some slightly soluble salt of mercury being employed for the dressings.

(d) The tube must be of large size at first, and a tube of some sort must be kept in until the discharge is reduced to a very minute quantity.

If the abscess have burst into the lung, pleura, pericardium, peritoneum, or kidney, and the position of the abscess can be clearly determined, it must be opened without delay. If the position of an ab-cess be only suspected and the patient be losing ground, it is right to puncture the liver in the most likely situations, bearing in mind that, though usually quite harmeless, a slight amount of risk accompanies this very trival operation. This rule applies to cases in which the abscess has ruptured into any of the cavitie‹ euumerated above. If, on the other band. whether the abscess have ruptured or not, there are means of diagnosing the whereabouts of the matter, and the patient be not losing or even gaining ground, the surgeon should hold his hand for a time.

5. Hydatids of the upper and back part of the liver are to be treated upon the same lines; but in cases of this sort, and in those of subdiaphragmatic abscess, it must be remembered that the diaphragm may be pushed up to a very great height, thus closely simulating i trapleural suppuration.

6. Empyema, pericarditis, and peritonitis caused by rupture of a heptic abscess or bydatid must be promptly dealt with on general principles.-Maryland Med. Jour.

EXTIRPATION OF THE BLADDER AND TOTAL EXCISION OF THE VESICAL MUCOUS MEMBRANE. Brohl communicates (Wiener Med. Presse, Nos. 27 and 28, 1889) four cases in which Bardenheuer for the first time undertook the extirpation of the entire bladder in the living human subject. They are briefly as follows: (1) A man, fifty-seven years of age, had a swelling occupying the whole fundus of the bladder, and extending more to the right than to the left side. The bladder was removed. For ten days the wound looked well, and was rapidly granulating, but death from uremia occurred on the fourteenth day. (2) A girl, seven years of age, had primary vesical tuberculosis. The whole mucous membrane of the b'adder was excised. Healing was complete. She lived one and a half years, and died of a return of the disease in the peritoneum. (3) A man, sixty-four years of age, was found to have infiltration of the vesical mucous membrane, with little grayish-white nodules of pin-head size, and a large papil

lomatous swelling of the posterior wall of the bladder. The entire mucous surface and all that portion of the wall of the bladder containing the tumor was removed. There were several complications, but he recovered with a uri ary fistula. (4) A man, thirty years of age, had little tumors of the size of cherries studding his bladder wall, which had undergone cicatricial change in the vicinity of the ureters. Total excision of the mucous membrane was performed. Complete healing followed.-American Journal of Medical Science.

For

The

HEREDITARY CHOREA.-Suckling (quoted in Practitioner, November, 1889, from Birmingham Medical Review, September, 1889) reports a case of hereditary chorea in a previously healthy man, thirty-nine years old. three to four years he had continually suffered from jerking of the hands and feet, stumbling, and "sniffing due to a spasmodic action of the diaphragm. The shoulders were much affected, and the tongue and face slightly so. speech was not involved and the knee-jerk was normal. The mother of the patient died at fifty-six years, having been choreic for sixteen years, and finally, quite helpless and unable to feed herself. Suckling also saw one of the patient's sisters, aged thirty-eight years, who had had the disease for five years. The patient's youngest daughter, of about twelve years, was also affected by the disease.

The author describes the affection as distinctly hereditary, occuring chiefly in adults, and never skipping a generation. The movements can at first be directed by the will, but finally become quite involuntary, until the patient becomes bedridden and demented. The affection may remit or exacerbate, but never disappears.

THE NEW ANTISEPTIC ARTIFICIAL MEMBRANA TYMPANI.-During the past twelve months I have extensively employed in my aural practice the new antiseptic artificial membrane, with excellent results. In many cases of chronic middle-ear disease marked improvement has followed its insertion into the meatus, but the most striking successes have always occurred in patients laboring under perforation of the membrana tympani. I have tested the value of my artificial drumhead in 130 cases of this disease, and, with only five or six exceptions, the results were extremely satisfactory. I have found it sometimes useful in cases of accommodative loss from alterations in the contents of the tympanum, in which the eustachian tube was unobstructed and the naso-pharynx fairly healthy.

The immediate improvement in the hearingpower is often a matter of much satisfaction. The intensity of the sonorous vibration is at once increased, and sounds can be clearly defined which before appeared to be only confusion. The sensibility of the organ is magnified, and the sense of hearing is so much changed that the patient does not appear deaf during ordinary conversation. The hearing distance is remarkably increased, and, in place of earnest looks and strained attention, the countenance expresses both pleasure and repose. Several patients have informed me that, with the assistance of the artificial membrane, sounds had been rendered audible which they had lost for many years. Others, laboring under perforation, but without serious deafness, have used them as ear protectors with great comfort. In such cases the artificial drumhead forms a screen between the middle ear and external meatus, and acts as an efficient shield during exposure.

