adulterated and sour milk; by being improper in kind, such as solid food for nursing children; and also by being given in too large quantities. These three errors in diet usually co-exist. The most important things in prevention are to obtain pure milk and to sterilize it before use, to restrict the diet and to guard against overfeeding. It is better, in summer time to give children too little rather than too much.-Medical and Surgical Reporter.

THE HEAT AND ITS EFFECTS.-The heat of the last two weeks has been remarkable as occurring so early in the season, it being very rare, indeed, for fatal sunstrokes to occur in the first summer month. More than a score have already taken place in this city, while the news of the daily press informs us of a similar mortality in other cities and towns, while even those who live in the country are not exempt from the fatal effects of the sun.

Reports of sunstrokes are usually of the heat effects on adults, while the direct and indirect effects on the infant population are many times as great. Too often their main nutrient, milk, has become tainted or poisoned from the absorption of germs and gases, making it a dangerous article of food and productive of summer enteritis, or other trouble that leads to a fatal termination.

At this time of the year it is a good plan to have all milk sterilized as soon as possible. This is a very simple process, and consists of putting the milk in a clean bottle, loosely corking with a clean, new cork, and then placing the bottle in a vessel of water, and heating it slowly to the boiling point, this temperature being continued for forty-five minutes; then tightly cork the bottle and set it in a cool place until needed for use.

The nutrient properties of the milk are not destroyed, or even weakened, by this process, but for most persons it is more easily digested and is more nourishing.

Babies, children, and adults, in hot weather, should live as much as possible in the shade, where there is the freest possible circulation of pure air. Long and frequent cool baths for infants are very conducive to their health and comfort. There is nothing like a long, cool bath, to relieve the discomfort of prickly or summer heat, following this with a little anointing of the creases of the skin with cold cream, vaseline, or fresh lard.

In case of looseness of the bowels, a few doses of the ordinary chalk mixture will usually furnish the desired relief. This should be given in tablespoonful doses, and after every stool. Where there is a weakening of vitality, with very great propriety and advantage, teaspoonful

doses of maltine may be added to the sterilized milk; the diastatic power of maltine being capable of rendering soluble and digestable any starchy food that may be in the stomach. Starch foods, such as Irish potatoes and breads, have often been regarded as the immediate and irritating cause of infantile enteric disorders. In part this may be true, and yet these starch foods were the very ones the lacteals and absorbents were crying for, and needed to stay the waste that was going on with fatal rapidity.

Right here the inestimable value of maltine, with its diastatic solvent properties, is quickly made manifest in changing the character of the discharges, and causing an irritant factor to become one of nutrition; given in sterilized milk the benefit of both is obtained.

In the city it is a good thing, in every possible case, to send the mother and infant out to the parks and suburbs for one, two, or three hours after sundown. The car ride is easy, while a shawl or other garment spread on the grass will afford a genuine relief and change from the mother's lap or cradle.

A little instruction from the family physician to his patrons in these simples may be the means of saving many valuable lives; nor should the physician take it for granted that his clients are informed in such matters, for very intelligent people sometimes are very ignorant of the plainest hygienic rules. This is especially the case in regard to the care of very young children. We recently saw an illustration of this in a very intelligent appearing mother, who did not even know how to hold her infant in positions of comfort to the babe and ease to herself. Even in such matters as this the doctor may give wholesome advice.-Cincinnati Lancet-Clinic, July 5, 1890.

ON THE ACTION OF SULPHONAL, - In the Therapeutische Monalshefte for March, Dr. Franz, of Breslau, says: Pertinently to the researches of Dr. Knoblauch concerning the effect of sulphonal in diseases of the mind (Therap. Monatsh., 1889, p. 495), I may briefly relate here my own experiments upon the operation of sulphonal in surgical diseases. I have administered sulphonal Bayer to eighty-two patients, in about two hundred and sixty doses, and from these experiments, which were made to learn what injurious collateral effects sulphonal might have, have reached very favorable conclusions. In the cases in which only an agrypnia nervosa had to be dealt with, comprising twenty-six patients and eighty-six doses, sulphonal failed me only four times, and those all with the same patient. This patient was very anemic, had pulmonary phthisis, and had been operated upon several times for tubercu

