THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. THE F. A. DAVIS CO., Publishers. 8. C. BERGER, Business Manager. Philadelphia, Dec., 1895. cancer a peculiar body which, in certain respects, resembles the psorosperm, but differs from the latter in its mode of development, and which their discoverer considers as belonging to the vegetable world. Neither the animal nor the vegetable parasite has been convincingly demonstrated as the materies morbi of cancer. Dr. Laplace very fittingly says that the occurrence of metastasis, so characteristic of MODERN RESEARCH AS REGARDS morbid growths, lends support to the theory of WITH CANCER. ITH the macroscopical appearance of cancer and the local and constitutional symptoms which it causes the profession has long been familiar. The development of microscopical investigation has acquainted us also with its minute pathological anatomy. In an article contributed to this number of the MEDICAL BULLETIN Professor Laplace points out briefly, but in a very interesting and instructive manner, the morphological relationships of cancer. The belief has gained ground of late years that the lesion of malignant disease is, in the beginning, a strictly local affection. In the progress of time, as infiltration occurs, the malady spreads to neighboring parts and at length becomes generalized. Nutrition is profoundly impaired, a cachexia is established, and the case goes on to a fatal termination. There is much in the mode of extension of cancer to suggest the idea that it is of infectious origin. Our contributor points to the fact that, whereas an external irritation gives rise to a benign growth, a malignant neoplasm is occasioned by an irritation acting from within the organism. Attempts have been made by various observers to isolate a microorganism as an etiological factor of carcinoma. Recent years have witnessed two movements in this direction. Darier and Albarran detected, in sections of cancerous tissue, bodies which Malassez and Balbiani (certainly high authorities) regarded as protozoa. The same organisms have been found by Cornil, Thoma, and Wickham. Whether they are really protozoa, however, and whether they must be acknowledged as the exciting cause of carcinoma, has not yet been decided beyond doubt. Dr. William Russell, of Edinburgh, has found in a parasitic origin. That cancer occasions a toxæmia is patent to every careful observer, but the exact nature and effects of systemic intoxication from this cause have only of late been scientifically studied. The disturbing influence which cancer exerts upon tissuechange has been illustrated by Müller and particularly by Klemperer, who has found increased destruction of albumin, augmented production of urea, fatty degeneration of muscular tissue, and diminished alkalinity of the blood. In accordance with these discoveries Oppenheim, Deutschmann, and others have recorded certain interesting and obscure clinical manifestations during the course of cancer. Toxic products of tissue change and possibly dependent upon the growth of micro-organisms have been very plausibly looked upon as the source of aphasia with paralysis and disturbance of vision followed by blindness in subjects of cancer without obvious lesion of the brain or apparatus of vision. Another closely-related question relates to the inoculability of cancer. Experiments upon animals have generally failed, possibly by reason of improper methods. At all events, success has followed some attempts, for Hanau has produced carcinoma in rats and Wehr in dogs. More recently d'Arcy Power reported a series of experiments upon white rats with negative results. Hanau is of opinion that, in an undertaking of this kind, the operator should avail himself of fresh surfaces or the serous cavities of the body. He furthermore suggests that, as carcinoma is a disease of advancing years, old animals should be used as the subjects of such experiments. Quite a number of cases have been reported in which inoculation of the human being seems to have followed intimate personal relations with cancerous patients. For instance, cancer of the penis has been witnessed in men whose wives suffered from epithelioma of the cervix. It may be, as some have claimed, that such cases are merely coincidences, or that those simulating inoculation depend upon a strong constitutional predisposition. The relationship is, however, to say the least, suggestive, and it is desirable that all such cases should be published and analyzed with the utmost exactitude. The most recent instance of the kind, to which at the moment of writing we have seen but an allusion and have no knowledge of the particulars, concerns a physician in New York, who was thought to have contracted cancer while in attendance upon a case of that disease. EPILEPTIC CONVULSIONS BEGIN- M. tongue badly. She received medical care for some time, when the treatment, which her relatives were not able clearly to describe, was given up because it did not seem to be of much avail. Attacks recurred at nearly every menstrual period until she was 18 years of age. They generally took place in the morning, soon after she arose, in the presence of one of her sisters who intelligently described the symptoms. At the date mentioned the