some symptoms in these cases that are common to all, and others that were manifest in but one or more of the cases. We will speak of the former first, as they are by all odds the most important.

First, we have coma, which occurred sooner or later in every case and was recovered from with but a single exception. Secondly, convulsions and muscular spasms, which symptom was more or less marked in each case. Cases Nos. 1, 3, 4, 5 had no general convulsion, yet the spinal and some of the other muscles were in a state of rigid contraction. The other two had most violent convulsions, so we are forced to conclude that one of the prominent symptoms of this affection is spasms, more or less marked, of all the voluntary and involuntary muscles. Another symptom, and one directly connected with the last mentioned, is fixation of the eyeball, produced by spasms af the ocular muscles. This, I am sure, occurred in every one of my cases. This set of muscles and those of the spine are the ones most likely to be affected in this disease. Then we have fever as a symptom. This occurred in all my cases, and in some it was very mild, in others very high and difficult to control. The most peculiar thing about the fever was its typical course and great variation in different cases. Next we have the peculiar odor of the breath. This occurred in at least four of my cases, and perhaps in all. It always had exactly the same character and is not to be described, but when once smelled will hardly be forgotten. It occurs to me that I have smelled the same odor in some other disease, but it was never so clearly defined. I believe this symptom is of very great importance, and will finally be regarded as important in making a diagnosis in this disease.

Of the other symptoms of less importance, but necessary to complete the clinical picture of this affection, we may mention facial expression. This may be, in the commencement of the disease, an anxious or frightened look, which changes. as the disease progresses and convulsions and coma intervene, to a gastly distortion of the countenance. Another very frequent symptom is vomiting, and when coupled with those already

named is of considerable importance. Next we have constipation, which occurs in nearly all cases unless purgatives have been administered at the outset. This occurred in nearly all of my cases. Derangement of the function of the bladder -retention or incontinance of urineoccurs in a majority of cases. A coated tongue. sallow skin and other symptoms of arrest of the secretory and excretory functions are usually present.

In discussing the treatment of this malady it will be unnecessary to state that there is no specific. Each case is a law unto itself, and must be individualized and treated according to the indications. Morphine and a hypodermic syringe are indispensible and should be used with a free hand, especially in cases like No. 5, where there is great restlessness and delirium and hope is passed. Bromides and chloral may be used when the patient can swallow, or they may be introduced into the bowel. Alteratives, of which calomel is a representative, are indicated in some cases. Intestinal antiseptics might be useful, and quinine should be given when there are malarial complications. Antipyretics are necessary in some cases, and I prefer cold water and ice, properly applied. I think blisters. are unnecessary, dangerous and inhuman, and of no especial benefit. Counter irritation to the spine and epsgastrium might be beneficial.

If called to treat another case my main dependence would be upon morphine and ergot hypodermically, counter irritation to spine, cold applications, in case of high temperature; bromides and chloral by the mouth or rectum, altertives when indicated, and all the nourishing food I could get patient to take.

I hope that what I have said will be helpful. Joppa, Ill.

TREATMENT OF TETANUS.

BY WILLARD H. MORSE, M. D.

HE New York Sun, the least sensa

tional and the most reliable of the metropolitan daily newspapers, has, during the past seven weeks, laid much stress on the fact that since the Fourth of

July there has been something very much like an epidemic of tetanus in New York and its vicinity, traceable to injuries due to the patriotic toy cannon or toy pistol. The number of these cases to date reaches 143, of which nearly all have been fatal.

I confess to a large and perennial interest in the subject of epidemics, an interest derived as a student of the late Dr. S. O. Vanderpool, who, as health officer of the port of New York, made quarantine measures against epidemics of yellow fever and typhus a chapter in the history of modern medicine. I was, therefore, that with the Sun widely quoted, I became early interested and felt the interest so completely that I sought to make confirmation of the matter. This was not difficult, and every case that was inquired into was substantiated by the attending surgeons.

This I do not need to dwell upon, and especially as I find that already the medical journals are making scholarly and exhaustive note of the facts in extenso. Three points of fact have come out, however, which are worth noting.

The first is that several of the surgical leaders have expressed a belief and a fear that other similar epidemics of tetanus are liable to occur, and to grow in severity and serious character, on efficient provocation.

Second, that in the seven weeks noted there has been notable occurrence of tetanoid symptoms in both private and hospital surgical practice.

Third, that not only have there been (July, August) note made of special severity of solitary cases of lock jaw occurring here and there, but that as well it has, within recent years, come to be regarded as more formidable and important than ever before.

