not only that, but that they should be done in the male hospital, so as to make sure of his operating.

In his introductory lecture to the students of the St. Mary's Hospital School Mr. Handfield Jones, by way of illustrating the necessity of "estimating not only the disease but the patient," related a story of a young lady aged nineteen, wealthy and of high social position, who came in January under the care of an eminent physican skilled in chest complaints. She complained of prostration and palpitation, and on examination was found to have "light irregularity of the cardiac action, with a soft bruit at the apex." After three months of treatment the condition of affairs was but little changed. But one morning in April the housekeeper had oc casion to call and see Mr. Jones, and she made this inter sting statement: "The doctors say her ladyship has got a slight form of heart dis. ease, but I know a young gentleman who, if he would only come forward, could do more for her heart than all the doctor's medicines." Curiously enough, adds Mr. Jones, the following week the young man did come forward, and the eminent physician lost his patient.

Dr. Symes Thompson has delivered a course of Gresham lectures on the subject of the preservation of health.

The Royal Commission on Tuberculosis has resumed its sittings after the summer vacation, and scientific evidence will now be called as to the state of knowledge at the present time with regard to the danger of tuberculous food products and the health of the community. LONDON, October, 1890.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

At the last meeting of the Société de Biologie the following subject was brought to our notice: The presence of the bacillus of tetanus in the excrements of the horse and of the bullock in a healthy state.

MM. Sanchez, Toledo, and Veillon: One says, since the researches of Nicolaïer, that the bacillus of tetanus is spread in very great abundance in the superficial strata of the soil. Since this discovery a great number of observations

of human tetanus have permitted one to prove not only the presence of the bacillus of Nicolaïer in the sore, but also the previous contamination of this sore by the earth. The telluric origin of tetanus is then henceforth clearly established. work that we pursue

In the course of upon tetanus, in the laboratory and under the direction of M. Straus, we have applied ourselves to search for the presence of the bacillus of tetanus or of its spores in some other media than the earth. M. Reitsch had found it in the dust of hay; other observers have confirmed this statement. Sormani caused various animals to swallow fodder soiled by the earth, procuring it from gardens, from the public way or from manured fields, and he proves that the excrements from these animals which did not contract tetanus were found to contain the sporulous bacillus of Nicolaïer. Chicoli Nicola declares he has found it in the excrements of horses affected with tetanus; but the manner of manipulation with this author, as well as the characters of the cultures that he obtained, rendered his experiences little demonstrative.

We have assured ourselves, as Sormani, that some animals (rats, mice, guinea pigs, rabbits) nourished with some aliments moistened with the pure cultures of tetanus do not contract the malady, but that their excrements were tetanigenous. These facts have led us to search for the presence of the bacillus of tetanus in the excrements of healthy animals.

Our experiences have concerned the excrements of the horse and of the cow. We have proceeded in the following manner: Some dejections of the horse are gathered at the same moment of defecation in some sterilized vases. In a bag prepared in the skin of the back of the rabbit, near to the base of the tail, one introduces the dejections of the horse. (It is nece-sary to inoculate in quantities enough notable, about the size of a large walnut.) As ractive animals it is indispensable to employ rabbits; the mice, and the guinea-pigs, which are very sensible to the tetanic virus, are not in the least so to the action of septic vibrion contained in great abundance in the excrements, and they die the most frequently from experimental septicemia (edème malin), which does not leave

to tetanus, malady of incubation much longer, the time to establish itself. The rabbits, as one says, present a receptivity much less than the guinea-pigs and the mice for the septic vibrion, and that is the reason why it is necessary always to choose them when it concerns to inoculate from the earth, or from other containing matters, at the same time with the spores of tetanus those of the bacillus of the edème malin.

The rabbits thus inoculated with the excrements of the horse died, some of septicemia at the end of two or three days; the others, in much greater number, died at the end of five or six days with all the symptoms of tetanus. At the microscopic examination of the pus, or of the serosity of the sore of inoculation, one proved by the side of other bacteria (micrococcus, bacilli) the presence of the bacillus of Nicolaïer under its different forms of fine and thin bacilli, without apparent spores having slow and flexuous movements, and of the characteristic sporulous forms resembling the head of a pin. When the examination is practiced immediately, or a little time after the death, the sporulous forms are much more rare than the others. But if the carcase be left to itself, under the ordinary temperature, during twenty-four or thirty-six hours, one sees the number of the sporulous bacilli become more and more considerable.

