awake when the pains return. A second injection of from 1.5 to 3 decimilligrammes of scopolamine alone is given an hour after the first. Half an hour later the perceptive capacity of the patient is tested by asking her if she recognizes an object previously shown her half an hour before, or if she remembers how many injections she has had. If she fails to meet these tests, no further injection is needed. As a rule, all injections following the first contain scopolamine only. Patients may thus be kept semiunconscious for 24 hours. After a successful "dawning sleep" women awake postpartum perfectly happy, and declare they have felt nothing. It frequently happens that they will not believe they have been delivered. Everything depends on the correct dosing of scopolamine, and the only available standard as to the correctness of the dose is the test of the patient's consciousness. Loud noises, strong lights, etc., are a considerable drawback in achieving good results. The author's conclusions are based on his experience in 1700 cases. The length of labor is only immaterially increased, and the method is certainly without danger to the mother, and probably without danger to the child. Of the 1700 women only two died soon after confinement, and neither of the deaths could be in any

The above lotion would seem to be of service in cracked nipples, but if the nipples are fissured silver nitrate (2%) solution or lunar caustic is more effective. At all times during lactation the nipples should be washed before and after each nursing with saturated solution of boric acid or borax. The great thing would be to try and prevent this condition. Too little attention is paid to the care of the nipples during the last two or three months of pregnancy. The nipples should be exercised by light massage, and if the skin around the nipple or the nipple itself is tender, alcohol, pure or with equal parts of water (45%) will harden them and often prevent cracks and fissures. W. B. J.

light. According to experimental research upon healthy individuals, two types of sleep may be distinguished. The first type falls asleep rapidly and soundly, then the sleep becomes gradually lighter, and the sleeper awakens early in the morning rested and ready for work. (evening type). The morning type, on

the contrary, does not reach the greatest depth of sleep before the end of a few hours; the sleep does not become as sound as in the evening type, but it remains for a longer time at the same depth. Individuals of this type are especially well fit for night work, whereas they have to fight in the morning, after awakening, for a considerable time against a remnant of fatigue. The lecturer does not share the view to the effect that the morning type indicates a nervous disposition. According to the experiments of Czerny, the sleep of infants corresponds to the type of the evening sleeper. These experiments permit important conclusions as to the most suitable arrangement of their bedrooms. The removal of all external stimuli is of the greatest importance, also in the case of young infants, who must always be kept warm enough. It further results from the experiments as well as from practical experience, that the afternoon nap of children does not shorten or harm the total sleep of the night, and that, granting the absolute depth of the sleep to be somewhat less profound than without the afternoon nap, the sleep remains sound for a longer period of time.

Proceeding to the disturbances of sleep in children, the lecturer passes in review the manifold phenomena which interfere with the sleep of the young, in shape of night-terror, nocturnal enuresis, restlessness, crying spells, etc., or delayed falling asleep and frequent re-awakening. The cause underlying these symptoms must be carefully ascertained, and the differential diagnosis is often difficult in these cases. Sleep may be seriously interfered with by educational factors (lack of discipline); fright, diseased conditions, such as fever, pain, or digestive disturbances; by hunger, wet and cold, noise, etc.

their sleep actually represents a reliable test for the general health of children. The less it is possible to demonstrate external disturbances as the cause of the abnormal sleep, and the more the type of sleep differs from the normal condition, the greater is the importance which must be attached to the internal (nervous) predisposition. From this point of view, it may become necessary to designate a greater number of children as "nervous," but precisely in this way, general "nervousness" may perhaps be rendered more rare in adults. F. R.

The Treatment of In- Kephallinos (Jahrfantile Rectal Prolapse buch für Kinderby Longitudinal Stifheilkunde, Vol. 67, fening of the Rectum.

1908). Instead of retaining a prolapsed rectum by means of annular injections of paraffin around the sphincter, as previously suggested, the author aims at supporting the rectum in its natural position, according to the method proposed by Spitzy. This is accomplished by linear injections of paraffin into the para-rectal connective tissue. As a rule, two paraffin holders are applied on the right and left side, behind the rectum, but one is frequently sufficient for the purpose. The operation is done under partial æther anæsthesia. The technique requires some experience, so as to obtain a paraffin prothesis of uniform size. Altogether 32 patients were treated in the Orthopedic Department of the Children's Clinics in Graz, without a single instance of embolism. The results were so favorable in all the cases but one that the procedure is recommended for further adoption.

The treatment of rectal prolapse in children may be medicinal, electro-therapeutic (faradisation), topical (suitable plaster adhesive dressings), or operative.

author recommends the above-described paraffin-injections into the para-rectal connective tissue on either side of the rectum; in other words, the introduction of two paraffin protheses, on the right and left side, behind the rectum. The customary dressings are applied after the injection. The results were practically always favorable in an experience extending over three years.

The medicinal treatment of rectal prolapse in children consists in the external and subcutaneous employment of nux vomica; the subcutaneous application of ergotin; painting of the mucosa with a stick of silver nitrate; the employment of suprarenal substance, in a solution of suprarenal tissue in glycerine, which is administered as an enema. F. R.

ria in Children.

