hours.

Her

Miss E. F., aged 47, had been for some months under treatment for vague nervous symptoms, including a girdle sensation and various paræsthesias of the lower limbs. sleep was poor. She described the feeling just prior to going to sleep as "very queer," and was drowsy all next day.

Mrs. McK., aged 23, slept poorly during the last weeks of pregnancy, and continued to do so after labor. The first dose failed, but the second on the following night succeeded.

Mrs. L., widow, aged 47, with cardiac hypertrophy, chronic pericarditis, loud mitral murmur, bedridden for several months, slept well on trional. Bromides, stimulants, and antispasmodics had all been used before with indifferent success. It was administered only every other night. After some three or four doses had been used in this way she experienced a severe attack of cardiac depression, of which she had before had a number of a milder sort. The trional, however, had not been taken on the night immediately previous to this attack, but the possible influence of it as a causative factor would, nevertheless, seem to point to caution in its administration in so extensive a case of heart lesion.

Mrs. E., aged 32, always a poor sleeper, was suffering from very violent headache which had been preceded by an acute coryza and was accompanied by neuralgic pains in the sciatic nerve, from which she often suffered. She took during the night trional and during the day

Miss A., aged 40, a neurasthenic with frequent neuralgic and migrainous attacks, had some wheals of urticaria which she feared would result in another severe attack such as she had a year earlier and which proved extremely rebellious to treatment. She took trional for two nights in succession, with 3 grains sodii salicylas three times a day, promptly aborting the attack.

J. C., aged 32, male, in an advanced stage of pulmonary tuberculosis with a neuritic palsy of the serratus magnus muscle, had just passed through several slight hæmorrhages. He slept very soundly under the use of trional, but was very drowsy all next day.

Miss D., aged 23, always a poor sleeper, was suffering from the depression of influenza. She slept soundly on trional.

G. S., male, aged 40, was in the period of delirium and hallucinations of sight of his first attack of delirium tremens. He was extremely tremulous, and his urine was loaded with albumin. His appetite had been very poor for months before the attack, which resulted from steady, hard drinking, rather than from occasional debauches. His sleep, too, had been extremely poor. The trional failed entirely, though repeated within an hour, and later in the night 4 grain of morphia was injected hypodermatically and it succeeded in ducing sleep. A few nights later, when the delirium had almost entirely subsided, but the sleep had not yet become established, 20 grains of trional succeeded admirably, and no further medication was required in this direction.

Mrs. D., aged 39, with hysterical diathesis and great nervousness and depression from anxiety about a very sick daughter, slept fairly well on taking 15 grains of trional.

Trional was also given in a variety of conditions in smaller doses, with, a view of ascertaining what other properties, besides those of an hypnotic, it might possess.

In a number of the milder cases of la grippe that presented themseves, where the main

4. That

it may be found useful in chorea and other

neuroses.

R Quin sulphat., Trional,

Salol,

Camphora,

:

āǎ gr. x.

M. et in capsul. no. x div. Sig. One capsule four times a day. It will be seen that the quinine and salol were given in too small a dose to have much efficacy alone, while it must be admitted that camphor is usually a very excellent medica. ment in the more acute cases of this kind in the dose used. I am, however, inclined to think that the combination is more useful than any one of the drugs singly, and this, too, with a full experience in the use of the

older ones.

In a case of severe chorea which the mother said had existed since infancy, the boy being 7 years of age, quite remarkable results were achieved by the administration of 4 grains t. i. d. for two weeks. Fowler's solution had been tried for the same length of time, without any appreciable result. The patient, being a dispensary case, has not returned; so that the further result remains in doubt. In another case of chorea, a girl of 4 years, 3 grains four times a day failed utterly to do good.

A woman of 60 years, with a heart murmur,

had also been for some months afflicted with a

brachial neuritis, which periodically became intensely painful and required occasionally

the use of opiates. She was very promptly relieved in her last attack, and apparently more permanently than previously, by

1701 DIAMONd Street.

THE ETIOLOGY AND TREAT MENT OF INFLAMMATION OF THE UTERINE APPENDAGES.

