cases. He maintained that gynecologists were far less open to the reproach of not looking beyond the pelvic organs than were surgeons to the charge of neglecting these primary organs which were the ruling power in women.

DR INGLIS PARSONS said he had had two patients supposed to be suffering from a malignant disease sent to him for the electrical treatment. In both cases hot water douches had diminished the hemorrhage. In answer to Dr. Fenton, he said he had not had the questionable advantage of making a postmortem examination after using the constant current, though this had occurred in one case after the faradic current. He mentioned three cases treated by the constant current in which permanent relief had been recorded. He said that he had a good many cases of fibroids treated by electricity under observation which he should one day publish. He quoted one case sent to him by Dr. Edis in which he had made some thirty applications. It had the effect of relieving the hemorrhage, and she was practically free for two years, but recently she had had one profuse attack. He mentioned a case sent to him by Dr. Fenton of a patient, aged 43, who had a well-marked fibroid and profuse hemorrhage. In that case the current kept the hemorrhage in check, provided it was used about once a week, but not otherwise.

DR. BANTOCK observed that in the cases of menorrhagia in very young subjects it was impossible to find any appreciable local dis ease, and they were restricted to constitutional treatment. Constipation very frequently coincided, and saline chalybeate aperients, followed by iron and ergot, usually brought about the desired result. There were, however, cases in which this treatment was of no use, and the patient might even die. Some years ago there was a case of this kind at the Dorset House branch of the Samaritan Hospital. One condition to which Dr. Edis had given great prominence was that of menorrhagia and metrorrhagia. due to retained placenta. He observed that when a portion of the placenta had been actually protruding from the os, that part of it was decomposed, while the upper part, particularly that near the adhesion to the uterine wall, was often perfectly free from decomposition. He agreed that the best curette was the nail of the index finger, but he could not agree that the blunt curette was preferable to the sharp curette, the spoon curette being that which he preferred. He did not think

there was a more useless instrument than the ovum forceps, for the portion grasped was sure to tear away. He insisted upon the beneficial effect of the tincture of the muriate of iron when symptoms of pyæmia declared themselves, given in doses of from 10 to 15 minims every two or three hours. He observed that large doses of ergot might increase the hemorrhage when 10-minim doses would diminish it. With regard to the administration of bromide of potassium, he said that he had tried it years ago, but had quite given it up since it seemed to conduce to, rather than check, the hemorrhage.

DR. EDIS, in reference to Dr. Fancourt Barnes's case upon which he had operated, mentioned that the patient was very ill at the time, her temperature when placed on the operating-table being over 104° F. The "mass" of placental tissue described as having been found post mortem was only about the size of a filbert and stuck up in one cornua, and even post mortem was by no means easy to identify. He defended the use of the ovum forceps. He said they were useful in certain cases. When he spoke of not giving

ergot he alluded to cases in which there was reason to believe that something had been retained in the uterus, and to that general rule he adhered.

THE ANTITHERMIC PROPERTIES OF

HYDROCHINONE.

In 1877 Brieger first called attention to the antithermic properties of hydrochinone, but it was not until 1883 that this substance, from the work of Seifert and Steffen, acquired a certain amount of repute as an antipyretic; later, in 1886, Silvestrini and Picchini published a number of observations of their experience with this drug, both clinically and experimentally, which, while establishing the fact of the antithermic properties of hydrochinone, were not sufficiently extensive to explain the mode of action of this remedy. The subject has again been taken up by DR. GAETANO TRAVERSA, whose results are published in La France Médicale for May 16, 1890.

His experiments were undertaken with the object of determining whether the remedy was capable of lowering both physiological and febrile temperature, and to establish the degree and duration of the antithermic effect of different doses, as well as the phenomena which accompany or follow the thermic de

pression. Through his studies he has arrived at the following conclusions:

1. Hydrochinone has an influence both on physiological and pathological temperature, although in healthy individuals the lowering of temperature is much less marked than that which follows the administration of the same dose to fever patients.

