Hydrochloric acid is recommended in the saline variety of purpura, and fresh air and turpentine in the vascular. The London Lancet, commenting on the death from scurvy of a sailor from Calcutta, observes: "Lime juice no doubt is an excellent preventive; but if ships were provisioned in accordance with the opportunities now afforded by cold storage and hermetically sealed tins, it would become unnecessary." Alex. Faulkner" has employed salicylic acid with success in the treatment of scurvy at Peshin, S. Afghanistan.

HÆMOPHILIA.

Pathogenesis.-H. Hughes20 believes that this disease is caused by lesion of the vaso-motor centre, and consequent vascular paralysis. This theory has been accepted by Dr. Oliver, of London. Dr. Hughes rejects the theory of changes in the blood and the vessels because no such changes have been demonstrated. But he fails to demonstrate the lesions that his hypothesis would have us to localize in the vaso-motor centres. Furthermore, we do not find any evidences of vaso-motor palsy in hæmophilia, beyond the signs of deficient arterial tonus that is found in all anæmias. Finally, it may be observed that the spontaneous arrest of ordinary hæmorrhages is brought about by this very condition of vascular relaxation, which is supposed by Dr. Hughes to be the only cause of persistent hæmorrhage. Vascular relaxation means retardation of the blood current, which is one of the essential factors of blood clotting. It is evident that no explanation of these hæmorrhages can be satisfactory that does not account for the deficient formation. of occluding thrombi. That the blood of these patients when removed from the body does coagulate, signifies nothing. The tissues and the products of their metabolism are probably the source of hindrance. We have an example of this in the noncoagulability of the blood sucked by the leech. The theory of Dr. Hughes is particularly defective in its application to malarial hæmaturia. This is frequently not a hæmorrhage at all, and is always a manifestation of profound blood changes.

Cases. One reported by Savoye." A girl, 8 years old, with good family history, excepting the grandmother, who died of cancer. Dr. Blake reports a boy 5 years old with a family history of phthisis. Dr. Chambers reports four cases: (1) Male, aged 30 years, with rheumatic family history. Two other

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members of the family are bleeders. (2) A boy 6 years old. No family tendency. (3) A boy 3 years old, without any family tendency. Hæmorrhages coming on after diphtheria treated with large doses of bichloride of mercury and iodide of potassium. (4) Male, 48 years old, without any family tendency. James Graham reports a case of a male, age 20 years. Two brothers are bleeders and five sisters are not. No previous family tendency. Herbert W. Page" gives the history of a male, 22 years old. The maternal grandmother was a bleeder. The following or second generation consisted of 11 children, 6 males, who died of unknown causes, and 1 male and 4 females, who are all bleeders. One

of the latter is the mother of the patient. Her children alone of the third generation are bleeders. She has 4 daughters and 3 sons. Of these 3 daughters and 1 son are bleeders. The fourth generation consists of 2 children of the eldest sister of the patient, who is a bleeder. These children are not affected. Another case of a male, 52 years old, is reported.26 There is no previous family tendency. Of his 7 brothers and sisters, 1 brother and 1 sister's son are affected. Henry Skelton" reports three cases, all males, aged respectively 12 years, 16 months, and 17 months,-the latter with a history of asthma on the mother's side. Edmund C. Wendt28 reports a very interesting case, with autopsy of a newborn male child. Parenchymatous hæmorrhages probably commenced in utero. The parents of the child were healthy. Another case of a newborn child is reported by J. K. Caldwell.29

DISEASES OF THE SPLEEN.

Regeneration of the Spleen.-An experimental removal of the spleen of the fox was followed by the formations of a splenic nodule in the splenic region, and also numerous new formations in Peyer's glands, in the adipose tissue of the mesentery, and in the liver.

Movable Spleen.-A case in an epileptic woman is reported by A. Lükin.101

Abscess of the Spleen.-Mr. Choudhoory,105 of India, reports that of 30,000 cases of malaria treated, only three presented abscess of the spleen. He describes one, of slow development. The abscess was freely opened, after pointing, and was treated successfully by drainage, boracic lint, and iodoform.

