bacteria. But the diamines are a direct product of such bacteria, not, like the aromatic bodies found in the urine, formed from a previous substratum due to bacterial activity. Moreover, we have no clear ideas on the transition of such diamines into the urine. Hence, at present we have only to fall back on the physiological action of pathogenic bacteria as an index of their exist ence. Baumann's and von Udransky's quantitative estimate of pentamethylene diamine (Brieger's "putrescin") in the urine, but originating in the intestine, constitutes the latest advance in this direction.-British Medical Journal.

PYOSALPINX AND LAPAROTOMY.-In some clinical remarks recently published by Dr. Richelot in La Semaine Médicale (and commented on by Mr. Verchère in La France Médicale, No. 124) the indications and contra-indications for laparotomy in pyosalpingitis are pointed out. These, he says, largely depend on the duration of the disease. A simple acute or subacute salpingitis may get well spontaneously or by simple means, while it is as much an abuse to remove an ovary simply because it is inflamed as it would be to castrate for orchitis. In his cases an interval of two years from the onset of symptoms is, ceteris paribus, allowed to elapse before removing organs which by that time would have become useless. Severity and constancy of pain, especially in laboring women, would perhaps justify interference. Of course, wherever the presence of pus can be found, surgical interference is called for, to obviate pelvic peritonitis and worse evils. The advice of some surgeons to wait for the spontaneous opening of the al scess is deprecated, and so is the proposition (in imitation of the usual course followed by nature in spontaneous cures) to operate through the vagina rather than directly through the peritoneum. London Lancet.

HERNIA AND DISEASE OF THE UPPER AIRPASSAGES.-Dr. W. Freudenthal read a paper on this subject at the meeting of the American Medical Association, at Newport, Rhode Island, last June. He stated that, of 500 subjects with abdominal hernia who had passed under his examination, 143 were subject to marked disease of the upp rairpassages that made surgical interference absolutely necessary. Among about 80 membrs of a family, also examined by Dr. Freudenthal, almost all had diseases of the upper air tract and one third had hernia. Where

nasal diseases are less frequent there also less herniæ are found. According to the frequency of diseases of the upper air-passages, hernia was found in 50 out of 1.000 conscripts in the United States, in 22.89 in France, in 16.61 in Italy, in 14.09 in AustroHungary, and in less than 14 out of 1.000 conscripts in the German Empire. Hard physical work, such as lifting weights and ascending mountains, never gave a predisposition to hernia. On the other hand, sedentary occupations and certain causes which predisposed men to post-nasal catarrh and other diseases of the upper air-tract decidedly, on that account, predisposed to hernia. In women hernia was rarer than in man, on account (according to Dr. Freudenthal) of the weaker stress used in pressing down the intra-abdominal contents during the act of hawking or clearing the throat.-British Medical Journal.

CODEIA IN GYNECOLOGICAL PRACTICE.-Dr. Freund, of Strasburg, who was induced by the favorable opinion of Professor Schröder on the suitability of codeia for the treatment of pain in diseases of the female genital organs to give it a trial, has published the results of his experience in the Therapeutische Monatsheft. He remarks that Dr. Lauder Brunton's testimony to the value of codeia in pain affecting the lower portion of the abdomen must be accepted in gynecological practice with considerable limitations. He found that pain originating in the uterus, and depending upon either acute or chronic affections of that organ or upon dysmenorrhea, was only affected in a very transitory way by codeia, and never to nearly the same extent as by opium or morphia. Extensive effusions, too, into the pelvic peritoneum or into the cellular tissue were but little improved by codeia, and the same might be said of diseases of the tube. On the other hand, however, he found that it exerted a true, unmistakable, and immediate effect upon pains of all sorts having their origin in the ovaries, whether there was displacement, prolapse, ovaritis, periovaritis, or the so-called "ovarian eualgia." In all these cases codeia, even in small doses, appeared capable of exercising a marked control over the pain, and in many cases of arresting it altogether. Of course, suitable local and dietetic treatment was applied simultaneously. As to the doses given, the usual plan was to order a pill containing half a grain of codeia, made up with gentian and liquorice, to be taken three times a day. Occasionally larger doses had

to be given. In no case, however, was any unpleasant effect observed, and there were no signs of any cumulative action, some of the patients taking these pills for a month. London Lancet.

