insufflator may be contrived by rolling a spill of paper, inserting a little of the powder to be employed at the end that enters the nostril, and supplying the motive force by the parent's or operator's puff of breath. But the puff-balls or regular insufflators are effective and not costly. Iodoform, salicylic acid, and boracic acid are the three antiseptics that appear to be most in vogue. They should all be very fine, almost impalpable powders. Nasal douches are very effective if they can be managed, as in older and not too nervous children. The most effectual douche of antiseptic kind appears to be the I in 500 corrosive sublimate. Care is to be taken that no appreciable quantity of this solution is swallowed. Some practitioners employ simple nasal douches in the earliest stages, -say, a drachm of Condy's fluid or of common salt to the pint of water. And this is done as much to mechanically wash away secretions with contained contagia as to destroy the germs. Weak solutions of tincture of iodine and of alum are also used. These lotions may be syringed into the nasal passages, or the children may be induced to snuff the lotion up from the palm of the hand. Older children may be taught to take the powders as "snuff." Repeated applications of any of these methods are necessary to insure thorough topical treatment in the early stages of the catarrh. The antiseptic agents may also be applied, as in young infants, by means of camel-hair brushes charged with ointments, lotions, or glyceroles. It is necessary to clear away all secretions and scabs first, by syringing or anointing with oil. The agent is then directly applied to the bare congested surface of the mucous membrane. An ointment of half a drachm each of iodoform and eucalyptol to an ounce of vaseline is highly commended by some. The boroglyceride may be used in similar fashion, also lotions of corrosive sublimate. Any of the antiseptic solutions may be atomized by the steam- or handspray, and inhalations effected through the nostrils. It is doubtful whether the theory of this fashionable method is correct; but supposing it should be, it is equally dubious whether the good that results may not be from the mere treatment of the catarrh as such, apart from its supposed cause. A pledget of cotton-wool, or a chamomile flower placed in the nostril to prevent the access of air, alleviates the symptoms of an ordinary rhinitis. So it may be with the various applications, the principal of which we have mentioned. Cocaine is now widely used as a

four or five per cent. solution painted on to the nasal and pharyngeal mucous membranes, not only in whooping-cough, but in simple or severe catarrhs.-Lancet, January 15, 1887.

INVESTIGATION CONCERNING PERISTAL

SIS IN THE INTESTINE AND THE
ACTION OF CATHARTICS

HESS, of Munich, discusses at some length the theories which have been advanced to explain intestinal peristalsis and the action of laxatives, and describes his own experiments upon these points.

The original explanation of Liebig, that endosmosis and exosmosis governed the action of laxatives, and the theory of Aubert, that peristalsis depended upon an increased nervous reflex, have been defended and modified by other writers, some of whom have laid great stress upon the influence of increased secretions, and the hinderance to the absorption of these secretions which exists in venous stasis and accelerated peristalsis (Thiry). According to Vulpian, Lauder Brunton, Brieger, and Hay, laxatives cause increased peristalsis, as do also small doses of drastic purgatives; in large doses drastics cause an inflammatory exudate and hypersecretion; the neutral salts cause an outpouring of water into the intestine which is not a simple transudation, but a hypersecretion as well.

The author does not consider the present series of experiments as concluded, but as introductory to a more extended series. His method was as follows:

In a dog of medium size a gastric fistula was made, whose opening was near the pylorus. The finger introduced into the fistula was grasped by the muscle of the pylorus, and the beginning of the duodenum was accessible through the fistula. In the first portion of the intestine was placed a small rubber balloon, which terminated in a projection or handle to which a rubber tube could be attached; the capacity of this balloon, when moderately distended, was twenty to thirty cubic centimetres of fluid. To its tip or handle was attached a long rubber tubing, graduated in centimetre lengths and wound with thread to prevent its distention. After its introduction the balloon received from a graduated syringe a registered amount of water. The balloon sank into the pyloric opening, and began to pass through the intestine, advanced by the peristaltic action of the bowel. Its rate of advance could be easily measured by the graduated tube; it could be emptied by this tube, or further distended without removing it from its place in the intestine.

It is evident that but sufficient tubing was needed to traverse the entire intestine; the animal showed no signs of discomfort. By checking the progress of the balloon, it could be used as a tampon for dividing the intestines; by allowing it to be expelled, fluid could be injected into the lower bowel through the tubing.

To ascertain the mode of the normal peristalsis two series of observations were undertaken, in the first of which the balloon contained forty-five cubic centimetres of water, in the second twenty-two cubic centimetres.

The balloon in the first instance was filled in situ, and a laxative mixed with ferrocyanide of potassium administered.

An examination of the fæces showed the coloring-matter, and proved that the distention of the balloon was not so great as to entirely occlude the intestine. In twenty-nine hours and fifty minutes the balloon had proceeded a distance of one hundred and fortynine cubic centimetres, where it stopped, and, after remaining immovable for several hours, was finally emptied, and expelled by a soapand-water clyster. There was every reason to suppose that its lodgment was at the ileocæcal valve, which could not be passed by a ball of its dimensions.

