THERAPEUTICS AND PHARMACOLOGY.

BROMOFORM in five to twenty drops daily is said to exert a beneficial effect on pertussis.

ERYTHRINA.-Dr. Altimirano found alkaloid extracted from the seeds of erythrina coralloids to act in similar way to curare.

SULPHONAL AND DIGESTION.-Cramer has found that functions of the pancreatic juice are not at all interfered with by sulphonal.

PILOCARPINE IN TOXIC AMBLYOPIA.—Dr. Leptat (“"Annal d'Oc.") has found hyperdermic injections of pilocarpine of value in tobacco and alcohol amblyopia.

COLLAPSE FROM ANTIFEBRIN.-Dr. Jas. Wilding ("Brit. Med. Jour.") reports a case of acute tuberculosis in which ten grains of antifebrin produced decided collapse.

SORE

ACETANILID IN SCARLATINAL THROAT. Dr. Sahli (“Brit. Med. Jour.") claims good results in scarlatinal sore throat from three to six-grain doses of acetanilid thrice daily.

SULPHONAL IN FRACTURE-SPASM.- Dr. Edmund Andrews ("Jour. Amer. Med. Assoc.") states that sulphonal has very marked effects on the pain and reflex spasm from fractures.

PILOCARPINE IN TRAUMATIC TETANUS.Dr. Carati ("Brit. Med. Jour.") claims good results from the use of one-sixth grain doses of pilocarpine muriate in traumatic tetanus.

ARSENIOUS ACID IN GLYCERIN.-Siebold ("Brit. Med. Jour.") claims that a large number of specimens of commercial glycerin contained arsenious acid in a proportion of from I to 4,000 to 1 to 6,000 parts.

SOMNAL, a new hypnotic, is an ethylated chloralurethan. It is a clear liquid, readily soluble in water or alcohol. The dose is from fortyfive to ninety grains. Its physiological properties are not yet fully described.

OLIVE OIL AND BILIARY SECRETION.-Dr. Rosenberg claims, from experiments on dogs, ("Therap. Montsthft.") that olive oil increases the flow of bile and decreases its specific gravity. It may hence be of value in the treatment of gall stones.

CALOMEL IN HEPATIC CIRRHOSIS.-H. Kohn ("Centbl. f. ges. Therap.") has had good results in hepatic cirrhosis from the diuretic action of calomel. He gave three grains of calomel thrice daily, guarded by opium. A

potash chlorate mouth wash was used at the same time. Dr. Clevenger (MEDICAL STANDARD, Vol. II.) pointed out the principles underlying this use of calomel.

ICEBAG IN NIGHT SWEATS.-Dr. Rosenbach has had (“Wien. klin Woch.") good results from the icebag in the night sweats of phthisis. The icebag is applied frequently during the night over the abdomen. Its continued use is said to be well borne.

IDEAL ANTISEPTIC.-Dr. Rotter (Satellite") claims that the following mixture is an ideal antiseptic:

B Corrosive sublimate.
Sodium chloride.
Acid carbolic...
Zinc chloride

..5 parts. ...25 200

64

66

300

....60

..aa Io 100,000

This solution does not corrode surgical in

struments.

SULPHONAL IN INSOMNIA. Dr. S. Garnier ("Ann. Med. Psych.") finds that in cases of insanity where sulphonal is administered every other night the patient is quiet in the interval. He finds it more reliable than urethan, paraldehyde, or chloral hydrate. His results tend to corroborate those of Dr. Harriet C. B. Alexander (MEDICAL STANDARD, Vol. V.) He has found that in about five and one-half per cent. of the cases vomiting is observed, and in seven. teen and one-half per cent. slight diarrhoea resulted. Dr. Alexander had a similar experience, but attention to the gastro-intestinal canal prior to the use of sulphonal prevented these results.

MERCURY BENZOATE IN SYPHILIS.-Dr. Stukovenoff ("Satellite") has had good results from mercury benzoate in syphilis employed in the following methods:

1. Either it was injected deeply into the gluteal region in solution:

R Hydrargyri benzoici ox

y dati...

0.25 gramme (gr. iv) Sodii chloridi.. 0.06 gramme (gr. j). Cocaini hydrochlor... 0.13 gramme (gr. ij). Aquæ destill.... ...29.57 grammes (j) M. Sig.: Dose, one hypodermic syringeful daily.

