ments for the minute investigation of meat are made, it is certainly best to reject the meat of all tuberculous animals as unfit for human food, when such meat is obviously tubercular or not. This is the line on which the authorities have lately gone, to the dismay of the butcher. But the health of the community is too serious a subject to sacrifice for the pocket of individuals, and every impartial person must consider the authorities justified in their action.

In my next letter I will consider the antibacillic treatment of tubercular disease.

PARIS.

(From our Special Correspondent.)

Not the Dengue, only Grippe or Influenza-The Estimation of Glucose in Urine-Petroleum a Sure Cure for Itch-End of the Motte-aux-Bois Vaccine Controversy Physicians as Experts in Medico-Legal Cases.

One subject now overshadowing all others, even politics, is the prevailing epidemic which has brought down one-half of the Parisian population. At first, owing to its coincidence with the breaking out of dengue fever in Russia, all took it for granted we were in for a taste of dengue too, an experience hitherto unknown in this latitude. But physicians, after carefully observing their patients and comparing notes, have come to the conclusion that the present epidemic is not one of dengue, or anything like it. We simply have a sudden breaking out of a well-known affection, called here grippe, and in America influenza, a time-honored domestic complaint, so familiar as to be considered endemic. Every winter witnesses various slight outbreaks here and there. This season, for some unknown cause, it has spread everywhere with astounding speed, and spared neither age nor sex. In consequence, all Paris, in-doors or out, has the appearance of a grand coughing and sneezing concert, in which every one plays his or her little solo, without regard for time or music. Some years since your correspondent was in Florida, just after an epidemic of dengue fever, the real one without doubt. All the patients had recovered, but the symptom most striking to them all was the pain they had felt in the joints and bones. Some would almost shudder when relating their experience. Indeed, so characteristic is this feature considered, that "breakbone fever" is the popular name of the complaint. This symptom is entirely absent from our present Parisian epidemic, and so are the eruptions, desquamations, etc., mentioned by authors

conversant with dengue. The medical profession unanimously agree with the Academy of Medicine in declaring the sickness to be, not dengue fever, but a rather severe form of grippe, or influenza, and in good justice it is bad enough as it is.

The estimation of glucose in urine, the crucial test of some medicaments' therapeutic value, is a delicate process, which is not always interpreted alike by all experimenters. Dr. Blarez, professor of chemistry at the Bordeaux Faculty of Medicine and Pharmacy, has found an ingenious way to test the accuracy of the various methods. "The estimation," he says, "may be made with Fehling's solution, in which case the liquor should be titrated, so that ten cubic centimetres of it, diluted with an equal volume of distilled water, will be just decolorized with .050 gramme of inverted sugar, dissolved in 100 or 200 parts of water. The old method consists in considering inverted sugar and diabetic glucose alike in reducing power. On the contrary, Sohxlet, a more recent experimenter, avers that the ten cubic centimetres of Fehling's correspond only to.0475 gramme of anhydrous glucose. The same discrepancy occurs in regard to the interpretation of optimetrical observations." The other day an opportunity was found of deciding the question. A young man, aged 17, who applied to him for treatment, proved to be a real live sugar-factory. He daily produced two gallons of urine, containing for each litre 93.80 grammes of diabetic sugar, or some twenty-four troy ounces every twenty-four hours. With such a patient it was easy, before treatment could begin to take effect, to prepare sufficient quantities of pure diabetic sugar of undoubted genuineness. Experiments made with it have demonstrated that, so far as valuation with Fehling's solution is concerned, the old figures formerly accepted are correct and the pretended correction a mistake. Preliminary trials with the spectroscope tend in the same direction, but more time is needed to bring the matter to a sufficient degree of accuracy.

Dr. Bourgeois, of Noailles, reports that for several years past he has obtained excellent results from the application of petroleum in itch, and now invariably cures the disease within three days, at most, with the following. procedure: On the first day, before bedtime, the patient is to gently anoint his whole body, except the head, with kerosene, rubbing it in especially in parts most affected. After which he is to put on his old shirt again and retire.

Next morning the oily substance is to be washed off with white Marseilles soap and lukewarm water, clean underwear replacing that worn at night. On repeating the process three nights in succession, complete cure will invariably follow. Now and then the patient will, owing to itching, lose his first night's sleep, but the trouble never occurs a second time. Dr. Bourgeois remarks that the treatment is not only most simple, but also inexpensive, an important consideration, as such patients generally belong to the poorer classes. A quart of kerosene and a piece of soap is all that is needed. He also considers the application harmless, as he has used it with 8-yearold children; with younger ones, however, he would hesitate, and probably abstain.

