with copious discharge of acrid mucus, excoria- | gating fluid is also liable to cause systemic tive to all cutaneous tissues with which it came poisoning. in contact. Then an exudation became developed on the tonsils, uvula, soft palate, and pharynx ; but none was visible in the anterior nares. There was aphonia and urgent dysp noea; so that the larynx was also probably involved. Under constitutional treatment with sodium benzoate, salol, and brandy, and the topical use of hydrogen dioxide with boroglyceride, convalescence was markedly rapid and complete, being only slightly interrupted by a suppurative otitis. THE TREATMENT OF DIPHTHERIA. White (Medical Record, November 3, 4. Spraying the throat (also the pernicious treatment of swabbing the throat), whatever solution is used, can have no good effect, as the parts reached by the spray, except in the hands of an expert, must necessarily be very limited. In very young children the spray cannot be used at all with advantage. Frequent cleansing of the throat and nasal cavities with a bland solution, such as plain warm water or normal salt solution, is easier of application, more agreeable to the patient, and does all that any antiseptic solution can accomplish, either upon the duration of the membrane or the period of the isolation. 1894) gives the result of his experience in the REMARKS ON THE NATURE, DIAGNOSIS, progWillard Parker Hospital with the three different modes of local treatment. In the first series the nasal and throat cavities were thoroughly irrigated every one to three hours with warm salt solution until the pseudomembrane had disappeared, then less frequently till the entire disappearance of the bacilli. In the second series, in addition to the above treatment, a spray of peroxide of hydrogen of varying strengths was also applied to the throat and nares every three hours, except at night. In the third series a solution of bichloride of mercury was substituted for the salt water solution of the first series. The nasal cavities were irrigated every eight hours with a warmed I to 4000 solution, and the throat every three hours with a 1 to 3000 solution. Besides this local treatment, nearly all the cases received by the mouth frequent doses of the tincture of the chloride of iron, and of alcoholic stimulants. The conclusions arrived at from the results obtained in these cases, together with the investigation and observation of a much larger number of cases, may be stated as follows:: 1. Frequent washing of the air-passages attacked by diphtheria lessens the duration and amount of the diphtheritic membrane. 2. The addition of antiseptics, in sufficient strength to be germicidal, to the irrigating fluid is irritating to the mucous membrane, thereby causing extension and persistence of false membrane rather than the effect desired. 3. The addition of antiseptics to the irri NOSIS, AND TREATMENT OF AURAL VERTIGO. Mackenzie (British Medical Journal, May 5, 1894) introduces these remarks with reference to a pronounced case of aural vertigo in a man aged 50, beginning with vertigo, vomiting, and deafness. He deals with the subject under the following heads: (1) seat of lesion; (2) its nature; (3) the mechanism by which the chief phenomena are brought about,-(a) tinnitus, (b) deafness, (c) vertigo, (d) locomotor inco-ordination, (e) vital symptoms (faintness, perspirations, nausea, vomiting), (f) movements of the eyes; (4) the diagnosis; (5) the prognosis, and (6) the treatment of aural vertigo. In answer to the first point, the author inclines to the opinion that the seat of the lesion is to be found in the semicircular canals, and that this (the lesion) is of an irritative character, producing its effects so long as there is no absolute atrophy of the auditory nerve. It is pointed out that Buzzard and Dalby suggest a bulbar origin for some of these cases of aural vertigo. As to the nature of the lesion, it is observed that in few cases, indeed, has coarse disease been demonstrated in the semicircular canals. There are causes, direct and indirect, which may irritate the nerve-terminations of the former,-e.g., hæmorrhage; syphilis of the latter,-eg., otitis media. The theory of Spear, that there is a condition in the labyrinth resembling glaucoma, as well as Knapp's suggestion that Ménière's disease is an idiopathic, serous, exudative otitis interna, are referred to. Seeing that aural vertigo occurs in the latter part of life, degenerative changes in the local blood-vessels are probable, and Gowers's statement that it is associated with gout (in the labyrinthine membrane) is supported. ABSTRACTS. ANTITOXIN. Dr. J. J. Kinyoun, Passed Assistant Surgeon United States Marine-Hospital Service, Wash. In the case referred to, the author imagines that the lesion consists of inflammatory changes in the labyrinth, associated with middle-earington, D. C., has spent several months in disease. In discussing the mechanism by which the chief phenomena are brought