by provoking the fibrous transformation of the goitre. A sufficient number of injections must be made so that all points of the thyroid body may be brought under the influence of the medicinal agent. In this way complete atrophy of the morbid growth is eventually obtained.

Terrillon believes that the tincture of iodine constitutes the most efficacious treatment of goitre. At the same time, other irritant liquids may be injected into the thyroid body, such as a ten per cent solution of iodoform in ether. This acts in the same way, by provoking a non-suppurative inflammation of the tumor. Fowler's solution has been employed, but this is toxic, and can with safety only be injected by drops. Moreover, it is not so certain in its action as iodine; and the same may be said of ergotin, which was formerly much used in parenchymatous injections from the supposed power to cure atrophy of the hypertrophied gland-elements by lessening the blood supply.-Boston Medical and Surgical Journal.

THE TREATMENT OF INFLUENZA.-M. H. Huchard, writing in the Revue Gén. de Clin. el de Thérap. (December 12th), speaks of nervous prostration as being a chief clinical characteristic of severe cases of influenza, requiring for its treatment quinine, alcohol, and, in bad cases, even injections of caffein and ether. Quinine, he says, is indicated on account of the markedly remit tent type of fever, and to moderate the evening exacerbation it suffices to give a full dose (5 to 15 grains) of the sulphate or hydrobromate in the morning. Smaller doses more frequently taken are useful for their tonic rather than antipyretic effect. In neulalgic or rheumatoid form of influe za antipyrine (15 grains) combined with bicarbonate of soda (7 grains) is recommended by M. Huchard, to be taken every four hours, or, instead of antipyrin, phenace in salol (7 grains). Influenza often assumes a broncho-pulmonary form, and in certain cases is very grave. In the epidemic of "la grippe" in 1886, recorded by M. Menetrie, the pneumonic forms were very asthenic. In such cases, tonics, milk, alcohot, and, in fact, genral restorative measures are indicated rather than local applications to the chest. If the dyspnea becomes severe, and the condition termed by Graves “pulmonary paralysis" ensues, then strych nia is of value; or in case of impending a-phyxia or renal asthma, vene-ection; but when the asthenia itself threatens life,

there should be no hestitation at resorting to hypodermic injections of ether, and especially of caffeine. For the gastro-intestinal form, mild aperients, ipecacuanha, and the use of salicylates of bismuth or of magnesia, naphthol, or iodoform to promote intestinal antisepsis, are indicated.-Lancet.

A NEW SOURCE OF HYOSCYAMINE.-A rhizome which has recently been offered in the drug market as a substitute for belladonna root under the name of "belladonna scopolia" has been very fully investigated in the research laboratory of the Pharmaceutical Society. At the last meeting of the Pharmaceutical Society Professor Dunstan communicated the results of a chemical examination of the drug, which shows that it contains 0.5 per cent of hyoscyamine. With the possible exception of a mere trace of hyoscine, no other mydriatic alkaloid was found in the plant, which would seem by this circumstance to be distinguished from other plants belonging to the same natural order, viz., belladonna, hyoscyamus, siramonine, etc., from which different proportions of atropine or hyoscine are present in addition to hyoscyamine. Professor Dunstan points out, however, that this difference may possibly be due to the methods employed by previous workers in extracting the alkaloids from these plants, which may have led to the decomposition of the hyoscyamine by heat or by fixed alkalies. Among the other compounds isolated from the new drug were a crystalline sugar resembling dextrose, a fluorescent substance, and cholesterin. The latter substance is present to the extent of 0.1 per cent, and it was subsequently found to be contained in the root of Atropa belladonna. The resem blance between the two plants is borne out by a comparison of the structures of the roots, which has been made by Mr. Greenish. The rhizome was referred to Mr. Holmes for identification, and he states that it is derived from Scopola carniolica, a plant which grows apparently abundantly in Austro-Hungary and in other parts of Europe. The pharmacy of the drug is fully described in a paper by Mr. Ransom. The therapeutic action of preparations made from rhizome was the subject of a communication from Sir Dyce Duckworth, who shows that the drug may used with success as a substitute for belladonna, apparently with the advantage that it does not give rise to the dryness of the throat which is produced by belladonna. Further trials of its therapeutic action are being made. Since

Scopola carniolica contains more alkaloid than belladonna, is easily obtainable, and is at present cheaper than that drug, and moreover furnishes a valuable source of hyoscyamine, it is probable that more will be heard of its employment in medicine. The papers to which we have referred are printed in the Pharmaceutical Journal of December 14th.

