shows that it does not require gastric dilatation with left as remnants of the Graves' disease. Out of 24 stagnation to permit fermentation in spite of the pres- cases of psoriasis 11 were cured and 7 were improved ence of abundant hydrochioric acid, but that rather a by the treatment; in a few cases even tolerably large much smaller degree of disturbance of the motor activity doses seemed to have hardly any effect. It does not is sufficient. The patient had suffered from atony of seem at present possible to distinguish beforehand those the stomach with increased secretion of acid, which was cases of psoriasis which are benefitted by the treatment abundantly present even in the fasting state. In the from those which derive no benefit. Out of 12 cases of stomach,the motor activity of which was only moderately chronic eczema 9 were cured, 2 improved, and 1 got impaired, and notwithstanding a large proportion of worse under the treatment. At the beginning of the free acid, there was a considerable increase of bacteria treatment some of the cases showed an apparent exacer. at all times. The microscopic examination always bation before improvement showed itself. A girl, aged showed a bacterial fermentation, and this was confirmed 25, with slight ichthyosis, improved somewhat under by bacteriological culture. Besides the yeasts and sar-treatment. Two cases of epithelioma and 3 cases of cinæ and various bacilli which are inhabitants of water chronic ulcer of the leg remained uninfluenced by the and readily succeed in getting into the stomach, there treatment. Four cases of lupus vulgaris were treated. was a microbe resembling the bacillus coli commune The thyroidin appears to cause a local reaction some. which was certainly not usually met with. It differed from that bacillus in readily growing and thriving in the normal gastric juice with free hydrochloric acid. It was present at most of the examinations, even when the degree of acidity was high, and it flourished on acid agar. The chief interest of the case, however, was the existence of bacterial fermentation at the climax of digestion, even when there was a high percentage of hydrochloric acid.-The Practitioner.

what resembling, but milder than that caused by tuberculin. The lupus tubercles gradually disapper in some places, whereas fresh ones unnoticed before spring up in other places. The diseased tissue becomes sharply defined under thyroid feeding, and thus perhaps opera. tive treatment may be facilitated. Zum Bush believes that with proper care thyroid treatment in skin affections is not more dangerous than with arsenic or many other drugs. He thinks it may sometimes be of service where other methods have failed, and that in chronic skin eruptions the combination of local external treatment with intereal thyroid treatment is likely to give good results.-Brit. Med. Jour.

Thyroid Feeding.-Zum Busch (Dermatol. Zeit schrift), gives the results of thyroid feeding observed by him in various diseases. He likewise tried it for a considerable time in two healthy men, and noticed in them no effect at all except slight change in the body Internal Localization of the Gonococcus. weight, and in the amount of urine and urea excreted.-Bordoni- Uffreduzzi (Archives Italiennes de Biologie), These negative results in healthy people correspond records observations and experiments which appear to with the experience of Leichtenstern and Wendelstadt. furnish conclusive evidence that the gonococcus is able On the other hand, in patients with cutaneous affections to diffuse itself in the internal parts of the organism, various general effects were observed. The loss of weight and to give rise to inflammatory conditions. A case ob. was usually considerable, especially at the beginning of served by Mazza is first referred to, in which bilateral the treatment; there was considerable increase in the pleurisy and polyarthritis developed during an attack of amount of the urine and of urea excreted, the amount gonorrhea. The pleuritic effusion contained micrococci, was often doubled, and the pulse frequency was often which presented, microscopically and on cultivation, increased by ten or twenty beats. Disagreeable symp the characters of Neisser's gonococci. The author re toms were seldom observed, but when observed they lates a case of gonorrhea in which muliple arthritis deconsisted in great frequency of pulse, palpitation, head veloped. A quantity of fluid was taken from a joint, ache, faintness, tremors, and sweating. The appetite with bacteriological precautions. In the pus cells of this was usually good, but vomiting occurred in two cases, fluid the author discovered micro organisms having the both of children treated with rather large doses. In characters of the gonococcus as regards microscopical spite of the observation of Ewald, the thyroid feeding appearance and peculiarities of staining. After cultivanever produced albuminuria or glycosuria. In one case tion on a mixture of agar-agar and human blood serum it so happened that though temporary glycosuria had micro organisms were obtained which had the same been observed before the thyroid feeding was com characters as those in the pus cells. In order to furnish menced, it never reappeared during the treatment. In more conclusive evidence, the urethra of a healthy young all the five cases of myxedema treated the improvement man who had never suffered from gonorrhea, and who was rapid and striking The fifth case was particularly had not had sexual connection for four months, was ininteresting. The patient was a woman, aged 21, who oculated with a small quantity of material taken from was admitted with the symptoms of Graves' disease, and the second generation of a cultivation of the microwhilst under observation the symptoms of myxedema organism. (The inoculation was performed with the supervened, and partially replaced those of the Graves' man's consent.) The parts were examined for the disease. The myxedema was got rid of by the thyroid gonococcus before the inoculation, but only the orditreatment, but the exophthalmos and Graefe's sign were uary bacilli of the smegma were found. The glans

