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of food as well as quality. In this condition of tongue we have atony also. It is the tongue of advanced fevers, inflammations of the mucous membranes, and want of assimilation, hence great caution both of remedies and food. Here we must not use cathartics. Mild aperients may be carefully used.

A contracted, pointed tongue, with dryness and dark fur, is the usual tongue of typhoid and other low grades ef fever, when all thinking minds would use great care in the treatment and food.

The dryness or moisture of the tongue denotes the extent of the disease of the intestines, and will point us in that direction.

A fissured tongue points to the kidneys, either an inflammation or something wrong with secretion.

Yellow coatings are usually associated with morbid liver and want of biliary secretions, and would indicate mild hepatics and tonics.

Raised papillæ, bright red, denote irritation of ganglionic nerves and irritation of stomach, especially the mucus coating. Shows exhaustion; no digestion, and needs rest; nux vomica, twenty drops, and the food to be warm and taken in small quantities. Bismuth and pepsin after food.

Broad, thick tongue, papillæ not visible, but looking raw, denotes a septic condition of blood, and favors typhoid fever. Indicates, if deep red, sulfuric acid; if pale, soda sulfite. Liquid food, sippt warm, in small quantities.

Deep, dark red tongue and dark coating indicate septic condition of blood.

Shades of dark brown and black denote typhoid condition or septic conditions.

Pale, dirty fur on tongue, denotes acidity, and a septic condition of system; indicates soda sulfite; but if membranes are deep red, sulfuric acid will be admissible, because it would show an alkaline condition of blood.

Contracted, pointed, inability to hold still, and drawn to one side of mouth, denotes trouble with the nerves, and perhaps the brain. Requires great care and study of condition.

Dry tongue always denotes feverishness or inflammatory condition, affection of the nerve-centers of ganglia.

Thick tongue, and curved edges upward, denote atony of the nerve-centers of ganglia, requiring stimulants, nux vomica or strychnin and quinin.

sluggish condition of digestion and assimilation and congestion, especially of the base of brain. Restlessness and constant change of position are present. - Medical Age.

Ten Hygienic Aphorisms.

The late Dr. Franklin H. Hamilton, of Bellevue Hospital, is said to have framed the following decalogue of health precepts: 1. The best thing for the inside of a man is the outside of a horse. 2. Blessed is he who invented sleep-but thrice blessed the man who will invent a cure for thinking. 3. Light gives a bronzed or tan color to the skin; but where it uproots the lily it plants the rose. 4. The lives of most men are in their own hands, and, as a rule, the just verdict after death would be-felo de se. 5. Health_must be earned-it can seldom be bought. 6. A change of air is less valuable than a change of scene. The air is changed every time the wind is changed. 7. Mold and decaying vegetables in the cellar weave shrouds for the upper chambers. 8. Dirt, debauchery, disease and death are successive links in the same chain. 9. Calisthenics may be very genteel, and romping very ungenteel: but one is the shadow, the other, the substance, of healthful exercise. 10. Girls need health as much-nay, more than boys. They can only obtain it as boys do. by running, tumbling--by all sorts of innocent vagrancy. At least once a day girls should have their halters taken off, the bars let down, and be turned loose like young colts.-Medical News.

Hints.

It is a bad idea to have office, residence and stable in different portions of the city.

It is a bad idea to be too prompt with the hypodermic syringe. It is like a gun, dangerous without lock, stock or barrel.

It is a bad idea to have a small slate in your office. It indicates small business.

It is a bad idea to neglect your office hours. "Take care of your office, and your office will take care of you."

It is a bad idea to turn professional visits into social business.

It is a bad idea for the young doctor to live in single blessedness too long.

It is a bad idea not to send out your bills for professional service at the end of each quarter, making no exceptions.

It is a bad idea to encourage your patients to put off sending for you until unseason

Pointed, narrow tongue is the tongue of able hours.

It is a bad idea to make your business secondary to anything else.

It is a bad idea not to stand by your respectable professional brother. Curses, like boomerangs, come home to base.

It is a bad idea for the professional man to dress and look like a jockey.- Louisville Medical Monthly.

A Simple and Successful Method of Treating

Hemorrhoids.

