X-RAY AS A THERAPEUTIC AGENT.-Dr. William L. Heeve in the Therapeutic Gazette, October, 1892, says:

"In treating with the X-Ray I always protect the normal tissue by a sheet of lead, with an aperture over the surface to be treated, also encasing my tube in a box lined with sheet lead having diaphragm openings of different sizes, thereby protecting the operator from a possible dermatitis. I do not believe there is any gain or safety in using a grounded screen of sheet metal or silver as advised by Tesla.

The most astonishing feature about the X-Ray is that it possesses powerful analgesic properties, immediately relieving pain in cancer and ulceration, even if extensive ulcerations have taken place.

The distance between the tube and the patient should never be less than five inches nor more than twelve inches. The rule as laid down by the writer is as follows:

Sarcoma, six inches; epitheliomas, seven to nine inches; lupus, six to eight inches; ulcerations, tubercular, eight inches; varicose, eight to ten inches; skin diseases (eczema, etc.), eight to twelve inches.

With some patients, especially blondes, reaction occurs with depressing symptoms, as shock and fall of temperature. If such shock should occur, stimulants, as nitro-glycerin or nitrite of amyl, and a course of tonics, are demanded, and further treatment should be postponed until the patient's general condition is attended to.

In closing I wish to emphasize the fact that in treating sarcomata and carcinomata we must use a high vacuum tube, runing the static with the greatest number of revolutions possible."

Department of Obstetrics and Gynecology.

In charge of DR. P. MICHINARD, assisted by DR. C. J. MILLER, New Orleans.

THE DYSMENORRHEA OF GIRLS AND YOUNG WOMEN. -- The Journal of Obstetrics and Gynecology of the British Empire contains an extract of a paper by Bouilly which originally appeared in La Gynécologie.

The type of dysmenorrhea, he states, may be merely transitory, diminishing greatly during the early years of menstrual life; in other cases it persists until pregnancy occurs, which usually is followed by a permanent cure. He considers that in all cases the real lesion is an infantile state of the uterus as revealed by local examination, and he believes also that the ovaries are atrophic or infantile in type. The cause of the production of pain is still obscure; it certainly does not depend upon flexion or any mechanical obstruction to the menstrual flow, although the beneficial results of dilatation, in whatever way it may act, are very marked in the great majority of cases. Bouilly recommends slow dilatation with laminaria tents in preference to the rapid mechanical dilatation of Hegar and others. He strongly advises general hygienic treatment to stimulate ovarian activity. For this purpose he prescribes gymnastic exercise, bicycling, tennis, etc., avoiding prolonged rest and any intellectual exertion. He also administers ovarian gland substance for some time, as he believes that in many of these cases "ovarian sufficiency" is an important factor in maintaining the dysmenorrhea. He has also seen much benefit from the use of static electricity.

Since Bouilly advises the administration of ovarian extract it may be of interest to add here the experience of J. Coplin Stinson with thyroid extract which is reported in The American Journal of Obstetrics (July, 1902). In thyroid he believes we have a remedy of much value. It supplies material to the system which influences metabolism, is carried to the tissues and organs, in the plasma, and has a specific action upon the vasculo-motor nervous mechanism of the uterus and ovaries. As the sensibility to uterus and ovarian pain is readily diminished by thyroid, it is thus a uterine, and ovarian anodyne and seda

Marked systemic effects are produced by medium doses. The nervous and vascular systems are considerably affected, the pulse rate is increased, arterial tension lessened, the cerebrum is somewhat stimulated, loss of weight shows increased tissue waste, and the normal functions of the skin, uterus, and, presumably, other organs of the body are re-established. He has been able to give relief to over 80 per cent. of his cases. Thyroidin is given in one-grain doses three times a day for two days before the flow, the dose being doubled when menstruation occurs. Of course other measures were not neglected. During the interval

between the epoch, general tonic treatment, baths, massage and hygienic measures were closely followed. Local lesions are to be remedied by proper medical or surgical measures.

THE USE OF FORCEPS IN BROW AND ANTERIOR FACE PRESENTATIONS.—The Journal of Obstetrics and Gynecology of the British Empire contains an extract of an article by Stroganoff on this subject, which first appeared in the Monatschrift für Geb. u Gynäk.