pesis, and meatus were then washed in sterilized water, A Case of Bromoform Exanthem. - The and the micro organisms deposited in the urethra a little author speaks of the ease of diagnosis in typical cases beyond the meatus. A typical attack of gonorrhea was the result, and gonococci were found in the discharge. -Brit Med. Jour.

of drug eruptions, such as those due to quinine, antipy. rine, iodine, and the bromides, reporting here an interesting eruption due to the administration of bromoform in a child.

Three weeks before the patient was first seen an erup. tion appeared, beginning as papules on the face and on the left leg. New lesions appeared constantly, many becoming confluent and growing rapidly, some becom ing greatly elevated from the surface of the skin. No syphilitic family history was obtained.

Xanthoma Diabeticosum, with Report of a Case. This rare disease, of which eighteen cases have been reported, shows itself as a subacute inflam mation of the skin, characterized by the appearance of discrete or confluent papules. The papules are of a dull red color, often with yellowish summits, from the size of a pinhead to that of a pea. The skin lesion is asso- The child, when first seen, September 30, exhibited an ciated with glycosuria, comes on rapidly, and disappears enormous lesion on the right wrist joint, encircling it as the constitutional condition improves. Over the one half way as a bracelet. This lesion was 5.5 ctm. papules are often seen dilated capillaries. There is long, 3 broad, and 6 to 7 ctm. high, resembling a new usually itching, pricking, or tenderness in the lesions growth in appearance. Its edges showed it to be made It is rare to find the disease unassociated with glycos-up of three distinct lesions. It was not sensitive to uria; it is more often found in males than females. The touch, soft and succulent on palpation, and of a bluishpatients are usually corpulent and in apparently good gray hue. The upper surface was composed of small health. The prognosis is favorable, although the affec pustules. In the middle of the mass there was a depres tion may recur. The diagnosis is to be made from ordi- sion, suggesting a retrocession of the process. At the nary xanthoma. periphery the growth was extending, giving, therefore, acne at the periphery, and, toward the center, pustules and papillary lesions. On the posterior surface of the thigh and leg several more plague-like lesions were present, larger upon the lower than upon the upper part of the thigh. These were not so high, but were of the same general appearance, consistency, color, and had the depressed center, as noted above. At the middle of the forehead was a typical acne pustule. On the left cheek was a grayish yellow wart like lesion, 2.5 ctm. in diameter. Scalp, breast, abdomen, and back were free. On the posterior aspect of the left shoulder, a papilloma, the size of a penny, was observed. The thighs were covered with many discrete acne pustules. There were a few larger ulcerating spots arranged in rosettes, with a pustular base and surrounded by a zone of redness.

Pathologically, it shown an inflammatory affection, according to the majority of observers. Large endothetial and giant cells are seen in chronic inflammations, and the fatty degeneration is analogous to that seen in the atheroma of arteries. The pathology of the ordinary xanthoma is said to be of a different character, and shows, accordidg to Touton, neoplastic growth.

The case reported is that of a man, 34 years old, who felt perfectly well, and who consulted the physician because of his skin. Six weeks after the onset of the skin lesions, the urine, to which attention was directed by the character of the eruption, showed an abundance of glucose, thirst was increased, and the amount of urine voided was greater than normal.

