composition in the streets and sewers, and thus vitiated the atmosphere; but, most of all, it produced in the food given to young children putrefactive changes before it was taken into the stomach.

This was especially likely to occur with milk. One instance was cited of every one of twenty-three healthy children being taken in one day with diarrhoea from bad milk.

Closely related to this subject were the poisons produced from food, or ptomaines. Brunton had stated that most of the alkaloids produced from the decomposition of albumen caused diarrhoea. It was believed that many of the nervous symptoms in suminer diarrhoea had their explanation in the effects of these alkaloids. This was true especially where the discharges were abruptly arrested, either spontaneously or by opium. They were to be looked upon as a form of toxæmia.

The inflammatory changes found in the intestine were to be looked upon as a consequence of the diarrhoea rather than the cause of it. The most marked lesions were always found in the cæcum and sigmoid flexure, just where the irritating substances were longest detained in their passage.

Immense numbers of bacteria were found in the discharges, but no sufficient evidence had yet been adduced to establish the exist ence of a special microbe as a causative agent.

The indications for treatment were four: 1. To clear out the bowels. 2. To stop decomposition. 3. To restore healthy action in the alimentary tract. 4. To treat the consequential lesions.

It was proper to begin with a cathartic in all cases unless the stomach was very irritable. Castor oil was by far the best. If much vomiting were present, a copious injection of water, enough to wash out the colon, should be given.

Many mild cases could be cured by the oil alone, provided suitable dietetic regulations afterwards could be carried out. In severe ones it gave only temporary benefit.

For the second and third indications an antiseptic should be given and the diet carefully regulated. The best antiseptics were sodium salicylate and naphthalin. The former should be given in doses of 1 to 3 grains, according to the age of the child, every two hours, and the latter in about double the dose.

If vomiting were present, all food should be stopped for from twelve to twenty-four hours, and thirst quenched by thin barley

gruel or mineral-waters,-cold, and in small quantities.

Unless the child were upon the breast, in which case it should, of course, be kept there, it was better to withhold milk entirely. Winewhey, animal broths, expressed beef-juice, or even raw beef, could be used, and were usually sufficient.

To meet the fourth indication-i.e., to treat the lesions-astringents by the mouth were useless, with the possible exception of bismuth. The diet should be as carefully looked to in chronic cases as in acute. The antiseptic should be continued, to check fermentation and decomposition in the intestine, and the large intestine should be washed out once a day with pure water or a weak antiseptic or astringent solution.

Attention was called to the fact that, except opium, nearly all the drugs which had held their place in the treatment of this disease were antiseptics of more or less power. Bismuth, calomel, the mineral acids, iron and silver salts were cited. Pure antiseptics had been used in the treatment of diarrhoeal diseases since 1846. Creasote was first 'employed, and with great success both in England and in this country. Ten or fifteen years ago salicin was largely used, especially in the South, with uniformly good results, particularly in chronic cases. The use of salicylic acid and its salts, the bichloride of mercury, and naphthalin was also referred to. The last was of latest introduction, and seemed likely to prove of very great value, perhaps the most valuable of all.

Notwithstanding the successful results obtained by antiseptics, the great majority of the text-books still advocated the old plan of the use of opium and astringents as fifty years ago. An inquiry into the public practice of this city showed that in fourteen institutions and dispensaries, where it was estimated that twenty-five thousand children were treated yearly for diarrhoeal diseases, the main reliance was still upon opium, bismuth, chalk mixture, and castor oil.

The speaker had tabulated 300 cases of his own treated by such remedies. Of these, 50 per cent. were cured; 27 per cent. improved; 18 per cent. unimproved; and 7 per cent. died. During the past year he had treated 81 similar cases by an initial dose of castor oil, followed by salicylate of sodium, these being the only drugs used. Of these, 84 per cent. were cured; 7 per cent. improved; 7 per cent. unimproved; 1.2 per cent. died. Forty-four cases were treated by naphthalin,

usually preceded by the oil. Of these, 67 per cent. were cured; 15 per cent. improved; 13 per cent. unimproved; and 2 per cent. died. Resorcin was used in a similar manner in 27 cases. Of these, 55 per cent. were cured; 22 per cent. improved; 22 per cent. unimproved; and none died.

