seven London water companies, deriving their supply from the Thames and Lea, state that they have analyzed one hundred and seventyfive samples, two of which were recorded as "very slightly turbid," and one as "slightly turbid." The rest were found to be "perfectly clear, bright, and well filtered."

Between M. Pasteur and an old soldier, whose name is unknown, of the province of Iula, in Russia, we may hope that one day we may be able to get rid of hydrophobia altogether, and our dogs will not be obliged to go about in portable cages. The Russian remedy has at least the merit of simplicity; all that is needed is to scrape the dried bulb of the alisma or water plantain, spread some of it upon bread and give it to the patient. It is positively stated that this is an absolute cure even when the stage of acute mania has commenced, and that it is equally efficacious in the case of man or beast. If all this should prove to be the case, M. Pasteur's remedy is likely to fall into disuse. In the first place the latter has failed in cases where the acute stage has set in; in the second place, it requires the patient to be inoculated every other day for three weeks or a month; and lastly, the preparation of the microbe broth is of so complicated and delicate a nature that the remedy would be altogether beyond the reach of the ordinary general practitioner. It seems that the Russian cure has been in use, in the province of Iula, for the last twenty-five years, and in no instance has it been known to fail; this being the case, it is singular and unfortunate that the alleged virtues of the alisma have been so long confined to that district.

Dr. Bradley, of Chesterfield, who, by order of the Home Secretary, Sir Richard Cross, was liberated a few months ago from prison, where he had been committed for an alleged assault on a female patient, was lately, at Sheffield, entertained to dinner, and presented with an address and four hundred guineas by the members of the profession, as a mark of their esteem and their belief in his innocence. Sir William Jenner was one of the first promoters of the fund, and the address was signed by him and the leading medical men throughout the country. The presentation was made

by Dr. Foster, M. P., and Mr. Wheelhouse, of Leeds.

Dr. George Edward Paget, F.R.S., brother to Sir James Paget, Bart., has had the dignity of a Knight of the Order of the Bath conferred upon him. Sir George was born in the year 1810; he is a D. C. L. of Oxford, LL. D. of Edinburgh, and Fellow of Caius College, Cambridge. He has held the Regius Professorship of Physic at Cambridge University since 1872, and was most active in carrying out the various details connected with the visit of the British Medical Association, when they held their annual meeting at Cambridge.

LONDON, December, 1885.

Translations.

TREATMENT OF DELIRIUM TREMENS.-Dr. Christian, physician of the National Hospital, Charenton, contributes some notes to the Journal de Medicine de Paris, from which we gather the following points:

Since the

If one wished to enumerate all the medicaments that have been extolled for delirium tremens, it would be necessary to pass in review the entire materia medica. disease yields to so many diverse remedies, it is fair to suppose that no one of them possesses any special efficacy, and that the disease would yield as often and as well if abandoned to itself, and the treatment confined to simple expectation.

What strikes one in all these treatments, and what seems common to them, is the enormous doses of the medicines used, and these, though often poisonous and used in large quantities, have failed to produce toxic effects. There evidently must be a tolerance of these medicines in delirium greater than in the normal state.

Through all the various changes of treatment there have been those who have censured the use of drugs, and vaunted simple expecta tion. Geveget, of the Salpetriere, in 1831 maintained that patients got well as quickly and as certainly without opium and the bleeding then in vogue, and at the same time Ware demonstrated that spontaneous cure is the rule. In 1841 Professor Dunglison, figures

in hand, protested against the treatment by opium. At the Royal Infirmary of Edinburgh, in the same year, of four hundred and three cases treated with large doses of opium with brandy, one hundred and one died, about twenty-five per cent, while at the Glasgow Infirmary seventeen out of thirty-five succumbed; on the other hand, Dr. Laycock by simple expectancy cured twenty-seven out of twenty-eight, and Dr. Peddie lost not a single one out of eighty.

