solution of the hydrochlorate of cocaine of one tenth strength, ten minutes before his arrival. He ascertained that twenty-five centigrams of the cocaine had been introduced. Six minutes after the injection, which was retained in the canal by pressure on the extremity of the penis, the patient presented all the symptoms of poisoning, which, however, disappeared after two hours' appropriate treatment.

At a recent meeting of the Medical Society of Hospitals Dr. Dreyfous recalled that the conditions necessary for an antiseptic of the urinary organs are that it should be little soluble, that it should have no toxic action, that it should be neither antithermic nor a general nor an intestinal antiseptic, that all its action should be reserved for the urinary organs. Salol, which is separated in the intestine into carbolic acid and salicylic acid, which pass into the urine, the first as a sulpho-carbolate, the second in its natural state-salol responds to these conditions. Dr. Dreyfous has treated seven cases of gonorrhea with salol in doses varying from five to eight grams, either alone or associated with balsamics. In all the cases

the gonorrheal discharge was rapidly modified. In a case dating four days the cure was obtained in three days. He thinks there is every advantage to associate cubebs and copaiba with salol. He recommends the use of salol for operations on the urinary organs. It renders urine aseptic, which thus becomes innocuous when in contact with raw surfaces.

At the Academy of Sciences Dr. Tripier, of Lyons, had a paper read for him on a Surgical Method of Restoring the Eyelids. When the lower eyelid is concerned he dissects a tongue of skin from the suborbital region, taking care neither to dissect muscles nor nerves. The strip of skin thus free he places on the raw surface of the lower eyelid, which becomes grafted on it and constitutes an eyelid. To form the upper eyelid, a strip of skin is dissected in the supra-orbital region and fixed in the space which the eyelid should occupy. The photographs shown at the meeting indicated that

the patients thus operated on could open and shut their eyes. The disfigurement resulting from absence of eyelids is considerably modified.

In his report on epidemics, recently read before the Academy of Medicine, Dr. Ollivier recommended mercuric chloride in the form of Van Swieten's solution for treating cholera.

PARIS, December, 1889.

Abstracts and Selections.

ON TWO RAPIDLY FATAL CASES OF DIPHTHERITIC PARALYSIS.-C. R., a gardener, aged twenty-five, was attacked on May 22d with ordinary pharyngeal diphtheria. There was nothing noteworthy in the attack except that the membrane was somewhat unduly persistent, the tonsils not clearing till the thirteenth day. His temperature reached the normal on the ninth day. There was no albuminuria and but slight glandular implication, nor was the illness followed by undue prostration. After a few days in the country he resumed his employment.

On July 1st, having finished his day's work, he again presented himself, saying that he felt very unwell. The man was so obviously ill that he was at once readmitted to the hospital. According to his account he had never felt really strong or well since his illness. About six days previously he began to have difficulty in speaking plainly, and afterward noticed that there was in

creasing difficulty in swallowing, the food often getting into the air-passages or returning through the nose, with frequent fits of choking. Had felt numbness in the fingers and feet for the last two days, but was able to do his work, though greatly fatigued thereby. When admitted, at 6:30 P. M., it was extremely difficult to understand what he said, phonation being very imperfect and the voice hoarse and nasal. There was great difficulty in swallowing either liquids or solids, frequent shallow hoarse cough, with inability to clear his fauces. The vocal cords were seen to be lying in the cadaveric position, and moved but slightly toward the mid-line. The larynx was anesthetic. Muscular power in arms weak, and tingling in feet. Patellar reflex exaggerated. Temjerky. Pulse 120. 2d: Passed a restless perature 103.6°; respiration 40, shallow and night. Complete inability to swallow; fed with soft stomach-tube. Voice inaudible.

Dia

Respiration 48, shallow and noisy. phragm acting very feebly, if at all. Face dusky, sweating. Pulse 120, regular. Patellar reflex absent. Analgesia in legs, but can feel cutaneous pressure. During the afternoon the sweating continued; cyanosis became more marked. Pupils dilated. Respiration over 50, very shallow. Died quietly at 5:45 P. M. Twenty-four hours before his death the man was at work.