Hypertrophy of the Spleen.-Under the name of splenic pseudo-leukæmia, we find the careful record of a case by M. Potain. 106 It was one of emphysema, with progressive pallor, emaciation, weakness, and epistaxis for four years. There was no fever, no leukæmia. The red corpuscles were reduced to 2 millions per millimetre, the hæmoglobin to one-third of the normal, and the spleen was very much enlarged. There was albuminuria. No history of syphilis or malaria. Directions are given in this paper for the physical examination of the spleen. A similar case, in its last stages, ten days before death, is described by R. G. Shore. 107 This patient had pus and blood in the urine. The temperature was febrile, and death occurred from exhaustion. The spleen, weighing 5 lbs, is described as normal in appearence. It is probable that the acute congestion of the organ obscured the sclerotic changes that are found in these cases. In the lymphatic form of pseudo-leukæmia there is—as represented in the plate accompanying an article of Dr. Murchison's in the London Pathological Society Transactions-a hypertrophy of the Malpighian bodies which gives rise to a characteristic variegated appearance.

The Ague Cake.-Fazio 108 has obtained in two cases a decided reduction of the tumor after thirty-two and forty-five injections of quinine. The dose was of gr. iij−jv in m xv of distilled water. An ice-bag was applied after the operation, and all pain and febrile reaction was thus avoided. V. Richards109 has employed with success, as recommended by natives of India, the administration of borax in lumps of from 30 to 40 grains, to be dissolved in the mouth, mornings and evenings.

One case of hydatid cyst is reported by Besançon.' tumor was indolent. The patient died of pneumonia.

TUBERCULOSIS.

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The

Pathogenesis.-The State Board of Health of Maine has published an interesting report, by A. G. Young, summarizing the information concerning bovine tuberculosis, and its relations to man. Experiments were made by V. Galtier with tuberculous masses which were subjected to heat, desiccation, water, freezing, putrefaction, and the action of salt. He proves that the different processes for the preparation of meats do not insure absolute safety

from tuberculous infection.

W. Sibley112 read before the London

Pathological Society a report on avian tuberculosis as it occurred on a farm in Surrey. The disease generally appeared at the age of two years. Caseous masses were found in the intestinal walls. The cervical glands, larynx, trachea and vertebræ were also affected. A bacillus was found apparently identical with the human. A hereditary predisposition was shown.

With respect to the hereditary transmission of tuberculosis, it is difficult not to agree with Firket,113 who doubts that prenatal tuberculosis can have its source in tuberculous semen: if such were the case the development of the embryo should be affected and a monstrosity should result. This conclusion is not invalidated by the positive proof, advanced by Landouzy and Martin' that the semen of tuberculous animals does contain the tubercle bacillus. Six guinea-pigs out of sixteen were successfully inoculated with semen of tuberculous rabbits. This problem is far from being solved. It is important to remember in this connection that the tubercle bacillus has been found in the placenta. In another contribution,115 Landouzy calls attention to the frequency of tuberculosis in early life. During the first quarter of 1887, seven cases were observed at Tenon Hospital, aged respectively six weeks, and three, six, seven, ten and twelve months.

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Evidences of inoculation of tubercle in the human subject are multiplying. We have for instance the cases of tuberculous infection in the site of circumcision, reported by Bergmann, Hofmok1,116 Elsenberg,17 117 Lehmann.118 We have the probable inoculation of the stump of the forearm of a child by a nurse who was affected with lupus, reported by Wahl.119 We have also a most conclusive observation by E. Leser.' The patient, a healthy woman, had a small wound of the last phalanx of the thumb. The wound refused to heal, and became painful and ulcerated. In about a year a similar ulcer appeared on the opposing surface of the index finger. In about two years' time there appeared, first a suppurating lymph gland of the inside of the arm, and a large cold abscess under the pectoral muscle, with slight involvement of the third rib. The lymph gland was not examined, but the other lesions were found by histo-bacteriological investigation to be tubercular. F. Treves11 also reports a case of probable inoculation of a lacerated wound of the great toe. The tubercular process