mother recovered from inguinal abscess, the cause being an untrapped slop-stone-pipe.-5. Facial abscess in a girl, aged nine years. This was probably due to sewer-gas from an untrapped slop-stone pipe.-6. Pelvic abscess, and three cases of "summer-diarrhea." A patient had been confined six weeks. She was very anæmic, and had no appetite. This was due, undoubtedly, to the bad smell in the house. She was taken ill with an abscess in the pelvis. Just at the same time there were three other cases of summer-diarrhoea in the house. The infant died. For the sake of the woman, I recommended that the family should remove at once, which they did, and the patient made a good recovery. The abscess discharged itself per vaginam. The cause was a defective privy, from which there was a continual leakage of fæcal matter into the house.-7. Multiple abscesses. A baby, aged six months, had twenty abscesses, scattered on its legs, arms, and body. This state was due to bad emanations from a defective privy. The privy was at once altered at my suggestion, and the patient speedily recovered.-8. Temporal abscess in a patient aged eleven years. The cause was foul emanation from a defective drain.-9. Typhoid Fever, A death from typhoid fever being reported to me, I inspected the house and found that bad smells came from the untrapped slop-stone pipe.-10. Typhoid Fever. Another death from typhoid fever was reported. On inspection, I found the slop-stone untrapped, and an untrapped drain close to the door.-11. Typhoid Fever. This was a case of typhoid fever in a gentleman living in a new, well-built house. On inspection, I found the drains and slop-stone trapped. The wife, however, complained of bad smells coming from the water-closet, which was on the first floor. The watersupply in the summer being limited, the drain could not be well flushed. The mephitic gases, generated in large quantities in hot weather, would soon saturate the water in the pan of the water-closet, and pass into the house. The drain was long and unventilated; and the sewer gases, being of lighter specific gravity than the air, would seek an outlet at the highest elevation, which would be the water-closets. The drain has since been ventilated. The patient died.-12. Diphtheria, and three

cases of Sore throat. A child, aged three years, had diphtheria, and died in three days. In the same house, there were three adults suffering from sore throats, all of whom recovered. I found that there was a bad smell from untrapped slop-stone.13. Puerperal Septicemia. The third day after confinement, the patient had usual symptoms of septicemia. She nearly succumbed two or three times. After about five weeks, she had a relapse, which proved fatal. In this case there was a foul smell from an untrapped drain, within a few feet of the door, where the patient was confined.

REMARKS. It is difficult to state definitely the cause of many diseases. In some of the cases given above, it may be a coincidence, and sewer-gas may not have been the cause. Though I think in most, if not in all, sewer-gas was the chief factor, I would not say positively typhoid fever can be generated de novo from sewer-gas; yet my experience goes to prove that much may be said in favour of it.

Summer-diarrhea, especially in infants and young children, I believe, is often due to sewer-gas. In the summer, decomposition of sewage is very rapid. Infants who are nearly all day indoors in houses in which sewer-gas exists (and there are, unfortunately, a large number among the poor) soon get diarrhoea. Of course, there are other things to produce it.

Diphtheria and sore throats are often due to sewer-gas. House No. 12 seems to prove that the poison which generated diphtheria in the child, in the three adults caused bad sore throats. Several cases of death from puerperal fever have occurred, generally in houses which are subject to bad sanitary arrangements, especially as regards drainage and ventilation. I have had a large number of abscesses in children during the past summer. In nearly every instance there were strong reasons to believe it to be due to sewer-gas. As a rule, if two or more persons in a house are suffering from summer diarrhoea, or abscesses, we may suspect sewer-gas. Sewer-gas is especially dangerous to children. Older persons may resist its influence; but in them it will probably be the cause of anæmia, nausea, and headache. In the winter, when the decomposition of sewage

matter is far less active than in the summer, I have found that infantile diarrhoea and abscesses are very few when compared with the number of cases occurring in the summer months.British Medical Journal.

