BY JEROME WALKER, M. D.

PERICARDITIS IN CHILDHOOD.

Knoff (American Journal of Medical Sciences, Aug., 1890) reports ten cases. Of these, three were under one year of age; three between one and two; and four between six and ten. Pericarditis in the new born is usually due to a septicemic process, starting in the maternal organism or else from the umbilicus of the child. In older children the conditions which predispose to pericarditis are tuberculosis, inflammatory processes of the pleura, lungs, sternum, vertebral column, bronchial and mediastinal glands, thymus and œsophagus, and of the abdominal organs and the peritonæum. In six of the cases reported by the author, the disease followed inflammation of the pleura and lungs; in one it followed chorea; in two scarlatina; and in one no cause was ascertained. In very young patients the diagnosis is difficult, frequently on account of the absence of ordinary physical signs. Autopsies made by the author showed that the exudation was usually not abundant, and hence it could not influence the position of the heart, the area of dulness, or the relative position of contiguous organs. The exudation was also fluid in character, without fibrinous deposit, and hence the absence of friction-murmurs.

CASE OF RECTAL OBSTRUCTION IN A CHILD.

T. Sympson (British Medical Journal, October 4, 1890). "A boy, æt. ten years, while spending a week with some relations in the country, ate a large quantity of wheat. The day after his return home he was noticed to have lost his appetite, and to be listless. In the evening he suffered greatly from abdominal pain, frequent and urgent desire to evacuate his bowels, and severe tenesmus. These symptoms increased in intensity. On the third day I was called to see him. On examination through the abdominal wall, the sigmoid flexure was felt to be greatly distended, and a few grains of wheat had been found in the bed. On examination, liquid was seen oozing from the anus, and the rectum was enormously distended. Under chloroform, a quart pot of wheat was removed, with complete relief to all the symptoms.

SCARLET FEVER AND SANITATION.

(Brit. Med. Journal, September 13, 1890.) At an inquest held at Sedgley near Wolverhampton, where a child had died from scarlet fever, it was shown that though the home of the child was in good condition, its surroundings were "filthy," there being an open stagnant well near the house and no proper drainage. It was also shown that the sanitary authority sanctioned the removal of night-soil during the day from the vicinity of the house.

EUCALYPTUS IN CATARRH OF THE RESPIRATORY TRACT AND OBSTINATE COUGH IN CHILDREN.

Solomon Solis-Cohen, M. D. (Medical News, May 24, 1890). The author was led, by advice of Prof. J. M. Da Costa, to first try the fluid extract of eucalyptus in a case of obstinate cough. He says: "For internal use in bronchial and laryngo-tracheal inflammations the fluid extract seems to serve a better purpose than eucalyptol. In acute cases my usual custom is to administer it in connection with ammonium salts; in sub-acute cases a little paregoric may be advantageously added. In the obstinate irritative coughs following inflammatory affections which have apparently subsided, the fluid extract of eucalyptus is best given without other drug, in syrups of tolu or acacia, or in emulsion of oil (castor oil, olive oil, cod-liver oil, almond oil), as necessary, to disguise its taste or modify its action. The dose is about five drops for a child of two years."

CONGENITAL HYDROCEPHALUS WITHOUT ENLARGEMENT OF THE HEAD.

Dr. L. Emmett Holt (N. Y. Med. Jour., November 1, 1890) presented in Section in Pædiatrics, N. Y. Academy of Medicine, a brain removed from a child who had died at the age of three weeks, in which a very marked degree of hydrocephalus existed, the head, however, being of normal size. The lateral ventricles were much dilated, and contained six ounces of fluid. The brain outside was a mere shell. Spina bifida also existed. Death was caused by suppuration in the spina-bifida sac, which had extended upward along the whole cerebrospinal axis. No operation had been performed.

GYNECOLOGY.

BY WALTER B. CHASE, M. D.

