the diet once begun. The typhoid diets adopted by the writer are: (1) Milk diet, eight ounces every two hours, subject to special directions as to night feedings; (2) liquid typhoid diet, consisting of milk, milk with tea or coffee, albumin-water, beef-tea, malted milk, chicken-broth and barleywater, beef-juice and barley-water; broths, milk whey, junket, strained soups or gruels may also be given; (3) soft typhoid diet, to be added to the milk or liquid diet (a) ice cream, well cooked (boiled) rice, broths thickened with it; (b) soft boiled or poached egg on soft toast, blanc-mange and milk puddings, calf's foot and other gelatin jellies; (c) gruels, crackers or bread softened in milk or broths, macaroni, finelyminced or scraped meats; the increase in diet to be very gradual, one addition only each day; (4) typhoid convalescent diet, to be added to anything above, the soft parts. of oysters, a sweetbread, chop, cutlet, squab, game (small), chicken, fish, steak, rare roast beef; a mealy baked potato may also be given with any of the meats; (5) full typhoid diet, 6 A.M., milk; 8 A.M., a cereal with cream and a little sugar, milk with tea or coffee, egg on toast, bread or toast with butter; 10 A.M., bread and butter, with gruel or milk, or broth with egg; 11.30 A.M., soup, meat or fish (anything mentioned above), ice cream, blanc-mange, or milk pudding; 2 to 3 P.M., like 10 A.M.; 4 to 4.30 P. M., creamed chicken or a bit of cold chicken or roast beef, bread, and milk flavored with tea or coffee; 6 P.M., cocoa, gruel or broth: at night, milk two to four times. Any change from a less to a more generous diet should always be gradual. The mortality in the 150 cases, thus fed, was 8.67 per cent. There were relapse-like rises of temperature in 30 of the 117 cases. nine cases this relapse occurred before, and in 21 after, a more generous diet was begun. The writer believes this high proportion (18 per cent.) of relapse to be due to the fact that he has doubtless included among the cases of relapse many which would not be so classified by others. temperature charts show very clearly that

In

The

the increased feeding does not interrupt the deferescence. The important features in these diet lists are (1) the article permitted, and (2) the directions for the increase in diet, insuring the gradualness of any increase from a less to a more generous diet level. The new level was in the average case in about four or five days. Moorehouse says that patients fed generously begin to put on flesh at once, and show a continuous gain in strength and spirits as well as in flesh. He thinks that liberal feeding is a distinct advantage as regards prompt recovery of normal condition.

THE DIETETIC AND MEDICINAL TREATMENT OF DIABETES MELLITUS.

BY R. B. GLASS, M.D.

(Extract from Clinical Report.)

THE more prominent symptoms in diabetes mellitus, viz.: thirst, inordinate appetite, copious diuresis and emaciation, are unquestionably dependent upon the amount of glucose in the blood and tissues. Our first duty is to combat all disorders of skin, stomach, bowels, and internal organs. Regulation of habits of life, correct diet and proper clothing are valuable means toward perfect recovery. Withdraw from the diet as completely as possible (but not too suddenly) all sugar-producing articles-the most important being potatoes and bread.

Admissible foods are cheese, eggs, poultry, game, oil, fats, butter, pure cream and fish. Green vegetables such as spinach, lettuce with plenty of oil and mustard, onions, water cress, cabbage and celery. Soups prepared from meat or the above vegetables are greatly relished. Tea or coffee without milk or sugar. The The vegetable kingdom abounds in articles containing a large percentage of sugar, and these must be rigidly. excluded.

The non-admissible foods are liver, honey, milk, beans, peas, parsnips, turnips, pota

toes, carrots; sago, rice, macaroni, vermicelli, tapioca. Avoid sweet fruits, such as oranges, pears, apples, plums, currants, gooseberries.

As to the medicinal treatment, I have found nothing which in therapeutic force equals arsenauro. The results as described in the following case are practically identical with those secured in several others which recently came under my care.

