Tuberculosis and Sterility, 28. Typhoid Fever, 37, 170; Ascarides and, 149; in Chicago, 19; Purpura in, 157; 146. Umbilical Hernia, 73. Untoward Effects: Atropine, 153; Co- Ureteral Implantation Rectal, 38. tum, 49; taken for a Lympathic Gland, 120. VA VACCINATION, 168;in the Insane, 125, 148. Varices, Aristol on, 72; Leg, 118. 155; Urethra Prolapse in, 119. Wood, Dr. T. F. (Obit), 113. CONTRIBUTORS. Ayres, S. Pittsburg, 11. LLEN L. B., Humboldt, Neb., 21. BALDY J. M., Philadelphia, 147. Bean S., Bronson, Fla., 106. Bigelow H. R., Philadelphia, 12. IHON A. L.. Washington, D. C,, 1. Variola, 168 Darkness Treatment of, 144. H Hektoen L., Chicago, 96. [AVEN A. C., Lake Forest, Ill., 176. Vertigo, 39: Virchow (Ed.), 113. Visceral Lesions, 136, 137. "Vis Medicatrix," 64. "Vitaline," 16. Vivisection, 171. Vomiting Stront. Brom. in, 116. WERLHOF'S Disease, 158. Wilder, Dr., Homicide (Ed.), 82. Henning J. A., Garnett, Kas., 116. JOHNSTONE J. H., Cincinnati, 137. KI IERNAN J. G., Chicago, 14, 15, 21, 61. Madigan, M. J., Brooklyn, 125. PACKARD, J. H., Philadelphia, 159. RACHEL, G. W., New York, 74. Reed, C. A. L., Cincinnati, 54. Rone, G. H., Catonsville, Md., 132. SAALFELD, E., Berlin, Ger., 69. TAYLOR, W. H., Richmond, Va., 91. Thayer, W. S., Baltimore, Md., 35. VERITY, W. P., Chicago, 157. WARREN, C. E. Boston, 110. F. B., Medford, Wis., 129. The discovery of this or that microbic cause, or coincident or inevitable consequent of cause, of one disease after another, naturally led to the deduction of special germicidal agencies for each, and for a time there was an appalling prospect of preventive hypodermic tattooing, scarcely less repulsive than the disease, and a bravado resolve to let each particular microscopic devil do its worst. Multiplying a million a minute, it was realized that we could be no match for our Lilliputian enemies, whom we could not kill by drugs without at the same time killing ourselves. Apace with the bacteriologists' revelations have been the chemists' syntheses, which, however we might be disposed to recommend to our friends and patients, none of us were brave enough to care to take within our own economies. I confess to no intimate familiarity with these latest evolutions of the laboratory, though the names of some I know by sight very well, even if most of them I neither can speak nor can spell. Hence it was a gratifying announcement that we had within ourselves our Own defenders and defenses. "In the blood is the life thereof" began to have greater significance through the belief that its living cells devoured these countless swarms of intruders, and thus prevented their disastrous inroads. It was enough for us, then, by tonic and alterative, and stimulant and corroborant, to preserve the appetites of these domestic phagocytes, and see that they were always in sufficient force to patrol the avenues of the circulation. So, the homely phrase of cleansing the blood of its impurities came back like an old friend in a new dressbut already we are called upon to abandon our bio-therapeutics, with its war of the microbes and the final victory of good over evil-minded bacteria, as poetic fancy, and now comes the chemist with potencies, that are marvelously. alike in looks, which set sail on their mysterious voyage in the channels of the blood to neutralize the toxic products of each malefic monad. *Abstract from Address on General Medicine, Detroit Meeting, A. M. A. Among the pleasantest recollections of my early life are those of my old preceptor, whose father, himself a favorite pupil of Benjamin Rush, had conferred the latter's name upon his own son, which doubtless explains my inherited admiration for that wonderful man. I recall how carefully I was indoctrinated with the belief, which I have not been over-ready to abandon, that nosological nomenclature was a treacherous guide, that diseases were not so many entities for which specific antidotes were to be sought, and that the cardinal points of diagnosis to guide the medical pilot were the grade of action as indicated by the pulse, the state of the secretions and the condition of the organic fiber. To-day, we go behind these with lens and test-tube to ferret the particular microbe, bacterial proteid or chemical toxine, which has disturbed the circulation, obstructed the flow of the secretions, or irritated, inflamed or disorganized the basis structure of the tissues. It would be unpardonable, therefore, if, in an address on medicine, however cursory and superficial, one should neglect to give due credit to the bacteriological investigators, the scope of whose researches embraces not merely the discovery of disease causation, but the means for its prevention and cure. The busy practitioner, perhaps, has little time to follow diligently the