was in fairly good order. The skin was dry, and a few spots of psoriasis were found on various parts. The urine was cloudy with phosphates, and below the average in quantity. A hot bath at a temperature of 105° Fahr. was ordered. Next day he felt quite cheerful and well, remaining in this state for about a fortnight, when all the old symptoms had returned. A hot bath was again taken with the same result as before. This patient managed to maintain his health in a very fair condition simply by taking a hot bath.once a fortnight. It was estimated the quantity of urine and weight of urea passed during the three days previous to the bath was considerably less than that on the three days following the bath. If the other secretions and excretions were proportionately increased, there is a clear reason to account for the marked improvement brought about in the general condition of the patient. The time and manner of application is of some importance. Like all other baths, the hot baths should be taken before the principal meal of the day. The duration of the bath should be fifteen minutes, and the temperature 105° Fahr. If faintness should occur, the whole head should be immersed in the hot water for a few seconds.--Lancet.

ACTION of Drugs in Albuminuria.-Brit. Med. Jour., Nov. 1886. Dr. Robert Saundby records a series of observations upon the action of drugs in albuminuria in its various forms, and to examples of "functional albuminuria." In speaking of the "action of drugs" the author refers solely to the effect of remedies introduced into the body by any channel. In making calculations on the amount of albumen present in the urine, several difficulties are met with: (a) in acute and even in subacute Bright's disease the albumen may diminish and disappear without the use of any drugs whatever; (b) chronic cases are liable to intercurrent acute exacerbations of greater or less intensity which may clear up, and then there is a subsidence of the albumen: (c) the amount of albumen is influenced by diet, increased by exercise, and diminished by the recumbent position. Cases of "functional albuminuria" afford the best opportunity for testing the influence of drugs, but the author has never seen one of these cases in which the disappearance of the albumen was due to the direct action of the drugs. The use of alkalies in the form of diluents, in a series of chronic cases, with persistent and copious albuminuria, produced distinctly favorable results; under this heading the author includes bitartrate of potash, citrate of lithia, bicarbonate of potash, benzoate and bicarbonate of potash. Tannate of soda proved so nauseous that Dr. Saundby instituted in its stead the following formula: Acidi tannici, sode bicarb., āã gr. x., glycerini mxv., aq. 3j., and reported very favorably of its advocacy in chronic cases, but in acute cases its action was uncertain. In acute cases nitro-glycerine proved useful. With regard to fuchsin, the author has tried it in a great number of cases and was unable to observe results which bear out the reputation acquired by this drug. Digitalis appears to increase the amount of albumen, and this holds good of other heart-tonics, such as caffeine,. strophanthus, and sulphate of sparteine. Iron, including the acetate, sulphate and perchloride, has the same effect of increasing the albumen. Terpene, apocynum, and turpentine failed in producing any decided benefit in cases as a rule. The injurious effects of prolonged albumin

uria have been greatly exaggerated, and while improvement in the condition of the kidneys is generally accompanied by diminution in the loss of albumen, this may continue to persist for years, even in relatively large amount, without injury to health, and with fair performance of the renal functions.-London Med. Rec.

RHUBARB in the Treatment of Thread- Worms.-Dr. Sidney Martin thinks that in many cases, although the irritation about the anus may have been relieved by injections, the persistent irregularity of the bowels and disturbance of sleep are owing to the fact that worms still remain in a higher part of the intestine. In such cases he has found that small doses of rhubarb are efficient in bringing the worms away and in regulating the bowels, so that in most instances injections may be dispensed He has found the following formula most useful, varied slightly according to the age of the child: Tincture of rhubarb, 3 minims; magnesium carbonate, 3 grains; tincture of ginger, I minim; water, to 3. This amount is to be taken two or three times a day, according to the effect on the bowels. Whether the rhubarb acts as a vermicide or simply by "moving the worms on," he is unable to say. -Practitioner.

CAFFEIN in Heart Disease.-In the Brit. Med. Jour. notice is taken of some researches carried on last year by Dr. Otto Leiffert on citrate of caffein. All the patients to whom it was given were suffering from organic affections of the heart with imperfect compensation. In some it was given in a single dose, in others in repeated doses. The quantity given daily should be from one to two grammes. The advantage claimed for this drug is that it quickly improves the action of the heart and regulates the cardiac beats. It is also a diuretic, and has no cumulative action. The principal drawback to its use is that its effects last only for a short time. In those cases where compensation has been re-established, the action of caffein may be as prolonged as that of digitalis. The general condition is influenced in a striking manner; the palpitations, the dyspnoea, and as a rule, the insomnia, also rapidly dis

appear.