Introduced in this way, the drug acts swiftly; roseoles wholly disappeared after 3 to 10 injec

tions, papules after 6 to 15, tubercles after 8 to 20, periostitis and gummata after 12 to 24. Intense salivation does not occur. Gingivitis is rare and mild.

2. Or it was injected in the form of the following 10 per cent. emulsion:

R Hydrargyri benzoici oxydati.

Vaselinæ puræ,

Olei vaselini, aa q. s. ut fiat suspensio 10 per cent. hydrarg. benzoici.

Sig.: Inject deep into each gluteal region 0.025 gramme (gr. 2-5).

Roseoles and other syphilitic symptoms disappear after two or three (double) injections (0.10 to 0.15 Gramme [gr. 1% to 2%]) of the drug. The procedure causes a slight burning, which sometimes lasts for two or three days. Moderate gingivitis and salivation are rather frequent.

3. Further, the drug was given internally in pills (with some bitter extract and licorice root), beginning with 0.006 to 0.021 Gramme (gr. 1 to 13) at a time, twice daily. The therapeutic effects are comparatively weak. Roseoles begin to disappear on the twelfth to the fifteenth day, after forty to sixty pills have been taken. Occasionally (in two cases out of fifteen) diarrhoea follows.

4. Externally the benzoate was used either in powder (per se or in mixture), or in aqueous so lution (in chancroids 1 to 3 pp. to 500 of water, or 1 to 2 pp. to 3.000 of water in syphilitic ulcers). Chancroids become clean and lose their specific character after three or four applications of powder (i. e., in one or two days). There is a fairly severe burning, even when a bland diluent is used (1 to 4). Hence, the lotion mixed with cocaine is preferred.

5. In gonorrhoeal urethritis and cystitis, injections of a solution (1 to 7,680 of water) are used three times a day. In acute gonorrhoea, intra-urethral injections of this strength rapidly diminish the discharge, and relieve pain on micturition. After acute symptoms disappear, increase to double strength.

SURGERY.

VESICAL PROSTATISM.-Under this title Guyon ("Amer. Jour. Med. Sc.") discusses the symptoms which characterize the third stage of hypertrophy of the prostate, and which are produced by senile changes in the muscular apparatus of the bladder, with or without enlargement of the prostate. This condition consists in a connective tissue degeneration of the vesical muscles, and may lead to marked distension of the bladder. The tumor formed by the distended bladder has often given rise to diagnostic

errors.

Two clinical symptoms are of especial importance. Polyuria, which is attributable to interstitial renal changes, and hæmaturia, due to the congestion of the vesical mucous membrane. The primary cause of prostatism is an arterial sclerosis of the kidneys, bladder and prostate. In some cases cure may be effected. In the treatment it is of importance not to evacuate the bladder at one sitting, since this may give rise to profuse hæmorrhage. Catheterization must be practiced under strictest antiseptic precautions. If cystitis is present irrigation with saturated solutions of boric acid is indicated.

TREPHINING IN SKULL INJURIES.-Dr. H. F. Zeidler ("Medical News") concludes that cerebral symptoms in cases of head injury indicate trephining only when signs of intra-cranial hæmorrhage are present. In simple fractures of the skull unaccompanied by symptoms of intra-cranial hæmorrhage, trephining is not indicated. Depression of fragments of bone cannot of itself be considered as an indication for trephining. The object of primary trephining, which should be performed as early as possible, is asepsis, or the arrest of hæmorrhage. Secondary trephining is indicated even when symptoms of commencing meningo-encephalitis. are present, and in some cases will abort the inflammatory process. Trephining is indicated in cases of depressed fracture, in which the fragments irritate the brain and provoke epileptoid seizures. In fractures opening into the sinuses the bleeding should oe arrested by the antiseptic tampon, and not by suture. The term trephining should only be applied to the operation upon the uninjured skull, the term débridement being a better designation for operative measures employed in complicated cranial frac

tures.

measures.