D

R. AUGUSTIN H. GOELET, of New York, read a paper on this subject, at the recent meeting of the American Medical Association at Baltimore, in which he stated

that the contention was not that these inflammations of the tubes and ovaries can always be cured, but that it is frequently possible and, unless immediate operative interference is absolutely demanded, the patient should be given the chance and the attempt should be made before submitting her to a radical operation. This he thought particularly important, since treatment directed toward attaining this end did not militate against a subsequent operation for their removal should it become necessary, but, on the contrary, improved the chances of

an ultimate successful result. He called attention to the fact that when once removed these organs cannot be replaced, and asked the question if it were not a serious error, in the light of recent developments in the etiology

and pathology of the inflammations of the appendages, to remove these organs without previous attempt at a cure or removal of the cause which may be operating to maintain eased tubes and ovaries are removed unnecessuch condition. It may be denied that dissarily, but it must be admitted that they are

able to patient and persistent treatment, or

too often removed for disease which is amen

which may be cured by a minor surgical operation involving no risk, such as curettage or repair of a lacerated cervix.

If these cases are submitted to careful treatment instituted for the purpose of clearing up the surrounding exudation and favoring drainage through the natural channel (the uterus), in many instances the necessity for a radical operation would be removed and the woman would be restored to a life of usefulness and happiness.

In corroboration of these views he reported twelve selected cases which had come to him

from other gynecologists, who believed that removal of the diseased organs was the only method to be adopted for restoration of their health, yet these patients recovered completely without the loss of these organs.

The writer stated that these were not the only cases with such an unfavorable outlook which he had been able to cure in this manner, but they had been selected from among a number of others because they had consulted other gynecologists before they came under his observation.

ABSTRACTS.

TANNIGEN IN ACUTE INTESTINAL CATARRH.

Since its advent into therapeutics tannigen has been utilized in chronic affections of the intestinal canal, and has been recommended by Drs. Muller and Kunkler, especially in the diarrhoea of phthisical patients. Recently Dr. Richard Drews (Allg. med. Centr. Ztg., Nos. 35, 36, 1895) has published the results of his experiments with tannigen in fifty five cases of various intestinal diseases of childhood, which in his opinion demonstrate sufficiently the curative effects of tannigen upon the diseased intestinal canal, and prove that this remedy is efficient in a larger number of cases than those previously in use, such as calomel, benzoate of soda, bismuth, naphthalin, etc. Unlike Kunkler, Drews found that the remedy is as useful in acute as in chronic catarrh of the intestinal canal. In acute enteritis and gastro-enteritis the administration of tannigen in doses of 0.2 to 0.5 gramme three times daily, in connection with regulation of the diet, effected a more rapid cure than any other method of treatment. The author advises that, after the disappearance of the catarrhal symptoms, the drug should be continued for two or three days for the removal of any intestinal irritation and for the prevention of recurrences. In conclusion, he remarks as follows: "Tannigen is an excellent remedy in the intestinal diseases of childhood, producing a prompt cure by virtue of the astringent and antibacterial properties of tannic acid. Aside from this it has the advantage over similar remedies of being tasteless, odorless, and of not disturbing the gastric functions, and of being perfectly innocuous even when administered for a long time. For the latter reason it can be prescribed in knife-pointful doses in the case of poor patients."

EUROPHEN IN MINOR SURGERY.

As an antiseptic and cicatrizant in cases of minor surgery, europhen has been favorably commented upon by a large number of authors, and Dr. Doermer has recently added his testimony as to its value as a serviceable remedy to the general practitioner. As he has had occasion to employ it in over eighty cases, his observations are entitled to more than ordinary consideration. Extensive use was made of europhen in the form of the powder in cases of fistulas after extirpation of glands, fresh incised wounds, abrasions of the skin, abscesses, and ulcers of the leg. In the form of a 3-percent. ointment it was used in the treatment of contusions, burns, glandular enlargement, and in the after-treatment of operation wounds. In combination with boric acid, I to 30, it was employed in middle ear catarrhs and ulcers of the leg, and as 5- to 10-per-cent. gauze in all kinds of recent wounds, abscesses, furuncles and carbuncles, phlegmons, glandular suppuration, etc. In all these cases the author had formerly been in the habit of using iodoform, and he found it difficult to discard this longtried remedy and resort to another. The results of his change, however, were highly satisfactory. In almost all the cases he was able to completely dispense with iodoform, and never observed eczema or other cutaneous eruptions during the use of europhen. The fact that the latter remedy is devoid of the penetrating odor of iodoform is also greatly in its favor, while symptoms of poisoning were never observed even when it was employed in large quantities. The good qualities of europhen are that it forms an adhesive covering over wounds and that it exerts an antiseptic influence due to the liberation of iodine. Of course, a few instances occurred in which suppuration of wounds was not arrested under the use of europhen, but this happens frequently under the iodoform treatment. The application of a 5- to 10-per-cent. europhen gauze appeared to be the most serviceable dressing for wounds both fresh and suppurating. The powder also proved very effective in cases of markedly secreting wounds; and in ulcers of the leg europhen exerted an actually specific influence and produced healing much more rapidly than under all forms of other treatment. In cases where iodoform gave rise to irritation of the skin in this class of cases europhen proved extremely serviceable, applied