MANAGEMENT of Typhoid Fever.-In addition to the keeping up of the nutrition of the patient by suitable food, and supporting by stimulants, it is a matter of great importance to control the temperature, which is done by the following means:

1. A soft towel folded is soaked in a basin of iced water, then wrung out and applied over the forehead and temples.

2. The palm of one hand and the arm are "sponged off" with another towel which has been dipped in the cold water and wrung out.

3. The towel which has been left upon the head is turned and reapplied, so as to have the cold surface next the skin.

4. The other hand and arm are treated as was the first.

This process strictly followed, is continued for fifteen to thirty minutes, or until such time as the surfaces treated have become thoroughly cooled, and should be repeated whenever there is a rise of the surface heat. Sometimes, if it does not cause fatigue, both hands and arms, if

hot and dry, are allowed to be immersed or to be bathed directly in the cold water.

This mode of using cold water he has found efficient and valuable in the treatment of various forms of fever, in which the hyperpyrexia was of such a degree as to be regarded an element of danger.

In the later stages, characterized by dry tongue and sordes, with low muttering delirium, stimulants should be administered very freely, together with the application of revulsives (emplastrum cantharidis) to the back of the neck, where cerebral complications, delirium, etc., are marked. As long as the tongue is dry give almost unlimited discretionary powers to attendants and nurses to continue stimulants. This positive indication has been too little regarded.

In further reference to some remedial agents which are valuable in the complications which arise in this disease.

Oil of turpentine is applicable to meet four separate morbid conditions.

1. Tympanitic distension resulting from perverted conditions of the mucous and secretory surfaces of the intestinal tract.

2. As a special stimulant at the stage of general depression.

3. As an astringent or styptic, with opium, to prevent or arrest hemor rhages from the intestines, kidneys or bladder.

4. Combined by means of mucilage with the carbonate and chloride of ammonium, to relieve the irritation or inflammation of the bronchial tubes, when these are affected.

Cotton batting over the whole chest, covered with an oil-silk jacket, has been found most valuable additional means in treating bronchopneumonia.-N. C. Med. and Surg. Journal.

CARDIAC Changes in Typhoid Fever.-A very unusual lesion has recently been pointed out by Dégérine as occurring in the muscular structure of the heart during the course of typhoid fever. On examining the heart of two patients who died suddenly during apparent convalescence from this disease, extensive microscopic changes were detected into the myocardium. In both cases, the lesion consisted in a separation of the intercellular cement of Eberth, which, in a normal condition, unites the cells of the cardiac fibres. There was neither fatty, putrid nor pigmentary degeneration. It is due to the solvent. action of sarcolatic acid, which is formed in great abundance in the intercellular cement. No bacilli were found in the myocardium. Similar charges have been detected in the myocardium after pericarditis by Lundrouzy and Renant.-Med. Digest.

ORIGIN of Malaria.-The theories as to the origin of malaria are receiving constant additions, and each new observer is as confident as his predecessors that he has discovered the origin of the malarial poison. Dr. Karl Schwalbe, of Magdeburg, has published a very interesting paper "On the Experimental Production of Melanæmia and Melanoma by Carbondisulphide and Carbonoxisulphide, with some Remarks on the Malaria Poison." From his numerous experiments he has found that he can inject a 5, 10, or 20 per cent. solution of carbon