A large protruding crop of pile tumors around the whole circumference of the anus, with redundency of tissue, an extremely varicose condition of the hemorrhoidal veins, and complicated with the above an inveterate and incurable eczema ani, may be a suitable case for the Whitehead operation, but the majority of cases met with in surgical practice may be treated by a method much simpler, less dangerous, recovery much quicker, and with the result that a complete cure is the rule. The method that I have employed for some years past is a modification of the clamp and cautery operation. I employ a loop of unannealed wire, which is lighter than the clamp and easier handled. For this purpose I use Jarvis's nasal snare, or the instrument of Dr. Kellogg, of Battle Creek, which is a modification of it.

The principle of these instruments is that they strangle the pile tumors and act partially as ecraseurs. The evening previous to the operation I direct the patient to take a dose of oil, in order to empty the colon and rectum, and the following morning he is placed upon the operating table in the left semi-prone position. With an assistant at my side, with my thumbssometimes with Pratt's speculum-I dilate the anal opening and expose the pile tumors. If by this dilatation it is not possible to bring down the pile, I employ Allingham's speculum and bring it into view through the cleft in the same, and irrigate the pile with some antiseptic solution, preferably Wampole's, which contains a small portion of formalin. I now inject hypodermically a few drops of a five per cent. solution of cocain into the pile, sending in the drops superficially along the surface of the tumor. I wait a few moments, and then introduce small forceps through the wire loop of the instrument; the pile is then seized and drawn down within the same, and the loop is well pressed down around the base of the tumor so as to be in a position to hold it well, or, if necessary, to strang

ulate it. With a few turns of the nut at the proximal end of the steel rod, the loop is tightened and the tumor well compresst. Holding the pile tumor within the loop, in my left hand, and drawing it down, I commence to sear it with a small point, either of Paquelin's thermo-cautery, or the small point of a galvano-cautery electrode, which I hold in my right hand. While I am searing the pile tumor, I have an assistant standing by me, who by means of a dentist's bellows, after each contact and burning of the heated electrode, maintains a stream of cold air, which is directed upon the burned pile; this keeps the tissues cool and protects the adjoining parts and the pile from too great a heat, and from the pain of the same. I now slightly tighten the loop but continue to sear, and as soon as the pile is burned near to its base, I release the loop and remove it. Then I attack the next pile tumor, proceeding in the same manner in every particular as with the first, and so continue until all of them have been destroyed. In treating hemorrhoids in this way, the operation is practically painless, the patient can at once get up from the operating table, and usually express astonishment that his piles have been removed with so little discomfort.

The after-treatment consists of dusting the stump with an antiseptic powder, and introducing within the anus a little salicylated cotton smeared with carbolated vaseline. This method of treating hemorrhoids has the following advantages:

1. The easy application of the loop over the use of ligatures, injections of carbolic acid, and of the heavy steel clamps, will at once be made manifest to any surgeon who will try the plan.

2. The operation is absolutely aseptic, so rendered by the destructive action of the cautery.

3. There is no danger of secondary hemorrhage, and this is one great advantage of the operation, the eschar made by the cautery soon drops off, and the healing process is rapidly completed.

4. Injecting the pile a few moments before operating with 10 drops of a five per cent solution of cocain renders the operation almost painless, and in my experience I have seen no indication of systemic intoxication from it, as the anesthetic action is localized, because the pile is so constricted by the wire loop that only a minimum of the cocain is taken up into the general circulation.

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There are certain hemorrhoidal swellings which are merely dilated veins containing a clot of blood that obstructs the circulation and occasions much distress. form of a pile tumor may be easily managed by opening the vein enclosing the clot, and removing the same. This simple operation will relieve a poor sufferer, who, from the mere presence of such a thrombus, has been in agony at times, perhaps for months past. For external piles, called cutaneous piles, we never use either the loop or ligature; they may be excised at once, and the anal outlet trimmedthat is to say, freed from all excrescences or tags about it.-Dr. T. Griswold Comstock.

Nitroglycerin in Spasmodic Croup.

Dr. G. G. Marshall has found in nitroglycerin an ideal remedy for spasmodic croup where steam inhalations and emetics fail, or where they depress too much to bear repetition. He recommends it to be given in small doses frequently repeated. To children from five to ten months old he gives from one ten-hundredth to one sixhundredth of a grain, repeated in from five to ten minutes if no effect is noticeable. Usually in ten minutes there is markt relief in the dyspnea and general appearance of the child. By repeating these small doses from every fifteen minutes to once in one to three hours, the laryngeal spasms are controlled. Sometimes it is not necessary to repeat it more than once

or twice; at other times the remedy has to be continued at more or less frequent intervals for two or three days.-Philadelphia Medical Journal.