ANGINA PECTORIS CAUSED BY COMPRESSION OF THE SYMPATHETIC NERVE.-From the majority of dissections, it has been found that the cause of angina pectoris is in all proba bility an irritation of one of the three nerves which assist in respiration: the phrenic, the vagus, and the sympathetic nerve; and, as a rule, the seat of the trouble is in the thorax. An exception to this rule was ob served in the following case, which is reported in the Deutsche Medizinal Zeitung for August 1st, by Dr. Humbert Mollière.

The patient, a man fifty-nine years old, who for ten years had been troubled with a cough, and two months before had had profuse diarrhea with pain in the abdomen, and was greatly emaciated. In conjunction with the cough, he was also troubled by frequent and long-continued attacks of angina pectoris of a most severe form. Upon physical examination he was found to be suffering from bronchial catarrh, but no abnor mal condition of the abdomen was found. For the next few days the attacks became much more frequent, and the patient rapidly lost strength, and finally succumbed while suffering from an acute attack of the angina, in spite of all that was done to relieve his sufferings.

At the autopsy it was found that the mesenteric and the prevertebral nerve ganglions had undergone cancerous degeneration, and that portion of the sympathetic nerve between the stomach and the pancreas was surrounded and compressed by a carcinomatous mass of lymphatic glands.

Emphysema was found in both lungs, as well as secondary carcinomatous nodules. The bronchial and pulmonary nerve ganglions were entirely intact, the ends of the vagus and phrenic nerves extended to the solar plexus. This last was compressed in such a way that it was undoubtedly from this cause that the angina had proceeded. It is most probable also that in an analogous manner an irritation of the ends of the sympathetic nerve, which are in the mucous membrane of the bowels, would also give rise to angina pectoris.-Medical and Surgical Reporter.

AN INTERESTING OPERATION.-A unique medical phenomenon, a native wing-membrane, which Professor Julius Wolff, of Ber

lin, has observed in a girl of nine, is being much discussed here at present. Between the thigh and the lower part of the child's left leg extends a peculiar formation, such as is found only between the upper and fore-arms of the wings of birds, and which Professor Wolff therefore calls "wing-membrane." Three of the fingers of the child's right hand are webbed together, and her right leg terminates in a club-foot of the most pronounced charácter. The "wingmembrane," which is eighteen centimeters long and two centimeters thick, and covered all over by normal skin, is a smooth continuation of the soft parts, and the knee-joint could never be stretched, but only bent to a right angle, so that the girl could only move about on her knees. Professor Wolff resolved to make it possible for her to walk erect by removing the club-foot and cutting the wing-membrane through. The first of these two operations succeeded easily, with the help of waterglass bandages; but the second proved very difficult, and had not the desired effect. year elapsed before the wound was healed and the possibility of stretching the kneejoint completely attained. The little girl is now able to walk erect without stick or crutch, and to go to school. Her gait is, of course, awkward, for the left leg is about twelve centimeters shorter than the right one. Professor Wolff's success is regarded as a decided triumph of surgical skill.London Lancet.

A

TREATMENT OF ASTHMA.-Within a recent period we have noticed in our exchanges many articles on the treatment of asthma. As to the remedies recommended for this disease, there is no end. With no intention of deprecating the value of several old and well-tried remedies, we shall only refer to agents which have recently forced themselves to the foreground. Of these, perhaps citrate of caffeine stands first. The dose is 1 to 5 grains dissolved in warm water. It does not appear to be a very dangerous agent, since, in one instance, a patient took 60 grains by mistake, without fatal consequences. feine is said to afford very prompt relief. Arsenic, in the form of 2 or 3 minims of Fowler's solution, is reported as making striking cures in appropriate cases. Arsenic has the peculiar property of supporting respiration, as, for example, in making ascents. Its beneficial effect in asthma is no doubt due to this property. Iodide of potassium is sometimes combined with Fowler's solution. A valuable combination in the bronchitic form is iodide of potassium and carbonate of ammonia. Chloral hydrate, either

Caf

alone or in combination with bromide of potassium, is also followed by excellent results in certain cases. Cocaine in doses of of a grain of the muriate, given in the form of tablets, has been very highly recommended for the relief of the spasm. In the form of stagnant respiration, with congested lips and nose, and cold extremities, strychnia has been found highly useful. The liquor may be given in doses of from 3 to 5 drops, with dilute phosphoric acid.