2, a. In patients with fever a dose of 3 grains produces only a maximum reduction in temperature of about .7° C.

b. In doses of 5 grains there occurs a reduction of temperature of .85° C.

c. Doses of 6 to 8 grains produce a depression of 1.48° C.

d. Doses of 9 to 11 grains produce a thermic depression of 12° to 3°.

e. These doses are well tolerated, and produce no gastric disturbance or nervous phe

nomena.

f. The reduction of temperature results from thirty to forty minutes after the administration of the remedy, and reaches its maximum from one hour to one hour and a half afterwards.

g. The antipyretic action is not ordinarily accompanied by any disagreeable symptoms, though sometimes doses of 6 to 11 grains, frequently repeated, are followed by abundant sweatings, chills, and when the antipyretic effect passes off the temperature rapidly increases.

h. The blood-pressure does not appear to be sensibly modified unless the doses are extremely large and frequently repeated, when the reduction of temperature is accompanied by a slowing of the pulse, especially in febrile cases, and the blood pressure is considerably reduced.

3. In a healthy man, with doses of 6 to 15 grains, given at once, the depression of temperature does not amount to more than .8° C.

4. Animals do not support the influence of hydrochinone as well as man. In rabbits the rectal temperature, even with doses of 3/4 to 4 grains, is diminished a degree or more; with doses which are not fatal, but which are yet capable of producing convulsions, the temperature increases, and may amount to 38.4° C. In dogs, with doses of 1⁄2 grain to 1 grain for every two pounds of body-weight, the temperature falls from to 1⁄2°; but, on the other hand, with fatal doses, amounting to 2 grains for every two pounds of body-weight, symptoms of collapse appear and constitute the characteristic symptoms of the poisonous action of this substance, and the temperature, which had been already depressed, maybe

one or two degrees, still continues to descend, until death results.

5. It is well to note that hydrochinone, though tolerated in large doses, does not give constant effects. The action frequently varies greatly in the same individual at different times with the same amount. The author's conclusions as to the mechanism of this drug are as follows:

1. Hydrochinone in small doses greatly increases the dissipation of heat, and, as a consequence, both in febrile patients and in healthy individuals, the peripheral temperature may be increased from 1⁄2° to 2°, while the central temperature is depressed.

2. This dispersion of heat is in great part due to the quantity of blood contained in the peripheral vessels as a consequence of vascular dilatation.

3. In a healthy man and in febrile cases the vascular dilatation precedes by about ten to fifteen minutes the reduction of the axillary temperature.

4. The vaso-dilatation does not depend upon the action of the vaso-motor centres, but is due to a modification of the peripheral centres in the vascular walls. The chills, which are observed on the subsequent ascension of the temperature, and the rapidity with which the vascular dilatation disappears, are proof of this fact.

5. As regards the mechanism of the antipyrexia, in addition to an increase in heat dissipation, the author states that there is likewise a diminution in heat production. This fact explains the reduction of rectal temperature which is produced by hydrochinone in rabbits in whom the external dissipation of heat has been prevented.

6. As to the manner in which the excretion of urea is affected, of sulphuric acid, phosphoric acid, and sodium chloride in the urine of animals subjected to the influence of hydrochinone, these principles, especially after the administration of moderate sized doses, are diminished in amount.

From these results the author concludes that hydrochinone reduces the temperature both by dissipation of heat and by preventing the production of heat. Thus hydrochinone diminishes heat production by retarding the chemical processes and oxidation which occur in the organism.

The author seems inclined to experiment with hydrochinone in typhoid fever not only on account of its antipyretic properties, but also because it possesses considerable power in arresting fermentations of various kinds.

THE TREATMENT OF EPILEPSY WITH BIBORATE OF SODIUM.

A paper published by MESSRS. J. S. RISIEN RUSSELL and JAMES TAYLOR in the Lancet for May 17, 1890, emphasizes a fact which seems to be little known,-namely, the value of the biborate of sodium in the treatment of epilepsy, while at the same time they call attention to some of the ill effects which may result from its use. The literature on this subject is very scanty. Fulsom, in an article to the Boston Medical and Surgical Journal for 1886, page 147, says that the effect of borax in cases where bromide was not well borne, or had been taken for a long time without effect, was very satisfactory; and he quotes the details of two patients, in both of whom severe symptoms of bromism made it impossible to continue this form of treatment. Fits became frequent and severe when the bromide treatment was discontinued; accordingly, the administration of borax was commenced, at first in 10 and later in 20-grain doses three times a day. In one of these cases seventy eight days were allowed to elapse before the new treatment was commenced, and it was continued for two years; during the last twelve months only two fits had occurred, caused on each occasion by "indigestion." The other patient had only two fits in eighteen months. Both patients became all right mentally, and were in perfect health; in both a scaly eruption appeared, but disappeared when arsenic was administered; and one patient was troubled by vomiting at the commencement of the treatment, but this ceased when aromatics were combined with the borax.

