and its nature. in doses of from to 1 grains, mixed with a little glycerine, hypnone determines profound sleep, and in alcoholic subjects its hypnotic properties appear to be superior to those of chloral and of paraldehyde. No inconvenience arises from its administration, except that it gives the breath a disagreeable odor by its elimination through the lungs, which, however, may be overcome by certain pharmaceutical combinations. Seven to fifteen grains of this substance, used subcutaneously in a guineapig, caused gradually induced coma, which terminated in death at the end of five or six hours. Injected under the skin of a dog, hypnone does not produce somniferous effects, whatever may be the dose employed. The same is the case when introduced into the stomach; in this latter case the animal always vomits. When, on the contrary, the medicine is injected into the veins it determines profound sleep, which is accompanied by analgesia and anesthesia; but the dose necessary to produce sleep (one gram on an average to a dog) is a toxic dose; the animal never wakes, but dies in from about five to eight hours, and this effect is invariable. At the autopsy, the kidney is found infiltrated with blood and the lungs are studded with apoplectiform patches. Under the influence of injections, considerable modification of the respiratory rhythm and a notable lowering of the arterial pressure are also observed, the beats of the heart becoming extremely feeble. Finally, the local irritative effects produced by hypodermic injections of hypnone would render its use almost impracticable. It is therefore advisable, as with all new drugs, to use this substance with the greatest prudence.

Administered to an adult

At a debate which took place on this subject at a recent meeting of the Société de Therapeutique, Dr. Dujardin-Beaumetz and other members fixed the dose of hypnone at six or eight drops, to be taken at once; and, in order to prevent its irritating the stomach, to be admini-tered in glycerine or syrup. To overcome the disagreeable odor imparted to the breath, M. Limousin, recommends its administration in gelatine capsules, after having previously dissolved it in almond oil. According to M.

Limousin this oil has the effect of attenuating not only the strong odor of the drug, but of diminishing that communicated to the breath. M. Trasbot read a note on the action of the sulphate of eserine in the treatment of gastrointestinal affections in the horse. According to this veterinarian, the sulphate of eserine is an energetic excitant of the ganglionic system of nerves; it is this action that would explain. the good effects obtained in horses and dogs. in the treatment of colic and indigestion.

Dr. Lassenne lately described a sign of death, which he had occasion to verify a certain number of hours after the assumed decease of the person, and which to him appeared very decisive. The doctor was ignorant as to whether this sign was noticed before, but he had not seen it mentioned in works on the subject. If a needle be inserted in the skin of a corpse, and the wound be examined, it will be found that the puncture remains open as though it were a piece of leather. In the living subject, even supposing that no blood issues from the wound, as may happen in hysterical patients, the wound closes over immediately after the withdrawal of the needle without leaving any visible mark.

It has long been pointed out by Professor Verneuil and others that intermittent fever may reappear after years under the influence of local pain or traumatism. The following note, published by Dr. Liegey, in the Courrier Medical, affords another example in confirmation of this statement. Dr. Liegey was consulted in November last by a young man of twenty-five, good constitution, and habitual good health. who had had no other ailment than an attack of intermittent fever contracted at Berri at the age of eighteen. Some time before he had been to the doctor he suffered from neuralgic pains of the face, appearing to anse from a decayed molar of the left side, the extraction of which produced complete relief. A short time after he was seized with similar pains arising from a decayed molar on the right side of the lower jaw. On the same day, at about four in the afternoon, this young man was seized with violent shivering, although he was in a warm room at the time. This was followed by a general heat of the body which

was well marked, and which was followed by copious perspiration. On the following days the patient had exactly the same symptoms,

about the same time, which lasted about four hours, though in a mitigated form, on each occasion. Supposing that the tooth, acting like a thorn, was the cause of the intermittent fever, the doctor extracted it, and henceforward the fever disappeared without the patient taking any quinine or any other drug to combat the fever. Dr. Liegey adds that he is not aware of another example being recorded of a decayed tooth producing a veritable paroxysm of intermittent fever.