When defluction from the mucous surface is very profuse, belladonna probably answers best. Medium doses should be given every four hours. Grindelia robusta a short time ago was largely used, but failed to come up to expectations, and is now much less used. Quebracho is also a remedy in much repute. We occasionally meet cases of continued distress, despite the use of ordinary means. In these cases there is usually much bronchial tumefaction and dryness. In cases of this class nothing can equal grain of pilocarpine with grain of morphine, administered hypodermically. The relief is prompt, the tumefaction subsides and is followed by profuse expectoration. As to change of climate, experience shows that the asthmatic should not seek a dry atmosphere. A warm, moist atmosphere is the most suitable. In mild cases a mere change from one locality to another may create immunity from this harassing trouble.

The remedies here mentioned, which are culled from a large number of remedies in use, seem to be the ones most relied on at the pres ent time. It must not be understood that the remedies in this list are to be depended upon in symptomatic asthma, when the condition is merely a symptom of a disease usually of a much graver nature. The bronchial muscles are here in a normal condition, some probably serious organic trouble being the cause of the symptom, and requiring a separate treatment, as indicated by the pathological conditions.— The Canada Lancet.

INVOLUNTARY AUTO-INOCULATION OF GLANDERS.-A painful case was reported by the Vienna correspondent of the Daily News, on the 28th ult., of the death of a young physician, Dr. Hoffmann, from glanders, under the following circumstances. In August a man suffering from glanders was admitted into the General Hospital, and Dr. Rowalski studied the case bacteriologically, isolating the bacillus cultures, of which he gave to Dr. Hoffmann, who was skeptical as to the transmission of the disease by inoculation of the cultures. The latter's experiments made with the cultures, however, convinced him of their continued virulence.

In the beginning of October he took cold, and had severe pain in the side, for which he had recourse to morphia injection, using the same syringe he had employed in his experiments. The syringe had been heated to redness, and was thought to have been thus thoroughly disinfected; but that it must have retained some of the virus in an active state seemed to be proved by the melancholy sequel of the unfortunate physician becoming infected with glanders, from which he died. The account forwarded to the Daily News is circumstantial, although somewhat sensational. Assuming the facts to be as related, the moral of the case is obvious, showing the disastrous consequence of a thoughtless use of the same instrument as that employed for experimental inoculations and hypodermic medication. It demonstrates also the virulence of the glanders poison, and suggests the difficulties that may beset experimenters in ridding their instruments of all traces of the virus with which they deal.-London Lancet.

M. Fiat. pulv. Dis. in capsule No. X.

Sig: One capsule to be taken, in the intervals of the attacks, every two or three hours.

Phenacetin, he says, does not act so promptly when given alone. This treatment may be kept up until a decided remission occurs, and this does not have to be waited for long.-Wiener Med. Presse.

THE GUINEA - WORM IN EUROPE. The guinea-worm, or filaria medinensis, is not usually seen in northern Europe, but of course European travelers or natives of some Asiatic or African countries may bring it. A Brussels practitioner, Dr. Robinet, has recently had two patients suffering from this parasite among the members of a troupe of negroes from Accra, on the Guinea coast, who have been performing in Brussels this year. In both cases the worm was in the leg, and was removed in due time, after the cautious opening of the pustule which it produced, by the process of winding it very gently round a match.

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THE INFLUENZA.

Early in December the fact that the people of St. Petersburg were in the grip of the time-honored epidemic, acute catarrhal fever, was telegraphed over the world, since which time it may be said that the "Genius Epidemicus" has successfully divided the honors of the season with Santa Claus. The disease soon made itself felt in Vienna, then in Paris, later in Boston and New York, and now, if we can credit reports, some of the western cities are under the pandemic spell. If we read the signs of the times aright, the sternutatory influence will soon encircle the globe, and for a time it may be said that the sun never sets upon the sneezers.

To date there has been little in current medical literature relative to the coming plague. The daily papers have devoted liberal space to its discussion, but, as is usually the case, the articles have been sensational and of little scientific worth. But the disease has, in fact, a voluminous bibliography. Thus Zuelger, who devotes a classic article to the subject in Ziemssen's Cyclopedia of Practical Medicine, says that "the literature of influenza has reached such an extent that we must renounce the idea of presenting it in this place." Nevertheless he gives the titles.

and authors of nearly fifty articles. With one exception (a learned editorial in the British Medical Journal of December 7, 1889) the medical journals have made only brief references to the epidemic. It may, therefore, be well, in view of its near approach, to pass in review some of the practical points involved in the study and management of the disease, our source of information being as above mentioned.

