After making an ineffectual attempt to reduce it by taxis, I sent him into the Malvern Rural Hospital. After his arrival there the symp. toms subsided to a great extent, there had been no return of the sickness, and the pain had almost disappeared. After holding a consultation with Drs. Dawson and Holbeche, and making another effort to reduce by taxis, I decided to operate at once without waiting for further or more urgent symptoms. The operation was performed under the influence of chloroform. On opening the sac a little bloodstained serum escaped, and the intestine was seen to be considerably congested; the stricture was very tight, but after incision allowed the intestine to be returned. A catgut drain was inserted, and the wound closed with three silk sutures. The symptoms subsided immediately after the operation, but there was no action of the bowels till the third day, when an enema was given. The wound healed by first intention, and the sutures were removed on the fourth day, the catgut drain having been removed the morning after the operation. The patient was discharged after having had a special truss made to cover both the inguinal and femoral rings.

The remarkable features of this case are, firstly, the occurrence of an inguinal and femoral hernia, on the same side, both being strangulated; and, secondly, the subsidence of the acute symptoms in spite of a very tight strangulation, showing that symptoms can not be depended upon as a guide to operation, and emphasizing the rule that, other means having failed, the sooner the operation is performed the better.-Dr. G. Tyrrell, London Lancet.

NEURASTHENIA AND DILATATION OF THE STOMACH.-Carron de la Carrière has published in the Bulletins et Memoires de la Société de Médecine Pratique an article of considerable interest on the subject of Neurasthenia and Dilatation of the Stomach. He describes an aggregate of symptoms often associated with dilatation of the stomach, symptoms which have been sufficiently familiar under the name of nervous dyspepsia. There is a sensation of weight and distension of the stomach after meals; this is accompanied by flushing of the face, and a tendency to somnolence. These patients are apathetic, and seldom in trim for mental work; they are incapacitated for much physical exertion. Constipation is habitual. In bad cases the appetite is diminished or lost; digestion is painful and accompanied with pyrosis; and palpation and succussion give the characteristic signs of gastrectasia. Fatigue is a prominent symptom; exercise speedily tires. The eyes ache

after reading a few minutes; there is a continual disposition to lie down; such patients. are often more tired in the morning on rising than when they went to bed. They complain much of insomnia. Headache and backache are every-day phenomena. The extremities are cold and livid.

Carron hesitates amid the complexity of symptoms, and asks whether in these cases, which are only too frequent, the gastric alteration is primary, reacting on the organism, and bringing about in the long run, by failure of nutrition, the general dilapidation and the want of equilibrium in the nervous system, or whether one has to do with a primary neurasthenic condition in which the gastric phenomena predominate? He inclines to the opinion that there are two classes of cases: one in which the stomach is primarily affected, entailing on the organism pertubations; the other, in which neurasthenia commences and the affection of the stomach completes the tableau."

the

Of course, the treatment would be widely different in the two classes, and an accurate diagnosis is imperative in order that successful therapeutic results may be obtained.

Dujardin-Beaumetz makes gastric neurasthenia the subject of a recent Cochin hospital lecture, and of a subsequent communication to the Society of Practical Medicine. He believes that in the great majority of cases neurasthenia is of gastric origin, and that patients affected with this malady will be found to have all the symptoms of dilatation of the stomach. He insists on the emaciated appearance of these subjects, their bilious hue, their melancholic disposition, the odd, varying, nervous symptoms, which are not, however, those of hysteria; palpation gives a splashing sound; sometimes the liver is congested, and, when the dilatation is considerable, in most cases there is a rightsided renal ectopia. These persons are always dyspetic and constipated. He mentions the various theories which have been proposed to explain the relationship between the neura-thenia and the gastrectasia, and inclines to that of Bouchard.

According to Bouchard, all the train of morbid phenomena depend on the penetration of the economy by toxines, which result from vicious fermentations taking place in the dilated stomach. These toxines produce a veritable systemie poisoning, and the passage of these organic alkaloids through the liver congests that organ, and gives rise consecutively to a crowding down of the right kidney, a displacement which tends to become permanent.