lar abscess. The patient declared besides that he could not sleep without morphine. In all the other cases the patients slept very well after sulphonal; and the sleep was, according to their representations, beneficial and refreshing. In no case had the patients any trouble from sulphonal; they did not complain of dizziness or staggering or headache, nor did any ataxic symptoms appear. Only the single patient (a morphine-taker), already mentioned, once had, after a dose of three grams of sulphonal, somewhat marked delirium; otherwise he had no trouble. In one case we succeeded in weaning a moderate morphino-maniac from his habit by sulphonal. The maximum dose was in most cases one gram. Somewhat larger doses had to be taken by patients who were suffering pains from wounds or other causes. With them a dose of two grams was sufficient to produce in a short time healthful sleep. Only in five cases did sulphonal fail to remove violent pains, and then, indeed, in doses of only a gram. In one case the pains of a violent supra-orbital neuralgia-following a phlegmon of the left half of the face-ceased after the administration of a gram of sulphonal. With another patient, toothache disappeared after giving sulphonal. In all these cases no headache, dizziness, ataxia, or other collateral symptom appeared.

Sulphonal also agreed well with all patients when given immediately after narcosis with chloroform. The pains, headaches, and vomitings that accompany the narcosis were not increased by it. No inconveniences followed the sulphonal; the numbness and the heaviness of the head after chloroform were in no case increased, but in many cases ceased. Sleep during the night following the operation was relatively not so good as in the other cases; but only three of the patients were unable to sleep. In the other cases the sleep was light and sometimes broken, but was otherwise generally good. Several patients averred that they slept better after sulphonal than after morphine, which was given them alternately with it.

Sulphonal had a marked effect with children, to whom it was given in seventeen cases in doses of from five to eight centigrams. Sound sleep soon came on, without any unfavorable symptoms being induced.

When did the effect of sulphonal appear? I must first remark that no patient who took sulphonal between two and four o'clock in the afternoon slept during the day or till evening. In the other cases sulphonal was given between six and eight o'clock in the evening, and sleep came on in the case of patients with agrypnia nervosa in the course of an hour, while with those who had violent pains or were still under

the influence of chloroform it generally held off somewhat longer. In a few cases a sound and healthy sleep did not set in until toward morning. I should mention that the sulphonal in all the experiments was given in wafers, so that the difficult solubility of the sulphonal may be responsible for the delay in the patients' going to sleep.-New York Med. Jour.

SODIUM SALICYLATE IN THE TREATMENT OF CHOREA.-In an article in the Bulletin Général de Thérapeutique, No. 16, 1890, Dr. Dresch speaks very favorably of the action of salicylate of sodium in cases of chorea. The disease, he says, is of greater gravity than is generally, supposed, for it not infrequently causes death either directly or indirectly. The importance, therefore, of an intelligent and active therapy is manifest. He believes that chorea is a microbial disease, the micro-organism of which is probably of the same family as that of rheumatism. The choreic movements are to be regarded as reflexes provoked by the presence in the tissues of the specific microbe, and are similar to the cough of pertussis, the spasms of tetanus, the premonitory chill of certain fevers, etc. Having these views as to the nature of the disease, he adapts his therapeutic measures to them, as far as it is possible to do so, although he admits freely the inefficiency of salicylic acid as a microbicide. The treatment should be begun at the earliest possible moment, and should be energetic, whether the beginning of the disease be severe or mild. The drug is not given as a germicide or an anti rheumatic, but rather because of its action upon the medulla and cord, where it affects the motor centers as well as the sensory, thus restraining the movements of chorea as well as the pain of rheumatism. It is probable also that it would act. equally well in diminishing the severity of the paroxysm in whooping cough, though the author has never tried it in that affection. to this sedative effect of the drug he attributes the fact that he has never seen any excessively severe cases since beginning its use, and has not been obliged to have recourse to any of those agents which calm the paroxysms only by stupefying the patient. But another great advantage possessed by the salicylate is that it increases the elimination of waste products, being, like benzoic acid and its derivatives, a solvent; in other words, it opens the kidneys instead of closing them as do quinine and antipyrine, which are so often given in chorea. It is evident that the choreic movements must greatly augment the amount of waste products, both muscular and nervous, thrown into the circulation, which products are toxic and of themselves excite convulsions. It is of the ut

