shows febrile symptoms, and these likewise in a more considerable degree. Accordingly it more speedily runs its course, which is finished in a few days. It sometimes terminates by a spontaneous sweat, and this in some persons produces a miliary eruption. It is, however, the febrile state of this disease that is especially finished in a few days, for the cough and other catarrhal symptoms do frequently continue longer, and often, when they appear to be going off, they are renewed by any fresh application of cold." (From First Lines of the Practice of Physic, by William Cullen, Philadelphia, 1822.)

He

It has been my fortune to see no better description of influenza than that of Sir Thomas Watson in his well-known Lectures, a book that, it is needless to say, has perbaps been more widely read among physicians and done more to influence medical thought than any work published in the English language. Watson delivered his first course of lectures during the winter of 1836-7, and in January and February of that season influenza was epidemic in London. During its prevalence Watson lectured on influenza, and, with his usual felicity of expression, produced a clear, graphic, and accurate description of the disease. says: "The symptoms, taking them altogether, are somewhat as follows: The patient is chilly, and perhaps shivers, presently headache occurs, and a sense of tightness across the forehead in the situation of the frontal sinuses, the eyes become tender and watery, and sneezing and a copious acrid defluxion from the nose ensues, followed or accompanied by heat and uneasiness about the throat, hoarseness, a troublesome cough, and oppression of breathing. In short, the symptoms are the symptoms of catarrh, including in that term all the varieties thereof that are sometimes met with separately; gravedo, coryza, bronchitis, and with these symptoms a sudden, early, and extraordinary subdual of the strength, and most commonly great depression of spirits. The debility which comes on at the outset of the complaint is one of its most singular phenomena, taking place in some cases almost

instantly, and in a greater degree than would seem proportioned to the malady which it thus ushers in. Indeed this rapid prostration of strength is more essentially a part of the disorder than the catarrhal affection, which sometimes (though rarely) is absent or imperceptible. It is upon the mucous membranes, however, that the stress of the disease generally falls, especially upon the internal lining of the air-passages. Those of the alimentary canal seldom escape entirely, but they suffer in a less degree. The tongue is white and creamy, the palate loses its sensibility, the appetite fails, nausea and vomiting are not uncommon, and sometimes there is diarrhea. The pulse, in the uncomplicated disease, is soft and generally weak. The skin, at first hot and dry, soon becomes moist, and sometimes exhales a peculiar musty smell. The patient complains also of pains in the limbs and back, and of much soreness, a bruised fatigue or tender feeling along the edges of the ribs and in various parts of the body. In its simple form and ordinary course the disease abates of its violence after two, three, or four days, and the patient is usually convalescent before the termination of the week, but cough and much debility are apt to survive the other symptoms, and while these survive the complaint is very easily renewed.” (Watson's Lectures, Ed. 1857.)

Thus, at the risk, I fear, of taxing the patience of my readers, I have taken the liberty of quoting what three great English physicians and teachers, one of them of our century, one of the eighteenth and one of seventeenth, have had to say on influenza, a disease that has so recently excited our curiosity and that we have had such ample opportunity to study.

CHAMPAIGN, ILL.

DOCTOR: "Well, Dennis, did you take the pills I sent you?" Dennis: "Indade, docthor, an' I did not; ye wrote on the box 'One pill three times a day,' an' I've been waitin' till I see you to ask you how a man was to take a little bit av' a pill loike that three times in wan day?"-Harpers' Weekly.

Reviews and Bibliography.

Monthly Nursing. By A. Worcester, A. M., M. D., Fellow of the Massachusetts Medical Society, Physician to the Waltham Hospital. Second edition. 12mo, 250 pp; cloth. New York: D. Appleton & Co. 1890.

Syllabus of the Obstetrical Lectures in the Medical Department of the University of Pennsylvania. By Richard C. Norris, A. M., M. D., Demonstrator of Obstetrics, University of Pennsylvania. 12mo, pp. 154; cloth. Price, $2.00. Philadelphia: W. B. Saunders. 1890.