If one inoculates the pus of the sore of these rabbits into mice, white rats, or guineapigs, one gives to them a tetanus type, and in examining the pus of the sore of these animals one finds there the bacillus of Nicolaïer mixed with other organisms.

We have likewise succeeded in obtaining some pure cultures of the bacillus of tetanus, with the pus and the serosity of the sore of rabbits inoculated with the excrements of the horse. With eight inoculations made into some rabbits with the excrements of six horses, we have four times determined tetanus.*

We have had the same experiences with cow dung which has been inoculated into two rab bits; these two animals died of tetanus.

*One sees that these results are in contradiction with those btained by M. Peyraud (de Libourne), who declares to have ad only negative results in inoculating the dung of the orse (Academy of Medicine, 7th October, 1890.)

The experiences that we are about to relate convey a new proof in support of this fact: That the feculent matters of healthy animals, not at all affected with tetanus, do often contain the tetanic microbe clothed in all its virulence.

We have shown that the excrements of the horse are often tetanigenous. Here, therefore, is an experimental fact, instructive in point of view of the interpretation of the theory of the equine origin of tetanus produced and defended with authority by M. Verneuil. It results, in fact, from the very minute search to which he has devoted himself, that tetanus comes unlooked for very frequently in consequence of traumatism to individuals in contact with horses. This fact henceforth finds its interpretation quite natural, since we know that the excrements of the horse may contain the bacillus of Nicolaïer.

We do not, however, conclude therefrom, be it well understood, that tetanus is a malady of equine origin, as is glanders, for example. The importance of our studies lies in the establishment of the fact that tetanigenous excrements may come from healthy animals. We maintain only that the horse and the cow take to themselves with their aliments, hay, straw, herbages, more or less soiled by the earth, and swallow thus some spores of the bacillus of tetanus. These spores, as those of septic vibrion, resist to the action of the digestive juices and are again found in the excrements and in all their virulence.

Upon a case of tetanus in an epileptic, by M. G. Camuset, the author of this memoir reports the observation of an epileptic affected with madness, together with mental troubles and presenting convulsive fits, who was taken with traumatic tetanus in consequence of a burn he had received in falling into the hearth of his chamber.

During the whole term of the tetanus the crisis of epilepsy cease, and it was not till twelve days after the first appearance, when the stiffness of the muscles was less marked, that the first epileptic attack showed itself. What is singular, after the end of the epileptic crisis the muscles entered into complete resolution; then, after some time, they tetanized afresh.

The explanation of this fact, which is analogous to what one under the force of an very difficult to find; when the epileptic release takes place, the cells of the anterior horns of the marrow obey the cerebral cells, although they be in some special pathological conditions-conditions into which they return as soon as the cerebral discharge is appeased. This is an observation which has only a very hypothetical value.

observes in epileptics acute febrile affection, is perhaps, at the moment

PRACTICAL MEMORANDUM.-(How the physician ought to be careful of the skin of his hands, by M. Meyer.) The frequent washing with or without antiseptics irritates the skin and produces excoriations or redness. The author advises the rubbing of the hands, after having washed and dried them, with one of the following pomatums, which have been recommended to him by Professor Liebreich: 1st, Lanoline, 50 grams; vanilline, 1 centigram; essence of roses, one drop. 2d, Lanoline, 100 grams; paraffine, 25 grams; vanalline, 1 centigram; essence of roses, 1 drop.

F. s. a. It is necessary to take care to hold horizontally the canula of the English syringe in bending the head lightly forward and without taking breath while pressing upon the injector.

2. Then a second injection is made with. the mixture of the two following solutions which are prepared separately: (a) In a glass filled with hot water put a teaspoonful of the powder of boric acid. (b) In a second glass, containing tepid water, pour a dessertspoonful of the solution: Naphthol a or B, 5 grams; alcohol, 10 grams; boiling water, 1 liter.

A cresylic........ Glycerin.....

F. s. a. (We reject the employment of creolin and of cresyl in injections or atomizations.)

6. In cases where the secretion is abundant, and when the patient is not able to be regularly attended by the physician, it is necessary to add to the irrigations some atomizations with the solution of diluted naphthol, which alternates with a solution of creosote at 1 300 or with some balsamic solutions (pitch or tar, benzoin, balsam of tolu, turpentine) employed alone or united. PARIS, October 1, 1890.