Beaumetz thinks that the dilatation of the stomach, which causes the nervous phenomena, will. in almost all cases, be found to be a hereditary malady; it results directly from a toueless, paretic state of the gastric muscle; subjects of gastrectasis will be likely to transmit a similar condition to their offspring.

In the treatment of gastric neurasthenia two leading indications must be kept in view, to restore the stomach and intestine to a normal condition, and to remedy the depressed nervous state.

The first indication is the most important to fulfill. It comprehends all pharmaceutical and other means for combating the development of toxines in the digestive tube, and for restoring tone to the alimentary canal. Among the pharmaceutical agents, the antiseptics, naphthol, salicylate of bismuth, etc., are especially useful. DujardinBeaumetz combines five grains of salicylate of bismuth with the same quantity of magnesia and bicarbonate of soda for one powder, to be given shortly before meals. Five grains of naphthol may be added to each powder.

Laxatives occupy an important place in the therapeutics of this malady; podophyllin, cascara, senna, sulphur, the purgative mineral waters are all recommended; the compound licorice powder is a useful preparation.

When the dilatation is considerable, lavage of the stomach by means of the siphon is indicated; putrescent matters are washed out, and the stomach is disinfected by boric acid solutions (1 per cent) or naphthol a, 1 per 1,000.

The dietetic treatment of gastrectasis comprises three indications: to reduce to the minimum the quality of liquid ingested; to introduce food into the stomach only when that organ is freed from the remains of a former meal; to introduce the smallest possible quantity of ptomaines with the food. The first indication is fulfilled by a dry diet; only half a pint of liquid with each meal; no drink between meals. Soups, broths, milk, champagne, etc., strictly forbidden. To meet the second indication, only two meals a day are allowed, the one at 10:30 A. M., the other at 7 P. M. No lunches. To meet the third indication, the diet should be mostly vegetable. Little or no meat; all meats to be thoroughly cooked. Toasted bread instead of plain bread, wellcooked vegetables, and fruit are permissible; eggs are unobjectionable.

To combat the neurasthenia, various me

HYPOCHONDRIASIS.-Professor Mendel, in a lecture before the Association of Physicians at Berlin, defines hypochondria as a functional disease of the brain, the essential symptoms of which are fear and anxiety about the patient's own state of health. This disease appears, according to Professor Mendel, in three different forms. The simplest of these forms, for which the lecturer proposes the name of nosophobia, is when the patient considers himself seriously ill or near death. The second form shows not only the same fear and anxiety, but also various organic hallucinations. The internal organs have probably, like the extremities, a center in the cortex, and any irritation of this center will usually produce a special class of sensations, which in this case become hallucinations. The third form shows, in addition to all the foregoing symptoms, hallucinations of the higher senses. Patients believe their hearing and sight are getting worse; they also sometimes hear voices, as it were, within the head. The affection is, according to the course it takes, divided into acute, subacute, and chronic or constitutional hypochondria. Contrary to the general belief, it is very frequent among females of every age. Nosophobia is certainly much more frequent in man, probably because women act as nurses, and consequently have no fear of infection. The second form is very frequent among women, and is generally connected with the sexual organs. These patients generally come under the care of the neurologist only after having become much worse through unsuccessful gynecological treatment. The so-called cerebral form is most frequent. Patients say that their head feels as if it were in a vice, or that it is soft, empty, or too light, and that the spinal column can not support it. They are consequently in fear of apoplexy or insanity. The third form appears chiefly among women. Patients fancy themselves altered; when standing before a looking-glass they believe their faces to be wrinkled, etc. They fear that their means will become insufficient to live upon, that they will lose their place, and they suffer

from claustrophobia. Hypochondriacs are characteristically egotistic. This symptom is more prominent in womeu than in men. One woman kept her bed for twenty-five years without any disease, and committed suicide in bed. Generally, however, suicide is rarer in hypocondriacal women than in men. Sleep is usually good. Paresthesia and hyperesthesia are frequent, as are also cold feet, while the head is warm. Professor Mendel has frequently discovered a spot on the head of such patients which felt hotter to the hand than the rest of the head. In complications of hypochondriasis with other affections (hypochondria cum materiâ), Dr. Mendel teaches that the latter are the cause of the neurosis. Especially important is the complication with hysteria, which is generally the primary affection-London Lancet.

