until signs of feebleness threaten to complicate the case. Avoid strychnine and quinine always until the fever has abated.

5. Cold applications have done good in some cases, and harm in very many. Hot applications do all the good the cold applications do and a great deal more, in that heat adds force and power to the venous capillaries, unloading the congestion and throwing off the tissue waste. Heat stimulates the arterial capillaries, carries off the products of inflammation, and conduces to the quick restoration of the normal condition. It is the logical, physical, reasonable, and highly scientific method. It can not possibly do harm.

6. Opium in any form in the treatment of pneumonia is not needed when the specific action of the remedies herein. advised is thoroughly understood. It promotes the exact pathological conditions that the disease depends upon, and is thus positively contra-indicated.

7. The primary acute congestion that underlies a case of pneumonia—that just precedes immediately the inflammatory stage should be considered as a separate and independent condition, and if recognized immediately can be overcome, and a normal condition restored before the actual acute inflammation of the lung structure supervenes. This is done in every case where pneumonia is aborted or jugulated.

Position After Operation.

A Good Deal of Nonsense is Talked on This Subject, Which the Writer Satirizes.

S. K. Vines, in a communication to the British Medical Journal, indulges in some ponderous satire on the subject-much overdone we must admit-of the position to be assumed by the patient after a laparotomy.

Changes, he says, do not always mean progress and sudden changes are even bewildering. Of late "Fowler's position" has been much to the fore in current medical literature. I had the pleasure last month of listening to a lecture before a medical society in which it was highly praised. Not so long ago the craze was all for the "posture of Clark," the peritoneum was to do its own drainage; in the neighborhood of the midriff was the all-important absorbing area, and the foot of the bed was to be raised.

It would be grievous to add to the giddy sensation which a rapid mental review of the various positions advocated

during the last few years produces in the mind which is not special, but there is a further maneuver which may be deemed worthy of consideration by abdominal surgeons.

From a general practitioner's point of view an operation is successful which is not too closely followed by death, and which leaves no legacy of evil after-effects. The owner of the scar of an old abdominal incision, who complains interminably of pains and aches, is the bane of the lives of some of us. Our burden would be lightened if the formation of bands and adhesions could be prevented. Again, the impression on the mind of a patient who finds himself the subject of some curious, post-operative, acrobatic procedure, is not to be neglected. Yet again, a gentle, rhythmical motion often has a soothing action on the human economy. Perhaps dim, unconscious memories of an arboreous ancestry are responsible alike for the movements of the cradle and the fondness of old people for rocking chairs.

I should wish, therefore, to call the attention of celiotomists to the "rocking movement" as a post-operative therapeutic measure. Among its advantages are: (1) The hustling of fluids which may be lurking in out-of-the-way holes and corners; (2) a discouragement of palsy of the bowel; (3) hindering of the formation of bands and adhesions; (4) a generally sedative effect. The cogitative may well add to these advantages. A rolling motion is preferable to a pitching, and excess must be guarded against.

Intermittent Closing of Cerebral
Arteries.

A Rational and Likely Explanation of Many Cases
Similar to the One Described.

T. H. Moorhead, in the British Medical Journal, thinks that this theory accounts for many otherwise obscure cases of temporary paresis. He cites an illustrative case of a lady patient.

On her first visit in 1907, she stated that about a fortnight previously she had been suddenly seized with clonic spasm on the right side with "numbness." The mouth on that occasion only was drawn to one side. This attack and several subsequent ones passed off quickly and she felt no ill effects. Up to the present time, she had had several similar seizures. Careful examination failed to discover any cause. On her recent visit she stated that these attacks had con

tinued during the two years, but were becoming more frequent and were always immediately preceded by profuse sweating for a few moments. Now in this case there is, first, relaxation of the systemic arterioles, and immediately. after contraction of the cerebral arterioles on the left side. On questioning her the author found the sense of heat and sweating was chiefly felt to the right side.

Moorhead has seen, as most other practitioners have, these transient cases of hemiplegia where no cause could be traced unless that vague term, "neurasthenia" can be called one. The temporary character of these attacks, and the fact that they leave no permanent traces, seems to me to exclude any organic cerebral lesion, and contraction of the cerebral vessels is a reasonable hypothesis. Why it should be localized is probably as inexplicable as "dead fingers.'

Treatment of Duodenal Ulcer. Medical Treatment Should Be Given First Chance, But Surgery Resorted to Sooner Than in Gastric Ulcer.

Einhorn, in the American Journal of Medical Science, holds that the treatment should at first be medical. In the mild cases regulation of the diet (frequent meals, abstention from highly-seasoned substances, acids, and too fatty foods), improving the general condition by means of iron, arsenic, cold sponging, good air, avoidance of bodily exercise, and the use of alkalies are sufficient to effect a considerable amelioration, if not a cure. In several cases olive oil (two tablespoonfuls morning and evening) seemed to be of service.

In graver cases of duodenal ulcer (hemorrhages, severe pain, etc.) a strict ulcer cure with rest in bed and rectal alimentation, and afterward fluid diet, must be instituted. In these cases large doses of magnesia and bismuth are of benefit: calcined magnesia 0.5 (8 grains), bismuth subnitrate 2.0 (30 grains), in powders-one powder three times a day, a half-hour before meals. If a strict rest cure has been unsuccessful, or if we have to deal with severe hemorrhages endangering life, and returning frequently, or if obstinate spasm of the pylorus occurs, associated with severe pains in the pyloric region and slight peristaltic restlessness of the stomach, an operation (usually gastroenterostomy) is indicated.