crises disappeared without assignable cause. The patient married in her twenty-first year, had in two years as many children, who never had convulsions or serious nervous trouble. She herself continued in good health until the age of 28. During ten years neither her rela. tives nor husband observed anything which in the slightest degree resembled an epileptic paroxysm. After the birth of her second child the patient began to work in a burnisher's shop. For four years she was employed there regularly without suffering any trouble due to the occupation. Four years ago she was, during a menstrual period, attacked in the morning while dressing. Her husband, who was present, knowing nothing of her antecedents, imagined that she was trying to frighten him, because, before she fell, she went through all the movements of her avocation with her right hand. Since that time such crises have often occurred during the catamenia, and sometimes even after slight emotion. One of the sisters and the husband of the The CH. FÉRÉ, whose physiological and clinical work has often been noticed in the MEDICAL BULLETIN, has described an interesting case which illustrates the fact, demonstrated by Luciani and Tamburini, that those cerebral centres are most excitable which correspond to the muscles most often brought into action.* The patient was a woman, 32 years of age, belonging to a family of artisans of easy circumstances and free from neuropathic antecedents. She had two older sisters who enjoyed good health. Each sister had. two healthy children. The patient was always patient, who had often witnessed the attacks, well until her fourteenth year, when her described them in an identical manner. menses first appeared. At several successive patient looked fixedly before her, became periods she suffered from one or two convul- somewhat pale, her right forearm flexed at a sive seizures, in which she suddenly fell back-right angle, the elbow applied to the body, ward with stiff arms, clenched fists, and turned- the shoulder leaning slightly forward, the in thumbs. She rolled her head and moved hand closed, the little finger much more bent the four limbs symmetrically. than the others, the thumb closed upon the Bloody foam issued from the mouth. When the movements other fingers, while she executed four or five horizontal to-and-fro movements, exactly the ceased the girl slept for about a quarter of an hour, and remained in a state of lassitude dur- same as she used at her work. Then she suding the day. She generally passed urine into denly threw herself backward with arms exher clothing. Upon one occasion she bit her tended along her side, with shut fists and thumbs turned inward, the attack terminating in the manner already noted. *Note sur un cas d'Epilepsie dont les Accès débutent par des Mouvements Professionels Extrait des Comptes Rendus des séances de la Société de Biologie. The two witnesses of the attacks insisted, The patient presented several malforma tions: there were nodosities upon the ears and the root of the helix was joined to the antihelix; the hard palate was abnormal; both the upper and lower teeth were irregular, but there was no marked asymmetry of the jaws. Louis's angle was very pronounced in the sternum. erethism, excitability, agitation, spasm, or contracture. In essential and symptomatic epilepsy the potassium salt is an efficacious remedy. It is of no less service in other convulsive attacks of childhood with or without cerebral lesion, in spasmodic hemiplegia, in simple and tuberculous meningitis during the stage of excitement, in tetanus and tetany, particularly and independently of each other, upon the different effect upon the hand at the beginning and during the generalization of the attacks. They dwelt upon the fact that at first the little finger was more flexed than the others and the thumb was outside, and this was exactly the way in which the tool was held at work. From the moment when the patient fell the attitude of the hand changed. in spasm of the glottis and laryngismus striduThe characters of the paroxysm, the duration lus. The hysteria of young subjects, whether of the convulsive period, which scarcely ex- latent or developed, is not cured by this salt, ceeded a minute, were those of epilepsy. The which should not be prescribed in a routine patient possessed no hysterical stigmata, and manner in all cases, but reserved for those the attacks became less frequent when a bro. which exhibit paroxysms alarming by reason mide treatment was adopted. These attacks of their frequency or violence. It is a sedanever occurred while she was at work. tive, says M. Comby, in certain hysterical attacks, but not a remedy for hysteria. Potassium bromide possesses a better action in chorea, the agitation of which it relieves. It has also a good effect in certain cases of nocturnal incontinence, in genital erethism, and in onanism. It is serviceable in nervous insomnia and headache, as well as in true migraine. In these cases it seems to act by relieving cerebral congestion. The same salt is of value in nervous palpitation, essential tachycardia, and cardiac irritation of nervous children of arthritic diathesis. All the spasmodic affections of the respiratory passages may be advantageously