brief period, and then diminished; the bloodpressure is at first raised and then depressed, so that apparently the circulation and respiration are simultaneously affected, the action of the heart outlasting that of respiration. Quinquaud has given an extract of the seed in doses of 1 to 11⁄2 grains in various diseases, and has come to the conclusion that it can be used in paralytic affections of a toxic nature, atony of the intestines, and in tremor. some cases of urinary incontinence, distinct improvement followed the use of the drug. The indications for suspension of the treatment are the presence of headache, vomiting, or a sensation of weakness.-Provincial Medical Journal, November 1, 1886. A LIQUID VESICANT. In BIDET recommends the following: Cantharides is treated with choloroform in a distillation apparatus, so that the quantity of chloroform shall remain by redistillation a litre in the following mixture: Cantharides, 1000 parts; -Pharmaceutische Post, October 30, 1886. COLOMBINE. M. Roux has observed the effect of pure colombine on fowls, the only animals which he has been able to get to take the medicine by way of the mouth. The symptoms produced by the ingestion of the poison were those that are associated with fatty degeneration of the liver and destruction of its working elements. Colombine irritates the intestinal tube, causing increased secretion from the gastric, intestinal, and biliary surfaces. The occurrence of these serious symptoms makes it necessary that the administration of the drug to human beings should always be in the form of small doses. The daily dose to commence with should not exceed one centigramme (gr.) of the alkaloid, and the powders of columba are to be preferred to the less certain alcoholic and ethereal liquid extracts.-The Lancet, October 2, 1886. MOBILITY OF THE HEART. DR. M. M. SHERSHEVSKI publishes in the Vrach a paper on the mobility or displaceability of the heart. The fact that the heart's position is liable to slight changes, according to the position of the body, has been recognized by Bamberger, Gerhardt, Luschka, and other observers, but they have none of them formulated the conditions under which it takes place. Dr. Shershevski gives details of the examination of forty persons, all of them free from cardiac and pulmonary affections, in whom he noted accurately the position of the heart's boundaries in the upright dorsal, left lateral, and right lateral positions. chief mobility was towards the left side, but the heart was often quite perceptibly displaced to the right, as well as downwards and even backwards. The chief conditions under which this occurred were youth, nervous states, and freedom of the vessels from signs of sclerosis. Displacement backwards was found in nearly half the cases, and this shows that the heart ought to be examined in the upright posture. The writer specially re The marks on this when the examination is made as a prelude to the administration of chloroform, whereas, as a rule, the stethoscope is applied when the patient is lying down and in a very agitated frame of mind, which latter condition always renders the organ more easily displaced; and the diminished diameter due to this may lead to erroneous conclusions if the measurements be not previously taken in an upright position. This has reference chiefly to young persons. subjects over sixty years of age, and of much younger persons whose arterial system had already begun to show signs of degeneration, there was little or no displacement produced in any position.-The Lancet, November 20, 1886. In the case of CREASOTE IN CHOLERA MORBUS. Spir. chloroform, Tinct. opii, Sp. camphora, aä fziss; Olei cinnam., gtt. vii; Sp. vini gallici, fzii. M. S. 10 to 20 drops every five minutes. -Med. Record. ANOTHER CORN CURE. R Empl. adhæsivi, 1000 parts; L. art. -Süddeutsche Apothek. Z. In our last issue the residence of Dr. H. J. Boldt should have been given as 243 West Forty-second Street, New York, instead of 411 Sixth Street. 145 The Non-Contagiousness of Pulmonary anate of Ammonium on the Nervous System. By Wm. E. Parke, M.D.... 167 Remarks on the Therapeutic Value of Manaca, Jamaica Dogwood, and Euphorbia Piluli'era, Viburnum Prunifolium. By Allan S. Payne, M.D..... 171 Meteorology. By A. Comstock, M.D.. 174 Muriate of Pilocarpine in Uræmia. By A. D. Bundy, M.D....... Use of the Abdominal Bandage in the Second Stage of Labor. By Cheves Bevill, M.D.......... Leading Articles. 177 .... 177 PAGE Reports on Therapeutic Progress. The Therapeutic Value of Tincture of Morphine in Diabetes...... Antifebrin........... PAGE 183 ..... The Antiseptic Treatment of Summer 186 Cannabis Indica in the Treatment of Subacute and Chronic Dysentery...... 196 Persistent Vomiting as a Cause of Ear Troubles........... 196 Surgical Treatment of Hydatids of the Liver........... .......... 197 199 Cocaine Cotton.... ...... 200 The Administration of Phosphorus in Rickets......... Tests for the Purity of Cocaine............ 187 Reviews.......... Correspondence. 188 Absorption from the Mucous Membrane 200 200 ........ 201 .......... 207 209 ... 211 .... 