The duration of the disease in these cases before treatment was about the same in each class. The duration of treatment in the cured cases was much shorter by sodium salicylate than by the use of opium, astringents, etc. In cases of long standing the very great superiority of the salicylate and naphthalin was clearly shown. Resorcin was much inferior to the drugs just mentioned.

The following conclusions were drawn from the paper:

First.-Summer diarrhoea is not to be regarded as a disease depending upon a single morbific agent.

Second. The remote causes are many,heat, improper and artificial feeding, bad hygiene, etc.

Third. The immediate cause is the putrefactive changes which take place in the stomach and bowels in food not digested, which changes often are begun outside the body.

Fourth. These products may act as systemic poisons, or the particles may cause local irritation and inflammation of the intestine.

Fifth. The routine use of opium and astringents is not only useless, but, especially at the outset, may do positive harm; since, by checking peristalsis, opium stops elimination and increases decomposition.

Sixth.-Evacuants are to be considered an essential part of the antiseptic treatment.

Seventh. The salts of salicylic acid and naphthalin are the antiseptics which, thus far, seem to be best adapted to the treatment of diarrhoeal diseases.

DR. R. W. WILCOX spoke especially with reference to the use of naphthalin in diarrhoea in adults. Since reading Rossbach's paper in the Berliner Klinische Wochenschrift, in November, 1884, he had used naphthalin in thirty-two cases, nearly all being in adults. He had come to feel as much confidence in the use of this drug, under certain circumstances, as in the use of mercury or the iodides in syphilis or of quinine in intermittent fever. As mercury and quinine may fail to accomplish their work if used without observance of a few well-known precautions, sò naphthalin may fail if improperly employed. The most frequent cause of failure has been

the use of too small quantities, less than 60 grains daily being a needless waste of a very good medicine. He had given up to 120 grains during the twenty-four hours in divided doses, usually in starch capsules with a small quantity of oil of bergamot to conceal the somewhat unpleasant odor. If the impurities of the drug are removed by washing with alcohol, no such untoward effects as have been occasionally reported in the journals will occur. Frequently during its administration the urine will assume a smoky color, resembling that of acute nephritis, but a careful examination will fail to detect either albumen or casts.

In chronic diarrhoeas he had used naphthalin as the only drug in twenty-one cases. Nearly all degrees and varieties had been represented; some could be traced back to an acute process, others were the result of improper food or followed debilitating dis

eases.

He related one case: James D., messenger, 18 years of age, came to him, complaining of a diarrhoea of over two years' duration. Its commencement was in the second summer previous to his first visit. The assigned cause was overindulgence in unripe or spoiled fruit. The trouble had continued through the following winter, with intervals of cessation, and had been aggravated the following summer. Since summer his loss of flesh, previously considerable, had increased, his tongue was heavily coated, the appetite poor; his discharges were five to six daily, unformed, varying much in amount, sometimes watery, very foul-smelling, much gas, no tenesmus, no blood; pain at times, but no fever. though he was in a deplorable condition, and so long as his work remained severe and his food unsuitable recovery seemed impossible, by the use of 60 grains of naphthalin daily the number of movements were reduced, within a week, to two daily, and, for the first time, became formed and devoid of odor. About six months afterwards he reported that after three weeks he had discontinued his medicine, having had no further necessity for using it.