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who, at a clinical lecture, told his students to pay all their attention to diagnosis and prognosis. After an exhaustive dissertation on a case, he was leaving the bedside without prescribing any treatment, when the house physician asked what he should give the patient. "Oh," said the physician, "a hopeful prognosis and anything else you please."-N. Y. Med. Jour.

Chloroform Externally During Labor.

Dr. Archangelsky (Vratch) says that for several reasons the external application of chloroform to the abdomen in severe and irregular labor-pains is superior to chloroform-anesthesia. He employs a mixture of one part of chloroform to two or three parts of olive oil, rubs it in well on the abdomen, and then apples a warm compress. In a very short time the pain is relieved, the contractions become regu lar and more effective Its advantages over chloroform-anesthesia are: The patient remains fully conscious, the pulse and the respiration remain good, there are no nausea, no vomiting and no uterine atony.-Amer. Med.-Surg. Bul.

When

Atresia of the Cervix in Labor. all cases due to the inflammation of the Campbell says that this condition is in cervix which, in the early stages of preging surfaces of the cervical canal. leads to adhesion of the granulatnancy, labor begins the upper part of the cervix yields and thins out, while the lower portion remains undilated, and the os is not to be discovered by digital examination. As labor advances the cervix descends, and finally appears at the vulva or even protrudes beyond the orifice in the form of a dark red, thick-walled, fluctuating tumor, which becomes tense with every pain. The os is concealed by the perineum, and is to be sought for on the posterior aspect of the presenting mass. It may be median or to one or the other side of the middle line. When detected, its position is indicated by a small circle of a brighter hue than the rest of the surface. The treatment consists in scratching with the fingernail and then dilating with the finger. Rupture of the membranes should in all cases be delayed as long as possible.-British Medical Journal.

Read THE WORLD's special articles on seasonable diseases and you will surely subscribe. One year, $1, four years, Write us your experiences in the treatment of theumatismi This disease needs thoro discussion.

What are your views as to treatment of diphtheria

Class-Room Notes.

[From Dunglison's College and Clinical Record.] -To make a differential diagnosis between Hysteria and Epilepsy you must remember that these diseases may and do occur together. An important point of difference is that hysteric convulsions occur while the patient sleeps. Epileptic convulsions on the other hand do occur during sleep.-Dercum.

never

-It is quite as important to use antitoxin early in Diphtheritic Poisoning as it is to use hydrated sesqui-oxid of iron early in arsenical poisoning. Just in proportion as it is used early are its effects of advantage to the case. Where the posterior nares or the larynx become involved larger doses must be given. Start with 1500 units and repeat two or three times in twenty

four hours. There is no limit to the dose of antitoxin.-Hare.

-Prof. (Montgomery has recently used Postural Drainage subsequent to pelvic operations done thru the abdomen with encouraging results. The technic is simple. A large quantity of normal saline solution is allowed to remain in the abdomen, and the foot of the patient's bed is raised eighteen inches for thirty-six hours after the operation. The results are that the exudate, if infective, is greatly diluted and may all be absorbed by the peritoneum; if inflammatory, is kept liquid; and organized exudates are avoided. The pressure of the viscera is removed, intestinal adhesions are avoided, peristalsis does not cause pain by irritation, the patient suffers less distress and discomfort, and convalescence is naturally more rapid.

A New Symptom of Cancer.

under his observation; it is particularly
frequent in cases of epithelioma of the
stomach and uterus, but less common in
malignant disease of other organs.

Menstruation and Conception During
Lactation.

Remfry (Revue Internationale de Médicine et de la Chirurgie, 1896, No. 5) has found by an investigation among 900 nursing women that in 57 per cent. only did there occur an absolute amenorrhea. Menstruation was regular in 20 per cent., and irregular in 43 per cent. It was also common for conception to occur during lactation, 60 per cent. of the menstruating women conceiving. Among the non-menstruating women but 6 per cent. conceived during lactation.--Univ. Med. Mag.

