handkerchief, which is afterward to be burned. (3) If ordinary handkerchiefs are ever used for expectoration, they should be put into boiling water before they have time to become dry, or into some disinfectant solution to be ordered by the doctor. (4) Wet cleaning of rooms, particularly of bedrooms occupied by sick persons, should be substituted for "dusting." (5) Sunlight and fresh air are the greatest enemies of infection. Every consumptive should sleep with his bedroom window wide open top and bottom, and during the day should occupy a well ventilated Re-breathed air is the main condition favoring consumption. If the patient is warmly clad he need not fear keeping out in any weather. N. B.-The patient himself is the greatest gainer by the above precautions, as his recovery is retarded and frequently prevented by renewed infection derived from his own expectoration. (6) Persons in good health have no reason to fear the infection of consumption. Over-fatigue, intemperance, bad air, and dusty occupations favor the spread of the disease.

room.

A bill has been introduced in the Denver city council providing for the fumigation and disinfection of all sleeping cars passing through Denver. The bill gives the health commissioner free license in the matter. With proper regulations it is to be hoped the bill may be passed. Too much care cannot be exercised in providing for the cleanliness of all sleeping apartments whether on a moving train or elsewhere.

FORMALDEHYDE BETTER THAN SULPHUR.-Sulphur is now but little used in Denver for the purpose of disinfecting rooms that have been occupied by persons ill with contagious diseases. Formaldehyde is now being used for this purpose. The same agent will also be used in the 200 receptacles about to be placed in different places in Denver for the reception of Sputum to aid in preventing the spread of tuberculosis.

W. A. B.

GYNECOLOGY AND OBSTETRICS.

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

Cysts of the Breast: Their Relative Frequency, Diagnosis, and Treatment.

To "The Lancet" of April 28, 1900, Bryant has contributed, in a condensed form, the conclusions to which his investigations and clinical experience of breast disease have brought him. The following are the most important:

That simple cysts of the breast are far more common than they are generally believed to be.

That they are chiefly found in woman during the same peroid of life as that in which cancer is met with.

That they are mostly quite amenable to local treatment without the sacrifice of the breast gland in which they are situated. That there is no reason to believe that women who have these cysts are more prone to cancer than those who do not have them.

With respect to the diagnosis of these cases there may be a difficulty, and particularly in the case of a middle-aged woman, with a hard, slow-growing lump in her breast, and in whose history there is clearly an absence of the influence of lactation and of any inflammatory breast condition, and the condition of the nipple and soft parts covering the lump are normal.

To decide whether the case be one of cyst or one of early cancer, a careful local examination should be made, with the patient placed flat upon a couch and the breast gland made to rest upon the ribs, when, should the surgeon's sense of touch be keen enough to detect an elasticity in the swelling or even fluctuation, the diagnosis of a cyst may reasonably be hazarded, although what the nature of the contents of the cyst may be cannot be otherwise than obscure. If a clear serous fluid can be made to flow from the nipple by manipulation of or pressure upon the tumor, the probabilities of the cyst being a simple serious

cyst are much enhanced. If the fluid be brown or blood-stained, the existence of an intracystic growth of some kind may be suspected; and if the discharge be more like pure blood the presence of a soft solid growth, sarcomatous or carcinomatous, should be feared. When, however, there is no nipple discharge, as is often the case, and the other conditions are the same, the chances against the swelling being caused by a cyst are not lessened, although the view of the supposed cystic enlargement of the breast being due to the presence of some soft cancerous growth would be encouraged.

To make the diagnosis certain, an exploratory incision should be undertaken. Should the tumor be due to a cancerous infiltration or sarcomatous disease, the breast gland should be removed; the operation being, in these circumstances, undertaken at the period of the tumor's growth, after which the most favorable result may be fairly expected.-Therapeutic Gazette.

The Treatment of Obstructive Dysmenorrhea.