The skin presented the following lesions: Pinhead to pea sized, obtusely conical, discrete papules of a yel lowish red color, of dense consistence, sharply defined, and elevated about one sixteenth of an inch above the surface of the skin. Small dilated capillaries were pres ent; the color of the lesions was uniform. About seven hundred papules existed, distributed upon the arms, neck, axillary folds, loins, buttocks, thighs and hands.

The patient improved greatly upon anti diabetic treat ment. Owing to the fact that the excised papule was hardened in alcohol, no fat was detected. Under a low power there was seen a dense but sharply circumscribed cell-infiltration, involving the papillary bodies and extending deep into the corium. These cells were leucoThere was dilatation

The author states that the acne pustule on the forehead and similar ones on the thigh aroused his suspicions as to a drug eruption, that of iodism occurring to him at first. A careful history then elicited the fact that in twenty-five days, beginning the latter part of August, twenty three grains of bromoform had been administered for pertussis. The fifth day after the first dose was given a few pustules appeared. On October 2, when child was seen the second time, the lesion on the arm had increased in height and the two large lesions on the thigh in circumference. The lesions on the left cheek showed improvement, while on the head and cheek there were several fresh pustles. On the left cytes and connective tissue cells. cheek, in the center of the large lesion, normal skin was of the papillary vessels, and a few large endothelial present. In the gluteal regions, the acne pustules had cells were found in the lumina of these vessels. The spread and had become rapidly papillomatous, reaching xanthoma giant cells, some of them multinucleated, were a height of about 3 ctm., and forming rosettes in out. scattered here and there. Some of the sweat glands showed infiltration. The papule was in the vicinity of a hair follicle, which was also invaded.-Amer. Med.Surg Bull.

line. The tuberous excrescences simulated keloids, and upon section, blood exuded. The upper surface was raspberry like, reddish brown in color, and shining, and between the excrescences small yellow points were

noted. The large plaques in the wrist lesion, although tion and insufficiency of the pylorus. (2) Delayed continuing to spread at the periphery, were diminish evacuation without dilatation. Here the period of digesing in height and clearing in the center.

A solution of salicylic acid, lactic acid, and traumati cin was applied, and, internally, Fowler's solution was given. Improvement was noticed at once, keloidal changes taking place quickly, and the lesions more and more resembling condylomata. An occasional fresh pus tule was noted. Acute gastro-intestinal disturbances necessitated the discontinuance of the arsenic eleven days after it was begun. In two months from the time that the child was first seen she was well. All the warts had disappeared, leaving a simple pigmentation, vary ing from a bright red to a dark brown color.

tion is considerably prolonged. The anatomical sub stratum consists in a parenchymatous gastritis with hyperpepsia and hypersecretion. It may last long with out ending in dilatation. The diagnosis is chiefly made by chemical investigation and subjective symptoms. (3) Delayed evacuation with dilatation. Prolonged digestion with slow evacuation as the most common cause. Among these come the dilatations due to atony, mechanical obstruction, etc. Whether a gastritis with delayed eva. cuation or mechanical obstruction is the first cause the mechanism is the same. The organ hypertrophies owing to overwork, this hypertrophy ending in atrophy and The lesions present had included papules, pustules, atony. Three phases may be recognized, (a) gastritis superficial ulcers, ulcus elevatus, and papillomatous with subintrant digestion, that is, during the day be tumors. Dr. Muller differentiates from syphills, which fore the stomach is emptied another meal is taken; the the case so closely resembled. The polymorphous stomach thus only becomes empty during the long recharacter of the eruption, the lack of pruritus, the pres-pose of the night. This produces excessive distension ence of condylomata, the central clearing, and the ap which itself leads to dilatation. Nutrition is generally pearence of fresh pustules many days after the bromo affected; there is wasting with excess of appetite; (b) form had been discontinued, speak in favor of syphilis. phase of active dilatation or dilatation with hypertro On the other hand, the non-symmetrical arrangement of phy. The organ still empties itself during the night. the lesions, the absence of mucous patches, the ex The stomach with excessive work to do, presents anal tremely rapid development of the excrescences, the apogies to the heart in obstructed circulatiou; (c) phase pearance of the acne pustules, militate against such a of atonic dilatation. The stomach often contains more diagnosis. The author also differentiaties the case from gas than flaid. Atrophy has succeeded hyertrophy. pemphigus vegetans. The question to be considered in The mucous membrane becomes thinner, and the muscuthe prognosis is the duration of the lesions and the coslar coat loses its normal structure. Sometimes a stretchmetic results. In the treatment any method which will invade the subcutaneous tissues is to be avoided-Amer. Med. Surg. Bull.

