this series of experiments was that sulfonal in doses of one gram (15 grains) is an uncertain hypnotic. The effect of doses of two grams (30 grains) was very different from the preceding. In these cases also parallel experiments were made with indifferent drugs, but here in a large series of cases starch powders and capsules had no effect, whereas sulfonal produced a sound sleep; in very few cases did it fail. Sulfonal was given in some cases in the morning after a previous good night's rest to robust men who were told that they were taking a stomachic or anti-rheumatic; these were men who were not accustomed to sleep in the day-time; yet the effect was excellent, the patient sleeping from two to five hours; only those patients who did not remain abed, or who walked about in the garden, were affected. There were no bad after-effects after two-gram doses except with those who were psychically affected, that is, those who also complained of the most outré symptoms after starch capsules, such as vertigo, dullness, headache, and nausea. Only a small number complained of a feeling of dizziness; other symptoms, as headache, were never observed. Sulfonal was given to many patients with heart diseases without injurious effect.

not

The conclusion from this series of experiments was, that in two-gram (30 grains) doses, sulfonal is a certain hypnotic, which fails only in the rarest cases; there are no unpleasant symptoms following its use. In its hyp notic power, two grams can be compared to ten to fifteen milligrams (grain) of morphine without the after-effects of the latter. Sleep occurs in from one half to one and one half hours after ingestion. This dose has a decided effect on the sensibility of the bronchial mucous membrane. It was given to a large number of tuberculosis patients who were prevented from, sleeping by their irritating cough. Although a number of these slept well, and felt a diminution of bronchial irritation after the starch powders and capsules, a stil larger number obtainined no relief except from the sulfonal. Many others did not obtain

sleep and relief from two grams, but only after three grams of sulfonal had been taken. One sixth of a grain (0.01) of morphine was more effective in preventing bronchial irritation than even three grams of sulfonal. There were no unpleasant after-effects following three-gram doses of sulfonal. When four grams (60 grains) were given, a deep sleep followed, lasting three to four hours in the day-time or from eight to twelve hours at night.

The effect was much more powerful than that produced by 0.02 (3 grain) of morphine or two grams (30 grains) of chloral hydrate. All patients awake with a dull, dizzy feeling, which often continued throughout the day. On the night following the patients generally slept better than usual. Bronchial irritation was allayed by this dose better than by a dose of 0.01 (grain) of morphine. Besides dullness and dizziness, no other after-effects were noticed; but these effects last so long after four gram-doses that such a quantity should only be given in extreme cases. Rosin's general conclusion is, that sulfonal in doses of two grams is a hypnotic not inferior to morphine, chloral, and others, and by reason of its freedom from its after-effects, even when four grams (60 grains) are given, is to be recommended in all uncomplicated cases of insomnia.

Oesterreicher's researches agree with those of Kast and Rabbas, and may be summed up as follows: Sulfonal is an innocuous hypnotic followed by no inconvenient after-effects. It does not influence the respiration, pulse or kidney secretion even in cases of albuminuria. At present we can not tell if distur bances arise after a protracted use of the drug. It deserves preference over amyl hydrate and paraldehyde, especially among the insane, owing to its being tasteless and odorless. Its effect is not absolutely certain, but is at least equal to that of chloral, to which it is to be preferred, owing to its safety, even in heart affections; also because it produces no condition of intoxication or preceding excitation.

In the first days of abstinence from morphine it has as little effect as the three

drugs just mentioned. After its use sleep follows in from one to three hours-later than after the use of the other drugs, but the sleep is continuous and sound. It is advisable to administer the drug several hours before bed-time.

In the present state of our knowledge we can not tell if a sulfonal habit can be established. At any rate it is not quickly established.-Berlin Klin. Woch.; Internat. Woch.; Internat.

Rundsch.

TREATMENT OF TUBERCULOSIS WITH CREOSOTE. (Professor Struempell, Muench. Med. Woch. 1888.) We selected such patients for our therapeutical experiments whose general condition as to nutrition was relatively good, those in whom the tubercular destruction was limited in extent but had not been influenced by proper hygienic measures. It can not be doubted that the most certain, in fact the only clinical means of determining the progress of the disease is the temperature measurements. When a consumptive has even a slight daily elevation of temperature which can not be explained by other causes, we may be certain that the tubercular process in the lung is active. If, on the contrary, he is free from fever, the process in the lung is at least temporarily at a standstill. Under favorable external surroundings such pauses almost always occur, and often a decided improvement takes place, which lasts until the local process in the lung again becomes active. Appreciating these facts, we selected patients in whom we found slight elevations of temperature, indicating a steady, if slow, advance of the disease. We found creosote completely valueless in most of the cases. Former observers have acknowledged that creosote has no effect on the temperature of consumptives, and yet without such an influence we can not affirm that any drug, even creosote, can exert any real curative influence upon the disease.

