INFLUENCE OF SALICYLIC ACID ON THE EXCRETION OF URIC ACID.-At a meeting of the Royal Medical and Chirurgical Society, Mr. Alexander Haig read a paper on the Influence of Salicylic Acid and its Salts on the Excretion of Uric Acid. (Lancet.) In a paper read before the Society in May, 1887, the writer has shown that a certain form of headache is accompanied by a very large excretion of uric acid; and in a subsequent paper in the Journal of Physiology he has attempted to show that within certain limits it is possible to increase or diminish the excretion of uric acid at pleasure by means of acids and alkalies; alkalies always increase and acids always diminish the excretion. And further, he has shown in the same paper that the above form of headache may be cured, and the large uric acid excretion which accompanies it may be stopped by a dose of acid. Salicylic acid, however, forms an important exception to the above statement, for while it increases urinary acidity it does not in any way diminish the excretion of uric acid. Further, acids given while salicylates are present in the circulation have no longer the power of diminishing the excretion of uric acid. This action of salicylic acid and salicylates forms the subject of the present paper, and is of great importance in explaining the value of these drugs in gout, rheumatism, and other diseases connected with uric acid. Figures are given to illustrate the excretion of uric acid under salicylates, and are contrasted with others showing the normal relation to acidity. Excessive excretion of uric acid taking place under salicylates is not accompanied by any headache, and salicylates have been previously found useful in this headache. The action of acids and alkalies on uric-acid excretion is probably due to the fact that alkalies increase and acids diminish its solubility, and the same with the exceptional action of salicylic acid; for salicyluric acid, which it is supposed to form, differs from uric acid in being very greatly more soluble in water, and probably also more soluble in dilute acids. Benzoates do not act in the same way as salicylates, probably because hippuric acid, which they form, is less soluble than salicyluric acid. Extracts were given from Watts' "Dictionary of Chemistry" on the solubilities of these bodies. Both uric and salicyluric acids are present in the urine passed under the influence of salicylates; this is possibly due to the salicylate acting on the uric acid in the blood, and not on the uric acid, which is excreted direct from the kidneys. (See paper in Journal of Physiology.) Headache is present with the rush of uric acid which takes place under alkali, but not with the rush under

salicylates; possibly, therefore, under salicylates, uric acid is present in the blood in a different chemical combination (salicyluric acid). Several chemical points with regard to salicyluric acid require further investigation, but it is difficult to obtain it in a state of chemical purity; but the facts now brought forward explain a great part of the value of salicylates in disease.

Dr. Ward said he could corroborate the increase in specific gravity of the urine at the time of headache. This headache was associated with gout, and, if successfully treated by acids, it seemed the alkaline treatment of gout might with advantage be altered. Excessive exercise and meat-eating certainly increased the headaches. In France but little meat was eaten; yet headaches were very common. More mental work increased migraine, and this would show that it depended on more than mere excretion of uric acid; there was a nervous element; straining the eyes could induce an attack. Strychnine and aromatic spirits of ammonia were valuable drugs in megrim.

Dr. A. Garrod said that, if the teaching of the paper was right, the salicylates ought to have most marked action in gout, yet their influence was trifling. They gave relief to rheumatic gout, with which uric acid had nothing to do, nor with the pathology of rheumatic fever, in which the blood showed no excess of uric acid.

Dr. Haig, in reply, said that he could induce headache by the ingestion of agents believed to increase the formation of uric acid. It was in the intervals of the headaches that diet and regimen were so successful. The nervous system was debilitated in women, but they even would be better for leaving off the meat. The French drink a large quanity of acid wines, causing retention of uric acid. Exercise increased the output of uric acid through the perspiration. He believed that uric acid is the irritant that caused the headache, which was predisposed to by the state of the nervous system. In chronic gout salicin was useful, but in acute_gout the salicin would come too late. It was Latham's theory that uric acid was operative in acute rheumatism.-Therapeutic Gazette.

DIPHTHERIA; LOCAL TREATMENT.-" Diphtheria," says one of our best writers on this disease, Professor Jacobi, "is analogous to the septicemia of wounded men and of puerperal women, and the local disinfection which has been accepted as the sheet anchor in the treatment of these affections must be, also, the main reliance in the treatment under consideration."