THE MICROBE.-The microscopic germ or microbe of to-day, or the old-time entity, has assumed an important rôle in our lives. Of late years a flood of light has been thrown on the subject of germs by the work of M. Pasteur, his researches in ferments and fermentation, and his extraordinary findings in chicken cholera, charbon, and hydrophobia. These have attracted the attention of the medical and lay world, and have been the means of leading to endless investigation in every clime.

To-day, thanks to such researches, upward of two hundred germs, microbes, or bacteria are known, the majority wholly harmless as diseaseproducers--in a word, most useful in the many physiological processes taking place within our bodies.

While trying to establish the raison d'etre of some of these microbes, a new one is announced that temporarily promises to be king. The new bête n ire is influenza, doubtless due to a specific organism wafted through the atmosphere to our circulation. In common with other microbes, "like produces like." This influenza bacillus is an old-time globe trotter. Its antiquity makes it intensely respectable and correspondigly annoying. He hails from the land of the unknownthe East. The Russians attribute it to the Chinese. Certain it is, from St. Petersburg it has spread all over Europe and, instead of continuing a harmless course, seems to have taken on virulence in its travels, and now is said to be deathdealing. Doubtless thousands of eyes scientific are watching for the "little stranger."

The conclusion that "like produces like" is an unalterable law in disease and nature. What practitioner would expect a patient with smallpox to cause scarlet fever, or one with the latter to produce puerperal fever in another? What agriculturist planting corn would expect wheat?" Like produces like."

Does vaccine produce scarlet fever or measles? Or has it through long decades simply produced the usual effects of vaccination in all ages and climes? Here a new thought intrudes itself. The result of a successful vaccination is a scab or crust, a scar, and subsequent immunity from small-pox. How many of our readers have paused and attempted to reason out the exact modus operandi of vaccine within

the system? What does it do in the body? Does the scientist live who in a few well-chosen words can explain that action, or is our reasoning anent it empirical as it is on other equally important questions in disease? What does the cow-pox or humanized vaccine do in our life currents-they that alike distribute nourishments and disease to our tissues, and eliminate effete products? That a successful vaccination exerts a specific influence on the blood, we accept. Do the entities in the vaccinal fluid set up a fermentation within, as evidenced by the often great systemic disturbance, flushed face, rapid pulse, and high temperature? Then follows a gradual subsidence of the disturbance, and the irritative effects of the poison pass away. The septicemia, or whatever you may be pleased to to call it, is over, and protection against smallpox becomes an accepted fact. We know that for long years the serum of the vaccine vesicle was not supposed to be particulate; but thanks to the investigations of Dr. Lionel, Mr. Beale Godlee, and others in England, we now know that it is particulate and full of moving entities. Further, that if vaccine serum be filtered the fluid that passes through the filter, if used on new-born children, produces no effect; but that if the filtrate be used, the usual characteristic effects follow.

The vast field of bacteriology at present offers some of the grandest problems to faithful workers. Patient investigators should be accorded the largest measure of patience and fair play. The truly vital problems will only reveal themselves to the faithful workers. On our part it must be patience and charity in their crucial and incessant research.

And apropos of inoculations, the press of the country has again referred to the inoculations practiced at Rio de Janeiro, stating that the city council of that city has been so favorably impressed by their ascertained value as protecting against yellow fever, that six hundred dollars a month has been voted for vaccinal establishments. To us at a distance, it seems that the reasoning of Dr. Domingos Freire, of Rio de Janeiro, Brazil, Dr. L. Girerd, late of Panama, and Drs. Carlos Findlay and Celgado, of Havana, is sound and based on the reasoning applied to vaccination. From a case of speci fic yellow fever blood is taken from the finger and a culture is made. The attenuated culture is used for inoculating. Natural result, a mild yellow fever, or planting corn that they may get corn, to use a homely simile. Dr. L. Girerd, while in that hot bed of yellow fever, Panama, inoculated himself and produced a mild yellow fever. in December, 1886, the Canada Medical Record published a translation of his paper. In Havana, Cuba, Dr. Carlos

Findlay repeatedly has inoculated new arrivals with the happiest results, that is, subsequent immunity in that hot-bed of yellow fever. Again "like produces like." That the blood of a patient suffering from specific yellow fever must be full of its poison goes without saying. In attenuating it, by cultures made a la Pasteur, the gentlemen named have worked on accepted lines. They are well-known writers and investigators, as native and foreign medical literature testifies. They have fixed on certain germs or microbes which, from their constancy in their cultures. they believe to be the specific germ. Many years ago, during a limited epidemic of yellow fever at Southampton, England, Dr. Hassell, of that city, detected an unknown germ or entity in the blood of his patients. Ziemssen refers to it. But be that as it may, from the blood of yellow fever patients the poison of the disease is obtained.