Orthostatic Albuminu- Jehle (80. Naturforscher und AerzteTag, Cologne, Sept. 22, 1908).— Pædiatrical Section.

This disease is of very common occurrence in children, and is characterized by the albumen excretion, instead of being constant, as in nephritis, making its appearance only when the patient leaves. his bed and follows his occupation. As long as these children assume the horizontal position, they are free from pathological manifestations, but the excretion of albumen begins within a few minutes after their rising. The patients frequently complain of headache and lassitude; they are pale and languid, with a marked tend

tem.

ency to vomiting, also to fainting, in the severe cases. The lecturer discovered the cause of this peculiar condition to consist in a characteristic change in the configuration of the spinal column, a socalled lordosis. As soon as these children leave the recumbent position this curvature of the spinal column takes place, and with it the pathological excretion of albumen begins. The cause of this affection is therefore not referable to disease of the kidneys, or the nervous system, as hitherto assumed, but it may be explained by simple mechanical factors. The lecturer claims that as soon as the child is prevented from assuming the injurious position it may at once move about without any symptoms of disease; in other words, the child may be cured by a simple correction of the position of the body. The correctness of this observation was demonstrated by a number of experiments. Rapid improvement and recovery may be obtained by means of suitable orthopædic treatment, the wearing of a support or corset, and proper instruction of the patient's friends, whereas the former methods of treatment have proved inefficient. These children were rigorously guarded against all physical strain in the past without any benefit, whereas the lecturer's method of treatment permits moderate play and exercise without injurious results. The term "lordotic albuminuria" is proposed by him as the correct designation of the disease. F. R.

The Effect of Caffeine Wimmer (80. NaUpon the Nervous Sys- turforscher und Aerzte-Tag, Cologne, Sept. 23, 1908).-Section for Applied Chemistry.

The nerve centers in the cerebrum, medulla and cord are first stimulated, and subsequently paralyzed, by caffeine, a feebly basic proximate principle obtained from the dry seeds of the coffee

tree, and from other plants. Small doses stimulate the cerebral functions by increasing the supply of blood to the brain; the cerebral circulation is often overstimulated by large doses (gr. v-viii), which may cause great heaviness of the head, flashes of light before the eyes, tinnitus aurium, insomnia, restlessness, and even delirium. When used in moderation the various beverages containing caffeine are more or less stimulating to the mental processes, and sedative to the nervous system. The disturbances of health produced by persistent use of coffee are essentially due to the toxic action of its alkaloid, caffeine. Used to excess, coffee disorders digestion and causes functional disturbances of the nervous system, shown by headache, vertigo, mental confusion and palpitation of the heart. It increases secretion, blunts sensation, exalts reflex excitability, increases mental activity, and may produce insomnia and great nervous restlessness. The wakefulness is usually preceded by a short period of drowsiness.-(Potter).

A number of experiments have been carried out with the object of preparing a caffeine-free product from the coffee seeds. A satisfactory result was obtained by certain methods which aim at subjecting the entire raw seeds to a procedure by means of which the caffeine-salts are decomposed, and the seeds are rendered amenable to subsequent extraction with a volatile solvent of caffeine. This procedure is at present employed in Bremen and in Mannheim, Germany. Nature has produced a plant free from caffeine, native of Madagascar and Réunion, but unfit for use on account of its bitter principle. Grafting experiments have not yet proved successful. The requirements in case of the artificial non-poisonous product are its almost entire harmless

ness, together with an unchanged appearance, taste and aroma. F. R.

Investigations Concern- Brewitt-"Untering Remote Results suchungen über die After Complicated Cranial Fractures.

Spätresultate nach Komplizirten Schädelbrüchen" (Archiv. f. Klin. Chir., Vol. 79, H. 1, 1906-7).

The author reports a series of observations from the Berlin City Hospital, service of Koerte. Among 72 patients. with complicated cranial injuries, 60 were discharged cured, two left the hospital with slight disturbances, and 10 died. The chief endeavor of the treatment consisted in exposing the bone injury and in closing the gap in the skull capsule at once, if possible. Re-implantation was abandoned in those recent cases where thorough cleansing was not feasible, on account of serious contamination of the site of the defect as well as the bony fragments. It was likewise omitted in old cases with unclean wounds. The cases presenting hernia cerebri, or deepseated destruction of the brain with exudation of cerebral fluid, also did not enter into consideration for the primary closure. In the technique of the re-implantation the essential feature consists in the union of the soft parts by suture, since in open-wound treatment the bony fragments are pushed away and extruded by the granulations. Among 36 re-implantations the fragments healed without reaction in 28 instances. The procedure of re-implantation has often been objected to on the plea that the implanted bones exert pressure upon the underlying brain, furnishing the cause of severe nervous disturbances. The author was only once enabled to observe a sinking-in of the implanted fragments of bone, and it is doubtful if the cerebral symptoms and disturbances were not