has followed this method in thirty cases and has never seen it fail to diminish the amount of sugar in the urine. One of his cases, a woman of sixty-eight, had had a double cataract for two years. She passed five or six quarts of urine a day, and it contained two and a half ounces of sugar to the quart. Subcutaneous injections of ergot were practised for fifteen days. On the eighth day the sugar was reduced to one half ounce per quart. On the fifteenth day the patient read the newspaper. Treatment was suspended for a month, when the sugar increased to over an ounce per quart. On commencing the injections again the sugar fell to three drachms per quart. This patient would never consent to diet. L'Union Méd., Nov. 13, 1886.

Chéron (J.) on Camphorated Bisulphide of Carbon in the Treatment of Lumbo - Abdominal Neuralgia.The writer employs a saturated solution of camphor in the bisulphide of carbon. It is applied to the painful point for three or four minutes by means of a brush. The skin becomes white as the camphor is left in a fine adherent powder on the evaporation of of the solvent. It produces first a sensation of intense cold followed by a burning. It produces a marked local anæsthesia. The writer has found it particularly useful in neuralgias of the lumboabdominal type, painting the skin covering the lumbar spine, the sacrum, and the points of emergence of the small sciatic nerves. Rev. de Thérap., Dec. 1, 1886.

Cimicifuga in Chorea.-Dr. D. Colvin, of Clyde, N. Y., corroborates, by a thirty-years' experience, the very great utility of cimicifuga in chorea, as recently advocated by Dr. H. Corson.' He also finds it very useful in rheumatism and the nervous irritability of phthisical patients. Dr. Colvin gives it daily in the last month of pregnancy, when he has reason to suppose that labor will be tedious, and with the best results.-Med. and Surg. Reporter, Dec. 1, 1886.

Love (J. N.) on Vaginal Alimentation. The author says: "In many cases vaginal feeding, stimulation, and medication is beneficial; in many others it is a potent means for saving and prolonging life.

"Whether the vagina or rectum be used for purposes of feeding, the materials

1 See MEDICAL ANALECTIC, Dec., 1886, p. 535.

should be as thoroughly digested previous to using as is possible; the milk, albumen, or beef fibre completely peptonized and the starchy matters changed into dextrose or glucose."

After the introduction of the food or medicament, he usually places over the vaginal opening a small mass of absorbent cotton covered with oil silk, and held in position by a T-bandage.-New Eng. Med. Monthly, Nov. 15, 1886.

Stockman (R.) on the Action and Therapeutical Value of Vegetable Astringents.-Either when locally applied, or after absorption into the blood, gallic acid evidently exercises no other action than that of a weak inorganic acid, and certainly has no claim to any special action as an astringent. The only action which it can have in this direction, is the power which it possesses, in common with all other acids, of diminishing the alkalinity of the blood, and thereby increasing its tendency to coagulate. Stronger acids, however, will act much more powerfully in this direction than it does. Any influence in lessening the calibre of the blood-vessels, either by peripheral or central action, must be denied to it. When locally applied, the fact that it does not precipitate albumen must prevent it having any influence on a catarrhal inflammation.

As regards tannic acid, the matter is somewhat more complicated. Locally applied, its action for good depends on its power of precipitating albumen, the layer of tannate of albumen which is formed acting as a protective to the underlying mucous membrane. To this action is due its value in catarrhal inflammations of the alimentary canal, and in discharging surfaces generally.

Its usefulness is limited to such cases, and that as a remote astringent it is valueless. In weak solution, and uncombined, its action on contractile tissues, such as the vascular walls, is simply that of a dilute acid, while it is only when stronger solutions are used (much stronger than can ever exist in the blood, even if it were not in combination there) that its power of precipitating albumen comes into play. When its chemical affinities have been satisfied by neutralizing it with a base or with albumen, it is no longer capable of precipitating albumen, and exercises, therefore, little or no influence on the parts with which it comes in contact.

Independently of these considerations, the very small quantity in which it exists at any one time in the blood, and that in combination, must also militate against its having any remote action. As we have seen, the only channels of excretion besides the bowel are the kidneys, and hence it is hardly possible that it can have an astringent action on any of the other mucous membranes, such as the bronchial. It is now almost an axiom in therapeutics, that substances which do not possess a very decided general action, can affect only those mucous membranes by which they are excreted, and it is improbable that tannin is any exception to this.

With regard to its action on the kidneys, it is conceivable that it may have a favorable influence in diminishing albuminuria, but even this is to be regarded as doubtful. Many eminent clinicians have expressed disbelief in its value, and the only cases which I have been able to find, in which the amount of albumen in the urine was carefully estimated from day to day, tend to confirm this view. They are four cases of chronic Bright's disease reported by Briese (Deutscher Archiv. f. klin. Med., xxxiii., p. 220, 1883) in which the admistration of tannate of soda for long periods had no influence, either on the amount of urine or the albumen present in it.-Brit. Med. Four., Dec. 4, 1886.