Miss H., clerk in confectionery, ate much candy, noticed constant thirst, drank water frequently, ravenous appetite, voided urine to the amount of nine pints in twenty-four hours. Thought she had a tape-worm, her appetite being insatiable. Polyuria and an eczema of the genitals prompted her to consult me. Examination revealed spongy gums, carious teeth, eczema of the genitals with distressing pruritus, very weak heart, breath sweetish, swelling about both ankles. Specific gravity of urine was 1.049, sugar 12 per cent., albumin a trace; placed her upon a diet of fresh meat, eggs, sardines, cheese, peanuts, tea and coffee; ordered a warm bath every evening, the alimentary tract flushed with a saline once weekly. She followed instructions implicitly. Arsenauro was given, ten-drop doses in a full goblet of water, t. i. d. the first day, twelve drops four times a day the second day, thirteen drops four times third day, fifteen drops four times fourth day, eighteen drops four times. fifth day, twenty drops three times sixth day. Urine was then examined; great improvement, quantity reduced to fifty-two ounces, specific gravity 1.030, patient had gained three pounds in a week. For two days I continued the same dose of arsenauro, patient's condition remaining stationary. I then increased the dose to twentytwo drops in a full goblet of water t. i. d. As she was slightly constipated, I ordered a saline to again flush out the alimentary tract (as I consider this most important in all cases). Arsenauro was gradually increased until forty-eight drops were taken t. i. d., when physiological effects showed. The quantity was reduced to forty-five drops t. i. d. and continued for ten days (the

patient feeling most comfortable). I found that rapid amendment had set in, pruritus gone, eczema had almost disappeared, swelling about the ankles gone, quantity of urine reduced to almost normal, with a trace of sugar. The restricted diet was continued three weeks longer-the sugar had then entirely disappeared, the patient had reached her original weight and felt perfectly well.

There are certain important facts to bear in mind in the treatment of diabetes mellitus with arsenauro or mercauro.

First.-Administer a saline and flush out the alimentary tract. For this purpose two teaspoonfuls of Carlsbad sprudel salt should be dissolved in one pint of hot water and the patient should be directed to take this quantity in three portions at least one hour before breakfast.

Second. See that the digestive organs are in good condition. I usually follow the saline with 3 grs. of caroid and 3 grs. of bicarb. soda in powder, to be taken just after meals for four or five days.

Third. Now begin the use of arsenauro or mercauro. If the case in hand be complicated with Bright's disease, then mercauro should be given preference.

Uncomplicated diabetes demands arse

nauro.

Method of Administration.-Commence with a small dose, say five drops in one-half goblet of water after each meal. Day by day increase the dose in drops until the patient gives evidence of physiological saturation. This will be observed when under the lids puff or there are loose, griping evacuations. Some patients will show this early, at eight or ten drops; others will not manifest this intolerance before reaching sixty or eighty drops, but each case is a law unto itself, and it is imperative that this point of saturation be reached in each individual.

When these untoward manifestations are apparent, the solution should not be increased, but the quantity lessened a few drops to a dosage which does not produce these symptoms, the patient being continued on this lessened dose (which does not ir

ritate) for eight or ten weeks, before permanent results are to be expected.. It is well to keep the patient on the solution long after the disappearance of all sugar. No affection carries in its train more debility and discomfort than diabetes. Persons experience a degree of debility known scarcely to any other form of malnutrition.

It may be said that arsenauro and mercauro have the power to cure diabetes mellitus by quieting the irritation of the vaso motor centers whence the glycosuria and other symptoms of diabetes emanate.

Arsenauro and mercauro are powerful blood makers and blood builders and exercise their specific influence by virtue of their nutritive effect upon the nerve centers.

Malnutrition and its accompanying debility, whenever met, are positive indications for these tonic alteratives; and for the ill nourished and anemic child with a weakly constitution, arsenauro and mercauro produce astonishing results.