212 tient and his surroundings. Therefore, fully appreciating the difficulties which envelop this problem, and holding the highest regard for the intelligent minds with whom we are compelled to take issue, we shall offer no other apology than the importance of the subject for making it the topic of this paper; with the express avowal, however, that this is not undertaken for the mere purpose of entering the arena of controversy, but from a conviction that the belief in the contagiousness of the disease is erroneous, and with a sincere desire to add something which, perchance, may be of value in placing this much-disputed question on a more solid basis than it has heretofore occupied. Viewed from the broad stand-point of evo lution, as this question naturally must be, it will appear that all the infectious diseases are the result of a living union and interaction of unlike though not too highly specialized cells; or, to be more specific, these diseases are the products of grafting one cell on another, a process identical with that of grafting practised in the vegetable world, and with skin-grafting frequently resorted to in the human subject, and their intensity depends on the activity of the reproductive power with which these cells are endowed. This reproductiveness is common to every living cell in the animal body, but varies widely in different cells, being most active in those which are least differentiated, or, in other words, in those which retain the nearest approach to the original cell-type. In the lower stages of life all the cells in an organism are equally endowed with the power of reproduction, and any indifferent segment is capable of reproducing the whole animal. Thus, protozoa multiply by spontaneous fission, and the original organism resolves into a number of new individuals like the parent. But in the evolutionary changes of animal life the cells of some tissues undergo a greater modification than those of others, and those which diverge most from the original type become the least reproductive, while those which undergo no, or very little, change remain the most reproductive. In this higher stage of life the process of reproduction is carried on by a specialized tissue, the ovary and testis, the cells of which only retain the power of reproducing the whole animal, while in the cells of the other tissues, although they are still capable of reproducing themselves, this power is lost. The form elements of the body consist of epithelial tissues, tissues of the connective substance, the muscular, and nervous tissues, and of all these the nervous tissue has the highest and the epithelial tissue the lowest organization. Gegenbaur says that epithelium represents both phylogenetically and ontogenetically the oldest and most primitive form of cellular tissue. Now, reproduction itself is generally regarded as a very complicated process, and one for the performance of which highly specialized organs are considered essential; but on examination it will be found that both the sperm-cell and the germ-cell originate in the epithelial layer, which, as we have seen, is the simplest and most unspecialized tissue in the body. Hence, from a biological point of view, it is an extremely simple process. In relation to this subject Herbert Spencer ("Biology," vol. i. p. 220) says, “The organs for preparing sperm-cells and germ-cells have none of the specialty of structure which might be looked for did sperm-cells and germcells need endowing with properties essentially unlike those of all other organic agents. On the contrary, these reproductive centres proceed from tissues that are characterized by their low organization. In plants, for example, it is not appendages that have acquired considerable structure which produce the fructifying particles: these arise at the extremities of the axes, where the degree of structure is the least. The embryo-cells are formed in the undifferentiated part of the cambium layer; the pollen-grains are found at the little-differentiated extremities of the stamens, and both are homologous with simple epithelium-cells. Among many inferior animals, devoid of special reproductive organs, such as the hydra, the ova and spermatozoa originate in the layer of indifferent tissue that lies between the endoderm and the ectoderm,— that is, they consist of portions of the least specialized substance. specialized substance. And in the higher animals these same generative agents appear to be merely modified epithelium-cells,-cells not remarkable for their complexity of structure, but rather for their simplicity." But this is not all that concerns us here; for, in accordance with a well-known physiological law, organic cells manifest an elective affinity for one another during the process of fertilization, which is weakest when the sperm- . cell and the germ-cell possess too much sameness, and strongest when these cells originate from the same tissue in different individuals of the same species. This is well shown in the vegetable world. Nearly all plants are hermaphrodites,—that is, they are so situated that it is possible for the