A. M. G.

mon.

research. As it became familiar to observers, fresh points in its clinical history were added to the list of its phenomena. These new features were more or less essential, while some of the points once deemed essential were noted to be not infrequently conspicuous by their absence. Thus there has been gradually evolved a considerable category of disorders of innervation and nutrition which are linked together under the same nosological head, but which, taken apart, might have seemed to have little in comIt would be presumptuous to say that the catalogue is yet complete; indeed, there are obvious lacunæ still to be filled, and there is no reason to doubt the possible existence of other manifestations of a neurosis so varied and so all-embracing, which may possibly have eluded observation, or from their infrequency have passed unrecorded.. The affection shows the importance to be attached to the record of signs seemingly trivial and slight. However, whether there is much more to be ascertained or not, the striking fact is that the points already established have widened enormously the clinical conception of Graves' disease. It is impossible now, in the presence of such additions to knowledge, to a-sign a primary importance to either of its leading features, for example, the thyroidal enlargement, the proptosis, or the cardio-vascular derangement. These and all the other manifestations, of which tremor is, according to Dr. Hector Mackenzie, the most prominent, can not but be the effect of some central derangement to which they are all subsidiary. In what that derangement consists no one can precisely say. Dr. Warburton Begbie's belief in a general blood change is not supported by facts. The original idea of some primary disorder of the functions of the thyroid could only be maintained when so much of mystery enshrouded that organ, and on the erroneous belief that the goiter was an invariable feature of the affection. Now that increased light has been thrown on the functions of the thyroid, ari-ing out of the investigation of myxedema, such a view is no longer tenable. Nor is it possible, without straining analogy too much, to see any connection between myxedema and Graves' disease. Almost the only point of affinity lies in the fact, common to both, of the greater liability of the female sex to be subject to them. Otherwise there would seem to be far more in the nature of antithesis than of analogy between the two conditions, the one of which seems to depend on the abeyance of function of the thyroid gland, and the other to exhibit as one (and that not the most constant) of its features an enlargement of this body.

In marked contrast to the degree in which

the clinical conception of Graves' disease has expanded is its singular lack of pathological evidence, and the failure to find, after the most careful scrutiny, any substantial lesion which could be regarded as the fons et origo mali. Even in cases marked during lite by positive paralysis, as in the remarkable one of ophthalmoplegia recorded by Dr. Bristowe, no definite cause of such defect has been ascertained. Such changes that have been described are notable for their fitful character and their, so to speak, accidental presence. Lesions have been met with in brain, cord, and sympathetic, but so inconstantly as to deprive them of any real significance. In spite of these failures it must be that the root of the trouble lies in the nerv ous system, since there is no other central mechani-m, disorder of which could produce so complex and so varied a group of phenomena as is met with in the forms of the disease. Still the search for nervous lesions has been in many cases so profound, with, on the whole, such barren results, that we are almost forced to the conclusion that either our present means are not fine enough to detect the radical organic lesion, or that the change is such as to defy all such scrutiny, being, in fact, dynamic rather than organic. The existence of such a change must always remain in the region of hypothesis until at least some tests as yet unknown can be applied to dead tissues to prove the past occurrence of purely functional disturbance.

Such, we gather, is the conclusion that has forced itself on the mind of Dr. Hector Mackenzie, who is singularly happy in his comparison of the symptomatology of Graves' disease with the more transient neuro-vascular disturbance excited by the emotion of fear, a comparison which is heightened by the definite information we possess of the initial history of many a ca-e. Like epilepsy, chorea, and perhaps diabetes, it may be that in this disease the origin of its varied phenomena depends on some fine derangement of the cerebral, mechanism. It requires no great effort of imagination to relegate its phenomena, in all their variety and capricious association, to the loss of nerve control. To follow out Dr. Hector Mackenzie's parallel, we see in the manifestations of fright, the staring eyeballs, the rapidly beating heart, the trembling, and the sweating, signs which are reproduced in Graves' disease, and even the swelling throat of emotional disturbance may be typified in the goiter of the malady. And of the signs and symptoms reviewed in these interesting lectures there is not one which may not be referred to primary disorder of nerve function, acting either immediately or through the medium of the circulation. Such are the cramps, the paretic, and paralytic phenom