about, tinnitus is attributable to pressure-disturbances in the cochlea; possibly minute changes (degeneration) occur in the cochlear nerve. Deafness, almost always present at some period in aural vertigo, is again due to some change in the cochlea. The vertigo defined by Hughlings Jackson as the conscious ness of disturbed equilibration-a rudimentary inco-ordination of locomotive movements, associated, as it is in this form, with deafness and tinnitus is no doubt due to disease in the semicircular canals. The lesion may be functional or organic, and may be in the trunk or in the nucleus of the nerve; but the proved existence of disease in the middle ear renders it highly probable that it is a peripheral and not a central lesion in these cases. The locomotor inco-ordination may in some cases be due to the abeyance of function in the cerebellum, or in other cases to alteration of this organ. The vital symptoms (nausea, vomiting, faintness) are due to shock, and attributable, perhaps, to overflow of the irritation in the acoustic nucleus to the closelyadjacent vagus nucleus in the medulla. The true diagnosis of the disease is difficult, -i.e., the different conditions that may cause the disease. When tinnitus, vertigo, nausea, and vomiting occur together, suspicion as to an aural origin ought to be entertained. Europe investigating the production of antitoxin and its use in the treatment of diphtheria. He has visited a number of hospitals where the antitoxin has been employed, as well as the Pasteur Institute in Paris, the Institute for Infectious Diseases (Koch's) in Berlin, and the Schering Laboratories in Berlin. In his letter to the Supervising Surgeon-General dated Berlin, November 6, 1894, he makes the following statement: "Through the courtesy of Dr. Ditmar, the Director of the Schering Chemical Factory, I was also accorded the privilege of visiting their place to observe the methods employed by Dr. Aronson in obtaining the antitoxin, some of which I had seen used in the hospital wards. "At one of their factories, near Berlin, the firm has a well equipped bacteriological laboratory for producing the toxins and preparing the serum. Near by they have well-arranged stables and paddocks for the animals. At this time they have 70 horses, 30 sheep, and a number of goats in various stages of treatment. "The work as carried out by Dr. Aronson and his assistants compares favorably with any which I have seen in Berlin. He has all the necessary appliances in his laboratory, possessing the requisite knowledge and training in this special branch. Being provided with the facilities for good work, I see no reason why he cannot produce as good serum as any others here. In some of the technique I am inclined to believe it is better than that practiced by those in the Koch Institute,-i.e., in the preparation of the serum. Aronson adds a small quantity of trikresol to the serum,-0.4 to 0.6 per cent. This causes a slight flocculent precipitate, which is filtered off, and then the serum is passed through an unglazed porcelain filter, when it is transferred into small, sterilized bottles and sent out for use. "Aronson has not attempted to make more than one strength of the antitoxin. That which I saw used in the hospital had the same effects as Behring's No. 2 (1 to 1000). Aron- | dietetic. These favorable results reported by In a brief clinical note in the Therapeutische Monatshefte, September, 1894, Dr. Fedor Schmey, of Wiesbaden, calls attention to the value of piperazin in the treatment of vesical catarrh. As internal treatment with remedies such as salol had always proved ineffective in his practice, he suggests the use of piperazin, on the following grounds : "The remedy is perfectly innocuous, and passes unchanged through the system by way of the urine. It is, therefore, possible to charge the urine highly with piperazin, which, according to Bohland, possesses marked antiseptic properties. These statements are confirmed by the experience of Biesenthal, who has reported two cases in which an existing vesical catarrh disappeared during the use of the remedy. A contribution to the therapeutics of piperazin in the uric diathesis has recently been made by Dr. J. F. Barbour (American Therapist, No. 12, 1894). He reports three cases of this condition, and states that in the acute attacks the remedy seemed to give the speediest results. Fifteen grains, dissolved in one ounce of water, should be employed daily, and this is to be further diluted by the addition of a small quantity of this solution to each tumblerful of drinking-water. The free use of water, both externally and internally, is recommended. The author believes that this method eliminates the excess of uric acid and aborts the further diathesis, the treatment of which is entirely hygienic and Dr. Barbour have been confirmed by a large number of other observers, and piperazin is now considered a valuable acquisition to the materia medica of the uric acid