discussion as to whether the bacteria themselves are the real enemies of health, or only the agents for the introduction of their proteid products or toxalbumins, ptomaines or other chemical toxines, which are the actual pathogeners. He is chiefly concerned as to the practical results of these investigations. Dr. Sternberg in a recent valuable paper admi s that until a very late day the bacteriologist's demonstration of the specific cause in a considerable number of infectious diseases had not resulted in the discovery of a specific treatment for these diseases. Preventive medicine has almost exclusively profited by his researches, as when the discovery of the bacterial parasite placed tuberculosis among the infectious dis eases and the destruction of the sputum became a recognized practical necessity. Of the same order are the precautions of modern aseptic surgery and obstetrics, and the use of antiseptics in traumatic infection and in localized infectious processes. Sternberg has described 475 species of bacteria of which 158 species are pathogenic, although all are not differentiated by morphological characteristics, and the latest discoveries have established the fact that the pathogenic action of those bacteria, which have been shown to be concerned in the etiology of specific infectious diseases, is due to the formation of toxic products during the active development of the bacterial cells, and to isolate these toxines and toxalbumins is now the attempt. Recent experimenters, significantly prominent among whom were three Japanese biologists, having demonstrated that the blood of an animal having a natural immunity against anthrax, if injected into the body of a susceptible animal, protected the latter from anthrax, it was subsequently found that the blood of animals having an artificial immunity against tetanus or diphtheria injected into susceptible animals, in like manner, protected them against the effects of the injection of virulent cultures of the bacilli of tetanus or diphtheria, and finally Dr. Rudoph Schwarts, assistant to the surgical clinic at Padua, reported the actual successful treatment of an advanced case of traumatic tetanus by injections of tetanus antitoxine obtained by Dr. Tizzoni from the blood-serum of a dog, which had been rendered immune against tetanus, and three other cases of success with this same treatment elsewhere have been since reported. Since Behring's experiments, in Sternberg's opinion, suggest the possibility that the potent toxalbumin of the diphtheritic bacillus may be neutralized in the bodies of infected animals, and the Klemperers having shown the probability that the blood serum of animals which have an artificial immunity against cultures of micrococcus pneumoniæ crouposæ, when injected into other susceptible animals, renders them immune, Sternberg indulges the hope that croupous pneumonia in man may be arrested by a similar mode of treatment. He further says, from analogy, based upon experimental evidence, the successful treatment of tuberculosis appears to call for the administration of antituberculin rather than that of the active toxic principle elaborated by the tubercle bacillus. Ehrlich's experiments with pathogenic toxal bumins not produced by bacteria, but of vegetable origin, Sewall's showing that immunity from poisoning by rattlesnake venom may be produced by injection of small doses of its toxic agent, and others strongly support the view that all infectious diseases are due to the action of substances resembling the toxalbumins already discovered, and that acquired immunity from any of them is due to the formation of antitoxines in the blood of the immune animal— but while in many infectious diseases the toxalbumin is produced by a specific micro-organism, we have no evidence that this is the case in the strictly contagious eruptive fevers, and none to justify a generalization that all infectious diseases, as small-pox and scarlet fever, are due to specific micro-organisms. Sternberg suggests the possibility that in these diseases the toxalbumin, which gives them their specific character, is a product of the living cells of the body of the infected individual, and says the inference is justifiable that the blood and tissue-juices of any individual who has recently suffered an attack of small-pox or scarlet fever, contains an antitoxine which would neutralize the active poison in the circulation of another person immediately after infection, and he holds the experiment warrantable to ascertain whether a small quantity of blood drawn from the veins of the protected person would suffice to arrest or modify the course of these diseases. The transfusion of a moderate amount of such blood might be curative or confer immunity in advance of infection, and