producing an acute septic arthritis of some joint. The local or joint symptoms present the cardinal characteristics of a local inflammation.

From a pathological standpoint, the affection presents a local leucocytosis, followed by hemorrhage and destruction of cartilage; and if the patient survive long enough, by complete destruction of cartilage, followed by true bony union.

In arriving at a diagnosis it is necessary to eliminate the existence of simple synovitis, and aneurysm; and to differentiate from serous synovitis, chronic synovitis and tuberculosis. But before incising a suspected septic arthritis of a joint, the writer believes it imperative to employ a hollow needle or hypodermic syringe to determine the character of the contained fluid.

Chronic synovitis may follow the acute form or be chronic from the beginning. Many cases called chronic synovitis are, in truth, tubercular disease. Swelling may vary in amount at different times; pain is usually absent.

As in all doubtful bone and joint affections, no diagnosis is at the present day complete without resort to the Roentgen rays.

The treatment of acute septic arthritis consists in the prompt and thorough drainage and counterdrainage of the infected area. In the knee-joint incision should be made below the patella, on both sides, from 1 to 2 inches, and a drainage tube should be inserted. In cases of the hip-joint, an incision should be made below the anterior superior spinous process, in a line passing downward, for 2 or 3 inches. Counter-drainage should be made behind the trochanter, avoiding a too posterior incision, for fear of injury to the sciatic nerve. The joint should be washed with a weak solution of bichloride of mercury, 1:4000, or formalin solution may be employed, in strength of 12 of 1 per cent., subsequently irrigating with the same solution, or with a solution of boric acid. The drainage tube should be removed as soon as possible. of the part has some value, but this is not essential. A few years past a method of free incision was advanced by Murphy and by many others, in which the entire knee-joint was laid open. I have tried this method, but I do not think that it is either necessary or desirable to expose a joint so freely; neither was the treatment satisfactory, and convalescence was greatly prolonged.

Retro-peritoneal Hernia.

Fixation

C. H. Fagge, London, in British Journal of Surgery-Two cases are reported. The bowel was contained in a peritoneal fossa and had not been forced into connective tissues through a rent in the broad ligament. In the first case the pouch was below the ovarian ligament. In the second, it was above the ovary and below the tube. The first occurred after straining at stool. The second occurred at 2 A. M.

Operation with recovery was the procedure and its result in both cases. The collapsed coils were traced to a small hole in the peritoneum where they were caught and held tensely. The margin of this opening was divided with scissors and the distended loops were withdrawn. The opening was then closed with a continuous catgut suture, while the coils that had been strangulated were kept covered with hot cloths.

Medicine vs. Surgery in Chronic Bowel States.

Mabel D. Ordway, Boston, in Boston M. and S. Jour., deplores such frequent removal of the cecum and portions of the colon in the absence of neoplasm, a surgical vogue she blames upon the vicious circle existing between the nervous and digestive systems, especially in neurasthenic and psychasthenic states. Add to this intestinal intoxication, and the symptoms may delude one into rushing to surgical intervention.

A careful case-history is given emphasizing the points made; but enforced rest, rational feeding, and some medication made operation unnecessary. The Doctor contends that patient use of conservative proven methods will avoid much surgery.

Painful Abdominal Scars.

Maj. E. P. Quain and Capt. Carl Eggers, M. R. C., U. S. A.

In The Military Surgeon painful abdominal scars are divided into four classes: 1, simple adhesion of omentum or gut to peritoneum under and surrounding the scar; 2, small submuscular hernia of omentum through peritoneum; 3, thin stretched scars with hernia-like bulging of the abdominal wall numerous with adhesions; 4, retention of appendix with adhesions following drainage of abscess. To prove that nerve fibres are pinched in scar, try local anesthesia in the neighborhood of painful area. In positive cases all pain will cease and progressing to excision of scar will cure.

Seven case histories are given. Operation with the necessary indications in all seven.

The Treatment of Pulmonary Edema. Charles Greene Cumston, M.D., Geneva, Switzerland, in The Therapeutic Gazette.-Withdrawing 300 to 400 grammes of blood from the circulation has positive results in relieving this condition. Don't forbear an account of the pallor of the patient, for the condition is asphyxia and not syncope.

Adjuvant medication and other measures are: hypodermics of strychnine in bronchoplegia, wetcupping or counterirritation over the sternocostal area in disturbances of innervation, aspiration in some extreme cases, stoppage of iodides if being given in arteriosclerotic cases, and cæsarean operation in pregnant cases.

Following an attack give theobromine and place the patient on a milk diet.

Helpful Points

Iodine Therapy

In many respects iodine is the most interesting substance used in the practice of medicine. It is one of the very few drugs whose remedial power is unreservedly avowed by all physicians; whose precise mode of action has not yet been determined to the complete satisfaction of those who entertain no doubt regarding its power to favorably modify a variety of morbid processes; whose influence on morbid phenomena is not even simulated by that of any other drug.

