been irritation of the sympathetic nerve. It was, however, experimentally shown that, according to the dose employed, cocaine would give rise to reverse symptoms. Small doses would increase the tension of the circulation and large doses lower it. There might also be vaso-dilatation or vaso-constriction. This case, said Schede, belonged to the graver forms of poisoning by cocaine in the second degree, which was shown by the fact that the amyl nitrite had no effect, for the dilatation of the blood-vessels increased. The cramps indicated irritation of the spinal marrow. Schede calls attention to the dangers of cocaine, which result principally from the idiosyncrasies of certain subjects. In mild cases of poisoning amyl nitrite has a favorable action; in the grave cases inhalations of oxygen, phlebotomy, and intravenous injections of a solution of sodium chloride must be resorted to. It has also been recommended to add nitroglycerin to the cocaine solution. In order to avoid as much as possible symptoms of poisoning, solutions of not more than two per cent., or still more diluted, should be used for hypodermical injections, which must not follow each other too closely. According to Kummer, the region to be injected must be rendered bloodless before the injection is administered.-St. Louis Med. and Surg. Jour.

Have We Too Many Doctors ?

Our contemporary, the Medical News, in its issue of July 27, editorially discusses the comparative standing of the American medical profession, and, among other wise and timely remarks, refutes the trite and senseless charge that, because its numbers are disproportionately large, therefore the quality of the profession must be poor. It is pointed out there are other factors to be taken into consideration besides that involved in the statement that this country had one physician to every 500 inhabitants, while England has only one to 2000, France one to 3000, Germany one to nearly 4000, and Spain and Russia one to 7000 of population. There is the law of supply and demand for one thing, and the density of the population for another. One competent physician, says the News, is probably capable of properly performing the medical serv

ices required by 1500 or 2000 people, provided that they live within a radius of three miles of his office, and for an even larger number within a mile. But what about the district where he would have to drive forty miles to reach 500 people? A physician is as absolute a necessity to a "cowboy" town or mining camp of 300 people, with no other medical aid. within fifty miles, as to a factory town of 5000. Indeed, many a "superfluous," poorly educated, uncouth country doctor, out on the frontier, with his clientele scattered over two counties, who loves his patients and profession, commands as much of our admiration and respect, deserves as well of his country, and is as "necessary" in every way and sense of the term, as the most scholarly and polished consultant of a European center. If we were to divide this country and England each into geographic settled districts, each requiring the residence of a physician, nearly two-thirds of our "excess of doctors" would disappear at once. Furthermore, it is argued "the number of physicians is a good index of the intelligence of a race. And as civilization becomes more complex and the whole field of preventive medicine-scarcely surveyed as yet-is added to our domain, a still higher proportion of skilled, intelligent advisers will be demanded by the community."-Jour. Am. Med. Asso.

Serumtherapy.

Schaefer (Arch. gen. de Med., August, 1895,) discusses the present position of the serum treatment after referring to the researches upon which it has been built up:

(1) Tuberculosis. Richet and Hericourt were the first to treat the disease with serum obtained from refractory animals, but up to the present moment no very good results have been. obtained.

(2) Rabies. Serum treatment does not appear to have a great future, as immunisation by intensive vaccination gives greater success.

(3) Pneumonia. After referring to the investigation, the author observes that the serum treatment deserves to be considered. The reason that it has not been more generally adopted is probably on account of the difficulty of obtaining the serum from immunised rabbits.

(4) Enteric Fever. Here the clinical application of laboratory facts has not given any very good results. This may be partly due to the length of time between the penetration of the poison and the treatment, and partly, possibly, owing to mixed infections.

(5) Typhus. The injection of serum from patients who had suffered from typhus was adopted, with good results, by Legrain in an epidemic in Algeria.

(6) Cholera. The cholera peritonitis of animals is very different from cholera in man. Behring recently announced that he had obtained a curative serum, but the results have not yet been published.

(7) Syphilis. The serum from the dog and lamb have been employed, and sometimes with good results.

(8) Streptococcus Infection. Animals have been vaccinated against this infection. The serum so obtained has been used in puerperal fever with good effect. It has also been employed in erysipelas and angina.

(9) Cancer. The results as yet obtained are insufficient to carry conviction.

(10) Tetanus. Well marked tetanus is very difficult to cure in animals, and thus it is not to be wondered at that the results. obtained in man are not conclusive. The serum, however, provides a valuable prophylactic agent against tetanus.

