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sylvestris (B. P.), and may therefore be employed when the official formula is found too irritating. It is a very mild stimulant to the mucous membrane, and an agreeable remedy for inhalation in relaxation, congestion, and chronic catarrhal affections of the respiratory tract. Oleum pini pumilionis is also an excellent addition to other inhalations, such as creosote and various essential oils. It disguises the disagreeable odor of some and imparts its own fragrance to others. It also mixes well with eucalyptol and other inhalan's. Internally, the ordinary dose is from one to five minims. Small doses can be taken in lozenges or on a lump of sugar, as terebine is ften taken, or a mixture can be made with tragacanth, etc., or larger doses may be given in capsules. In the stomach it acts as a carminative. It is quickly absorbed, and probably behaves in the blood and tissues like other terebinthinates. It is eliminated chiefly by the lungs, kidneys, and skin. It is its action on the bronchial membrane during excretion that renders it valuable in disease of this surface, being a stimulant, expectorant, and disinfectant, hence indicated in chronic bronchitis, dilatation of bronchi, bronchorrhea, some states of phthisis, and other affections. The effect on the kidneys should not, however, be forgotten. The violet odor of the urine is produced as with some other terebinthinates, and small doses seem diuretic, but its use in diseases of the urinary passages manifestly requires care. Externally, sprinkled on flannel, or, better still, on spongio-piline, the oil is a cleanly, prompt, and useful stimulant and counter-irritant, and sometimes appears to possess slight anesthetic properties.

2. Terpin hydrate affords a curious contrast to oleum pini pumilionis. It has but a slight ta-te, is rather insoluble, has no odor, and is solid. It may be seen as small needles when it spontaneously crystallizes from a mixture of turpentine and water, or may be obtained in large rhombic crystals by allow ing alcohol (three parts), turpentine (four), and nitric acid (one) to stand in shallow dishes three or four days. Terpin hydrate is only dissolved in small proportion by cold water or turpentine, but is taken up more readily by hot water, alcohol, and ether. For this reason it is best given in pills or wafer paper. For small doses pills containing two grains each are convenient, and one can be taken every three or four hours. For larger doses, which should not be repeated so frequently, wafer paper is better. An emulsion may also be made, but this is not

an agreeable method. The hydrate may' however, be dissolved in warm glycerine' and after solution an equal quantity of some syrup may be added. This makes a suitable linctus. From sixteen to twenty-four grains in the ounce gives two to three grains to the teaspoonful, and this dose can be taken every three or four hours. It is well to begin with these small quantities, as they are often found sufficient to affect the bronchial membrane, and they act on the kidneys. Germain Sée, Hausmann, Ferreira, Chèron, and others, have given much larger doses-ten grains, and in some cases fifteen. It is obvious that such doses might have a serious effect on the kidneys, and large quantities given to animals have been followed by hematuria. A dose of ten grains in wafer paper produces a feeling of fullness and heat at the epigastrium, and a sense of cerebral stimulation, which in sensitive individuals may amount to giddiness. The effects of both small and large doses are analogous to those of other terebinthinates, and it is as a tasteless, odorless substitute for them that it is most useful. In restraining the cough and secretion of bronchitis, and stimulating the membrane to more healthy action, perhaps also disinfecting the sputa, it will be found useful. Germain Sée also found full doses restrain the copious sputa of some cases of phthisis, and he met with no gastric irritation after long continuation of the drug; but others have not been equally fortunate. In some instances small doses seem to increase bronchial secretion. It has also been ‹mployed successfully in hemoptysis. Its diuretic ef fect has been utilized; and, in short, it has been tried in most cases in which the other terebinthinates are useful, including neuralgias. Dr. Royland seems inclined to credit hydrate of terpin with some hypnotic property, but perhaps the sleep may be attributed rather to the rapid relief to the cough, which, in the cases he reports in the New York Medical Record, so constantly followed the administration of the remedy.-Dr. Prosser James, London Lancet.