To repeat, time, patience and investigation will clear up the minor details; the great ones seem to be indisputable. That yellow fever is due to an entity or germ all students of yellow fever accept. The year 1890 should show great strides in bacteriology and preventive medicine, and the unfolding of many of nature's secrets. Let scientists work, resting a-sured that time will do justice to all, and that medical science will place her laurels where they belong.-Journal American Medical Association.

INTERTRIGO.-Intertrigo, or chafed skin, is such a common affection that it is generally overlooked, except, perhaps, the application of any available salve. Yet it is often painful, and may under certain circumstances result in eczema. Again, the application of unmedicated ointments may do considerable harm by increasing the superficial inflammation and becoming rancid. A simple and A simple and most efficacious salve is the following, which we quote from the Journal de Méd., November 10, 1889 (Med. and Surg. Reporter):

found so abundantly in the liver, spleen, and kidneys in this particular case.

2. The presence of blood-pigment, recognizable on microscopic examination, of whose source there could be no doubt, as it appeared in the urine in the form of granules similar in appearance and character to those afterward found in the cells of certain of the renal tubules.

3. An increased excretion of iron.

All these changes point to the existence of one condition of the blood, namely, an excessive destruction; and they all agree in one respect, namely, that they varied in degree from time to time, the aggravations of weakness from which the patient periodically suffered being marked by higher color of urine, excretion of blood-pigment, and increased excretion of iron.

In addition to this, their pathological significance. these changes are, I am inclined to think, of no little importance from a diagnostic point of view. The high color of the urine observed, unaccompanied as it was by any diminution in quantity or any rise in specific gravity, and the presence of granules of blood-pigment in the urine, pointed so unmistakably to the nature of the pathological process at work in the blood that they established conclusively the diagnosis of the case as one of pernicious

anemia.

One must, however, in this connection guard one's self against a misconception. that may not improbably arise. The urine in pernicious anemia need not always show these well-marked and, when present, characteristic changes. It may be said, however, with some degree of assurance, that they will be found more or less marked in all cases at some period or other of their history.

In all cases, as in the foregoing one, there will be times corresponding to the periods when the patient is gaining ground, when the color of the urine will be that of health, and nothing abnormal will be microscopically recognizable.

The aggravations of weakness will always, however, be evidenced by a higher color of the urine; it may be also by the appearance of blood-pigment granules in the urine, both changes marking the nature of the process within the blood which is the occasion of these attacks, namely, excessive hemolysis.

In the recognition of this fact as to the nature of this form of anemia, and of the farther fact that, as I have endeavored to show elsewhere, this destruction is initiated

in the portal system, and depends upon changes occurring within the gastro-intestinal tract, is to be found the great indication for that treatment of the disease which will most probably be of value. Having established, as I think these various observations conclusively do, what is the nature of the morbid process within the blood, our next endeavor must be to recognize and combat the changes within the gastro-intestinal tract on which they depend. This subject I hope to deal with in a future paper based on further investigations either already made or still in progress.

THE

PRIMARY TUBERCULAR DISEASE OF EYE.-Like all comparatively rare diseases, cases of primary intra ocular tubercle may give rise to considerable doubt in the minds of those under whose care they are, both as regards diagnosis and treatment. In certain instances it is next to impossible to distinguish between tubercular and syphilitic nodular iritis; yet in reference to the adoption of active treatment a correct diagnosis is all-important. Such doubtful cases have been described on several occasions as granuloma of the iris, a name which is said by some authors to signify that the disease is of syphilitic origin, while others hold that it is tubercular. At the best it probably means that our knowledge of such cases is not yet complete. The doubts which arise regarding treatment chiefly concern operative measures. If the disease be tubercular, should the eye be excised, in the hope of removing a center of infection, and thus preventing general tuberculosis? If syphilitic in nature, active antisyphilitic treatment is indicated, and these measures would but doubtfully conduce to the cure of tubercle. The records of cases seem to point to enucleation as the best treatment for primary intra-ocular tubercle; on the other hand, in a certain number of cases recovery has ensued from disease which had all the clinical characters of tubercular iritis. One point seems fairly well established, viz., that if any operation is undertaken it should be removal of the entire globe; iridectomy performed with the intention of removing the diseased portion of iris has been almost uniformly unsuccessful. British Medical Journal.

