DIPHTHERIA.-Henoch (Münch. med. Wochenschr., October 22, 1889, 747) reports his experience in 192 cases of diphtheria, from which number he carefully excluded al doubtful cases and all instances of scarlatinal necrosis. Scarlatinal diphtheria he considers an affection entirely distinct from true diphtheria. There are certainly instances in which scarlatina and diphtheria are combined, but either the former has appeared in cases of diphtheria well underway or in the stage of decline, or the latter affection has developed in the later stages of scarlatina, certainly after the third or fourth day. Only in such cases of scarlatina does diphtheritic paralysis appear.

To distinguish diphtheria from angina lacunaris is often not possible until after continued observation. In some instances, indeed, it is impossible, namely, in those in which there occurs a deposition of fibrin in addition to the collection of pus in the depressions of the tonsils. In these cases the bacteriological examination would give certainty, if only we know more accurately the nature of the bacillus and of the pathological anatomy of the affection. Diphtheria can, indeed, only be recognized positively when all or several of the cardinal symptoms are united, such as bilateral distribution of the membrane in the throat, involvement of the soft palate, urula, etc., albuminuria, involvement of the nasal cavities; contagiousness. Swelling of the glands and fever appear in many simple anginas as well.

In 110 of the cases the membrane was confined to the pharynx; in 82 it spread to the larynx or still further down. In 12 of these latter tracheotomy was not performed on account of various contra-indications, while of the remaining 70 on whom the operation was done, 9 recovered, a percentage of 13. Many of the cases died of pneumonia, bronchitis, collapse, or heart failure, after the operation had apparently had a good result. Henoch attributes this low percentage of recoveries not to a severe form of the disease, but to the fact that more than half of the children were already suffering from different constitutional diseases, others were very poorly nourished, and many were quite young, while, in addition to these factors, the hygiene of the hospital was extremely bad. One great source of error in statistics is, that writers include in them the cases of true croup, and thus greatly increase the apparent number of recoveries. Henoch has seen 36 cases of croup, of which 24 (66 per cent) recovered after tracheotomy.

Of 110 cases of pharyngeal diphtheria, 32 died-a favorable percentage.

The degree of fever proves nothing as to the severity of diphtheria. The swelling of the glands usually undergoes resolution; it is seldom that suppuration takes place as in scarlatina.

The diphtheritic membrane is of prognostic significance. Membrane on the hard palate is an exceedingly unfavorable sign, while involvement of the cheeks, tongue, lips, genitals, and anus also makes the prognosis bad. On the other hand, the spread of the membrane to the nose is not especially unfavorable even in bad cases.

Diphtheritic nephritis appears from the third to the fifth day, and is characterized by tube casts, epithelium, and a few red blood-cells, in contradistinction to scarlatina, in which the number of blood-cells is large. The appearance of albumen not until a later period of the disease is very unusual, and can not be affirmed unless the presence of scarlatina or the persistence of an early albuminuria can be absolutely excluded. Henoch has seen this late nephritis but twice.

Edema is much rarer than in scarlatina; uremia is very exceptional; affection of the joints has come to his observation but once. A croupy cough and stridor form no indications whatever for tracheotomy. The author has tried various methods of treatment, and found them all useless in severe cases.American Jorunal of Medical Science.

THE INFLUENCE OF DILUTION ON THE ACTIVITY OF THE TUBERCULOUS POISON --Bollinger (Munch. med. Wochenschrift, 1889, No. 43, 731) communicates the results of the important experiments conducted in his laboratory by Gedhardt during the past two years. As it has been shown by Hirschberger that fifty-five per cent of all tubercular cows produces an infectious milk, the first step was to determine the infectiousness of the ordinary market milk. Samples obtained from ten different places of sale, and inoculated on as many guinea-pigs, gave entirely negative results. Inoculations were next made with milk taken directly from the healthy udders of tubercular cows after their slaughter, and diluted to different degrees. It was thus found in three cases that dilutions of 1-40, 1-50, and 1-100 respectively were required to destroy the vir ulence. Both these tests prove that the virulent milk of tubercular cows loses its infectiousness through a certain degree of dilution. The mixing of the diseased milk

with that of many healthy cows thus lessens the danger, as also does the dilution usually employed in preparing milk for infants. Milk coming from large establishments is always, therefore, to be preferred to that from a single cow.