disulphide into a rabbit in doses of 1 ccm. three and four times a day. After ten grammes of carbon disulphide have been introduced into a rabbit he finds that, although up to that point the rabbit has no pain, eats well, and bears young, it loses weight, and its mucous membranes are pale. On examining the blood drawn from a rabbit so treated, it is found to be very pale, and when microscopically examined, although a few red blood corpuscles are normal, the majority are reduced to mere shadows, and in one or more in each field pigment granules may be seen. The white blood corpuscles are found to be less numerous than usual: they are often very pale, and sometimes full of black pigment. The total quantity of blood is greatly lessened. Neither albumen nor sugar are found in the urine. On post-mortem examination of a rabbit killed after having been treated as mentioned above, the spleen was always found to be much darker in color than usual, and in many cases it was much enlarged and gorged with blood. A considerable quantity of black, brown, and yellow pigment was found in the spleen. Venous blood taken from the spleen was discovered to contain numerous pigment cells; the black was especially noticeable in large quantities, and resisted all the usual reagents in a very remarkable way. Pigment was also found in the lungs, kidneys, and marrow, also in the brain, pia mater, and spinal cord. The brain was softened in many places. Like experiments were performed upon a rabbit from which the spleen had been previously removed. In this case the animal gained in weight, but on a post-mortem examination being made the blood was found to be pale, the white blood corpuscles very few in number, and pigment was seen in the red blood corpuscles, liver, kidneys, lungs, heart, brain, and spinal cord, but not in the marrow. The thyroid body, which was enlarged, contained yellow, red, and black pigment. This experiment proves that although the spleen forms and stores up more pigment than any other organ in the rabbit, yet its removal does not prevent the production of new pigment in the body. Similar experiments with the same results were made with carbonoxisulphide. From these experiments Dr. Schwalbe believes himself justified in stating that the introduction of carbonoxisulphide will induce alterations in the body of a rabbit which resemble those induced by the action of the malarial poison in man. It is well known, he says, that the malarial poison exerts the following action on the blood: (a.) The solids are diminished in quantity; (b) there is an increase in the volume of red blood corpuscles; (c.) black pigment makes its appearance in the red blood corpuscles; (d) the white blood corpuscles are much more diminished in number than the red. In cases where death occurs to a man who has not suffered from malarial fever for weeks or even months quantities of pigment are found in the spleen, liver, and marrow. Carbonoxisulphide Dr. Schwalbe believes to be the cause of malarial fever, for it may be introduced into the body either in solution or by inhalation for some time with impunity, but at length, should its introduction be continued, it disturbs nutrition to such an extent that an incurable condition is induced. The specific weight of the gas is 2.1046; its smell is peculiar and characteristic, it decomposes easily in water, in the sunlight, especially in the presence of ammonia. In 1885 Dr. Schwalbe proved by chemical examination that carbonoxisulphide was present in a

dried-up marsh at Herrenkrug. He thinks that the gas is decomposed during the day by the sun, and that during the night it is inhaled by men, and thus induces malaria. In combating the germ theory of the origin of malaria he lays great weight upon the fact that no observer has yet obtained germs by night, but only during the day. He considers that, on account of the weight of the gas, a slight elevation would prevent its exerting its power, but he thinks that such elevation would be powerless against germs, supposing them to be the origin of malaria, as he considers that they would ascend to a great altitude. The upholders of the germ theory say that a gas can not be the cause of malaria, because of the long-continued action of the poison upon the system. Dr. Schwalbe meets this objection by saying that snake poison and carbonoxisulphide may also affect a man for months and years after having been once introduced into the system. Dr. Schwalbe also denies that malaria alone causes the three well-known stages of an attack of intermittent fever. He knows of a case of real gout, he says, in which the typical attacks began suddenly in the night with chill, heat and sweating, during the day the patient being almost free from fever, which, however, returned again and again on several occasions, quinine always preventing their recurrence.-Archiv für Pathologische Anatomie, etc.

BOOK REVIEWS.

ARCHIVES OF GYNECOLOGY, OBSTETRICS AND PEDRIATICS.-Series of 1886. Leonard & Co., New York. Pp. 584.

The bound volume of the Archives of Gynecology for 1886, presents an extremely interesting resume of the progress of gynæcological and obstetrical science and art during the past year, containing as it does nearly four hundred articles, the cream of American and European medical literature. Among those whose articles or abstracts therefrom are to be found here, we note the names of William Alexander, William Goodell, Alfred Meadows, E. M. Hale, T. Gaillard Thomas, T. M. Madden, T. Parvin, Graily Hewitt, Lawson Tait, and others equally known to fame. The journal is very appropriately named as it is a veritable register of the facts and theories of the allied arts of obstetrics and gynæcology, and a book not only to be read but to be kept as a work of reference. We are glad to see that its merits have been so well appreciated by the medical profession, that the publishers have been encouraged to make the change from a bi-monthly to a monthly.

OXYGEN IN THERAPEUTICS.-A Treatise explaining the Apparatus, the Material and the Processes used in the preparation of Oxygen and other gases with which it may be combined; also, its Administration and Effects, etc., etc. By C. E. EHINGER, M. D. Chicago: W. A. Chatterton & Co. Pp. 157; price, one dollar.

It would seem somewhat strange, if we did not realize the extreme conservatism of the learned professions, that so potent an agent as oxygen should have been so long neglected. It is only within the last few