treated by the alkaline bromides. It is the reliance of many physicians in whooping-cough. As regards the effect of bromoform in this disease, our author expresses himself with some reserve, believing that it is yet upon trial. Potassium bromide has been sometimes used with success in diabetes mellitus and insipidus. The bromides may render relief in affections of the skin attended by itching, as simple prurigo, urticaria, and paresthesia without lesion, but are without avail in the dermatoses properly socalled. THE BROMIDES IN DISEASES THE HE useful series of papers which Dr. J. Comby has been contributing to La Médecine Moderne has, from time to time, been noticed in these columns. In the number of August 28, 1895, we find a communication upon the indications and contra-indications of the bromides in the affections of young patients. The author begins by mentioning the chief bromine combinations which have been thus employed, and expresses a favorable opinion of ethyl-bromide as an anesthetic in short operations. He refers briefly to the physiological action of the alkaline bromides, pointing out the fact that they diminish muscular power and nervous energy as well as sensibility of mucous membranes. In large doses potassium bromide is capable of causing gastralgia, diarrhoea, epistaxis (by lessening the density of the blood-serum), actual paralyses, acne, offensive breath, and a cachectic condition with emaciation. The bromides are particularly indicated in maladies of the nervous system attended by These compounds are contra-indicated in children who, instead of erethism and excessive cerebral excitability, are languid and somnolent, have a dilated heart, a feeble and intermittent pulse. Such patients do not require depressants, but tonics and stimulants, as alcohol, caffeine, digitalis, and strychnine. These remedies are likewise to be withheld in cases marked by lack of appetite, indigestion, AN ADMIRABLE WINTER RESORT. and diarrhoea. [OW is the season when many Northern In severe cases, as repeated attacks of convulsions, whether epileptic or non-epileptic, in laryngismus stridulus and violent headache, the bromides should be administered in massive doses. They are but slightly toxic in children, and are rapidly eliminated by all the emunctories. The author formulates this rule: a gramme (15 grains) daily for each year of age. He mentions a serious case of whooping-cough in which he succeeded in arresting convulsions by the exhibition of 4 grammes of potassium bromide daily to a child 4 years of age. On the first day there were seventeen convulsions with foaming at the mouth, on the second day but ten paroxysms, on the third day two, and on the fourth day not a single attack. Insomnia of children, of whatever age, may be serviceably treated by potassium bromide in combination with chloral. When a bromine compound must be used continuously for a considerable period, some have recommended to associate it with naphthol, and thus secure intestinal antisepsis and obviate or lessen the liability to bromism. The writer, however, prefers a combination with sodium bicarbonate or Vichy water. In order to mask the taste potassium bromide may be given to children in milk. The alkaline bromides may be employed in whooping cough by atomization, a 5-per-cent. solution of potassium, sodium, or ammonium being sprayed upon the throat every two or three hours. In malaria the hydrobromate of quinine is of service in the same doses as the other salts of the alkaloid. This combination is especially useful in nervous, excitable children. It is more soluble and contains a larger proportion of the alkaloid than quinine sulphate, and may be given by the mouth or rectum. Its solubility is further promoted by an association with antipyrin. THE Central Illinois District Medical Society held its twenty-first semi annual session at Pana, Ill., October 29th. Dr. George N. Kreider, of Springfield, is president, and Dr, J. O. Nelms, of Taylorville, Ill., secretary. Now people are obliged to leave their homes in order to escape the 'perils of an inclement winter. Of this number a large proportion will be making their first journey in search of health. Their destination must awaken much interest and discussion in the family circle. There are many places from which to choose, and questions of accessibility, climate, scenery, conveniences, and means of recreation will occasion anxious debate. The surroundings of a health resort should be attractive, for it is desirable that invalids should spend a large part of their time in the open air. Furthermore, the sick people are often accompanied by relatives, friends, or attendants who enjoy the blessings of health. Not infrequently circumstances permit the temporary location of an entire family at a spot chosen for the benefit of one of their number. The more varied and decided the attractions of a resort, consequently, the more it is capable of satisfying the tastes of all its frequenters as well as of ministering to the physical well-being of the debilitated. Upon the western coast of Florida an ideal resort for well or ill is found at Tarpon Springs. The spring communicates by a river and bayou with Clearwater Bay, which is an inlet of the Gulf of Mexico. The town