ANATOMY OF ABSCESS.-As regards the mode in which an abscess is produced by these organisms, a considerable number of facts have recently been obtained from the examination of parts after infection Where

the organisms are circulating in the blood and become deposited in the smaller capillaries in the form of plugs, as is seen in pyemia, the first effect is the change in the tis sue, termed by Weigert "coagulation necrosis," and figured by me in a paper on Micro

cocci in Relation to Suppuration, etc., published som⚫ years ago. On staining sections of tissue in which these plugs are present with the ordinary aniline dyes, it is found that, while the mass of organisms is intensely staine 1, and while the nuclei in the section have become well colored, there is a ring of tissue around the central mass of organisms which does not take on the stain, and which presents a homogeneous translucent appear ance; this ring evidently results from the action of the concentrated products of the micrococci, the tissue being brought into the condition of coagulation necrosis. After some hours, a second ring appears, at a greater distance from the mass of organisms, this ring being composed of a dense layer of leucocytes, apparently collecting where the chemical substances are more dilute and do not interfere with the life of the cells. As time goes on, the intermediate translucent layer becomes infiltrated, on the one hand with cocci from the central plug, and on the other hand with cells from the outer ring, and the original tissue rapidly disappears, probably as the result of the peptonizing action of the cocci. At the same time the fluid effused does not coagulate, probably also on account of the peptonizing action of the cocci on the fibrinogen, and thus we come to have a central collection of fluid containing leucocytes and micrococci, surrounded by a wall of leucocytes and cocciin other words, an abscess.

When the cocci spread into the surrounding tissue after injection, or from wounds in the skin, etc., they apparently at first frequently follow the course of the lymph channels. In the case of injections, as in Bumm's cases, we find at the seat of injection a central mass presenting a yellowish appearance, due to the presence of large numbers of leucocytes and cocci infiltrating the injured parts, this central yellow mass being surrounded by an inflamed area, in which are also leucocytes and micrococci. At the margin of the inflamed area the cocci are seen to be multiplying and penetrating into the surrounding tissue in all directions, the mode in which they spread vary according to the density of the tissue; thus, where the tissue is fairly dense, they spread in masses, while in the loose cellular tissue they form small groups and chains of four to six members. The cellular tissue attacked soon loses its fibrous appearance, the fibrillæ swelling up and a homogeneous mass forming, this ma-s ultimately undergoing liquefaction, just as in the case previously described. Beyond the area of infiltration with organisms a

layer of leucocytes is formed, but at first this layer does not seem to be able to oppose the spread of the organism. In rabbits, however, after about the third-and more especially the fourth-day, their spread begins to be limited, and the zone in which the cocci are penetrating into the tissue becomes thinner. In rabbits, by the ninth day the tissues have, as a rule, completely got the upper hand, and the micrococcal growth is surrounded and limited on all sides by a layer of leucocytes (Ernst). The sequence of events in man is quite similar, but, as a rule, the cocci become inclosed more quickly than in rabbits. I may say that I have here been speaking of the effects of staphylococci; the mode of spread and action of the streptococci is, as Ogston first pointed out, and as will be after ward mentioned, somewhat different, and these differences apparently bear some relation to differences in the peptonizing power of the two species of organisms.

As regards the mode in which the cocci act on the skin, for example, in the experiments made by Bockhardt, the following seem to be the facts. The points at which the pyogenic cocci penetrate into the skin are the ducts of the sweat glands, the orifices of the sebaceous glands and hair follicles, and portions of the skin where the protective epidermis has been scratched or destroyed. If the micrococci penetrate by one or other of these paths into the skin, they multiply either in the wall of the ducts of the sweat glands and the adjacent part of the Malpighian layer, or they penetrate into the external root sheath and into the Malpighian layer at the orifice of the hair follicles, or they develop at some part of the Malpighian layer which has been deprived of the epidermic covering. They multiply rapidly at the seat of infection, and set up violent suppurative inflammation in the neighboring papillæ. the violence of this inflammation being evident from the rapidity with which the pustules appear after inunction. As a rule, when the micrococci on y set up in impetigo pustules, they do not spread beyond the epidermic tissue; if they do so we have the conditions necessary for the production of an abscess in the skin; this, however, generally only occurs after coarse mechanical injury to the skin. A boil develops, especially from impetigo pustules which have formed in connection with hair follicles, or with the orifices of the ducts of the sweat glands in the following manner: After the micrococci have entered these parts and set up the impetigo pustules, they gradually

spread in the wall of the ducts until they reach the end of the sweat gland, or sebaceous or hair follicles. Coagulation necrosis occurs around them, and violent inflammation is set up in the vascular tissue surrounding these ducts and glands, with the result that a layer of leucocytes is formed like a wall around the affected epithelial tissue. As the necrosed wall of the duct or hair follicle becomes infiltrated with pus cells, the core of the boil is formed; pus forms around the core, and ultimately the skin gives way and it is expelled.-W. Watson Cheyne, British Medical Journal.

