as well as that in the cases of mitral regurgitation renders it probable that the drug may, after the maintenance of a maximum bloodpressure in the renal arterioles, so constrict these as to impede the blood-supply. It will be well, therefore, with convallaria, as with digitalis, to suspend the administration at intervals. It is a fair conclusion that convallaria is an important diuretic in cases of mitral stenosis, comparable in its effects with caffeine in mitral regurgitation, and that its effects in this direction are more pronounced in the obstructive than in the regurgitant lesion. We will now consider the cases of mitral stenosis in reference to the

Effects of convallaria on the pulse and respiration. In one case the pulse rate progressively fell under ten-grain doses of the convallaria extract, from 112 to 80, 76 and 72, and after suspension of the drug rose to 92, to again fall under digitalis to 70. In another case the pulse-rate which under ten-minim doses of tincture of digitalis had increased from 99 to 110, decreased under convallaria to 102 and 64, rising after the suspension of the drug to 72 and 120. The sphygmographic evidence is more valuable and more conclusive from the mere observation of the rate of the pulse.

The breathing was improved under the drug in nearly all the cases; in one case there was severe dyspnoea, which lasted during a fortnight (in this case bronchitis and emphysema existed in marked degree), but afterwards there was gradual improvement, and the patient left the hospital free from all distressing symptoms. It was evident that in these cases the drug acted very favorably. Only one case died in hospital; in this pericarditis and severe pulmonary complications were manifested; the patient improving during the time that convallaria was administered, and the temperature was reduced from 101° to normal, but after the omission of the convallaria the temperature rose to 103°; the patient died suddenly after having for a time considerably improved.

So far as I have been able to judge, convallaria compares favorably with caffeine in the treatment of mitral stenosis. In one case a girl, aged seventeen, in whom there existed tricuspid regurgitation in addition to mitral stenosis and regurgitation, the quantity of urine rose from a maximum of 30 oz. to 54 oz.; but in regard to the pulse and respiration there was no perceptible influence. In another case of stenosis with oedema, the daily urine rose only from 36 oz. to 40 oz., and here also the pulse and respiration were not perceptibly influenced; the patient died. I was not encouraged to repeat the treatment by caffeine in the cases of mitral stenosis whilst I obtained such good results with convallaria; but in cases of this affection manifesting edema or ascites, where a diuretic effect could not readily be obtained by convallaria, I should administer caffeine in addition.

My general conclusions are that caffeine is an agent of great value in the treatment of cases of mitral regurgitation, especially those in which there is much dropsy; and that convallaria, though manifesting no very favorable influence in cases of mitral regurgitation, except as an occasional substitute for digitalis, is of considerable therapeutic importance in mitral stenosis.

COFFEE AS A DISINFECTANT.-Years ago some studious German made the observation, the correctness of which he endeavored, and to a great extent also succeeded, to establish, by statistical data, that coffee, if taken early in the morning on an empty stomach, acted as a preventive against infectious and mainly acute epidemic diseases. He quoted a great number of cases where individuals accustomed to drink a cup of hot coffee for breakfast, had either escaped an epidemic of typhoid then ravaging the part of Germany in which the observer lived, or if attacked by the disease, contracted it in a much milder form; while all those who died from the disease had not been in the habit of taking coffee in the morning. This was a good number of years ago, at a time when in many parts of Germany coffee was still either an unknown, or so costly a beverage as to be looked upon as a luxury that only the rich could enjoy. We have forgotten the name of the physician, but remember that the medical profession did not take kindly to the idea of coffee being a disinfectant, or as they then said, an anti-zymotic, and those who could not deny the correctness of the observation itself, ascribed the apparent immunity to other causes, many to the hot water with which the coffee was prepared.

