to the tissues and is largely wasted. Ordinarily, when this waste ceases there is a corresponding abatement of wakefulness and other neurotic symptoms.-New York Medical Journal.

EXTRA-PERITONEAL FAT SIMULATING HERNIA. The following condition was met with in the anatomy rooms a few days ago, and appears of interest surgically. A well-developed male body was noticed to have a small swelling above Poupart's ligament on the right side, which could not be diminished by pressure, and was apparently in the inguinal canal. On removing skin and fascia the bulging was more pronounced, and was now seen to be entirely in the inguinal canal, on opening which a rounded portion of fatty tissue was found lying on the spermatic cord, which was flattened to accommodate it. The mass was polypoid in shape, about two inches long and an inch and a half across its free extremity; the neck could only be seen on drawing it down from the abdomen; the fat was very soft, and on its posterior aspect a thin fibrous cord was formed, but no covering as of peritoneum existed. On examining the interior of the abdomen, a short omentum was found, and perfectly free. The peritoneum over the inguinal region was without pouching, therefore the fat was certainly not omental. this region and on each side of the pelvis there were well-marked eminences, due to the enlargement of portions of the extraperitoneal fat, and on making a section into the inguinal canal the mass of fat discovered here was continuous with and part of one of these enlargements. One can imag. ine how such a condition so marked as to give rise to a distinct swelling externally would undoubtedly have been "cut down upon" if any symptoms of intestinal obstruction had manifested themselves. fact, the appearance was one of well-marked bubonocele.-W. T. Thomas, London Lancet.

In

In

FIBRINOUS MEMBRANES WITHIN THE SPINAL CANAL.-Dr. Joseph Wigglesworth reports three cases of general paralysis in which he found, post-mortem, fibrinous membranes in connection with the spinal cord. In the first case the membrane was from one to two lines in thickness, and was found lying upon the external surface of the dura mater on its posterior aspect. It extended from the third to the seventh dorsal vertebra, and was attached both to the dura mater and to the walls of the spinal canal.

In the second case the membrane was similar

to the foregoing one. In the third case it ex

tended from the lower cervical to the lower dorsal region, and involved the roots of some of the spinal nerves. It was everywhere coherent, and could be detached as a separate membrane. The three membranes were all external to the dura mater, in which respect they differ from the similar formations which are frequently discovered in the cranium, especially in post-mortems of the insane. Dr. Wigglesworth believes that the membranes described are the result of a hemorrhagic effusion within the spinal canal; that an inflammatory process is not concerned in their formation, and that they would be discovered much more frequently if sought. In the third case he suspected the presence of the membrane before the death of the patient, on account of the symptoms of irritation of the spinal nerves which existed, to wit, retraction of the head and rigidity of the extremities.-British Medical Journal.

On

CARBOLIC ACID IN TYPHOID FEVER.-The following case may be of interest as evidence of the abortive power which has been ascribed to carbolic acid in typhoid fever. The patient. a young man aged twenty-one, lived in a house at which I had, during the early part of the present year, attended two consecutive cases of this disease. On being summoned I elicited a history of well-marked premonitory symptoms, including pains in the back and limbs, severe headache, lassitude, anorexia, vomiting, and rigors. physical examination I found tenderness on pressure in the right iliac region, accompanied by gurgling and tympanites. Temperature 103.4°, pulse 95, tongue furred, patient apathetic and drowsy. I ordered the usual strict dieting, and prescribed a mixture containing minim doses of carbolic acid and two grains of quinine to be taken every four hours. On the second day of attendance I found the patient much better. Temperature subnormal; bowels, which had been somewhat constipated, relieved by a single foul liquid motion; no aperient had been given. given. For the following three days the temperature continued to be subnormal, although I had discontinued the quinine; it then gradually approached the normal, and never again rose above it. Beyond the appearance, on the fourth day of attendance, of a few somewhat equivocal rose-colored spots on the back and abdomen, the characteristic eruption was not developed. By the seventh day all symptoms had disappeared, with the exception of occasional pain and a little tenderness on pressure in the iliac re

gion. Taking together the well-marked premonitory symptoms, the condition of the patient when first seen, and the fact of two cases having previously occurred in the same house, I think I was justified in diagnosing typhoid fever, and in attributing its arrest and cure to the administration of carbolic acid.-E. A. Thompson, London Lancet.

