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book and the field it covers an excellent antidote to the strain and worry of either commercial or big shot slot machine professional life. The doctor may well write out two prescriptions for the book, one for himself and one for his patients, but must not fail in his pre- scription to give careful directions for the taking of the medicine, lest the patient overtax his weak- ened heart big shot casino and hardened arteries by too sudden and great devotion to the'oldest of all callings, that of the gardener. This danger being guarded against, there is no better "spring medicine" than a spade ami a hoc and the Manual of Gardening. GASTROSPASM. Gastrospasm, according to Waldvogel (Miinch- cner viedicinische- Wochenschrift, January loth). is a well defined morbid entity, a statement quite in opposition to the opinion of more or less skeptical modern internists. In his opinion, not only is gas- trospasm a frequent 'affection, but it is one of the commonest gastric disorders. In many cases the chemical composition of the gastric secretion varies and is of only insignificant interest. The disturb- ances of the motor functions, considered entirely from the spasmodic viewpoint, should hold the first |)lacc, and they are rendered quite coinprehensible from the recent studies in the normal and patho- logical physiology of the stomach. One should consider the case as one of gastro- spasm when the patient complains of pressure, gas- tric fulness, gastralgia, and eructations, when gas- tric palpation is negative and after insutflation per- big shot free slots cussion shows that the lower boundaries of the or- gan do not reach below two or three fingers' breadth above the umbilicus. One should both see and feel that it is the intragastric gas that distends the stom- ach and cannot escape by the pylorus. The causes of such a pyloric insufficiency are usually not to be looked for in hysteria, the pres- ence of a malignant neoplasm, or perigastric adhe- sions. One should invoke rather, among other more or less numerous affections, neurasthenia, oc- casionally saturnism, nicotism, arteriosclerosis of the abdominal viscera, coprostasis, etc. In all cases play big shot slot the prognosis is good. As far as treatment is con- cerned, the best results will be obtained by the use of half a milligramme of atropine twice daily, heat applied to the epigastrium, and the ordinary treat- ment of the nervous symptoms. WOUNDS OF THE PANCREAS. According to Tarsia {Gazctta di medicina, Sep- tember 25, loiol, wounds of the pancreas, like all others for that matter, heal by the formation of connective tissue, part of which is derived from the omentum and part from the fundamental con- nective tissue of the organ itself. In the glandular elements in the neighborhood of the wound phe- nomena of proliferation are observed. That por- tion of the gland v/hich remains detached from section of the pancreatic canal undergoes a pro- gressive degeneration and atrophy of the glandular structures, the space thus produced being filled with connective tissue. .\n occlusion of the duct from section, or by be- ing included in the suture, without restoring its continuity, never gives rise to the formation of cysts, while the escape of small quantities of pan- creatic juice into the peritoneal cavity is absolutely harmless. In cases of wounds, either superficial and limited in extent, or completely involving the gland and its main duct, the reaction of big shot slot game sugar and that of Cammidgc are negative at all times, but both become positive when there is destruction of an extensive area of glandular parenchyma. The diagnosis of a wound of the pancreas can- not he based on any characteristic symptom, ex- cej)t in those instances where an external wound gives exit big shot slot free play to pancreatic juice. Suture of the pan- creatic wound is the proper treatment, but when this is found impossible gauze packing should be resorted to. EDITORIAL ARTICLES. 687 SYMMETRICAL NODULAR OSTEOPERIOS- TITIS OF THE SKULL IN INFANTS. In certain tuberculous infants in whom the ma- jority of symptoms leading to the diagnosis of tuberculous disease are absent, Tribaulet and Riba- deau-Dumas {Archives de medecine des enfants, October, 1910) point out that foci of osteoperios- titis may sometimes be found scattered over the cranium and should be looked upon as visible mani- festations of a tuberculous septichjemia. In point of fact, the)' are tuberculous lesions developing in the diploe and adjacent periosteum, which, when occurring during the progress of general wasting or dyspeptic phenomena of an apparently mild na- ture, acquire a very considerable senieiological value. The frontal and parietal bones are the seat of pre- dilection, and the lesions undergo their evolution either by the formation of sequestra or perforation or, more infrequently, in the form of a progressive infiltration. From the clinical viewpoint, these lesions are eas- ily mistaken for syphilis, but their tuberculous na- ture can ht detected by a study of the pus, which will be found to contain the tubercle bacillus. From ihit fact they possess a real semeiological value for the diagnosis of other symptomatic manifestations presented by this class of cases. THE ORIGIN OF NURSES' TRAINING SCHOOLS. Readers of the address to the nurses of the New York Hospital, by Dr. George L. Peabody, pub- lished on another page of this issue, may be aston- ished to learn that the idea of training women to the profession of nursing was due. not to Florence Nightingale, as is popularly supposed, but to a Ger- man clergyman and philanthropist, Theodor Flied- ner. In fact Pastor Fliedner established at Kaiser- werth in 1S36 the very deaconess house and nurses" liome where Florence Nightingale obtained her training and absorbed the ideas of which she sub- sequently made such noble use. The popularization of the movement and its widespread adoption throughout the world are tmdoubtedly due to the indefatigable efforts and self denial of the heroine of the Crimea. form is characterized by contractions of the thumb and fingers or by severe cramps in the calf or thigh, coming on at night. The latter are big shot slot immediately re- lieved by standing up, and the patient on his way to light the gas finds himself suddenly free from pain. Such an item of personal history is usually elicited only when the patient consults the physician for some other reason, and even then it is likely to be lost sight of in the light of apparently more im- portant symptoms. Massage, electricity, and strych- nine are said to be contraindicated, phosphorus and iron giving better results. It seems far fetched to

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