Safety in Anesthesia.

11

The comparative safety and the efficiency
of various anesthetics and various methods
of administration is a topic of perennial
interest and importance. The discussion
at the Surgical Section of the College of
Physicians, an abstract of which appears
in this number, was not less important
than any which have preceded it. Dr.
Maduro, of New York, who has worked
with Schleich, spoke enthusiastically in
favor of the mixtures of benzine, ether
and chloroform, adopted by the latter. The
following are his formula:
MIXTURE I. (Boiling-point, 38° C.)

Chloroform, 45 parts.
Petroleum ether, 15 parts.
Sulfuric ether, 180 parts..

MIXTURE II. (Boiling-point, 40° C.)
Chloroform, 45 parts.
Petroleum ether, 15 parts.
Sulfuric ether, 150 parts.

G. Bogdan (Brit. Med. Jour.) relates the case of a woman, aged forty-eight, who MIXTURE III. (Boiling-point, 42° C.)

Chloroform, 30 parts.

• Petroleum ether, 15 parts. Sulfuric ether, 80 parts.

In the above formulas petroleum ether signifies purified benzin, having a boilingpoint between 60° and 65° C.; and by

had suffered from cancer of the stomach. The disease had gone thru a long period of latency. The patient presented on each cheek a patch of wine-red discoloration formed by the dilatation of the superficial venules; the stain showed out sharply against the pale yellow of the surrounding sulfuric ether" is meant the ether (96 skin. On the strength of this symptom per cent. ethyl oxid) of the U. S. Pharalone Bogdan was able to make a diag- macopeia. The boiling-point of the mixnosis of probable cancer at a time when ture is the point upon which Schleich lays there was yet no other manifest sign of great stress. He asserts that when the that affection. He looks upon such super- boiling-point is higher than the temperaficial varicosities on the cheeks as a valu-ture of the blood the quantity of an anesable help to the only recognition of certain cancers; he has seen it in about two-thirds of the cases of cancer which have come

thethic necessary to narcotize is less than when these are equal; furthermore, that the narcosis is much greater with a given

40

THE MEDICAL WORLD.

quantity of the anesthetic, when the boiling-point of the latter is greater than the temperature of the body. Hence, the nearer the boiling-point of the anesthetic approaches the body temperature the less likely are unpleasant results. The boilingpoint of chloroform is 65° C., of ether 34°C. By mixing ether and chloroform in definite proportions, with the addition of benzin, Schleich has succeeded in producing anesthetic mixtures of any desired boilingpoint; the use of which, he claims, gives the rapidity of chloroform with the safety of ether, with quick recovery, and a minimum of unpleasant results. Dr. Maduro had collected in the neighborhood of 1,000 cases, in which these mixtures had been given by Schleich and others, and the general result of which seemed to be quite favorable.

At the Polyclinic Hospital we have been employing for nearly three years the combined administration of ether and oxygen. The method is very simple. From a cylinder of compressed oxygen, with or without the interposition of a rubber bag as a regulator, the oxygen passes thru a wash bottle in which, instead of water, ether is placed, and taking up the anesthetic on its way, enters the patient's nose and mouth thru a mask of spun metal edged with a rubber pneumatic cushion and fitted with two valves, which automatically open and close for inspiration and expiration respectively.

If it is desired to increase the amount of ether in proportion to the oxygen, the long tube of the wash bottle is pushed further into the fluid; if it is desired to give very little ether in proportion to the oxygen, the tube is brought nearly to the surface of the fluid; and if oxygen only is to be given, the tube is lifted entirely clear of the fluid or better, a switch connection is made by which the oxygen passes into the mask without going thru the ether bottle. With this method, the patient remains ruddy during the entire process of anesthesia. One feels quite assured of the safety of his patient, even in cases in which otherwise he might be in doubt. It is possible that Schleich's mixture used with oxygen might be better than ether. That remains for experience to determine. We certainly feel justified in urging upon the profession that, notwithstanding the rarity of direct accidents from ether, it is their duty to guard against misfortunes, even so little to be expected, by the conjoined use of oxygen. In addition, the fact that anesthesia can be

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prolonged with so much less ether than is usually the case. diminishes the probability of the unpleasant after-results from irritation of the kidneys, of which surgeons in general take so little account.--Phila. Polyclinic.

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