of them increase kidney excretion only by irritation and that is what we wish to avoid at this particular time. This can best be accomplished by flushing. Give the patient large quantities of fluid for a day or two previous to operation. If he will not drink sufficient quantities of water, give lemonade, preferable hot, and it will increase diuresis and skin elimination also. A tea made of triticum repens is an efficient non-irritating diuretic and is plesant to take, especially if a little sugar is added.

If the patient will not drink sufficient quantities of fluid he should be given high normal saline enemata. There is no better way of flushing the kidneys than to give a hot saline enema high into the colon.

The mouth and upper air passages should receive attention, the teeth be carefully cleansed and the mouth and pharynx frequently rinsed with a mild antiseptic gargle. This is no attempt to sterilize the mouth, but many "would be" harmful micro-organisms can be removed by this simple proceedure and many times a lung complication prevented. In all emergency cases in which the stomach is full, lavage should be done.

Armstrong, surgeon to Montreal General Hospital, reviews in the British Medical Journal, the lung complications in 2,500 cases operated with anæsthesia. Of the 2,500 cases, fifty-five or 2.2 per cent developed some lung complications, thirty-two or 1.28 per cent came to autopsy. Of the fifty-five cases thirty-five occurred during the cold months from November to March. All developed within forty-eight hours after the operation, and thirty-seven of this fifty-five had some septic focus before operation. In eight cases, emphysema was noted before, one chronic bronchial asthma, and nine chronic nephritis.

The complications were sixteen cases broncho - pneumonia, fourteen pneumonia, bronchitis nineteen, plastic pleurisy three, serous pleurisy one, and two empyema. He states that this series of cases does not show that ether per se was a very active cause, as in nearly all the cases a more probable cause was present.

The conclusions based on this report are:

1.-Cooling of the body surface contributes largely the lung complications.

2. The existence of septic foci, particularly in the abdomen is a common cause, for when the abdominal muscles are painful they do not aid in expelling mucous that collects in the bronchial tubes, and the transmission of septic emboli from the abdomen to the lungs is easy.

3.-Aspiration of vomitus and accumulation of blood and mucous in the air passages in unconscious cases is a very common cause.

4. The larger percentage of cases occurred in the right lung, because the right bronchial tube is larger and allows more ready aspiration.

5.-Patients should have stomach lavage when food is present and the mouth and pharynx should be cleansed well before and after anæsthesia, and especially when the patient is unconscious.

6.-Septic peritonitis cases develop lung complications more frequently than any others.

7. Common predisposing causes are weakened heart, with hypostatic congestion, age, alcholism, cachexia and sepsis.

In the preparation of the patient these points should be kept in mind, since neglect of any of them may cause disagreeable symptoms following the anesthetic.

The relations of the attendance to the anesthetized patient should be just as asthetic as when the patient is awake, and careless lifting and moving of the limbs, uncomfortable strained position, and the barbarous use of the mouth gag and tongue forceps for some fleeting disturbance of respiration should never be allowed. If the cause is sought the disturbance can be avoided without injuring the patient's mouth and tongue. Oftentimes by simply turning the patient's head to one side or pushing the lower jaw well forward, the disturbance for which the tongue forceps are so often used, will be avoided.

What can be done to make the patient comfortable after anæsthesia? In fact, there are many things that can

be done that are usually not. Thirst is more bitterly complained of than anything else This can be almost entirely prevented by colonic injections of warm saline, one-half to one pint, every hour or two beginning as soon as the patient is removed from the operating table. This does not cause nausea nor is it often contraindicated by the nature of the operation, and it is of inestimable value in protecting the kidneys from the concentrated irritant. One to three injections should be given in every case in which the operation does not contraindicate, as a matter of protecting the kidneys, even if it did not prevent the intense thirst.