Munk on the Action of Diuretics.The great difficulty in experiments on the kidney in living animals, is that of estimating how much of the effect produced by a drug is due to changes in the circulation, or in the nervous system, which has an influence on the secretory activity of the kidney, as well as on the blood-vessels. Munk has, in his recent experiments, eliminated these factors by investigating the action of diuretic drugs on an excised kidney. The organ, after excision, was nourished, under a pressure of 100 to 190 millimetres of mercury, by a stream of blood and salt solution through the renal artery. The drug was added to the liquid, and its effect noted by the amount and quality of the urine, collected through a canula placed in the ureter. Before the addition of any drug, it was found that the amount of urine secreted in an hour varied from 4 to 24 cubic centimetres; that this was a true secretion, and not a simple diffusion, was shown by the fact that it contained a greater proportion of

saline constituents than the circulating fluid. The addition of chloride of sodium, nitrate of sodium or potassium, caffeine, dextrose, cane-sugar, or glycerine to the circulating fluid, increased the secretion of urine three to fifteen times, the pressure remaining the same; while in the case of nitrate of potassium and of caffeine, there was an increased rapidity of flow of the circulating fluid. Diuresis of this nature and under such conditions, could only result, according to Munk, from a stimulation of the secretory cells of the kidney by the drug, a conclusion which, as regards caffeine, had already been arrived at by von Schroeder, the appearance of hippuric acid in the secretion from the kidney, when benzoate of sodium and glycocol were added to the fluid circulating through the vessels of the kidney. As is well known, benzoic acid given to any animal appears as hippuric acid in the urine; and this result has been supposed to be due to the action of the intact blood-corpuscles. But, in Munk's experiment, these were absent; hence he concludes that the transformation is probably brought about by the oxygen which is combined with the hemoglobin.— Brit. Med. Four., Dec. 11, 1886.

MEDICINE.

Terrillon on Neuralgia of the Testicle.-Neuralgia of the testicle, whatever be its local cause, is most often seen in persons having hysterical attributes which may be latent and have to be searched for with care, but which sometimes are very evident and general and manifested by regular hysterical attacks.

The knowledge of these facts is of the greatest importance as it is of much help in treatment.-L' Union Méd., Nov. 16, 1886.

Dauchez on Vaccination Followed by Inflammation, Choleriform, Diarrhea, and Death.-The writer vaccinated, a perfectly healthy child of two years with healthy lymph. In a few days the child complained of malaise, fatigue, vagrant pains in the limbs, and at the same time became feverish, and was seized with vomiting and diarrhoea. The stools were watery, yellowish, and there was much epigastric pain. The vaccination point became enlarged and surrounded by a large dark red areola. There was at no time any enlargement of axillary glands.

The diarrhoea continued, the temperature became subnormal, the face and extremities pinched and cold, and death took place from collapse. A sister of the child was vaccinated at the same time and had no marked disturbance.

The mother of the child, however, was easily upset, and frequently had alarming diarrhoea from trivial causes.-La France Méd., Oct. 26, 1886.

The Result of Dr. Shakespeare's Recent Investigations upon Cholera. -During his stay abroad Dr. Shakespeare made personal visits to those whose labors have rendered them distinguished in this field; not only in several countries in Europe, but also in India. He gives brief accounts of recent epidemics of cholera in the different countries where it had been studied, and illustrated his remarks by diagrams of morbidity and mortality. The connection between the outbreaks of the disease and infected water-supply are clearly shown in nearly every instance.

Although the proof of the statement that the comma-bacillus is the active and efficient cause of cholera Asiatica was not entirely satisfactory to his mind, the lecturer felt no hesitation in declaring that Koch had conferred an inestimable boon upon the race by placing in the hands of every practitioner an infallible means of diagnosis of this disease from cholera morbus and other diseases resembling cholera. He expressed the opinion that a health-officer or physician who, in the presence of suspected cases and before the prevalence of the malady as an epidemic, should fail to employ this means of deciding whether or not the disease is genuine cholera, would be guilty of criminal negligence.

He

After a personal visit to Ferran, in Valencia, and an examination of his methods of investigation, he was prepared to endorse the verdict of the French Commission with regard to the condition of his laboratory, but as to Ferran himself he arrived at a different conclusion. was impressed by his modest bearing, and believed him a cultured gentleman, possessed of no mean skill as a bacteriologist. In his laboratory Dr. Shakespeare found as pure cultures of the comma-bacillus, and as handsomely mounted and stained specimens, as could be found anywhere in Europe. A few of these slides, made in his presence, were exhibited after the lecture was finished.

With regard to the result of Ferran's inoculations, Dr. Shakespeare demonstrated by the official returns made by the government officers, who are not friendly to Ferran, that there was a sudden and marked reduction in the number of cases and in the mortality in several villages after the inoculations were begun,—this measure apparently having about six times the value of ordinary hygienic precautions in checking the epidemic. The facts concerning inoculation, so far as they have been reported officially, seem to indicate the importance of making, in future epidemics, this method the subject of a searching scientific investigation, such as it has not received up to the present time.-Med. Times, Nov. 27, 1886.

