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gramme every hour, and reducing the dose to the minimum required to give any effect. The other plan was to commence with a minimum dose, and increase it until an effect was produced, and then to continue the prescription at the dose thus attained. The action of thallin is especially noticeable in its effect on the sensorium and general condition of the patient, who presents the appearance of convalescence, whilst the splenic swelling and roseola are still present; and if the drug be discontinued the temperature will rise again. It is not therefore surprising to learn that, whereas of twenty-eight cases treated by bathing the average stay in hospital was thirty-seven days, of seven cases treated by thallin (minimum doses) the duration of treatment was forty-seven days, and cases on a scale of progressive doses thirty-eight days. However, Professor Ehrlich claims advantages for the drug in the absolute control it exerts over the pyrexia, and the sense of wellbeing enjoyed by the patient. There were no intestinal hemorrhages in these cases, and no instance of perforation. The kidneys were not affected, but sequelæ in the form of hyperæmia and oedematous swellings seemed due to the use of the drug. It was not thought that thallin had any specific action against the typhoid bacillus, but it did seem to limit the degree of intestinal ulceration. Professor Ehrlich considers it to be on a level. with the bath treatment. Dr. Fränkel pointed out that if the statement were correct that thallin is not found in the nerve-centres its action in reducing temperature was rather inexplicable. He had exhibited it in increasing doses, but could not say that the patients experienced any special benefit attributable to the diminished fever. Dr. Guttmann had not been favorably impressed by its use, and had noted the production of rigors.-The Lancet, December 25, 1886.


The extensive use of borax and its compounds as antiseptics has given especial interest to the question of the poisonous effects and mode of elimination of this drug. JOHNSON, of Stockholm, has made clinical studies upon this subject by introducing borax and its compounds into the stomachs of patients in the Caroline Institute, and has tested for borax by the curcuma test, which, in proportions of 1 to 2000, gave well-marked reaction, and also by the spectro-electric tube of Vigier,

which detects only the proportion of 1 to 1000. In twelve cases in which the dosage ranged from 20 grains to 50 grains daily in irregular doses, after the largest doses had been taken, three exhibited signs of intoxication, headache, vomiting, malaise; in one case, after the use of borax for ten days, a slight acceleration in the pulse-rate was observed, accompanied by increase of temperature, loss of appetite, headache, redness of the fauces, and bronchial catarrh, and finally by a well-marked papular erythema upon the thighs and joints. The urine commonly gave a reaction for borax ten minutes after the dose was taken : it was not found in two days after the drug had been used by inunction. In other cases it persisted in the urine six, eight, and fourteen days after the patient took it. Boracic acid had a distinctly diuretic effect: albumen disappeared from the morning urine in some cases where albuminuria existed; when the greatest diuresis was produced, the drug itself disappeared from the urine. Borax was found in the perspiration; in small amounts in saliva; irregularly in fæces, often after several days' ingestion, which the author thought due to its presence in the bile. Twice borax was found in ascitic fluid.

It is interesting to observe that after footbaths containing boracic acid borax was found in the urine, and also after the application of vaseline containing boracic acid to an ulcer it was present for two days after its use. Its presence in the organism after its use with hot-water applications is probably owing in part to the influence of the steam which is present. Johnson's observations do not tend to show the danger of the use of borax and its compounds, but to call attention to the fact that after its use in the stomach, intestine, bladder, and pleural cavities ill effects have followed a five per cent. solution, and the observer advises that after the use of solutions of a strength of two per cent. or over, care be taken that no great amount of the fluid remain in the body, and that afterinjections of water or neutral carbonates be made as a prophylactic measure.—Medicinisch-Chirurgische Rundschau, December 15,


CHLORIDE OF METHYL IN THE TREATMENT OF NEURALGIC AFFECTIONS. From an experimental paper with the above title, published in the Kansas City Medical Index (December, 1886), DR. DUDLEY TAIT draws the following conclusions:

1. Chloride of methyl spray may be used.

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The first case in which this treatment was employed was that of a patient who had roseola and mucous patches upon the vulvæ, which had resisted all other modes of treatment. The first injection made contained of a grain of calomel, the second injection contained grain.

A vigorous inflammation occurred at the place of injection, but without suppuration. Eight days after hypodermic medication began, the unpleasant symptoms which had so long annoyed the patient disappeared.