ena, the occasional thermal disturbance, the defective nutrition of skin and its appendages, the mental derangements, the dyspnea, vomiting, and other signs; while to secondary vaso motor disturbance may be assigned such events as the intermittent albuminuria and many another symptom. Chief of all must be placed the functional disturbance of the heart, as shown in palpitation and acceleration. Of late much attention has been given to the "rapid heart," which in some persons seems to be habitual, and in others developed independently of any other noticeable derangement of the nervous system. Many of such cases doubtless belong to the same category as Graves' disease, for the line is too fine to be drawn between them and those cases in which the more characteristic features of this affection are but slightly marked. We have learned that the term exophthalmic goiter" is too narrow a designation for a morbid state which may exist without either exophthalmos or goitre, and therefore we concur in the propriety of retaining the neutral term "Graves' disease," although the area implicated by the affection recognized by that illustrious clinician was but small compared with that which it is now known to occupy. Yet we may be content to leave nomenclature aside, provided only that we recognize the wide-reaching affinities presented by the clinical facts of so many types, but all more or les bound up together. The subject is one for thought as well as observation, and the whole tendency of the knowledge so far gained upon it is to relegate Graves' disease and its allied disordors to the great group of the neuroses.-London Lancet.

THE ACTION OF EXALGINE. - M. Desnos has recently undertaken a series of researches on this new substance. He finds its influence on high temperatures to be very slight, while its action as an anodyne is, on the contrary, very marked. He insists, however, on the sensations, almost amounting to vertigo, which not unfrequently manifest themselves when the drug is admini-tered under certain conditions. Sweating, often profuse, was also noted in many instances, often localized or most marked at the spot where the pain for which the drug was given had its seat. These drawbacks did not usually supervene except when the dose administered ranged from 50 to 75 centigrams. With the latter amount very slight cyanosis, which often escaped observation, was developed. He finds that the alteration of the blood does not go the length of developing methemoglobin, as has been asserted by H nocque, but there was a certain amount of destruction of oxyhemoglobin. Generally

speaking, this substance is well borne by the digestive organs, eruptions being rarely or never developed. The urinary secretion is usually diminished in quantity and gives chemical reactions, showing the presence of exalgine in considerable quantity, which goes to show that it is largely eliminated by the kidneys. As to dose, 25 centigrams will sometimes suffice; 50 centigrams, however, is an average dose; but as much as one gram and a half may be given in twenty-four hours, in divided doses of 25 centigrams. M. Desnos has employed this substance in facial neuralgias, especially of a congestive origin. In a case of ophthalmic zona one gram and a half relieved the suffering, which was most acute. Cure was also soon brought about by means of exalgine in neuralgia of a syphilitic or anemic origin. In intercostal neuralgia the relief obtained was not so satisfactory, while in that of the abdominal regions again the effect was good. In a severe case of sciatica the exhibition of one gram and three quarters during a period of three days completely removed the pain. It was also found of great service in a case of renal colic; while in tabes dorsalis it appreciably diminished the lightning pains. short, exalgina is an important addition to the Pharmacopeia, and will be found of service in suitable cases, provided it is handled with ordinary care and intelligence.

In

He

The Etiology and Treatment of Tetanus. At a recent meeting of the Academy of Medicine M. Nocard read a paper by M. Peyraud on this subject. M. Peyraud, having inoculated a number of rabbits with an infusion which he male from hay, says he was able by this means to bring on an attack of tetanus in fifty per cent of the animals inoculated. The animals thus inoculated succumbed in the proportion of five out of every six. M. Peyraud has a theory that a chemical substance capable of exciting symptoms analogous to those caused by the invasion of the system by a given microorgani-m will prove by inoculation to be a vaccine against the ravages of the microbe. has applied this theory to strychnine, considered as the vaccine against tetanus. His method of proceeding was as follows: He injected hypolermically for a period of five or six days a dose of strychnine, varying the dose according to the size of the animal and the appearance of the convulsions. The animals being thus prepared, he inoculated them with pus obtained from an animal previously dead of tetanus. Ten of such rabbits were inoculated; but, in addition to these ten already prepared, he inoculated, as a controlling experiment, four others not previously protected by strychnine vaccination. The whole four non