POISONING BY TINCTURE OF IODINE.-Dr. A. N. Collins, of Detroit, Michigan, reports the following case of poisoning by tincture of iodine. The patient was a young woman of twenty, who was seen fifteen or twenty minutes after the drug had been swallowed. She was found to be suffering from symptoms of acute gastric irritation and burn

ing of the throat, and was very much frightened. The patient, who had not partaken of food for six hours, stated that she had swallowed half an ounce of tincture of iodine in mistake for her medicine which was standing near it. Dr. Collins gave her a draught of water thickened with starch, followed by a teaspoonful of mustard in water and a copious draught of warm water. Vomiting was immediately produced, the vomited matter having the blue color of iodide of starch. The treatment was repeated until color-change was no longer produced on the starch, and was followed by a hypodermic injection of grain of morphine and grain of atropine. Next day the patient had no trouble beyond epigastric pain and indisposition to take food, and she was soon able to resume her work.

CAUTION IN THE USE OF COCAINE.—Dr. C. W. Richardson narrated before the Medical Society of the District of Columbia a case of cocaine-poisoning, for the purpose of directing attention to a novel toxic manifestation of the action of the drug. In attempting to remove from a married woman of twenty-five a cartilaginous spur projecting from the septum into the left nasal cavity, and pressing upon the inferior turbinate bone, he injected a few minims of a ten-per-cent solution of cocaine into the tissue to be removed. In in a very short time unquestionably erotic manifestations were observed. The operation was postponed for a few days, when, on again using cocaine sparingly and in a local manner, similar manifestations occurred. As a strong tendency exists among most practitioners, after they have used a remedy for a long time without its producing any serious or unusual effects, to become careless in its application, the case before us ought to serve to impress the obvious danger which may arise from the incautious or careless administration of this drug.-Journal of Amer. Med. Association.

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It is the glory of modern medicine that, under the encouragement of the majority of the profession and the assiduous labors of a few devoted doctors, sanitation has grown to be almost an exact science, and contemplates nothing less than the annihilation of zymotic disease. Thus, under perfect sanitation cholera and yellow fever may be barred out of any given country, typhoid fever may be avoided by any enlightened human being, while the dissemination of tuberculosis among men may be mitigated or prevented by measures so simple that their importance is, therefore, likely to be overlooked. The price which the apostles of Hygiea have had to pay that man might have the priceless boon of immunity of epidemic scourge, while not Promethean, has been sufficiently high. They have been compelled to work against the stolidity of ignorant legislators, the prejudice of ill-informed doctors, the opposition of powerful corporations, the sophistries of pettifoggers, the machinations of municipal rings, and the careless indifference of the people at large; and now a new hindrance to progress confronts them in the belittling criticisms of some learned men.

Thus our esteemed contemporary, the New York Medical Record (8th inst.), after praising the sanitarians in a graceful paragraph, submits their ranks to the following fusillade:

They are apt to go too far and attempt to prove too much. Men are willing to be scared a little, but they will not allow themselves to be scared too much. They are reasonable also, and are ready to put up with very many inconveniences for the good of the community; but their patience and their faith have limits. When one thing after another is forbidden simply because some sanitarian says that it contains the germs of disease, they begin to doubt. They see that their fathers drank ice-water in moderation and yet lived to a good old age, although they are now told that ice holds many bacteria which only await liberation to work destruction among the sons of men. They have seen people riding in sleeping-cars for many years, but are now informed that it is only at the peril of their health that they ever pass a night in these pest-wagons. They have been accustomed to look upon a sea voyage as health-giving, but are now told that it is almost a miracle if one reaches the shore without having received into his lungs the germs of consumption. It is no wonder that they become incredulous after a time and refuse to accept any advice from the sanitarian, especially if such advice runs counter to their material interests.

"Much, if not most, of the opposition which health officers have to contend against comes from individuals or corporations whose interests are threatened, and the only effectual way of overcoming such opposition is through an appeal to public opinion. Laws are useful and necessary, but they are of comparatively little avail unless backed up by the intelligent approval of the public. We may gain the support of the people by appealing to their reason and common sense, but not by working upon their fears and conjuring up causeless alarms, which their own experience tells them are existent chiefly in the mind of the zealous sanitarian."