That the physician, however, has not been so wrong, has been but recently proved. During the last meeting of the Prussian army surgeons in Berlin, medical director OPPLER reported that after extensive investigations, which he related in detail, he had discovered that we possess in coffee an antiseptic remedy of no mean value, but one which could well serve for the purposes of a first dressing of a wound received in a battle. If employed at once it totally prevented suppuration, but if used after pus has already accumulated in the wound, it leads to the formation of a scab, beneath which the wound heals with complete asepsis. The coffee should be employed in the form of a powder, and as it might entail the loss of valuable time to have to grind first the roasted coffee bean, which in Prussia every soldier is bound to carry with him, O. recommends the use of caffee-tablets, which have been recently discovered by a Hamburg firm, and which answer their purpose admirably well, as it is only necessary to rub these tablets a little. when they at once assume a powder form.

DR. OPPLER presented two cases at the meeting, where an injury of the head, accompanied by a great deal of laceration of the soft tissnes, had been treated with powdered coffee alone. and when the wounds had healed as well and as quickly as under strict aseptic treament. He applies the coffee in a similar manner as gypsum is used in bandaging, viz.: he takes a gauze-bandage and partly spreads the powdered coffee over it, partly presses it into the bandage, with which the wound is to be covered.

He also made some experiments with urine. blood, glue, and meat, which under the aseptic influence of coffee he managed to preserve for a long time in an unaltered condition. A colleague of his employed a salve, to which coffee had been added, in two cases of eczema, connected with a great deal of moisture, and in both cases a rapid cure resulted.

The aseptic action of coffee seems to be less

due to the caffein than to the aromatic constituents, which are set free when coffee is roasted. Considering the cheapness of coffee and its easy procurement, OPPLER'S discovery may yet prove of great value.-Med. and Surg. Reporter, Apr. 10, 1886.

ATROPIA HYPODERMICALLY TO PREVENT THE HEART DEPRESSANT EFFECTS OF CHLOROFORM.-Medical men are well aware (some painfully so) of the fact that the administration of chloroform is a dangerous procedure, excepting, perhaps, in obstetrical cases, and are very reluctant in giving it in general surgical practice, because of its paralyzing action upon the heart. Probably every medical student in America has been warned, emphatically, during his college course, about the danger of administering chloroform; indeed, so great stress is put upon it that many enter practice with the determination never to try it, and I have met with physicians who have been in active practice for a number of years, and who have told me they had never yet dared to give chloroform. I, myself, started out with the same determination, but I soon found that time was too precious and the effects of ether too disgusting to hold me to the old resolution; therefore, I began anew the reading of therapeutics and physiology, with the view of finding some drug which might counteract the effects of chloroform or be antagonistic to it. I began to experiment practically, by trying spirits of ammonia aromat, brandy, and all the cardiac stimulants; but in many cases (the usual percentage) the lips and nose were as blue as though I had used no stimulant, and the pulse as small and weak. I investigated thoroughly the physiological action of nearly all the prominent drugs in the materia medica and studied their action upon the different structures, especially the brain and spinal cord, and the result was a choice of belladonna.

Now, this drug is physiologically antagonistic to chloroform, it paralyzes the termination of the pneumogastric nerve in both heart and lungs-as proven by DRS. RINGER, H. C. WOOD and others-and stimulates the sympathetic, which is exactly the reverse action of chloroform. I therefore concluded to try the hypodermic injection of one-twentieth of a grain of atropia at the next opportunity and watch the result. The subject was a lady, having already a weak heart and in a run down condition from the effects of malignant disease of the breast (the skin being considerably involved). I gave her the above dose of atropia hypodermically, and then began the administration of the anæsthetic. She took it without a murmur; there was no trouble in breathing, no blue lips or nose, and the heart's beat was regular and even stronger than usual, and I completed the operation without a single bad symptom.

This was the first encouragement, and I concluded to try it in every case where an anæsthetic was needed, which I did, with similar results.

Care must be exercised, however, against too large doses of belladonna, lest the sympathetic nerve force become exhausted by over-stimulation.-DR. J. C. KERR, in So. Cal. Prac.

