days after this the patient became comparatively rational, and by the end of the second week the mental symptoms had entirely disappeared. The patient soon began to improve physically and was finally discharged. Recovered four weeks after.*

Case 3. The patient had been in very good health up to about three months before admission, which occurred during the year 1874, when he was attacked by headache, for which, on the supposition of its being malarial, three grains of quinine were prescribed three times a day; after taking three doses of this the patient was seized by a violent attack of incoherent frenzy, with marked hallucinations of hearing of a depressing type. There was considerable dimness. of vision. These phenomena persisted for three months as the quinine was continued, and the patient treated with morphine subcutaneously. On admission to the asylum, which was at length rendered necessary, the patient was in the condition already described, and was placed under chloral and hyoscyamus as a hypnotic, and conium to quiet motor excitement. Under this treatment the patient was in fit condition to be discharged within six weeks after admission. He manifested, a day previous to discharge, some slight evidences of malaria, whereupon quinine was administered, which had the effect of bringing on a fresh attack of frenzy with the same symptoms as previously. The quinine was stopped. and the same treatment was instituted with equally good results.

Case 4. A forty year old painter became incoherently insane during his third attack of lead colic. He felt bees stinging him and saw them flying through. the air at him. After three weeks' home treatment he recovered.

Case 5. A six year old girl was attacked by scarlet fever which went through its early stages in the usual way. About the sixth day after the scarlatinal eruption appeared, the temperature (104°) sank to 98°, and the child became extremely restless and violent. She had been frightened by a Chinaman two weeks before her attack of scarlatina. She now complained that she saw him at the window with his hands outstretched to grasp her. This condition continued for two days, when it gave way to an incoherent hallucinatory state, accompanied with great agitation. The patient recovered in a week.*

Case 6. A forty-two year old woman who had been engaged in harassing litigation, was grossly insulted by a lawyer during an interview. She wandered away in a stupid state but was picked up by a friend who took her home. She remained in this stupid state for thirty-six hours and then became incoherently hallucinated visually and auditorially. Three weeks later she had fully recovered but retained a very confused recollection of her illness.

The phenomena presented by this psychosis bear a superficial resemblance to the episodiacal excitement of paranoia as well as to the period of transformation. Both are attended by hallucinations and agitation, but in paranoia there is an underlying intellectual element which together with the precedent history serves for demarcation. The febrile disorders often set up a neurosis which serves secondarily to the acute confusional insanity as a basis for the development of paranoia. Such an association is however

*Jour. of Nerv. and Ment. Dis., 1881.
*St. Louis "Clinical Record," 1881.

purely fortuitious. Acute disorders may expedite in degenerate subjects the development of paranoia after an acute confusional insanity, but this has no special relation to the succeeding psychosis since paranoia was simply hastened in its development, not created by the confusional insanity. This fact however led Westphal erroneously to classify acute confusional insanity with paranoia. Rosenbach has recently pointed these resemblances in a very graphic man

ner.

*

The temperature in typhomania and the furibund symptoms differentiate it from acute confusional insanity as well as the greater mental defect. Treatment consists in proper nutrition, quiet and relief of agitation. The prognosis is usually good. A question has been raised as to the essential aetiological factor. Kraepelin, who has studied psy. choses of this type most extensively, is of opinion that to systemic nervous exhaustion-not to toxic elements is it due. This is also the opinion of Moelit who, in a case resultant from lead colic, claims that the exhaustion from the colic, not the lead poisoning, was the chief cause of the psychic symptoms.

Binswanger ** in discussing the psychosis as it supervenes on fever from brass poisoning in brass founders, inclines to Moeli's opinion.

As will be seen by the quotation from Spitzka already cited, he regards the adynamia as the essential basic ætiological factor. This opinion of Spitzka has been adopted by H. C. Wood. Ferguson insists that the toxic factors play a part in certain cases. This may be granted but they as a rule produce no symptoms differing from the cases developing on exhaustion from other causes. This adynamia is, as many of the older clinicians have shown, simply a nervous asthenia produced by various causes ranging from psychical to toxic. On it the whole group of adynamic psychoses designated as primary or acute confusional insanity develops.

Frequency: During eleven years private and insane hospital practice in Chicago, I have observed* one hundred and three cases thus divided as to race and ætiology.

The Boston Medical and Surgical Journal states that Dr. Robert Koch has interrupted his bacteriological studies by marrying a popular danseuse.

On the ground of his experiments Maurel concludes that the danger of hypodermic injections of cocaine hydrochlorate lies from the start in the concentration of the solution employed and not in the quantity of the drug administered; and afterward, in the accidental penetration of the toxic solutions into the blood vessels.-Therap. Gazette.