By anterior face and brow presentations the writer understands those in which the fetal back is directed to the front, while the chin in face presentations, or the brow in brow presentations, lies posteriorly. He believes that in anterior face presentations (with the chin to the back), if the head is fixed at the pelvic brim or lies in the pelvic cavity, forceps should be applied to aid in the rotation of the chin or the forehead. Rotation should be promoted slowly, and step by step, by the forward movement of the head, and the normal mechanism of the position should be imitated as much as possible. Only moderate force should be employed, lest the maternal parts be damaged. Should eight or twelve attempts at traction fail, the head may be perforated, provided there are maternal indications for rapidly ending the labor. If the face of the fetus lies in an oblique diameter of the pelvis, the forceps should be applied twice, after the manner of Scanzoni-i. e., first in one of the oblique diameters, to bring the long axis of the head into the transverse diameter of the pelvis, and then in the other oblique diameter to bring the head from the transverse to the auteroposterior diameter. If the face is lying almost in the transverse diameter of the pelvis, the forceps should be applied by Lange's method-i. e., one blade being introduced posteriorly and carried up to near the promontory of the sacrum, the other being introduced behind the symphysis. Straganoff prefers the straight forceps to those with a pelvic curve, though he admits. that the operation may be performed very well with the curved instruments.

Department of General Medicine.

In charge of DR. E. M. DUPAQUIER, New Orleans.

TYPHOID INFLAMMATION OF BONE AND JOINTS IN CHILDREN.— In children and youth the typhoid fever infection acts on the bones and on the joints.

(a) The bone manifestations are often met with, chiefly in the lower extremity, in the diaphysis of the long bones, but the bone marrow everywhere and anywhere in the osseous system may be affected. It is most important to know that osteomyelitis may appear as early as in the first days of the course or as late as three, four, seven and eight months after the termination of typhoid fever, but it usually shows during convalescence between the sixth and eighth week.

Bacteriologically, there are three kinds of cases: (1) with bacillus typhosus alone; (2) with bacillus typhosus and another organism; (3) with no bacillus typhosus, but a variety of pyogenic organisms.

Clinically, it goes without saying, the degree and location of the inflammatory process give rise to a variety of pictures, but most of the cases for practical purposes can be brought under three forms:

(1) Subacute, rheumatoid, diffuse, ending in resolution; (2) acute, localized, ending either in resolution or suppuration; (3) chronic, localized, ending in resolution, suppuration or exostosis.

Rheumatoid Form.--It is the most frequent, varying according to the degree of inflammation. When mildest there exist in the limbs vague unlocalized pain which after a duration of two or three weeks disappear leaving no trace. But the whole body has grown in length and reddish linear marks are observed on the skin from violent distention about the intermediary cartilages between the epiphyses and diaphyses. When more marked the medullary inflammation may lead to osteoperiostitis. Temperature rises, pains are severer and after their disappearance some hyperostosis at times is left.

Acute Form.--Here we have a localized osteomyelitis. Ordinarily it begins during convalescence with vague pains limited to one segment of the limb and the case runs a course similar to periostitis, ending in either resolution or suppuration.

Chronic Form.-Here, as late at times as several months after the termination of typhoid fever, the affection takes a chronic character from its very onset. There is no fever, no chill, pain is only light, though aggravated by paroxysms at times and a small tumor starts, growing slowly, projecting from the surface of the bone without alteration of the skin, forming an exostosis. It remains such or resolves, in which case it decreases gradually as the pain ceases. But, it may also end in suppuration, in which case it continues to grow, becoming fluctuating. Typhoid osteitis is altogether not serious since in three-fourths of all cases resolution takes place.

(b) The articular manifestations are not as often met with as those in the bones. They usually occur during convalescence, but may show at any time during the course of the fever, even at the very onset (arthro-typhus of Robin). The lower extremity is ordinarily affected, the hip joint in particular, on one side only; but both these and other joints may be involved. The bacillus typhosus is very seldom found, and it seems that the inflammatory process is less due to typhoid infection of the joints than to simple extension of the inflammation of the neighboring epiphyses.

Marfon describes three forms of typhoid arthropathies.

First Form-Polyarticular, serous, subacute, the most frequent of all, occurs at all times, onset, course (second or third week) and convalescence. Small joints affected. Acute pains in the limbs at first, then localized successively in several joints (simulating acute articular rheumatism) exaggerated by pressure and motion. Peri-articular region swollen, edematous, hot and red. Neighboring epiphyses swollen and painful. In the latter, inflammation prevails, in the joint proper it is but secondary. Not uncommonly effusion in synovial capsule. Temperature rises to 39 deg. C. or 102.2 F. and 40 deg. C. or 104 deg. F. But all phenomena disappear rapidly in a few days. In the mildest cases there exist only pain and fever. Second Form

cence.

Mono-articular. Chiefly during convalesLocates in hip joint. Ordinarily remains localized in