Sometimes good results can be obtained by simply adjusting the artificial membrane and replacing it as often as necessary. But, in a large majority of cases, perforation of the tympanic membrane is associated with chronic suppurative disease of the middle ear, so that other important remedial measures must be diligently practiced, and the ear must always be thoroughly deodorized before the introduction of the artificial drumhead. I always tell my patients that they may hope for progressive improvement, but that they must not expect to realize the full amount of relief until they have regularly carried out the local treatment and worn the membrane for two or three months.

During the last half-century a large number of artificial drumheads have been introduced by different surgeons, and probably all of them have been found more or less useful in suitable cases; but not one of these devices has obtained a wide and general adoption. The ordinary cotton pellet has been extensively recommended by aurists, but it is my experience that few patients can be induced to persevere with it, because it is so liable to get out of position, and requires so much dexterity in putting it in and taking it out of the meatus.

On the other hand, the new antiseptic artificial membrane presents many practical advantages:

1. It decidedly improves the hearing power for distance and conversation, and this appears to be due, at least in some measure, to its peculiar shape.

2. It is especially adapted for self-application, and can be easily placed in the right position and readily removed.

3. It is extremely light, and causes no sensation or irritation in the meatus by its presence. 4. It is serviceable as an efficient ear protector, and acts as a screen for maintaining the moisture of the exposed tympanic cavity.

5. It is manufactured in different sizes, to suit the varying capacity of the external ear, and when once placed in position it is not liable to displacement.

6. It is obtainable at a trifling cost, so that a new artificial membrane can be used as often as necessary. Dr. John Ward Cousins, American Journal of Medical Sciences.

BACTERIAL STUDIES ON THE INFLUENZA AND ITS COMPLICATING PNEUMONIA.-Dr. T. Mitchell Prudden, in an article on the present epidemic, in the New York Medical Record, February 15, 1890, says there are So many features which the disease called familiarly la grippe shares with the common and more completely studied acute infectious diseases that medical men have pretty generally agreed in classing it with these, in spite of its marked peculiarities and the wide variation in its manifestations. Furthermore, so much positive knowledge has been recently accumulated regarding the etiology of many of the acute infectious diseases that the assumption that the epidemic influenza is probably caused by some kind of micro-organism seems fairly justifiable on the ground of its clinical manifestations alone.

We have as yet no positive knowledge. whatsoever as to the exact nature of the assumed micro-organism. By the aid of the new technique for the study of micro organisms no investigations have yet been made on this subject whose results have been formulated and published.

Now it so happens that nearly all of the acute infectious diseases whose etiology has been satisfactorily established on a basis of actual observation and experiment have been proved to be caused by bacteria; that is to say, by micro-organisms which belong to a particular class or group.

There seems to be, both in the clinical manifestations and in the mode of spread of la grippe, much to suggest, not, indeed, that in its etiology it may be allied to malaria, but that it may stand related in its etiology to the better known acute infec tious diseases much as malaria does--that is, may be due to a micro-organism, but to one of an entirely different class. The plasmodium malariæ belongs not among the bacteria or their close allies at all, but among an entirely different group of living beings.

We might apparently have gone on trying to make something grow out of malarial blood upon our nutrient gelatine and agar, etc., indefinitely, if the constant presence of the disease with us had not permitted such morphological studies as have led to fairly definite notions as to its etiology, without recourse to the more subtle culture methods.

Whatever the truth of the matter may be concerning the assumed germ of epidemic influenza, it is evident that studies with the current bacteriological technique should not be neglected until they are proven to be useless, or some better method of observation is made known. For even negative results may throw a side light on this or closely allied problems.

The results of Dr. Prudden's studies may be summed up in a very few words. In two of the three cases of influenza associated with bronchitis a very large number of streptococcus pyogenes were found; this was the prevailing species. All the rest were scattering forms, commonly found in the sputum in bronchitis, most of them the ordinary aërial bacteria. In another case of bronchitis large numbers of the diploco cus pneumoniae of Fraenkel and Weichselbaum were found, associated with a few staphylococcus pyogenes aureus and several scattering forms.

In the secretion from the nose in one case with coryza were a few of the staphylococcus pyogenes aureus, while all the rest, which were not numerous, were scattering forms.

Pneumonia has been a frequent, and in many cases a serious complication in our recent epidemic. Dr. Prudden has examined by the culture methods the sputum from five cases suffering from a prolonged and irregular pneumonia immediately following the influenza attack, all hospital cases; also the irregularly hepatized lung from a fatal case of pneumonia following influenza, and six cases of pneumonia following influenza in all.