The second case occurred in a child aged five years, C. D., admitted on August 28th, with faucial diphtheria. Complained of sore throat, and vomited the day before. The case was a very severe one, characterized by abundance of exudation on tonsils and pharynx, much glandular swelling, rhinorrhea, and great prostration. On September 6th he had a severe syncopic attack, but rallied under stimulants. The membrane in this case too was very persistent, the throat not becoming free until the sixteenth day. The temperature reached the normal on the eighth day, and afterward was usually subnormal. There was slight albuminuria from the first, which remained as a nearly constant trace throughout the illness. With the exception of some paralysis and loss of reflex in the palate and a certain amount of glandular swelling, the ensuing convalescence presented nothing unusual. On the 17th it was noted that the voice had quite lost its nasal tone. On the 20th the patellar reflex disappeared; the palate was anesthetic. No motor paralysis observed. On October 2d food was noticed to return through the nose. Palate immovable; no reflex. Bilateral ophthalmoplegia externa especially affecting the right internal rectus, which was quite paralyzed. Accommodation sluggish; irides react to light.

Walk

very "groggy;" patellar reflex absent. 14th: Double ptosis, most marked on left side; albuminuria slight. Child sitting up in bed playing with its toys. 15th: Inability to swallow; voice indistinct; dyspnea. Ocular paralysis complete. The legs and back appear very weak; can not support himself in a sitting posture. No resistance to passing the stomach-tube. Diaphragm not acting; thoracic respiration feeble (40 to the minute); inability to cough; restless and sweating; pulse 100, regular. Toward evening cyanosis became marked. Temperature 99.8°; respiration over 50, shallow and noisy. Died at 11 P. M., the pulse being perceptible for some time after respiration had ceased.

It is remarkable that in both instances, although paretic symptoms were present for about a week before death, yet it was only

within the last thirty-six hours that the cases took on a serious aspect and proved fatal by respiratory paralysis. The symptoms pointing to an affection of the vital functions occurred during the late stage of convalescence, viz., in the fifth and sixth week, a time when it is more usual to find a form of paralysis mainly characterized by an affection of the spinal nerves supplying the limbs. In both cases the faucial affection was severe, the membrane being very persistent. This is in accord with my own experience, viz., that it is the severe cases which are most frequently followed by subsequent paralysis, the mild ones usually escaping altogether. I believe that in a good many cases of paralysis which are diagnosed to be of diphtheritic origin the original attack of diphtheria is accepted on insufficient evidence; the statement elicited from the patient or his friends that he has had a sore throat some weeks previously (in one case I remember it was three months) being taken as sufficiently conclusive evidence that it was an attack of diphtheria, whereas the case might with equal propriety be referred to the operation of some other cause of which we are ignorant. Cases of peripheral neuritis of alcoholic origin may be the type of a wider series, and they certainly bear a close clinical analogy to diphtheritic paralysis.

I have been repeatedly struck by the fact that those cases of diphtheria which during the acute stage present a large amount of mucoid secretion at the back of the pharynx, accompanied with rhinorrhea, are of the most grave kind, and rapidly reach a fatal termination. The increased secretion, however, is probably only apparent, the accumulation being due to retention, and is a sign of the oncoming paralysis of deglutition, which quickly becomes associated with laryngeal affection and cardiac or respiratory failure. It is this paralysis of early onset, affecting as it does the vital functions, which is so frequently fatal, and tends, I think, to support the view adopted by Hilton Fagge, on the theory of a "neuritis migrans," that there is direct association between the local process and an affection of the nuclei of origin or of the nerve trunks emanating from the medulla and floor of the fourth ventricle, from some of the peripheral fibers of which the diseased surface de

rives its innervation.-London Lancet.

THE TREATMENT OF TYPHOID FEVER BY ANTISEPTICS.-A recent communication to the Bulletin Général de Thérapeutique, by

Professor Pétresco, of Bucharest, gives the results of the treatment of typhoid fever in the Roumanian army by various antiseptics, and especially by phenic acid, naphthol, and sulphide of carbon.