A second series of experiments was made on the influence of dilution on the virulence of the sputum. The results showed that, as compared with milk, the sputum was excessively infectious, and that not even a dilution of 1-100,000 served to diminish its poisonousness, whether communicated subcutaneously, by inhalation, or by intra-peritoneal inoculation. On the other hand, 32 minims of the tubercular sputum in a dilution of 1-8 failed of any positive result when given with the food. A different specimens of sputum differ naturally in the number of bacilli contained, Gedhardt next made similar experiments with pure cultures of supposedly the same strength. The results showed that 16 minims of a dilution of 1-400,000 fully preserved its virulence, as did 8 minims of the same when inhaled. The general conclusions reached were that the greater the amount of the tubercular poison taken into the system the more rap idly is it spread throughout the body.

An attempt made to estimate the number of bacilli in the sputum showed that 16 minims contained about 810,000 to 960,000. According to this estimate, about 820 bacilli are required to set up a fatal tuberculosis in a guinea-pig.

The subcutaneous connective tissue, the peritoneum, and the lungs are especially and about equally predisposed to the reception and increase of bacilli, while the digestive tract is decidedly more resistant. The order of the organs attacked by artificial infection is abont as follows: lymphatic glands, spleen, lungs, liver, and, lastly, kidneys and genitals. The place where the disease first develops is, however, not always dependent on the port of entrance of the bacilli; for example, a pulmonary tuberculosis is not always to be attributed to an infection by inhalation.

The experiments also tend to prove the existence of an individual predisposition, since some guinea-pigs were unaffected by a stronger dilution than that which poisoned others.

It is certainly proved that a fluid may be virulent, although the few tubercle bacilli present may escape microscopic detection. Consequently the failure to discover bacilli in the sputum is not a proof of their absence, and inoculation would be a much more delicate test.—Ibid.

CHLORALAMIDE AS A HYPONOTIC.-Mr. Geo. P. Cope, in the Dublin Journal of Medical Science, for February, 1890, describes his experience with chloralamide, and says: "I think these cases demonstrate that chloralamide is undoubtedly a sleep producing agent, that the sleep created varies from five to eight hours, and appears to be sound and refreshing. A dose of 25 to 35 grains was sufficient to cause sleep in patients suffering from melancholia and chronic mania, but in cases of acute mania small doses had no effect, and sleep was not produced by less than from 40 to 50 grains. No recognized evil effects followed the continued use of this drug for eight days, and only one out of twenty-five persons under treatment with chloralamide was noticed to be suffering from gastric disturbances, viz., giddiness and sickness, with dry, brown tongue, which followed six hours after a draught, when no sleep ensued.

In comparison with other hypnotics, chloralamide, as it consists of a combination of chloral, somewhat resembles it in its action. Both induce sleep, lasting from five to eight hours, but they appear to possess little analgesic influence unless when they cause sleep. Unlike opium, they will not relieve pain. The time that elapses before sleep is produced varies from thirty minutes to an hour, and the sleep appears to be natural and refreshing. Its action on the circulation is stated to be quite the opposite of that of chloral hydrate, which acts directly upon the blood pressure, slowing the pulse and respiration, and producing poisonous effects, by direct action on the cardiac ganglia and respiratory center, causing paralysis of the heart and cessation of respiration. Chloralamide appears, as far as I have been able to ascertain, to be free from such danger. In five cases-one of pneumonia, one of phthisis, one of cardiac disease, and two of insomniaI obtained sphygmographic tracings before and after its administration, and the blood pressure was not lowered in any of them, while the respiration and temperature remained the same. Dr. Daniel Leech (British Medical Journal, November 2, 1889), writing about chloralamide, states that "it seems probable that the formamide ele. ment, containing as it does a substitute NH group, will stimulate the circulatory and respiratory centers in the medulla, thus tending to counteract the depressing influence of chloral on them." Reichmann noticed that with do-es ranging from 30 to 60 grains the blood pressure was not lowered.