(11) Diphtheria. It is in this disease that the serum treatment has registered its greatest triumphs. Where mixed infections exist the results have naturally not been so favorable. The slight accidents caused by the treatment are to be disregarded, in view of its remarkable efficacy.

The author then refers to the successful application of the serum treatment to snakebites. The general results thus far obtained by the serumtherapy promise a successful future for this new method of treatment.-Brit. Med. Jour.

Plural Births.

In New England, in 1892, there were 1153 plural births, of which 2286 were twins and 30 were triplets.

The American Public Health Association meets in Denver, Col., October 1.

Death in Acute Pneumonia.

Bollinger (Munch. Med. Woch., August 6, 1895,) mentions that death in acute pneumonia is usually attributed to-first, inefficiency of the lungs owing to extensive consolidation; second, severity of the infection, as in septic forms of pneumonia; third, complications, such as meningitis, pericarditis, etc.; fourth, heart failure, which may be due to inherent weakness in the heart, or be brought about by the pneumonic infection. Individual resistance is also an important factor. The author draws attention to two facts noted after death from acute pneumonia-first, the general anæmia of all organs, and, second, the absence of so-called collateral hyperæmia in parts of the lungs unaffected by the pneumonic process. The author would attribute this to the extensive exudation, which robs the blood of its important elements. The results of this exudation are practically similar to those produced by the recurrent internal hemorrhage noted in some of the infections. The leucocytosis seen in acute pneumonia is a regenerative process to compensate for the loss to the blood occasioned by the exudation. Thus the author thinks the critical collapse manifestations in croupous pneumonia, and the fatal cardiac insufficiency are due to the oligamia which leads to an inadequate nutrition of the cardiac muscle. Finally, he draws attention to the harm done by blood letting. Fluid should be administered by all possible methods; perhaps even the infusion of saline solution should be adopted to compensate for the oligamia.-British Med. Jour.

A Pathogenic Bacterial Parasite of Fishes.

Sieber (Gazeta Lekarska, 1895, Nos. 13, 14, 16 and 17) discusses the question of poisoning caused in man by eating certain fish. It is known that several fish secrete poisonous materials for the purpose of self-defense, and these the authoress calls "physiological." But poisoning by fish that produce no such physiological poisons is by no means uncommon, especially in Russia. Sieber investigated the cause of a fish epidemic in Nencki's laboratory at St. Petersburg. In an aquarium in the palace, where fish destined for the table had been kept during the past ten years, there occurred on a cer

tain occasion so high a mortality that thirty fish died in two days. The bacterial investigation of the cause of this mortality was entrusted by Nencki to Sieber. From the muscle and organs of the dead and sick fish, from the surface of the aquarium and from the exit tubes, as also from the water in the aquarium, was found an anaerobic bacillus called by Sieber B. piscicidus agilis, which is intensely poisonous for coldblooded animals. It is a short, actively motile, sporogenous, gas-forming bacillus, which can be cultivated on the ordinary culture media, and which grows well at 12°, or 37.5° C. It keeps its vitality and virulence for a month in ordinary spring water. It is very virulent for frogs, guinea-pigs, mice, rabbits and dogs, but birds are immune. From all animals, cold as well as warm-blooded, the bacillus was regained in pure culture after death from inoculation. By filtration through a Chamberland filter a fluid was obtained which gave an intense red color with ferric perchloride. The symptoms produced in the animal by injection of the toxin are rapidity and shortness of breathing, with general discomfort; larger doses lead to apathy and paralysis. The investigator separated from the cultures certain alkaloids, such as cadaverin, etc., and also another present only in small quantities, but intensely poisonIt must be added that Sieber found the same bacillus in the evacuations of two cholera patients and in many fish. bought in the St. Petersburg market during the cholera epidemic.-British Med. Jour.

ous.

Tobaccoism and Its Treatment.

In the American Practitioner and News for February 23, 1895, Kempf tells us how to treat the tobacco habit and its results:

A belladona porous plaster is put over the region of the heart, and bromide of sodium, 3 ii; fl. ext. cactus grandiflora, f3i; fl. ext. pulsatilla, f 3 ss; fl. ext. passiflora incarnata, f 3 ss; water, f3 iv. M. Sig: A teaspoonful, after shaking, in water every four hours.

8

And, aloin, gr. ; strychnine, gr. ; belladonna ext., gr. ; ipecac, gr. 1. M. A pill. Sig: From two to three pills at bedtime.