ing of the pylorus with augmentation of the gatro-intestinal angle is superadded. This the outcome of a local peritonitis, which later is in all probability the result of the gastritis. These adhesions have been looked upon by some (Glenard) as supplementary ligaments, but they do not exist in the child.-Brit. Med Jour.

Stomach Diseases. - Hayem and Lion (Arch gen. de Med.), begin a discussion as to the investigation and diagnostic application of objective signs. Notwithstanding the great advances recently made there are The Neurotic Element in Pulmonary Constill many difficulties. The subject is divided into the sumption.-Many observers have advocated that physical and chemical investigation. The objects of consumption is attributable to a disordered nervous systhe physical examination are to make out the situation, tem. The author lays down the proposition that any shape, dimensions of the stomach, its structural changes, agent which interferes with the respiratory nerves in the ease with which it can empty itself and the influence particular, or with the nervous system in general, has of adjacent organs upon it. The authors attach great importance to the influence of deformities of the chest as produced by the corset (corset disease). Three varities of these constrictions producing gastric symptoms are described: (1) The submammary, causing ptosis (enteroptosis of Glenard) and the displacement of the organs; (2) the hepatic, producing constriction of organs without necessarily ptosis. Here the pylorus may be compressed between the liver and the vertebral column, giving rise to mechanical obstruction; and (3) the subhepatic, leading to upward displacement and respiratory difficulties. The authors then shortly describe the nor mal gastric functions, including the localization of the lower limit of the stomach and the duration of diges tion. Under the morbid conditions the following are discussed: (1) Premature evacution of the stomach produced by chronic gastritis, with diminution of secre

the power to produce pulmonary phthisis and other lung troubles. He has found over one hundred cases of phthisis in literature, where either the pneumogastric nerves or the respiratory centers were in a pathological state due to injury or syphilis, alcoholism, diphtheria, measles, diabetes, multiple neuritis, locomotor ataxia, bulbar paralysis, tumor of the pons, etc. Phthisis fol. lows many nerve poisons.

Kussmaul's investigations show that a majority of workers in mercury, who have mercurial intoxication, also contract phthisis. The children of those engaged in mercury manufacture are exceedingly apt to have scrofula, rickets and pulmonary phthisis. An instance is given of a worker in mercury whose three wives, also working in mercury, died of phthisis. Five of his children also became phthisical. The children born before the mother began working in mercury were well. Lead

deteriorates the nervous system and provokes pulmonary trition and predisposed to tuberculous conditions." In phthisis. According to statistics the disease is from a history of 100 families, recorded by Dr. I. U. Kerlin, two to three times more prevalent among lead workers in each of which there was a case of idiocy, there were, in Wales than among the farmers in the same locality, or among the general population of England and Wales. The abuse of alcohol is one of the most potent agents in the production of phthisis. This agent produces a poisonous influence on the peripheral nerves. A parenchymatous degeneration with more or less interstitial neuritis can often be noticed on close observation.

Syphilis, the virus of which is another nerve poison, is often the unsuspected cause of pulmonary disease; we find in this a proliferation of the interstitial connective tissue, peri bronchial induration, thickening of the lobular parenchyma, broncho pneumonia, etc.

A specific spasmodic affection of the nerves is seen in pertussis. The pulmonary changes in pertussis are interesting, because they show a direct relation between the disease of the nerve and the organ it supplies. In cases of pertussis there are congestion of the pharyngeal, laryngeal, and bronchial mucous membrane and of the lungs, together with dyspnea and feeble respiratory sounds. Epistaxis, hemoptysis, emphysema, chronic bronchitis, broncho pneumonia, and phthisis are frequent complications.

Influenza is essentially a disease of the nervous sys. tem. Walsbe says the disease seems to exert a special influence on the pneumogastric nerve.