The next experiment was with the balloon containing twenty-two cubic centimetres of water, and resulted in the passage of the balloon nearly to the anus, a distance of two hundred and twenty centimetres in the animal used, in twenty-three hours and twenty-five minutes. It was, as before, expelled by an

enema.

The experiments of Crampe have estab lished the ratio between the body length and length of the intestines at eight and one-half times. By this proportion the length of the intestines in the animal the subject of this experiment was six hundred and eighty centimetres. A post-mortem measurement gave five hundred and thirty centimetres as the length. The balloon passed less than two hundred and fifty centimetres in traversing the intestines, and the difference is accounted for by the contracted condition which peristalsis induces. This condition of contraction was followed by relaxation behind the balloon, which rested in a sac of intestine for varying intervals. This was demonstrated by the difference in the distance traversed at ten-minute intervals during the progress of

the experiment. Subtracting the one hundred and forty-nine centimetres from the two hundred and twenty centimetres passed by the balloon the second time, we have seventyone centimetres as the length of the large intestine, the distance from the anus to the ileocæcal valve. Post-mortem measurement gave this distance seventy-three centimetres.

It was observed that peristalsis began a short distance below the pylorus, and was, as has been said, intermittent in pauses of even an hour's duration. It was also much more vigorous near the pylorus, and became less active as the distance from the stomach increased, as Nothnagel had shown previously. It was noticeable that the bolus which moderately filled the intestine passed more rapidly than the larger one which distended it. Expiration favored peristalsis. In the large intestine the balloon moved much more slowly than in the small bowel.

The relative vigor of peristalsis during day and night was 3 to 1.

Long pauses in the movement of the balloon were observed with some animals, which could not be explained.

As the balloon progressed more deeply into the bowel a secretion was established in the stomach, which was thought to be the result of reflex action.

The force exerted in normal peristalsis was measured by passing the rubber tubing over a pulley, and attaching to its extremity a bag in which shot was placed. The following were the results:

Just within the pylorus the force exerted by the intestine sustained two hundred and twenty-eight and one-half grammes, or about seven ounces. As the distance from the stomach increased, the weight sustained and raised diminished to 90.4 grammes and 75.5 grammes. While the author does not consider this portion of his experiment as at all conclusive, yet it illustrates forcibly the peristaltic power of the intestines.

In ascertaining the mode of action of laxatives the rubber tampon (the balloon) was allowed to go some distance in the intestine, and then kept stationary. A cathartic was given, and the phenomena attending its action in the presence of the tampon were observed, and, with the exception of ox-gall, none caused diarrhea, while their entrance to the small intestine only was allowed.

When the balloon was collapsed, diarrhea generally began promptly as soon as the drug had gone farther into the large intestine. As before, it was endeavored to fill the intestine without distending it, and potassium ferrocyanide was used as previously. In addition to those cases in which no diarrhea was caused by the descent of the laxative material, there was a proportion of cases in which the cathartic seemed reabsorbed by the intestine before it reached the large intestine.

The list of laxatives used in experimenting included sodium sulphate, castor oil, calomel, senna, croton oil, colocynth, gamboge, and oxgall. Each drug was given first, without its confinement in a particular part of the intestine, and its effect, when given in this manner, was contrasted with that produced when, by the agency of the balloon, its effect was limited to a particular portion of the bowel. At the conclusion of his experiments the author repeats as follows what we have stated: "All laxatives with which experiments were made, especially in active doses, occasioned no diarrhea when prevented by the balloon used from going into the large intestine."

These laxatives effected the results which followed their ingestion by a direct action on the mucous membrane of the intestine. Those drugs which cause laxative effects when injected into the blood are absorbed too slowly and in too small quantities when introduced into the intestine to produce their previous effects.

Supposing catharsis to result from accelerated peristalsis, these experiments would tend to show that the action did not result from the contraction of long portions of the muscular coat, nor from a rapid action communicated from one muscle to another, but through the irritation of successive portions of the mucous membrane of the intestine. It is also a reasonable supposition that the peristaltic distention, which was always present just above the balloon, was disseminated through the whole of the small intestine, and excited afterwards by the cathartic in the large intestine.

The author took especial pains to avoid the paresis of the intestinal muscle, which overdistention of the balloon used might have caused through its pressure, and the balloon was allowed to play only the part of a moderate accumulation of faces.-Deutsches Archiv für Klinische Medecin, Band 40, 1 Heft.

A NEW TREATMENT OF GONORRHEA.

that the microbe can only live in an acid medium; finding, moreover, that in this disease the discharge is, as a rule, acid, proposes to treat gonorrhea in the acute stages by urethral injections of sodic bicarbonate, three or four injections being made daily of a one per cent. solution. For this treatment, which is but a logical inference from the premises, he claims remarkable success, although the cases on which it has been tried in St. Mandrier, as yet, number only a dozen. The injections of bicarbonate of sodium are commenced as soon as the discharge appears, or the patient comes under observation; the urethral secretion is tested every day with litmus-paper, and the injection is kept up till the discharge becomes alkaline or neutral. For internal treatment the patient is given flaxseed tea, with occasional doses of bromide, if there seems to be any indication for the sedative effects of this salt. His conclusions are as follows:

1. The urethral pus in the first stages of the disease is generally, if not invariably, acid; this acidity is quite pronounced.