Al

In chronic dysentery he had used naphthalin in seven cases, with excellent results. The most interesting case was that of James C., 66 years of age, who contracted dysentery while serving in the Federal army in 1862-64. He had never been free from the disease except for a few weeks at intervals. He could remember no day during which he had not had more than one passage. He was ema

ciated, with sallow, dirty skin, marked tenesmus, abdomen painful on pressure, red tongue, pulse very feeble, no appetite. His stools averaged seven movements daily,-slimy, blood-stained, of extremely foul odor. This man had 90 grains of naphthalin daily, and at the end of the month he would have hardly been recognized as the same man. Four months after he reported himself so much improved that he considered himself a well

man.

His experience in the diarrhoea of typhoid fever had been limited to two cases: Charles B., 25 years of age, and John F., 16 years of age, both of whom he saw for the first time in the third week, the diagnosis being thoroughly established. In both there was commencing tympanites; diarrhoea, to the extent of six to ten passages in the twentyfour hours. Naphthalin was administered up to 60 and 90 grains in the day, with the result of "stiffening up" the motions and reducing them to two daily. The odor of the stools, in both cases, was lost. In fact, he felt so confident that the intestinal canal and, consequently, the fæces were disinfected that he did not take any other precautions. He also directed attention to the antipyretic effect of this drug. In general, the use of antipyretics in typhoid fever he considers unsafe; but if the practitioner was thoroughly imbued with the idea that he must use an antipyretic, let him use naphthalin, which reduces temperature, indirectly, by disinfection of the intestine. In point of safety it compared favorably with such drugs as antifebrin, thallin, antipyrin, etc. Whether typhoid fever had ever been aborted by this or any other drug he did not pretend to say; but if it could be accomplished, in his opinion, naphthalin, by its vigorous action upon the contents of the alimentary canal, should tend to that result.

Of the use of naphthalin in acute intestinal catarrhs, and in the diarrhoeas of children, he had had no experience. In the diarrhoea of chronic tuberculosis he had had no opportunities for experiment. In all his cases of diarrhoea evidences of tuberculosis in other organs were sought for, but were not found. He would emphasize the claims of naphthalin as the drug to use in all cases in which it was necessary to disinfect the alimentary canal, as in typhoid fever, intestinal catarrhs, and dysentery, because it seems to be, of all the drugs at our disposal, the most certain, and at the same time the one most free from danger.

THE MEDICATION OF PHTHISIS.

In a recent number of the Progrès Médicale the editor discusses the changes in the treatment of phthisis which modern pathological researches would indicate. Recent suggestions in antibacilli treatment are the inhalation of hydrofluoric acid and the rectal injection of sulphurous gas.

We are able, however, to hope for very little from these methods.

The means for combating tuberculosis which seems most worthy of serious attention is the use of iodoform.

This substance has been tested by injection in cold abscesses, by inunction in tubercular meningitis, and internally given in enlarged glands and pulmonary tuberculosis. The purity in which iodoform is now made, our better knowledge of its solubility, and its poisonous properties, enable us to use it as a most important agent in the extirpation of a local tuberculosis before the organism can become affected; it has thus an important part in preventive and hygienic medication.

We must agree with Jaccoud in placing the administration of nutritious elements as still our most important duty to the phthisical patient. Cod-liver oil, to the extent of 4 ounces daily, is of the greatest benefit, and especially those oils which contain iodine and phosphorus in greatest amount.

AN IMPROVED METHOD FOR COM-
PRESSING AIR.

DR. E. L. OATMAN, of Nyack, N. Y., sends to the N. Y. Medical Record (December 25, 1886) an account of a simple and apparently very effective method of compressing air for use in atomizing fluids. In the cellar or basement a common galvanized iron range-boiler is placed, and connected by two pipes, entering it below, with the main water-supply and with the drain. At the upper end a tube is attached, which passes up to the physician's office. All the pipes are fitted with stopcocks. To charge the reservoir, this air-tube and the discharge-pipe are closed, while the supply-pipe is opened. The water now rushes in, and places the contained air under a high pressure. When the water ceases to flow, the supply-pipe should be closed. The compressed air may now be used when required by opening the air-pipe, the stop-cock of which is placed in the office. When the pressure is exhausted, the reservoir may be emptied by opening both the air-tube and the discharge