POSSIBILITY AND UTILITY OF WASHING OUT THE PELVIS OF THE KIDNEY AND THE URETERS THROUGH THE BLADDER.-In the Lancet of October 29, 1887, I have illustrated the use of suction as a means of extracting certain kinds of foreign bodies from the bladder, and incidentally referred to a case where I believe a renal calculus had been dislodged from the ureter in this way. In connection with some experiments upon which this practice was based, I would now refer more especially to the possibility of distending the ureters with fluid, and thus reaching the pelvis of the kidney. In the normal condition of the parts such a proce-s could only be brought about, I believe, by very gra tual means, as the mode in which the ureters enter the bladder is to render sudden regurgitation of fluids from the latter toward the kidneys well-nigh impossible. In cases of long-standing stricture and prostatic obstruction, we see this provision gradually destroyed until the ureters and pelvis of the kidney become little else than subsidiary bladders. Again, in other instances the valve like arrangement which prevents fluid passing along the ureters in any other than a downward direction is liable to be deranged by the passage of calculi and suppurative débris, as we so frequently see in tubercular disease of the kidney. With conditions like these, it occurred to me that fluid might be mate to pass from the bladder along the ureters to the pelvis of the kidney, and this observation has suggested some trials in practice which I think are worthy of notice.

I have, in the previous communication here referred to, alluded to a case where, I believe, a calculus was dislodged from the ureter by distending the bladder with fluid by means of a suitable apparatus, and thus causing a back flow along the canal, which would tend to dilate that portion of it which was below the stone, while at the same time some slight movement would probably be

communicated to the obstruction. That the ureter was more or less dilated I thought probable from the fact that the patient had been in the habit of passing kidney stones, and had suffered much on these occasions from renal colic. Whether my conclusion that the escape of the calculus was connected with the injection into the bladder was a correct one it is impossible to say, but I thought the coincidence a suggestive one.

Take another instance. A middle-aged man was under my observation a short time ago for acute renal pain and hematuria, which I felt sure, from his previous history, was due to a stone in his left kidney. The symptoms continued in spite of a variety of attempts to dislodge the calculus. Then I suggested nephrotomy, but the patient would not consent. Shortly after this the position of the pain changed and I had reason to believe that the stone had made its way into the ureter. Shampooing of the side, friction, and other means were tried, but without benefit. I then resolved to try fluid distension of the uretor. After washing out the bladder, I filled it with tepid water, upon which pressure was exercised by the evacuator usually employed in lithotrity. The patient made the observation spontaneously, "I can feel something moving in my back." On examining the glass receiver of the aspirator bottle, after a few manipulations, I found that it contained about half a teaspoonful of tragments of phosphates and urates, not in crystals, but apparently in small pieces. These were examined by Dr. Barron and found to be portions of a calculus. Wherever they may have come from, it was clearly not from the bladder. This process was again repeated in a fortnight afterward. with similar results, care being taken in the first instance to empty the bladder of any thing that it might contain.

A second case, very similar to the one just nariated, is also under observation, where the proceeding was followed by the withdrawal in this way of a small teaspoonful of what proves to be fragments of a urate

stone.