Gowers, in the second volume of his "Manual on Diseases of the Nervous System," says that he has found borax useful in some cases of inveterate epilepsy, in which bromide had no influence; but that the influence of borax is not comparable to that of bromide in cases in which this is effective. He states that the administration of the drug may be continued for years, in doses of 15 to 30 grains given three times a day after meals, without any ill effects beyond a possible eruption of psoriasis, amenable to arsenic. The drug has also been tried at Ward's Island Lunatic Asylum, where ten patients were selected who had been on bromide treatment for several months, with frequent convulsions. The dose given was 10 grains three times a day for the first nine days, and it was then increased to 15 grains; but no marked improvement occurred in any of the cases at the end of thirty-four days.

Fére and Lamy, in a paper in the Nouvelle Iconographie de la Salpêtrière for November and December, 1889, quote two cases in which an eczematous eruption had been provoked by borax. The patients were epileptics, who were taking 30 and 45 grains respectively three times a day, and the eruption only faded when the drug was discontinued. These observers considered the eruption an ordinary eczema provoked by borax in persons who were predisposed, as both of the patients had seborrhoea of the scalp, and one had, in addition, a few patches of old eczema, and they are inclined to look upon the stomach disorder as probably accountable for the skin eruption.

The following is a tabular statement of the cases treated by the authors:

Case 14 was that of a young man whose fits were only controlled by such large doses of bromide as produced severe symptoms of bromism. As smaller doses failed to influence the fits, biborate of sodium was given, and the patient continued to take the drug up to the time he left the hospital, seven weeks later, without any ill effect and without having any fits.

Case 7 is that of a boy who presented distinct evidence of congenital syphilis, and was accordingly put upon antisyphilitic treatment for a time; but as the fits did not diminish in frequency or severity, this method of treatment was abandoned, and the administration of biborate of sodium in gradually increasing doses commenced. The result was most marked, as in a day or two he ceased to have fits and had no more, with the exception of two very slight ones, up to the time he was discharged nine weeks later.

Case 12 shows very strikingly the effect of the drug in a boy aged 10 years, who had been subject to fits for seven years, and who, during the last five years, had been having three or four slight fits daily. The interval between the attacks became gradually lengthened until six weeks after the treatment was commenced. He had no more fits from that time until he left the hospital three months later. After he had been taking the medicine for a month, the dose being then 120 grains per diem, it had to be discontinued for a few days owing to sore lips and tongue, together with slight vomiting and abdominal pain. It is a remarkable fact, though one not unfrequently observed in this connection, that the authors were able to resume the administration of the drug in even larger doses without again producing any vomiting or abdominal discomfort.

In Case 2, although the patient, a young woman, aged 32 years, had no fits during the two months she was under observation, yet the writers do not feel justified in drawing any conclusions from this, as the usual interval between the fits had been two months.

Case 20 is that of a girl who had been subject to attacks of petit mal for ten years. Various remedies had been previously tried, but none altered the frequency of the attacks, whereas she has been free from fits for six weeks under treatment by the biborate.

Case 17 shows the effect of biborate of sodium where bromide of potassium produced little or no effect.

In the first cases the authors commenced with 30 grains in the twenty-four hours, and pushed it up, as soon as possible, to 180 grains; but they found that nothing was gained by giving such large doses, as they had, in consequence, to suspend the medicine very frequently, owing to gastro-intestinal disturbance, and thus lost time. Therefore, in

the later cases, they were contented with 30 grains as the maximum dose, given three times a day after meals. Though this drug undoubtedly possesses the power of controling the frequency of fits in many cases, and oftentimes does so when bromide has failed or cannot be given in sufficiently large doses without producing great depression, yet its administration is attended with certain unpleasant symptoms, to which brief allusion should be made. The most constant of these is an affection of the lips, which in its most typical and fully developed form results in swelling, chiefly of the lower lip, upon which small vesicles make their appearance and then become larger by coalescence; the contents then become opaque and milky, some of the vesicles burst, while others dry up, and the result is a scaly, chapped condition of the lips, resembling that commonly seen in cold weather. Other cases develop the chapped condition without the previous formation of vesicles. In two of the cases the tongue became sore and denuded of its epithelium at one or two points.

Two of the cases had slight eczematous patches on the skin close to the angles of the mouth, in addition to sore lips, and one of them (Case 3), a little girl, aged 4 years, who was taking 20 grains in the twenty-four hours, had, in addition, an inflammatory condition of the mucous membrane of the nose with slight purulent discharge, and psoriasis guttata scattered over the trunk and extremities.