More recently, in 1871, Dr. Decaisne arrived at identical conclusions. He treated five patients by opium, four by digitalis, three by chloral, and eight by the expectant method, and found that the latter, with one exception, recovered more quickly than the others, and with none of the accidents, such as vomitings, etc., experienced by the others.

The more recent authors are partizans of the simplest and mildest treatment; to be assured of which, one has only to read Magnan in his book on alcoholism, and the articles in the dictionaries in course of publication signed by Lancereaux, Fournier, Ball, and Chambard.

The expectant treatment does not consist merely in folding the arms and watching the development of the symptoms. The method is the antiphlogistic, less the bleedings; that is, of isolating the patient from former surroundings, inducing quiet, a light diet, moderate temperature, abundance of cooling drinks, gentle saline purgatives, tepid baths and sponging.

Dr. Christian details the history of fiftythree cases in his own experience, of which seven died on the day of entering the hospital, and five died of injuries and complications, while of the forty-one simple 'and uncomplicated cases every one recovered under the treatment described, and concludes with the expressed belief that in the immense majority of cases, delirium tremens is an affection easily cured by the simplest means.

A THEORY OF UTERINE CONTRACTION.Schatz, after exhaustive study of the subject, is of the opinion that uterine contractions in the human as in animals are of a peristaltic nature, beginning at the orifices of the tubes and

proceeding toward the os, and that they modify in a very irregular manner the intra-uterine pressure. He thinks a wave of contraction passes from the tubal orifices to the internal os in about thirty seconds.-Annales de Gynecologie.

Thus, in the well

FACE PRESENTATIONS.-Schatz has also been occupied with the etiology of face presentations. He states that up to this time we can only indicate a certain number of circumstances which favor face presentations, but that the primordial cause is still unknown. formed uterus the distance between the cornua is less than that between either of these and the internal os; but in others the distance between the cornua is the greater, the cavity being therefore shorter than usual.

In such short uteri the child finds itself curved in the form of an arc. Habitually this curve is made to the abdomen of the child, for in this way the infant is best sheltered from all irritation and excitement to movement. More rarely, and almost always temporarily, this incurvation is made toward the back. The presentation of the face is never any thing but a consequence of this anomalous incurvation. This explanation has been borne out by two cases of face presentation which he has observed, associated with anomalies of uterine development. It is liable to occur also in twin pregnancies, narrow pelves, tumors, etc.-Ibid.

PREMATURE LABOR BY ELECTRICITY.-M. Bayer, of Strasburg, has had, during the past year, four opportunities to test the efficacy of the constant electric current in inducing premature labor. In all these cases the electricity developed uterine contractions, dilated the os, and overcame the constriction of the neck, but the action was found to be unequal. The best effects were had in subjects whose uteri were powerfully muscular, the cervices not being too rigid.-Ibid.

A UTERINE DILATOR.-Kuestner has invented a new dilator for the uterus. It is me tallic, and presents points of advantage over gutta percha or other dilators in being more easily disinfected, and in conforming more. readily to the shape of the uterine cavity.

Abstracts and Selections.

MULTIPLE NEURITIS; PROGNOSIS AND TREATMENT. In the early stage of multiple neuritis of non-alcoholic form, when the disease is spreading almost hourly so as to invade fresh nerve districts, the prognosis is necessarily an anxious one. The cardiac and respiratory apparatus may easily become involved, and death occur almost suddenly. But it is quite remarkable, as was seen in two cases of my own which I have related, to what an extent the respiratory apparatus may become affected and recovery yet take place. When the disease seems to be no longer making fresh inroads, but, on the contrary, slight ameliorations begin to appear, a highly favorable result may generally be looked for. It is not so easy to speak as regards the alcoholic cases, as in them the brain also is always more or less involved in the disorder. But, as I have already remarked, my personal experience has decidedly disposed me to give a very favorable prognosis, even in cases which are marked by extensive paralysis and muscular atrophy.