When we take clinical facts such as these and compare them with pathological specimens-as, for instance, the one I have elsewhere figured (through the kindness of Dr. Reliquet of Paris), where an open ureter ultimately induced a calculous pyelitis-I do not think we can deny the possibility, under certain circumstances, of our being able to distend a ureter with fluid, and thus to reach the pelvis of the kidney. When we consider that most urate stones are usu

ally formed in the kidney, and grow, as it were, by reason of their being accidentally trapped in the bladder, the importance of securing their discharge in the earliest periods of their formation must be obvious. Further, the practice I have thus endeavored to illustrate may possibly be found useful in facilitating the discharge of inflammatory products from the kidney, and as a means of direct medication in certain cases of hematuria which are generally regarded as being beyond the reach of surgical manipulation.-Reginald Harrison, F. R. C. S., London Lancet.

being, in fact,

ACEPHENETIDIN AS AN APYRETIC.-Dr. J. Georgievski publishes in the Vrach an account of a series of observations made by him in Professor Lesh's clinic in St. Petersburg on acephenetidin, a substance which appears to act as an apyretic, and to possess several advantages over other drugs which are used for this purpose. Observations on the action of acepheletidin have been published both by Hinsberg and Kast, and by Kobler during the last twelve months. Both the papers state that ten-grain doses have no effect on healthy persons, but that from five to ten grains produce a reduction of 3° or 4° F. in persons with fever; also that no unpleasant symptoms are caused. Acephenetidin occurs as a crystalline powder of a grayish rose color. Its formula is CH13 NC, or CH, NH (C,H,O);" (C2H2O benzol C6H6, in which two atoms of hydrogen are replaced by compound radicals, as shown. It has no taste or smell, and is at the temperature of the body almost insoluble in water, acids, alkalies, gastric juice, and pancreatic juice. In alcohol it dissolves in the proportion of 1 in 20. It arrests the alcoholic fermentation of grape sugar. In order to test the action of the drug on the healthy body. Dr. Georgievski took thirty grains a day in three doses of ten grains each, separated by intervals of an hour. This was about half a grain per kilogram of body weight, or about three times as much as the doses used by Hinsberg and Kast. The only se sation produced was a slight feeling comparable to the beginning of alcoholic intoxication. No reduction of temperature was produced, though the drug was taken for some days. The color of the urine was unchanged, but when a few drops of solution of chloride of iron were added to it, it give a reddish-brown or black color. Sulphate of copper gave a somewhat similar reaction. The urine was affected in half an

hour after taking the dose, the reaction being much more distinct in two hours, remaining very strong till the fourth hour, after which it gradually became weaker, but did not entirely disappear even in the course of twelve hours. Observations were made on thirty febrile patients, including cases of phthisis, typhoid, typhus, acute rheumatism, croupous pneumonia, erysipelas of the face, quinsy, diphtheria, and pleurisy. A single dose of from three to five grains was sufficient to lower the temperature. Usually in half an hour it had gone down nearly 1°. This reduction continued, the lowest point being reached in three or four hours after the dose had been taken. The subsequent rise which then began was very gradual, the original height not being reached for five or six hours more. As a rule, a three grain dose reduced the temperature 1.8°, and a five grain dose 3.6°. It appeared to be more advantageous to give. five or ten grains all at once than in two or three divided doses at an hour's interval. The nature of the disease seemed to have a decided influence on the effect of the medicine; thus in phthisis, typhoid, and pleurisy, in which affections the temperature curve generally shows great variations, acephenetidin produced a greater and more prolonged reduction than in the diseases like pneumonia and typhus, in which there is a less variable temperature. When complications occurred, occasioning a rise of temperature, the action of the acephenetidin was weakened and large doses were required; thus during the course of acute rheumatism, when fresh joints were being attacked, the drug had but little eff ct. Like other antipyretics, acephenetidin appears to have a powerful analgesic action. Dr. Georgievski gave it with most satisfactory results in cases of cephalalgia, neuralgia of the fifth, and migraine. The dose in these cases was ten grains, with directions to repeat it or to take five grains in an hour's time, if necessary. Dr. Georgievski invites other medical men to give this drug a trial, the only objection to it being its high price. It can be obtained from Bayer, of Elberfeld, and costs about 18. 9d. a dram.—Ibid.