A Treatise on Fracture. By Prof. Armand Després, Surgeon of Charity Hospital, Member of the Society of Surgery, of the Anatomical Society, etc. Translated by E. P. Hurd, M. D. 12mo. Price, paper, 25 cents; cloth, 50 cents. Physician's Leisure Library. Detroit: Geo. S. Davis. 1890.

Massage and the Swedish Movements, their Application to Various Diseases of the Body. By Kurre W. Ostrom, from the Royal University of Upsala, Sweden, Instructor in Massage and the Swedish Movements in the Hospital of the University of Pennsylvania. 12mo, pp. 96; cloth, 75 cents. Philadelphia: P. Blakiston, Son & Co. 1890.

Text-Book of Medical Chemistry for Medical and Pharmaceutical Students and Practitioners. By Elias H. Bartley, B. S., M. D., Professor of Chemistry and Toxicology and Lecturer on Diseases of Children in Long Island Hospital, etc. Second edition, revised and enlarged. Sixty-two illustrations. 12mo, pp. 423; cloth. Philadelphia: P. Blakiston, Son & Co. 1890.

A Hand-Book of Obstetrical Nursing for Nurses, Students, and Mothers, comprising the course of instruction in Obstetrical Nursing given to the pupils of the Training School for Nurses connected with the Woman's Hospital of Philadelphia. By Anna M. Fullerton, M. D., Demonstrator of Obstetrics in the Woman's Medical College of Pennsylvania. 12mo, pp. 214; cloth. Price, $1.25. Philadelphia: P. Blakiston, Son & Co. 1890.

The National Medical Dictionary, including English, French, German, Italian, and Latin Technical Terms used in Medicine and the Collateral Sciences, and a series of tables of useful data, by John S. Billings, A. M., M. D., LL. D., Edin. and Harv., D. C. L., Oxon., member of the National Academy of Sciences, Surgeon U. S. A., etc., with the collaboration W. O. Atwater, M. D., Frank Baker, M. D., S. M. Burnett, M. D., W. T. Councilman, M.

D., James M. Flint, M. D., J. A. Kidder, M. D., William Lee, M. D, R. Lorini, M. D., Washington Matthews, M. D., C. S. Minot, M. D., H. C. Yarrow, M. D. Vol. 1, A to J-Vol. 2, K to Z. Royal 8vo, 731 and 799 pp.; leather. Philadelphia: Lea Brothers & Co. 1890.

A Manual of Organic Materia Medica, being a guide to Materia Medica of the Vegetable and Animal Kingdoms, for the use of Students, Druggists, Pharmacists, and Physicians. By John M. Maisch, Ph. M., Phar. D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. Fourth edition. Two hundred and fifty-nine illustrations. 12mo; cloth. Price, $3.00. Philadelphia: Lea Brothers & Co. 1890.

A Guide to the Diseases of Children. By James Frederic Goodhart, M. D., F. R. C. P., Physician to Guy's Hospital, and Lecturer on Pathology in its Medical School. Rearranged, revised, and edited by Louis Starr, M. D, Clin

ical Professor of Diseases of Children in the Hospital of the University of Pennsylvania. Second American from the third English edition. 12mo, pp. 772; cloth. Price, $3. Philadelphia: P. Blakiston, Son & Co. 1890.

Spinal Concussion: Surgically considered as a Cause of Spinal Injury, and neurologically restricted to a certain symptom group, for which is suggested the designation Erichsen's Disease, as one form of the Traumatic Neuroses. By S. V. Clevenger, M. D., Consulting Physician in the Reese and Alexian Hospitals, late Pathologist County Insane Asylum, Chicago. 8vo, pp. 359; cloth, $2 50. Philadelphia and London: F. A. Davis, publisher. 1890.

Anesthetics, Ancient and Modern: Their Physiological Action, Therapeutical Use and Mode of Administration, together with a historical resumé of the introduction of modern anesthetics, nitrous oxide, ether, chloroform, and cocaine, and also an account of the more celebrated anesthetics in use from the earliest time to the discovery of nitrous oxide. By George Foy, F. R. Č. S., Fellow of the Royal Academy of Medicine in Ireland; Surgeon to the Whitworth Hospital, Drumcondra, etc. 12mo, 175 pp.; cloth. London: Bailliére, Tindall & Cox. 1889. Received through the courtesy of West, Johnston & Co., Richmond, Va.