In diphtheritic paralysis the prognosis is distinctly favorable. It is probably through invasion of the pneumogastric that a fatal result now and then occurs, and for that reason serious modifications of the circulation, especially if accompanied by vomiting, should cause anxiety and care. So long as the knee reflex is absent, the patient should be looked upon as still an invalid, and not allowed to be incautious. This will obtain equally in other forms of multiple neuritis.

There are various degrees of severity shown by this disease, from a slight loss of power scarcely noticed by the patient, to a rapidly extending and complete paralysis, involving not only the nerves of the extremities and trunk, but also those belonging to the organs whose functions are essential to life.

The treatment of localized neuritis occurring in a person of gouty habit, and presumably dependent upon that exciting cause, should be in accordance with the customary methods adopted for acute gout. After the acute symptoms have subsided, good is sometimes experienced from the application of small flying blisters in the neighborhood of the affected nerves, and comfort may be derived from the employment of the constant current.

In severe cases of a progressive multiple neuritis it is advisable to place the patient at once upon a water-bed, although it will have been noted that in this disease there is not seen the same tendency to dangerous bed-sores which is observed in certain lesions of the

spinal cord. But I think that the water-bed supports the weak patient better than an ordinary couch; and this becomes of importance when, as sometimes happens, life is carried on with difficulty, owing to the nerves presiding over respiration, deglutition, and the heart's action becoming involved in the progress of the disease. In such cases as these the administration of food in easily assimilable form and quantity, and at very short intervals, is urgently required, and stimulants often needed. During the first stage of the disease it will be advisable to administer iodide of sodium in all cases except examples of diphtheritic paralysis, and those in which a syphilitic taint can be safely put aside. In the progress of the disease it may be found necessary to give the salt in increasing doses. In one of my cases the dose of iodide of potassium was increased from ten to sixty grains, three times a day, with evident advantage, and to this mercurial treatment was added. In a case of multiple neuritis with a distinct syphilitic history, I should now begin with mercurial inunctions, and also employ iodide of sodium at the same time. In cases of non-specific character, and especially where there is reason to think that exposure to cold and other causes of rheumatism have been present, it will be well to employ the salicylate of sodium, which, in the hands of Leyden, has apparently yielded favorable results. The dose and mode of use is like that for acute rheumatism. For the relief of pain a combination of morphia with Indian hemp and belladonna may be employed internally with advantage, and lint steeped in chloroform may be pressed for a minute or two on the seats of greatest suffering if the state of the skin admits of this; but very often, and especially in alcoholic cases, there is an amount of exquisite hyperesthesia which renders it difficult to apply any local remedy. In such instances the best thing is to envelop the tender limb in cotton-wool and cover this lightly with oil-silk. When multiple neuritis has arisen in connection with the abuse of spirits, I am accustomed, as a general rule, to withhold alcohol in any form, and to depend entirely upon the frequent administration of food for the support of the patient. Nutrient enemata will sometimes be required. In such cases as these it is remarkable how rapidly the pains and hyperesthesia, which have been the cause of intense suffering to the patient, cease. It is very difficult to say how long a patient suffering from multiple neuritis should be kept strictly and absolutely at rest. This should certainly be done during the continuance of pain or hyperesthesia, and in case there is any important elevation of temperature. But when

it is evident that the process of regression or repair has taken place to a considerable extent, the patient should be allowed to get up and cautiously try to move the muscles of the affected limbs. By slow and careful steps the effort at voluntary movement may be increased. At the same time the galvanic current slowly interrupted should be applied to the muscles.