As to the value of local treatment in this disease, there can hardly be said to be any difference of opinion, and all authorities advise cleansing and disinfectant topical medication. Some, as Billington, Jacobi, and Smith, rely largely on sprays, gargles, and syringing; others, as Liebermeister, make great account of local applications of sulphur.

With regard to energetic cauterizations, and the frequent clearing of the throat of false membranes by swabbing, there has of late years been a general agreement among medical authorities in avoiding these harsher methods, and for the following reasons:

1. Experience has proved that the violent removal of false membranes does no good, the diphtheritic patches being speedily re-formed. Only when the patches are already loose, and ready to separate of themselves, is their removal by the brush or swab really beneficial.

2. The milder caustics, as nitrate of silver and perchloride of iron, do not penetrate deeply enough to destroy the multiplying infection, and their frequent application adds to the discomfort of the patient.

3. The stronger caustics (undilute carbolic acid, muriatic acid, caustic potash) are very painful, not easily limited in their action to diseased parts, and are likely to cause dangerous swelling of the tissues.

4. Add that the patient is often a young child, whose opposition and whose struggles make the difficulties in the management of caustic applications well-nigh insurmountable.

5. Finally, cauterization of the throat in children has often provoked spasm of the glottis and death from asphyxia; it has also caused lesions of continuity of healthy parts, which have been speedily covered with false membranes.

These considerations, and the results of treatment by cauterization, which have not been encouraging, have led most authorities to renounce caustic agents altogether.-Boston Medical and Surgical Journal.

ACETANILIDE AS AN ANALGESIC.-Dr. O. Seifert (Ctrlbl. f. d. ges Ther.,) October 1887; Wiener Med. Woch., 1887, No. 35) has employed the drug in the following fifteen cases: three of trigeminal neuralgia, two of migraine, six of anemic cephalalgia, one of diffuse nervous headache, one of neuralgia resulting from a cicatrix, and two of supposed migraine. It was given as follows: One dose of 0.5 gram (gr. vijs) in a capsule was ordered; this was repeated in one or two hours, and if the pain was not relieved a third dose was administered. As a rule some wine was given afterward. In

Un

those cases where the pain was continuous or irregular the same quantity was given one hour after breakfast, two hours after dinner, and three hours after supper. toward effects were never observed when this method was followed, and the administration was kept up for eight days. The results in the trigeminal neuralgia were brilliant; in one case of migraine the drug proved efficacious after several other remedies had failed. It failed in one case of headache from an unknown cause, and in the case of neuralgia resulting from a cicatrix. New York Medical Journal.

THE VERMIFUGE PROPERTIES OF THE SIDA FLORIBUNDA.-Dr. M. Martinet (Nouveaux Remedes) relates how his attention was attracted to this plant by the instinct of his dog, which, after having been sick for several days, set out himself searching for a remedy. This he found in the leaves of the Sida floribunda, and after having eaten some of the leaves he was relieved at the same time of his sickness and of a large number of intestinal worms. This malvaceous plant is common in the neighborhood of Lima. It is rich in mucilage, but a chemical analysis failed to find any thing to which anthelmintic properties could be assigned. microscopical examination, however, showed that all the leaves of the plant were covered with minute spines, which the author thinks fail to be digested in the stomach on account of their cellulose structure, and act as a mechanical vermifuge in the intestines.-New York Medical Journal.

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The Therapeutic Gazette, of January, 1888, lays an earnest plea before the profession of America in favor of the much-slighted Index Medicus. It says:

"There is no profession in which the spirit of research and of literary activity is as strong as it is in the medical profession. Indeed, according to our thinking, it would be better for the profession if its activity was somewhat checked; at least it would be much easier for those of us whose position requires that they should keep ahead or abreast of the ever oncoming tidal wave. Some little time since we made a careful estimate by going over a volume of the Index Medicus, and found that in round numbers about fifteen thousand doctors had written books and articles on medical subjects in the year. These doctors probably averaged three articles apiece, and if unsigned and uncatalogued editorials, etc., are counted in, probably not much less than fifty thousand articles were cast adrift upon the waters of medical publication in 1885. It is a fair estimate that one out of thirty of these articles was worth reading by a serious man, and the labor of hunting out the good pieces of timber in the vast mass of drifting wood is certainly

gigantic. Indeed it would be impossible to do the thing satisfactorily at all were it not for such publications as the Index Medicus. Of all keys of current medical literature that have been published since the world was, on this or on any other planet, the Index Medicus is the most complete and the most satisfactory. To the literary doctor who has once used it, it has become as necessary as the morning cup of coffee or the evening meal, without which life is a burden and effort a despair."