Due regard for these three points, added to a due appreciation of the Snn's enterprise and the confirmation by the attending surgeons, led, quite naturally, to my indulging in a line of special research. I will confess that this research was actually entered upon and with an idea that it was high time that the offending bacillus was given just prominence and a reliable remedy brought forward. I knew -as I think we all know more or less ex

perimentally-that

the treatment of tetanus proves unsuccessful in a large proportion of cases. If we take, as we please, the relative value of the principal measures, we soon discover that we have nothing to rely on in the use of strychnine, chloral, bromides, gelsemium, physostigma, quinine, tobacco, belladonna, aconite and cannabis indica, which are more or less exploted as "the ten remedies," named in every text-book, distrusted on every hand and actually ridiculed by the authorities.

The opportunity seemed to promise remarkably well and, to go on with my "open confession," I entered upon the cultivation of the offending bacillus with considerable zest, but, as suddenly as you please, I abandoned the research. And why? Simply and solely because the specific for tetanus is already at hand and under command, and is Daniel's Concentrated Tincture of Passiflora Incarnata.

It is a specific, and it is the certain specific that is demanded. With it at our command it is unnecessary to bother with the "ten remedies" or to study to determine still another.

Now, do not expect me to write a "testimonial," or to quote from the many already written or writable. Indeed, I need but to use pathological facts, with bacteriological substantiation, viz: First, tetanus is attributable to a well-recognized bacillus; second, that bacillus causes degeneration of rerve cells, and especially cells of the spinal cord. And, without dissipation of reasoning, we have but to state that Passiflora Incarnata (a) repairs nerve-cell degeneration, (b) prevents nervecell degeneration, (c) precludes the condition of spasm due to such degeneration, (d) destroys the bacilli, (e) aids to inhibit its ravages, (f) aids in the removal of the products of its ravages.

So, in conclusion, I will only say that Daniel's Concentrated Tincture will promptly interrupt the recurrence of the paroxysms of tetanus in the vast majority of cases (either idiopathic or traumatic), and, in consequence, correct the embarassment of respiration and do away with the muscular rigidity and the abnormal nerve irritability.

Westfield, N. J.

The dose can be graduated according to the age of the patient. This mixture has been found useful in wooping-cough, bronchial catarrh, and the pneumonia following measles.-Med. Surg. Bulletin.

NIGHT SWEATS.-The treatment of night sweats in phthisis is very discouraging. The first thing to be thought of is atropIne, either by the mouth or hypodermically. If it causes dry mouth it will have to be substituted by other things, and here the oxide of zinc with the extract of belladonna may be used. Aromatic sulphuric acid, or even ergot, may be tried. Agaricin is also a very good remedy which does not always fail in time of need. Frequently a combination of these remedies, and by alternating them, good results may be accomplished.

BORIC ACID.-An old subscriber of the SUMMARY writes: "Since I see you recommend boric acid in certain troubles, have you ever noted any unpleasant effects from its use on the kidneys? I referred to Dr. Finley Ellingwood's new work on therapeutics to find if such effect was therein noted and found none. I I have used it for several years in pretty full doses, three to five grains three or more times a day, and have yet to see any untoward effect.

Dr. P. F. Barbour, in Pediatrics, says: In colic the use of warm enemata will usually remove the gas. The enema may be of soap suds and water, or may contain a few drops of turpentine, or half a teaspoonful of glycerin. Hot applications should be made to the abdomen, and the feet and hands be warmed at the fire or by a hot-water bag. Small amounts of hot whisky and water with a drop of essence of peppermint and a little sodium bicarbonate by the mouth will give relief. Dr. Larrabee used to recommend one of the following combinations: B. Spt. ammon. aromat..... Sodium bicarbonatis. Syr. rhei aromatic.... Aqua carui..

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cause of colic is the presence of too much proteid in milk, as is evidenced by the stools containing undigested casein or having the cheesy odor. Therefore, in habitual colic proteids should be diminished.

Summer Diarrhea in Children.

Abroad, of late years a good deal has been said of the value of Tannigen in controlling the stools. Dr. Blackader of Montreal, in the March number of Progressive Med., in an excellent review of the recent literature on summer diarrheas, quotes no less an authority than Escherich, the well known professor of children's diseases at the University of Graz, in Austria, who speaks very favorably of Tannigen, and claims for it a distinct disinfectant and bactericidal effect. Kraus and Biedert have also written in its praise, especially for chronic intestinal catarrh.

It is a tasteless power, therefore easily administered and is given in doses of two to five grains four times a day. It is especially useful in cases of follicular enteritis, where local measures are of little avail. Its administration is continued

in lessened doses after the acute symptoms have subsided, and it is said to hasten convalescence, which is often apt to be tedious.-Med. News.