Cerebro spinal meningitis is nearly always associated with pulmonary disorder. Other diseases in which the nervous system and the lungs are affected are beri-beri, pellagra, diabetes and leprosy.

In epilepsy the medulla oblongata is involved, and in this area must be sought the long-recognized association between epilepsy and pulmonary disease. Echeverria states: "I have more closely investigated the relation of pulmonary tuberculosis and epilepsy, and undoubt. edly the genesis of tubercles in the lungs is favored by the lesion in the medulla oblongata proper to epilepsy. I have traced the pulmonary trouble from its inception, and feel convinced that the association is more than a casual coincidence of both morbid conditions."

Asthma is a spasmodic affection of the pneumogastric

nerve.

There is not much clinical evidence to support the belief that asthmatics are long-lived. Despite the fact that asthma and lung phthisis are supposed to be antagonistic. Fuller states that many asthmatics die of phthisis. Williams shows that in 385 cases of phthisis, 7 began with asthma.

among the grandparents, parents, brothers and sisters, 145 cases of phthisis. Among the hereditary causes of idiocy and imbecility phthisis ranks the highest, with a per cent of 28.31, while insanity, epilepsy, and alcoholism have a pertentage respectively of 16.47, 8 69 and 16 38 Dr. Langdon Smith says: "It appears to me that tuberculosis must be accepted as one important cause of idiocy, that it impresses special characters thereon, while imparting a strong family likeness to the subjects of this class." It is no less clear that idiocy of a non tuberculosis orgin leads to tuberculosis. Whether through the influence of the pneumogastric, malassimilation of food or defective innervation, the connection between the two is more than accidental. Many writers have noticed the clinical association between pulmonary disase and insanity. It is said that the death-rate from phthisis among the insane is four times greater than among the general population.-Thomas J. Mays in Lancet; Amer. Med.-Surg. Bull.

On the Diagnostic Importance and Treatment of Albuminuria.-From the time that albumin was found in the urine of people other than those afflicted with nephritis, and even of people apparently in good health, albuminuria lost much of its terrible significance as a symptom.

In determining the importance of albuminuria, three questions present themselves to the physician:

1. Is there a form of albuminuria which is not a symptom of any diseased condition, and under what circumstances do we find it in healthy individuals?

2. In what pathological conditions, other than renal diseases, does albuminuria exist?

3. What is its importance in the diagnosis of renal diseases?

The author in this article limits the meaning of the term albuminuria to true albuminuria, in contradistinc. tion to the spurious variety, in which the albumin depends on the mingling with the urine of particles from the urinary tract.

He believes that the first of these important questions has been satisfactorily answered, and he states that there is a physiological albuminuria. For our knowledge of this condition we are indebted to Senator, who regards urine as a mixture, consisting of the albuminous The respiratory organs are implicated in hysteria, as transudate of the glomeruli and the non albuminous seen in dyspnea, aphonia, laryngeal paralysis, etc., and secretion of the uriniferous tubules. This eminent authis has a tendency to cause lung disease, either in the thority also believes that every specimen of urine con. individual or in the offspring. Among the grandparents, tains traces of albumin, but that we are unable in many uncles, aunts, brothers, and sisters of 44 hysterical instances, to detect them by the ordinary methods. patients, there were 60 who had phthisis. In 2,380 idiots and imbeciles 28.31 per cent were phthisical. Among the last 100 post-mortems on idiots, at Eirlswood Asylum, 62 were found to have had phthisis. Under what conditions may we get an excretion of "Defective innervation, in all probability, led to malnu- albumin in the urine of healthy individuals? The latest

Practical experience supports this theory by finding albumin in the urine of a large number of perfectly healthy individuals.

investigations on this subject have determined the following:

3. Conditions under which albumin is excreted. Must consider the various groups of causes mentioned

(a) Albumin may be excreted in the urine of healthy above. individuals without any demonstrable cause. It is 4. Excretion of albumin. In physiological albuminusually found in persons of middle age, may be present uria small quantities of albumin are found, and then for longer or shorter periods of time, lasting for years, only for short periods of time. If the excretion of without deteriorating the general condition of the indi- albumin persist for some time, even though the quanviduals, and without giving rise to renal lesions. tity be small, the case becomes suspicious.