A few years ago, when this publication was languishing to its death, Mr. George S. Davis, the well-known publisher, of Detroit, Mich., took it under the wing of his protection, and saved, as he supposed and as every body allowed, to the profession of America an indispensable help to successful work in medical literature.

This venture, though a labor of love on the part of Mr. Davis, was not undertaken without expectation of due encouragement at the hands of the profession, and it is creditable neither to the gratitude nor to the literary methods of our many writers that he should now be compelled to suspend the publication or continue it at a heavy pecuniary loss.

The latest report of the status of the Index shows that it has a subscription list of only four hundred and sixty-three names. One hundred and twenty-three copies are taken by physicians in foreign lands, and one hundred are taken for distribution among the medical officers of the United States army. These, subtracted from the grand total, leave to the Index two hundred and forty individual subscribers in the United States. When this number is distributed among the States the average quota for each is ridiculously low; and when we learn that one hundred and seventy-eight copies go to the States of New York, Massachusetts, Pennsylvania, Maryland, and the District of Columbia, leaving but sixty-two subscribers in the rest of the Union, and that several of the great Western and Southern States (Kentucky among the number) are not represented by even one subscriber, we are amazed at the light esteem in which this important publication is held by the grand army of our reading and writing doctors.

A revival along the line of medical research

is sadly needed in this part of the world if our writings are ever to have scientific solidity and permanent worth, and the Index Medicus is a veritable means to this end. We therefore urge our readers to rally to its support, assuring them that we shall strengthen precept by example, and forthwith forward our name and the subscription price to the publisher.

Notes and Queries.

Editors American Practitioner and News:

TREATMENT OF INGROWING TOE-NAIL. The article by Dr. W. C. Dugan upon the subject of ingrowing toe-nail, in your journal of November 12, 1887, prompts me to suggest a simple but very efficient remedy, viz., the probe-pointed bistoury. I was a sufferer from this trouble from my boyhood until I began the use of this instrument; the toe has given me no annoyance since. In operating it is necessary to pass the knife under the side of the nail to the root and cut out. It may be done in a moment, and without pain, nor is there danger of wounding the toe. I have done this operation upon all who have applied to me with ingrowing nails for several years, and I never hear any more complaint from them. Though not likely to make a permanent cure, this treatment is so simple and easy of application that I think it preferable in any ordinary case of ingrowing nail to the operation suggested by my friend, Dr. Dugan. S. T. TURNER, M. D.

MARFA, TEXAS, February, 1888.

TUMOR OF THE INTESTINE: SYMPTOMS SIMULATING BILIARY COLIC.-Dr. J. Lewtas reports the following unique case (British Medical Journal): Colonel M., aged fortyfive, who had lived in India for some twenty years, was seized about 2 A. M. on 4th June with agonizing pain referred to the right side of his abdomen. An injection of morphine gave relief. But in the course of the following night the pain returned with even greater intensity, so much so that recourse was had to chloroform inhalation. The case

seemed obviously to be one of gall-stone colic, and directions were given to wash the feces through muslin. On the 6th of June the patient passed what he thought was a "piece of flesh," but which was a lymphoma of nearly square outline, measuring about one inch and a half along each side, and a quarter of an inch in thickness. This is not the place for a description of the tumor. As the text-books give no warning of this source of error in the diagnosis of biliary colic, it seems worth while to place the case on record. Regarding the patient's subsequent history, a dull pain in the abdomen, chiefly on the right side continued for some days, at the end of which he regained his usual excellent health. There has been no recurrence of symptoms up to date.