ovules of each flower to be fertilized by pollen from the same flower; yet practically this does not occur, for Mr. Darwin has demonstrated that either the ovules and pollen of the same plant do not ripen simultaneously, or that other obstacles arise which prevent fertilization in this direct way, and that the most vigorous vegetation is produced when fertilization takes place between different plants. The same law of cell affinity also exists in the highest organisms. That which is of the greatest interest to us at present in these biological phenomena is (a) that the cells of every tissue in the animal body possess the power of reproducing themselves; (b) that the power of reproducing the whole individual is shared only by the cells of the epithelial tissue; and (c) that the process of reproduction is most active between the slightly differentiated cells of the same tissue not in the same, but in different individuals. And we shall find that these deductions are as applicable to pathological as they are to physiological processes, for disease is propagated in the same manner as health is. When under proper conditions a germ which has been modified by disease is grafted on a healthy germ, disease-germs will be produced, and the number of disease-germs thus produced will depend on the facility with which both germs reproduce themselves; and from what has been said it is evident that disease-germs will be most abundant when the epithelial tissues are involved, and least abundant when they originate in the nervous or muscular tissues, while those coming from the white or connective tissues occupy an intermediate position in this respect. We have now arrived at a point where we are enabled to define the term contagion. Broadly, it may be stated that all infectious diseases are either contagious or inoculable, and that both of the latter terms represent processes which differ in degree only and not in kind. It is essential to both that their respective germs should find lodgment in the circulation before the disease is transmitted from one individual to another, and whether a germ is contagious or not depends on the facility with which it gains admission to and multiplies itself in the tissues for which it has an affinity; or, in other words, if a germ has the power of entering the circulation through the coverings of the body, it is a contagious germ; but when this is not the case, and it must be introduced by means of artificial force, then the germ is not contagious, but inoculable. Now, the facility with which a germ enters the blood is in a great measure owing to its reproductive activity outside of the blood. A germ which rapidly multiplies, and which disseminates a great number of contagious germs throughout the atmosphere, will expose the recipient body to a greater number of such germs in a given time, and hence will be more communicable than that germ which is devoid of these properties, or possesses them in a less degree. That the numerical element plays a very important part in the process of contagion and of inoculation is very evident from the examples which Darwin gives us in illustration of the analogous process of sexual genesis. He says, "This view of the importance of * Animals and Plants under Domestication, vol. ii. pages 435 and 436. the quantity of formative matter seems probable from the following considerations: There is no reason to suspect that the spermatozoa or pollen-grains of the same individual animal or plant differ from each other; yet Quatrefages has shown in the case of the Teredo, as did formerly Prevost and Dumas with other animals, that more than one spermatozoon is requisite to fertilize an ovule. This has likewise been clearly proved by Newport, who adds the important fact, established by numerous experiments, that, when a very small number of spermatozoa are applied to the ova of Batrachians, they are only partially impregnated, and the embryo is never fully developed. The first step, however, towards development, namely, the partial segmentation of the yelk, does occur to a greater or less extent, but is never completed up to granulation. The rate of the segmentation is likewise determined by the number of the spermatozoa. With respect to plants, nearly the same results were obtained by Köreuter and Gartner. This last observer found that even thirty grains did not fertilize a single seed; but when forty grains were applied to the stigma, a few seeds of small size were formed. Naudin made the following interesting experiments: A flower was fertilized by three grains, and succeeded perfectly; twelve flowers were fertilized by two grains, and seventeen flowers by a single grain, and of these one flower alone in each lot perfected its seed, and it deserves especial notice that the plants produced by these two seeds never attained their proper dimensions, and bore flowers of remarkably small size." Taking into consideration, then, what has been said concerning the fertility of the epithelial tissues and the comparative infertility of the other tissues, it will be obvious on a priori grounds that those diseases