possibly an antitoxine may be obtained from the blood of vaccinated calves, which would have a curative action in small-pox. Dr. Sternberg has himself demonstrated, by recent experiments with the blood of vaccinated calves, that there is something in this blood which does neutralize the specific virulence of vaccine virus, both bovine and humanized. I can hardly close without a passing reference to the malady which is on every tongue, and is credited with the virulence of a plague-the influenza-the influence whose mysterious grip upon the physically strong and robust, as upon the feeble and frail, leaving all alike mentally and bodily prostrated, has been attributed to some occult cause, acting upon or through the nervous system. It too is now known to have its bacterium, the latest micro-organism to be discovered, unless the verification of the Berliner Hospital experiments shall give that distinction to the alleged bacillus of measles. The bacterial proteid of influenza has not yet been isolated, TOXINES. Europhen Olive oil.. Vaselin. Lanolin 3 grams 7 grams .60 grams ..30 grams He obtained the best results from this ointment, and what was especially remarkable was the marked diminution of the secretions. Owing to the latter effect it was found possible to leave the dressings in place for three or four days, and to renew them easily and without pain. Many patients were enabled to continue work under the use of a starch dressing. Severe burns of the third degree healed completely after three or four dressings. The longest period of healing (twenty-two days) was observed in a case of severe injury from hydrochloric acid, extending from the elbow to the wrist, over a breadth of five centimeters. It should also be noted that the europhen ointment relieved the pains from the moment it was applied to the burns. In children europhen can also be employed without risk, since it may be regarded as innocuous, at least in the doses which obtain here. TREATMENT OF SCARLATINA.-LauderBrunton ("Med. Bull.") speaks favorably of arsenic, when the tongue remains red and irritable during convalescence. Ammonium carbonate in frequent doses is greatly recommended. Ringer recommends chlorine water for sloughing throat; arsenic and nitric acid for persisting red tongue in convalescence; cold compresses to the throat throughout; ice to be sucked; gray powder for inflamed tonsils; packing throughout, especially on retrocession of rash; veratrum for convulsions. BISMUTH SALICYLATE.-Dr. Miknevitsch emphatically recommends ("St. Louis Med. and 3 Surg. Jour.") the treatment of protracted diarrhoeas in children under two years of age by the internal administration of bismuth salicylate after the formula: Ꭱ Bismuthi salicylici.. Gummi arabici.. Sacchari albi. Terendo adde Aquæ destillatæ.... Fiat lac. Tum adde Aquæ destillatæ.... gr. xxiv 3 i 3 iss 3 viii 3 xlviii M. S. Shake well before using. Give from one to two teaspoonfuls from three to six times a day. Each teaspoonful of the mixture contains about one-half grain of the salicylate, which represents a normal individual dose (repeated three or four times daily) for an infant aged from six to eight months. The bottle should be kept in ice or cold water (to prevent nausea, sometimes produced by the salicylate). In emaciated children the remedy, in largest doses, is apt to induce profuse perspiration, accompanied by general weakness. Hence, as soon as the sweating appears, the dose should be correspondingly diminished. In recent cases (of a few days' standing) the salicylate is useless. In FRACTURES OF THE HUMERUS.—Dr. J. B. Roberts in a paper read before the American Surgical Association arrives at the following conclusions anent the treatment of uncomplicated fractures of the lower end of the humerus: the treatment of fractures of the lower end of the humerus, the divergent angle between the axes of the arm and forearm must be preserved; and hence, dressings which interfere with the normal difference in level of the radius and ulna are not permissible. Fractures of the lower end of the humerus of ordinary severity are, as a rule, more successfully treated in the extended than in the flexed position, because the "carrying function" is less liable to be impaired. Passive motion at an early date is harmful, and should be deferred until union has occurred and the dressings have been finally removed. Good results as to anatomical conformation and as to motion are generally to be expected, and can usually be obtained. Recent fractures in which satisfactory coaptation is not obtainable under anæsthesia may with propriety be subjected to exploratory aseptic incisions. Old fractures, in which deformity and impairment of function are marked, may, within certain limitations, be sub jected to refracture or osteotomy for the relief of these conditions. INSANITY AFTER THE KEELEY "CURE."