If now we sum up the whole series of Dr. Prudden's examinations, we find that in the secretions from seven cases of simple influenza no special new forms of bacteria were discovered which there is reason to believe have any thing to do with causing the disease. The only pathogenic species which were found were well-known pyogenic bacteria, staphylococcus pyogenes aureus, streptococcus pyogenes (in four of the cases), and the diplococcus pneumoniæ (in one of the cases). In the pneumonia following the

influenza (six cases) no special new forms of bacteria were found, but the same pyogenic forms (in five of the cases) and the diplococcus pneumonia (five cases).

Thus, while we gain no positive new light on the etiology of epidemic influenza in this series of examinations, we are able, from the results of the studies on the pneumonia which accompanies it, to establish the probability that the pneumonia, although apt to be irregular in its course and atypical in its morphology, is usually due to the same bac terial agency as is at work in the ordinary acute lobar pneumonia. How much this may be further complicated by the frequent presence of the pyogenic bacteria is a question which must be settled by further studies on the general relationship of these organisms to inflammations of the respiratory organs and to other mucous membranes.

It would seem, furthermore, that the relationship of the influenza to the pneumonia is that of a predisposing factor only-a conclusion, indeed, toward which clinical investigators have been already led by a different line of observations.

The phase of pneumonia which this epidemic has brought into prominence, is instructive in its relationship to the ordinary typical acute lobar pneumonia. It seems pretty well established that the diplococcus pneumoniæ of Fraenkei and Weichselbaum is the most common, if not the exclusive, primary etiological factor in acute lobal pneumonia, judging from its constant occurrence in the affected regions, from its pathogenic effects upon animals in experimental inocculation, and from its frequent occurrence in complicating lesions.

The very frequent occurrence of this micro-oganism in the saliva of healthy persons not only does not militate against its etioogical importance, but furnishes a most satisfactory rationale of the occurrence of the disease. For under ordinary conditions the diplococcus pneumonia appears to be quite harmless in the saliva. It is only when the suitable predisposing conditions-which we recognize in injuries, and in exposure to cold and wet, but which in many cases we do not understand at all-are fulfiled, that the growth of the germ in the lungs and its accompanying lesions can occur.

It would seem that the influenza, with its tendency to an involvement of the respiratory passages, furnishes, not indeed the common, but an analogous predisposing condition leading to an atypical pneumonia. This form of predisposition to pneumonia seems to be in many respects similar to that which

measles furnishes in children to the incursions of varying forms of pulmonary inflammation whose determining esiological factors have not yet been sufficiently studied.

It may be remarked, in conclusion, that to the negative results of these studies on the influenza only such importance should be attached as the small number of cases examined will justify. We simply learn that in these few cases the use of the culture methods and media commonly employed in the study of bacteria and allied forms of microorganisms has brought to light no living germs which there is reason to believe has any thing to do with causing the disease.

But this negative result should leave us entirely unprejudiced toward any other series of observations which, with more abundant material and a more refined or favorably applied technique. may promise a solution of the problem.-Med. and Surg. Reporter.

THE OPERATIVE TREATMENT OF ERYSIPELAS. The method of treating erysipelas devised by Dr. Kraske, and mod fied by Drs. Riedel and Lauenstein, has been employed with marked success in a large number of cases in Germany, and has lately been strongly recommended by Drs. Meyer and Seibert, of New York. It consists in surrounding the erysipelatous area with a broad zone of numerous fine incisions intersecting one another, similar to those made in vaccination, and sufficiently deep to draw blood. These incisions are made at a distance of one or two inches from the borders of the diseased parts in tissues yet healthy, strict antiseptic precautions being observed throughout the entire operation. A solution of corrosive sublimate 1-1,000 or 1-2,000 is then rubbed into the wound and a dressing of absorbent gauze and cotion applied with sufficient frequency to keep the parts moist with the antiseptic solution.

The object in locating the incisions in healthy tissues is to prevent their invasion by Fehleisen's microbe, which is present in the lymphatics of the diseased area. The scarification and subsequent disinfection of the healthy tissues tend to keep them in a thoroughly aseptic condition.

In a recent number of the New York Med ical Journal, Prof. Seibert reported three cases of erysipelas of unusual severity, occurring in children of debilitated constitution, in whom this method of treatment proved markedly successtul. Its beneficial effects were seen, not only in the arrest of the disease at the borders of the incision markings, but also in the prompt reduc

tion of temperature and the general improvement of the patient. Prof. Seibert operated without an anesthetic, and for the purpose of scarification employed a vaccination harrow, which is a sharp pointed metallic comb. He is positive that this method of treatment will cure every case of erysipelas, if employed in due season.