Some Early Signs of Consumption.

Dr. John W. Moore, in British Med. Jour., writes as follows:

The so-called "tuberculous red line" along the gums may mean much or little. Its absence encourages; its presence, on the other hand, may be due to other causes than tuberculosis. I have seen it in the neighborhood of carious teeth, or where "tartar" incrusts the crown of a tooth. Its diagnostic value is thus qualified.

Clubbed finger-tips are common to phthisis with many other wasting diseases. or conditions which interfere with nutrition, such as valvular or other heart affections.

Morning sickness and want of appetite for breakfast are common forerunners of consumption. To the same category be

longs distaste for fatty foods and capricious appetite. Myotatic irritability of the pectoral muscles and of the platysma myoides is a valuable sign. So also is tenderness on pressure over an apex of a lung which is the seat of commencing tuberculous deposition.

Interrupted inspiration (jerking, or cogwheel inspiration) is a sign of doubtful value. It is so often present in nervous youths or in nervous and chlorotic girls that its diagnostic importance is largely discounted.

Among the earliest physical signs of phthisis we should include lessened movement of the chest wall (expansion), an abnormally clear percussion note, deficient vesicular breathing, relative or absolute intensity of the heart sounds over the affected apex, and relative or absolute intensity of the pulmonary second sound.

Treatment of Influenza.

Dr. L. D. Sheets, of Brooklyn, N. Y., in Med. Record, says: "At the beginning of the last visitation of la grippe, I devised a prescription which has met with such uniform and complete success that I think I ought to make it public. In all my cases, so far as I am aware, recovery has been complete, without any sequelæ. I have prescribed this remedy and nothing else (except a dose of compound cathartic pills, in suitable cases, at the commencement of treatment) in all forms of the disease, neurotic, catarrhal, gastric, or combinations of these varieties. Some may smile at the simple, oldfashioned remedies, but I have never seen anything act so effectually, cito, tuto et jucunde.

"I will mention one case. A gentleman called on me one evening for treatment. I prescribed a dose of compound cathartic pills with the mixture. Next day, in passing my office, he said he could not go by without informing me of the success of my remedies. He said: 'I took the pills and in half an hour a dose of the mixture, and repeated the dose before retiring. After the second dose I felt better. During the night I took another dose, and in the morning I arose perfectly well.'

"M. Sig.-Two drachms every three hours."

Ulceration of Cervix and Polypus of Uterus.

Mrs. L, Stamford, Conn., Swede, age 31; admitted April 4, 1899; diagnosis, uterine polypus and cervical ulceration. Patient was put to bed and prepared for operation. April 14th, polypus was snared off, ulcer curetted and dressed with Bovinine pure. The dressings were renewed every three hours. April 29th, the point from which the polypus had been removed was entirely healed, and the ulcer reduced one-half in size. Dressings were now ordered three times a day. May 8th, ulcer entirely healed, but patient remained in hospital for Bovinine treatment on account of extreme anemia. to this time a teaspoonful of Bovinine in grape juice has been given every two hours; the quantity was now increased to a wineglassful in lime water and milk every three hours. May 26th, patient was discharged cured.-From Sound View Hospital Records.

Diphtheria.

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"It will be seen that by alternating the topical application with the internal treatment, one or the other will be brought in contact with the diphtheritic membrane every two hours. I give the bromine in doses of 1-8 to 1-2 a drop, according to the age of the patient.

"The efficiency of this bromine treatment will be fully appreciated by every physician trying it, from 40 to 48 hours after the first topical application, and if no improvement is apparent within that time it will be as well to lay it aside and adopt some other course."

Diet of Prospective Mothers.

This subject of diet is very often brought to the nurse's attention. Without doubt, some of the discomforts of pregnancy and child-bearing are greatly aggravated by improper diet. The fol

"Bromine is readily soluble by the addition of 10 per cent. of alcohol, but if the solution is long kept it loses its color and becomes hydrobromic acid; it should, therefore, be prepared in small quantities as required for use.

"My method is to commence with a cathartic, as calomel and rhubarb. Two hours later I begin to apply bromine solution topically (using the same strength for all ages and conditions), with a camel's hair brush, probang or a swab, to every part of the diseased membrane and beyond it.

journal, may be of use to some one:

An excess of water and albuminous food should be avoided-water, on account of its tendency to produce hydroamnion, and albumen, because it favors excessive growth of the child.

The following is the diet prescribed, which has been tried in a number of

cases:

Meat once a day, green vegetables and potatoes; avoid eggs, peas and beans, as they are too rich in albumen. The advantages claimed for this regime are:

1. The patients are active until the eve of their accouchement; they do not suf