The profession in general and the medical press in particular have sustained a great loss in the death of Dr. Dechambre, the well-known editor of the Gazette Hebdomadaire of Medicine and Surgery, which took place on the 4th inst. at his residence in Paris, from an attack of cerebral hemorrhage. He had been ailing for some time, and rapidly broke down, looking considerably more than his age, which was seventy-four at his death. He was principal editor of the “Encyclopedie des Sciences Mèdicals" which was begun some twenty years ago, and will probably take as many years before it is finished.

PARIS, January 8, 1886.

Abstracts and Selections.

THE EARLY OPERATIVE TREATMENT OF PSOAS ABSCESS. By Dr. Julius Dollinger, Professor of Orthopedic Surgery in Budapest. An abstract:

The author, after stating that the management of abscesses resulting from inflammation of the vertebræ has been vastly improved by the introduction of antiseptics, describes the several methods of Lister, Volkman, and others for opening them, and then very justly says: But before the abscess reaches a point where this practice is ordinarily pursued, much valuable time has been lost. The high evening temperature exhausts the sufferer and the abscess will have opportunity to form attachments in the pelvis, which will increase the difficulty of subsequent shrinkage and healing. Having seen a number of cases ending in this way, I determined in future to treat abscesses arising from inflamed vertebræ just as I would

other abscesses, that is, to evacuate the pus as soon as its presence could be ascertained. Acting on the suggestion of Bouvier, I made, wherever I suspected abscess, careful examination of the base of the chest, the loins, the iliac fossæ and the anterior surface of the psoas muscles through the relaxed abdominal walls. As a result, I have occasionally been able to locate the abscess near the vertebral column in the thoracic cavity, by percussion, while in other cases I have detected the swelling before it had reached Poupart's ligament, and while it was yet in the iliac fossa, where it had acquired the size of one's fist.

The moment I am clear that the abscess has formed, I look to its evacuation. When a psoas abscess is seen sufficiently early and examined with due care, it will be found that the matter lies in the sheath of the psoas muscle or along the fibers of the iliac muscle, and is always outside the peritoneum. The outlines of the abscess can usually be made out by palpation through the abdominal walls. Oftentimes it is no deeper down than the middle curve of the ilium, whence it may extend inward nearly yond this, reaching above the crest of the to the median line, and in some cases even beilium, forming a well-defined tumor in the side of the abdomen, but not projecting so far downward as Poupart's ligament. Fluctuation is usually marked except when the abscess walls are rendered specially tense by the matter, when the swelling resembles a fixed tumor. Opening the abscess being decided on, I adopt antiseptic precautions, using for this purpose carbolic acid, apply an anesthetic, and proceed to divide the skin and superficial fascia just behind the anterior-superior spinous process of the ilium immediately above the cr st and parallel to it for six to eight centimeters. I now cut the fibers of the external and internal oblique and transversalis muscles, near their insertion into the crest. By keeping the cutting edge of the knife close to the bone, the vessels which are divided will rarely need to be tied. Cutting now through the layer of fat usually found here, I pass the finger of one hand into the wound, and with my other hand press the abdominal walls in order to push the abscess toward the cut. If I find the abscess lying on the iliac muscle, I merely push aside the loose cellular tissue, that I may conveniently reach. the abscess, which is readily recognized by its pearly appearance. If the abscess lies among the fibers of the iliacus, I either push these aside or divide them. There seems to be no danger in dealing in this way with large abscesses, but when they be small, I deem it safer to keep close to the inner table of the sacrum in order to avoid all risk of wounding the peri

I

toneum. The abscess being reached, I open it by a free incision and evacuate its contents. Having carefully explored its cavity, the wound is thoroughly washed with a one-to two-per-cent solution of chloride of zinc. then make the rear or counter opening and carry into it a drainage - tube of sufficient caliber to admit the finger. If necrosis of the bone is present or be likely to occur, instead of pushing the tube through the tissues, I divide the parts freely with the knife.

SUMMARY.

1. Pus resulting from inflammation of the vertebræ ought to be removed early.

2. The opening of psoas abscess while it is still in the iliac fossa, and above Poupart's ligament, is easily effected by this procedure.