THE OFFICIAL REPORTS ON THE ILLNESS OF THE CROWN PRINCE.-The Berliner Klinische Wochenschrift of February 20th refers to the recent publications of Professor Virchow and Sir Morell Mackenzie to the following effect: "The above publications come at an opportune moment, for both of them are calculated to allay the excessive anxiety of the public caused by the performance of tracheotomy (on H. I. H. the Crown Prince) and the possible consequences of that operation. It is now clear even to the nonmedical public that tracheotomy does not constitute a verdict in itself either for or against the previous treatment and opinion of the disease on the part of the surgeons in charge of the case. It is clear, too, that the operation has not come unexpectedly to those surgeons, and that it is by no means a last resource. That every thing is being done in the after-treatment-and this is for the present the most urgent part of the task-that human agency can do is beyond question. We have at least the satisfaction of knowing that our first surgeon, Von Bergmann, is present in the case, and we hope that he will not remain apart (fern bleiben) in its further treatment. At first sight the mention by Virchow of 'epidermoidal nests' might raise alarm; but the same conditions are evidently present as those referred to

by Virchow in his reports of last year, his address on pachydermia laryngi, and his publications regarding his previous reports. Therefore we may not yet give up the hope of a happy termination of this painful crisis; but no one, and least of all we medical men, ought to be surprised if, in such a tedious and severe affection, various contingencies arise, and one day can not be prophesied from another."-The British Medical Journal.

PLAGUES ANCIENT AND MODERN.-At a meeting held at the Parkes Museum on February 16th, Sir Douglas Galton, K. C. B., D. C. L., LL. D., F. R. S., in the chair, Dr. J. F. Payne gave a lecture on Plagues Ancient and Modern. The lecturer compared the distribution of certain specific diseases over the globe to the geographical distribution of plants and animals. They were native or indigenous in certain centers or regions, from which they had at certain times migrated. The history of their migration was the history of epidemics. From the history of the oriental plague-of which the black death in the fourteenth century was the most destructive outbreak-it appeared that this great pestilence was derived from Asia. Contemporary witnesses had observed, and indeed accompanied, its march from the borders of Tartary to Italy. The probability was that its original starting point was still further east, in China, or possibly in India; and in confirmation of this it was shown that the true plague, in a form closely resembling the black death, still exists, or has existed, within the last few years in both India and China. The original seat of the disease must therefore be placed in one of these countries, probably in China, and its invasion of Europe in the fourteenth century was an instance of migration from it original home. The historical sweating sickness, which prevailed in England in the time of the Tudor kings, was next spoken of. It was thought to be a disease imported from France by the foreign mercenary soldiers of Henry VII, and owed its extraordinary severity to

the fact that it was a new disease in England, since diseases often spread in a new country with great rapidity and virulence. Another instance was afforded by the introduction of European measles into the South Seas, where, especially in Fiji, it had caused an enormous mortality. A disease closely resembling the sweating sickness still recurred from time to time in certain parts of France, and a considerable epidemic of it was observed only last year, when it spread through numerous villages and caused a not inconsiderable mortality. In both these cases the old historical pestilences were to be found still existing in modern times, but at considerable distance from countries in which their most destructive visitations had occurred.

PYE-SMITH ON PROGNOSIS.-Dr. Pye-Smith sums up the conclusions arrived at in his very able paper in the following prognostic aphorisms:

Epidemic diseases are most fatal when first introduced. Acute diseases, following chronic, are the most dangerous. A degree of pyemia which is of slight importance in a child is grave in an adult, and imminently perilous in an old man.

Typhus fever is most dangerous to persons who have passed their sixtieth or fiftieth year; less so to infants and those between thirty and fifty-five; and least dangerous to children about five, and to young adults.

Smallpox in these particulars closely resembles typhus. Whooping-cough is dangerous during infancy, and benign after five years of age. Scarlet fever seldom takes on a malignant form when it attacks adults. Acute lobar pneumonia has usually a favorable issue in youth, and is usually fatal in advanced years. In young adults pneumonia is rarely fatal unless the patient has disease of the kidneys or of the heart, or is of intemperate habits. Pneumonia is also a dangerous complication of fevers or acute rheumatism. Acute lobar pneumonia, when not fatal, leaves the lung uninjured after recovery, and the patient in good health. is seldom or never followed by phthisis even

It