Comparing chloralamide with sulphonal,

which has been extensively used in the Richmond District Lunatic Asylum, with very satisfactory results, for the last year and a half, I need not dwell upon the advantages of the latter as a hypnotic agent, because I have practically nothing to add to the observations made by Dr. Conolly Norman (ee Dublin Journal of Medical Science, January, 1889), and fully confirmed by further experience. Speaking of sulphonal, Dr. Norman states that "its disadvantages are, (1) that it is bulky and practically insoluble, therefore difficult to administer, and that, perhaps, owing to its insolubility, (2) it is slow in action," and its price is high. Chloralamide, on the contrary, is not bulky, is tolerably soluble, quick in action (thirty minutes to one hour), and is now cheaper than sulphonal has ever yet become.

On the whole, it seems that this new hypnotic is well worthy of a trial, having proved so far safe and reliable.--Medical and Surgical Reporter.

THE VALUE OF THE PHENYLHYDRACIN TEST FOR SUGAR.-Jo-ef Geyer (Wien, med. Presse, 1889, No. 43, 1686) says that the use of phenylhydracin as a test for sugar was first proposed by F scher, and has been warmly recommended by Von Jaksch, who considers it very reliable for even the smallest quantities of sugar. Rosenfeld, too, has recently examined the reaction and estimates it as the most delicate and reliable. This would make the substance most valuable in the recognition of sugar, since existing methods reveal small quantities of it with difficulty. It is, therefore, very important to determine absolutely whether there is any allied substance which could produce a combination with phenylhydracin resembling phenylglycosazon. Thierfelder has already shown that hydro-chlorate of phenylhydracin and the potassium salt of glycuronic acid will produce a compound, when treated according to Fischer's method, which resembles and has the same charac

teristics as phenylglycosazon, and can easily be confounded with it. Now, glycuronic acid occurs in the urine, and it is probable, as Flückiger has shown, that some one of its combinations helps to make up the reducing substance found in normal urine.

In order to elucidate the matter, Geyer has studied carefully the relations of gly. curonic acid to phenylhydracin, in order to discover whether they actually formed a compound resembling phenylglucosazon. He prepared glycuronic acid by a method

which he describes in detail, and found that it deviated the plane of polarized light to the right-though its compounds deviated it to the left-and reduced copper on heating in alkaline solution, both of which effects are accomplished by sugar also. The reduction of the copper by the acid, however, differed from that by the sugar in that it occurred only after prolonged boiling, and often not until cooling had taken place. Glycuronic acid or its soda salt, treated with phenylhydracin after the manner of Jaksch, gave yellow crystals so resembling in appearance and solubility those of phenylgluco-azon that no difference could be detected. To apply these facts to the examination of urine, the author examined a series of specimens obtained from cases in which the phenylhydracin test had given a possitive re-ult, yet in which he thought sugar was absent. In order to determine positively whether sugar was present, he found that the examination by fermentation and by the polariscope were the only reliable methods. As these tests, however, are only delicate to 0.1 per cent of sugar, it was first necessary to isolate and concentrate it, which he accomplished by the Abéles-Ludwig lead method. Fourteen cases were thoroughly examined, and though all of them contained a substance resembling phenylglucosazon, and gave a positive reaction with Trommers' test, only four responded to the fermentation test, and with the polariscope deviated light to the right. He concludes, therefore, that phenylhydracin is not a reliable test for sugar, and can give positive results with normal urine, and that termentation and polarized light are the only accurate means at our disposal.-American Journal of Medical Science.

THE ANTISEPSIS OF THE RENAL PASSAGES BY THE INTERNAL USE OF SALOL.-In the intestinal tube, says the Therapeutic Gazette, February 15, 1890, as a con-equence of the action of the pancreatic juice, salol splits up into carbolic and salicylic acids, which are then eliminated by the kidneys, carbolic acid without being changed, salicylic acid after combining with sodium. Investigations by Nencki, Sahli, and Lépine have proved the truth of this statement beyond contradiction, and these writers have, as a consequence, recommended its internal use in "internal disinfection" in cholera, typhoid fever, and bacterial diseases. Dr. Dreyfuss (Wiener Medizinische Blätter, December 19, 1889), bearing these facts in mind, has recommended its use internally as a means of inducing the passage of an antiseptic