URETHRAL INJURIES.-Dr. C. Hagler ("Internat. Jour. of Surg.") concludes that in extensive lacerations of the urethra immediate external urethrotomy is to be preferred to all other The posterior end of the urethra should be sought for, and may be usually found without difficulty in recent cases. The divided ends should be brought together by sutures as accurately as possible, although exact coaptation is not always necessary. The question whether the mucous membrane should be included in the suture has not been as yet satisfactorily decided. The sub-mucous suture, however, has much in its favor. The employment of a permanent catheter for a short time (twenty-four to forty-eight hours) is preferable to repeated catheterization. The perineal wound should not be closed, so that in case the sutures give way there will not be infiltration of urine. Bougie

cause of hæmorrhoids exists in the increase of volume of the uterus, which acts by compression on the rectal veins; besides this, there is a vascular tension in the organs of the pelvic region which is much increased during pregnancy, and the anorectal veins permit of easy dilatation through this extra fluxion. Constipation then is also usual, and the consequent distension of the rectal ampulla irritates the mucous membrane and causes increased effort during defecation. As to the symptoms and complications they are the same as in any hæmorrhoidal cases, and the diagnosis of vegetations is not difficult, owing to the bright-red color of the latter. It is essential to remember that hæmorrhage may occur from internal piles during pregnancy, and not to mistake it for some other and more serious bleeding. Budin advises Storer's method of turning the rectal mucous membrane inside out in such cases, and it is the most certain way of avoiding a mistake in diagnosis. It is practiced as follows: The index finger is passed into the vagina along the posterior wall, and when it has gone beyond the anal sphincter it is turned forward like a hook, and continuous pressure is made from above downward on the rectal membrane until it is turned inside out and appears at the anus little by little; then, if there is an internal pile, a smaller or larger black tumor will be seen on the membrane. (It need hardly be said that the finger nail should be cut close before doing this operation). As to treatment, one should not fear to purge pregnant women and to advise moderate exercise and baths; but there is a difference of opinion as to the kind of evacuant to be used. Tarnier and others think well of castor oil, but Fordyce Barker accuses it of causing irritation of the rectum and conges

157

tion of the pelvic organs. M. Budin finds that sodium sulphate (in three six-drachm doses) acts very well. Leeches are not applied now to hæmorrhoids, as it is feared that they may open the door to infection. All such patients should use lotions of water for cleanliness, as the use of paper after defecation may bring about hæmorrhage by rubbing too hard and irritating the piles.

PULSE DURING PUERPERIUM.-The "Montreal Medical Journal" says that as a rule the pulse begins to slow down immediately after labor. It is most rapid at the beginning of the first week, less rapid at its end, alike in multipara and primipara. Beginning at 61, it falls to 50-51. There is a diurnal variation in the pulse curve as in the temperature curve. The pulse is slowest at midnight and quickest at 8 A. M.; it rises most from 6 A. M. to 8 A. M., and from 12 M. to 2 P. M. The difference between the maximum and minimum rate any one day is on an average seventeen beats (60-77). The pulse rises after meals. The slowest pulse taken during these observations was 36, which was found on two occasions in nursing multiparæ on the seventh day. Blot and Depaul have observed a pulse of 35 in the puerperium, Olshausen and Quinquaud 34, while McClintock has reported a pulse of 30 after the birth of triplets. This is the slowest puerperal pulse yet recorded. The main cause of pulse-slowing in the first puerperal week is probably the altered condition of the blood, while physical and mental repose is probably a subsidiary factor. Has the pulse-rate any prognostic value? As long as the pulse remains slow the puerperal patient is not suffering from any serious febrile disturbance, but as soon as febrile symptoms appear, the pulse rises. If there is elevation of temperature without corresponding rise of puise, the febrile disturbance is probably only ephemeral. Of course a diagnosis or prognosis cannot be safely based upon the consideration of a single symptom; the pulserate must be considered along with the temperature curve, and the other symptoms subjective and objective. After regular labors the temperature rises continuously and reaches its maximum in six or seven hours, then it falls steadily for ten to twelve hours, and reaches its minimum sixteen to nineteen hours after delivery. The remission is greater than the rise, because at the conclusion of labor the temperature is above the normal. In primiparæ the temperature two to three hours after delivery is almost half a degree higher than in multiparæ, but in eighteen or nineteen hours the effects of the more severe labor have passed off and there is no longer any marked difference between them. After irregu

lar labors the temperature is one-half degree to one degree higher than after regular labors, and it takes a proportionately longer time to fall to the normal A normal temperature curve for the first twenty-four hours is a favorable prognostic as far as it goes, but of course is no guarantee of a subsequently favorable puerperium.