diathesis. Piperazin Bayer, prepared by the Farbenfabriken of Elberfeld, can be obtained in 1⁄2- and 1 ounce vials, or in tablets of 16 grains each, which afford a convenient method of administration, as each tablet is equal to about the average daily dose of the remedy. THE REAL VALUE OF THE MEDICINAL PEROXIDE OF HYDROGEN PREPARATIONS FOUND IN THE MARKET. H. Endemann, Ph.D., chemist, formerly with the Health Department of New York City, gives, in the Times and Register, the results of his examination of fourteen fresh samples of perHydrozone is far superior to any other brand oxide-of-hydrogen preparations. He writes: which has ever been made, not only on account of its containing a much larger amount of available oxygen, but also owing to the presence of a small quantity of several essential oils, the respective nature of which could not be determined, very likely because they have been submitted to the oxidizing action of peroxide of hydrogen before being used to make hydrozone. oils the great superiority of hydrozone over any other brands of H2O, as a healing agent. "I attribute to this small quantity of essential 2 2 "When hydrozone is diluted with distilled. water, in the proportion of half and half, the resulting mixture contains about 13.5 volumes of available oxygen. "My opinion is that a standard solution of medicinal H2O, must answer the following tests: 2 2 "1. It should contain at least 15 volumes of available oxygen. "2. The quantity of free acids contained in 100 cubic centimetres should require not less than I cubic centimetre and not more than 3 cubic centimetres of normal volumetric soda solution to be made neutral. Such a small quantity of free acid is not objectionable. "3. It should not contain any soluble baryta salts. "4. It must be free from sediment. "These brands have been tested for the vol- | dietetic and hygienic management one looks ume of available oxygen, the amount of resi- naturally to ferruginous remedies for its acdue, the degree of acidity, and the amount of complishment. This has been my endeavor soluble baryta salts contained therein, as per under every method of treatment, but the following table :available preparations have not only failed me in the majority of instances, but they have frequently interfered with the improvement in other respects by disturbing the digestion and assimilation of food. Twelve months ago I rather reluctantly undertook the administration of peptomangan. BRANDS. No. 1. John Bene's Per oxide of Hydrogen Medicinal. No. 2. Hydrozone Volume of available oxygen determined Residue obtained from 100 c. c of per- Acidity expressed in cubic centimetres Baryta found in soluble baryta salts contained in 100 c. c. of peroxide. No. 3 Larkin & Scheffer's 9.65 0.1206 6.75 No. 4. Mallinckrodt's Per oxide of Hydrogen Medicinal 9.55 0.1408 1.43 No. 5. Marchand's Perox ide of Hydrogen Medicinal 16 55 0.564 1.29 No. 6. McKesson & Rob bins's Peroxide of Hydrogen Medicinal 10.95 0.0540 No. 7. Merck & Co.'s 4.57 None. 6.15 0.0880 2.6 0.0017 0.0018 None. None. 12.40 1.004 12.04 Nonc. "The brand No. 2, which is sold without any mention of volume, is really a 27.35 volume solution, viz., 90 per cent. above the standard." "In its clinical use I found, in the first place, that the remedy was palatable and readily taken by the patients, and from its first use to the present time I have had only two cases in which I was obliged to abandon it. These were cases with tubercular ulceration of the epiglottis, and they complained of more smarting pain and distress than from the swallowing of ordinary liquids and foods, even when the remedy was largely diluted; in all other cases it was well borne by the stomach; in quite a number the appetite improved very early; neither is there evidence of its producing constipation in any case. "In the six weeks previous to the use of the peptomangan there were ten patients in whom the loss or gain in their blood condition could be compared; seven of these patients gained in all 1,408,000, or an average of 200,000 each; whereas these same patients gained under peptomangan 3,609,000 corpuscles, or an average of 510,000 each. "As to hæmoglobin, a similar increase is perceptible. In six weeks preceding, of the seven patients, six also gained in hæmoglobin in all 56 per cent., or an average of 9 per cent.; but under peptomangan these same six patients gained in all 81 per cent., and on an average 131⁄2 per cent. "Further, whereas of the ten patients only seven gained in corpuscles and six in hæmoglobin in the six weeks preceding, under the peptomangan nine gained in corpuscles and hæmoglobin, and no loss occurred except in one, and she lost only a third as much as in the THE USE OF PEPTOMANGAN FOR ANÆMIA IN six weeks before." THE PREPARATIONS OF BISMUTH. From a paper read by Dr. Reynold W. Wilcox before the Clinical Society of New York, we extract the following: Dr. Karl von Ruck, of Asheville, N. C., in a paper published in the New York