There are some grounds for believing also that faradization with the wire-brush upon the dry skin may be employed with advantage. Massage is also useful in this stage, and in this I would include passive movements by the operator, as well as active movements against resistance on the part of the patient. In the contracted state of limbs which occasionally results, the contracture being due to unbalanced muscular antagonism, division of a tendon may sometimes be adopted with advantage.

siderable patience should be employed before proceeding to this measure, as I have known contractures, which were to all appearance hopelessly permanent, yield, without operation, to assiduous massage combined with active and passive movements. Along with the contracture of the muscles it will sometimes be found that adhesions have taken place in some of the joints owing to disuse. These should be forcibly broken down. The aim generally should be to disengage muscles from obstructions to their movement, and to encourage their growth and functional activity by various kinds of physiological stimuli. Dr. Thomas Buzzard, Medical Press.

RECENT PROGRESS IN GYNECOLOGY.-The prolongation of life and the alleviation of sufferings formerly beyond possibility of help, which have resulted from this progressive development of modern gynecological science, afford, I think, a more than sufficient answer to the attacks which have been recently again directed against our specialty and its followers by Dr. Clifford Allbutt and others. Nor can those who devote themselves mainly to gynecological practice be said with truth to be engaged in any narrow specialism. On the contrary those thus occupied have constant necessity for treating the constitutional consequences of peri-uterine disorders, reacting as these do, not merely on the physical but also on the mental condition of their patients, and hence requiring that whoever are responsible for their treatment, while primarily gynecologists, should also be, in the highest sense of the term, accomplished physicians, conversant with the principles and practice of medico-chirurgical science.

It is not improbable that the process of gynecology might have been still more rapid than

it has been had its advance not been somewhat retarded by the over-hasty generalizations by which successive discoveries and improvements, however important and valuable in certain cases, were dignified into systems and extended to cases wholly beyond their proper sphere. Thus, as I have previously observed, when I entered the profession, Dr. Henry Bennett's theory concerning chronic inflammation and ulceration of the cervix uteri was almost universally adopted. At that time hardly a female patient, whose symptoms could possibly be converted into any evidence of supposed uterine disease, escaped the frequent vaginal examinations and local application to the cervix of nitrate of silver or other uterine escharotics then in vogue. In this way it was that, in those halcyon days of early gynecology, many a practitioner speculated his easy way to fame and fortune. At last, however, this facile line of practice became played out, and the cylindrical speculum and stick of caustic ceased to draw crowded consulting rooms. Then came the no less generally accepted and perhaps better grounded doctrine of orthouterine therapeutics, acting on which, for the last fifteen years, the followers of Dr. Graily Hewitt have found the evidence of some uterine displacement or flexion in every variety of pelvic ailment, and exhausted their inventive fertility in the designing of new pessaries, or the remodeling of old instruments. This mechanical theory of uterine pathology has not, however, had as undisputed a supremacy as that which it displaced, being interfered with, first, by Dr. Emmet's widely adopted and important views concerning the influence of cervical lacerations in the causation of uterine hyperplasia; and secondly, by the revival, in recent practice, of the old doctrine of the ovarian and tubal origin of many of the diseases peculiar to woman, and their curability by oophorectomy and removal of the fallopian tubes. The former idea, originally suggested by Dr. Blundell, was resuscitated by Dr. Battey, whose operation is now employed with increasing frequency and success, though in some cases in which I would myself prefer a trial of less heroic treatment. These theories - each of which, however unquestionably applicable in many cases, has been pushed beyond its legitimate employment-all point to different forms. of purely local treatment, and have tended to the existing disposition to ignore or underestimate the value of constitutional remedies in conjunction with whatever special local treatment may also be necessary. Another circumstance that may be alluded to is the enthusiasm prevailing with regard to abdominal surgery in the treatment of uterine tumors, malignant

disease of the uterus, pyo- and hydro-salpinx, and other peri-uterine diseases. None can estimate the value of operative gynecology in all appropriate instances more than I do, nor better appreciate the success which has attended the practice of some eminent authorities in this branch of surgery. Still I venture to repeat, for the benefit of younger practitioners, that in cases, for example, of uterine fibro-myomata, abdominal section, either for hysterectomy or oöphorectomy, is by no means invariably indispensable. Such tumors may in some instances be removed by enucleation per vaginam, in other cases they require no active treatment whatever; and in others again by purely medical means we may be successful in tiding patients suffering from myomata over the dangers that otherwise await them before the occurrence of the menopause, when some arrest in the development of the disease, or some abatement of its most formidable symptoms, may naturally be anticipated.-Thomas Moore-Madden, Ibid.