THE EFFECTS OF MODERATE DRINKING ON THE HUMAN CONSTITUTION.-Alcohol, when taken in small quantity, is in general said to act as a direct cardiac stimulant, and its stimulating effect is supposed to be due to its possessing the faculty of increasing the muscular power of the heart. I take an entirely different view of the matter, and shall

now endeavor to show how the increase in the force of the heart's movements, the quickening of the pulse, the flushing of the face, the congestion of the retinal blood-vessels, as well as all the other visible appearances of accelerated cardiac functional activity, are in reality in nowise due to the stimulating action of alcohol, either on the heart's muscular tissue or the nerves supplying it, but actually to the very reverse-namely, its paralyzing effects on the cardiac nerve mechanism. This may appear a strange idea to those unfamiliar with the advanced theories regarding the accelerating and restraining heart's nerve forces. Nevertheless, it is quite consonant with the results of modern physiological investigations, which go far to prove that every function of organic lifeno matter whether it be the expulsion of the urine, the peristaltic movements of the intestines, the throbbings of the heart, or. involuntary respiration-acts under the immediate influence of a bifold nerve mechanism. For example, the human heart is endowed with two entirely different and opposing centers of nerve force, and so retroactive are their respective functions that the sole duty of the one appears to be to regulate and control the functions of the other. To the former has been given the name of inhibitory or restraining mechanism; to the latter that of the exciting or accelerating nerve agency. The inhibitory nerve center being thought to exist in the medulla oblongata, in close proximity to the vaso-motor nerve center, and the vagus being supposed to contain the fibers with which it communicates its influence to the heart. The sympathetic, on the other hand, is believed to be the channel of communication between the moto-cardiac nerve center and that organ. Destroy or paralyze the inhibitory nerve center, or arrest its power of communicating with the heart by dividing the vagus, and instantly its controlling effect on the cardio-motor mechanism is lost, and the accelerating agent, being no longer under its normal restraint, runs riot. The heart's action is increased, the pulse is quickened, an excess of blood is forced into the vessels, and from their becoming engorged and dilated the face gets flushed and the retina congested-all the usual concomitants of a general engorgement of the circulation being the result. Instead of paralyzing the vagus by section, and thereby arresting its inhibitory cardiac nerve power, paralyze it through the instrumentality of a toxic agent, and precisely the same chain of phenomena will of necessity be the result. The most powerful paralyzer

etc.

of the vagus we at present know of is atropia; and what happens when it is given in a full dose? Nothing more or less than the effects we have here attributed to the section of the vagus-tumultuous heart's action, quickened pulse, congested face and eyes, Alcohol acts on the heart, I believe, in precisely the same manner as atropia does, although less strongly. That is to say, it quickens the heart's action, as well as apparently increases its power, by paralyzing its restraining or inhibitory nerve mechanism. This, however, is only the primary action of alcohol on the cardiac organ, for no sooner is the quantity administered sufficiently increased than all its at first apparently stimulating effects vanish. From its now possessing adequate power to paralyze the accelerating as well as the retarding cardiac nerve mechanism, the heart's action therefore now becomes diminished, pari passu, with the amount of the paralyzing agent employed, until at length (if a sufficiency be given) the cardiac movements are totally arrested, and death closes the scene. Effects

on the human organism being, when properly interpreted, like effects in the inorganic world-exactly proportionate to cause-the at first sight apparently stimulating and consequently salutary action of alcohol on the heart, when taken in moderation, is as much due to the alcohol's paralyzing power as the destruction of all vital action is its result when it is taken in poisonous quantities. From this, however, it is not to be inferred that its incipient paralyzing power over the inhibitory cardiac nerve mechanism must necessarily be in all cases detrimental. On the contrary, it may actually in many instances be beneficial. Just in the same way as atropia, strophanthus, digitalis, and daturine-which are all cardiac inhibitory nerve paralyzers-prove exceedingly useful medicinal agents when they are judiciously employed in appropriate cases. alcohol, by the doctor's skill, may in like manner be so used as to paralyze to cure and not to kill.

So

It being well known that intemperance is a most fruitful cause, not only of all the various forms of heart disease, but likewise of the degenerations of the coats of the blood-vessels, all I at present require to do is to prove that even what is called moderate drinking has a much greater share than is generally supposed, in not only greatly increasing heart diseases, in cases where they already exist, but also in inducing their development in the constitutionally and hereditarily predisposed to become affected