Medical Journal, says: "It is quite rational to seek to aid the regeneration of the blood, the more so as in all advanced cases it takes place very "Bismuth is by no means a new remedy. slowly if at all; and in addition to proper | Although its external use for cosmetic purposes is many centuries old, it was Pott who first em- | naphthol bismuth, and after four months' ployed it internally in 1739. Odier in 1786 treatment the condition was apparently relieved. recommended this drug, curiously enough, for Six months have now elapsed since any sympalmost the same conditions as one would indi- toms have been noticed. In the chronic cate to-day,-gastralgia, gastritis, and diarrhoea, intestinal catarrhs, which are continued through --although he found it also useful in menstrual the presence of micro-organisms, the same drug difficulties. Of quite as much importance as is strongly indicated. During the past nine the establishment of the value of bismuth when months, in all cases where bismuth has been given internally is the discovery that it will indicated, I have made use of the phenol, form definite chemical combinations with sali- beta-naphthol, and tribromophenol bismuths cylic acid, phenol, beta-naphthol, and pyrogal- as made by von Heyden, to the exclusion of lol. Bismuth salicylate (dose, 5 to 20 grains) the older official preparations. As the result has deservedly become popular as an intestinal of the observation of at least one hundred antiseptic, the decomposition taking place in the cases, I believe that better results have been small intestine, the salicylic acid being excreted obtained, and in a shorter period of time, in the urine as salicyluric acid. The phenol than could have been expected with the inorand beta-naphthol bismuths (dose, 15 to 30 ganic compounds. In typhoid fever there are grains) are mostly decomposed in the stomach probably no remedies so generally useful, as into phenol or naphthol and bismuth. Whatever intestinal antiseptics, as the bismuth salicylate may pass into the small intestine, in the upper and beta-naphthol bismuth, providing they are portion, may still be decomposed, so long as used in the earlier stages of the disease; and its contents are acid. The phenol is absorbed in an estimation of the value of the salicylate from the intestine and appears in the urine as I am quite in accord with Huchard. They sulphocarbolic acid, making its presence known certainly lessen the diarrhoea, render the disby the change in color to pale or darker charges less foul-smelling, and, by more rapolive-green. Tribromophenol bismuth (daily idly healing ulcerations, reduce temperature dose, 75 to 105 grains) is a further example and pulse-rate, prevent systemic infection, and of this peculiar combination. The tribromo- thus not only shorten the disease, but obviate phenol of itself possesses great antiseptic proper- many of its complications and indirectly lessen ties and is said to be non-toxic. Its rather sweet- its mortality. In Asiatic cholera Hueppe has ish taste and astringency are also advantages. made trial of tribromophenol bismuth in twenty Pyrogallol bismuth resembles the salicylate in cases of moderate and of great severity, of that decomposition takes place only in alkaline which five died, all of the mild cases commedia. Since it has been shown that beta-pletely recovering, and from these observations naphthol will destroy certain micro organisms in situ, and it is a clinical fact that phenol, tribromophenol, and presumably pyrogallol possess antiseptic properties, so far as the digestive tract is concerned, the importance of these combinations is seen to be very great. The combinations are valuable not only because they possess the soothing effect of the bismuth, but as well because the disadvantages of the single drugs are overcome. he is of the opinion that the use of this remedy should be encouraged. In one case in which the drug had been given and death resulted from apoplexy, on autopsy cultures were made from the contents of the ileum with negative results. Certainly we have direct evidence that it acts directly upon the cholera bacillus. Conclusions: 1. In many diseases of the digestive tract bismuth is useful and necessary. 2. Of the preparations of bismuth, the organic compounds are preferable. 3. The treatment of infectious diseases by intestinal antiseptics, in which the early manifestations are in the alimentary canal, is a real advance in thera "Of intestinal diseases the diarrhoeas, whether colliquative, typhoidal, or choleraic, are bene fited. If there is simple intestinal indigestion the ferments, with the addition of alkalies, are needed. If there is fermentation the beta-peutical practice." naphthol or tribromophenol bismuth is indicated. In a patient suffering from membranous enteritis (exfoliative), who had been unsuccessfully treated for several years by various methods, relief followed the use of beta CHLORALO ARABINOSE AND CHLORALO XYLOSE. |