VESICO-VAGINAL FISTULE.-Dr. Polaillon ("Satellite") reports the following new operation: The case is that of a young woman who introduced some hairpins into the bladder. Around these foreign bodies calculi formed, which were removed by a vaginal incision. After the operation there remained a fistula of some size, situated upon the posterior wall of the urethra. Many attempts at closure were made by different surgeons, but without success. M. Polaillon dissected across the orifice of the fistula a fold of mucous membrane from the internal portion of the anterior wall of the urethra and of the neck of the bladder, and sutured it to the posterior wall of the urethra. After a month and a half or two months at the hospital she was discharged cured. There remained behind the obliterated fistula a narrow track, owing to a suture that had cut through the tissues. The patient urinated by the meatus, and a little later by the narrow track produced by the suture, but she never had incontinence. The urine did not irritate the denuded surface.

GENERAL MEDICINE.

INSANITY FROM MUMPS.-Cases of this ætiology have lately been reported which do not differ in their symptomatology from cases due to other acute conditions of constitutional exhaustion.

DIPHTHERIA CONVEYED BY CATS.-Dr. Lawrence of Halstead, Kan., states ("Med. Age,") that he was called to attend a three-old girl with diphtheria. She had not been exposed to the disease, although there were some cases within a mile of her father's house. He incidentally learned that there was a sick cat in the house, which had been fondled by the little girl some days before. The cat died shortly after its playmate becaine sick, and a second cat also became sick and was killed. Suspicions were aroused that the disease was conveyed by the cat, and inquiry revealed the fact that one neighbor farmer had lost seventeen cats, and another fifteen, with some throat trouble. One of the farmers stated that he had examined the throats of some of the cats, and found them covered with a white membrane. The little girl died and her little brother a few days later had a

severe attack of the same disease. Cats are disposed to run from house to house at night and one diseased cat may be the means o carrying diphtheria to half the cats in a neighborhood, they in turn carrying it to the children whom the parents are taking every means to protect from danger, It is well to keep an eye on the cats in times of diphtheria. Dr. Kiernan ("MED. STANDARD, Vol. V.") in a discussion before the Chicago Medical Society, called attention to the possible dangers from this source of infection.

SKIN AND GENITO URINARY DISEASE. CRAB LICE IN THE EYELASHES.—Dr. J. M. Winfield reports four cases of this rare condition ("Jour. of Cut. and Genito-Ur. Dis.") in children from two to eight years old. The cilia are the only angular hairs in children, whence the frequency of this parasitic location in childhood.

SYPHILIS FROM TATTOOING.-Dr. H. R. Whitehead ("Brit. Med. Jour.") reports that twelve soldiers were tattooed by a skillful tattooer, who had mucous patches. Sometimes he used saliva, and in five instances syphilis resulted therefrom. The sores were of the true Hunterian type. The incubation was short.

VARIOLOFORM ERUPTION FROM MERCURY BICHLORIDE. Dr. Guelpa ("Jour. des Mal. Cut. et Syph.") reports a case in which mercury bichloride vaginal injections were given to heal perineal cuts made to facilitate labor. Ten days thereafter lentil shaped reddish macules, which were disseminated and confluent, made their appearance on the hands, forearms and feet. The abdomen was covered with a dense miliary reddish eruption. Some papules were also present. Similar 'cases have been reported in Lewins' "Untoward Effects of Drugs."

MULTIPLE FACIAL CHANCRE.-Dr. M. J. Braquehaye ("Ann. de la Polyclin. de Bordeaux") reports a case of a twenty-four-yearold woman who, six months after marriage, observed a papule on the left cheek. Two weeks later one appeared on the chin to the left of the median line. Seven days later one appeared on the lower lip slightly to the right. A month and a half after the first lesion a seemingly cicatricial patch about the size of a twenty-five cent piece, with a coppery raised bor. der was present on the left cheek. There was an elevated lesion with a dime-sized base on the chin. A pea-sized elevation resulted from the lower lip papule. Alopecia, roseola, laryngitis and headache followed, which disappeared under anti-syphilitic treatment.

THE MINNESOTA BOARD OF HEALTH elected Dr. F. Staples of Winona, president.

THE BEAUMONT HOSPITAL AND MEDICAL COLLEGE in St. Louis was destroyed by fire October 9.

SHELBY CO. (ALA.) MEDICAL SOCIETY met Aug. 8. Dr. Jerome Cochrane read a paper on "Sanitation."

SAN JOSE (CALIF.) MEDICAL SOCIETY.-At the August meeting, Dr. Wright read a paper on "Injuries to the Head."

ANDERSON COUNTY (TEX.) MEDICAL SOCIETY.— At the August meeting, Dr. J. W. Douglass read a paper on "Hæmorrhagic Fever."

THE COLLEGE OF PHYSICIANS AND SURGEONS OF CHICAGO held their annual opening exercises Sept. 24 Dr. A. Reeves Jackson presided.