OWNERSHIP OF PRESCRIPTIONS.-A recent trial in a Detroit court resulted in placing the ownership of prescriptions in the hands of the patient and not in those of the pharmacist. Testimony going to show that druggists everywhere regard the prescriptions as their rightful property was excluded, on the ground that the patient has the highest claim to the written formula. Jour. A. M. A

According to the New York Medical Journal, Sir William Gull may be taken as a type of the candid consulting physician. His remarks to his professional brother, who had called him in, were sometimes almost as unreserved as if he were thinking aloud. In a recent memorial notice of him, in Guy's Hospital Reports, we find mention of the following instances bearing on this subject: He once met a physician in a case of rheumatism in which Dr. Gull recognized a pericardial friction sound. Nothing was said to the family about this newly discovered element in the case; the general treatment was approved and the two medical men left together. The physician in charge expressed his thanks to the other that he had not disclosed the "dreadful oversight," and added: "I cannot think how I can possibly have failed to detect the pericarditis." "Never mind," said Gull, "it is just as well, for, if you had detected it, perhaps you might have treated it." To a family practitioner who had much to say about his patients' constitution and pecuculiarities, Gull would say: "How can you understand anything about this man's 'constitution,' when you have never made an examination of his urine ?"— Col. and Clin. Record.

** Neurologisches Centralblatt, 1882. *Medical Standard, July, 1892.

A Newspaper Opinion of the Medical Profession. The usual attitude of the secular press toward the medical profession makes the following from the New York Sun of particular interest.

In times of danger from pestilence, at all times when the public health is imperiled, the doctors come to the front with heart of grace, ready to take any risk and to go wherever duty calls. We have not forgotten how hundreds of them offered and gave their services last winter when the city was threatened with an epidemic of typhus-young medicos many of them, just entering upon their professional career. There seemed to be rivalry among them at times to get to the most dangerous posts, even to North Brother Island. They displayed again the same noble mettle when there was apprehension of the spread of smallpox. They are displaying it now once more when the Asiatic cholera is threatening to invade the country.

Let us praise the worthy doctors, the ever-undismayed doctors, always ready to undertake any professional duty, however dangerous or unpleasant it may be.

As it is here, so it is all over the world. It is a striking item of news that we got last week from the city of Vienna, in Austria. The Asiatic terror is confronting Vienna, and here is one of the dispatches

from there:

"Vienna, Aug. 25.-In this city four hundred and eighty-five doctors have offered to attend cholera patients, on condition that in the event of their death while in the discharge of duty, their families shall be provided for."

Could men do more than this? Could any sacrifice be more impressive than that which these Viennese doctors thus offer? There are such doctors in Paris and Berlin and London and Hamburg and Antwerp and Havre and all other cities, including, we have not a doubt, the plague smitten cities of Russia. We have plenty of such doctors here in New York. Honor to them!

In ancient times that illustrious pergamite doctor, Galen, confronted the pestilence, probably cholera, that raged in the Roman camp at Aguileia. Centuries before his time, that still more renowned doctor Hippocrates of Cos, strove to master those epidemics which entered Greece from Asia, and about which he wrote. Thus have doctors always acted. everywhere in times of plague. Truly, the immortal Socrates spake wisely and well when, after the poison had reached his heart, he uttered those last words of his life: "Crito we owe a cock to Esculapius; pay it, and by no means neglect it."

ABSTRACTS.

Medicine.

MISCONCEPTIONS AND MISNOMERS REVEALED BY MODERN GASTRIC RESEARCH.--1. The conditions usually called lithæmia, chronic gout and oxaluria, in this country, are in reality almost always forms of toxæmia of gastric origin.

2. That the albuminoid diet so often advised in these conditions is frequently harmful and based on a misconception.

3. The toxemia of gastric origin expresses itself in special symptoms which are sometimes misunderstood. That certain affections of the nervous system, the air passages and the joints are, amongst others, the result of autointoxication.

From his case-book, Dr. Stockton reported a number of instances showing that neurasthenia, vertigo, persistent headache, insomnia, muscular spasm, and epileptiform convulsions, nasopharyngeal catarrh, laryngitis, tracheo-bronchitis, asthma, Bouchard's nodules, some cases of so-called arthritis deformans and other joint troubles, depend upon gastrointestinal toxæmia. These cases proved manageable by treatment directed to the digestion, as guided by a study of the gastric contents, although in most instances they had long resisted other lines of treatment.-Dr. C. G. Stockton.

On

POSITIVE AND NEGATIVE MEDICATION.-More or less deaths occurring in practice are due to the incompetency of physicians, the incurable nature of given disease, careless nursing, and the adulteration. and substitution by dishonest pharmacy. A point of primary importance is to assure ourselves of the solubility in the stomach of the remedies we use. this account pills and capsules are often objectionable. Not infrequently they pass through the system, and are found unchanged in the dejecta. Furthermore, in all fevers and in many other states, the solvent power of the secretions is greatly lessened. Dr. Brown uses only glycerine or honey as excipient for pills; and gums of all kinds are open to the same charge of insolubility as sugar and gelatine. Often we must use solutions; and if these are not well borne, resort to rectal medication. Here mucilage offers itself as a proper vehicle for quinine when the latter remedy is indicated. The cold bath in high temperatures may often further increase the absorptive power of the system. Moreover, one should see to it that when we order infusions and decoctions, the latter are made out of pure materials. We should avoid cheap drugs, because that very cheapness is a confession of inferiority.-Dr. Bedford Brown.