pure or mixed with boric acid 1 to 3. Inas much as it produces rapid healing in cases of fistula resulting from extirpation of the glands and other scrofulous or tuberculous foci, Doermer suggests the use of emulsions of europhen with glycerin, ether, or alcohol for the treatment of cold abscesses or tuberculous diseases of the joints. Among all the above-mentioned diseases he is unable to find one in which the remedy proved an absolute failure, and hence he considers himself warranted in counting it among the most valuable additions to the materia medica.

TRIBROMOSALYL.

Hueppe divides the intestinal antiseptics into two groups: 1. Those which are soluble only in alkaline fluids (as, for example, tribromphenol). 2. Those which are decomposed by the intestinal juice before being dissolved and exerting their action (as salol). According to Fajans, tribromosalyl has the formula CHOH+COOC,H,Br and shares the properties of each class. It is decomposed by weak alkaline solutions (soda solution 0.25 to 100) without the aid of the pancreatic fluid. Moreover, in its passage through the system it is, for the most part, split up into tribromphenol and salicylic acid. It is comparatively free from toxicity, as a rabbit weighing 2 kilogrammes (about 41⁄2 pounds) took 15 grammes (nearly 1⁄2 ounce) of it without accident.-La Médecine Moderne.

again demonstrates the profound disorder which erysipelas may cause in the lymphatic circulation.-La Médecine Moderne.

EARLY DIAGNOSIS OF DIABETES.

At the Thirteenth Congress of Internal Medicine, held at Munich, M. von Noorden spoke of a sign which permits an early diag nosis. In fifteen individuals who ultimately became diabetic the administration of starch produced no glycosuria, but the ingestion of 100 grammes of grape sugar upon an empty stomach determined, at the end of about four hours, a urinary excretion containing from 6 to 8 grammes of glucose.-La Tribune Medicale.

THE RELATION OF GASTRITIS TO
MENSTRUATION.

Under this title M. Kuttner, of Berlin, publishes a paper in which he reviews the etiology, clinical symptoms, pathological anatomy, and diagnosis of gastric hæmorrhages. He insists particularly upon the connection of these with the menses. Hæmorrhage from the stomach, according to this writer, is much more frequent than hæmatemesis. When a hæmorrhage is suspected it is necessary, in the absence of hæmatemesis, to examine the stools. At times a microscopical, chemical, or spectroscopical examination of the fæces is required in order to determine the presence of blood. blackish-brown color of the contents of the stomach is a presumptive, but not positive, sign of the presence of blood. The mixture of a

A

MEMBRANE.

At a meeting of the French Society of Dermatology and Syphilography M. du Castel presented a patient suffering from lymphatic dilatations of the mucous membrane of the mouth consecutive to repeated attacks of erysipelas. The patient, a young man aged 20 years, had had since his tenth year at least ten attacks of erysipelas. The face remains swollen. Upon the mucous membrane of the lips and cheeks, on a level with the interdental spaces, exist small projections the size of a millet-seed and slightly acuminated. Some are of a whitish opaline color, while others are absolutely transparent. They are small cysts, constituted by lymphatic dilatations similar to those described by M. Tenneson in December, 1893, in a patient who had repeatedly suffered from erysipelas. The case

a characteristic appearance. Thus, inspection alone cannot lead to a diagnostic certainty. In doubtful cases additional modes of examination are necessary. The positive results of the guaiac reaction are not a proof of the presence of the coloring matter of the blood. On the contrary, the negative results demonstrate infallibly the absence of blood. In treating suspected contents of the stomach with concentrated acetic acid and ether and the ethereal extract by tincture of guaiac and essence of turpentine we have the most rapid and certain process for the discovery of blood.

Gastric hæmorrhages are often periodical, related to menstruation and its anomalies. There are menstrual gastrorrhagias. Hæmorrhages occurring periodically in the subjects of amenorrhoea are related as cause and effect to menstrual anomalies, though it is not neces