dyspnea. The next day six minims caused dyspnea and vomiting, and later a smaller instillation produced the same symptoms.

Mr. A. Roberts (London Lancet) injected sixty minims of a six-per-cent solution prior to amputating breast. Patient became blind, and talked incoherently; blindness lasted four hours.

Mr. Mayo Robson mentions two cases. In one cocaining, amount of drug not stated, prior to circumcision was followed by severe syncope; the other, before removing nasal polypus, caused asphasia for four hours.

Dr. Barsky (British Medical Journal) cited a case in which one and one third grains caused pallor, vertigo, general numbness, dysphagia, dyspnea, chest oppression, and vomiting.

Dr. Walter Tothill (London Medical Record) reported case of a girl in whose gums one grain was injected. In ten minutes she became unconscious, remaining so for two hours and a half. Another, male, aged twenty-seven, cocaine was applied in the same way prior to extraction. Within a minute he became violent, his pupils enormously enlarged, pulse beating six times with each inspiration, face pale, with dark lines around the mouth and eyes."

66

Schubert noted a case of a strong, healthy, non-nervous female, aged twenty-eight, in whose gum six minims of a twenty-per-cent solution were injected before extracting a tooth. In ten minutes vision was impaired, gaze fixed, and soon became quite blind and unconscious.

Dr. George O. Williams (New York Medical Journal) reported that he injected one half grain of Squibb's cocaine, three injections five minutes apart, for local anesthesia prior to removal of small tumor from fore-arm. Ten minutes after last injection there were general numbness of fore-arm, excessive dryness of throat, pupils dilated, vision so disturbed that he could not distinguish acquaintances at forty feet, and his gait was staggering. Symptoms persisted two hours. Visual disorder and dry throat continued through a sleepless night, and toxic symptoms persisted, in part, for nearly a week.

Dr. Call, in a paper before the Madrid Chirurgical Society, stated that he found fifty centigrams of a one-per-cent solution injected into the bladder caused convulsive movements.

Dr. Emmet Holt (New York Medical Journal) reported five cases of children aged three to twenty-one months, suffering from whoopingcough, in which the use of a four-per cent solution by swabbing or spraying caused toxic symptoms. They were vomiting, great restlessness, rapid, shallow respirations, pulse too frequent to be counted, pupils widely dilated, profuse perspiration, temperature rose to 102 degrees, constant and disconnected talking, marked delirium and convulsions; "very critical condition." In a child four months old, one swabbing with a four per cent solution caused well-marked toxic symptoms; and "alarming" effects followed two sprayings of the same solution in two infants, three and six months old. His opinion is "cocaine must be used with great caution in young children under all circumstances."

Grube injected one and one quarter grains. in a woman for local anesthesia. It caused pallor, vertigo, vomiting, general numbness, pulse weakness, difficulty in swallowing, chest oppression and dyspnea.

Dr. Heiman cited case of a melancholic female to whom he gave two sevenths of a grain subcutaneously. In five minutes she became very maniacal, continuing nearly an hour.

Schnyder reported case of a druggist who took two doses of three fourths of a grain each, forty-five minutes apart, for relief of headache, causing loss of sensation, trembling of hands and feet, spasms, cold extremities, thready pulse of 150, labored breathing, intense headache, jactitation, gesticulation, and delirium.

Bresgen put a pellet of cotton wool moistened with four to six drops of a twenty-per-cent solution to the nostril of his wife. It caused chilliness, nausea, unsteady gait, excitement, followed by depression, difficult articulation, and restlessness which continued for a whole night. Dr. F. Tipton reported to me the case of a vigorously healthy female in whom he injected four minims of a four-per-cent solution for local anesthesia. In five minutes she was "deathly pale, vomiting, feeble, frequent pulse, sighing, hiccoughing, and complaining of great numbness with the sense of impending death." Symptoms persisted three hours.

Heyman observed the case of a boy, aged

ten, in whom cocaine applied by brush to larrynx caused apathy, continuing five hours.

Minney noted two cases of toxic effect from repeated applications of a four-per-cent solution to the nostrils.

Dr. Howell Way gave me details of four cases observed by him, in which five to sixty minims of a four-per cent solution, instilled or injected for local anesthesia, caused toxic symptoms, blanched face, blue lips, aphasia, dyspnea, hallucinations, delirium, and unconscious

ness.

Dr. Geo. N. Monette (Journal American Medical Association) noted three cases occurring in dental practice, in which two to four drops of a twenty-per-cent solution injected in the gums caused vertigo, blindness, cold perspiration, and inability to walk; "completely unnerved; acted as if deranged."