* BY R. DEWEY, M. D., KANKAKEE, ILL. Whether drunkenness be a disease, a habit, a vice or a combination of the three or whether alcohol be looked upon as the agent to remove those not fit to survive, is what the physician can but have a certain interest in. As superintendent of the State Insane Hospital at Kankakee, eight patients have come under my care, who were committed directly after a residence at Dwight. In the first case insanity had never occurred until after the Dwight treatment and a cure was effected; the second case, one of morphine habit, resulted in insanity after the Keeley "home treatment"; not cured of insanity; case three, alcohol habit, sent to Kankakee insane hospital after treatment at Dwight; patient cured of insanity, but still drinks; case four, alcohol, morphine and cocaine habits, treated at Dwight, relapsed, was wildly insane, recovered mentally, but still drinks; case five, alcohol and morphine, sent to insane asylum from Dwight, still in asylum; case six, alcohol, morphine and cocaine habits, took Keeley "home treatment," sent to Kankakee insane hospital, not insane before going to Dwight, but received insane and discharged cured; case seven, alcohol case, insanity developed at Dwight while undergoing treatment, still in insane asylum; case eight, alcohol case, insanity developed one month after leaving Dwight, not previously insane, still in insane asylum. In each of these cases insanity resulted from the Dwight treatment. There seems to be no doubt that ordinary well-known tonics are combined with some narcotic, and mydriatic drug, probably atropine. As to the presence of gold, there is great doubt. The moral influences are remarkable, the patients going to Dwight with an earnest expectation of benefit, which places them in the most favorable attitude for beneficial results. The powerful influence of an aroused expectation is similar to that resulting from hypnotization, prestidigitation and mediumistic performances and from the apparently miraculous results of visits to Lourdes or of laying on of hands by some people supposed to be endowed with supernatural powers. Any person who is powerfully "doped" with stimulating and narcotic drugs, as strychnia or atropine, will, for the time, lose all accustomed appetite for other stimulants or narcotics. Ply *A. M. A. Trans. Cond. ing of the patient with such powerful drugs partially paralyzes him, mentally and physically, and this is important as a means of impressing him with the idea that some great and remarkable change is taking place in his system. He naturally believes that he is being reconstructed from top to toe, and that a great process of elimination is going on, which, when completed, will make him a new creature in all his appetites and desires. He is told that his appetite for liquor will disappear, that he will not care for it any more, and he devoutly believes it. He is told, perhaps, that he cannot take liquor even if he should wish it; that it will disgust him and not remain on his stomach. That it will disgust him is a fact, for liquor is disgusting to a healthy man. It has been shown that Keeley's patients have actually found, as predicted, that they could not swallow whisky, or, if they did, it would be expelled by the stomach. The very fact of the prediction has a great deal to do with this. It is the same principle that the mesmerist uses in talking to his subjects, the fact that they are in his power; that they must do as he says; that at a certain time they will feel a certain impulse they cannot resist to do a certain thing. The hour comes, they feel the influence and obey it, providing they believe what the mesmerist has said. It is an important question whether there is any treatment which will remove the appetite for liquor, and it remains to be shown whether anything further than the operation of natural causes is required to account for the undisputed fact that a large proportion of Keeley's patients do lose their appetite for liquor. There is another question about the Keeley system to which an answer is required by science and humanity. Dr. Keeley announces that drunkenness is a disease. He makes no exception to the statement that it is a disease pure and simple. If this be true the question arises why he refuses to treat patients a second time. In doing this is he not punishing them, in his own showing, for their misfortune? What would be thought of any hospital or sanatarium which refused to receive a patient with pneumonia or rheumatism because he was guilty of having a second attack? It does not answer this question to say that the effect on others is bad to take in old cases, though we know the |