Duke ("Medical Press and Circular," No. 3179, 1900) states that mechanical treatment of obstructive dysmenorrhea has so far given the best results. To insure permanent relief the cervical canal must be kept open and the uterus as much as possible in the normal position. Duke has treated a considerable number of inveterate cases by either gradual or forcible dilatation, and in some cases by the cutting operation of Sims, followed directly in all by the introduction of his spiral wire stem, which is worn by the patient when up and about for at least three months, by which time the stem becomes loose and can be removed, insuring a patency of the canal unobtainable by any other means. This stem can be worn with comfort, there being no necessity for a recumbent position except for the first week at most after its introduction. Its flexibility and hinged disk at base keep it in position. In case it becomes blocked it is easily cleared by a sound sinus syringe, but if the wearer follows directions and uses the vaginal syringe or douche regularly every morning on rising, there should be no trouble.

Formalin in the Treatment of Inoperable Cancer.

Mitchell ("Medical News"), (from "Brit. Med. Jour."), employed a solution of formalin containing 20 per cent, of formic alehyde to stop the almost constant hemorrhage from a sarcoma of the cheek. The healthy skin was protected by painting it with a solution of caoutchouc. The solution of formalin was applied on a bit of absorbent cotton, which was covered with guttapercha tissue to prevent evaporation. The hemorrhage was stopped immediately, and the tumor issue was necrosed for a depth of about a quarter of an inch. The following day the necrosed portion was carefully cut away and the formalin was reapplied. The treatment was repeated daily until the tumor was entirely removed without the loss of a single drop of blood. Injections of the formalin solution with a hypodermic syringe produced an alarming swelling and gave no better result than the external application. There was no suppuration. This method of treatment is simple, produces no shock, and is absolutely bloodless. This formalin has a much more penetrative power than the usual escharotics. As the necrosed tissue is shaved away, an admirable view is presented of the extent of the new growth, and if desired the excised portions can be examied microscopically, as they are already hardened.—Columbus Med. Jour.

"The potency of the remedy is a secondary consideration. The chief thing is the adaptation of the remedy to the characteristic symptoms of the disease in accordance with the rule Similia similibus curentur. If that is made out satisfactorily it matters little what "potency" is employed, provided that the medicine is not given so strong as to cause perturbing effects, or so weak as to be incapable of producing a curative action."—Dudgeon.

Conducted by J. W. Mastin, M. D.

Acetic Acid.

Acetic acid antidotes all anesthetic vapors.

The acetic acid patient is irritable, nervous, anxious.

A glassful of vinegar will sober a very drunk person in twenty minutes.

Owens says that acetic acid is the only drug whose provings have developed a typical cancer cell.

Acetic acid is indicated where there is general anaemia; more especially the anaemia of nursing women, where the milk is impoverished and the child does not thrive.

Dilutions of this remedy, up to the 3x, are prepared with distilled water; after that alcohol is used.

Apply hot clothes wrung out of vinegar and water to the region of the bladder, after parturition, for retention of urine.

Brewer, so says Malcolm and Moss Regional and Comparative Materia Medica, cures many cases of consumption by inhalations of pure acetic acid and feeding his patients peanuts.

The same authority says: "Dr. Howe, of Atchison, Kansas, claims that the free use of cider vinegar is the best prophylactic for small-pox. Two years ago, during an epidemic of this disease at Lenora, Kansas, Dr. Howe was called to the locality after both physicians of the place had died and a great many of the inhabitants were either very sick or very badly scared. Dr. Howe's claims were well founded, apparently, as but few new cases were reported after the advent of the doctor and his little barrel of cider vinegar.

Dr. W. A. Yingling, of Superior, Kansas, has been experimenting in connection with Dr. W. D. Gorton, with a very old fashioned remedy put in Homeopathic form. He has taken the juice of the peach, pear, plum, and apple, mixed with an equal amount of alcohol, mascerated fourteen days, and potentized by