difficult, excision of the gut being rarely required except in long standing cases. The proximal end of the gut should never be pulled in attempting the reduction, as this procedure is often productive of tears of the intestine. Reduction is to be produced by pressure upon the apex of the mass through the gut at the distal end. Should adhesions between entering and receiving the gut prevent reduction they may usually be broken down by the passing of a blunt instrument between the two portions.

LARYNGOLOGY.

BY WILLIS SIDNEY ANDERSON, M. D., DETROIT, MICHIGAN.

ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE Detroit College of MEDICINE

LOCAL ANESTHESIA IN SURGERY OF THE UPPER AIR PASSAGES.

JAMES A. BODINE (Laryngoscope, April, 1903) calls attention to the possibilities and limitations of cocain. The psychic element and the idiosyncrasies of the patient are mentioned. The statement is made that the actual vasomotor paralysis occurs in proportion to the patient's nervous susceptibility. The author advocates weak solutions hypodermatically, one-quarter of one per cent down to one one-hundredth of one per cent. The injection should be made into the skin or mucous membrane, not beneath it. Fresh solutions should be made for each operation, and are more effective if warmed. Anesthesia resulting from application to the mucous membrane is greatly inferior to infiltration. Cocain acts by paralyzing the sensory nerves. Experience indicates that one grain of cocain is a safe dose for absorption for an adult. Morphin is a reliable antidote for cocain poisoning. Even in profound morphin narcosis, cocain is the safest and quickest antidote. They antidote each other. In connection with surgery of the larynx, Crile states that extensive experimentation justifies the statement that cardiac and respiratory inhibition is impossible if the area be cocainized.

REMARKS ON GENERAL ANESTHESIA IN OPERATIONS INVOLVING THE UPPER AIR PASSAGES.

THOMAS L. BENNETT (Laryngoscope, April, 1903) says that for operations which may be completed in about one-half minute and in which immediate consciousness is not objectionable, nitrous oxide is reasonably satisfactory and very safe. For cases requiring longer anesthesia ether or chloroform should be used.

In closing he calls attention to the method suggested by Crile, which is as follows: The patient being fully anesthetized in the usual manner, rather heavy walled rubber tubes of as large a diameter as possible are passed through the nostrils to a point in the pharynx opposite the top of the larynx, whereupon respiration will take place through the tubes. The mouth is now opened, the tongue pulled well forward and the space

thus formed at the back of the pharynx is packed tightly with gauze, so as to completely shut off communication between the mouth, nose and larynx. The free portions of the tubes are carried up over the forehead, the ends covered with gauze, upon which ether or chloroform may be dropped to continue the narcosis. In the cases wherein I have availed myself of this plan the results have been satisfactory in every particular. The protection of the lower air passages has been absolute, the respiration has been normal, and narcosis perfect. This method should be of service in antrum and frontal sinus cases. It can be carried out with one tube only if one of large caliber can be passed, thus leaving the other nostril free for exploration, which is desirable in some of these cases.

DERMATOLOGY.

BY WILLIAM FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.

LECTURER ON DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.

THE BACILLUS OF LISLE-JULLIEN IN SYPHILIS. DOCTOR L. B. SOVINSKI (Russ. Jour. of Cut. and Ven. Dis., 1902, Volume IV, page 33), in a paper on "The Bacillus of Lisle-Jullien in Syphilis," and again in a paper on the "Bacteriologic Investigation of the Blood of Syphilitic Patients," which was published in the same journal (Volume IV, page 592), expresses the opinion that syphilis is not a bacterial disease. He is led to this opinion by the results of his principal experiments: (1) Examination of the Spanish fly plaster-of the kind used by Lisle and Jullien-to obtain the plasma of syphilitic patients, which resulted in the discovery-on the plaster itself of the same rodlike bacterium found by Lisle and Jullien in the plasma and venous blood of syphilitics; (2) Sovinski examined the blood of untreated syphilitic patients in various stages of the disease and found it sterile. upon all media.

THE SPECIFIC ORGANISM OF SYPHILIS.

DOCTOR G. PINI (Giornale Italiano della malattie veneree e della pelle, Volume XLIII, 1902) gives a report of his "Bacteriologic Rescarches in Secondary Syphilis." His experiments were originally conducted along lines similar to those of Lisle and Jullien but his results were negative. A few distinct bacilli, five to six microns long, and having Brownonian movement, which ceased in about two hours, were found in suspended drops of plasma. It is impossible to discover bacilli in the dried plasma. Cultures of the bacillus in bouillon were employed in attempts to inoculate guinea pigs, rabbits, and dogs without success. Finally similar experiments were made in the human, both by hypodermic administration and attempts to inoculate an abrasion with the microorganism, but with negative results. Doctor Pini concludes that the specific organism of syphilis is yet to be discovered.

THERAPEUTICS.

BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.

LECTURER ON MATERIA MEDICA IN THE DETROIT College of Medicine.

DISEASES OF THE GASTROINTESTINAL TRACT. S. COHN (The Journal of Advanced Therapeutics, May 1, 1903) introduces this subject by calling attention to the great advances that have been made in treating diseases of the intestinal tract during the past twenty-five years. The greatest advance, he says, is associated with the discovery of the value of an examination of the stomach contents—particularly after the test breakfast.

By means of this procedure treatment is now directed in accordance with facts connected with the individual, and not, as formerly, by the exhibition of remedies at random.

As a result treatment by drugs has been almost entirely superseded by dietetic and physical treatment, with the former much the more important.

Doctor Cohn takes up the subject of diet and first considers it in respect to health. He calls attention to the fact that foodstuffs may be divided into the three principal groups, proteids, carbohydrates, and fats, and that the main functions of food are to repair wear and tear of the tissues, and to serve as a source of potential energy which can be converted into heat and work.