The author has treated five other patients similarly, and with excellent results.

Two hours after injection traces of calomel are found in the urine.

Scarenzio and Smirnoff have treated secondary syphilis with 8 grains of calomel in four doses, and at intervals of twenty days. They claim good results, without returns of the disease.

The use of the oil of vaseline as a vehicle greatly diminishes the tendency to form abscesses after hypodermic injection.—La Presse Médicale, December 5, 1886.


It was remarked by Wecker in the Annales d'Oculistique (1884, t. xcii. p. 218) that the action of eserine on a cocainized eye is greater than when no cocaine had been used. This difference he attempted to explain by suggesting that the slight cocaine anæsthesia of the iris and ciliary body may cause a somewhat similar effect on the pupil to that of eserine. DR. E. L. TUREVICH, however, who has recently published a "preliminary communication" on this subject in the Vrach, points out that the action of cocaine by itself on the pupil and accommodation is exactly the reverse of that due to eserine, cocaine dilating the pupil and paralyzing the accommodation, while eserine contracts the pupil and causes spasm of the accommodation; besides, it has been conclusively shown that a combination of atropine and cocaine produces a more powerful dilating effect on the pupil than atropine alone; and Ad. Weber has even given the equivalents of eserine and pilocarpine as antagonists of cocaine, these being 1 to 25-30 in the case of eserine, and I to 4 in the case of pilocarpine. The fact of eserine acting more powerfully on a cocainized eye is therefore paradoxical, and by no means easy to explain. How, writes Dr. Turevich, can the anesthesia of the ciliary body, even if cocaine does produce such an effect, which is extremely doubtful, favor the action of eserine, as Wecker suggested? We should a priori expect that the contraction of the pupil by eserine in a cocainized eye would be, if anything, less than in an ordinary eye; and indeed it was shown by Weber that when a drop of a two per cent. solution of eserine was combined with 25 to 30 drops of a similar solution of cocaine, its effect on the pupil was entirely masked. In the hope of clearing up the paradox, Dr. Turevich undertook a series of observations on the paralyzing effects of eserine and pilocarpine on his own eyes and on those of others, both with and without the previous instillation of cocaine. The course of the accommodationspasm was observed by measuring the refractive power of the eye every five minutes from the application of the eserine or pilo

carpine to the time when the effects had passed off. Fifteen comparative observations were made, which completely confirmed Wecker's statement as to the greater effect of eserine on a cocainized eye, showing also that the same is true of pilocarpine. The explanation suggested of the apparently opposite action of cocaine when applied previously to the eserine and when combined with it is that when anesthesia of the conjunctival sac is present, first, the surface absorbs more of the eserine than when the eye is as sensitive as usual, the introduction of a foreign liquid causing less winking with less consequent expression of the liquid between the lids; secondly, the secretion of mucus is smaller, and thus the solution is less diluted and less likely to be washed away; and thirdly, the conjunctiva and cornea are drier, and thus absorb the eserine more readily. The author convinced himself by special experiments of the difference in the behavior of cocaine according as it was applied before or simultaneously with the eserine or pilocarpine, and the above explanation is the only one which appears to him adequate to explain the apparent paradox.-The Lancet, January 8, 1887.


OTTо and KÖNIG have given this drug in various cases of mental disease, with the following results:

In a case of great excitability in a woman who had been paralyzed, urethan was given in doses from drachm to 2 drachms without any apparent effect. Larger doses produced Larger doses produced very unpleasant after-effects in gastric symptoms. In excitability of idiotic children it was given with good effect; in children from 4 to 10 years old the doses ranged from 8 to 16 grains in the younger, from 20 to 40 grains in the older.

In the treatment of men who had been paralyzed its use was quite without effect.

König concludes that paraldehyde in such cases is much better; in large doses it also produces gastric disturbance, and when used for a long time cerebral impairment.

Rottentiller, in Budapest, has had much better results from the subcutaneous use of urethan with from one to three injections of one-fourth syringeful of a thirty per cent. solution. A restful sleep of six or eight hours followed, and the injection was unattended by unpleasant after-effects locally.

The experiences of the writers did not lead them to expect any well-defined and practical effect from the use of urethan.-Zeitschrift Apotheker-Vereins, No. 33.