which are located in the former are contagious only, while those lodged in the latter are inoculable but not contagious; and we shall see with what remarkable uniformity this induction obtains among the infectious diseases when they are classified in accordance with this idea. Thus, the principal infectious diseases of the epithelial tissues are It will be observed that the contagiousness of the first group of the infectious diseases as above given is directly related to the severity of the cutaneous eruption; and this is a practical confirmation of the above-made deduction that the degree of contagiousness is due to the number of contagium particles thrown off from the skin and diffused throughout the atmosphere. Smallpox produces the most extensive as well as the most intensive disturbance in the skin of any of the eruptive fevers, in all probability emits the greatest number of germs, and is admittedly the most contagious. Next in order of contagiousness comes measles, the cutaneous disturbance of which is no more marked than that of scarlatina; and yet it is said to be more contagious, because the eruption of measles is chiefly confined to the skin, while the most intense lesions of scarlatina are concentrated in the throat, from whence the contagium particles are less readily diffused than they are from the free external surface of the body. Then, again, it is a well-known fact that in many cases of measles the cuticle is cast off in a finer state of division than it is in scarlatina, and this of itself renders the epithelial germ of the former disease more diffusible. Owing to the violence of the process of diphtheria, this disease, although not accompanied by any well-defined skin-affection, ranks next to scarlatina in point of contagiousness. In regard to the contagiousness of typhoid fever, in the sense in which the former term is used here, there can be but one opinion, but for the reason which has already been given, viz., that diseases of the internal surfaces are less contagious than those of the external surfaces, its contagious influence is rather limited. Occasionally, however, in cases where the dejecta are unduly exposed to a dry and warm atmosphere, or where they are confined in an improperly ventilated cesspool, the contagium particles diffuse so rapidly in the first instance, and accumulate and enter dwellings through drainage-pipes in such quantities in the second, that they become an undoubted source of contagion. Gonorrhoea is the only one of the infectious diseases of the epithelial tissues in the above list which is not contagious; due, undoubtedly, to the fact that only a small surface area is involved, and that the lesion is confined to a tubal cavity with a narrow opening on the outside, all of which forbid a multiplication and dissemination of germs in sufficient quantity to give rise to the danger of infection through contagion. Erysipelas is essentially a skin-disease, and, as a rule, is non-contagious. Generally it is limited to a comparatively small area, and hence is not so liable to contaminate the surrounding atmosphere, and so become contagious; yet when the disease involves a large extent of surface, and at the same time exists in an aggravated form, or becomes epidemic, it certainly throws off a sufficient number of gemmules to become contagious, as is well attested by many clinical facts. From what has already been said it follows that the infectious diseases of the second group cannot be contagious, because they are principally located beneath the cutaneous and mucous surfaces of the body. It is well ascertained that, with the probable exception of carcinoma, all of them originate from or inhabit the connective tissue. Thus sarcoma and syphilis invade the subcutaneous, the submucous, or subserous fibrous tissue, or the connective tissue of other organs; while tubercle infects the lymphatic system, which is but a modified form of the same tissue. There can be no doubt that the stroma of cancer is of connective-tissue origin, but whether its cells come from the same source, or are of epithelial origin, is a disputed point among our best histologists. This is immaterial so far as the question is here concerned, for these growths, like those of sarcoma, syphilis, and tubercle, are almost exclusively confined below the bodily surfaces, and hence have not sufficient communication with the atmosphere to become contagious. All these diseases are, however, infectious, for they have been communicated by means of inoculation. They all manifest a strong tendency towards auto-infection,-i.e., the original cells multiply and distribute their germs throughout the body by means of the blood and lymphatic circulation. In this manner sarcoma and carcinoma disseminate themselves and become very malignant in their course, the rapidity of the dissemination depending somewhat on the softness or succulency of the original growth. In the same way syphilis and tubercle are capable of contaminating the white or connective tissue of the principal organs of the body from one infectious centre. Thus when the infectious diseases are |