pipe, and the air may then be again compressed as before, by closing the latter pipes and opening the supply-pipe. The dischargepipe should be of large calibre, say two inches, so that the apparatus may be quickly emptied. The arrangement would be improved, Dr. Oatman writes, by using two connecting reservoirs, allowing the water to enter only the first, which should be the larger of the two, thus compressing the air in the second, where it can be kept ready for use. The water may now be discharged from the first, for which purpose it should be provided with a second air-tube, leaving it ready for instant use when the pressure is exhausted in the second reservoir. All the cocks governing the tubes of the apparatus may be placed in the office, if desired. Ten dollars will cover the entire cost of the apparatus.

RECENT RESEARCHES IN DIURETICS.

To what extent the Malpighian corpuscles and the renal tubules respectively take part in the secretion of urine is not yet accurately known, although the researches of Heidenhain, Nussbaum, and others have added much to our knowledge. It seems likely that an investigation into the mode of action of diuretics will throw great light on the question, because a diuretic drug may act either on the Malpighian corpuscles, increasing the flow of urinary water, or on the renal tubules, increasing the amount of urinary solids, or on both structures. The great difficulty, however, in experiments on the kidney in living animals, is that of estimating how much of the effect produced by a drug is due to changes in the circulation, or in the nervous system, which has an influence on the secretory activity of the kidney, as well as on the blood-vessels. MUNK has, in his recent experiments, eliminated these factors by investigating the action of diuretic drugs on an excised kidney. The organ, after excision, was nourished, under a pressure of one hundred to one hundred and ninety millimetres of mercury, by a stream of blood and salt solution through the renal artery. The drug was added to the liquid, and its effect noted by the amount and quality of the urine, collected through a canula placed in the ureter. Before the addition of any drug, it was found that the amount of urine secreted in an hour varied from four to twenty-four cubic centimetres; that this was a true secretion, and not a simple diffusion, was shown by the fact that it contained a greater proportion of saline constituents than

the circulating fluid. The addition of chloride of sodium, nitrate of sodium or potassium, caffeine, dextrose, cane-sugar, or glycerin to the circulating fluid, increased the secretion of urine three to fifteen times, the pressure remaining the same; while in the case of nitrate of potassium and of caffeine, there was an increased rapidity of flow of the circulating fluid. Diuresis of this nature and under such conditions could only result, according to Munk, from a stimulation of the secretory cells of the kidney by the drug, a conclusion which, as regards caffeine, had already been arrived at by Von Schroeder. An interesting result obtained by Munk was the appearance of hippuric acid in the secretion from the kidney, when benzoate of sodium and glycocol were added to the fluid circulating through the vessels of the kidney. As is well known, benzoic acid given to any animal appears as hippuric acid in the urine; and this result has been supposed to be due to the action of the intact blood-corpuscles. But, in Munk's experiment, these were absent; hence he concludes that the transformation is probably brought about by the oxygen which is combined with the hæmoglobin.-British Med. Journal, December 11, 1886.

ELIMINATION OF POISONS.

A study of the means by which nature rids the economy of what is harmful has been made by SANQUIRICO, of Siena, and his experiments and conclusions are as follows:

He finds that the vessels of the body, without undergoing extensive structural alteration, can by exosmosis rid themselves of fluid to an amount eight per cent. of the body weight of the subject of the experiment.

Through the injection of neutral fluids a great increase in the vascular tension is effected, which is relieved by elimination through the kidneys.

With reference to this fact, the author, in 1885, made experiments with alcohol and strychnine, and continued his researches in the use of chloral and aconitine with results favorable to the method employed, which is as follows:

The minimal fatal dose of a given poison was selected, and found to be in a certain relation to the body weight.

Immediately upon the injection of the poison a solution of sodium chloride, .75 per cent. in strength, was injected into the subcutaneous tissues of the neck, in quantities

being eight per cent. of the body weight of the animal.