Case 9 developed a curious erythematous condition of the hands. The fingers, backs, and palms of the hands and lower fourth of forearm were of a bright-red hue, and looked slightly swollen. The redness disappeared on pressure, and there was no evidence of pitting. The parts affected gradually became more dusky, so that in a few days they were almost purple in color, and about this time a few bright-red patches, looking almost like extravasations, but disappearing on pressure, made their appearance on his face. The tongue also became very red, sore, and denuded of its epithelium in several places.

Case 6 developed an eruption of small

punctiform papules, resembling the condition seen in sudamina more than anything else. The eruption was scarcely perceptible at times, while at other times it would be well marked, intensely irritating, and accompanied by redness of the skin, which looked a little swollen, and was sweating. The parts chiefly affected were the palms of the hands and soles of the feet; but patches were also seen in parts exposed to friction, such as waist, neck, axilla, etc. After the condition had existed for a week or more, very slight desquamation was observed on the palms and soles.

Case 18 developed an abundant crop of small papules all over the face, more especially on the forehead, below the eyes, and along the naso-labial folds, after he had been taking this drug about ten weeks. Associated with the papules was a reddish-coppery, patechial-like eruption, which did not disappear on pressure. No discomfort complained of. A week later the above had almost completely faded, when the patient had a severe fit, after which there was an exactly similar condition to that above described. Borax had been suspended when the first rash appeared, and the patient was then taking arsenic and salicin.

Nausea, and in some cases vomiting, necessitated the temporary suspension of the drug; but, as before stated, often the drug could be resumed without again causing any such symptom. In one case the vomiting was attended with abdominal pain, and in two there was diarrhoea. These patients were taking 120 grains in the twenty-four hours at the time when these symptoms showed themselves.

A considerable number of the patients became somewhat emaciated, and pulled down physically after they had been on this treatment for any length of time, but in no case was there ever any sign of mental depression. One patient, who was also taking cod-liver oil at the same time, put on flesh in spite of being on the borax treatment for nine weeks, which suggests that this would be probably a judicious combination in all cases.

Case 8, a young woman, aged 25 years, was attacked with pleurisy while taking the drug. The symptoms were pain, short, hacking cough, and rise of temperature; and a well-marked friction rub could be heard on auscultation. At no time was there any evidence of effusion, though there were several relapses after the first manifestation of the disease. The patient had never had a similar attack before, and as no history

could be obtained of any of the usual causes of pleurisy, it might be suggested that the affection of this serous membrane was similar to that which we had seen in skin and mucous membranes, and depended on the biborate of sodium.

As regards the treatment of complications, there is little to be said, as all that is necessary, as a rule, is to suspend the administration of the drug for a time. In cases where vomiting is a repeated symptom, small doses of cocaine, given half an hour before the borax, will be found to obviate this.

In conclusion, the authors do not wish in any way to compare borax to bromide in the treatment of epilepsy, but consider it well worthy of a trial, especially in those cases where bromide has failed or is badly borne.

THE TREATMENT OF ACUTE GONORRHEA.

In the Archiv für Dermatologie und Syphilis appears a paper by DR. FRIEDHEIM, containing an elaborate account of a large number of experiments made in the clinic of Professor Neisser, of Breslau, with the view of determining the best method of treatment in acute gonorrhoea. The object aimed at was to find the local application which possessed in the highest degree the power (1) of killing the gonococci, (2) of influencing the inflammatory phenomena, (3) of promoting epithelial desquamation, and thereby securing mechanical elimination of the micro-organisms. Among the numerous drugs experimented with were various preparations of mercury, including the perchloride and salicylate, permanganate of potash, iodoform, boric acid, pyrogallic acid, resorcin, antipyrin, thallin, and many others. But of all those now tried, the best results, as tested by the microscope, were obtained from a solution of nitrate of silver, of a strength varying from 1 in 4000 to 1 in 2000. The treatment is begun by the injection of this solution in the ordinary way, from four to six times a day, the result being that at first the discharge becomes more abundant, thicker, and more purulent; but in about four days the secretion diminishes, becomes thin, and contains a quantity of epithelium. The gonococci also diminish in a remarkable manner, and after a few days disappear altogether. When this has taken place, the number of injections of nitrate of silver is reduced to two and afterwards to one daily; and other injections, such as boric acid or some preparation of zinc, are used as well. But, in spite of the