Osler (W.) on the Treatment of Pleurisy with Effusion by Hay's Method.-Dr. Hay found, when investigating the physiological action of saline cathartics, that if the salt was given in a very concentrated form, when the intestines of the animal contained very little fluid, it produced a very rapid concentration of the blood, owing to the abstraction of water to form the intestinal secretion excited by the salt.

Our usual plan is to order the patient to take nothing after the evening meal, and then, an hour or so before breakfast, the salt is given dissolved in as little water as possible. The sulphate of magnesia is preferable to the sulphate of soda, as it is more soluble. Four to six drachms in an ounce of water is the usual dose, but two ounces, or even more, may be given. The patient must not drink after it. This usually produces from four to eight watery stools without pain or discomfort of any sort.

The essence of the method lies in getting the strong salt into the intestine at a time when the fluid contents are scanty. The concentrated bitter solution excites a copious secretion from the intestinal glands, which distends the intestine and induces rapid peristalsis. Saline, as well as other purgatives, have long been employed in the treatment of dropsies, but this plan of Hay's is so simple, produces so little irritation, and at the same time acts powerfully, and, as you have seen, effectually, that with us it has superseded other methods in cases in which we wish the action of a powerful and prompt cathartic.-The Med. News, Dec. 11, 1886.

Reeve (J. C.) on a Case of Sudden Death from the Introduction of an Aspirator Needle. The patient was a man of twenty-three, who had been ill for six weeks with symptoms of hepatic abscess. No anæsthetic was used. A point had been selected for the puncture a little over an inch to the right of the median line, and not quite two inches below the margin of the costal cartilages. The writer says: "I took a medium-sized needle of the aspirator and thrust it in at this point, upward and backward, to a depth of about three inches. As the stop-cock was turned, and I looked to see if pus appeared, my attention was attracted by the heavy breathing of the patient; I looked at his face, saw the head drawn to the left, the eyes turned and fixed, a slight convulsive tremor passed over his features, which bore the plainest impress of death. I found his pulse gone; no movement of his heart could be felt. After a brief interval of entire cessation of breathing, he drew one deep inspiration, which was the last manifestation of life. I should estimate the whole time from the puncture of the needle until he was gone at not over one minute and a half.

A partial post-mortem examination was made the next day. Upon opening the abdomen the liver was seen to be enlarged, reaching down to the level of the umbilicus. The puncture of the liver by the needle was plainly visible, surrounded by a small patch of ecchymosis. Upon lifting the organ up to remove it, an abscess of the right lobe gave way upon the under side near the centre, from which eight or ten ounces of pus escaped. The right auricle was extremely distended with blood. In texture the organ was somewhat softer than normal, tearing easily."-Med. News, Jan. 1, 1887.

Ouchterlony (J. A.) on a Case of Latent Pericarditis Purulenta, with Fatty Degeneration of the Heart, and Atheroma of the Ascending Aorta. Henry Willis, aged forty-two, married, railroad man, was admitted to the Louisville City Hospital November 18, 1886.

Previous History. His father died, at the age of forty-five, of a destructive ulceration of the face, said to have been cancer. Four months ago his present illness began. He has used alcoholic stimulants in moderation, but has been excessively addicted to

smoking. His illness began with pain in the right epigastrium, rather constant and aggravated by the ingestion of food; he has also been much troubled with flatulence and other digestive disturbances, but had vomited only twice prior to his admission. His appetite had kept up tolerably well, but he has lost flesh steadily and in considerable amount.

The patient was rather tall and gaunt, eyes somewhat sunken, but bright; color rather good, certainly not suggestive of cachexia. He complained of a bad appetite and symptoms of indigestion as described above. The integument over the epigastric region was discolored over an oblong-square, which he said marks the site of blisters ordered by his former medical attendants. He complained of severe, deeply seated pain in this locality, shooting up under the sternum. There was tenderness under pressure, most marked at a point corresponding to the pylorus. Palpation revealed increased resistance, but no tumor could be detected. The liver appeared somewhat enlarged. He had no cough, but vomited several times after entering the hospital. Pulse was weak and slow. Temperature was subnormal, reaching but 98°. There was nothing abnormal observed about his chest.

The day after his admission he complained of very severe pains in the epigastrium and precordia. At 3 o'clock in the morning he was breathing hard; pulse was imperceptible at the wrist; his extremities were cold. The heart sounds were barely audible. His mind, however, rsmained perfectly clear. At 6 o'clock A. M., on the 20th instant, he died.

Autopsy. About five hours after death rigor mortis marked. Body thin, but not emaciated, moderate amount of fat in subcutaneous areolar tissue and omentum. Liver somewhat enlarged and congested; spleen full-sized, capsule opaque and thickened at various points; kidneys congested..

The pericardium was highly injected, and its cavity contained about two drachms of pus. The heart was distended and flabby, pale, fattily degenerated; left ventricle contained black, soft coagulæ, left auricle contained a very firm, white, fibrinous clot, entangled in the cordæ tendinæ of mitral valve. Aorta ascendens thickened from incipient atheroma; orifices of coronary arteries almost obliterated. No disease of the stomach was found.

Dr. A.