Notwithstanding the fact that iodine possesses remedial powers that render it indispensable in the treatment of a variety of affections, its nature is such that its employment is attended with certain ojectionable features. When applied externally in one or another of its elemental forms, such as the ointment or tincture, it stains, irritates and sometimes destroys the structures with which it comes in contact.

Within recent years chemists have vied with one another in an endeavor to present iodine in a form in which it will exert its maximal remedial power without giving rise to the local and constitutional revolts that are provoked when the drug is administered in its elemental state or as an iodide.

The Norwich Pharmacal Company has taken an active part in this rivalry and as a result has presented three products that mark a distinct phase in iodine therapy: Norlodin, a non-staining, non-irritating fluid for external use; Calcoid tablets, which contain 15 per cent. available iodine and break up in the stomach, and Kasodin tablets, an organic combination of iodine and casein, of which the iodine content is absorbed in the intestines and which, because of its not

causing gastric disturbance, is much used in place of potassium iodide as an alterative. Write The Norwich Pharm. Co., N. Y., for literature on iodine therapy.

MANY PHYSICIANS AND HOSPITALS NOW USING A TISSUE GAUZE

Saves Cotton Net; Has Remarkable Absorbency Speed. The technical department of a paper manufactory has developed a new gauze which has decided economical advantages, particularly in surgical work.

This gauze being a tissue, scientifically made from selected wood pulp, is less expensive than cotton net. Through skill in manufacturing, it has an absorbency speed rated in a good many tests at three times that of other porous materials.

"Zorbik," as the new tissue is called, feels soft and fine. It is free from injurious matter and its physical properties are not affected in any way by sterilization. Repeated tests show that it is as soft after sterilization as before and does not disintegrate in the process.

It is easy to see that a suitable tissue gauze which has the remarkable powers of absorbency that have been demonstrated in Zorbik, would prove of considerable value for quick drainings. Physicians and nurses have made some notable uses of Zorbik in dressings of this nature. In a case at the Crozer Hospital, Chester, Pa. which involved abdominal abscess following operation for appendicitis, the new tissue was used very effectively as a dry dressing, although the wound had discharged freely.

The method of using Zorbik in such cases is first to cover the wound with a thin layer of net gauze and then pack Zorbik over the gauze so that it will have (Helpful Points continued one leaf over.)

35 West Thirty-second Street

New York City

Helpful Points

an opportunity to absorb and hold moisture in great quantities if need be.

The economy of such a tissue can also be carried to the maternity ward, where it is used very practically for pads, drains and dressings to replace gauze and

cotton.

In a good many hospitals it has already been found of value for tampons or mops for mopping wounds. Cutting it with scissors serves to seal the edges, making a successful and inexpensive tampon. Nurses report that the tissue also may be used advantageously for diaper pads.

In view of the increased costs of cotton dressings and the greater absorbency of Zorbik, it seems to be growing rapidly in favor and has already been given wide use by physicians and hospitals in various parts of the country. Samples of this new product and descriptive booklet will be sent on request. Address Scott Paper Company, Technical Department C, Chester, Pa. How the H. K. Mulford Company Prepared to Meet the Influenza Epidemic of 1918 Realizing that the epidemic of influenza raging in Europe was likely to invade the United States, the H. K. Mulford Company early prepared to meet the demand for serums and vaccines required for the prevention and treatment of the disease and its complications.

The disease was known to be due to a mixed infection in which the influenza bacillus (Pfeiffer's bacillus), pneumococcus, streptococcus, micrococcus catarrhalis and the staphylococcus were the invading causative micro-organisms.

Early in September the facilities of the Glenolden laboratories offered to the hospitals of Philadelphia to aid in the investigation of the cause of influenza and particularly the pneumonia complications. Material was sent from the Philadelphia Hospital, U. S. Naval Hospital and other institutions for study. Fifteen strains of the influenza bacillus and virulent strains of streptococcic hemolyticus taken from the material sent in from the hospitals were added to the influenza bacterins to insure their greater specificity.

The pneumonias following the attacks were known to be due to the pneumococcus and streptococcus, consequently anti-pneumococcic and anti-streptococcic serums were prepared in large quantities to meet the requirements.

These bacterins, known respectively as Influenza Serobacterin Mixed and Influenza Bacterin Mixed have attained high reputation both as prophylactic and therapeutic agents.

It is too early to supply exhaustive statistics, but enough evidence has been accumulated to fully justify the employment of Influenza Serobacterin or Influenza Bacterin Mixed for the prevention and treatment of influenza. It has been amply demonstrated that patients immunized by the bacterins rarely acquire influenza and those who take the disease are practically insured against complication of the pneumonias which have proved so fatal during the recent epidemic.