There are few disorders which cause more discomfort and distress than those accompanied with incessant attacks of vomiting; there are few disorders which try more the patience and the skill of the practitioner. DR. F. P. ATKINSON gives us in the Practitioner (for November, 1886) a number of points which may prove useful in relieving certain forms of obstinate vomiting.

In cases of simple bilious vomiting he states that a mixture containing 15 minims of solution of potassium and 4 of laudanum administered every four hours acts like a charm, and he asserts that in no uncomplicated cases will there be any vomiting after two or three doses. For the vomiting of pregnancy he suggests a little milk and tea, with a small piece of bread and butter or biscuit, immediately before rising in the morning, and a biscuit or two at various intervals throughout the day, whenever there is a feeling of emptiness. In vomiting from ulceration of the stomach the great object is to give the stomach as much rest as possible. This may be accomplished by giving very small quantities of peptonized milk or koumiss at short intervals; thus a teaspoonful of the above may be mixed with. cold water, and given every four hours. Dr. Atkinson further recommends that the body should be oiled night and morning to help nutrition, and covered with warm clothing to prevent cold. Later on, when the pain has almost subsided, various simple foods may be allowed. When the vomiting is very urgent, of course the stomach should be given entire rest, and peptonized meat enemata should be administered.

In the vomiting which occurs in infants brought up by hand, the most frequent cause is found in the inability to digest the casein. of the milk. In such cases it is advisable to use one of the many peptonizing powders now on the market, or the following may be given: Two tablespoonfuls of whey, two tablespoonfuls of water, and one tablespoonful of cream; if there be some diarrhoa, a little meat juice may be given three or four times daily, while the body should be oiled night and morning.


In the session of the Academy of Medicine of France held November 30, 1886, the Academy discussed at length the question of the reinforcing of wines with alcohol, and, after a long controversy, arrived at the following conclusions:

1. The addition of pure alcohol to wines in quantities not exceeding two degrees may be allowed; but amounts greater than this cannot be tolerated.

2. Addition of alcohol is dangerous, not only because of the quantity and quality of poor alcohol used, but because it destroys confidence and perpetuates fraud.

3. Alcohols commonly called good increase considerably the injurious effects of brandy and liqueurs; alcohol added to these liquids. should be absolutely pure.

4. The Academy called the attention of the authorities to the necessity of reducing the number of smaller warehouses for keeping and altering wines, and of putting in active operation laws against drunkenness.-Bulletin de l'Académie de Médecine, No. 48.


At a recent meeting of the Medical Society of London, MR. HERBERT ALLINGHAM (Lancet, December 18, 1886) read a paper, and showed cases illustrating a new method of excision of the knee. The operation consists in making a vertical incision over the joint in front, beginning two or three inches above the patella, and prolonged over the patella down to the tubercle of the tibia. The knife splits right through the quadriceps tendon above the patella into the synovial pouch there. The soft tissues over the patella are divided to the bone, the knee-cap sawn through, dividing it into two lateral halves, then the ligamentum patellæ is also split down to the tubercle of the tibia. By this means the joint may be thoroughly exposed by drawing outwards each half of the patella and associated structures to its corresponding side of the joint. The two halves of the patella are wired when the operation is finished. He claimed the following advantages for the operation 1. The attachments of the fascia lata, the lateral ligaments, and the prolongation of the vasti to the tibia and fibula are not divided, and consequently there is much more support to the joint during the healing process, and when the leg is well. 2. Above

the patella the synovial pouches are well opened, and all the synovial membrane can be thoroughly removed. 3. Dislocation of the tibia backwards and tilting of the femur forwards, which commonly occur after the operation, are thus prevented. 4. The joint and the end of the bones can be thoroughly examined, which was not possible by the method of lateral incisions. 5. The undivided quadriceps is a strong antagonist to the hamstring muscles, and should the splint be left off the leg is much less likely to become bent. 6. Progression is greatly improved, the attachment of the quadriceps being neither divided nor the muscles shortened, as must necessarily take place when either the transverse H- or U shaped operation is performed. 7. And, above all, as we hope after excision to obtain movements in the knee-joint, the chances, Mr. Allingham thought, of such a result being brought about will be greatly facilitated by the operation described. future operations Mr. Allingham said he would remove thoroughly the whole synovial membrane, and only dig out with a gouge the diseased spots on the cartilage, and should not in any way interfere with any of the cartilage that looks healthy. If the crucial ligaments are not extremely diseased they should be left undivided. The joint should be kept at absolute rest until the wound has healed, when passive motion may be commenced.