The Motte-aux-Bois vaccine controversy was officially closed before the Academy of Medicine by a report read, on November 26, by Dr. Hervieux, who had been assisted in his final examinations by an English practitioner, "Dr. Thorne Thorne, director-adjunct of the local government board." After closely examining every one of the patients, they found them all completely and absolutely cured. All the ulcerations had healed up, all indurations disappeared, and not one symptom could be detected of secondary syphilis. In consequence the late outbreak, which so deeply excited the whole rural population, is now officially declared not to have been of a syphilitic nature. At the same time the Academy will not undertake to decide what was the nature of the affection.

For years the French medical profession has kept protesting against the shabby treatment forced upon them by lawyers. Legal gentlemen who are not in the habit of laboring gratis for Dame Themis, their patroness, take advantage of an obscure law-text, dating from 1811, to compel physicians to act as experts in medico-legal cases, for a remuneration absurdly inadequate. At last, patience ceasing to be a virtue, the physicians of Rodez, a small southern town, decided to refuse their services, and test the law and lawyers. Near the end of August last the body of a girl, supposed to have been murdered, having been found in the woods, five physicians of Rodez were required by a justice to view the body and report. They unanimously refused to obey the order, under the plea that the law applies only to flagrante delicto cases, and they could not be compelled to act as experts in a case like the cne in point, in which death had evidently taken place several days before. Next the recusant

physicians were summoned, on October 4, before the Rodez justice of the peace, who sentenced them to a nominal fine of six francs (one dollar and twenty cents) each. But, on appeal (near the end of November), the Rodez correctional tribunal reversed the judgment and remitted the fines, holding that the defendants had not violated the law. It is unnecessary to add that the Rodez case made considerable noise all over the coun

The medical profession took advantage. of the excitement to air their grievances and try to obtain redress. They remarked, with good reason, that about courts of law every one lending his aid to the courts of justicejudges, lawyers, witnesses, jurymen, and even expert chemists-will receive suitable compensation. The physician alone is expected to do expert work for a boy's salary. For instance, for a post-mortem the law allows him from five to nine francs (one dollar to one dollar and forty cents), less than a knacker gets for opening a horse. Finally, so much noise was raised on the subject, that the question forced itself upon Parliament. On December 9 it was the object of an interpellation in the Senate, and there is every hope that the matter will be equitably adjusted. And the singular part of the Rodez affair is that the real point at issue-the question of remuneration-never came before the courts. All the fuss and trouble has been about a side complication, which no one cared for in the least. But no matter, the medical profession have gained their point, and compelled the legislature to pay some attention to their just grievances.

PARIS, December 20, 1889.

CONTAGION OF SCARLET FEVER. To the Editor of the THERApeutic GazeTTE:

DEAR SIR-The article by Dr. H. C. Wood on the "Duration of the Contagion of Scarlet Fever" recalls a similar one to my mind, the recital of which may interest you. Three years ago one child of Mr. C. Nismer, a large restaurant keeper here, 608-10 K, N. W., was taken with scarlet fever and subsequent diphtheritic invasion. The three remaining children were at once removed to an upper story, completely isolated for six weeks. During the fifth week the whole lower floor was cleaned; bedding boiled, destroyed; walls, furniture, etc., scraped, repapered, scrubbed, aired, disinfected; everybody bathed, etc.; in short, the most complete precautions taken

remove any possible contagion which modern ingenuity could devise. The second night after reunion the next youngest child was taken with severe scarlet fever; within the week the two others also contracted it in a most violent form, the subsequent diphtheria being very persistent. Fortunately, all got well.

A number of cases, being removed from other houses at once and kept away for four weeks, contracted it within a week after reunion. The case recited above, however, is the most striking in my experience of the futility of isolation in any domicile and under conditions usually met with.

Respectfully,

R. G. MAUSS, M.D.

[We do not think that the case reported by Dr. Mauss shows the futility of isolation, as he intimates, but, especially in the light of the cases reported by Dr. Wood, it shows that six weeks' isolation is not sufficient in scarlet fever. In Dr. Wood's case the second child who took the disease was not brought back to the house where the disease had been, but certainly took it from the person of the first patient, and it is probable that in Dr. Mauss's case that the room was thoroughly purified, and that the disease originated through contact with the first case.-ED. THERAPEUTIC GAZETTE.]

NITRO-GLYCERIN as a remedy fOR SHOCK.