"The potential energy is expressed in terms of calories. A calorie is the quantity of heat necessary to raise one kilogram of water one degree Celsius. As it has been found that one kilogram of proteids corresponds to four and one-tenth calories, one kilogram of fats to nine and three-tenths calories, and one kilogram of carbohydrates to four and onetenth calories, we will be able to express all the food taken in this way by the amount of calories."

As to the amount of food necessary for the daily needs of the body, Doctor Cohn says the average from the figures of many experimenters gives for a healthy man of middle weight one hundred and twenty-five grams of proteids, about sixty grams of fats, and about five hundred grams of carbohydrates. These amounts can be expressed in terms of potential energy by multiplying each by its unit of calories. These amounts, as already said, are for a healthy individual. As proteids are derived chiefly from the animal kingdom and carbohydrates from the vegetable kingdom, and as both are needed to sustain the body, it is clear a diet made up of materials from both these kingdoms is the proper

one.

In treating diseases of the stomach and intestines use should be made of principles derived from the processes of digestion carried on in health. In the first place, the intestine must be looked upon as a more important digestive organ than the stomach. The digestive work of the stomach is limited to proteids. Its more important function is to carry food to the intestines. The latter is a point of great value in treating chronic dis

eases of the stomach. "No matter how great the disturbance of the digestive function of the stomach may be, as long as the mechanical power is not impaired, the food will be taken care of."

The question of rest of the stomach is an important one. In acute diseases rest should be advised. But in chronic conditions this measure is decidedly contraindicated. "Too much rest will always favor the progress of atrophy, whereas methodical adaptation to work will always strengthen an organ." The stomach must be trained to do normal work. To gain this point a system must be employed and the work performed by the stomach gradually developed. A scale of foodstuffs is essential. Of physical therapeutics lavage comes first. The best time to wash out the stomach is in the fasting condition. By doing so the tube is not blocked with food, the presence or absence of undigested food is determined, and no food needed for nourishment is taken away. Contraindications for the use of the tube are hemorrhage, ulcers of the stomach, and aneurysm of the aorta.

Electricity can also be used as a remedial measure. This may be applied externally or internally. If in the former manner the electrodes can be placed one on the abdomen and the other on the back. All currents can be used.

If the internal method is employed treatment should be applied while fasting. The electrode is swallowed by the patient who drinks water afterward so as to protect the walls of the stomach and at the same time to distribute the current. Galvanic or faradic currents can be used.

EDITORIAL COMMENT.

THE ROLE OF RADIUM IN MEDICINE.

THERAPEUTIC experience with radium has demonstrated the practicability of employing the several forms of this product in the treatment of certain diseases. The metal was discovered by Bemont and Curie, who isolated it from pitchblende in 1898. Pitchblende, which is the chief source of radium, contains about one ten-thousandth per cent of the metal, and estimate places the quantity thus far extracted at one pound, which represents the expenditure of an immense amount of money, considering that if the supply of the precious substance were equal to the demand the enormous price of about £15,000 per ounce could be procured therefor.

Medicine is probably one of the most important domains at present open to radium. The special field in which this agency has already proved markedly serviceable is that of malignant disease, although it has been employed to some extent in other conditions and is suggested as a treatment for consumption. It may be utilized in the form of

rays, heat and gas. Four kinds of rays have been observed to emanate from the product: those resembling the x-rays; others corresponding to the cathode rays; a third variety represented by infinitesimally small atoms of matter; and still another kind, some of which are invisible, although invested with penetrative power sufficient to produce burns. It has been demonstrated by Curie and Laborde that heat is continuously emitted from radium and that one gramme of the substance is capable of supplying one hundred calories per hour. Infinitesimal quantities of gas are represented in the spontaneous and continuous radioactive emanations produced by the metal, but the supply may be greatly increased by consigning the element to water.

The apparatus for employing radium rays is not so cumbrous as that required for an x-ray outfit, and its practical application is therefore rendered possible in instances which do not admit of recourse to the latter. However, that the rays of radium are destined to supplant. the x-rays, Finsen light, or high-frequency and potential currents in the treatment of lupus, superficial carcinoma, and rodent ulcer is still an unsettled question.

Danlos reported a number of cases of lupus successfully treated with radium rays some time ago, and the excellent results obtained by this experimenter have prompted more recent election of the new remedial measure. Macintyre has called attention to several cases of lupus and one of rodent ulcer wherein treatment with radium rays effected apparent cure. Davidson and Gussenbauer have employed the product in the treatment of cancer with remarkable success. Soddy has suggested utilizing the gas generated from radium in the treatment of consumption. The method contemplates accumulating the gas in a reservoir and subjecting the patient to inhalations at stated intervals, the general germicidal properties of radium being depended upon to destroy the tubercle bacilli.

A property that radium rays bears in common with Roentgen rays is that of producing burns. Macintyre has reported the burn of an arm by allowing the rays from a few milligrams of radium to pass through a thin layer of air and another of mica for one hour. The reaction did not occur immediately but the result has not disappeared after more. than two months, and the present condition of the wound indicates that some time yet will be required to effect healing. Other experimenters have encountered similar mishaps, one reporting a burn caused by radium enclosed in a bottle which was carried in the vest pocket, the heat penetrating the clothing and severely burning the flesh.

The particular role that radium is destined to play in the treatment. of disease is impossible to prognosticate, but that the metal possesses great power for good or evil is evidenced by the calculations of Curie, and Rutherford, who declare that there is sufficient energy stored in one grain to raise five hundred tons a mile high.