TREATMENT OF HERNIA BY INJECTIONS OF OAK BARK WITHOUT CONFINEMENT TO BED. -In an article on the treatment of hernia by W. B. DEGARMO, M. D., published in the Med. Record April 3d, 1886, the author alludes as follows to the use of injections of oak bark, viz: In closing this somewhat disconnected paper, I desire to bring before you a method for which I expect, at a later date, to claim an important place in the list of means at our command for the palliative treatment of hernia.

I expect to make even broader claims for it, as my experience confirms me in the belief that in this method, combined with the skilful mechanical treatment of hernia, we have the means which will afford the greatest relief, and produce the largest number of cures attainable. I refer to the injection of the extract of white oak bark into the inguinal canal, in quanties of from five to ten minims, repeated at intervals of about two weeks, and this without confinement to bed, or detention from ordinary business.

The fluid used is after the well-known Heaton formula, and the injection is made into the outside the hernial sac.

The patient is first supplied with an accurately fitted truss, which shall retain the hernia as perfectly as possible; after this has been worn for about one week the first injection is made, and is made in the following manner: With the patient in the recumbent posture, the end of the forefinger of the right hand is passed into the external ring by invaginating the scrotal tissues, the cord and sac being held to the outside of the finger. The forefinger of the left hand is now pressed firmly over the end of the finger that is in the ring, and as the latter is withdrawn, the former is pressed directly into the ring. The needle is passed at the end of the left forefinger directly into the canal, and the fluid gradually deposited. Where the subcutaneous tissues are thin, an ordinary strong hypodermic needle is used, but in cases with a thick deposit of adipose tissue covering the external ring, the hernial syringe described by me in the Medical Record of February 7th, 1880, is employed.

Slight discomfort follows the injection, which usually continues for two or three days, and the parts are sensitive for a week afterward. The truss is worn constantly, even at night, if too much discomfort is not produced. As the injections are repeated the truss-pressure is reduced.

I make this preliminary report on this method merely to place it before the profession, that others who so desire may also use it. My first case was treated by this method two years since, and resulted in a complete cure after five injections. I have used it for the past year at the Polyclinic, and with results which warrant my bringing it before you.

I have now in course of preparation a paper on the "Treatment of Hernia by Injection," which will include full particulars respecting this method.

CONSTIPATION AND ITS TREATMENT.-The causes of constipation may be either local or general.

Under the local causes we may include pressure on the intestines by tumor from without, as in the gravid uterus: growths in the

wall of the intestine, as in cancer; and obstruction of the canal by means of the fæces, intestinal worms, etc.

Under the general causes we include sluggishness of function, as in anæmia and the lymphatic temperament; sedentary habits; too great muscular activity; prolonged mental application; the continued use of aperients; the abuse of alcohol and tobacco; and general errors in diet. All these tend to produce constipation by causing dryness and hardness of the contents of the intestine from deficient secretion or too active absorption of fluid from the intestinal tract. There is usually present at the same time deficient muscular contraction of the muscular coat of the intestine, and this naturally increases constipation when the fæces are already hard and dry.

When constipation is once fully induced the evacuations are infrequent, solid, and deficient in quantity. They are hard and dry, and usually dark in color, and the depth of the color is greater the longer the fæcal masses have been retained within the large intestine. The tongue is coated, the breath fœtid, and there is usually a certain amount of acidity and flatulence, lassitude of body and mind, headache, and a hot sensation at the top of the head.

We will only mention the treatment of the general causes of constipation, as these are the most common, and, as a rule, less serious than the local causes.

Attention must, of course, be paid to diet, and to the general surroundings. Moderation in eating and drinking, and a certain amount of daily exercise, without any purely medicinal remedies, will often have the desired effect. A tumbler of hot water, taken twice daily one hour before food, aids the mucous ecretion from the bowels and increases the peristaltic action. In the majority of cases, however, such simple remedies are of no avail, and recourse must be had to medicinal remedies. Active purgatives, as a rule, are to be avoided, as, although giving relief for one or two days, they are usually followed by more obstinate constipation. An enema of half a pint of olive oil nightly, and retained in the bowels during the night, frequently produces an easy evacuation in the morning.