To the Editor of the THERAPEUTIC GAZETTE:

DEAR SIR-The article by Dr. F. X. Dercum, in the GAZETTE of October 15, on "Railway Shock and its Treatment," suggested to me the advisability of offering the following for publication:

Mrs. C., on April 7, 1889, had a chill, followed with fever and pains in side. Was called to see her next morning, and found her with croupous pneumonia. The case proved to be very stubborn from the outset, but on the eighth day there was a change for the better, and I expected that recovery by resolution would take place, but about 2 A.M. the following night she was seized with a severe pain in her side, so much so that I was called up to see her. I found her suffering a great deal from pain and prostration. My efforts to relieve her were fruitless for some time. I left her at 8 A.M. to make some other calls, and on my return at 10 A.M. found the family standing around the bed

very much excited. I hastened to examine Mrs. C., and was convinced from my examination that she was dying. Her pulse was almost imperceptible at wrist, the heart-beat very weak and accelerated, the skin cyanosed and moist, with cold, clammy perspiration. I could not note her respiration accurately from the fact she was trying to talk to those around her all the time. I was puzzled to know what to do; but calling to mind some recent utterances on nitro-glycerin in collapse, I at once decided to try the remedy, and gave her 5 drops of a one per cent. solution hypodermically. In five minutes her heart-beat was much stronger, and I could easily feel her subdued pulse. The surface gradually regained its warmth and normal color. Dr. Dismaker arrived at this time, and he advised the several hypodermics which I gave her. This was about II A.M. By 2 P.M. her symptoms were much better. After a careful examination we decided she was suffering from the second attack of pneumonia, which proved to be correct by the subsequent history.

I hope that I will be pardoned for reporting so much in detail a case that appears at first sight to be foreign to the subject, but the symptoms of collapse in the above case resemble so much those of railway shock described by Dr. Dercum that it occurred to me that nitro-glycerin would prove valuable in the treatment of the latter. Hence I write this note, hoping that it may elicit investigation from those who have an opportunity of treating railway shock, and that they will report the result of their investigation through the GAZETTE. Yours truly,

B. W. ALLEN, M.D. FLANIGAN, ALA., October 26, 1889.

[We print this letter, which was received some time since from Dr. Lallerstedt, but was for a time mislaid. The subject is one of practical importance, and the only conclusion that we can draw is that the fluid extract which the doctor has used is a remarkably inert preparation. The recorded cases in which serious or fatal symptoms have been caused by doses not larger than those used by Dr. Lallerstedt seem to show that his doses are unsafe with an active preparation; thus, 2 minims of the fluid extract, given three times a day, are reported to have produced very distinct symptoms. In a case put on record by Dr. Freeman, a quantity of the tincture, equivalent to about 12 minims of the fluid extract, proved fatal to a boy 3 years old; in another recorded case 35 drops of the tincture caused death in a day and a half; again sixty minims of the fluid extract, given in doses of 15 minims, at short intervals, was followed by a fatal result in less than four hours, and a teaspoonful of the extract of gelsemium given to each of two children caused death in three hours. Dr. Seymour records one case in which a teaspoonful of the fluid extract proved fatal to a young lady; in one case to minims of the fluid extract, repeated after half an hour, caused violent symptoms with collapse soon ending in death.-ED. THERAP. GAZ.]

SULPHONAL AS A HYPNOTIC IN TYPHOID FEVER.

To the Editor of the THERapeutic Gazette:

DEAR SIR:-I wish to report a case of typhoid fever in which one of our comparatively new remedies did most noble, or, I should say, most valuable work. On August 28, 1889, I was called to see Mrs. F., aged about 22, who was in her second week of the severest case of typhoid fever it has ever been my lot to treat in a practice of nearly nineteen years. She could not sleep; lay in that state styled coma-vigil until she became wild and maniacal. She began to talk wildly and wanderingly. at 10 P.M., and continued to

talk incessantly until the next night about the same hour, when she came under the influence of a 20-grain dose of sulphonal, given some hour or two previously. She slept soundly until about two or three o'clock next morning, when she awoke, when another dose of sulphonal was given. She fell asleep from this, and slept soundly till about seven o'clock, or about four or five hours more. She awoke for a few minutes, and appeared perfectly clear in her mind. She soon fell again into a slumber, and continued to sleep the greater part of the day. This was the last of the coma-vigil, and the nervous system remained in a very good state during the remainder of her illness, without giving any more hypnotics. She slept very well at nights after this, although she was confined to the bed with the fever for three or four weeks longer. I tried chloral, bromides, monobromated camphor, camphor-water, valerian, and other hypnotics, but none of them would do any good towards giving the nervous system rest, and I can say in this case the sulphonal was the hypnotic par excellence. Of course this one case is very little to decide the value of the remedy, but it is a slight pointer to act upon, and, perchance, others may try it in their cases of typhoid fever, and report as to its value in the THERAPEUTIC GAZETTE.

GREENVILLE, Texas.

J. POWEL BAIRD.

REMARKABLE TOLERANCE FOR

MORPHINE.