We gave the drug in large doses. Patients took daily from eight to eighteen capsules, each containing 0.06 (1 grain) of creosote and 0,02 (grain) of balsam of tolu.

As a

rule the medicament was well borne, but once in a while patients were compelled to give up its use temporarily, owing to abdominal pains caused by it.

Most of the patients praised the effect of the drug on the cough, sputum, and appetite; but little dependence can be placed upon the sanguine expressions of consumptives.

The drug was at times borne well by patients with intestinal tuberculosis and diarrhea, so that the latter is not always a contra-indication. No favorable effect on intestinal disturbances could be observed. Taking it all in all, we find that creosote even in large doses has no injurious effect in tuberculosis. At times we notice an apparently favorable symptomatic effect. We failed, however, to observe any real influence exerted by creosote on the progress of the disease.

Abstracts and Selections.

CLASSIFICATION OF DISEASE BY MEANS OF COMPARATIVE NOSOLOGY.-(Dr. Clifford Allbutt, of Leeds, England.) The above was the subject of the address in medicine by this distinguished investigator and physician before the Glasgow meeting of the British Medical Association. He thought disease should be classified by affinity, which should supersede our present system of classification by clinical features. The advances made in comparative nosology, a term rarely heard, have been less than should have been the case.

The nervous system, the highest organization, the functions of which have been of late years so ardently studied, received attention. In man the diseases of the nervous system have attained a development so enormously beyond that of the highest pithecoid forms that the diseases of man are correspondingly heterogenous. Modern observers are beginning to say that in man not fever only, but all maladies are primarily or secondarily neurotic; as the nerv ous system develops in the higher animals all diseases must take on a change of type, become more systematic, more complex, more sympathetic with disorder elsewhere, must tend in a word to primary or secondary neuroses. The diseases of the lower races of men will differ, and as a matter of fact do differ from those of the higher.

In classification by affinity four methods of inquiry must be followed, namely, the hereditary, historical, geographical, and experimental. In the records of hereditary disease we find that observation has been almost wholly directed to the detection of the recurrence of the same form of malady in one family tree, but if we desire a scheme of all the fatal and non-fatal diseases found in the same stock, it can not be furnished. The inherent tendency of organisms to vary, "nature's bent for inequality" in the words of Matthew Arnold, is well known if not yet explained.

The historical method leads to the philcsophical in all studies, and no less in nosology; unhappily this study has not yet emerged from the prehistoric period. In the comparison of human disease as it now exists with its past history, we must remember that in the ruder states of man morbid variations were constantly eliminated in the struggle for existence. But we begin to see the converse of this condition when human society attained a high degree of development. Natural selection is modified by deliberate counterplots; bad strains are preserved which in former times would have died out; however, bodily improvement may be sought at the cost of the higher mental and effective organizations. Dr. Allbutt gave an interesting resume of racial characteristics in disease. He finds the Dutch rarely the subjects of irritative neurosis; the Scotch likewise have a relative rarity of purely nervous diseases, but cancer is more common in Cumberland than any other of the border counties. Apoplexy and palsy are more common among white than colored people, and among the Germans than the Irish. Among the Indians diseases of the nervous and circulatory systems are rare, but scrofula and consumption common. The Englishman is The Englishman is patient and courageous under sickness, while the Scotchman lies down and gives away under the same conditions, while the Irish Celt is fired with alarm and magnifies by his vivid imagination both his sickness and recovery. The study of racial peculiarities is intensely interesting, but the variations are known to be manifold. The Arab is not liable to tetanus; the poison of beriberi does not attack Europeans until they have lived in its district for a length of time; the resistance of negroes to yellow fever is common to all negroes, as is also their relative immunity from sunstroke and paludal fevers.

In speaking of the geographical method,

Dr. Allbutt queried: How have the morbid varieties of man arisen? We can only answer in general terms that we must have especial regard to areas long undisturbed, and as we can not confound nations with races, so we must not confound kingdoms with physiological areas. As in various families in as various regions, we must work out in each not only the prevalence of disease taken singly, but more especially the schedules of its diseases, noting both coexistence and respective degrees of intensity.

The experimental method will teach us. that drugs and poisons will not vary in their clinical effects on living beings by gradual augmentation of differences, but by leaps and bounds, as musical scales respond to scales of vibration. It teaches us that clinical types can be no basis of nosological classification. As we rise higher and higher in the planes of function we enlarge the office of inhibition.

On motion of Professor McCall Anderson, a vote of thanks was given Dr. Allbutt for his address.