METHYL CHLORIDE AS A LOCAL ANESTHETIC. Dr. Ernst Feibes, in a recent number of the Berliner Klinische Wochenschrift, draws attention to the extensive and successful use in the Paris hospitals of methyl chloride as a local anesthetic. Methyl chloride (CH, CL) is a colorless, easily liquefied gas, with an odor resembling that of ether and chloroform. The readiness with which the gas liquefies adapts it for convenient use, as it can be stored in a siphon or in a bottle of any size especially constructed to conduct heat badly. It may be applied to any surface directly from the siphon, or as a spray, but this method is objectionable, owing to the anesthetized area not being in most cases sufficiently circumscribed. Bailly uses the following method, which he calls "stypage": Tampons composed of cotton wool, surrounded by a layer of flock-silk and then covered with thin silk, are saturated with methyl chloride and applied to the part by means of wooden or vulcanite holders. After contact for some seconds the part gets pale and anemic, and diminishes in sensitiveness. If the tampon be then removed there is marked reaction, shown by congestion and slight itching; but if the application be continued for a short time longer (a few seconds) the skin assumes a white, dried, parchment-like appearance. This is the time to operate. If you proceed further superficial necrosis may result. The application is sometimes succeeded by itching and au urticaria like eruption. It is employed in all kinds of small operationscircumcision, opening abscesses, and in neuralgia, lumbago, muscular pains, gout, etc. In scraping lupus it is best applied by means of a camel-hair brush, as special parts can then be anesthetized with perfect precision.-British Medical Journal.

IODOFORM GAUZE IN POST-PARTUM HEMORRHAGE.-Dr. O. Piering, assistant in Prof. Schauta's obstetric clinic in Prague, has published his experience in the employment of Dührssen's plan of plugging the uterus with iodoform gauze for post pa tum hemorrhage due to an atonic condition of the organ. Dührssen recommends that, when post partum hemorrhage comes on the bladder should be emptied and forcible friction and intra-uterine irrigation of hot

or cold water, along with ergotin in hypodermic injections, employed; that, if the hemorrhage still continues, the cavity of the uterus should be filled with iodoform gauze, the irritation produced by this setting up active and permanen't contraction. The method has, according to Dührssen, the advantages of great certainty, complete harmlessness, and facility in its performance. Olshausen, Veit, and Tehling, however, say that the contraction set up is not always permanent, and that the method is not so free from danger as Dührssen believes. In consequence of these conflicting views, Dr. Piering resolved to give the method a trial, and he details several cases in which he employed it with complete success. In no case was any harm done by it. He advises that resort to the plug should not be too long delayed, and he prophesies an important future for the plug of iodoform gauze in post-partum hemorrhage.

London Lancet.

THE CONTINUOUS USE OF BLUE MASS IN SMALL DOSES--The patient was a man of large frame, about fifty five years of age, whose occupation or habits prevented him from getting sufficient sleep, as he rose each morning by 4 or 4:30, although he did not retire until 11 P. M. Evident signs of heart failure began to show themselves about a year ago, with dyspnea on exertion, difficulty in going up stairs or lifting weights, increasing edema, and albumen in the urine without casts. He had been treated in various ways, chiefly by iron in conjunction with diuretics, as acetate of ammonia or nitrate of potash. The symptoms steadily increased until the edema invaded the trunk and genitals, and he was almost confined to his room. When he came under treatment repeated trial was made with similar remedies, but finding no good result, and that the digestive system was in fairly good condition, the following pill was ordered:

Mass. hydrargyri, pulv. digitalis, cinchonidiæ sulph., aa gr. xl. Fiat mass. et div. in pil. No. xl. S: One pill three times a day.

These pills were begun November 10th, and were continued regularly until November 22d, by which time the full number had been taken. He was also ordered to remain in bed until 7 o'clock each morning, thus securing at least eight hours' rest During the day he was directed to lie down for one hour.

The only appreciable action of the remedy was a steadily improving tone of cardiac action with increased secretion of urine, with diminished proportion of albumen, and progressive decrease of edema. By November 22d all the symptoms had disappeared, urine was free from albumen, and the edema was en

tirely gone. There had been no purgation and no evidence of mercurial action. The change in his appearance was extraordinary, as he seemed shrunken away, showing that the entire body had been infiltrated with serum. He felt weak, but the only remedy ordered was an ounce of whisky twice daily. Upon this he rapidly regained his strength, and now seems in very good condition and ready to return to work.

I have in some cases of general edema, both with weak heart and with organically diseased heart, given the above combination for much longer periods than in this case, and with remarkably good results, but in other cases it becomes necessary to suspend very soon, chiefly owing to gastric disturbance. If the mouth is frequently washed with a solution of chlorate of potash, there does not seem much danger of ptyalism, but a constant close watch for this should be kept up. The remedies should always be joined with carefully regulated hygiene and diet.-William Pepper, M.D., University Magazine.