ON DIFFERENTIAL DIAGNOSIS OF HYDROSALPHINX.

Dr. Skene, at October, 1890, meeting of the Brooklyn Gynecology Society, related a case of a female having the rational and physical symptoms of hydrosalphinx (the diagnosis having been reached independently by an eminent American gynecologist) associated with disease of both ovaries.

Laparotomy was performed, the tubes and ovaries removed, but the tubes were not distended. After convalescence the physical symptoms of hydrosalphinx remained. On placing the patient in the knee-chest position, the condition simulating tubal distension disappeared, showing it was due to distended veins.

TREATMENT OF CANCER OF THE CERVIX UTERI BY HIGH AMPUTATION.

In a discussion on Dr. Coe's paper on "Limits of Vaginal Hysterectomy," in the proceedings of the New York Obstetric Society, ap

pearing in American Journal Obstetrics, June, Dr. Hanks said he had become so accustomed to high amputation by scissors, knife, and cautery that he seldom resorted to vaginal hysterectomy. The results had been very satisfactory. He had seen many cases of malignant disease of uterus, and yet within five years only one patient had come under his individual care, in which all the good which could be accomplished would have been by Byrn's, Sims', or Baker's operation.

SECONDARY PERINEORRAPHY AT TIME OF A SUBSEQUENT LABOR.

Dr. Charles Jewett at the October meeting of the Brooklyn Gynæcological Society, gave cases of the above operatiou.

The repair of a former injury to the pelvic floor may be done immediately after labor, when the patient is in favorable condition. Union takes place as kindly as in ordinary primary operations.

The patient's time is saved and the operation less formidable. Have done this in four instances, two in August last in which there was no tear during the last labor. In the other cases there was a slight flesh laceration. Here the old scar-tissue was removed and the whole perinæum restored, instead of simply suturing the new tear. The results were highly satisfactory.

[This new departure by Dr. Jewett, which promises so well, will be watched with interest until larger experience shall determine its proper status as a conservative operative procedure, both as regards results, and any dangers which might follow of the septic variety, particularly in these cases in which there was no injury to pelvic floor at time of last labor.-W. B. C.]

SECONDARY PERINEORRAPHY.

Under this head, Saurenhaus (Centralblatt für Gynäkologie, July 3, 1890), reported at a recent meeting of the Berlin Obstetric Society twenty-five cases in which he repaired laceration of perinæum at periods varying from five to twenty days after the original injury, with only two failures. The surfaces were freshened by the scissors or sharp spoon, and were united by a continuous catgut suture. In the discussion which followed the reading of the paper, the concensus of opinion was in favor of using the continuous catgut suture for the immediate repair of perineal lacerations. Amer. Journal Med. Science, Oct., 1890.

PERFORATION OF UTERUS WITH CURETTE,

(Phila. Obstet. Society, April 3, 1890). Dr. J. Hoffman reports case of perforation of uterus in a septic uterus following a six weeks' conception. Laparotomy was performed four hours afterward, which was followed by recovery.

A difference of opinion existed as to whether the accident was due to the curette, or to the forcible dilatation which preceded its use— which was a Molesworth's dilator.

In the discussion following Dr. Gooddell reported two cases of malignant diseases of endometrium, in which the curette penetrated the abdominal cavity, in which no serious consequences followed.

CATGUT IN ABDOMINAL SURGERY.

Dr. Robt. T. Morris (Journal Gynecology and Pædiatry, Sept., 1890), discusses his experience with catgut. He regards it as superior to everything else both for suture and ligatures. He prepares it by placing it first in oil of juniper for a few days. He then immerses it in 95 per cent. alcohol and adds bichloride of mercury, four grains to the pint.

He uses three sizes of catgut, Nos. 9, 7 and 5, which are absorbed in about six, twelve and nineteen days respectively. He appends a table of 47 operations, catgut being used, in which he shows untimely absorption in two cases (both in integument); two were followed by mural abscess, and three by infection of catgut.

