water one pint. This was followed by prompt relief, and in a few days the cure was complete.

Not only the eruption but all the annoying symptoms connected with it promptly disappeared under the above treatment, but in ten days more she went into labor, which was normal in every respect. No untoward symptoms of any kind seemed to result from the eruption.

What gave rise to the eruption unless the accumulation of uric acid in the system, due to the inability of the kidneys in their crowded condition to eliminate it? Was there danger of uremic convulsions? She was well in every other respect. W. A. B.

What Fruit Contains.

Our ordinary fruits contain the following substances in great

er or less proportions:

A large percentage of water.

Sugar, in the form of grape and fruit sugar.

Free organic acids, varying according to the kind of fruit. For example, the predominating acid is malic in the apple, tartaric in the grape, citric in the lemon.

Protein or albuminoids, substances containing nitrogen, which resemble the white of eggs, and are its equivalent in food value. Pectose, the substance which gives firmness to fruit, and which upon boiling yields various fruit jellies.

Cellulose or vegetable fiber, the material that forms the cell walls, and which is found in all parts of plants.

A very small percentage of ash or mineral salts.-American Journal of Health.

GYNECOLOGY AND OBSTETRICS.

Conducted by S. S. Smythe, M. D.

Appendicitis Following Minor Uterine Operations.

Dr. Howard Crutcher, in the "Medical Visitor" (February, 1900), says:

"For years past, I have observed at times that appendicitis. has followed minor operations upon the uterus, such as curettement and the repair of cervical lacerations. At first I was inclined to regard the appendicular complication as a mere coincidence, and I am free to say that I have now no doubt that I have often made the mistake of attributing certain post-operative attacks of pelvic peritonitis to tubal and ovarian complications. In more recent times some startling facts have come out in such a manner as to leave no doubt whatever that a direct risk to the appendix is involved in many cases from very simple uterine operations.

The appendix is in woman more of a pelvic than an abdominal structure. Its attachment to the uterine appendages is so well-known as to require no comment. The following cases are recorded in the hope that others may be brought out, and that their narration may aid in some measure, the evolution of the truth in pelvic pathology." ·

The doctor, after citing a number of interesting cases, all calculated to confirm his idea, concludes as follows:

"From the cases herein presented-and many more might be cited I am not disposed to set up certain generalizations. Nevertheless, I cannot regard the frequency of appendicitis after minor uterine operations as a pure coincidence. That mistakes are often made along these lines I have no question, and that many deaths have been laid falsely at the door of the tubes and charged to faulty technique, admits of no doubt. In August, 1896, I was called by Dr. Frank R. Waters to see, with him, an unmarried woman of seventeen who had aborted two weeks before-the re

sult, we thought,of certain manipulations upon the part of the patient, although she denied all such imputations. In spite of the fact that the treatment of the case had been above criticism, I decided that the infection had spread from the uterus. An enormous collection of pus was evacuated by a median abdominal incision. Death followed within a few hours. The post-mortem examination revealed the remains of a gangrenous appendix glued to the right Fallopian tube. It is unnecessary to dwell upon the cause of the infection in this case. It was reported fully in "The Medical Record" for September 26th, 1896.

In this connection I recall another case in which death followed a simple uterine curettement, and was, of course, attributed to infection spreading from the endometrium. Unfortunately, no post-mortem was held. The appendix was not guiltless in this

case.

The proximity of the appendix to the so-called pelvic organs of woman, throws about the diagnosis of pelvic troubles a vast amount of confusion, some of which our increasing experience will eliminate, and some of which, in the nature of things, we can hardly hope to escape."

Manganese in the Treatment of Dysmenorrhea.

The habit of dysmenorrhea tends to intensify itself in neglected cases, growing worse monthly, and harder to relieve; beginning early in the menstrual life and rapidly fastening upon the sufferer such a fear of the recurring pain that life becomes a burden. For this reason it is advisable that treatment should be instituted at as early a period as possible. Dysmenorrhea does not disappear of itself; it always grows worse if left alone. Therefore it is bad practice to put off the mother of a young girl whose early periods already cause her great pain, by telling her that time will bring relief. It will not; on the contrary, we have every reason to believe that each month will, if let alone, be worse than the last. But the ardor of the operating gynecologist has been such

that many mothers, from fear, refrain from mentioning their daughter's ailment. It is in such cases that manganese offers the best means of relief and cure. It is extremely efficient in those young women whose dysmenorrhea seems due to functional neuralgia, beginning almost with the establishment of menstruation. If administered early in the course of the disease, great relief is experienced; if persisted in, the habit is, in many cases, readily broken up and the health of the sufferer saved from impairment. Such young girls should never be examined, even by the rectum, unless there is very positive evidence of serious local. inflammation, until manganese has been given a full trial.

After the habit of dysmenorrhea has been established for years, in older women, it is a more difficult matter to destroy it, but in many instances it can be done. The most important thing to remember is that one should not be too soon discouraged. If a trifling improvement can be seen after two or three months of constant use of manganese, it means that a great relief can be given by it. One need not despair until four or five periods have passed with no benefit from the drug In many cases it is not necessary to wait so long. If the case is a suitable one, the first succeeding period will be notably easier, and after that little or no pain will occur during the administration of the remedy.

I have found the black oxide the most satisfactory, given in doses of two grains, by itself or in combination with iron or other adjuvants, about an hour after each meal. It may be used for an indefinite time without any effect, and should be given constantly until its efficiency or inefficiency shall have become manifest. If benefit is obtained at once, I then order it to be taken for two weeks before the next period; if that has been nearly painless, it is given during one week before the following period. In successful cases this is usually enough, and taking the drug during one week just before menstruation insures a painless period. No deleterious effects follow its use in this manner. It should be continued indefinitely; usually after a few months the patient feels cured, and stops taking the pills; but this is apt to allow a return of the dysmenorrhea, especially in those women who have suffered for any length of time. In young girls the habit seems

to be more readily destroyed, and the general systemic improvement renders the cure permanent. One must not expect cure, or even relief, in all cases.-Med. Council.

Don'ts for the Sick-room.

Use sperm

Don't light a sick-room at night by means of a jet of gas burning low; nothing impoverishes the air sooner. candles, or tapers which burn in sperm oil,

Don't allow offensive matter to remain; in cases of emergency, where these cannot at once be removed, wring a heavy cloth, for instance, like Turkish toweling, out of cold water, use it as a cover, placing over this ordinary paper. Such means prevent the escape of odor and infection.

Don't permit currents of air to blow upon the patient. An open fireplace is an excellent means of ventilation. The current may be tested by burning a piece of paper in front.

Don't give the patient a full glass of water to drink from unless he is allowed all he desires. If he can drain the glass he will be satisfied; so regulate the quantity before handing it to him.

Don't neglect during the day to attend to necessaries for the night, that the rest of the patient and family may not be disturbed. Don't ask a convalescent if he would like this or that to eat or drink, but prepare the delicacies and present them in a tempting way.

Don't throw coal upon the fire; place it in brown paper bags and lay them on the fire, thus avoiding the noise, which is shocking to the sick and sensitive.

Don't jar the bed by leaning or sitting upon it. This is unpleasant to the sick and nervous.

Don't let stale flowers remain in a sick chamber.

Don't be unmindful of yourself if you are in the responsible position of nurse. To do faithful work you must have proper food and stated hours of rest.-Health.