PHTHISIS IN HIGH ALTITUDES IN SWITZERLAND. From a report by Dr. L. Schrötter on the distribution of phthisis in Switzerland, it would seem that the inhabitants even of high altitudes are by no means so free from phthisis as we are perhaps wont to suppose. The tables of deaths for the eleven years 1876-1886 show that phthisis is endemic in every part of Switzerland, not a single district (Bezirk) being free from it. On the whole, the deaths from this cause are fewer in the high than in the low-lying districts, but it can not be said that the mortality from this cause is inversely proportionate to the altitude. Wherever there is a large industrial population the phthisis mortality is considerable. Industrial populations always suffer much more than agricultural populations where the altitude is the same.-Lancet.

RESORCIN IN WHOOPING-COUGH.-Dr. Justus Andeer, who had previously written in recommendation of the employment of resorcin in whooping-cough, has recently published some fresh cases illustrating, as he believes, the advantages of this method of treatment. One of the patients was his own child, a little girl of seven years of age, who, during an epidemic of measles and whooping-cough, was attacked by the catarrhal form of the latter affection and suffered severely for a week, notwithstanding a change of climate. He then prescribed an ounce of a two-per-cent solution of resorcin four times a day, part of which solution

the child was to gargle and part of which she was to take. This very soon began to show signs of affecting the course of the disease, for on the second day the fits of coughing very perceptibly diminished, and in eight or ten days the child was free from cough. Five other children, who had been unsuccessfully treated for some time, immediately began to improve under the resorcin treatment. In the case of a baby of six months old a sweetened solution of the strength of one half per cent was given by means of a feeding-bottle, and answered admirably.—Ibid.

CHLORATE OF POTASSIUM.-Dr. Coghill, in a paper read at the ninth International Medical Congress, confirmed the results of Wöhler that chlorate of potassium is excreted in the urine unchanged and in the full amount ingested, and hence does not give off oxygen to the tissues. Nevertheless, besides its local uses, he finds it of value in preventing abortion in all cases of pulmonary insufficiency, as phthisis, chronic pneumonia, and bronchitis, in anemia, chlorosis, and general malnutrition. In addition it has an antiseptic action in diseases of the genito-urinary tract, where there is suppuration or purulent or phosphatic urine.-British Med. Journal.

EXPERIMENTAL ARTICULAR TUBERCULOSIS. Dr. Pavlovski, in a paper recently published in the Vrach, gives an account of some researches he had made in Professor Pasteur's laboratory on the development and spread of articular tuberculosis, his special object being to find out whether the tubercle bacilli develop in the white corpuscles or in the connective tissue or in both. In order to carry out his research he prepared cultures of tubercle bacilli in peptone glycerine and injected the virus into the knee-joints of guinea-pigs, these joints being examined after the lapse of from half a day to eight weeks. After twelve hours the bacilli could be detected both in the connective-tissue corpuscles and in the white blood corpuscles. It was found that the white corpuscles play an important rôle in the production of tubercle, undergoing a series of progressive changes until they assume an epithelioidal character, experimental tubercle consisting of epi-, thelioidal cells due both to white blood corpuscles and to connective-tissue corpuscles. Dr. Pavlovski was also able to demonstrate the propagation of the bacilli along the course of the lymphatics, the nearer glands becoming first infected, and subsequently those at a greater distance.-London Lancet.

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DENGUE, OR INFLUENZA ?

A noticeable feature of the prevailing epidemic is that the more prominent symptoms differ from those ordinarily present in influenza. In view of which, according to the Lancet of December 28th, certain French physicians ask, not impertinently, the question which heads this article.

"Thus it is asserted that catarrhal characters have been notably slight, the predominant features of the few days' fever being muscular pains, pro-tration, headache, and in some cases a scarlatiniform eruption. Now it is pointed Now it is pointed out that dengue, an affection hitherto almost confined to tropical climates, prevailed extensively in Syria last spring, has since occurred widely in Constantinople, and even has been observed elsewhere in the South of Europe. This fact, added to the unusual features of the present epidemic," at least gives color to the notion that the supposed victims of la grippe are really in the clutches of dengue.

A paper on the Syrian outbreak of dengue, read before the French Academy, precipitated a learned discussion of the question among the assembled savants with about an even balance of opinion on the two sides.