3. Early opening guards the patient against the dangers which accompany the burrowing of pus, and when in spite of this a second abscess forms, as it sometimes does on the opposite side, it may also be opened in the same way.Translated from Weiner Medizinische Wochenschrift.

HYDRONAPHTHOL; A NEW ANTISEPTIC.-In a series of papers on hydronaphthol, communicated to the New York Medical Journal by Dr. George R. Fowler, Surgeon to St. Mary's Hospital, Brooklyn, he concludes as follows: The following is a résumé of the antiseptic methods employed in this hospital with hydronaphthol :

Preparation of Sponges. Medium-sized sponges of good quality are selected and thoroughly beaten so as to break up and loosen all calcareous particles. These are thoroughly washed until all gritty matter is separated. They are then placed in a solution of permanganate of potassium of the strength of thirty six grains to the pint, and there allowed to remain for a few minutes, or until they are of a brown color. They are then washed in clean water and placed in a bleaching solution made as follows:

Sodium hyposulphite.......10 ounces;
Water...

...68

Dissolve, and add muriatic acid, 5 ounces.

This solution should be made the day before required for use, so that the sulphur may separate from the solution. It should be decanted off. The sponges should be immersed in this solution for a few moments only. They should then be washed in clean water, and, in order to make certain that no sulphurous acid remains, it is well to immerse them a few moments in a solution of bicarbonate of sodium, 100 grains to the pint. They are then sterilized by being

immersed in a 1-1000 solution of corrosive sublimate for two hours. From this they are transferred to a 1-1000 warm solution of hydronaphthol and kept hermetically sealed in a screw cap fruit-jar or museum-jar. If it is desired to keep them in a dry state, glycerine should be added to the last-named solution, in the proportion of half an ounce to the pint, in order to prevent the sponges from becoming harsh and brittle. For hospital use, a separate jar is kept for each day's supply of sponges, and, as soon as they are no longer required, they are washed thoroughly, again sterilized as before, and placed in the hydronaphthol solution in the jar in which they belong, which is numbered for the purpose of identification, and not put to use again until at least a week has elapsed. This insures the most perfect immunity against infection from every source, and enables one to employ the same sponges again and again without incurring the slightest risk.

Irrigation. During operations and dressings an almost constant stream of hydronaphthol solution. 1-3000, in water previously sterilized by boiling, is kept running over the parts. The jar containing the irrigating solution is kept partly filled with the saturated solution, and, at the time of operating or otherwise employing the irrigating solution, warm water is added in the jar in sufficient quantity to reduce it to a weaker solution.* In cases of chronic

joint disease, or cases of hydrops articuli, if no purulent accumulation be present, the hydronaphthol is used to wash out the joint. If, upon tapping the joint, purulent and flocculent fluid flows through the cannula, a solution of corrosive sublimate is first used to thoroughly sterilize the interior, and this is, in its turn, well washed out with the hydronaphthol solution. By this means corrosive-sublimate poisoning is guarded against; a portion of the hydronaphthol solution may be left in the joint cavity. In all cases of a septic character sterilization had best be accomplished by the aid of the mercuric-bichloride solution, the latter being always washed away subsequently with the hydronaphthol solution.

Bath for Instruments. The instruments are placed in shallow pans, porcelain-lined, and covered with a saturated solution of the compound. A towel, wrung out of the same, is spread out in a convenient place, upon which the operator drops the instruments when not in use, and from which an assistant transfers them to the bath until again needed. Towels for the purpose of isolating the field of operation

*Solutions of from 1-3000 to 1-500 are sufficiently strong for all purposes. The saturated solution, although generally well borne, has seemed at times to overstimulate the tissues and lead to increased secretion, a very undesirable feature in any antiseptic agent.

are wrung out of a 1-1000 mercuric-bichloride solution.

Preparation of Catgut. The catgut should be wound upon hard rubber, glass, or porcelain spools. It is then sterilized in a one-per-cent solution of mercuric bichloride, being immersed for twelve hours. It is then transferred to an alcoholic solution of hydronaphthol, one tenth of one per cent, for permanent preservation. The latter hardens the gut sufficiently, and preserves it against all further change.

