man yet being fed extensively by milk the curds of which he purged and vomited with marked distension of the abdomen, and in the fourth week, a week after the fever had practically disappeared, the temperature went up to 104-5° F. and the man died. No intestinal antiseptic had been used in the case, nor could I induce them under the circumstances to relieve the intestine of this noxious material by active purgation. I believe purgation then does a great deal of good by carrying out these irritating fermentative products. We can do much in such cases by thoroughly cleansing the alimentary canal, by relieving the kidney of much work that would otherwise devolve upon it, also by antiseptic treatment of the alimentary canal.

Much has been done in recent years by the introduction of these intestinal antiseptics. I would mention in addition to salol, benzosol, and beta-naphthol, a preparation that I have recently been using with some degree of satisfaction, a combination of valerian with both creosote and guaiacol. This is a combination that seems to possess an unusual value, though my experience has not been sufficient to speak positively. In cases such as referred to by the essayist, we should lessen the work that has to be done by the kidney, as well as secure intestinal antisepsis. The uremic manifestations are not always evidences of kidney disease. There is a condition of the system which the kidney is unable to meet, and the result is practically the same as it would be if the kidney itself were diseased. It is immaterial if we have a normal kidney that is incompetent to perform the duties devolved upon it; the effect is the same as if the kidney itself were in a state of disease; it is unable to rid the blood of the effete material.

Dr. S. G. Dabney: I believe that the case reported by Dr. Cecil was seen by myself and afterward by Dr. Ray when I left the city. He had a well-defined optic neuritis in each eye. His intellection was very much impaired, his answers were uncertain, and it was impossible to test his vision. There was some disturbance of the ocular muscles; he had a considerable degree of strabismus. Shortly after seeing the patient I left for Virginia, and Dr. Ray afterward visited him. I understand he afterward developed hemiopia-half-sightedness—and that usually indicates a lesion either in the optic tract or in the cortex. This subject has attracted some attention generally in the line of eye diseases, and at the recent meeting of the American Medical Association at Denver, Colorado, the subject of tobacco and quinine amblyopia and the effect of auto-intoxication upon the vision were brought up for

discussion, and some remarkable cases were reported, especially by Young, of Iowa. In some of his cases he claimed there was but a perception of light, and in a day or two they were entirely relieved by free purgation. A symptom that he dwelt upon at length was a peculiar odor to the patient's breath, also a peculiar complexion and great impairment of sight.

We see in our line of work very often less well-defined symptoms, probably the result of intoxication, such as the essayist has referred to. Dr. J. B. Marvin: The points made by Dr. Bailey are very apt, but I do not see how we can limit the discussion as has been suggested. We must include all conditions that come from the toxines. We ought to make a distinction between the ptomaines, toxines, and leucomaines. Auto-intoxication produced by the fermentation of food really comes under the head of leucomaine poisoning; substances so produced within the intestinal canal belong either to the uric acid or kreatine series. Outside of the leucomaines and ptomaines, all the poisons generated in the intestinal canal are caused by bacterial growths, so you are bound to take them into consideration.

I thought while Dr. Stucky was reading his paper that he had become fascinated with this French author, Bouchard, as I was. I think many of Bouchard's statements will not hold water, in the light of recent investigations. If the statements made by Bouchard were to be relied upon, the management of these cases would be rendered very simple; all one would need would be a stomach tube and a rectal tube. The most serious of these cases are those due to some form of septic poisoning, and would not be influenced by this method of treatment.

Another point, we ought to be very careful about making a distinction between simple deodorization of the fecal discharges and genuine disinfection. It is perfectly possible to give some of these chemical substances and have fecal discharges which do not smell at all, still you can cultivate bacterial growths from the excreta, showing that disinfection has not been accomplished.

Dr. A. M. Cartledge: Surgeons are as much interested in this subject as are physicians. I have come, in a general way, in doing surgery which requires cleansing the intestinal canal, to look upon intestinal antisepsis in relation to purgation about as we look upon antisepsis and asepsis in surgical work. Personally, when I want to get rid of the intestinal contents, and the dangers that might arise from the presence of germs, especially the colon bacillus, I prefer a large dose of rochelle

salts to any thing else. I have never regretted purging anybody yet; I never make the mistake of purging them too much, but I use purgatives in connection with surgical operations much more now than I did formerly. I find this acts much better than the so-called intestinal antiseptics when you want to secure intestinal cleansing and avoid autointoxication. I have not much faith in the ability of the so-called intestinal antiseptics to disinfect twenty-six to twenty-eight feet of intestine.

Dr. T. H. Stucky: I recognize the difficulty of trying to limit a subject of such magnitude to a certain line of poisons. Like Dr. Marvin, in reading Bouchard's book I was fairly carried away with it. And like Dr. Marvin, I believe a great many of his statements are "Frenchy" and have really been disproven. I only quote Bouchard in so far as to refer to some special researches, the said researches having been confirmed.

As to relief of these cases: If it were possible to thoroughly cleanse the digestive tract, this would be the ideal method. Lavage does it thoroughly if the fermentative or putrefactive changes are taking place in the stomach. The intestinal douche, or intestinal lavage, if you will permit the statement, will do it if the colon is thoroughly flushed and the amount of fluid carried into the intestine is sufficiently large to empty it.

I believe that the best intestinal antiseptic we have is full doses of calomel. The point that has been made that we are inclined to give calomel in too small doses and repeat them frequently is a very serious error. I now have better results from this remedy by giving it in onequarter to one-half grain doses every hour than formerly when I gave it in one-tenth grain doses.