Thus, M. Proust demurs on the ground that dengue has never been known to pass the limits

of 45° north and 25° south latitude. M. Rochard said that the prevailing affection was not dengue, because it lacked the articular pains and eruption characteristic of that disease; while, in the opinion of M. Colin, the symptoms exhibited by sufferers in the present epidemic are just like those noted in former epidemies of la grippe. On the other hand, M. Dujardin-Beaumetz, M. Bucquoy, and M. Bouchardt put forth some facts that give weight to the dengue theory. M. Bucquoy, however, seems to have been the only physician present who had noted the articular pains, redness of the palate, and scarlatiniform eruption which constitute the grounds upon which the credentials of the present visitor have been challenged. Further, the subject was discussed at the Medical Society of the Hospitals on the 18th of December:

"M. Legroux introduced the topic of the epidemic, and pointed out how it differed from classical influenza, catarrhal manifestations being exceptional, headache, ocular pain, nausea, colic, and fever chiefly marking it, and recovery following after two or three days in bed. He had seen some grave cases, and cited one of a lady in whom the pains in the head were so severe, with nausea, delirium, rapid pulse, and temperature of 102.2° F., that meningitis was feared. The symptoms disappeared in fortyeight hours under treatment by antipyrin. In children he had observed coryza or bronchitis, or more often gastro-intestinal catarrh. In every case the duration was shorter than ordiinfluenza. M. Sevestre had noticed two types. In some, the minority, there were the features of ordinary influenza. Others were marked by the absence of catarrh of the respiratory passages, by intense pains in the head, eyes, and loins, and by fever. In one third of his cases there was an eruption on the face resembling either scarlatina or measles, and recalling dengue. In terming such cases la grippe the usual meaning of the term was altered. altered. A writer in Le Progrès Médical (Dec. 21st), under the heading "Grippe ou Dengue," in which the outbreak among the employes at the Louvre at the end of November is stated to be the starting-point of the epidemic that rapidly spread through many large establish

nary

ments in Paris, refers to the descriptions given by Dr. Le Brun of the Beyrout epidemic of dengue, and suggests that both influenza and dengue are now prevailing in Paris. In particular the characters of an outbreak observed in a large scholastic institution in Paris are noted as closely approximating to the latter affection-sudden onset with frontal headache or orbital pain, difficulty in walking, pain in the limbs, etc; rarely cough, but slight tickling in the throat; many having constipation, nausea, or even vomiting. The throat was congested, tongue dry, pyrexia high (102 2° to 104°), and by the end of the first day a scarlatiniform rash appeared, which became more like that of measles on the second day, when the fever slightly abated. The rash faded on the third or fourth day, when the patients were nearly recovered. In some cases, where the patients got up too soon, there were relapses of fever, with rigors and headache, but no fresh eruption. Desquamation was not observed in any case. In the Gazette Medical (Dec. 21st) Dr. de Ranse points to the discussions at the above named Paris societies as justifying the hesitation at first expressed by the Russian physicians before concluding that the epidemic at St. Petersburg was influenza. He propounds three questions, which, shortly put, are: 1. Are influenza and dengue distinct diseases, or only the same disease modified by climate? 2. May they develop simultaneously in epidemic state in the same region and combine to form a hybrid affection? 3. If entirely distinct, is the present epidemic influenza or dengue? In answering these questions and concluding in tavor of influenza, he rightly says that the exceptional occurrence of some cases showing a rash is not enough to ally it with dengue, and believes that some of the earlier recorded epidemies of influenza would show as marked an absence of pulmonary catarrh as is now presented."

It would seem, if we are to take the opinion of the French lights in medicine, that the victims of the present epidemic are doomed to suffer without the satisfaction of knowing what is the matter with them; but since the treatment advised and now universally practiced is effective, the patients will be glad to avail

themselves of it now and let the doctors name the disease at their leisure. It might have been stated in the above discussion that the promptness with which the fever yields to quinine gives weight to the opinion of those who believe the disease to be dengue.

Notes and Queries.

LOUISVILLE MEDICAL SOCIETY.-As secretary of the Louisville Medical Society I feel called upon to ask certain questions not only of the Fellows of the Society, but of the whole medical faculty of Louisville.

First, it seems proper to ask the Fellows of the Society whether, through their neglect, it is to pass out of existence?

Not meaning to cast any reflection upon any other organization. I would ask the Fellows, do any or all of these limited societies fill the needs that are claimed for an unlimited society?

Is the profession of Louisville individually so strong that it does not need these gatherings to keep it up with the times?

Other cities claim great good from large organizations, on account of the exchange, of thought and the benefit arising from stimulation of discussion. Cities as large or larger than ours boast of their well-organized and splendidly governed societies accomplishing much each year for the advancement of their professional learning.

But a short while back a Cincinnati journal gave a glowing account of the work that its general society had done, and spoke of the effort that was successfully being made to have a well-equipped library in connection with the society.

Is it not important to the general profession of Louisville that we have such an organization open to every reputable medical

man?

If the interest of the profession could be aroused, and instead of about sixty inactive members we could increase the Society's strength to a hundred active, earnest workers determind to assist and be assisted in the search after knowledge, is it not certain that much benefit would accrue to us?