A CASE OF DIABETES BENEFITED BY PHOSPHORUS. As new therapeutical results are probably more often the result of chance than of design on the part of the investigator, I may perhaps be held excused in communicating to you what, so far as I know, is a new and somewhat important therapeutical fact; but which, whatever it may be worth, is as certainly not the result of any premeditated design on my part.

A man, aged sixty, was brought to me on October 9th by Dr. Williams Jones, of Manchester, who wished my advice as to his patient, who for a long time had been affected somewhat severely with eczema of his face, neck, and upper limbs, including his hands. Dr. Jones had previously consulted two or three other practitioners as to his patient's condition, and informed me that his patient, who had become much worn out from want of sleep, was now willing to do whatever might be required of him. Dr. Jones also informed me that his patient had long been affected with diabetes, for which he had treated him.

To

I suggested to Dr. Jones that, in addition to the local remedies which we agreed on, the patient should take phosphorus "perles" for the improvement of the eczema. this Dr. Jones saw no objection. I accord ingly proposed to him that the patient should take one "perle" three times a day for three days, and that, should no nausea result from their use by the end of that time, the dose should then be increased to two "perles" three times a day. Owing to some difficulty in obtaining the "perles," the patient did not commence taking them until November 1st, and after the expiration of three days Dr. Jones put his patient on the double dose.

On November 11th the patient visited me

at Dr. Jones' request, and certainly as to his eczema he is nearly quite well, and he tells me that he now enjoys sound sleep at night. This much I was quite prepared to hear. But I was a little astonished when he informed me that these were by no means the only benefits that he had derived. He was also greatly better of his diabetes, very suddenly and very markedly so. He says that for the last four or five days he has been far better in this latter respect than he has been for many months. He had been used to being obliged to get out of bed four or five times in the night to pass water; but, for the last four or five days, he had not had any call of the kind at night. The quantity that he passed in the twenty-four hours had for long been a very considerable quantity, but it had suddenly diminished in amount very notably. The urine has until quite recently been very pale in color, but now it presents a fairly natural degree of color. He suffered from constant thirst, which he was compelled to assuage frequently. He is now no longer troubled with thirst. He traveled this time from Manchester to London without wanting any thing to drink on the journey, and required to get out at Bedford only to pass water. He assured me that his first journey to me was by no means so free of incidents either as to incomings or outgoings of liquid. He stated that he felt now very much better in health altogether. I requested him to pass water just before he left, but he felt so little inclination that he doubted whether he could. However, he passed about six fluid ounces.

Although I had no reason to doubt Dr. Jones' diagnosis, I thought I would, before writing this note, obtain independent confirmation of the fact that the patient's complaint was beyond doubt diabetes. I accordingly asked my neighbor, Dr. Goodhart, to examine the urine for me. Dr. Goodhart, after remarking that the color of the urine was somewhat exceptionally good for a diabetic, found that its specific gravity was 1032, and that it contained plenty of sugar and no albumen. He has kindly permitted me to use his name for the purposes of this note so far as concerns these facts respecting the quality of the specimen of urine that I submitted to him.

The quantity of phosphorus that the patient took may be estimated from the basis that each of the "perles" contained one thirtieth of a grain of phosphorus dissolved in oil. So that, for the first three days of his phosphorus treatment, he took a tenth of a grain a day, and for the remaining seven.

days he took a fifth of a grain daily. From such experience as I have in the administration of phosphorus internally, I should be disposed to say that he was fairly under the influence of phosphorus; moreover, he has just begun to experience a slight but decided degree of nausea from its use.