Dr. R. M. Griswold informed me of a lad, aged fifteen, in whom he injected fifteen drops of a four-per-cent solution for local anesthesia. In four minutes patient complained of faintness, vertigo, had stertorous breathing, with thready pulse of 160, and became blind and unconscious.

Manheim noted a woman in whom the subcutaneous injection of two decigrams caused dyspnea, irregular and suspended breathing, dysphagia, and agrypnia, lasting thirty hours.

Gougenheim has collected a number of cases in which cocaine solution applied to the throat was followed by urgent symptoms. Conclusions:

There is a lethal dose of cocaine.

This dose is uncertain.

Toxic affects are not rare.

They may be sequence of doses large or small, in patients old or young, the feeble or the strong.

This risk should induce caution.
Antidotes should be at command.

These are nitrite of amyl and hypodermic morphia.

THE experiment has been tried in India during last year, of vaccinating from a young buffalo instead of from a calf, and the results are said by an Indian contemporary to have been "in every way satisfactory."

Reviews and Bibliography.

A Manual of Medical Jurisprudence with Special Reference to Diseases and Injuries of the Nervous System. By ALLEN MCLANE HAMILTON, M. D. Pages, 390. E. B. Treat, New York. 1887. Price $2.75.

This book is presented as an elementary treatise and a book of reference for lawyers and doctors. Its scope is limited, for only those conditions of the nervous system are considered which have become frequent cases of litigation.

The book manifests throughout sound sense, ripe judgment, and robust morals.

The various questions considered in the work are better developed in their legal aspect than is the case in most treatises on medical juri-prudence. The author exposes with proper severity the legal fiction which goes by the name of emotional insanity, and which is a fashionable cover and extenuation for so much crime.

The treatment of the vexed question of the relation of railway injuries to nerve diseases, is especially lucid and helpful, while the tone and spirit of the whole work is a rebuke to those medical mercenaries who are ready, either on account of prejudice or a tempting fee, in too many cases to prove whatever the attorneys suggest, and who constantly exert themselves to bring expert testimony into reproach.

Hamilton's Medical Jurisprudence within the limits of its scope may be justly recommended as classical.

Report on Progress of Medicine. By J. B. Marvin, M. D. Reprint. The Radical Treatment of Trachoma. By A. E. Prince, M. D. Reprint.

Progressive Muscular Atrophy Beginning in the Legs. By J. B. Marvin, M. D. Reprint.

A Case of Gastrostomy for Cancer of the Esophagus. By E. Collins Warren, M. D. Reprint.

Wounds: their Aseptic and Antiseptic Treatment. By David Prince, M. D., Jacksonville, Ill. Reprint.

Translations.

DECUBITUS.-The decubitus which the sick adopt may or not have a relation to their disease. In the first case it is called determinate, in the second, indifferent.

The indifferent position, which has a variable character, generally indicates a favorable prognosis.

The determinate position, which has a constant character, embraces the supine decubitus, the ventral, the right lateral, the left lateral, the diagonal, and orthopnea apart from postures partly dependent on certain nervous diseases and some cases of muscular rheumatism, as torticollis, opisthotonos, emprosthotonos, and pleurosthotonus, and on alterations of movement which we shall also cite in this chapter.

The supine decubitus, which fat people adopt for convenience, is characteristic of peritonitis, since those who suffer from this affection are not able to endure the least friction on the abdomen, and it is observed also in diseases of acute and grave character, such as tetanus, articular rheumatism, etc. This decubitus takes the name of passive, when the patient, having lost his strength, occupies the lowest part of the couch, the head falls from the pillow of its own weight, the arm, as indeed the whole organism, obeys the action of gravity, as occurs in infectious diseases and intense inflammatory processes. This position is usually accompanied by disordered movements of the hands, as if the patient would reach up to something suspended before the face (carphologia), and also to the inferior extremities, which always indicates a grave condition.

The ventral decubitus is observed in abdominal diseases accompanied by strong nervous pains, gastralgias, flatulent nervous and nephritic colics, etc., and sometimes in case of anterior pulmonary cavities. In the former affections the patients find relief by compressing the affected region; and in the latter they hinder by this position the escape of the exudate from the cavities through the corresponding bronchial tubes, consequently calming the cough.

According to Barelli, children who suffer from hydrocephalus have a tendency to place

the head lower than the body, and therefore when held in the arms they allow the head to fall.