fluid through the kidneys, ureters, bladder, and urethra; and claims that it acts in a much more intensive manner and covers a wider field than can be accomplished through an injection of antiseptic fluid. Sahli further has shown that the urine of patients who have taken salol internally is aseptic, and that salol in large doses is well borne and never produces toxic symptoms. It is, therefore, quite as suitable for producing antisepsis in the urinary passages as naphthol is for the anti-epsis of the intestinal tract. Dreyfuss has employed salol, either alone or in composition with various balsamics, in blennorrhea, the full dose varying from 75 to 120 grains. Even in acute cases, treated at the very outset, this mode of treatment rapidly diminished the secretion, and in some few cases arrested it within a few days. Its effects are especially marked in combination with the use of cubebs or copaiba.

Finally, Dreyfuss recommends this use of salol in operations upon the urinary organs, for in this way the urine is kept aseptic, and one source of danger is thus avoided.

RUPTURED TUBAL PREGNANCY. - Sutton (Lancet, November 16, 1889) reports a case in which cessation of menstruation, collapse, and swelling of the ab tomen had been symptoms. Examination revealed the u erus empty, ill-defined swelling in both iliac fo-sæ extending to the costal cartilages on the right side; there was slight elevation of temperature. Laparotomy disclosed a putrid blood-clot extending from the pelvis to the liver; free bleeding from the right broad ligament. The ligament was transfixed, the right tube and ovary removed, the abdomen irrigated, and a glass tube inserted for three days; recovery followed. The ovary contained a corpus luteum of pregnancy, and a rounded mass removed contained an apoplectic ovum with a fetus of eight weeks. Sutton believes that the sudden enlargement of an apopletic ovum frequent y ruptures a tube; no extra-peritoneal hematocele should be attributed to ruptured tubal pregnancy, however, unless membranes, a fetus, or both are present. He also reported an abdominal section at which a hematocele, encysted in the great omentum, was removed with the tube and Ovary. Rapture had occurred an inch from the abdominal end of the tube; an apoplectic ovum lay in the hematocele, as large as a chestnut. The patient recovered.

In discussion (Royal Medical and Chirurgical Society), Priestley thought that cases of pure hematocele generally occurred, and should be let alone unless suppuration occur

red. Intra-peritoneal rupture required operation. When in doubt he would not operate.

Ducan had recently seen in a year twelve cases with clinical signs of tubal pregnancy which recovered without operation. He had seen a case recover from marked collap-e, and eight months after a dead fetus was removed from the abdomen. Hematocele was no proof of tubal pregnancy.

Herman considered an apoplectic ovum one which had slight bleeding into the chorion.

Cullingworth had seen many hematoceles; in two he found by palpation a large tube. Abdominal section revealed no rupture, but in one hemato-salpinx, in the other ruptured varicose vein. He would operate only when a large tube could be detected and the cause of hematocele still remained.

Walter report d a case of large intra-peritoneal clot reaching nearly to the umbiliCus. When tapped, one and a half pints of fluid escaped. A clot as large as a fist was in the bottom of the cyst; the clot was lined with chorion, in which the viscera of a six weeks' fetus were found; it was an apoplectic ovum.

In conclusion, Sutton believed that in apoplectic ovum the effusion occurred into the decidua before the placental circulation was formed. Amniotic hemorrhage was not necessary to diagnosticate apopletic ovum. The conditions were analogous to cerebral apoplexy. The ovum from the uterus contained a cavity with a fetus or cord; the ovum from a tube showed a compressed amniotic cavity. Hemorrhage generally occurred into the decidua before the ovum left the tube.-American Jour. of Med. Science.

THE SYMPTOMS OF DISEASE OF THE PANCREAS.--Considerable interest has been excited in the subject of diseases and injuries of the the pancreas by the contributions of Senn and of Fitz in this country, and by those of Lancereaux, Minkowski, and Von Mering, and others of Europe. The pancreas is an organ which is rarely subject to organic disease, or to injury; nevertheless, it is not entirely free from ills, and. it is likely that minor and functional disorders are not so very rare.

In a recent review of this subject by M. F. de Grandmaison (Gazette des Hôpitaux, January 4, 1890), the following diseases are said to affect the pancreas: Acute and chronic pancreatitis, abscess, lithiasis, apoplexies, and tumors, including cysts. To this may be added lipomatosis, degenera

tive atrophies, disorder secondary to compression, and functional affections.