In what manner the phosphorus has acted in controlling the diabetes, as it seems to me it unquestionably has acted, I am not prepared to offer any kind of opinion. That the

may exist in the uterine vessels in preg nancy would raise the general blood-pressure, Dr. Heinricius first performed the very simple experiment of tying the aorta just above its division into the iliacs, and found that in four rabbits no change took place in the arterial tension of the carotids. Hence no effect was to be expected from ligature of the uterine arteries, nor from any such obstruction as might proceed from their distribution in the pregnant uterus and in the placenta. He next proceeded to ascertain

liver most decidedly is well known, because, in undue and over-prolonged doses, phosphorus is capable of producing fatty degeneration of the liver. This circumstance would seem to afford the clue to its marked action in this case in controlling diabetes, but I am not prepared to assert that this is the correct explanation. It is possible that the effect of the phosphorus may be due to its action on the nervous system.

In any case the circumstance seems to me well worthy of record in the columns of the Journal, because I venture to think that, when the question comes to be sifted by observers more competent than myself, it will be found that phosphorus exerts a very potent action in the control of diabetes.-Balmanno Squire, M. B., British Med. Jour.

Such

THE EFFECT OF DISTENSION OF THE ABDOMEN ON CIRCULATION AND RESPIRATION.-The effects of pregnancy, ovarian dropsy, ascites, and other diseases leading to great distension of the abdomen, in impeding respiration and disturbing the action of the heart, though there is little unanimity or precision in the opinions that are entertained respecting them, are generally admitted. affections are, indeed, of a chronic nature; the abdominal walls have time to yield, and the organs both in the abdomen and in the chest are enabled to accommodate themselves to the altered conditions; but we are not aware that any experiments have been undertaken to determine the effects of sudden distension of the abdomen in animals until the appearance of a paper by Dr. G. Heinricius, of Helsingfors, in a recently published number of the Zeitschrift für Biologie. It is generally believed that in pregnancy there is marked increase in the tension of the systemic vessels, and that as a consequence the heart undergoes hypertrophy; but although such statements are to be found in almost every gynecological text-book, the evidence on which they rest is extremely slender. In order to determine whether any obstruction to the circulation which

the abdominal cavity in the rabbit and cat. He employed a double canula, which was introduced through or at the side of the linea alba by a small puncture in narcotized animals; one arm of the canula was connected with a vessel containing normal saline soIntion at the temperature of the blood, and the other with a manometer. Arrangements were further made to record graphically the respiration and the blood-pressure in the carotid. The respiratory and blood-pressure curves were taken after each 50 or 100 cubic centimeters of the solution had been injected into the abdomen from the vessel, and the phenomena which were presented proved to be remarkably uniform. In all the experiments, which numbered fifteen, it was found that the abdominal cavity could be filled with a large quantity of fluid, so that the parietes were quite tight, without either pulse or respiration being materially disturbed. It was only after very great distension had been produced that the respirations became more frequent and deeper, the expiratory effort being particularly well marked. This dyspnea was apparently attributable to the diaphragm being pressed upward and the capacity of the thorax correspondingly diminished, so that mechanical obstruction to respiration was occasioned. The effect of this was that the accessory respiratory muscles were brought more into play, and the breathing became more and more thoracic in character. But these ef forts soon became insufficient to compensate for the defective action of the diaphragm. The respiratory center became excited, but was soon paralyzed by the venous blood. The respirations underwent a change; they became first shallow and slow, then deeper; dyspnea finally occurred, and the animal died. If we turn now to the effects of the distension on the circulation, we find that when the distension became considerable the pulse at first increased in frequency, then became fuller, afterward less frequent, and before the death of the animal usually