SEMMOLA, of Naples, in an article in the Wiener Medizinische Blätter, No. 49, advises strongly against allowing a patient who is suffering from nephritis to come in contact with cold in any avoidable way. Such patients are excessively sensitive to cold, and cold baths are followed by great shock and depression. Violent massage and exercise of the muscles the author also strongly deprecates as followed by great shock and weakness.

He would advise the patient to live in a dry and equable climate; to strictly avoid all exposure or going about in severe winter weather; to practise mild gymnastics in a comfortable room rather than venture into a temperature below 18° or 20° C. The author emphasizes the remarkable sensibility of the skin of the sufferer with Bright's disease to all variations of temperature. Sodium iodide and chloride is advised in doses as large as tolerated. When, after two or three weeks, albumen has not entirely disappeared and dropsy

has been relieved, phosphates of sodium or calcium are given in quantities as large as 40 grains or a drachm daily. The efficacy of these drugs the author believes consists in their power to promote the assimilation of albumen.

The methodical inhalation of oxygen, which Semmola has urged since 1867, has been repeatedly proved to be of the highest benefit. Albumen soon disappears after its use, and although casts may remain in the urine, the patient's general condition is so much improved that the author thinks we have here an argument for the dyscrasic or hæmatogenic origin of Bright's disease.

All astringents are considered not only valueless but also injurious. Especially is the action of ferrum sesquichloratum and plumbum aceticum thought injurious because of their astringent influence on the capillaries of the skin.


DR. J. MITCHELL BRUCE, writing in the Practitioner (November, 1886), is able to confirm the statements already made as to the value of hyoscine as a cerebral sedative. His experience shows that there can be no doubt about the rapid and thoroughly complete effect which it possesses in quieting delirium. With the exception of this drug, our present sedatives are not sufficient to meet every case.

The bromides, chloral, and morphine, which constitute the entire group of sedative drugs to which we have recourse with any feeling of confidence, will often fail us one after the other in urgent cases. The bromides have not the power, while chloral and morphine are dangerous in many cases, and dare not be given. In such cases Dr. Bruce believes that hyoscine will be thoroughly reliable, and that in cases of troublesome, noisy delirium there is no treatment at once so prompt, successful, and safe as a hypodermic injection of hyoscine. As might be expected, its use is not entirely unattended by some disadvantages. Thus, within half an hour after the administration of from to of a grain it may cause failure of respiration in the form of rapid, shallow breathing, or often Cheyne-Stokes rhythm. It has also been observed that cough has been noticed on the nights that hyoscine has been given in delirious cases. The pulse may become weak, the face livid, and the pupils dilated, the whole appearance of the patient being calculated to cause anxiety. There is not, how

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FISCHEL, of Prague, has used cocaine in six cases of labor, with two negative, one

fully successful, and three partly successful results. He regards it as an adjuvant to chloroform. Cocaine is useful only in annulling pain caused by the tension upon the maternal tissues. Fischel proposes to apply a four or five per cent. solution through a speculum to the tense and dry tissues. When abundant liquor amnii has escaped, the powdered drug, mixed with an accompanying neutral powder, is advised.-Wiener Med. Wochenschrift, December 11, 1886.



A definite idea has of late gained ground as to the nature and origin of whoopingcough. The idea may or may not be pathologically correct; but the treatment founded on it is decidedly of a rational description. What is more to the practitioner, this treatment is said to prove remarkably successful. Correctly speaking, the idea is compounded of at least two factors. One of these is fully as familiar as whooping-cough is common. Micro-organisms are the cause of the affection. The microbe effects an entrance into the economy from a special site, and that site of entrance is the soft tissues of the nasal fossæ. The rational therapeusis is founded on formulæ of an equally explicit character. Antiseptics or germicides will destroy the living germs. They should be used early, and their sites of action are the nasal fossæ. The number of remedies already recommended is sufficiently striking. The method at present in greatest favor appears to be insufflation. Convenient contrivances of different designs for effecting the insufflation may be met with in great variety at the surgical instrument makers. A clumsy but successful

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