Of these somewhat numerous affections, it is only chronic pancreatitis, lithiasis, tumors, and perhaps functional or secondary disorders from compression that can be at present recognized. All the acute disorders, except perhaps abscess, are practically unrecognizable. The cardinal symptoms of pancreatic disease are stearrhea, glycosuria, phenomena of compression, and rapid emaciation.

The stearrhea was first noted as a symptom of impaired function of the pancreas by Cl. Bernard, who produced it by expeiments on animals. It has also been noted clinically by Kuntzmann, Bright, Unckel, Ancelet, and others. Sometimes there is associated with it fatty vomiting. The fatty stools persist even when fat has been withdrawn from the food. However, stearrhea may be absent in severe pancreatic disease, and it is not by any means a pathognomonic sign.

Glycosuria has been produced experimentally in animals by destruction or injury of the pancreas, and according to Lancereaux and his pupil Lapierre, it may be an evidence of pancreatic disease. M. Lancereaux, indeed, asserts that there are three forms of diabetes, viz: (1) The nervous, (2) that occurring in the obese, and (3) the emaciative form, the latter being due to chronic pancreatitis or pancreatic lithiasis.

The nervous form, of diabetes results from emotional shocks, traumatism, combined with lithemic states, and it is usually temporary. It is, in fact, a glycosuria of symptomatic character only. The diabetes of the obese is the more common form; it comes on slowly and progresses slowly.

The diabetes with emaciation comes on suddenly, the patients rapidly lose weight, the amount of sugar in the urine is large (50 to 85 grams daily), and the duration of the disease is not long, the patients dying usually of tuberculosis. The skin is rough and dry, but the boils and carbuncles which occur in the diabetes of the fat are not observed here.

The symptoms of pancreatic disease due to compression are chiefly those resulting from compression of the bile duct. The gall-bladder is distended, the liver remaining of normal size, and icterus gradually develops.

The general symptoms in organic pancreatic disease are those of cachexia and great emaciation. Often there is epigastric pain and intestinal dyspepsia, with much flatulence and loose stools.

As for the special significance of the above symptoms we are still much in the dark. Stearrhea, we are told, is rare in pancreatic lithiasis, but more common in primary cancer of the head of the pancreas.

Diabetes with rapid emaciation, if indica tive of any pancreatic disease, points rather to lithiasis and secondary pancreatic inflammation and degeneration.-Medical Record.

SURGICAL ASPECTS OF HEPATIC ABSCESS.Text-books affirm that hepatic abscess is a rare affection in this latitude; experience, however, has taught surgeons that this is not strictly true; and abscess of the liver, being a more common affection than might be supposed, is often passed over unrecognized. It is well to bear in mind that the thoracic parietes close around a large part of the abdomiinal organs, and Rickman J. Godlee, M. S., F. R. C. P. (British Medical Journal, January 11, 18, 25, 1890), calls attention to the signs of hepatic abscess which many clinicians are apt to refer to disease of organs above the diaphragm. After some preliminary remaaks and discussing multiple pyemic abscess, pylephletis, suppuration and tropical abscess, with a report of twenty-four cases, with remarks on each case, he closes with the following summary:

1. Pyemic abscesses do not call for surgical interference, or if in rare cases one should point, it is only opened to relieve symptoms, but without hope of doing permanent good.

2. The same observations apply to abscesses resulting from suppurative phlebitis of the portal vein.

3. Multiple abscesses associated with dysentery or ulceration of the bowels are very unfavorable for surgical treatment. They must, however, be opened and treated on the same lines as the single or tropical abscess, because they can not be certainly diagnosed.

4. Single abscess of the liver, whether tropical or not, must, if it approach the surface, be opened, the following precautions being adopted:

(a) If it present at the epigastrium, the presence of adhesions must be ascertained before incising the liver.

(b) If through the chest wall, a spot must be chosen below the normal limit of the pleura; but, if by chance either pleura or peritoneum be opened, the opening must be closed with a double row of stitches before incising the liver.

(c) Strict antiseptic precautions must be throughout adopted, either carbolic acid or