suddenly smaller. The arterial blood-pressure first began to rise when the frequency of the pulse had considerably diminished, and then gradually fell as the pulse became smaller. Dr. Heinricius gives, in the article we have alluded to, numerous tracings which collectively show that the abdomen may undergo great distension without abrogation of the more important vital functions. The abdominal cavity of a rabbit can support in this way the introduction of 500 cubic cenmeters of fluid without difficulty, and nearly a liter and a half of fluid can be further injected before dangerous symptoms supervene, clearly showing how extraordinarily yielding the abdominal parietes are, and af fording a proof that it is not necessary to appeal to the slowness with which they are distended in pregnancy and in cases of abdominal tumor to explain the slight interference with the main functions of life that occurs in those conditions.-London Lancet.

THE NECESSITY FOR A HIGHER STANDARD OF ACCURACY FOR TOXIC AND NARCOTIC DRUGS.-Show us a physician or pharmacist who has not been many times puzzled by the variable action of toxic drugs, indicating lack of uniformity in preparation, and such an one will be found to have had no practice in either art. While the question of standardizing preparations of toxic drugs is not a new one, and has been the dream of every progressive pharmacist and physician, practically it would seem difficu't to determine just what standard of strength to adopt.

According to the Pharmacopeia, one cubic centimeter of a fluid extract represents one gram of the drug employed in making it. It is apparent that such a preparation, although made from the best quality of drug the market affords, will not be of invariable strength. In the purchase of this crude drug the quality must be largely judged by physical indications, which are often very deceptive. An estimation of the active medicinal ingredients is the only true criterion by which to judge the quality of a drug; and this is subject, even in carefully selected drugs, to a wide variation. Fluid extracts must, of course, share in this variability. It is this defect which is to be remedied.

That a pound of crude drug of good qual ity, properly manipulated, should produce a pound of fluid extract, seems a good basis for operations; but when the variability of crude drugs and the consequent variability of fluid extracts produced therefrom is known, one can not but look forward to the advent of the new pharmacopeia with the hope that

some uniform and more reliable method of standardizing fluid extracts upon some safer. and surer foundation, by which a preparation must be produced that can be used with more confidence in its definite therapeutic value, may be adopted. Individuals and manufacturing houses have, in a measure, recognized the necessity for such a standardization, and have in the past in various ways endeavored to meet the requirements of the medical profession in this respect.

The result has been that there are already standardized preparations on the market, but these vary greatly in the strength adopted as the standard. There should be one only, and for this the Committee of Revision of the Pharmacopeia for 1890 should prescribe the process. To do this intelligently they should avail themselves of the work that has already been done in this direction; and this brings us naturally to a discussion of this work.-Medicul Age.

THE ANTISEPTIC FUNCTION OF THE GASTRIC JUICE.-Professor Kast, the director of the new General Hospital, Hamburg, writes on this subject in a "Festschrift" on the occasion of the opening of the hospital. Spallanzani showed a hundred years ago that the gastric juice has an antiseptic influence, and it has since then been proved by N. Sieber, C. Schmidt, and others that this influence is due to the free hydrochloric acid which it contains. The investigations of Baumann have shown that in healthy subjects the aromatic bodies found in the urine are due exclusively to intestinal decomposition, their amount, as united with sulphuric acid, being in a direct relation with the amount of the products of decomposition in the intestines. In Professor Kast's experiments the exact relation of the ether sulphates to the other sulphates in the urine was ascertained by daily examinations, a uniform diet being given, and then copious alkalies were supplied in the food, so as to neutralize the gastric HCI; and the effect of this on the ether sulphates of the urine was examined. The conclusion is arrived at that the antiseptic function of the gastric HCI is its chief funetion, while its digestive function is a subordinate one. This is only true so far for the products of ordinary decomposition; the case is different with the pathogenic bacteria, many of which are highly resistant organisms. We have no means at present of estimating the amount of the chemical products due to the vitality of pathogenic organisms in the intestine. It is true that Brieger regards the diamines as due to pathogenic