The lateral decubitus, and especially the right, is the most physiological position that the sick can adopt, and it always indicates a satisfactory degree of muscular strength.

In pneumonias children generally rest on the left side, but not so adults, who, if they do not adopt the supine position, present ordinarily the lateral decubitus on the sound side. I believe that this double position in the same disease may be explained by the fact that in children pneumonias are more diffused and affect nearly the whole of a lung, and therefore they instinctively avoid compression of the sound lung in order to allow it to perform its function with greater freedom; in adults, on the contrary, the disease is ordinarly limited and there is no inconvenience in adopting lateral decubitus on the sound side; at the same time they avoid in this way increasing the congestion of the affected part and thereby diminish the pain and cough.

In painful dry pleurisies the patient keeps the affected part still as much as possible, and, according to Dr. Renzi, rests on the sound side to diminish the congestion of the affected side, which, being elevated, the cough and pain are mitigated; but the period when position becomes marked is during the period of exudation, during which the patient constantly adopts the lateral decubitus on the diseased side, with the object of not compressing the opposite lung and allowing it to perform its function with entire freedom. The change then, if an accentuated decubitus, is a sign that a dry pleurisy has become exudative.

In cases of pulmonary cavernous tuberculosis, caseous pneumonia, abscess, patients also sometimes adopt the lateral decubitus on the diseased part in abscess, and the opposite in tuberculosis and caseous pneumonia. Professor Renzi explains this variation in the following manner: The cavities of abscesses are occupied by an abundant fluid liquid, which easily penetrates the bronchial tubes when they are elevated, provoking thus by reflex action a troublesome cough, which is diminished by adopting the lateral decubitus on the part af

fected; the others, on the contrary, contain a limited and adherent exudate, and the walls are inflamed, and consequently may occupy the more elevated position without exciting cough, obtaining thereby a diminution of the parietal inflammation and at the same time avoiding the hyperemia which produces that stubborn cough. In cardiac palpitation, whatever may be its nature, the sick generally adopt the right lateral decubitus to diminish the free space in which the heart effects its movements, thus diminish ing this space and the concomitant painful sensation.

When the liver is the site of large tumors the patient rests on the right side, and on the left if it is situated in the base; when they exist in any of the other viscera the individual adopts the supine position. In this manner they diminish the compression and the weight inherent to these alterations.

If the stomach is the seat of a circular ulcer, the right decubitus is generally chosen; nevertheless, if the ulcer is in the pylorus, the left decubitus is adopted; if the anterior aspect is the seat, the dorsal, and vice versa, the aim being always to avoid the irritation of the injured part by the contents of the stomach.

The diagonal decubitus is a medium position between supine decubitus and dorsal decubitus, and is commonly observed in exudative pleurisies.

The unstable decubitus is a want of fixed position, a continual change of decubitus, an intense excitation of the nervous system; the head of the patient turns continuously from right to left, the limbs are moved without rest, the trunk is not quiet, and the whole individual is attacked with a general irritability, so that he makes continuous efforts to uncover himself and leave the bed. This phenomenon is usually observed at the acme of acute infectious fevers, in meningitis, acute peri-encephalitis of the ver tex, and also precedes at times eruptions of the infectious fevers, crises, and relapses. When it is accompanied by an intense anguish, truly indescribable, it is a grave symptom that precedes by a short time only the agonies of dissolution.

The position in orthopnea is characterized by a general distress, the forward inclination of

the trunk, the fixation and elevation of the arms, as if to give the thorax a point of support and to bring into exercise the auxiliary muscles of respiration, and is observed always when an obstacle hinders almost completely the contact of air with the respiratory surfaces, whether this obstacle be in the larynx, the trachea (as foreign bodies, false membranes, cicatrices, or tumors, which act either by stopping up the passages or by compression), or in the bronchia or pulmonary vessels (exudates in capillary bronchitis, pneumonia, tuberculosis, emphysema, or pulmonary compression by exudates and pleuritic transudations, pneumothorax, flatulent dyspepsia, ascites, etc.), in asthma and in cardiac affections, especially in those of the right side, which then depend principally on extravasations in the pulmomary veins.

The more obtuse the angle formed by the trunk and the surface of the bed, the more intense is the orthopnea.

Consumptives are accustomed to remain seated for many hours, with the object of hindering the escape of liquids from cavities through the corresponding bronchia, which provokes cough and simulates in this way a true orthopnea; but a little attention is sufficient to realize that it is a false orthopnea.