THE London Medical Recorder states that methyl-benzo-sulphinic acid has sweetening properties many times superior to saccharin. Like it, too, the new drug has disinfectant properties.

Abstracts and Selections.

THE USE OF ANESTHETICS IN NATURAL LABOR.-Obstetric anesthesia is quite different from surgical anesthesia, the latter being indicated for all obstetrical operations. Obstetric anesthesia may be general or local. For the former are used ether, chloroform, chloral, and a variety of mixtures, including the bromide of ethyl and the protoxide of nitrogen. Chloral can hardly be considered as a general anesthetic in the same sense as ether and chloroform. An injection of three or four grams of chloral in solution given during the period of dilatation, and repeated perhaps in four or five hours, will often prove of the greatest benefit and comfort to the patient, regulating the pains, moderating the suffering of the patient, and abbreviating the duration of labor. In the latter part of labor chloral is less useful than chloroform, this substance being now almost universally used in parturition. When it is employed only in the first stage of anesthesia no particular influence is exerted upon the contractions. If it is pushed to the second stage, the contractions are retarded, but soon resume their normal rhythm. In the third stage of chloroform anesthesia the contractions are diminished or may cease altogether. This is a stage of danger, for not only the uterus but the heart and other muscular organs may be paralyzed. The fetus experiences very little of the effect of the chloroform. The author's experience is summed up in the following propositions:

1. Chloroform given in small do-es produces a condition of physical and moral calm in the patient.

2. If the inhalations are prolonged for a considerable time, the result will usually be an attenuation of the uterine pain. The perceptions of the patient become less keen and the uterine contractions are slower.

3. If the period of complete anesthesia is reached with analgesia there is surgical and not obstetrical anesthesia.

4. In some cases chloroform excites instead of calming, and in such cases its use should be discontinued.

5. In some cases chloroform has unquestionably diminished the retractability of the uterus, and has thus been the cause of more or less severe hemorrhage after labor.

6. Chloroform has no action upon the fetus. 7. Chloroform given during the period of expulsion has a less decided effect upon the contractions of the abdominal muscles and the resistance of the perineum than is gen

erally supposed. The sensation of pain at that period is not entirely abolished, the contractions are frequent, and Charpentier has failed to notice that which has been called by Campbell dissociation of the sensations of touch and pain.

Chloroform is especially indicated

1. In primiparæ who are nervous and excitable, and in whom the pain may even cause delirium; also in those with whom the labor is greatly prolonged, thus becoming a source of danger.

2. In all cases in which there is a spasm, contraction, or rigidity of the back of the neck or body of the uterus. Contra-indications are the absence of severe suffering, the existence of placenta previa, general prostration, disease of the circulatory or respiratory organs, cerebral disease, alcoholism, etc.

During the period of dilatation chloroform is most required, but only to the extent of obstetric anesthesia, as a rule. It sometimes gives rise to nausea, vomiting, headache, and various nervous troubles. Hemorrhage is not likely to result unless the anesthesia is profound. Chloroform can not cause convulsions; on the contrary, it is one of the best means for relieving them. It may also be useful in warding off puerperal mania from those patients in whom the intense pain of parturition might lead to such a result. Dutertre has found reports of forty cases of sudden death during labor attributable to chloroform, but of that number thirteen should be eliminated as irrelevant. Of the others, some had cardiac or pulmonary disease, some suffered from alcoholism, and in the others narcosis was too profound. A first condition in the use of chloroform is that it be chemically pure; death from respiratory syncope may follow the use of an impure article. Small quantities should be given, the patient being in the horizontal position, and there should be an interval between successive inhalations.

Subcutaneous injections of antipyrine, twenty-five centigrams at a dose, have been used in a number of cases to produce obstetric anesthesia. Chiari and Guéniot report good results from its use. Various mixtures have been suggested, in most of which ether, chloroform, or chloral is an element. Doléris has advised the local use of a five-per-cent solution of cocaine muriate to mitigate the pain of labor, but the author expresses his views upon the subject as follows:

1. Nothing can be applied to relieve the pain caused by the distension of the lower segment of the uterus, which causes the pain felt during the contractions.