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most importance, therefore, that any remedy given for the disease should favor the elimina tion of these materials by the kidneys and other emunctories. Dr. Dresch has found the salicylate well borne in most cases, a child of twelve years taking without trouble as much as sixty grains in the twenty-four hours, the only precaution being to give the drug in small and repeated doses well diluted with slightly alkaline water. It is not usually necessary to continue the use of the remedy more than eight or ten days. During the first period of the disease the patient should be kept in bed in a well-ventilated room at an even temperature, and noise should be avoided as far as possible. A milk diet is the best if it is acceptable to the patient, but beef tea is not to be recommended. An enema of tepid water once a day is useful, but should not be insisted upon if the patient objects strenuously. Nothing, indeed, should be done that is liable to excite the child. As the disease begins to subside the treatment should keep pace with it, the child being allowed to get up and gradually resume his usual diet and amuse himself in his accustomed way. author objects decidedly to sea-baths. -Medical Record.

The

THE ETIOLOGY OF CONSUMPTION. — Dr. August Haupt of Soden, a beautiful wateringplace at the foot of the Taunus Mountains, has published a pamphlet, entitled "The Importance of the Heredity of Tuberculosis in Comparison with its Propagation by Sputum." It treats of the heredity of tuberculosis, its direct inheritance, its incubation, statistics of heredity, and contagion. Dr. Haupt maintains that the inheritance of tuberculosis from parents or ancestors can not possibly be disputed, and that the theory of absolute contagion is weakly founded. He quotes from the report of the Collective Investigation Committee in respect to the Brompton Hospital, in which the danger of infection is declared to be utterly improbable. Celli, Guarneri, Aufrecht, and others, are of nearly the same opinion. Robertson found that in at least 80 of 100 married couples in which the husband or the wife was consumptive, the other party did not become so. Leudet observed that out of 112 widows and widowers of persons who died of consumption after illness varying from one to twenty years in duration, 105 remained perfectly healthy. During the fourteen years of Dettweiler's work as physician in the Consumption Hospital at Falkenstein, there has not been a single case of infection among the attendants, some of whom were for seven years in constant contact with patients who were dangerously ill. The author quotes the following words of Professor Leyden:

"Immediately after the discovery of the tubercle bacillus there was a tendency to attach much more importance to contagion than before, but further observation has shown that it does not play so very great a part, and that the majority of cases are due to heredity." Of 680 Italian physicians 59 declared for contagion, 124 against it, and 497 mainly for heredity. In England 792 out of 1,078 declared against contagion. Dr. Haupt reports his own experience at Soden thus: Among the 1,500 inhabitants of the place there are 101 who let lodgings. In most of the houses the wives, with sisters or daughters, serve and tend the tuberculous patients who come for treatment. In many houses servant girls from the neighboring villages, hired for the summer, help, making the patients' beds, cleaning their rooms, beating the carpets, removing the sputum-these occupations, so closely connected with the danger of infection, are, among others, the tasks of these persons; and it must be added that they prefer the severest cases, because, as more help is required, the remuneration is higher. In winter the members of the landlords' families occupy the rooms in which generally the most severely affected patients have lain-the rooms on the ground floor. Between 1855 and 1888, 48 of the 238 members of such families died, 10 of them of tuberculosis. In 6 of these 10 cases heredity was demonstrable, and the remaining 4 were due to colds and external causes. Of the 415 servant girls 17 died, 5 of them of tuberculosis, also demonstrably due to other causes than infection. Within thirty years, then, among 653 persons, most of whom were for several summers with and in attendance on the patients, there were 15 deaths from tuberculosis, not caused by infection. The same proportion prevails among other persons in close contact with consumptive patients, attendants, washer-women, etc. As to the general mortality of Soden, the pamphlet contains the following data: Seventy-six persons died during the last three years, 10 aged from eighty to eighty-five, 11 from seventy to eighty, 9 from sixty to seventy. Of these 76 deaths, 7 were due to tuberculosis, including two cases of tuberculous meningitis in children and one of tuberculosis of the bones, also in a child. Of the four other cases, only one was that of a person who came in contact with patients, and this was a case of alcoholism, ending in phthisis.-London Lancet.

