was then sought to discover, irrespective of any necrosis of the ossicles, the result of medicinal treatment alone. The following therapy was employed in the cured and relieved cases: Hydrogen dioxide in 20; formalin in 9; borolyptol in 3; camphoroxol in 5; menthoxol in 1; protargol in 1; boric acid in alcohol (sat. sol.) in ô.

Over 50 per cent of the cases were reported cured; 38 per cent. improved. Both the method by irrigation and the so-called "dry method" were employed. Harris considers the latter the ideal method, but experience proved it to be impracticable at the clinic and a combination of the two was found to serve the best. From the experience gained with these cases he offers in conclusion the following deductions:

1. Chronic otorrhea in a large percentage of cases is amenable to suitable medical treatment.

2. In addition to proper attention of a general character and to the naso-pharynx, peroxide of hydrogen with or without formalin solution, gives the best results, all minor operative procedures of course first being attended to when necessary

3. The results of such treatment are in a good number of cases permanent.

4.

The risk of an uncured otorrhea with good drainage is relatively very small (or of fatalities).

5. Medical treatment failing, after a suitable interval of time, the danger of fatal complications in absence of all symptoms should be laid before the patient and the promise of relief by operation stated.

6. When there is no good reason to the contrary, such as intracranial or mastoid complications, the intra-tympanic method by ossiculectomy should be preferred, (a) Because its results as regards the cure are equally good. (b) The risk to loss of hearing is vastly less. (c) The danger of unpleasant sequelæ, such as facial palsy is avoided. (d) The possibility of prolonged after treatment is obviated.

7. The radical operation is not without risk to life.

8. When ossiculectomy fails or mastoid or other symptoms exist pointing to extension of the disease into the bone, the radical operation then becomes the suitable and valuable method of relief.

of.

9. The protecting and assisting power of nature is never to be lost sight (J. S. B.)

Clinical and Anatomical Contributions to Metastatic Ophthalmia.BIETTI (Supplement to Vol. 41 of Klinische Monatsblaetter fur Augenheil kunde) gives details of three cases of metastatic ophthalmia of rare forms with histological descriptions. In the first a bilateral metastasis of pneumococcal origin apparently started from the choroid, in the second restitution of vision after amaurosis, with healing of a total bilateral metastatic detachment of the retina, was observed, and the third case, a puerperal infection, took a comparatively benign course, without leading, as usually, to perforative panophthalmitis. (C. Z.)

Contributions to the Pathology of the Optic Nerve in Brain Diseases.— YAMAGUCHI (ibidem) reports a case of relapsing choked disc with thrombosis of the central retinal vein in sarcoma of the frontal lobes. The intense swelling of the disc set in after atrophy and degeneration of the disc with shrinkage had existed for several years, and was due to thrombosis of the central vein, in consequence of strangulation by cicatricial tissue in the obliterating intervaginal space. (2.) Atrophy of the optic nerve and anomalies of menstruation in basal tumors. Four cases of tumors at the region of the chiasm with simple atrophy of the optic nerves are reported as illustrations of the relatively frequent lacking papillitis in tumors of this region, which may be explained by obstruction of the optic sheaths, by compression, cell-proliferation, etc. The etiology of amenorrhea in these cases had to be attributed to the intracranial tumors. Thus Y. warns against too readily assuming an amenorrhea as the cause of atrophy of the optic nerves. (C. Z.)

Arthritis in Blennorrhea Neonatorum.-A. DAHLSTROM (ibidem) compiled 18 cases from literature and 2 of his own observation. The conveyance of gonococci to the joints may take place from a possible simultaneous infection of the urogenital system, from corneal ulcers, or from the conjunctiva without any lesion of continuity through the lymphatics and the blood. The latent stage of gonorrhoic arthritis probably does not exceed 4 to 5 days.

(C. Z.)

Contribution to Affections of the Optic Nerves in Purulent Cerebrospinal Meningitis.-DE LIETRO-VOLLARO (ibidem) reports 5 cases of meningitis, terminating fatally, with anatomical descriptions of the optic nerves. The obturating infiltrations of the optic sheaths at the region of the optic

foramen stops the free communication between intracranial cavity and intravaginal spaces and thus prevents the entrance of pus germs into the latter. L. infers from his cases a corroboration of the opinion of Axenfeld that the purulent ophthalmia in cerebrospinal meningitis is owing to metastasis and not to a direct propagation through the optic sheaths. The enormous perineuritic and interstitial infiltration of the optic nerve within its osseous canal is important for the bilateral retrobulbar blindness, so-called "basal," remaining for weeks after meningitis, mostly with negative ophthalmoscopic condition, immobility of the pupils, and frequently with ultimate recovery. L. does not doubt that it is due to the affection in the optic canal. (C. Z.)

Mydriatics.-C. A. OLIVER (Annals of Ophthal., Oct., 1903) in an excellent article, discusses the various drugs used for this purpose, largely from the standpoint of his own experience. He calls attention to their local sedative and analgesic action in conjunctival, lachrymal and corneal diseases and to their value as cycloplegies not only in refraction work, but in the treatment of diseases affecting the deeper structure of the eye. He says they are valuable when carefully guarded and constantly watched in temporarily continuing useful vision in some forms of cataract, especially the nuclear variety. He discusses fully the dangers of the unwise use, and over-use of these remedies. (G. E. S.)

Embolism of the Central Artery of the Retina from Paraffin Injection Into the Nose.-L. M. HURD and W. A. HOLDEN (Medical Record, July 11. 1903) reports a case that adds another to the list of unfortunate results following paraffin injections. Immediately following the injection of paraffin and ordinary white vaselin, with a melting point of 110 deg. F., for the correction of the deformity of a saddle-shaped nose, the patient became blind in his right eye. Ocular examination twenty-five minutes after the injection, showed the media clear and the retinal veins normal, but the main inferior branch of the central artery and its deviations were empty and collapsed, being recognizable only by the faint white outlines of their lateral walls. The main superior branch contained some blood, but when gentle pressure was made upon the eye-ball, the blood column here broke up and the blood flowed backward into the central artery. Efforts to dislodge the embolus and force it forward into one of the branches of the artery, by the use of heart stimulants and massage, and thus restore partial vision, were unsuccessful. The eye remained blind.

Other similar cases in literature are reviewed. The obvious lesson taught by these is that loss of vision, and even of life, may follow the injection of paraffin into a vein. This danger could be partly avoided, doubtless, by performing aspiration after the introduction of the needle, and if there was no evidence of penetration of a vein, injecting the paraffin through the needle without moving it. There would remain, however, the possibility that the needle had passed entirely through and beyond a vein, and then the paraffin when injected under high pressure might in its ramifications, pass backward along the course of the needle and thus gain entrance to the vein.

(J. S. B.)