Orthopnea indicates always a grave prognosis, but it is graver still when, in spite of a notable impairment of the respiratory function, it fails, because in this case the sufferer has either lost the consciousness of its presence, or lost strength to the point of inability to sit up. In typhus and putrid bronchitis, says Traube, these grave conditions are ordinarily found united, and hence frequently orthopnea can not be appreciated.

In tetanus and spinal meningitis the trunk may be curved in any direction. Torticollis is the lateral inclination of the neck either from rheumatism or from muscular retraction.Revista Agentina de Ciencias Medicas.

GONORRHEA IN WOMEN.- By Dr. Steinschneider, of Franzenbad. The author had an opportunity at the clinic of Prof. Neisser to examine fifty-seven women of the town, presented by the police as suffering from fresh

venereal infection. These he examined with a view of deternfining the location of the gonorrheal infection.

He proceeded on the assumption that for purposes of diagnosis it is necessary to confirm the presence of the gonococcus of Neisser.

At the instance of Prof. Neisser, he employed for staining, a solution of saffranin (1-100 alcohol 200 water).

Among the fifty-seven cases there were twenty without any appearance of gonorrhea, thirty-four cases of fresh gonorrheal infection, with whom gonorrhea had already existed for three, four, or five months, and in whom no discharge from the urethra was now any longer perceptible.

In all the thirty-four fresh cases he found the characteristic masses of goncoccus in the urethral secretion. The author therefore concludes that in all cases of recent gonorrhea in women there exists a true gonorrheal urethritis. There is then a true female urethral gonorrhea. the secretion of the vulvo-vaginal glands, the writer in only one case where there was present a Bartholinitis and urethretis could demonstrate the presence of gonococcus.

In

Next after the urethra, the cervical mucous membrane showed the largest percentage of instances as to the site of gonorrheal infection, being about fifty per cent. In sixteen cases of the thirty-four of the recently diseased and in two cases of old gonorrhea the gonococcus was found in the cervical canal.

The secretion of the uterine cavity was examined in sixteen cases, but only three of the six cases with concurrent urethral and cervical gonorrhea and in one case of cervical gonorrhea could the gonococcus be discovered.Deutsche Med. Zeitung.

RABIC ACTION OF THE ESSENCE OF TANSY. In the Academy of Sciences, November 27, 1887, M. Peyraud made a further report of his researches on the action of the essence of tansy. With this substance he had produced death with all the symptoms of hydrophobia. M. Peyraud, believing that bodies endowed with the same biological properties must have the same anatomical constitution, supposes that the essence of tansy should have the same

constitution as the rabic poison produced by the ferment of hydrophobia. He asks, then, if the inoculation of the essence of tansy may not be a substitute for that of the rabic medulla employed by Pasteur for the prevention of hydrophobia. Experience seems to demonstrate that this substitution is possible. M. Peyraud has, in fact, vaccinated rabbits previously to rabic inoculation with subcutaneous injections of the essence of tansy kept up for several days. The inoculation of the rabic virus made afterward on these animals had not resulted in their death, while paralytic hydrophobia rapidly killed the test rabbits not vaccinated. We have then, concludes M. Peyraud, in vaccination thus produced a veritable vaccine medicament.-Le Prog. Medical.

PROLONGED DIASTOLE OF THE AORTA.-M. Huchard, on November 25, 1887, read a new report on arterial sclerosis of the heart, in which he insisted strongly on the value of prolonged diastole of the aorta as a sign of exaggeration of the circulation in the smaller vessels and a precursory index of a generalized arterial sclerosis. He describes five forms of arterial sclerosis, the pulmonary, the painful, the arhythmic, the tachycardiac, and the asystolic forms.—Ibid.

Abstracts and Selections.

USTILAGO MAYDIS AS AN OXYTOXIC.-Dr. W. A. N. Dorland, of the Philadelphia Hospital, after a study of ustilago maydis, summarizes as follows:

1. The toxicology and physiological action of the drug. No cases of poisoning in man by the drug are on record. That it is, however, possessed of toxic properties in large doses has been proved by Mitchell. He found that in the lower animals, in large doses, it acted vio

lently upon the spinal cord, paralyzing first

the sensory, later the motor tracts, finally involving the motor and probably also the sensory nerves. Like ergot, then, it is probable that the chief force of the drug in toxic doses is expended upon the nerve centers, producing a toxic paralysis.

The action of ustilago upon the uterus has been more carefully noted. After the ingestion of a sufficient amount, in from twenty