AMAUROSIS AND STRABISMUS FROM ASCARIS LUMBRICOIDES.-(Jabez Hogg, F. R. C. S., in the British Medical Journal.) From a record of cases, carefully tabulated and extending over many years, I find that strabismus in young children is more frequently due to the irritation of intestinal worms than is generally stated in manuals of eye diseases. It is, however, quite an uncommon thing to find reflex amaurosis and and strabismus associated in one and the same persons, and arising from the same cause, the presence of worms. In the case I am about to narrate there is one other feature which renders it of more than ordinary interest. My little patient, barely three years old, was, when she came under my care, the intermediary hostess of three kinds of entozoa, namely, oxyurides. (the little thread-worm), taenia (tape-worm), and ascaris lumbricoides (round worm). On searching through the medical journals, I have not met with a paralled case, and I have discovered only a very few cases of reflex amaurosis from worms, one of which, narrated by Dr. Burgers, was published in the British Medical Journal in 1862. A still smaller number of cases have also been reported in which, it is said, death has resulted from the perforation of the intestine by ascaris lumbricoides It is aid that the three kinds of worms named by me will not exist together. It is difficult enough to account for their presence in the intestine of so young a child, and belonging as she did to the middle class of society. Polluted drinkingwater is the carrier of filariæ, and this might

have been unwittingly used by the nurse to mix with the milk which formed the staple food of the child. It is known, too, that the ova and embryos of parasitic worms will occasionally undergo a passive migration; that is, direct from intestine to intestine, and without passing through an intermediary host. It is quite possible, therefore, for embryos to be conveyed in the blood of the mother to the fetus in utero, and not reach their final stage until some months after the birth of the child. In my case, there was no history of the kind; the mother is quite certain she was never afflicted with worms, but, curiously enough, on going back another generation, the grandmother had passed several tape-worms after she was married. When Mrs. D. consulted me about her child's sight, the ordinary symptoms of worms were mostly absent. Her sleep was not disturbed; she had no nasal irritation; no craving for food of any kind; disliked meat, and had a small and capricious appetite; her daily food consisted for the most part of milk and bread and light, sweet puddings. She was spare in body, weak in her legs, and her movements were consequently slow, passing from one chair to another by touch. This the mother attributed to the loss of sight, which had now persisted for more than a year. Her speech was very defective; her Vocabulary consisting of a few unintelligible sounds, just sufficient to make her wants known to her nur-e, and no more. When placed in front of a strong light, the eyeballs rapidly moved upward, the irides being concealed by the upper lid. From this cause, and that of the persistent squint, I was quite unable to make any ophthalmoscopic examination. I, I, nevertheless, came to the conclusion, not shared in by any one who had previously seen the child, that the strabismus at all events was symptomatic of worms. I accordingly prescribed anthelmintics, commencing with scam. mony and jalap, which, after the administration of a second powder, gave the first intimation of the correctness of my diagnosis, as it brought away a large number of ascarides. My next remedy, filix mas, dislodged a portion only of a tape-worm, eighteen inches long; other portions came away some days afterward; and I next prescribed three-grain doses of santonin at bedtime, to be followed by a full dose of castor oil the following morning. This treatment proved very effectual; the first powder brought away five or six large lumbrici. In the course of the following fortnight, five or six, and twenty round worms, measuring from four to eight inches in length, were expelled; the relief obtained by the little patient was most gratifying to behold. Two months have elapsed. She is recovering her sight, and the strabismus. has

entirely disappeared. Her bodily health is quite changed for the better; she is strong on her feet, can walk a considerable distance, and has gained in intelligence and in speech-is, in fact, an altered child. From the large size and strength of the female lumbrici, I should not have been surprised if perforation of the intestine, in one so young and delicate, had taken place before I succeeded in dislodging all the

worms.

SUSPENSION OF THE UTERUS FOR PROLAPSUS. Dr. Malanco has recently brought before the Mexican Academy of Medicine an operation which was practiced for the first time more than three years ago for the relief of prolapsus uteri, and which, it is claimed, possesses advantages over the use of pessaries and over Alexander's operation of shortening the ligaments. The Mexican operation is denominated "suspension of the uterus," and it has been performed during the course of the last twelve months no less than eight times in the hospital Angel Gonzàles Echeverria in Mexico, the unilateral and bilateral operation being each employed four times. In all the cases the results were satisfactory in