2. Applications of cocaine may give relief if they reach the nerve endings of the supravaginal and infravaginal portions of the cervix and the nerves of the vagina. Thus the pain of dilatation may be modified.

3. For the pain produced by compression of the nerve trunks of the pelvis no local application will avail.

4. The pain in the vulva and vaginal mucous membrane during expulsion may be somewhat modified by local applications.

As to the value of hypnotism in parturition, it must have a limited range. Of thirteen cases in which it was tried, it was successful in only four, the patients all being of a hysterical temperament.--Charpentier, Bull. et mém. de la soc. obst. de Paris, 1889, N. Y. Med. Journal.

TYPHOID FEVER IN CHILDREN.-The treatment adopted in all my cases is limited to the attainment of two objects, viz., to keep the fever within the safety limit if possible, and to support the strength of the patient. As long as the temperature is kept under 103° F., little medication is used; if it went beyond this point, febrifuges were given p. r. n. Antifebrin and antipyrin are used to some extent, but my chief reliance has been on the cool sponging of the surface of the body with water at about 85° to 90° F. To the water a little bay rum or alcohol is added. The sponging process is repeated every second or third hour. In the very high temperatures, 105° F. and over, the antifebrin and antipyrin are very satisfactory in their action. Stimulants are used in all my cases, generally commencing at the beginning of the third week, and in some cases earlier. As is well known, their employment demands close watching, and they should not be given too early. Opiates and astringents are not used. Milk is the principal article of diet in every case, and, indeed, the only one for the first two weeks of the fever. To this is added the beef peptonoids, meat juice, and beaten egg from time to time, and gradually farinaceous foods.

In conclusion, I present the following points, which seem to be established from my cases:

1. Typhoid fever attacks young children only about one third or one fourth as often as it does adults.

2. As far as is known, it attacks boys. more frequently than girls.

3. The prognosis is better in young chil dren than in grown people, the percentage of deaths being from two to six in the hundred, while in the adult the death-rate is

from 8 to 20 per cent, according to the authority quoted, differing in different places and in epidemics. Murchison, of London, whose fever reports are probably the most extensive, gives the mortality in the London hospitals through a series of years. at 15.6 per cent. Hutchinson, quoted from Pepper's System of Medicine, gives the mortality at the Pennsylvania Hospital during a period of twenty years as 19.5 per cent. Liebermeister states the mortality at Basle through a long period to have been from 27.3 to 8.2 per cent, the difference being due to the treatment.

4. The treatment best adapted for typhoid fever in children is that which keeps the temperature within reasonable limits without attempting to force it down too far, and supports the strength of the patient until the disease has spent and the fever has left. Any procedure which has neither of these two objects in view is unnecessary and harmful, and it is far better not to treat the disease at all than to treat it too much. The more powerful depressants, aconite, veratrum viride, gelseminum, etc., are contraindicated. The ordinary diffusive stimulants, ammonia, nitrous ether, etc., and the usual heart tonics, quinine, digitalis, etc., are not needed, and therefore may do harm. The best febrifuge is the cool sponging with water at 85° to 90°, assisted, when the fever rises to 104°, by the antipyrin or phenacetine. Alcohol, in some of its various forms, is the best stimulant. Milk is the best diet. Dr. H. N. Read, Brooklyn Medical Journal.

HERNIA IN YOUNG CHILDREN.-The method of treatment for inguinal hernia which I have employed for the last two years is as follows: A skein of worsted is used, which, stretched out straight, should be twenty-two inches long. The threads should be tied across at intervals of about two or three inches, to keep them together. One end of the skein is placed over the abdominal rings and the folded worsted is passed horizontally across the abdomen over the line of the crest of the pelvis to the opposite side, around the hips, behind the pelvis, and over the hip on the side of the hernia. The end is then passed through the loop of the skein and will here form a knot, the bulging portion of which must be carefully adjusted so as to lie against the hernial opening, and being carried down to the upper part of the thigh it is then brought around the external side near to the great trochanter, and there tied or fastened with a safety pin. Mr. Pye recommends alloa yarn as being improved for