OPEN-AIR TREATMENT OF TUBERCULOSIS.— The ever-recurring subject of the treatment of this intractable malady, whose victims in all countries may be put down as legion, was again brought before the French Academy of Medi

cine at a recent sitting by Dr. Daremberg. He advocates what may be called the open-air treatment, and declares that of the number of phthisical people who followed out this method the great majority derived marked benefit. First of all, the fever was found to diminish, which indicated an arrest of the threatened general infection of the body, and a lessened activity in the parts already invaded. As a consequence better nights were passed, the appetite improved, the respiratory movements became more ample, and the cough much less frequent. At the same time that this treatment by abundance of fresh air is being prescribed, it is necessary to forbid all fatigue, even short walks, should the temperature be over 38° C. There is nothing, however, in the method which contra-indicates the use of therapeutic agents and the usual methods of treatment in ordinary use when judged desirable. Patients are found to support the treatment best when lying down in bed rather than when up and sitting, and in this way the treat ment may be begun by at first opening the bedroom window in the morning as soon as the temperature of the air reaches 8° C.

After a

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time it will be found that the night air can, with certain preliminary precautions, be supported and respired with advantage. When gradually habituated to this state of things, it was found that the sufferers bore well the atmospheric disturbances which usually cause so much distress to phthisical people who live a sheltered existence. The attacks of hemoptysis and congestion so frequently observed under these latter conditions are much more rare. must not be overlooked, however, that the almost absolute rest, or at least any thing approaching the smallest overexertion or fatigue, plays an important part in the results obtained, for without doubt exertion and fatigue are, next to the actual tubercle, the greatest enemies of the phthisical. In short, Dr. Daremberg concluded that rest in the open air constituted the most rational method whereby the patient could husband his strength and resources. The results were remarkable even in those suffering from high fever, and undergoing hectic emaciation, and in his opinion the method ought to become the adjuvant of all therapeutical treatment. At the same sitting M. Dujardin. Beaumetz condemned as useless the hot-air method advocated by Weigert.—Ibid.

HEREDITARY CHOREA IN ADULTS.-Dr. Bernatski reports in a Polish medical journal a case occurring in the Warsaw University Clinic, of the so-called " Huntington's chorea," or chronic hereditary St. Vitus' dance in adults. According to the accounts of it given in medical lit

erature, it is an extremely rare affection, appearing in adults and being complicated with mental disturbance. It is hereditary, whole families being affected by it. Irregular incoordinate movements appear first in the facial muscles, and afterward spread to those of the upper extremities and of the trunk. These movements become arrested or diminished during voluntary movements, this constituting, according to Landois, a pathognomonic symptom distinguishing the affection from St. Vitus' dance as described by Sydenham. The majority of authors who mention the disease describe it as incurable. Dr. Bernatski's patient was a man of forty-eight years of age, a shoemaker by trade, who when admitted had been suffering from choreic movements for five years. His mother and his maternal grandfather had been similarly affected. The movements occurred in the head, face, the upper extremities, and in the trunk. At first bromide of potassium was prescribed to the amount of sixty-two grains per diem. This, however, was quite useless, the movements continuing as before. Liquor arsenicalis, that is, of course, the Russian one, which is stronger than that in the British Pharmacopeia, in the ratio of 6 to 5-was then ordered. Six drops per diem were given at first, being gradually increased until ten drops daily were taken. After four days of this treatment there was some perceptible improvement, and by the eleventh or twelfth day the involuntary movements had very nearly ceased, the fingers only showing signs of them. It would, therefore, appear that arsenic is indicated in this disease, and affords some hope of cure. The patient referred to left the hospital and was not seen again. Ibid.

SOME PROPERTIES OF SODIUM SILICO-FLUORIDE.-It is about two years since sodium silicofluoride was introduced as an antiseptic agent, during which time it has been more or less extensively used, and yet there is little new evidence forthcoming in regard to its chemical properties and physiological action.

Some months ago I was engaged in making a series of sterile pancreatic digestions, and after employing many of the current germicides, I determined to employ a sample of "salufer." Upon doing so it was surprising to find that at the end of a few days the digestions were, some of them, absolutely putrid.

The digestions were made in two ways—either a two-per-cent solution of sodium bicarbonate was taken and the silico-fluoride subsequently added to saturation; or a known volume of the saturated solution of sodium silico-fluoride was taken and sufficient sodium carbonate added as would produce a two-per-cent solution.