In speaking of the treatment the writer says that these three facts must not be overlooked:

(1) The quantity of albumin excreted is not an indi. cation of the severity of the disease.

(b) There are certain conditions which the temporary appearance of albumin in the urine of healthy persons, for example, muscular movement and exertion, certain sensitive irritations, and a number of psychical condi tions, emotions, etc. Spiegler has shown that the slight (2) External influences may cause it to vary so greatly est disturbance of either the physical or psychical equili❘ that it is difficut to foresee the influence therapeutics brium of an individual can bring on albuminuria. Even will have.

such slight peripheral irritation as the itching sensation (3) The loss of albumin as such is so minute as to in scabies and eczema is able to produce this result A seem to be of no influence on the chemical changes in diet rich in albuminous foods can produce a temporary the individual. There is a greater loss of albumin in albuminuria, although this is not always the case, and suppurating wounds and in purulent discharges, as otornot in all individuals. Cold baths also call forth albu rhea and gonorrhea, than in chronic nephritis. min in the urine of some people.

The writer says it is no longer admissible to interpret the symptoms as belonging to cases of latent renal dis eases which become manifest later on, for, he says, not only have the investigations been made on soldiers, the healthiest kind of material, but its frequent occurrence, as shown by our improved methods of examination, is entirely out of proportion to the number of cases of renal disease.

The second question is answered by classifying the conditions into groups. In the first of these groups the author put all the diseases which bring about a change in the composition of the blood, as well as the diseases of the blood itself. The albuminuria of young people at the time of puberty, and of children, then that caused by hemoglobinuria and hemoglobinemia, as well as that found in the severer forms of anemia, leucemia, and diabetes, belong in this group.

The second group comprises the albuminuria caused by disturbances in the circulatory apparatus, such as the albuminuria of pregnancy, of general congestion, de pending on cardiac lesions and emphysema and of partial congestion in the sphere of the inferior vena cava and renal veins, etc.

The diet recommended by the author consists of milk, fish, white meats (without the addition of spice), together with large quantities of fats and carbohydrates. Alcoholic stimulants are practically avoided. Some stress is laid on good hygienic surrroundings, etc.-P. F. Richter in Aerztl Praktiker; Amer. Med-Surg. Bull.

The Role of Alcohol in the Treatment of Heart Disease.-Alcohol, particularly in heart dis ease, should be prescribed only for a definite purpose, and in measured, stated doses. A degenerated myocardium leads to dilatation of its chambers. There is a tendency to faintness or actual snycope; cardiac dullness is increased with an indefiniteness of the the apex beat and muffling of the first sound. Such cases should have a stimulant ready at hand. Alcohol, when not needed, works harm by unduly exciting an already weakened heart. An alcoholic gastric catarrh produces a disgust for food, and thus the general nutrition is affected. A congested mucous membrane is easily irritated.

The histories of these cases show an excess in the use of alcohol extending over many years. The beer drinker is bloated in appearance, with a liver enlarged out of proportion to his cardiac difficulty, and has much subcutaneous fat. The spirit drinker, sometime fat, may be thin, with even a contracted liver. When there is de

The diseases of the nervous system constitute the causative agents put in the third class, while the fourth group consists of the so called febrile albuminuria. The following points will enable the general practi-generation of the myocardium in both cases, the symp tioner to decide whether or not an albuminuria is ac companied by pathological changes in the individual:

1. General condition of the individual. He must show no signs whatever of disturbed good health, if the albuminuria is to be regarded as physiological. This kind of albuminuria appears only in youth and middle age.

2. The urine. We can not think of physiological albuminuria when the daily quantity of urine varies from the normal, and when we find corpuscular elements, especially leucocytes and casts.

toms are identical. The beer-drinker is more liable to pulmonary emphysema, masking the pulmonary enlargement. Excessive beer drinking seems directly responsible for some cases of heart disease. In Munich it is said that heart disease is very prevalent. The consumption of beer there is 565 liter per head annually.

When besides the signs of intemperance there is dys. pnea, which the condition of the lungs does not warrant, then degenerative changes should be looked for in the heart and blood vessels, and the kidneys examined. In such cases alcohol should not be thoughtlessly pre