Silk and horse-hair may be treated in the same manner, excepting that they may be boiled in the corrosive-sublimate solution for a half hour and then immersed for twelve hours. They should be preserved in the alcoholic-hydronaphthol solution, as in the case of the catgut.

Drains may be immersed in the corrosivesublimate solution also, in the same manner as the catgut, and then placed, for permanent preservation, in the saturated watery solution of hydronaphthol, to which glycerine, in the proportion of half an ounce to the pint, has been added.

Wood-flour and Sawdust. Sterilization of wood-flour and sawdust is accomplished by thoroughly triturating the same in a mortar with an alcoholic solution of corrosive sublimate, and in the same solution the hydronaph thol is dissolved, which latter gives to the dressing its permanent antiseptic character. The following is a good working formula for this purpose:

Hyd. bichlor., Hydronaphthol, ää Glycerine...

Spts. rectif..................

.... 3ss.;

3j; Oj.

This should be triturated with three pounds of wood-flour, or finely-sifted sawdust, and, after drying, placed in bottles with large mouths until required for use. Bags are prepared, of different sizes, of coarse cheese-cloth previously rendered hygroscopic by boiling in a strong alkaline solution, and then washed and dried. The material known as mosquito-bar or netting, if used, need not be rendered hygroscopic, as its meshes are so coarse as to readily permit of the passage of the wound secretions through and into the woodflour. These are dipped into the same solution prepared for the wood-flour, or sawdust, before filling. They are prepared and filled upon the day of operation, and kept in a tin can, or wrapped in some impervious material until

needed.

Absorbent Cotton. This is used for backing up and placing around the edges of the cushion or pad dressings when these are placed upon un

even surfaces. It is hydronaphtholated in an alcoholic or benzol solution, so that the former represents twenty per cent of the cotton by weight.

Absorbent Gauze. This is hygroscopic cheesecloth; what is known among dry-goods dealers as archery bunting makes a very good dressing after being rendered hygroscopic. It is hydronaphtholated in the same manner as the cotton, and, after drying, kept in tin cans until needed for use. It is used principally for making bandages. ing bandages. Should it be designed for use in immediate contact with the wound, it is prepared in the same solution used for the wood-flour, in order to insure its thorough sterilization by means of the mercuric bichloride. Paper-wool. This is manilla tissue paper, cut into strips one sixteenth of an inch wide and saturated with the same solution used for the wood-flour. It is passed through the rolls of a clothes-wringer, dried and carded. or pulled apart by hand. It is used as a cushiondressing, or may be applied in a mass directly to the wound.

*

Hydronaphthol Soap. Powdered soap, triturated with about four per cent of hydronaphthol, is found to be most convenient for use. The compound may be incorporated in cakes of ordinary toilet soap with advantage. It is useful in scrubbing the parts preparatory to operation, the surgeon's hands, etc.

Hand Scrubbing-brushes. These are kept in a saturated solution of the hydronaphthol. Two sets are always at hand, one for cases in which some suspicion of sepsis is entertained and sup puration exists, and the other for aseptic cases and the surgeon's hands.

Mention has been previously made of a hydronaphtholated magnesia for use as an absorbent along the line of sutures. I think that this is uncalled for in the majority of instances, and in antiseptic surgery whatever is uncalled for had best be omitted. Wherever such an

application is needed, this will be found a safe and efficient substitute for iodoform.

In addition to these, hydronaphthol incorporated in simple ointment, in the proportion of half a dram to the ounce, is found to be an excellent application when a stimulating ointment is indicated. Old leg ulcers and the like are found to behave very kindly and heal rapidly under its use.

Dr. F. W. Rock well, chief of our department of genito urinary diseases, informs me that he has had some excellent experiences with hydronaphthol in cases of purulent cystitis, washing out the bladder once or more daily with a saturated solution. In a case of irritable blad

*See article in New York Medical Journal, October 10, 1885.

der of long duration, in a female, I recently dilated the urethra so as to admit my indexfinger for exploratory purposes. An acute cystitis followed, which yielded readily to a daily irrigation with a warm solution of this compound.