This statement of Prof. Seibert is corroborated by the testimony of Prof. Meyer, of this city, who, in a paper published in the Medicinische Monatschrift, lays down the dictum that it is the duty of the physician in every case of erysipelas of the extremities, or severe erysipelas of the face, to resort promptly to the knife, and not to place dependence upon symptomatic treatment. In an unusually severe instance of the disease reported by him, the erysipelas overstepped the limiting zone, and the scarifications had to be repeated, but the operation each time was promptly followed by a fall of temperature and a marked alleviation of the general symptoms.

In view of these recommendations by two such careful and competent observers, it would seem that this method of treating erysipelas should enjoy a greater popularity than heretofore, especially as it is based upon a rational conception of the disease, and as no other local treatment has been found equally effective.—International Jour. of Surgery.

TURPENTINE IN POST-PARTUM HEMORRHAGE. "For for a number years," writes a correspondent, "I have used spirits of turpentine in postpartum hemorrhage, and in every case with the best results. When the ordinary means, that is, friction over the uterus, irritation of the uterus by introduction of the fingers, cold hypodermic injection of ergotine, etc., failed, by saturating a piece of lint with the turpentine, and introducing it with my hand into the uterus and holding it against the walls, rapid contraction took place, and all hemorrhage instantly ceased. In one or two cases, when the patient was almost pulseless, it seemed to act as a stimulant. On no occasion did its action fail, nor did it cause the slightest inconvenience, except in one, when the side of the patient's thigh was slightly blistered by some that came in contact with it, but it gave very little annoyance. I consider it to be much quicker and safer in its action than any other remedy; it does not cause any injurous result, and besides it is much more easily applied. In country practice, getting hot water or using injections often entails loss of valuable time.Lancet.

Two doctors of Bogota, Castaneda and Borda by name, believe that they have made a discovery of prophylactic value in the management of yellow fever. They take as the basis of their study the hypothesis that the symptoms and lesions of zymotic disease are due not to the damage done the blood and tissues by the invasion of rapidly multiplying specific microbes, but to the deleterious effects of ptomaines or leucomaines (organic poisons formed during the process of microbian proliferation), and the fact, as recently demonstrated by MM. Charrin and Ruffer to the Paris Biological Society, that the introduction of the bacillus pyocyaneus into the system of rabbits does result in the formation of organic poisons which possess the property of producing the same physiological effects as the bacillus it-elf. Now the enterprising chemist has found these toxic alkaloids in the urine of rabbits suffering with the "pyocyanic disease," and believing that if the above is true of one zymotic affection it must be true of all, the able theorists conceived the brilliant idea that yellow fever might be induced in mild form (a la Jenner with cow-pox) by injecting the urine of the yellow fever subject into the circulation of those who

by geographical situation might be in danger of developing the disease. Observations were accordingly made by putting animals to the experimentum crucis with the urine, sterilized and non-sterilized, of yellow fever patients, and an opportunity to test the truth of the theory upon man was eagerly awaited. It came in due time.

"A young man, about to settle in Cúcuta-a place which, it seems, has very evil reputation as a perfect hotbed of yellow fever-requested that an attempt might be made to afford him protection by means of chemical vaccination.' Accordingly, 0.02 centigram (sic) of sterilized urine from a yellow fever patient dissolved in a gram of distilled water was injected into his deltoid; this was followed by thirst, insomnia, headache, conjunctival redness, dilatation of the pupils, pain in the arm and subsequently in the legs, some erythema about the puncture, but by no rise of temperature. On the third day the symptoms. had all disappeared. A second inoculation was performed with 0.05 centigram (sic) of the sterilized urine in 0.50 centigram of diluted spirits, the thigh being selected for the seat of puncture. This was followed by a marked rigor, pain in the head and limbs, fever, thirst, and delirium, with jaundice of the skin and conjunctivæ and albuminuria. In three days all had passed off.”

This was certainly a beautiful example of faith in the masters on the part of the young physician, or a more than commendable willingness to put life in jeopardy for the glory of science and the good of mankind; but only time and many like tests can give the theory any definite value.

If, however, experiment shall prove the correctness of the conclusion of these gentlenen, it will be allowed by all that they have made the greatest hygienic discovery of the ages, since, if the theory holds good with yellow fever, it is probably true of all other zymotic diseases. Now that the chemist can easily isolate the animal alkaloids from the urine, they may be presented to the physician in a chemically pure form, who will thus find the prevention of typhoid fever, measles, scarlet fever, malaria, id omne genus, reduced to the trifling