THE LUZERNE COUNTY (PA) MEDICAL SociEry, at its last meeting, discussed typhoid fever, Drs. Woodbury of Philadelphia, and Taylor, opening the discussion.

THE CHICAGO WOMEN'S MEDICAL COLLEGE was opened by addresses by Drs. W. H. Byford and Mary A. Mixer. Over one hundred students have been enrolled.

THE CHICAGO MEDICAL COLLEGE held its thirtyfirst annual opening exercises in the college building Tuesday evening, Sept. 24. The introductory address was delivered by Dr. N. S. Davis, Jr.

CLARK COUNTY (CALIF.) MEDICAL SOCIETY.— At the August meeting, Dr. W. A. Smith read a paper on "Typhoid Fever Complications," which was discussed by Drs. Henan, Morrison and Hall.

PLYMOUTH DISTRICT (MASS.) MEDICAL SOCIETY. -At its August meeting papers were read on "Intubation" by Dr. G. W. Gay of Boston, and on "Post Diphtheritic Paralysis" by Dr. Roland Hammond of Campello.

THE CINCINNATI POLICLINIC elected the following officers for the ensuing year: Dr. Charles A. L Reed, dean; Dr H. Longstreet Taylor, secretary; Dr. Rufus B. Hall treasurer; Dr. T. V. Fitzpatrick trustee (five years).

CONGRESS OF PHYSICIANS -At the recent meeting in Philadelphia of the Executive Committee of the Congress of Physicians, an election was held for officers for the congress to be held in Washington, in September of 1891. Dr. S. Weir Mitchell was elected president, and Dr. William H. Carmalt of New Haven, secretary. Dr. C. H. Martin

of Mobile, was first nominated, but declined on the ground that no member of the Executive Committee should ever be elected to the presidency of the congress.

THE CHESHIRE COUNTY (N. H.) MEDICAL SoCIETY has chosen the following officers: President, Dr. M. T. Stone of Troy; vice-president, Dr. H. M. Dinsmore, of Keene; secretary and treasurer, Dr. I. J. Prouty of Keene.

BRIDGEPORT MEDICAL SOCIETY.-At the Au gust meeting, papers were read on "Operative Pro cedures in Brain Tumors" and on "Chronic Copper Poisoning" by Drs. J. W. Wright and C. C. Hoyt. The society is about to establish a medical library.

RUSH MEDICAL COLLEGE.-The forty-seventh annual course of lectures in Rush Medical College was opened Tuesday evening. Sept. 24, at 8 o'clock. Prof. Nicholas Senn delivered the introductory lecture. and Subject: "Regeneration Repair."

THE WESTERN ILLINOIS MEDICAL AND SURGICAL SOCIETY met at Roodhouse. Dr. Black of Jacksonville, read a paper on "Hot Air in Tubercu losis which was discussed by D:s. McEwen, Brown, Thomas and Allen of Roodhouse; Du Hadway and Van Horn of Jerseyville; Day of Winchester, Williams of Otter Creek, and Armstrong of Carrollton.

THE SUPERINTENDENTS OF ASYLUMS FOR IMBECILES held its annual meeting at Beatrice, Neb., Oct. 10. The following officers were elected: President, Dr. A C. Rogers of Minnesota: vice-president, Dr. J. L. Armstrong of Nebraska; secretary and treasurer, Dr. I. N. Kerlin of Pennsylvania. The next annual meeting will be held at Faribault, Minn., the date to be fixed by the president.

THE KALAMAZOO ACADEMY OF MEDICINE, at its regular meeting listened to the following papers: "Anæsthetics in Labor," G W. Nihart, Mendon; "Puerperal Convulsions from a Clinical Standpoint," Paul T. Butler, Alma; "Senile Gangrene Following Erysipelas," L. E Clark, Otsego; "Empyema of the Chest," H S. Smith, Schoolcraft; "Cholera Infantum," Rush McNair, Kalamazoo.

CHICAGO MEDICAL SOCIETY --At the August meeting, papers were read on "Sacro-Iliac Tuberculosis" by Drs. Hektoen, B. Holmes and J. B. Her rick; on "Fishbone in the Larynx" by F. E. Waxham; on "Intestinal Obstruction" by Dr. C. W. Earle; on the "Medical Library" by Dr. B. Holmes. Dr. J. H. Robison reported a case of subcutaneous fracture of the left ninth and tenth ribs, with