A case of intractable eczema capitis recently yielded rapidly to the application of the hydronaphthol ointment. I believe the naphthols have been employed in the Vienna skin clinics. for some time past with marked benefit.

To summarize the results of my experience thus far with this compound I would state that: (1) It is an efficient and safe antiseptic and anti-putrefactive agent. (2) This is accomplished in very dilute solutions; consequently it compares favorably in point of expense with carbolic acid, and it is especially as a substitute for the latter that its use is urged, not only on the score of cheapness, but of safety. (3) Its saturated solution is only of the strength of 1 to 1100, and consequently no mistakes can occur in its use. In this strength of solution it is at least five times above its antiseptic limit, and yet is non-poisonous, non-corrosive and, generally speaking, non-irritant.

EFFECTS OF COCAINE ON THE CENTRAL NERVOUS SYSTEM.-At a recent meeting of the Chicago Medical Society, Dr. D. R. Brower read a paper on this subject, from which we take the following:

My first proposition is, that cocaine is as powerful for evil as it is for good.

Its Effect upon the Brain. In small doses, that is, three or four drams of the infusion, or one half to one grain of the alkaloid, it is the most certain and agreeable of all cerebral stimulants. It increases the frequency of the pulse and respiration, and elevates the body temperature. It gives a sense of well-being, a freedom from care, and a pleasant mental exaltation. The first effect of the drug is upon the serebrum, then upon the medulla oblongata, the sense of mental exhilaration preceding the stimulation of respiration and circulation. In small doses it also stimulates the spinal cord, producing a desire for muscular activity and increasing activity of reflexes.

This increased activity of the central nervous system is usually followed by a quiet, composed, self-satisfied condition of the mind and body that eventuates in sleep. These agreeable effects are accompanied with loss of appetite, frequently with nausea, constipation, and diminished activity of the kidneys, of the sexual functions, and of the skin. In large doses, two to ten grains of the alkaloid, there are produced tinnitus aurium, photophobia, illusions, hallucinations,

great loquacity, and a marked tendency of the mind to exaggeration and misrepresentation. If continued for some time this dose produces perversion of the affections, a disturbance of the moral emotions, a tendency to quarrel with friends and former associates, and to form alliances with persons formerly regarded as inferiors.

This state of the nervous system may become very like delirium tremens, with the same kind of muscular tremor and the same kind of horrible hallucinations. During this time the loss of appetite and diminished activity of assimilation result in extreme pallor of the face, dryness of skin, extreme constipation, very much diminished urinary excretion, loss of sexual function, and great emaciation.

Cocaine in the Alcohol and Opium Inebrieties. Dr. Lewis Bauer began with one fifth of a grain, which the patient soon increased to ten grains by hypodermic injection, with the same disastrous result upon the nervous system as has been mentioned; but he expresses the opinion that cocaine inebriety was less objectionable than the alcoholic.

Dr. Erlenmeyer gave it, in various doses, in two hundred and thirty-six cases of opium inebriety, and expresses sentiments that entirely agree with my own. He says that while cocaine does modify and mitigate the phenomena of opium abstinence, its effect is only transient and of brief duration; he regards it of trifling value as a substitute for morphine.

Dr. J. T. Whittaker* reports, in an elaborate paper, the results from its hypodermic use in two cases of opium inebriety that were satisfactory. Dr. Palmer, of Louisville, Kentucky, who was one of the first to advise its use in such cases, continues to be an enthusiastic advocate of the drug.

My own experience is against its use in either of these inebrieties; it undoubtedly makes the withdrawal of either of these agents much easier for the patient, because its effects are so similar to opium and alcohol that he scarcely feels the need of either; but you place within his reach an agent much more rapidly disastrous and destructive to the nutrition of the cerebral convolutions; an agent that will soon sink him to a degradation much lower than is possible with either of the others.

Cocaine in Melancholia. The best results yet obtained from the administration of the drug have been in conditions of mental depression. Dr. Jerome K. Bauduy relates a very extensive experience with the drug in melancholia. His method was to inject one grain of the muriate of cocaine, and he frequently witnessed

*Medical and Surgical Reporter, August 15, 1885.