A strict adherence to a proper dietary is absolutely necessary.

of those whose lives are passed in our gloomy courts and alleys and underground work-shops is due to insufficiency of light. No wonder that children reared in badly lighted nurseries, and æsthetic people who delight in small windows, with colored glass still further to dim the entering light, should pay the inevitable penalty in pale face and impaired health. Certain skins are very susceptible to the direct action of the sun's rays. Freckles or small spots of discoloration are due entirely to an exceptional formation of pigment in the favoring light of the sun, and sometimes fade as rapidly as they come. The heat rays of the Isun act in just the same manner as a fire or mustard plaster, causing general pigmentation or sunburn. Absence of light is said to stimulate the cells in which pigment exists, causing them to contract and so hide the pigment; hence the surface becomes lighter in color, returning to a darker tint again on the reaction of light.

INFLUENCE OF LIGHT ON THE

SKIN.

THE influence of sunlight on the appearance of the skin can hardly be overrated, says The Family Doctor. Recent experiments with the electric light, which of all artificial illumination most nearly resembles sunlight, have shown how important a part light plays in promoting growth. It has long been known that plants deprived entirely of light soon droop. Some time ago the beneficial action of light was forcibly illustrated. At the close of a public lecture it was found that some buds which had remained on the table had actually blown under the influence of the electric light, while others which had been kept in the dark had made no progress whatever. Animals, too, are well known to have similar susceptibilities, and it is certain that much of the pallor observable in the faces

THE HYGIENE OF MANIA.

DR. ANTOIMIE, director of the Insane Hospital of Voghera, recently made an interesting address on the hygiene of mania before the Italian Society of Hygiene. The able chairman of the conference observed that the progress of civilization, the incessant intellectual work, the sharp struggle for existence, and poverty, have for the last twenty years doubled the number of insane people in Italy, which is very nearly 33,000. He' went on to speak of the active means that they might take concerning the mania either of persons under treatment or persons who have already been treated, and again persons who might require treatment in the future. For the first mentioned, a vigilant and intelligent care is necessary, in the choice of the duty (or work), which they wish to assign to them in (the) society, so that they be not constrained to fight a battle superior to their physical and mental forces. For the second, it is desirable that the work

of the patrons of the discharged patients should not be limited only to pecuniary help, but should surround them by a moral guardianship.

For the third, it would be useful to give to the insane hospitals more room for workshops, thus taking away the appearance of prisons, of great barracks, of cemeteries of the reason.

Dr. Antoimie talked at length of malnutrition as an important cause of mania, and he concludes by saying that he has not finished the argument, but only to give some advice in view of the benefits that can be drawn from a better-understood hygiene in the treatment of mania.-Exchange.

THE ELEVATOR DISEASE.

THE London News is responsible for the following warning, says the Boston Med. and Surg. Journal, which we believe may have an element of truth: "It looks as though people with weak hearts had, after all, better climb ten flights of stairs than effect the ascent by means of the lift. This convenient institution is becoming ubiquitous. We soar up to the topmost story of the sky-scraping flat, we descend through geological strata to the twopenny tube by its assistance. We thought we were thereby saving our vital energies and lengthening our lives. The doctors seem to hold another opinion. Lift attendants have died sudden deaths; people with weak hearts have noticed ominous sensations when in the elevator. We are told the sudden transition from the heavier air at the foot to the lighter air at the top is extremely trying to the constitution. Even millionaires and bishops and aldermen are now voluntarily tramping up stairs and avoiding the swifter but insidious route. In fact, a new disease has swung into our ken, 'liftman's heart.' We had all of us been risking this malady without knowing it. It is It is true

most people have experienced the singular sensation of internal collapse when the lift floor sinks beneath the feet, but none of us suspected the results might be so serious. Every new notion for health and comfort seems to bring its particular Nemesis."

STAMPING OUT MALARIA IN ITALY.