In duodenal ulcer the clinician must advise surgical treatment sooner than in

gastric ulcer, as the former, through its complications (hemorrhages, perforations, stenosis of the pylorus), endangers life much more readily than the latter. Gastroenterostomy in these cases is fortunately attended with good results. The ulcer will then soon heal, as the gastric juice does not longer flow over the ulcerated surface in the duodenum or irritate it. At all events, the dangers of hemorrhage, perforation and pyloric stenosis. are thereby prevented.

Effects of Alcohol.

An Arraignment Which Ought to Finally Dispose of Alcohol's Claim to Usefulness.

Henry J. Berkley, in the Johns Hopkins Hospital Bulletin, thus summarizes the results of introducing alcohol into the system:

A moderate dose causes a drop of 15 to 20 beats in the pulse rate and produces muscular lassitude and mental confusion.

The continued use of a moderate amount of alcohol produces fatty changes in the heart and blood-vessels, digestive disturbances, and mental impairment.

Later on there is a profound loss of memory; also delusions, loss of sensation in the skin, and loss of deep reflexes.

Taken in large amounts, alcohol results in great depression of the heart, complete loss of sensation in the skin, rapid dementia, and death from syncope.

The following account of the microscopical changes in the tissues as a result of alcohol is taken from observations on animals:

1. The most marked effects are produced on the blood-vessels.

2. The cells which line the vessels are swollen and broken and there are serious retrograde changes in all of the tissues. The white blood-cells become swollen and necrotic.

3. The lymph spaces become choked with broken-down white blood-cells, and the small blood-vessels are also completely blocked by plugs of detritus and. dead tissue.

4. In the veins the blocking is often so severe that the vessels burst from the backing up of blood in them.

The changes are always more marked in the vessels of the brain than elsewhere because they do not possess the special nerves which control their caliber, as do the vessels of other parts of the body.

Elemental Electro-Therapy.

A Basic Understanding of Voltage, Resistance and Amperage is Essential.

We strongly recommend to the physician who would use electricity as an adjunct to his practice to follow the advice of Dr. Neiswanger, and study well the three fundamental principles of electrical energy-voltage, amperage and resistance.

Voltage is not electricity, says Dr. Neiswanger, but only one of the component parts of electrical energy, and, although itself perfectly harmless, it becomes a dangerous factor under certain conditions. Voltage is the pressure at which electricity is used, and can be likened to the pressure in a steam boiler. We would not call the pressure in a boiler steam, and it would be evidently as improper to call voltage electricity. It is pressure. We then have:

Voltage pressure E. M. F.-E.

E. M. F. stands for "electro motive force," and is the best and at the same time the technical name for voltage, because it tells just what it is the force that moves electricity. Wherever we see the letter "E" in electrical formula it always means voltage.

Resistance is anything that opposes the passage of electricity. Every force has its resistance. If that were not the case we would be able to get something out of nothing, and thus violate the law of conservation of energy. If it were not for resistance we could easily produce perpetual motion.

The Ampere is the unit of current. It is the quantity of electricity which will flow through a resistance of one ampere under a potential of one volt.

Phenolphthalein as a Cathartic. Browntree, in the Journal A. M. A., asserts that clinical experience has confirmed early investigations, which show that phenolphthalein is a safe cathartic. It usually acts without pain in about six hours, and it is not followed by a tendency to sluggishness of the bowels. There are a few patients in whom the administration of the drug was followed by griping, but this is more attributable to the idiosyncrasy of the patient than to any irritating effect of the drug. In those cases it is well to add a small dose of belladonna to the phenolphthalein. One must also bear in mind that, while this is an excellent cathartic and that it usually produces purgation, some patients

do not respond to its administration. Constipation, of course, requires other treatment besides the giving of drugs.

Tunnicliffe states that the drug does not lose its effect when administered over a prolonged time. This does not agree with the writer's experience; in several cases the bowels responded by free purgation when the drug was first given, but later even an increase in the dose was without effect. These latter instances are, however, not common, and the administration of the drug is usually followed by satisfactory results. The drug may be prescribed in powder, pill or capsule. It is easily obtained, almost tasteless and not expensive, and some drug manufacturing companies put it up in the form of 1-, 2-, and 3-grain tablets. The dose for adults is from 1 to 5 grains. It is well to begin the treatment by prescribing a small dose, which may be increased to meet the requirements of the individual case. A dose of 3 or 5 grains (19 to 32 cg.), one, two or three times a day, will purge the average patient. The larger dose may be necessary in patients with obstinate constipation.

Blood Count in Whooping Cough.

Lymphocytosis a Constant Factor.

E. F. Cushing, in the Cleveland Medical Journal, points out that in treating whooping-cough one must contend with the lack of faith on the part of the parents as to the efficacy of therapeutic measures. Unusual exactness in the care of such cases is required. Early diagnosis is necessary. For this differential counting of the blood is of the greatest aid, as the lymphocytosis of pertussis is constant, and associated with a catarrhal cough is of the greatest diagnosis significance. A blood count should be as much a routine with a cough as a culture with a sore throat.

The Photoscope.

Operations Can, by Means of This Apparatus, Be
Performed in One Room and Witnessed
By Spectators Seated in Another
Apartment.

One of the chief objections to the indigent person availing himself or herself of the gratuitous services of the hospital surgeon for a major operation has always been that in consideration of the gratuitousness of the service it was very naturally stipulated that such operations should be performed in the presence and for the educative benefit of