While the intestines may be thoroughly cleansed before or after surgical operations by large doses of salines, this would not be applicable to acute affections involving the intestines themselves; I question whether it would be applicable to an ulcerative condition of the intestine such as we have in typhoid fever, where there is an involvement of Peyer's patches.

I recognize that the tendency of the profession at this time is rather to discredit the use of intestinal antiseptics. I am not willing to accept this teaching, believing as I do that there are marked changes taking place within this tract, that we are able to lessen the amount of abdominal distension, that we are able to prevent fermentation that is taking

place in the intestinal tract, and the consequent abdominal discomfort, by means of some of the intestinal antiseptics mentioned by Dr. Bailey and named in the paper. In typhoid fever, for instance, I have seen marked beneficial results from them. LOUIS FRANK, M. D., Secretary.

Abstracts and Selections.

BOULIMIA. On August 27th an inquest was held by Mr. Negus Wood at Plumstead upon the body of William Ward, aged eighty-four years, an army pensioner, who died from asphyxia. At the post-mortem examination three pieces of meat measuring in all twelve inches in length were found in the deceased's "throat." Evidence was given that the deceased was always a gluttonous feeder and in the habit of bolting his food. His daughter-in-law said that she used to mince his food, but that even then he would bolt such large spoonfuls that he had to gasp for breath. A verdict was returned of "Accidental death." Instances of ravenous appetite are not uncommon, constituting the condition known as boulimia or bulimy; moreover this craving for food substances is sometimes associated with, another condition known as polyphagism, when the sufferer eats pins, string, broken bottles, and other indigestible articles. In The Lancet for May 5, 1894, we commented upon the death of a man in the London Hospital whose stomach was found after death to be full of a heterogeneous mass of these things. Certain tribes in South America are known as earth-eaters from the habit they have of filling their stomachs with clay, and the custom of gorging is common among peoples who live a precarious life and scarcely know from one day to another when they will get another meal. Dr. Kane relates the case of an Esquimaux who ate an enormous quantity of walrus flesh and blubber, and in 1799 there was a French prisoner in England, by name Charles Domery, one of nine brothers who with their father were all remarkable for voracious appetite. One day he was allowed as much to eat as he liked, and between 4 A. M. and 6 P. M. consumed four pounds of raw cow's udder, ten pounds of raw beef, two pounds of candles, and five bottle of porter. The narrator remarks: “It is also to be observed that the day was hot, and not having his usual exercise in the yard, it may be presumed he would otherwise have had a better appetite." When unable to procure rational food he was accustomed to eat rats, cats, and dogs, and upon one occasion, when in action on board ship, feeling himself hungry, he began to eat the leg of a man, which limb had been shot off and was lying handy. We fancy the custom still exists in some parts of the country of having hasty pudding eating-matches, and at a certain college in Oxford the following rite obtains or used to do twenty

years ago. On Mid-Lent Sunday the first lesson in the evening is Genesis xliii, which gives an account of Benjamin's mess, which was five times as great as any of the others. Furmenty was always served in Hall on that evening, and the junior man at each table was considered as Benjamin and served with an enormous helping. If he ate it all he could "sconce"fine the whole table in sherry-if he could not he was himself fined. When this custom originated no one knows, but it is probably like so many other old customs a remnant of paganism with a veneer of Christianity over it. Lancet.

HEREDITARY CEREBELLAR ATAXY.-Miura (Reprint from Proceedings of Medical Faculty, Royal Japanese University, Tokio, 1898) reports three case of this rare disease, adding a long and valuable clinical study. Two of the patients were brothers, and suggestions of a similar affection were present in other members of the family-in this instance the male members of the family were most affected, but the disease was transmitted on the female side. In one of the brothers (the younger) the gait began to be affected at the age of twenty-five, and the disease was fully developed when he was thirty-three; in the other it did not commence till the latter age. This late onset is characteristic of the disease. In both cases the affection began with a febrile attack of unknown nature, lasting ten to fifteen days. The younger brother became unfit for work at thirty-seven, and died five months later; the eldest was not incapacitated till forty-two, and was alive when the memoir was written. In both cases the palpebral fissure was narrowed, but the pupils equal; in the first the reaction to light and accommodation was sluggish, and there was slight horizontal nystagmus. In both there was great limitation of visual field, being more marked in the verticle direction in the younger, in the horizontal in the elder; the boundaries of the optic disc were almost indistinguishable in both cases, and the disc itself highly injected in the younger. In both the speech was stuttering and explosive, and accompanied with spitting of saliva. The voluntary movements of the extremities were profoundly affected; swaying was present even while sitting, and neither patient could stand with his feet together. The gait was zigzag; the younger brother could only walk with a stick and while looking at the ground; the elder was several times arrested for supposed drunkenness. The inco-ordination extended to the muscles of the arm and face, resulting in irregular and often exaggerated movements. There was more or less loss of power in all the limbs; the tendon reflexes were present but not increased. In the younger there was temporary disturbance of the bladder, in the elder impotence. Cutaneous sensibility was unaffected in the former, lost on the outer side of the leg in the latter. The cutaneous reflexes were on the whole increased, and there was no muscular atrophy. The mental condition was low. The necropsy on the younger brother showed a marked atrophy of the pons, medulla, cerebellum, and cord relatively to the rest of the central nerve system.