is

this purpose by washing. In the case of very young infants lambs' wool will be sufficiently firm. I have found Saxony good for the trusses, taking from a quarter to a half of an ordinary skein, according to the circumstances of the case, and applying it in the manner described. Several of the trusses should be kept on hand by the mother of the infant. They can be washed, and should of course be changed as often as necessary for purposes of cleanliness. In the case of double inguinal hernia mentioned above I used this dressing, applying it to each side. It was perfectly successful, and in spite of the fact that its use was necessary during warm weather on a child that was quite fle-hy, no considerable difficulty was experienced in preventing chafing. The child wore the dressing pretty steadily for about four months, and after that for a few days at a time when it had any cough or trouble which might cause a recurrence of the hernia. I have used it on several other

infants with equally good results.

In the case of two little girls, sisters, aged seven and nine years, in both of whom inguinal hernia had developed, this method of treatment was used with perfect success so far as the retention of the hernia was concerned.-New Orleans Medical and Surgical Journal.

AMMONIA AND CHLOROFORM IN CROUP.-As far back as 1853 I treated what we then called phagedenic croup by inhalation of chloroform vapor with vapor of ammonia. There had been an epidemic of croup in the village, and in three fatal cases I had found, on post mortem inquiry, separation of fibrine in the heart, and had assigned the cause of death to the resultant obstruction. I was led, thereupon, to administer ammonia very freely by the mouth in such cases in order to maintain the fluidity of the blood. In one case the patient was a child six years of age, who absolutely refused to swallow medicinal doses of ammonia. In the house in which he lived there had been a death of another child from the croup, and, as in this new case death seemed certain, I determined to administer the ammonia by inhalation in combination with chloroform. With very little trouble I produced a gentle narcotism with the combined vapors, and was then able to increase the quantity of ammonia considerably. I kept up the inhalation for fourteen hours, administering food by enemata. In brief, the patient began to breathe with comparative ease within an hour after the commencement of the inhala

tion. In the course of three hours he had a loose cough, with expectoration which was easily ejected, although there was continued sleep. The fever rapidly subsided, and when the vapors were finally withdrawn there was quick return of consciousness with complete sub-idence of the acute symptoms. The recovery was rapid and complete.

The chloroform was used in this instance in order to allow the ammonia vapor to be carried into the circulation by the lungs while the patient was asleep and under easy control. The fetid odor from the throat very soon subsided under the antiseptic action of the substances inhaled, the ulceration of the mucous surface was favorably influenced, and portions of croupous membrane free of all fetor were easily expectorated.

In later research I tested the antiseptic. power of ammonia vapor by the side of the vapors of other chemical bodies. I tried it by the side of the vapor of chloroform, and discovered the new fact that the vapor of chloroform is nearly as good an antiseptic as ammonia vapor itself. I used these two vapors, singly and combinedly, with pure oxygen, and found that in the presence of pure oxygen the antiseptic action was, in both cases, as perfect as in common atmospheric air.

Here are two agents, vapors of ammonia and chloroform, both capable of administration by inhalation, both antiseptic, and both readily combinable either with oxygen or common air. Ammonia is not only antiseptic, but is alkaline in its reaction, is a diffusible stimulant, and, in the blood, is a solvent. Chloroform is an antiseptic, a narcotic, and, as I have repeatedly demonstrated, an antipyretic. By the combination of the two vapors we secure, therefore, a remedy which neutralizes acidities, sustains the circulation, reduces pyrexia, holds the blood fluid, relieves pain, induces sleep, and resists decomposition.

I take an alcoolic solution of ammonia (830 alcohol saturated with ammonia) and mix it in equal parts with chloroform. When the solutions are mixed, any water which separates is removed by blotting-paper, and in this way a mixture of ammoniated chloroform is obtained ready for use. In administering this compound by inhalation of the vapor I put one to two fluid drams of it into a bottle with a leather inhaler armed with an expiratory valve.

From the first the ammonia vapor is deprived of much of its pungency by the presence of the chloroform, and, in time, as the