produced by dilutions of potassium permanganate, 1 to 2,500, or 1 to 5, 000, but failed with higher dilutions. Experiments made on the external skin showed the substance entirely ineffective to produce desensitization, probably on the impossibility of its penetrating to the nerve endings. Such a method of producing satisfactory anesthesia of the mucious membrane of the urethra and bladder, without possibility of toxic results and simple in its application, should, he thinks, be welcome by those who are obliged to perform painful manipulations on these organs. He has seen no mention of the method in medical literature or heard of its use from his colleagues, many of them genito-urinary specialists.

Occlusion of the Esophagus in Infancy.

Dr. Thomas Morgan Rotch reported three cases of occlusion of the esophagus in early life not due to trauma. Two were, in his opinion, congenital with organic constriction and the third was spasmodic. In this case the spasm was twice brought on by foreign bodies, once a quarter and the second time a piece of bristle.

The first, age 25 months, died, as the stricture was too small to dilate. The other two made good recoveries after passing the esophagoscope and dilating the stricture in one, and overcoming the spasm and removing the foreign bodies in the other. Dr. Rotch suggests that the spasmodic cases were possibly due to a congenital condition of a brain center represented by a lack of inhibition.

Infectious Thrombosis of the Orbital Veins

Infectious thrombosis of the orbital veins is recognized by all ocultists as a most dangerous disease. Death from thrombosis of the brain sinuses is a common outcome. In view of this, Hertel (abst., in Zeitsch. f. Augenheilk, January 1913, 78) has recently reported the case of a patient with severe orbital phlegmon following a furuncle of the nose. The orbit was freely incised, but no pus was found. Three days later plugs of pus, evidently infected thrombi, could be seen exuding from the sides of the orbital cut and as there was high fever and slight mental confusion, H. exiscerated the entire contents of the orbit. This was followed by a decided improvement of the symptoms, but this was only temporary and death from thrombosis of the

cavernous sinus and meningitis occurred four days later. The veins in the orbital tissue were found to be transformed into lines of pus. The post mortem showed that the infection (pure culture of the yellow pus coccus) had spread to the cavernous sinuses and the meningeal veins. The reviewer has seen two of these desperate cases; one following the extraction of a tooth and leading to blindness of one eye, the other to death from brain abscess. There can be no doubt that Hertel's suggestion, if carried out early enough, would have saved many lives. The trouble is that neither surgeon nor patient can be brought to consider so radical a course until it is too late. One lesson which these cases teach is that every furuncle in the nose or neighborhood of the eye should receive the most respectful consideration.

Diphtheria.

In the last few weeks there has been a surprisingly large number of articles on diphtheria, most of them dealing with treatment both during the attack and afterwards, when a patient has proven by repeated throat examinations to be a carrier.

Behring has shown that antitoxin is not as efficacious as a prophylactic measure as we have supposed as the immunity is of such short duration, in some cases hardly more than a week. He has used a mixture of antitoxin and toxin and has been able to produce a much more satisfactory immunity.

From a recent epidemic in Hamburg one of the most important lessons learned was to give one large dose of antitoxin early and if necessary to repeat to give it intravenously. This corresponds with the findings of Nicoll and Park, working in the Willard Parker hospital in New York. On giving a dose of antitoxin either subcutaneously or intramuscularly, they found that it reached the blood stream slowly, increasing steadily to the third, fourth or fifth day, then slowly decreasing. If a second dose is given 8 or 12 hours after the first (as has been our custom) the improvement which follows is due to the first dose and not to the second. Given intravenously there is an enormous quantity of antitoxin in the blood at once which immediately decreases, but sufficient remains at the end of a week or more. They recommend the giving of 10,000 in all cases, but in the desperate cases to give it intravenously at once.

The Iowa State Board of Health, with several others, requires that two negative reports from throat swabs must be

returned before a case can be released from quarantine. In this way they have found several cases which have remained positive for several weeks in spite of antitoxin and all local antiseptic treatment, but have cleared up in a few days with a staphylococcus spray. In no case has harm come to the patient from the use of this spray and all users are reporting almost uniformly good results.

Department of Agriculture Advises That Milk Be Pasteurized at Low Temperatures.

Office of Information, U. S. Dept. of Agriculture.

In order to determine the best way of pasteurizing milk so as to kill the disease germs and yet not give the milk a cooked flavor or lessen its nutritive value, the Department of Agriculture, through its dairy division, has been conducting a series of experiments, treating milk at different temperatures and for different lengths of time. According to the report on these experiments in Bulletin 166 of the Bureau of Animal Industry, when milk is pasteurized at 145 degree F. for thirty minutes the chemical changes are so slight that it is unlikely that the protein (muscle building element) or the phosphates of lime and magnesia are rendered less digestible than they are in raw milk.