is beautifully situated upon the Anclote River, a deep, winding, and charming tropical stream. A short distance north of the Tarpon Springs Hotel lies a body of water known as the Salt Lakes, because, though really one, it is nearly separated into two by the approximation of its banks at a certain spot. The tortuous course of the river and the configuration of the lake rendered this part of the coast one of the hiding places of the old buccaneers. Near the mouth of the river the name of these sea-robbers is yet kept alive by the Buccaneer's Well, a fount of clear and pure water. All around Tarpon Springs landward extends a great primeval forest, in which the red cedar and pine predominate. Delightful roads meander through the woods, and walks, horseback riding or carriage exercise, according to the health, strength, or taste of the sojourner, boat, to walk short distances, and the course of improvement thus commenced will usually proceed without interruption. In hysteria, hypochondria, and melancholia excellent results are obtained by joining in the pleasant and cheerful out-door activities which the minister to his pleasure and good. Under the influence of irrigation the soil is remarkably productive. The vegetables and fruits of temperate and subtropical climates flourish in abundance. The woods and waters are alive and vocal with all kinds of birds. The waters teem with fish. In the bay and gulf large sea-place encourages. Chronic gastric and gastrofish abound. An object of interest to the visitor, also, is the great sponge-fishery, the headquarters of which is at Tarpon Springs. The climate is as near perfection as anything can be on this terrestrial globe. From the east the air is laden with the aromatic exudations of coniferous trees. From the west blow the briny breezes of the gulf. This combination or alternation insures a remarkably pure at mosphere. The northeastern storms of the Atlantic sea-board are robbed of their dangers before they reach Tarpon Springs. Although situated so near to the gulf, the humidity at this place is low. The variation of temperature is wonderfully small and scarcely exceeds 10 degrees, 65° to 75° F. being average winter weather. Fire is rarely needed except in the cook stove. Such are the conditions and surroundings of Tarpon Springs. The writer has had the pleasure of visiting this lovely region and can bear personal witness to its numerous attractions as a resort and to the efficacy of its climate as a remedy. How many hard-worked doctors are there in this country who would appreciate a month or two's rest in this spot! The doctors must stay at home and work until they break down, but are at least glad to know where to send their patients. Business and professional men who have long been under a strain of mental work and anxiety will find Tarpon Springs an excellent place in which to recuperate exhausted energies. The society woman or the overburdened housewife will equally be benefited. Insomnia —that curse of the night is cured by the occupations and diversions afforded by forest, lake, and gulf. The neurasthenic, arriving in utter prostration, soon begins to gain a little strength. He may swing for hours every day idly in his hammock until, little by little, an appetite asserts itself, he begins to find pleasure in his meals, to take a ride by carriage or intestinal difficulties are improved and often cured. Increased function of the skin and other secretory and excretory organs, the natural effect of the climate and mode of life, exercises a very beneficial effect in Bright's disease. Scrofulous and rachitic children show decided gain in health after a residence at Tarpon Springs. Cutaneous disorders, whether dependent upon scrofula, visceral or nervous derangement, are relieved or cured. The mild and equable temperature, exercise in the open air, and the consequent improvement of nutrition put an end to neuralgic attacks. This resort is of great benefit to those who suffer from disease of the respiratory apparatus. Asthmatic patients derive much relief, and the same is true of those who are the victims of chronic bronchitis, bronchial dilatation, and emphysema of the lungs. For pulmonary tuberculosis the climate is exceptionally favor able. Patients who are sent to Tarpon Springs at an early stage of the disease; who live much out-of-doors, in the forest and on the water; who breathe a pure, ozonized, and aseptic air, gain in appetite, nutrition, and respiratory capacity. The disease is arrested and practically cured in a large proportion of such cases. Every condition joins here to be of benefit to such patients. The consumptive needs an out door life; he also needs agreeable diversion. Its great natural endowments have earned for this locality the title of the Riviera of America. That its importance is appreciated is shown by the constantly-increasing number of visitors, the number of dwellings erected, and the various business enterprises projected. The hotel at the springs is commodious and well managed. Among those who resort to a place of this kind there are always many who, from disposition and past habits, cannot content themselves continually with sport and amusement. With restored energy they again feel the want of an object in |