The two cases of infection were those in which dealers' catgut was used.

DISEASES OF THE SKIN.

BY SAMUEL SHERWELL, M. D.,

Clinical Professor of Dermatology, Long Island College Hospital; Attending Physician, Brooklyn Hospital Surgeon to Skin and Throat Department, Brooklyn Eye and Ear Hospital.

ARISTOL.

Eichoff (Monatsheft f. p. Dermat., 1890, x) gives a very enthusiastic account of the virtues of this drug-a union of iodine and thymol, as is well known, first made by Messinger and Vorthnar, of Aachen; it is neither soluble in water nor alcohol, but fairly so in ethers and the fatty oils. He used it in parasitic diseases of the skin (both animal and vegetable), ulcers, eczemas, lupus, etc.; also in psoriasis recommends it, particularly on account of its not staining, as does chrysophanic acid, anthrarobin, etc. About the only exception he makes in praise of its action is in the chancroidal ulcer, in which, he says, either in finely powdered substance or by use of solutions, he has found little good effect. He thinks it preferable to iodoform, and very much more desirable, on account of its being odorless.

In a later article (Deutsche med. Wochenschrift, Nos. 28, 29) he comes about to the following conclusions, which, though positive enough, are somewhat more moderate in their claims, viz. :

1. That aristol is a medicament totally free from harmful properties. 2. It neither stains the skin nor the clothes of the patient.

3. That it is useless in the treatment of acute gonorrhoea, in chancroidal ulcerations, and in favus.

4. That it may be used with good effect in psoriasis and eczemas occasioned or accompanied by parasitic troubles, tinea tonsurans, and sycosis.

5. That it is a decidedly good remedy, and, as before said, an entirely harmless one, in the following diseases: Ulcers of the legs, syphilitic gumma, scrofuloderma, carcinomas of the skin, buboes, lupus vulgaris, and cases of gangrene, and in all of these, more particularly, when they have arrived at the ulcerative stages.

He has been sustained by some writers, as Dr. Alois Pollak, of Prague (Therap. Monatsheft, No. 7, 1890), who recommends a salve of aristol, sapo viridis, ether, and alcohol, for application in scrofulodermas and the like, who also used it in ulcers, etc., with good effect. Dr. C. W. Allen, of New York (Med. Record, October 11, 1890, p. 404), in a paper read at the American Dermatological Association (1890), gives a moderately favorable report of the action of this drug. He had used it in many of the diseases already mentioned by Eichoff and others, and in some not, as in condylomata around anus, etc.; he had, however, thought it was useful in chancroids, as had Neisser, who recommends it in those affections, and in suppurating buboes. Under the critical discussion which followed the reading of the paper in the Society, the doctor was unable to make any great claim as to its efficacy in psoriasis, eczemas, parasitic diseases, etc.

Dr. Wm. F. Waugh, of Philadelphia (Medical Times and Register, September 20, 1890, p. 258), gives an exhaustive review of the literature of this drug up to that date, and as well gives cases of his own, in which he claims great success by means of its application, and consequently looks upon it with much favor. The cases themselves include endometritis, ulcerating carcinomas, gleet, etc.; he gives names and dates. in his article of those having written on the subject, other than those before mentioned, as Drs. W. C. Wile, Shoemaker, Brocq, Schuster, Schirren, Lassar, Kriccicki (of Posen), Hughes (in Seifert's Clinic for Diseases of Nose and Throat, Würzburg), Gaudin, Soler y Buscalla, Rohrer, Rosenthal, etc.

(It seems astonishing, with all this review of favorable testimony, that the profession at large have not taken to this drug more kindly. Certainly, while all dermatologists, etc., have used it, and some much, we do not find any that are enthusiastic over it; in fact, we and they certainly believe that the earlier observers have been too sanguine in their claims. Personally we have used it in various ulcerative diseases,