Moreover, from a bacteriological standpoint, pasteurizing at low temperatures is found to be more satisfactory than pas teurizing at high temperatures. According to Bulletins 126 and 161, where low temperatures are used the majority of bacteria that survive are lactic acid organisms which play an important part in the normal souring of milk. When milk is efficiently pasteurized at high temperatures, the bacteria which survive are largely of the putrefactive kinds, and milk so treated if kept for any length of time has a tendency to rot instead of sour. From the standpoint of economy, the technologist of the dairy division finds that pasteurizing at low temperatures calls for less heat. It is found that it takes about 232 per cent less heat to raise milk to the temperature of 145 degrees F. than to a temperature of 165 degrees F. A similar gain is a saving of the ice needed, because it will require 232 per cent more refrigeration to cool milk to the shipping point when it is pasteurized at the higher temperature. The department, therefore, recommends that "When market milk is pasteurized it should be heated to about 145 degrees F. and held at that temperature for 30 minutes."

The Rationale of Roentgen-and-Radium-Therapy By W. Deane Butcher, M. R. C. S. From the "Archives of the Roentgen Ray.". London, June, 1913. No. 155.

"The first hypothesis, that of radio-vaccination, has gradually grown up to account for a number of phenomena otherwise inexplicable. The first of these was the fact that a number of skin diseases of totally different origin and nature seemed to improve under exceedingly small doses of X-Ray. Psoriasis, lupus, eczema, were all apparently benefited. An acne which had resisted treatment for years would disappear under the rays just as if treated by injections of vaccines. What more natural than to suppose that the patient himself had furnished the necessary vaccine, under stimulus of the Roentgen irradiation. The hypothesis received still further confirmation when cases of lupus were reported in which irradiation in one region—for instance, the leg-was followed by improvement in another region, such as the face. The same thing was observed in other diseases. Acne of the face was apparently cured by X-Rays applied to the similar lesions on the back or shoulders. Highfrequency effluves applied to a crop of boils would apparently render the patient immune to further inoculation; lupus erythematosus of one region was influenced by X-Ray treatment of another part, and even widespread carcinoma of the breast was improved by irradiation of a portion only of the affected

area.

Further corroboration was afforded by the observation that in certain cases of lupus and even of cancer, irradiation of the affected glands was followed by an improvement of the lesion itself.

Even the ordinary process of Roentgen epilation appears to be a biological rather than a merely destructive phenomenon. At all events, it is at least in part a vital reaction, a phagocytosis, since it has been found that the process of epilation is more rapid in the diseased areas, and is delayed by the application of disinfectants and the consequent depression of the processes of vital reaction and repair.

But the strongest evidence of the vaccinal action of X-Ray treatment is derived from a consideration of the various modes of attack on rodent ulcer. In the whole purview of medicine there is nothing more impressive, or more certain, than the cure of a small rodent ulcer by electrical methods. But the cure may be affected in many ways-by Roentgen rays, by radium,

by ultra-violet light, by high-frequency effuves, or by zinc ions. What is the common factor in all these cures? Cures, I say, for the process is not one of destruction, but of repair. It is not merely a bactericidal action, nor is it merely a selective action on the tissues. It is a biological recoil, the resentment of the cells of the organism to the insult of the ethereal vibration. The habitual defense of the living cells to such an insult is exactly the same as that to a bacterial invasion, viz.: the production of antitoxins and other antibodies. It is, in fact, a true vaccination.

One of the greatest arguments in favor of the vaccinal hypothesis is the occurrence of a latent period after a Roentgen or radium irradiation, a latency which precedes the reaction. This ominous pause is, to my mind, most eloquent. It proves that all the resources of the organism are being called upon to resent the insult. The reaction is not merely a physical or chemical one, but a true vital or biological reaction, in which the energy of the recoil may overstep the energy of attack. Let me explain. If I strike an inanimate object-the table, for example -it returns the blow immediately, and strikes my knuckles with the exact force I expended. But if I strike my neighbor, he would probably return the blow with interest, and interest which would be rather increased than lessened by a brief period of latency. Similarly, the pause after Roentgen irradiation is proportional to the degree of the insult, and is a participation of the whole organism to resist the electrical or ethereal invasion.' W. H. MICK, M. D. (Omaha).

Pituitary Extract in Uterine Inertia.

By J. Clifton Edgar, M. D., in the American Journal of Obstetrics and Diseases of Women and Children. Conclusions.

I.

Ampules or vaporales of the drug should alone be employed, as in our experience, constant results failed when the pituitary extract in bulk solution was used.

II.

There are three reliable prprietary preparations of the drug now on the market; all of these were used at different periods in

our cases.

III.

For decided action, 0.4 gram of the drug is usually called for, although in ordinary cases, with little obstruction, half that dose we found sufficient.