2. The treatment by bicarbonate of sodium rapidly lessens the discharge; it also rapidly diminishes or removes the pain in micturition.

3. In old urethrites, and in those which have been treated by the usual injections, it speedily brings about a cure. - Boston Medical and Surgical Journal, January 13, 1887.

THE SUBCUTANEOUS AND INTRAMUSCULAR INJECTIONS OF PREPARATIONS OF 10DINE IN SYPHILIS.

The rather unsatisfactory state of the therapeutics of syphilis at the present day justifies a careful attention to suggestions of improvement as found from time to time in the medical press. In addition to the exhibition of iodoform in syphilitic lesions, as discussed in a previous issue of the THERAPEUTIC GAZETTE, we now beg to review a recent paper of DR. CARL SCHADECK, of Kiew, which appeared in the St. Petersburger Medicin. Wochenschrift, No. 29, 1886, and advocates the employment of preparations of iodine.

Schadeck instituted a series of clinical experiments with the iodides of sodium and potassium on soldiers of the Kiew military hospital affected with syphilis. There were eight cases in all, and the number of subcutaneous and deep intramuscular injections made was ninety. The largest number of injections made in one individual was sixteen (in two cases); in the other cases the number of insalts of iodine.

R Potassii (sodii) iodat., gr. xlv;
Aquæ dest., fziiss.

This solution was daily prepared fresh, and injected by means of a Pravaz syringe, each patient receiving daily about 31⁄2 grains of the iodine salt. Of the ninety injections twentysix were carried deeply under the aponeurosis of the gluteal muscles (Arcari's method), and the remaining sixty-four in the ordinary manner. The deep intramuscular injections were made without raising a fold of the integument, piercing with the needle the skin, the cellular tissue, and the fascia perpendicularly. In this manner the entire quantity of the solution was carried directly into the parenchyma of the muscle.

The principal results obtained by Schadeck's experiments, as far as they interest the general practitioner, can be conveniently epitomized as follows:

1. The pain resulting from the injection itself, or the puncture of the needle, was either quite immaterial or wholly absent.*

2. The injected solution generated invariably a painful irritation, which differed in intensity, duration, and character in the various instances.

3. In no instance appeared an abscess or inflammatory infiltration on the point of injection.

4. In two patients appeared after nine or ten injections an iodine exanthema on face, trunk, and extremities in form of small acnepustules. This eruption disappeared almost immediately after withdrawing the applications.

5. As to the therapeutic effects obtained no palpable results could be anticipated, as the number of injections did in no case suffice to develop the full iodine action against the syphilitic lesions. It has repeatedly and conclusively been shown that iodine introduced into the system hypodermically is taken up by the bodily juices, and exerts thus its specific action. In two instances the experimenter succeeded in eliminating all syphilitic lesions by the ex

* In Germany the hypodermic syringes in use have all extraordinary long needles (compared with the American instrument), and are also carried into the muscular parenchyma in order to obviate pain and eventual abscesses of the cellular tissue.

6. Although these experiments are in themselves too scanty, and possibly too superficial to justify any definite conclusion as to the therapeutic value of the foregoing hypodermic uses of the salts of iodine, they nevertheless go far in showing that the mercurial treatment is no conditio sine qua non in the treatment of syphilis, and encourage further trials in the indicated direction.

A NOVEL TREATMENT OF PHTHISIS.

DR. BERGEON, of Lyons, recommends a method of treating phthisis which has, at any rate, the merit of novelty. His plan is to utilize the effects of sulphuretted hydrogen, and this he proposes to do by injecting carbonic acid gas, saturated with sulphuretted hydrogen, into the intestines. If care be taken to secure the absence of atmospheric air, no inconvenience, it is said, results from the injection even of large quantities of the mixture; absorption into the venous system and elimination by the lungs taking place very rapidly. It is claimed for this procedure that, by its means, the use of sulphuretted hydrogen is unattended with any toxic effects, and exerts its influence directly on the lungs themselves. It has been employed in a number of cases at the hospitals of Lyons, Bordeaux, and Paris, with great benefit to the patients, even in very advanced cases, and, latterly, similar observations have been made in the consumption hospitals of London, the results of which have not yet been made known. The method has been very much simplified by the introduction of an ingenious but simple apparatus whereby the carbonic acid gas is generated, and saturated with sulphuretted hydrogen, ready for use.-British Medical Journal, November 27, 1886.

THE DRUGS WHICH INCREASE AND DECREASE THE SECRETION

OF MILK.

GIURLEO calls attention to the peculiar properties of Ditana digitifolia, which, he claims, possesses the power to stimulate the secretion of the mammary glands, confirming the statements published in a previous issue of the GAZETTE. The author found an opportunity to try the remedy in a number of wet-nurses, and pronounces himself as extraordinarıly satisfied with the results obtained. In some instances, in which the secretion was