In 1883, on the occasion of an epidemic of typhoid fever which broke out in the garrison of Bucharest, Pétresco instituted the treatment by phenic acid. The results obtained were not satisfactory; out of 116 patients 28 died.

In 1884 he undertook a series of clinical and experimental researches on parasitism in typhoid fever, and made extensive trials with salicylic acid, turpentine, benzoic acid, and kairin. The results were still unsatisfactory, the mortality being from twentyfive to thirty-eight per cent.

In 1885, the same clinical investigator undertook to verify the antiseptic action of calomel, bichloride of mercury, sulphide of quinine, and boric acid. The results were not favorable.

In 1886 he treated his typhoid patients with the saturated solution of sulphide of carbon. The results were better, the mortality being but ten per cent.

In 1887, he "verified the antizymotic and antithermic action of antipyrin in doses amounting to two drams a day." The mortality was still relatively high.

Lastly, in June, 1888, the indefatigable professor of Bucharest, "inspired by the labors of Professor Bouchard," began treating his typhoid patients with naphthol in doses of fifteen grains three times a day. In some cases a fourth dose of one gram was given in the night-time. The results have been more favorable than those obtained by any of the other remedies. Out of forty-one typhoid patients who entered the military hospital in 1888, only twentyfive were treated in a systematic manner by naphthol; of these there was but one death. Hence Pétresco concludes that sulphide of carbon and naphthol have proved themselves more worthy of confidence than the other medicaments used in typhoid were, and he affirms that by these two medicines employed separately, or associated with coldwater treatment, not only are the morbidity and mortality of typhoid fever reduced, but the march of the disease is also favorably modified. The evolution of the disease takes place, he thinks, without presenting the grave ataxo-adynamic phenomena of auto-infection, such as show themselves in the sequela of treatment by other remedies.

The number of cases is too small, and the information as to disease-type in the differ

ent years is too scanty to permit of any very definite conclusions from Pétresco's results.

Dr. George L. Peabody, in a communication to the Practitioner's Society of New York (Medical News, December 14th), gives the results of treatment of fifty typhoid patients in the New York and Bellevue Hospitals during the year 1888, when the type of fever was less severe than usual, with betanaphthol and resorcin as antiseptics, and the cold pack as an antipyretic:

"When patients entered the hospital sufficiently early in the disease, that is to say, within the first ten days, the routine method was to administer a calomel purge of ten grains, and then immediately to follow this drug by a dose of one of the antiseptics, which was repeated at varying intervals, day and night, as a rule, until the temperature became normal and remained so.

"When resorcin was used, it was given in the dose of five grains every four hours; when beta-naphthol was used, its dose was two grains, given every two, three, or four hours, depending upon its effects. These drugs were administered in pill form, and each pill was carefully coated with keratine, to insure it against changes to which it might have been subjected in the stomach. Thirty-three well-marked cases of this disease came under my care in the New York Hospital last year, and of these twentyseven were treated antiseptically in one of the ways indicated.

"But little use was made of any of the newer antipyretic drugs, though in some cases occasional doses of phenacetine were administered. This formed no part of the plan of treatment, and was ordinarily given only a few times when the temperature remained persistently high.

"The effects of the antiseptics upon Ehrlich's diazo-reaction were interesting. This reaction, even though it might have been ever so plainly present when the patients began treatment (and it was so almost invariably), usually disappeared after the first few doses, and remained constantly absent while the drugs were given. In several cases, for experimental purposes, the drugs were stopped, and the reaction promptly returned, to disappear again when the administration of the drugs was resumed. Of unpleasant consequences of these drugs, I have to record the occurrence of blood, albumen, and casts in the urine in a few patients who took beta-naphthol. These symptoms were always looked

upon as positive indications to discontinue the drug, and they disappeared promptly when it was stopped. Resorcin produced absolutely no unpleasant effects."

