daily. Dyspnea was mainfestly relieved, the bronchial breathing diminished and later ceased, the rales were rendered coarser, and expectoration rapidly increased in amount. The temperature, where high, showed a tendency to fall. Recovery took place in seven instances. The emetine failed to bring on nausea and vomiting or to interfere with the renal function.

Though the number of cases treated was small, Renon is disposed to consider emetine of value in all instances of serious lung inflammation, and especially recommends it in conjunction with camphorated-oil injections, digitalis, and ammonium acetate in grave cases of bronchopnuemonia.Am. Jour. of Clinical Medicine.

A DIPHTHERIA CARRIER:-During the latter part of November, 1914, a small epidemic of diphtheria broke out in Gouverneur. The health officer, Dr. Sayer, deemed it wise to take cultures from the throats of school children of the grade exposed. The culture from one boy, aged fourteen, was positive, although he showed no symptoms of diphtheria. This boy was isolated for four weeks and was then allowed to associate with other children in his family, none of whom at any time showed any symptoms of the disease. Repeated cultures taken and examined at the State Laboratory showed that a virulent strain of the diphtheria bacillus was present. Guinea pigs were inoculated with these cultures and promptly died with characteristic symptoms. Examination of this boy's throat showed that the left tonsil was slightly enlarged, the right apparently normal. throat specialist was consulted as to the advisability of removal of the tonsils. He advised against the operation as he feared it would not be safe in the presence of diphtheria germs.

A

The boy was seen by the Sanitary Supervisor February 22, 1915. At that time his throat was slightly irritated from the constant use of alkaline sprays and gargles. The

State Department of Health recommended the removal of the tonsils, which was done. The boy made an uneventful recovery from the operation and cultures taken a few days later were negative.

There are two lessons to be learned from this case:

1. The apparent immunity which the boy had against diphtheria and the safety of tonsillectomy in a diphtheria immune.

2. Prompt disappearance of diphtheria carrier after tonsillectomy.-B. R. Wakeman, M. D., in N. Y. Health News.

PLACENTA PREVIA:-Dr. John F. Winn, Richmond, Va., in The Virginia Medical Semi-Monthly, February 12, 1915, lays emphasis upon the point that Braxton Hick's version is demanded both before viability and after it when, in the latter case, the use of the elastic rubber bag followed by podalic version is not available.

During labor, when there is great loss of blood, Braxton Hicks' version offers the best results for the mother; but it should always be followed by slow extraction.

Milder varieties of placenta previa should not be overtreated; merely puncturing the membranes may control the hemorrhage. Cervical and vaginal tampons, if used at all, should be employed under rigid asepsis. They are rarely needed.

Cæsarean section has a very restricted place. It should be chosen under the following conditions: with the approach of full term; with the placenta covering, a great part or the whole of the os; when hemorrhage is profuse, but not enough to make the mother a bad surgical risk; with the child probably weakened, yet offering reasonable prospects of being saved; when the cervix is in a condition suggestive of prolonged and difficult dilatation; where there is a negative history of vaginal contamination; and, the assurance of hospital technic.

REMEDY FOR SCIATICA:-I have read with interest and pleasure the reports of various methods of treating sciatica, as advocated by readers of Clinical Medicine. I want to suggest a method of treatment given me by my father, who graduated from the University of Michigan in 1854. He used this remedy for years, and with invariable success. Following his advice, I have used it myself ever since I began practice, and have found it effective, not only in sciatica, but also in other forms of neuritis. So far as I can remember, this remedy has not failed me once in twenty-five years; also, it acts just as nicely in the chronic type of sciatica as it does in the acute form, although a llttle more persistence is required when the case is chronic. How it cures, and why it cures, I cannot explain.

This remedy is ammonium chloride. I give it in 10- to 20-grain doses, three or four times a day, following it in every instance with at least half a glass of water.-O. F. Burroughs, of Plainwell, Mich., in Am. Jour. of Clinical Medcine.

EINHORN'S OPERATION FOR RECTAL PROLAPSE:-R. Tolken in Deutsche Med. Wochenschrift, March 15, 1915, describes the simple technique of the operation. During anesthesia the prolapse is reduced and the gut pushed up. While the left index finger is inserted in the rectum a needle is pushed through the skin on one side of the sacrum into the lumen of the rectum and brought out at anus. The large needle in a handle is then pushed through the skin on the opposite side, and after being brought out at the anus is threaded with the protruding suture and withdrawn. rectum is now held up by a suture which is tied on the skin over the sacrum.

The

A bandage is scarcely necessary. The bowels are kept confined after this operation, and food is also withheld. The operation is applicable to children on whom good results are obtained.-Cin. Lancet-Clinic.

THE SURGICAL TREATMENT OF VICEROPTOSIS.* BY W. A. BRYAN, M.D., F.A.C.S., NASHVILLE, TENN.

So

The neurasthenic has come justly or unjustly, to be the surgeon's bugaboo, even when presenting with a definitely recognized surgical lesion and gives the surgeon a case of buck-ague when seeking surgical relief from neurasthenic symptoms per se. The reason for this is manifest to every experienced surgeon, for assuredly that same patient will turn up again shortly with another appeal for surgical relief, and again and again ad infinitum, ad nauseam. the medical profession has concluded that neurasthenia, that neurasthenics, cannot be relieved by surgery; that these cases should not be subjected to surgery except in the direst extremity, and that when a surgeon accidently relieves a neurasthenic it is due to the fact that either it is not neurasthenia at all, or, if so, that the relief is due to some hypnotic power the surgeon practices and not to the exercise of his art upon the lesion present.

*Read at regular meeting of the Nashville Academy of Medicine.

The profession is no exception to the very human rule that men are prone to obsession. We had not so long ago an ovarian obsession. We are just now recovering from a Wasserman and a Salvarsan obsession; and are at present in the midst of a thyroid and tonsil obsession. So we have been seized with an obsession, a strange unusual obsession of a negative sort relative to neurasthenia.

But dawn comes sooner or later and we return at last to our senses. We have gone finally to our logic and are asking ourselves whether there is any such thing as neurasthenia, as we formerly understood the word, and whether it is an idiopathic nothing or a group of symptoms growing out of lesions which, if we would seek, we might find, and, if we would attempt, we might relieve.

I am not recommending surgery as a cure-all for neurasthenia, but the situation looks at present as if we would be compelled to admit that we have restricted our efforts too narrowly here and that we might safely broaden our field of useful work, whereas in the case of our other obsessions already referred to we have been and are being compelled to narrow the field of work. If we have been over-enthusiastic on one side we are beginning to learn we have been too pessimistic on the other.

I have so far been using the word neurasthenic, not because it is to be considered as synonymous with ptosis, but because the neurasthenic symptoms so frequently associated with ptosis have been the chief deterrent factor from attempting surgical relief of ptosed conditions. It is not the purpose, however, to convey the impression that all neurasthenics have ptosis, although the percentage who have is enormous, or that all cases who have ptosis develop neurasthenia, although a large proportion of them do develop it: nor do I wish to suggest that neurasthenia is the only symptom complex that ptosed cases manifest. It is no argument to say that because all cases of ptosis do not show neurasthenia, the latter is not dependent upon the former,