It is a mistake to withhold water from every case of general anesthesia, and it is a violation of nature's laws in concentrating the poisonous material in the blood to be eliminated when it should be diluted. During my service in the Louisville City Hospital, I carried on the experiment in considerably over fifty cases of giving every other anæsthetized patient water freely, per orum, and I regret that I did not tabulate the results, which were most gratifying. I usually gave my patients saline enemata and few of them had any great thirst, but in many the enemata were not given and the water given per orum, and I found there was less prolonged nausea and retching in cases allowed water than in those that were not. If a large glass of water is given and nausea occurs, either from or without the water, it does good by washing out and ridding the stomach to tenacious mucus and bile which will prolong nausea and retching as long as it remains in the stomach, for everyone is familiar with the relief vomiting gives when they are greatly nauseated.

Of course, in operations in which the intestine have been opened or some intra-abdominal septic focus exists, and it is essential to arrest peristalsis. I do not allow water, but I am satisfied from a large number of experiments that water does not increase nausea, but simply furnishes more bulk for the stomach to contract upon and causes the contents to be expelled easily, whereas the tenacious mucus

would adhere to the lining of the stomach and continue the nausea and retching.

From my experiments my conclusions are:

1.—That no larger number of cases vomit when given water freely than do when water is withheld absolutely. 2.-The nausea disappears and the thirst too more rapidly if water is given freely.

3. In the cases that retain all the fluid given the kidney elimination is very much enhanced.

4.-That enemata of normal saline should be given in every case in which the nature of the operation does not contraindicate it, and that in all cases except intra-abdominal operations that water can be given freely when the thirst is intense.

Since I first tried the experiment at the Louisville City Hospital I have since allowed such of my anæsthetic patients to have water as I have had control of for after treatment and the results has been equally gratifying.

SUITE 242 ATHERTON BUILDING.

[Continued in March issue.]

IRIS

SOME THERAPEUTIC HINTS.

BY NEWTON BOWMAN, M. D.
PHILAN, TEXAS.

RIS VERSICOLO is an ideal drug in those cases of sick headache brought on by sedentary habits. There is a type of headache so often encountered in individuals who spend most of their time in office or in close quarters, especially so if the air is not properly changed by good ventilation. This headache begins with the days work and gradually increases toward evening, accompanied by a certain amount of nausea and a general feeling of discomfort; no appetite, sense of fullness in the head, aggravated by motion or noise, irritable. In headache resulting from bad air, as so often found in coal mines, I administer ten drops of fl. Iris Versicola in twenty-four teaspoonfuls of water, and direct teaspoonful every fifteen minutes until relieved after which time give only every three hours. The

normal condition is very promptly restored. Skin becomes moist whereas it was dry and hot. Carotid pulsation and throbbing in temples cease and the circulation generally becomes softer and equalized.

In the apoplectic subject it is beneficial, relieves the vertigo and circulatory disturbances about the head and face. Following ptomaine poisoning from eating fish I have used it to good advantage. Generally speaking it acts well when there is a passion in activity of the capilary system. It no doubt has a wonderful influence on all secretion.

Colocynth.-I use this drug as follows: For every day prescribing I take 3i f. e. Colocynth to 3ix of dilute alcohol which makes a good tincture, and of this I add ten drops to twenty-four teaspoonfuls of water and direct two teaspoonfuls every fifteen minutes in infantile colic where the pain is of an intermittent character. The child drawing up its knees with every pain. Frequently the pain is relieved after the first dose; however, sometimes as many as four doses are given before relief. In cases of diarrhea associated with a pain that is relieved by firm pressure. Colic brought about by eating or drinking, especially so of cold drinks in the Summer season. Diarrhea brought about by every bite of food or drink swallowed.

Ovarian neuralgia, dysmenorrhea suppressed, etc., when associated with an intermittent pain (neuralgic) and can be relieved more or less by pressure.

in

Briefly this drug is indicated in all cases of severe colicky pains, obliging the patient to bend double and worse any other position. However, do not overlook the pain of glaucoma and iritis or such other pains about the eyes that take on the rheumatic or neuralgic character and can be more or less benefited by firm pressure.

Berberis Aquifolium.—In acne I prefer this drug to all else given in the following way:

Sig. Teaspoonful every four hours, preferably one hour before or after eating. Frequently women or young girls with acne manifest a nervous phenomena, and following is