Peabody concludes that, on the whole, the method of treatment by the cold-pack has been more gratifying to him than that by the internal use of antiseptics, but emphasizes the importance of using it systematically and so frequently as to keep the temperature always below 102°. At the same time he acknowledges the impediments in this country which the comparatively late periods at which typhoid patients enter the hospitals and the disposition of the hospital services thrown in the way of the proper and systematic treatment of typhoid fever.

Although such therapeutic studies are worthy of attention, we see nothing in them to lead us to alter our opinion that attempts to control the course of typhoid fever by antisepsis of the bowel will be ultimately adandoned as irrational and unavailing.Boston Medical and Surgical Journal.

NEUTRALIZATION OF THE BACILLUS TETANI. In June last Professor Sormani, of Milan, announced to the Lombard Institute of Sciences the results of his experiments on the neutralization of the tetanigenous microbe-results which seemed to justify his conclusion that iodoform, iodol, and corrosive sublimate are absolutely destructive of the bacillus in question. To these disinfecting agents he has, as the result of further experiments, added three more-namely, chloroform, chloral hydrate, and camphorated chloral; the latter being, he alleges, in a marked degree efficacious, while camphor and camphorated alcohol he found inert. On a general review of the whole, however, he gives the preference to iodoform. Seven rabbits were inoculated with materials charged with the tetanigenous virus. From six of these, after an interval of twelve hours, the foreign body was removed during the period of incubation; from the seventh the substance was removed only when the first symptoms of local tetanic convulsions had declared themselves. In all these animals the wound was scraped and thereafter freely medicated with iodoform. The seventh rabbit died of tetanus. Of the first six, five were saved. From this Dr. Sormani concludes that medication of wounds with iodoform ought to be practiced before the setting in of the first tetanic symptoms. Nevertheless, even during declared tetanus, the application of iodoform to the wound is capable of disinfecting it and of removing from it all trace of virulence. Wounds and

sores treated with iodoform, especially wounds or sores contaminated with earth, yield results highly welcome to the surgeon-such medication preventing the access of that fatal tetanic symptom which, having once declared itself, leaves but little chance for skilled interference. Dr. Sormani gave confirmatory proof of his thesis by cases of tetanus in hospital, where iodoform opportunely applied saved the patients, and where, from its use having been unfortunately suspended, two lives were sacrificed. Lancet.

THE LESIONS OF INFANTILE SUMMER DIARRHEA.--Dr. L. Emmet Holt, in a paper entitled " The Prevention of Summer Diarrhea among Infants, viewed in the Light of the Lesions," expresses the opinion that the dyspetic intestinal catarrhs of infancy produce lesions of considerable importance, not so much in their immediate effects as in their relation to the severer forms of the disease, particularly entero-colitis. His attention was first drawn to this subject by two autopsies upon children ten months old. One died of acute pneumonia, without intestinal complications. Throughout the large intestine in this case the solitary follicles were increased in size and number, some being eroded at their summits as if about to ulcerate. The child had been nursed entirely and its health seemed good; but during its first five months of life the bowels were never normal, the passages being green and nearly always containing mucus; in number they were never more than three or four daily. There was gradual improvement in regard to the discharges without treatment, and during the last five months of life the bowels were apparently normal. The second child feil from a window and died within an hour. In this child the colon was found in a condition similar to the other case. There had never been any acute diarrhea, but for three weeks before death the stools had been green and contained mucus. The microscope showed but slight catarrhal changes, the important feature being the great enlargement of the solitary follicles. Examinations of other cases in which a dyspeptic intestinal catarrh had been allowed to run on without treatment showed similar changes in the intestinal wall. If a child's intestine is examined some months after an attack of entero-colitis, similar anatomical changes will be found. In cases of acute entero-colitis of ten or twelve days' 'duration the solitary follicles are enlarged, and where they have broken down small circular ulcers will be found. Since the condition in dyspeptic catarrh is similar, it may be regarded as identical with the first stage of the ulcerative

process. The swelling in both cases is probably due to the same cause, the absorption of ptomaines produced by the intestinal decomposition. The majority of all severe and fatal forms of entero-colitis in summer are preceded often for weeks by a dyspeptic catarrh; this often passes unobserved, the mothers attach so little importance to it, especially if the infants are teething.