Many drugs, such as quinine, iron, nux vomica, and belladonna are useful. Within the last two years, much benefit, and frequently perfect cures, have been obtained by the use of the liquid cascara sagrada (PARKE, DAVIS & Co.) It should be given in tonic doses of from ten to twenty drops, in a wine-glass of water, three times daily, before food. A single large dose taken in the morning does not give the same satisfactory results, and frequently does harm. The use of the drug in the tonic doses above described may be continued for several months at a time, and the dose does not require to be increased; and in many cases it may be found actually beneficial to diminish the quantity taken each time.-Health.

ACTION OF GRINDELIA ROBUSTA ON THE HEART AND CIRCULATION. - Following the suggestion of PROFESSOR S. P. BOTKIN. DR. V. P. DOBROKLONSKY, of St. Petersburg, has undertaken (Ejenedelnaia Klinitcheskaia Gazeta, No. 34, 1884. p. 535) a series of experiments on

frogs, in order to examine the action of fluid extract of grindelia robusta (PARKE, DAVIS & Co.) on the heart and circulation. The main results may be summarized as follows: 1. In small pharmacological doses (01 to 0-2 cubie centimetre) the drug causes a slight and fleeting quickening of the heart and an increase of the arterial tension, lasting for several tens of minutes. 2. In large pharmacological doses (04 to 0.6 cubic centimetre) it decreases both the frequency of the heart and the arterial tension, the heart ultimately stopping in diastole. 3. In moderate pharmacological doses (0-2 to 04 cubic centimetre) the drug, in the beginning, slightly quickens the cardiac contractions and elevates the blood-pressure, but subse quently gradually, but considerably, slows the heart, the arterial tension falling somewhat later. 4. In toxic doses (0.6 cubic centimetre and upwards) the drug swiftly stops the heart in diastole. 5. A preceding division of the spinal cord, or of the vagi and sympathetic, or of both of the cord and nerves named, or a preceding subcutaneous injection of sulphate of atropine, does not change the phenomena as stated above; but when made after the subcutaneous injection of grindelia, they diminish the number of cardiac contractions from seven to six a minute. 6. A series of experiments with an isolated heart gave essentially the same results as the experiments with the whole animal. 7. Small doses of the extract cause constriction of the arteries; moderate doses first contract and then dilate the vessels; and large doses dilate the latter from the very beginning. 8. Moderate doses rapidly bring about a decrease of excitabilily of nerves and muscles; the excitability of nerves sinks somewhat sooner. and from comparatively lesser doses than that of muscles. DR. DOBROKLONSKY at present studies the action of grindelia on warm-blooded animals; he mentions, however, in his present note that the results obtained up to the date have been, in their essential features, identical with those for cold-blooded animals..-London Medical Record.

TREATMENT OF STRANGULATED HERNIA BY IRRIGATION OF ETHER.-The Canadian Practitioner, Feb., 1876, refers to this method advocated by BARTOSZ, FINKELNSTEIN, KRAVOSKY, and FILATOFF. FINKELNSTEIN'S method consists in pouring on the tumor, every half hour, a large tablespoonful of ether, and allowing it to gradually evaporate. The hernis disappeared spontaneously, or in the worst cases by means of a slight pressure, in the course of four or five hours at the most. The duration of strangulation varied in different cases from a few hours to some days. The author relates also a case of intestinal occlusion in a woman aged 60, with absolute constipation for nine days, incessant fecaloid vomiting, tympanitis, filiform pulse, etc., in which, after ineffectual trials of every known method, the irrigation of ether all over the abdomen caused at the expiration of an hour and a half, very copious stools, and the cure of the patient. The method of irrigation extolled by BARTOSZ can readily be replaced by pulverization or by the evaporation by means of a bellows of the ether poured drop by drop on the tumor. In fine, whatever be the method adopted, the ether acts in the same way as an icebag, by the refrigeration

that its evaporation produces. It is readily applied, and is to be cautiously advised in cases of strangulation that have lasted for several days, as in some of those in which the author has ventured to use it. To do so, is to return to the abdomen a loop of intestine, inflamed, altered, gangrenous, already perforated or on the point of rupturing. To one who has witnessed the perplexity of a careful surgeon, when it is a question of returning to the abdomen a loop of intestine whose integrity after a careful examination is still a matter of doubt, the method of taxis by refrigeration, after several days' strangulation, even when spontaneously successful, seems to be a very great risk which no practitioner would dare to run. these cases, to reduce after careful examination, is a bold procedure; but to return blindly without examination is inexcusable.