greater or less degree. The operation consists essentially in making a track, whose walls become indurated and indistensible, between the fundus of the vagina and the external surface of the abdomen just above the horizontal ramus of the pubes. At first it was proposed to employ the thermo-cautery, but this was abandoned on account of the danger of the heat given out by it affecting the peritoneum, and also because it was found that the retraction caused in the subperitoneal cellular tissue was insufficient, though that set up in the dermis is, as is well known, considerable. It was then determined to pass a thread or ligature through the track, and thus temporarily to tie the vagina to the abdominal wall until the tissues had become sufficiently retracted. Catgut was employed for this purpose, but, though admirable for its antiseptic qualities, it did not last long enough to accomplish the desired effect. A thread of silver wire has latterly, therefore, been substituted. This is made into a loop, which passes around a bit of metal in a piece of gum-elastic catheter, which acts like the quill in a suture, and is retained in the vagina. The other end is passed out above the pubes, and retained by a piece of lead. Iodoformed ether is injected into both the extremities of the canal. Cottonwool and collodion impregnated with corrosive sublimate are applied to the external wound, and frequent antiseptic irrigations are practiced per vaginam, with the object of keeping the internal wound free from septic matter. There is no need to tighten the wire much. It is then

well borne, and it can remain until the track around it becomes lined with tissue of a suffi

ciently resistant character. This, of course, forms a hollow cord connecting the vaginal mucous membrane with the skin of the abdominal wall. In one case, by some accident, the wire got broken in a fortnight. This was quite time enough to fix the uterus in its proper position. If, however, this kind of thing happens, there is no difficulty in passing a new wire without making any fresh wound. Indeed, the patient herself may be taught, in case of need, to reapply the wire ligature. The advantages of the suspension operation over pessaries are said to be that the vagina is not obliterated or dilated, the neck of the womb is not irritated, and the facilities for cleanliness are perfect. Lancet.

LARYNGOLOGY AND RHINOLOGY.-(Dr. Felix Simon, of Edinburgh.)-The president of this section in making his opening address said that this was the first time that the rank of a full section had been granted to laryngology and rhinology in the British Medical Association. Though the physiological principle of laryngology and rhinology had originated in this country, it was a curious fact that its medical application had been received by the profession from the first with a somewhat languid interest. The laryngoscope was for a long time looked upon by a majority of the profession as a physiological toy. The younger generation of laryngologists can not realize the struggles of the older. The present position of the specialty in Great Britain and Ireland is much better than the most aspiring advocate hoped for ten years ago. There remains still much to be done in the line of improvement in both teaching and society work. The following points should be attained, compulsory attendance on a practical course in laryngology and rhinology to be included in the official curriculum. That the proficiency of every student going up for his final examination be tested with regard to the use of the ophthalmoscope and rhinoscope in the course of his clinical examination. That the organization of the throat departments in the general hospitals be improved, and that co-operation among the teachers in the general hospitals be aimed at. That by bringing forward questions of general interest in general medical societies, the interests of the profession at large in their endeavors be further increased. The gist of the matter is that it was in remaining intimately connected with their mother science, medicine and surgery, that the true progress of laryngology must be

sought. They should avoid the fatal mistake of becoming isolated. He recommended for the maintenance of this bond of union the frequent reading of papers of general interest in general medical societies, and the publication of the same in general medical journals. From this point of view he could not but express his regret at the formation of a special laryngological and rhinological society. Had the Association absolutely refused to grant a position to laryngology, the formation of such a society would have been intelligible enough. There is reason to fear that the British laryngologists will be split up into camps and not allow of sufficient attendance on either. No specialty should retire into its own little snail shell and lead a self-satisfied existence. No specialty can lastingly flourish which aims at an independence at the expense of too great a separation from the general body.

Dr.

DANGERS OF ANTISEPTICS.-According to the Berlin correspondent of the British Medical Journal, at the last meeting of the Berliner Medicinische Gesellshaft, Dr. Emil Senger read a paper on the influence of antiseptic remedies on the organs of the body, with special reference to operations on the kidney. It is well known that after nephrectomy, or even nephrotomy, many patients die with symptoms of uremia or anuria, even when it had been ascertained beforehand by careful examination that the other kidney was quite healthy and capable of secreting the necessary amount of urea. James Israel, chief surgeon of the Berlin Jewish Hospital, has propounded a very complicated theory as to certain nervous sympathies between the two kidneys whereby an operation on one may give rise to degeneration of the other. Senger has now proved by experiments on rabbits and dogs that our antiseptic remedies are the cause of these complications. He injected into the ani-. mals, when in perfect health, one tenth or twelfth part of the quantity of corrosive sublimate, carbolic acid, etc., which is sufficient to kill them. He then extirpated one kidney and examined it microscopically, with the result that in all cases he found glomerulonephritis. There was exudation between the glomerulus and the capsule, and the epithelium of the tubuli contorti was almost entirely destroyed. He found also fatty degeneration of the liver, the spleen, the heart muscle, etc. The various antiseptic agents were found to be injurious in different degrees, corrosive sublimate being the most dangerous, then the others in the following order, iodoform, carbolic acid, salicylic acid, boric acid. Senger therefore recommends surgeons to avoid antiseptics in operations on the