(1) The disease is nothing new, it having been traced through a series of ninety epidemics. The first appeared in the year 1510, and the last in 1870. (2) Its names are old. The Italians call it influenza (something fluid, transient, or fashionable); the Germans, modefieber (fashionable fever), blitzkatarrh (lightning catarrh), schafs-husten (sheep-cough), etc., and the French, "la grippe," from agripper (to seize). (3) It is not properly called the "Russian influenza, since it is indigenous to no known part of the world. In Russia it is called the Chinese influenza, while in the Orient it has been accused of coming from still further east-the sea or the continent beyond. The first epidemic. described started at Malta and spread to the northwest over all Europe.

It does not always pursue a line of march. like other epidemics, but may be found simultaneously in two or more places in both hemispheres, with, of course, exactly opposite conditions of climate, temperature, etc. (4) It is no respecter of persons, nor is it subject to any known hygienic conditions. (5) Though generally a mild and manageable disease in the middle-aged and healthy, it is liable to develop serious lung and nervous complications; for example, pneumonia, cardiac weakness, adynamia, etc. Old persons and young children, the phthisical, the asthmatic, and those who have been weakened by any chronic disease are in great danger.

In the epidemic of 1580 the disease claimed nine thousand victims in Rome alone, and "Madrid must have been almost depopulated by it." To the doctors (blood-letting [?] was charged this great mortality. (Query: Was Dr. Sangrado alive and in

Madrid at that time?) In uncomplicated cases the disease commonly ends in recovery. The epidemics last, as a rule, from four to six weeks. (6) The connection of influenza with cholera is without scientific foundation; nevertheless the epidemic of 1831 preceded cholera, and that of 1837 followed after the disease. Cholera is now prevalent in Persia, and may spread over Europe on the heels of la grippe.

(7) The following, from a St. Petersburg correspondent of the British Medical Journal, is a good description of the disease as manifest in the present epidemic:

"It is frequently spoken of in the lay papers as influenza, but the typical symptoms of this disease are far more frequently absent than present, and the only features. in common are the rapid course, the extremely rapid spread, and the frontal headache, the great running at the nose and eyes being absent in all the cases that I have seen. The two most prominent symptoms in the present epidemic are those of high temperature and great frontal headache, accompanied in many cases by pain in the eyeballs, and in all by foul tongue and breath, constipation, and general malaise. The onset is rapid, the temperature runing up at once to 39°, 40° C., or even higher. The pulse in those cases I have seen is not raised proportionately with the temperature. In some cases there are added the symptoms of catarrh of the nose and frontal sinuses, in others there are sore throat and catarrh of the deeper air-passages, and in many there are vague rheumatic pains about the back, shoulders, and limbs. The duration is short, averaging from three to five days, though sometimes. prolonged to six or eight days, or even longer, and convalescence is rapid."

The above description would seem to indicate that the disease is of mild type. It is probably much nearer the truth than the accounts which have come into the public prints from Paris.

(8) The cause of the disease is a riddle. Dr. Seifert, of Würzburg, believes it to be due to a specific microbe which he thinks he as found and has named influenza-coccus.

The microbian theory of the affection is not to be sneezed at, but Dr. Seifert must prove his point. In view of the ultra pandemic character of la grippe, we wonder that some philosopher has not traced its etiology to the macrocosmic dust of the astronomers.

(9) The treatment of the disease is to be based upon accurate medical knowledge and

common sense.

Notes and Queries.

HYGIENE AND SUNDAY.-Among the questions treated of at the recent congresses in Paris, that of the observance of the Sabbath as a day of rest was not the least interesting. The Congress on this subject was presided over by M. Léon Say, who remarked that this rest, which several religions rendered obligatory, is a law of nature, and consequently a law of hygiene, the excellence of which has long been demonstrated, although it is not to be found in all national codes. The resting on the seventh day is of Biblical origin, and the custom of counting the days by seven was formerly the rule among the most diverse races-in India, as among the Celts, in China as well as in Arabia. Now that hygiene has become a positive science, it confirms the moral and material necessity for a temporary rest on the seventh day. The idea was adopted in principle by all the members of the Congress, which received the patronage of two political celebrities, Mr. Harrison, President of the United States of America, and Mr. Gladstone. In a letter, which was read publicly, President Harrison declared that he considered that all workers, whether with the hands or with the head, were in need of rest, which alone can guarantee the general observance of the Sabbath. Mr. Glad

stone declared that he attributed his robust health and longevity to his invariable observance of the Sabbath rest. Several reports were presented to the Congress, and physicians, professors, philosophers, and hygienists are in accord on this point. All, without exception, support for workers of all classes and of all ages a weekly day of rest, which should even be made obligatory. It may here be noted