To the Editor of the THERAPEUTIC GAZETTE:

DEAR SIR:-The following case of a male, colored, æt. 32, porter, is interesting, as illustrating the large amounts of morphine which may sometimes be given with impunity.

No syphilitic history. Case came under observation September, 1889, with remittent fever of three weeks' duration. Fifteen days after defervescence of fever, and while patient was still convalescing, the attention of the reporter was called to a swelling situated in perineum, midway between scrotum and anus. It was about size of half an egg, soft and fluctuating, quite painful, and throbbed subjectively. Temperature, 102°; pulse 100.

Diagnosis.-Perineal abscess; had a bistoury been at hand this would have been immediately incised, and probably no further trouble would have been experienced.

Next morning it was found that during the night the abscess had broken into the rectum. The perineum, from scrotum to anus, and for three or four inches on each side of perineal raphe, was intensely swollen, and studded with eight or ten fistulous openings, through which escaped gas and fæcal matter.

On the second day after this condition was observed, all the parts involved as above described were found to be thoroughly necrosed, and, beginning to slough, were entirely removed, and sphincter ani divided, in order to facilitate escape of gas and fæcal matter. The removal of the gangrened tissue revealed the muscles accellerator urinæ, transversalis perinei to attachment to tuberischii; erector penis; a portion of gluteus, maximus, and the sphincter ani with its attachment to coccyx. The line of demarcation was well defined. The patient's physiognomy presented the distressed, anxious appearance characteristic of gangrene. Temperature, 1021⁄2°; pulse, 140 and quite feeble; respiration, 38; abdomen very tympanitic and low, muttering delirium existing.

A euthanastic (if the coinage of a new word is permitted) dose of morphine, 21⁄2 grains, was administered hypodermically at night. Next morning patient was perfectly rational, and called vigorously for food. Milk, egg, and whiskey were given every four hours. Considerable suffering still existing, 21⁄2 grains morph. were given, and same dose repeated night and morning for two days, when this quantity was found to be insufficient, and was gradually increased to 7 grains three times a day until the tenth day after the occurrence of the gangrene, when the patient died of exhaustion. Wound was irrigated twice a day with a one per cent. carbolic solution, and dressed with absorbent cotton and iodoform. Patient had never used any opiates previous to this occurrence. The remarkable features of the case are

1. The rapidity of formation, and the large number of fistulæ after rupture of the abscess.

2. Rapidity and extent of necrosis of tissue.

N.B. This probably would not have occurred at all had not the tissues been more or less degenerated, as result of previous fever.

3. The large quantity and rapid increase in dose of morphine administered to produce analgesia and stimulating and tonic effect.

C. HOLZCLAW, M.D.

THE

Notes and Queries.

NEW HYPNOTICS - SULPHONAL, AMYLENE HYDRATE, HYDROBROMIDE OF HYOSCINE, HYPNONE, PARAL

DEHYDE, AND URETHAN..

At the sixth annual meeting of the New York Medical Association, held in New York in September last, DR. W. H. FLINT, of New York, opened the discussion as to the "Therapeutic Application, Contraindications, Toxicology, and Methods of Administration of the New Hypnotics." Although most of the facts contained in his address have been already laid before the readers of the THERAPEUTIC GAZETTE, we publish a full abstract of his paper, since it is largely based upon his own personal experience with these drugs.

The object of the present discussion was to give a summary of the therapeutical applications, contraindications, toxicology, and modes of administration, and in some cases to give the physiological action of these hypnotics with a view to throw some light upon the relative merits of the individual remedies. The writer desired to accomplish his part of the discussion by presenting a résumé of the most important papers on this subject which had come to his notice, adding thereto the results of his own observations. The group of somnifacients to which attention was invited comprised sulphonal, amylene hydrate, paraldehyde, urethan, and hypnone. In respect to sulphonal, he could report thirty-three cases treated, with the following conclusions arrived at: That sulphonal, even in single doses of 20 or 30 grains, was in the main a safe and reliable hypnotic, free from unpleasant concomitant effects, and usually from all undesirable sequelæ. The only objectionable after-effect witnessed by himself was moderate somnolence on the morning following its administration; in none of the cases was there derangement of the appetite or digestion, nor was the circulation or respiration appreciably affected. The cutaneous and renal secretions were neither increased nor diminished, and nausea, vomiting, or constipation did not follow the use of the drug. The average length of the time in which sleep ensued after the administration of sulphonal was about an hour. The average duration of the sleep was a little over six hours, and success attended the use of the drug in about eighty-seven per cent. of all the cases. Since his early experiments with the drug had been published, about a year ago, he had constantly employed it in private and hospital practice, and it had continued to