In the case of those poisons whose effect is not instantaneous, the injection of saline solution was made on the first appearance of toxic symptoms; in other poisons the injection was made at once.

The result of the use of salines was a diuresis varying in the promptness of its appear

ance and in its amount.

Those animals in which diuresis was limited at first and then increased generally recovered, while those in which diuresis was not established perished; the poison used was found in the urine of those which died and also those which recovered.

The author succeeded in rescuing animals. poisoned by alcohol, strychnine, chloral, and aconitine; with morphine, curare, and hypnone the method of elimination failed, although ten per cent. in quantity of the body weight of the animal was used in the saline injection. With aconitine diuresis was not always established, and when it failed the animal died in convulsions. Centralblatt für die Medicinischen Wissenschaften, December 18, 1886.

was given. The price of the acetanilide is not high, being about a shilling an ounce. It can be administered conveniently in wine.British Medical Journal, December 4, 1886.

INTESTINAL IRRIGATION IN CATARRHAL ICTERUS IN CHILDREN.

MONTI, in his clinic for children's diseases, has extensively employed the treatment of jaundice from icterus catarrhalis by cold

water enemata.

The

This treatment is well borne by children over three years old, and the water is used at a temperature varying from 50° to 60° F., and in quantities from one to two quarts. presence of diarrhoea is not a contraindication. In the larger number of cases four or five irrigations were sufficient to effect a cure; The in one case only were eleven needed. dyspeptic symptoms, clay-colored stools, and engorgement of the liver were promptly relieved by two or three irrigations. Löwenthal, of Berlin, reports good results from this method in forty-one cases.-Medicinisch-Chirurgische Rundschau, December 15, 1886.

ACETANILIDE-A NEW APYRETIC.

A substance known to chemists who work with dyes by the name of acetanilide, which is produced by the action of heat on acetate of aniline, and is contained in rosaniline made with acetic acid and iron, has recently been found by two German observers, DRS. CAHN and HEPP, working in Professor Kussmaul's clinic, to possess powerful febrifuge or apyretic properties. They have given it the trivial name "antifebrin." It appears to have, weight for weight, about four times the power of lowering the temperature of feverpatients that antipyrin has. The doses given. varied from 0.25 gramme to I gramme, as much as 2 grammes (1⁄2 drachm) being given during the twenty-four hours. In every case in which Drs. Cahn and Hepp gave the drug, it produced more or less reduction of temperature; sometimes the thermometer registered a normal temperature for some hours together, and in these cases the appetite often returned. The action of the antifebrin was accompanied by a certain amount of perspiration and with some redness of the skin, sometimes also by thirst and an increase in the urinary secretion. Occasionally a dark tint was observed in the skin of the feet and hands, but no serious symptom was observed in any of the twenty-four cases in which it

THALLIN IN TYPHOID fever.

The introduction of such drugs as kairin, antipyrin, and antifebrin has somewhat diverted attention from a very powerful antipyretic agent,-viz., thallin. PROF. EHRLICH lately presented to the Clinical Society of Berlin the results of some researches he has been making with this last-named agent, especially in the treatment of typhoid fever (Münch. Med. Woch., No. 47). From experiment, he had found that after administering the drug to animals it was not retained in the nerve-centres, but mostly in the fatty tissue of the body. He also found that there was a marked difference in toxic action, according as to whether it was administered by the mouth or subcutaneously, the greater inertness of its effect in the former case being attributable to the hindrance to absorption from the presence of intestinal contents. The lesions induced by a toxic dose comprised fatty degeneration of the kidneys, necrosis of the salivary glands and pancreas, and hemorrhagic infarcts in the renal pyramids. The chief action of thallin is antipyretic, but it is capable also of moderating inflammation. As regards typhoid fever, it was administered by Ehrlich in two different ways. The first plan consisted in commencing with doses of 0.06