In

The

HYDRASTIS CANADENSIS IN THE TREATMENT OF UTERINE HÆMORRHAGE.-M. A. MENDES DE LEON, of Amsterdam (Arch. f. Gynäk., xxvi, 1; Ctrlbl. f. Gynäk., Jan. 23, 1886), reports his experience in the treatment of about forty women with hydrastis canadensis. The remedy seems to have afforded the best results in cases of menorrhagia accompanied with severe dysmenorrhoea as a consequence of determination of blood to the generative organs; in catarrhal inflammation of the body and neck of the uterus; in chronic pelvic cellulitis with severe abdominal pains at the periods; in prolonged and painful menstruation connected with displacements, especially retroflexion and retroversion; and in hæmorrhage at the menopause. Instances are given of each of these five sorts of cases. In almost all of them the drug diminished the bleeding, and generally it overcame unnatural frequency of menstruation. author observed no untoward effect beyond slight digestive derangements, except in two cases; on the other hand, the appetite was improved. In the two exceptional cases, nervous symptoms made their appearance - the pulse became very weak and frequent, the patients were depressed and had hallucinations, and one of them suffered with transitory delirium and loss of consciousness. The drug was usually given for fourteen days before a menstrual period, in doses of from fifteen to twenty drops [preparation not specified] four times a day; in a few cases it was given during the whole intermenstrual period. Like SCHATZ, the author attributes the efficacy of hydrastis not so much to any action of the muscular tissue of the uterus as to its exciting vascular contraction and consequent diminution of pelvic congestion.-N. Y. Med. Jour., Feb., 1886.

TREATMENT OF CHOLERA BY ABDOMINAL COMPRESSION.-DR. C. BRUCKNER writes in Memorabilien, vol. xxx, No 8, to direct attention anew to a therapeutical measure employed by him successfully in the cholera epidemic of 1872. The excessive loss of fluids from the intestines and stomach causes an inspissation of the blood, in consequence of which the circulation is markedly impeded. The nutrition of the tissues, and especially of the intestinal nerves, already partially paralyzed by the con

tagium, is thus so seriously interfered with as to constitute in itself a special menace to life. The author was thus led to discontinue all medication, the blood stasis rendering absorption in most cases impossible, and sought to compress the abdomen by means of a cold sandbag, weighing from nine to fifteen pounds, such as is sometimes used in uterine hemorrhage after parturition or abortion. By means of this combination of pressure and cold (ice was also given internally), he states that not only were the intestinal discharges controlled, but the circulation was improved. When the pulse showed that circulation was again active, the remedies deemed appropriate could be administered with every hope that they would act promptly. DR. BRUCKNER employed this method in twenty-five cases of cholera at different stages, and lost but three patients. His papers were published in the Deutsche Klinik for 1873 and 1874 He advises as a more effective mode of producing compression, the application of an elastic band around the body; between this band and the abdomen are placed two metal plates which can be separated by means of a screw. In this way any desired amount of compression can be obtained, and at the same time the application of cold is facilitated by placing the ice-bag between the two plates. PROF. KASHIMURA, of Japan (Wiener Medizinische Presse, No. 42, 1885), employs a somewhat similar principle, placing large icebags on the abdomen. But the degree of compression obtained is much less by this method than by that just detailed.-Med. Record.