PURE TEREBENE IN THE TREATMENT OF WINTER COUGH.-During the last five years, I have employed a method of treatment which yields excellent results. I have before me notes of one hundred and fourteen cases of winter cough, some taken at the Chest Hospital, others at Westminster, and others again in private practice. They were all treated with pure terebene, a substance prepared by the action of sulphuric acid on oil of turpentine. It is an agreeable remedy, being a clear, colorless liquid, with an odor like that of fresh sawn pinewood. It will not mix with water, but, as the dose is small, it can readily be given on sugar. It is not the same as the patent medicine sold under the name of "Terebene." The best method of indicating its sphere of action and illustrating its utility will be to give a brief abstract of the notes of one of the cases. This, it should be said, is a fair average case taken quite at random.

R. N., aged forty-three, a commercial traveler, stated that he had been subject to cough every winter for twelve years. His work was against him, and he was a good deal exposed to wet and cold and the inclemency of the weather. His cough used to trouble him badly only in the winter, but, year by year, it seemed to be coming on earlier, and now he was hardly ever free from it. It came on in fits, which shook him to pieces, and it was always very bad the first thing in the morning, often making him retch and vomit. There was a great deal of phlegm, thick and yellow when he was in the country, but speckled all over with black in London. It was difficult to get up, unless he

could get some hot tea or something to loosen it. The shortness of breath was worse than all, for it prevented him from going about, and interfered with his business. He had never spat any blood worth speaking of, but there were at times streaks after a severe bout at coughing. He became no thinner, generally losing a little in the winter, and picking up again in the summer. He had had a great deal of treatment, and mixtures, lozenges, and liniments, without end. On examining the chest, it was found to be emphysematous, and there was a loud bubbling rhonchus at the base of each lung. On November 1st, he was ordered ten drops of pure terebene on a piece of sugar, every four hours. In three days, he returned, and said there had been a marked improvement; the cough was easier, the phlegm was lighter in color and not so thick, and the breathing was decidedly better. The dose was increased to twenty minims every four hours; and, a week later, the patient wrote to say that he was better than he had been for years, and was almost able to do without the medicine. I saw nothing of him again until January 6th, when, being in town, he came to see me. There had been some return of the old symptoms, and he was anxious for further treatment. I ordered him a small Maw's spray-diffuser, holding about an ounce, and instructed him to use it with the terebene as an inhalation several times a day. A fortnight later, he wrote, saying that he bought a larger apparatus, and that his complaint was more amenable to treatment than it had ever been before. The terebene-spray eased the cough, brought up the phlegm, and, above all, relieved the shortness of breath. On his long railway journeys, when he was unable to use the spray without inconveniencing his fellowpassengers, he rubbed the tere bene on his moustache and beard, so that it might slowly diffuse, and, as he said, "softened the atmosphere."

One of the great advantages of pure terebene is, that it is not a bulky medicine. An ounce bottle, carried in the pocket, will last for days, and is always ready for use. It is best to begin with five or six drops on sugar every four hours, and gradually to increase the dose to twenty minims. This is, for most people, the maximum quantity, but the drug has little or no toxic action, and one patient was so enraptured with his remedy that he insisted on taking a teaspoonful every four hours for a week. The only disadvantage I have ever noticed from its employment is that it gives a peculiar and characteristic odor to the urine, a circumstance which patients never fail to mention. When used as a spray, from one to two ounces should be diffused and inhaled every week. In some instances I have tried giving it mixed with an