PROFESSOR GRASSI, to whom the credit of demonstrating the mosquito conveyance of malaria is largely due, says the Med. Press and Circular, has undertaken the task of stamping out the disease in the south of Italy. He proposes commencing operations on the Mediterranean side of the peninsula below Naples, over an area which covers about 30,000 square miles, with a population estimated at close upon two and a half millons. His scheme comprises the rendering mosquito-proof of all houses by means of wire gauze, and the withdrawal of their owners within the protected houses between sunset and sunrise, not a very easy thing to enforce, by the way. Those already suffering from the disease will be supplied gratuitously with quinine, and some idea of the magnitude of the undertaking may be gathered from the statement that the cost of the necessary quinine will exceed £20,000 annually. The firm of Bisleri, of Milan, have generously offered to provide this enormous amount free of cost should the enterprise prove a failure. The rules of hygiene are to be enforced where necessary by the aid of the military, but, interesting as is the experiment, we must confess to scant confidence in methods which have to be enforced at the bayonet's point. To educate this large population to the necessity for these drastic measures, on the other hand, is indeed a task from which the boldest might well shrink; moreover, years would be required before any method of instructing this ignorant populace could produce any tangible effect.

EXTEMPORANEOUS METHODS OF WATER PURIFICATION.

SURGEON-MAJOR SCHUCKING of the Austrian army is of the opinion that of the various methods of purification there are only two that can be taken into account for the use of troops in the field: (1) filtration; (2) purification by the addition of chemical agents. Among filters aiming at the sterilization as well as the clarification of water, the Berkefeld-Nordtrueyer alone is so constructed as to meet the exigencies of war. But although well adapted for use in field stations, it can only be carried in baggage wagons. Portable filters only clarify muddy water. The use of them therefore requires to be supplemented by some means. of destroying micro-organisms. After extensive experiments and researches (Traube, Lode, Kratschmer, Vogel) such a means has been found in hypochloride of chlorine. This chemical agency certainly kills all bacilli in thirty minutes.-British Medical Journal.

DISINFECTION OF THE HANDS BY

MEANS OF ESSENCES.

EUGENIO CALVELLO draws the following conclusions from a series of experiments: I. That washing with soap and water and alcohol does not make the hands aseptic, although it does diminish the number of germs to a great extent. 2. That the methods of Fürbringer and Ahlfeld do not result in in complete disinfection. 3. That seven to eight per cent. solutions of essence of cinnamon, eleven per cent. of essence of thyme, and seventeen per cent. of essence of geranium act precisely as do solutions of bichloride used according to Fürbringer's method, and should be given the preference in modern surgery, because they do not cause the alterations that bichloride does. 4. Nine-per-cent. solutions of essence of cinnamon, eleven and twelve per cent. of essence of thyme, and eighteen per cent. of essence of geranium assure complete disinfection of the hands. 5. The essence of patchouli has no antiseptic powers.-Giornale Internazionale delle Scienze Mediche, September 15, 1900.

CANNOT ENFORCE PURE BUTTER LAW.

THE State Board of Health of Missouri has decided to withdraw its butter inspector from St. Louis, and to make no further attempts to secure the enforcement of the pure butter law in that city as long as the bench of the Court of Criminal Correction is occupied by Judge Clark. The sale of oleomargarine as butter will then be practically unrestricted. The law prohibits the coloring of any substance desired to be used as a substitute for butter, and also the manufacture, sale, or keeping for sale, of any such substance. It does not place any restrictions on the manufacture or sale of oleomargarine, or butterine, if sold on its merits, and not as an imitation of butter.

HYDROGEN DIOXID AS A LOCAL ANESTHETIC.

INJECTED under the epidermis hydrogen dioxid produces immediate and complete anæsthesia of the whole skin. Dr. H. E. Kendall in the Medical Record says: "I have used it for over a year in opening abscesses, cutting off redundant tissue in ingrowing toe nails, opening the pleural cavity, and in one case the abdominal cavity. I do not think any absorption takes place, as the intercellular inflation from the gas generated seems to produce such pressure that the skin cuts like frozen tissue."