On the Treatment of Diseases of the Colon.-Dr. Dubois enumerates the diseases of the colon in which the injection of large or small quantities of water is indicated. He then adds some practical hints on the different ways of administering the fluid. There are two different kinds of enemata employed. First, the simple enemata, which are used in cases of constipation, when it is found necessary to remove fæcal masses from the sigmoid flexure, the cæcum, or the rectum, in cases where the mucous membrane of the rectum is diseased, and it is indicated to bring it into contact with water or medicine; secondly, very large enemata, which will be found efficient in cases where the water ought to be injected high up into the large intestines, whenever there exists a catarrhal affection of these portions of the intestines. Some patients can. bear, without incurring pain or danger, enemata of 1,000 to 1,500 cubic centimetres of water, but in others such a large volume of fluid would either prove very dangerous to the intestines, or could not be injected on account of the great irritation of the intestinal muscles. In such cases, where it is of obvious necessity to inject a large bulk of liquid, the author advises the following method. Tepid water is injected till the patient feels a violent strain. The syringe is then removed, and the patient slowly changes under the bed-clothes from his right or left side to crouching on his knees and elbows. After one or two minutes the former position is again assumed for a short time, and then the patient lies down upon his back. The same operation and changes of posture are then repeated, and defecation generally ensues in about ten minutes or half an hour after the injection has been given. This method is indicated: a, in cases of constipation where purgatives and the usual enemata can either not be given or have proved powerless; b, in cases of coprostasis where fæcal tumors, varying in size, can be felt in the

cæcum or other parts of the large intestine, and have sometimes been mistaken for ovarian cysts. Here purgatives given by the mouth are either vomited or have no effect; c, it is well known that inflammations of the vermiform process are mostly caused in healthy individuals by accumulation of fæces. Whenever, therefere, a slight tenderness and increased resistance are felt in the iliac region, especially in persons who have suffered from typhlitis before, a bulky injection will be found very useful in preventing the inflammation and removing the fæces. Narcotics should also be used in these cases; d, in cases of general or local peritonitis, when constipation and accumulation of gases in the abdomen have been produced by paralysis of the intestinal muscles; e, in cases of diarrhoea caused by constipation or accumulation of fæces; f, in abscesses of the intestines, dysentery, etc. (Schweitzer Correspondenzblatt Memorabilien, 1878, ix. Heft)-The Practitioner.

The pathology of rodent ulcer.-An interesting discussion on the nature of rodent ulcer took place recently in the London Pathological Society. The discussion was raised by the Drs. Fox, who presented microscopical specimens to the meeting and stated that their investigations had led them to take different views concerning rodent ulcer from those advocated by other observers. Thiersch distinguished two kinds of epithelial cancer, the ordinary penetrating epithelial cancer, and the flat epithelial cancer; the latter being identical with the rodent ulcer of English writers. He was the first to insist on the epithelial nature of this affection. He bases his opinion that there are two kinds of epithelial cancer of the skin mainly, if not entirely, on the histological evidence, and considers it probable that the cell-masses in rodent ulcer take their origin in the sebaceous glands, because the general shape of the masses ressembles that of the glands, and because they are often found near a hair. He does not, however, find any direct evidence of the origin of the cell-masses from the glands. On the other hand, Verneuil published in 1848 a case in which ulceration of the face was produced by a cell growth, which he

believed to have begun in altered sweat-glands. Thiersch and Thierfelder have also both described undoubted fatal cases of adenoma of the sweat-glands. It can hardly therefore be doubted that adenoma of of the sweat-glands constitutes a variety of cancerous disease. In four cases of rodent ulcer, Dr. Thin was not able to trace the disease directly to any of the epithelial structures of the skin, but in two of his cases he found the sweat coil the seat of a new growth. From this, and from the resemblance of his cases to Verneuil's case, he was led to infer that it is highly probable that the cell-masses of rodent ulcer originally begin in the sweat-glands. He points out that the cells in rodent ulcer differ from those of epithelial cancer, strictly so called, never taking on the characteristic changes of the latter. His view, that in rodent ulcer we have a true adenoma to deal with, he believes to be strengthened by the fact that he has demonstrated a membrana propria between the cell-masses and the connective issue.

The Drs. Fox, on the other hand, say that rodent ulcer is an epithelial growth which takes its origin from the external rootsheaths of the hairs, that is to say, from a purely epidermic structure. In the discussion on their paper, Dr. Thin declared that the specimens presented were specimens not of one disease, as the Drs. Fox believed, but of two distinct diseases, some of them being preparations of ordinary epithelial cancer, and others of rodent ulcer. This wide discrepancy in the interpretation of the appearances naturally rendered the discussion unprofitable, except in so far as it has aroused attention to the questions whether there are two distinct kinds of epithelial growth producing cancer of the skin, and whether it is possible to distinguish them microscopically. We may expect before long to have this question definitely settled.-The British Med. Journal. Medical Record, N. Y.

The treatment of Acute Obstruction of the Bowels.-Writing on obstruction of the bowels, Dr. T. C. Allbutt says, in the British Medical Journal-Let us dispose hastily of all cases of essentially chronic obstruction. They rarely need heroic action or great presence of mind either