The author reports fifty-seven autopsies that have been performed upon cases of diarrheal diseases. In almost every case the solitary follicles were enlarged; in nineteen follicular ulceration existed. Follicular changes are slow in disappearing; this explains the long continuance of what are apparently very mild cases of intestinal catarrh, and the frequent relapses after the more acute attacks. The treatment of follicular ulceration of the intestines is very unsatisfactory; the proper treatment is preventive. Every diarrhea should receive early and intelligent treatment, best obtained by proper digestion, which means proper feeding and especial care not to overfeed.-Dr. T. M. Rotch, Boston Medical and Surgical Journal.

TESTS FOR MELANURIA. R. von Jaksch (Zeitsch. für Phys. Chem.) has been endeavoring to obtain more satisfactory tests for the condition known as melanuria. As ordinarily described, this is characterized by the passage of urine which becomes black or very dark on the surface as soon as it is exposed to air. On standing, a black pigment is deposited, which is termed melanine, and is distinguished from other coloring matters in urine by its insolubility in water, alcohol, ether, and acids, with the exception of strong nitric acid, which decomposes it. R. von Jaksch finds that when perchloride of iron is added to thick and highly colored urine a precipitate is formed. On the addition of a very dilute solution of perchloride of iron only a light blackish-brown cloud results. A tolerably concentrated solution gives a grayish-white precipitate. After filtration, fresh addition of perchloride of iron gives rise to a dark color and a light precipitate. With an excess of perchloride of iron the gray precipitate is dissolved and the black precipitate remains, and is only dissolved with a very large quantity of the reagent. The coloring matter thus precipitated is a mixture of different substances. It is soluble in hot formic acid and in lactic acid. It is insoluble in acetic acid, chloroform, glycerine, etc. It contains nitrogen, iron, and sulphur. With ferrocyanide of sodium and carbonate of potassium the urine gives a rose-red color if the solution is dilute, and a dark red color with concen

trated solutions. Mineral and organic acids change this to a deep, blue, and after a time a precipitate forms. This precipitate, separated by filtration, dissolved in carbonate of soda and treated with hydrochloric acid and perchloride of iron, gives a precipitate of prussian blue. This last reaction is not peculiar to melanine, and is only a confirmatory test after the pressence of melanine has been proven by perchloride of iron. Melanuria, that is to say, the presence of melanine in urine, is an important element in the diagnosis of melanotic cancer. Lancet.

WAKEFULNESS IN NEURASTHENIA.-The use of drugs, with the exception of sulphonal, perhaps, did not find much favor with the members. Some of them had found that their patients of this class slept when they were at the seaside, while others recommended the Colorado atmosphere. Some patients had been found to be able to sleep at sea, but not on land. The weight of evidence seemed to favor the resort to mountain air for patients who were anemic, with a presumption in favor of sea air for those who were plethoric. Dr. Solly, of Colorado Springs, has found that a large proportion of anemic neurasthenics find sleep on the mountain heights, but this can not be said of the entire class. It is not improbable that other conditions besides those of climate enter into the account where the patient travels from our eastern cities to the Rocky Mountains in pursuit of sleep. The jaded matron leaves the worries of the household, and the business man, broken down by the rush of daily cares, finds many things changed besides the atmosphere among the far western altitudes. Still, as a rule, the climate gets all the praise when an improvement takes place. Business men from the East report a larger percentage of recoveries than the matrons, however, probably because fewer of their anxieties can follow them. Improvement in the assimilation of food, it should not be forgotten, goes a great way toward sleep-production in those who are affected with derangement of the nervous system, and this is one of the frequent accompaniments of any change of scene and environment. Not that there is always any marked increase of appetite or in the amount of food taken, but there is an appropriation of the food by the nervous centers to their consequent strengthening. It is often a prominent feature in neurasthenia that the food may be taken in and digested fairly well, but stops short somewhere in its distribution