In the first case the digestion remained aseptic; in the second there was effervescence as the sodiunt carbonate was added, and the digestion became offensive at the end of a few days. In the first case the total fluorine was much greater, I believe, than in the second, existing probably in part as fluoride of sodium, and in part as unaltered silico-fluoride. In the second case the silico-fluoride became converted, on the addition of the sodium bicarbonate, into the silicate and fluoride of sodium, and so little silico-fluoride remained that it was not sufficient in amount to act as a germicide.

It was suggested by Thomson, who discovered the antiseptic action of the fluorides, that surgeons who placed their knives in solutions of sodium silico-fluoride should add a little carbonate of soda in order to prevent corrosion of the steel. Such a procedure appears, in the light of the above facts, to be more than questionable.

With regard to the mode in which the salt acts as an antiseptic, the following facts may prove of interest:

In order to preserve a five-per-cent solution of serum albumen in saline solution, an unmeasured quantity of silico-fluoride was added. After a few days the solution was clearer and free from a hazy turbidity previously noticed, but no trace of proteid was detected in the supernatant liquid. This effect I have never been able to reproduce in the same degree, although a saturated solution of the salt slowly and partially precipitates serum albumen, egg albumen, and paraglobulin from their solutions. In fact, a saturated solution proves an exceedingly delicate test for these proteids. With a saturated solution of the salt, albumen was detected in a sample of urine containing casts, which only gave a reaction with trichlor-acetic acid on mixing, and with picric acid by the contact method, and which gave none on boiling with the addition of a drop of acetic acid, nor with an equal volume of picric acid, nor with acid brine, nor with the cold nitric-acid test. The worst objection to its use as a test is that it must be used by the contact method, and that the drug varies a good deal in composition. Some specimens were acid, others neutral, and the majority alkaline.

While the saturated aqueous solution precipitates some proteids, there is yet another effect of the solid salt akin to that of certain other inert powders. M. Boymond pointed out that the filtration of a solution of serum albumen through bismuth trisnitrate sufficed to remove the proteid from its solution, and I find that upon leaving a solution of serum albumen in contact with an underlying layer of fine sulphur, a jelly-like layer of proteid separates out

and can be seen lying upon the sulphur, while the supernatant fluid is clear. Sodium silicofluoride appears to act in this twofold manner, and one or both of these properties appear to me to offer a possible explanation of its antiseptic action, epecially as similar precipitants of proteid as alcohol, mercuric chloride, picric acid, etc.--are generally antiseptics.

With regard to its internal administration, I can corroborate the results of those who describe it as not so innocuous as it has been represented. A single dose of two grains produced in one case discomfort and nausea. A quarter of a grain thrice daily, exhibited for some weeks, produced, however, no ill effects.

It appears to me not unlikely that it may be decomposed within the body in the same way that it is by sodium carbonate, glass, etc., and that after absorption it is as useless as an "internal germicide" in infective disorders as it is in certain cases in the laboratory.-Dr. E. Lloyd Jones, British Medical Journal.

POISONING BY ANTIFEBRIN.-Dr. J. Vierhuff, of Subbath, in Courland, communicates to the St. Petersburger Medicinische Wochenschrift the notes of a case of antifebrin poisoning, which are quoted in the Lancet, May 24, 1890, and which show what dangers people run who dose themselves with drugs of this class. A healthy young married woman, who had been in the habit of taking antifebrin for headache, feeling the pain come on early one morning last summer took, fasting, about a teaspoonful of the drug in some water. In about ten minutes, the headache not being relieved, she repeated the dose, which her husband remarked might prove dangerous. She consequently took a glass of milk and some alum-water in order to produce vomiting, which she succeeded in doing, but immediately afterward giddiness, singing in the ears, throbbing in the temples, and a dull pain in the head, together with a feeling of weakness, came on, and the face assumed a livid hue. When seen four hours after the drug had been taken the face was a livid color, the lips blue, the pupils contracted, but the heart, temperature, and mental condition were normal. An aperient and a stimulant were ordered. Shortly afterward the patient became suddenly collapsed, the pulse could not be counted and the breathing was very shallow; in fact, the woman appeared to be dying. The soles of the feet were brushed, vinegar was rubbed on the face, and cold water sprinkled over the face and chest; also a mixture of camphorated oil and ether was ordered for injecting subcutaneously. While this was being procured several syringefuls of dilute spirit, which was all that could be obtained, were injected and the patient was