THE TREATMENT OF FEVER BY ELECTRICITY. PROF. E. DE RENZI, having by chance observed a case of quartan fever cured by the application of electricity, instituted a series of experiments in this direction, and has formulated as a result of these observations, the following conclusions:

1. Fevers of malarial origin resist the action of the electrical current much more than do those symptomatic of bronchitis, pulmonary phthisis, etc.

2. During the application of electricity the temperature remains elevated, or even rises to a fraction of a degree; but soon after, at the most within an hour or two, a fall of several degrees occurs.

3. The best effect is obtained by holding a moist electrode in the hand while a metallic brush attached to the other pole is swept over the surface of the body.

4. Arterial pressure is increased during the application, the skin becomes reddened and often moistened with perspiration, and the pulse is increased in force. It is probable, therefore, that the antipyretic effect of electricity is due to the increased activity of the cutaneous capillary circulation, whereby caloric is more rapidly lost.-Gazetta Medica Italiana.

CALIUM APARINE IN PSORIASIS.-DR. T. R. ORWIN writes in the Brit. Med. Jour. of a woman who had psoriasis of the left hand for upwards of twelve months. She derived no benefit from chrysophanic acid ointment, tar ointment, or arsenic, and was unable to do any housework on account of the painful fissures

THE TREATMENT OF ACUTE PROSTATITIS BY HOT WATER INJECTIONS.-M. PAUL RECLUS speaks very highly of the value of hot rectal injections for the relief of the pain and turgescence of the prostate in acute inflammation of this gland. He uses water at a temperature of 130° F., and instructs the patient to retain the injection as long as possible. At the same time he applies wet compresses of the same temperature to the perineum. By this means he states the pain is almost immediately relieved, vesical tenesmus and dysuria disappear, the swelling diminishes, and a complete cure is obtained within a few days. He relates two cases, one the result of gonorrhoea, in a man thirty-one years of age, and the other in a man fifty-five years, in whom an acute prostatitis supervened upon a chronic enlargement of the gland. In both cases the relief obtained by the use of hot injections and perineal compresses was almost instantaneous.-Lyon Médical.

MENIERE'S DISEASE TREATED BY THE COMPRESSED AIR-BATH.-MR. J. FLETCHER LITTLE read notes of this case before a recent meeting of an English Medical Society. The patient, a professional man, suffered from syphilis before marriage. Since his marriage he had had several children, all of whom were free from specific taint. MENIERE'S disease was diagnosed by a London aural surgeon in the spring of 1885, and anti-syphilitic remedies were ordered. Last autumn, deafness had much increased. The general health was very indifferent, and the spirits greatly depressed. The compressed air-bath, at one and a half atmospheres, was tried, with immediate improvement. After two baths, the hearing had greatly improved, and the general health was better. An interval of six weeks had occurred without any return

of the symptoms of MENIERE's disease. The patient was now taking iodide of sodium.Med. and Surg. Reporter.

GRINDELIA ROBUSTA IN CHRONIC BRON CHIAL CATARRH.-In the Russkaia Meditz., No. 1, 1886, p. 11, DR. L. GRINEVITZKY highly praises the services obtained from the administration of fluid extract of grindelia robusta, in daily doses of two or three drachms, in inveterate chronic bronchial catarrh. Asthmatic attacks are as rapidly as strikingly relieved. Distressing cough soon disappears, nearly altogether, and expectoration becomes easy. The drug, however, entirely fails to relieve any respiratory disturbances accompanying other pulmonary diseases, as well as those by cardiac and nervous diseases. [DRS. RoCHESTER and W. MURRELL also think highly of grindelia as a remedy for asthma. See the London Medical Record, October, 1881, p. 409. Rep.-Idem.

TREATING DYSENTERY WITH COCAINE.— We have received many letters inquiring about DR. WINTER'S method of treating dysentery with cocaine. His treatment of a young child was as follows: Ten drops of an eight-per-cent. solution, in one drachm of water, were injected into the rectum, which relieved the tenesmus for two hours; then twenty drops of the same solution, in a drachm of water, were injected. This was repeated every five, six, or eight hours, according to indications.-Med. Record. Feb. 20, 1886.