REMOVAL OF PIGMENTATIONS, FRECKLES, LIVER SPOTS, ETC.-Dr. Saalfeld, of Berlin (Med. Neuigkeiten), recommends the following procedure: Apply to the spot to be treated compresses of mull which have been soaked in a 1 per cent solution of corrosive sublimate, dissolved in equal parts of alcohol and water. These are kept on for four hours. Corrosive sublimate causes a destruction of the uppermost layer of the epidermis; indeed, any similar remedy will have the same effect in removing the freckles. The vesicles are carefully punctured and the skin dusted

The last paste is much employed in chronic dermatitis, especially in lupous processes, where the addition of an acute process to the chronic inflammation greatly improves the skin.-Lancet-Clinic.

TREATMENT OF INCARCERATED HERNIA WITH ETHER: -Etlinger (Correspondenz-Blatt,) reports three cases. of strangulated hernia, all of which had as symptoms pain, vomiting and an irreducible tumor. An operation was considered necessary in all; but before that was done the cases were treated as follows with complete success: The hips were raised, the thighs bent, the scrotum lifted and all the parts concerned were treated by having two teaspoonfuls of ether poured upon the tumor at intervals of ten minutes. The penis, anus and scrotum were covered with olive oil in order that the parts might not be irritated with the ether. After about five hours' treatment the tumor becomes painless and soft, and taxis was successful in reducing the tumor.-Univ. Med. Magazine.

A STUDY OF 445 CASES OF DIPHTHERIA.-HoppeSeyler (Deutsche Archiv für klinische Medicine) has observed the above number of cases in two years.

Mortality. Of 117 cases 51.9 per cent died. Of 278 cases 41.8 per cent died. More of the cases occurred in July and September than during any

other months.

Sex. Fifty-four per cent of the cases were males, forty-six per cent were females; being a less per centage of males than is usual.

Age.--During the first year but six cases occurred. During the second year twenty-two cases. During the third year and following the mortality increased. The younger the child the greater the mortality; but in the tenth year of this series the mortality was double what it was the previous year. In the gangrenous cases no patient under twelve years recovered.

Constitution. From a study of the cases it is evident that the liability to diphtheria is independent of the constitution.

The Infection.-One hundred and forty-nine of the cases were infected from cases previously in the house; eleven cases were infected at school. One hundred and ten of the cases could give no history of the infection.

Initial Symptoms.-Most cases begin with a pain upon swallowing, less frequeutly with hoarseness or cough; sometimes, especially in young children, the child appeared simply unwell.

Temperature. In adults it was variable; in the beginning it varied from 98.5 to 104. In adults the lower the beginning and maximum temperature the more favorable the case. Most of the children began with normal or slightly raised temperature. The greatest mortality was with collapse with subnormal temperature. When there was high temperature in children, it was usually accompanied by some severe complications.

Seat of Exudation. -The tonsils were affected in 93 per cent; the palate in 43 per cent; pharynx, in 32 per cent; nose, in 16 per cent, and larnyx, in 49 per

cent.

Complications.-The sub-maxillary glands were swollen in 75 per cent. The swelling was especially severe in gangrenous diphtheria. In six of the cases abscess of the cervical glands occurred. Frequently in children diseases of the lung, mostly confined to the bronchi, occurred. Frequently, as a result, purulent bronchitis occurred, or sometimes broncho-pneumonia. The pleura was but seldom affected. Diseases of the heart played a prominent role in these cases, being present in 88 per cent of the deaths; whatever the cause of death. Usually there was cloudy swelling. In some cases of fatty degeneration there was marked paleness of the myocardium. Fifty-one per cent of all the cases were attacked with marked weakness of the heart, and of these 76 per cent died. In those which recovered there was long continued palpitation and pain in the region of the heart. The heart lesion began variously in from two to twenty days. Bleeding of the nose was frequent; also bleeding of the pharynx; and in three cases there were hæmorrhages under the skin. The kidneys were diseased in 52 per cent of all the cases; 17 per cent of the adults and 61 per cent of the children. This was noted by albuminuria. In the beginning there were usually but few morphological elements, as the albuminuria was more severe, casts and red blood corpuscles appeared. Paralysis occurred in 15 per cent of the cases, alysis of the palate and pharynx occurred most frequently. Infection of the ear was common. The vagina was affected once. An erythema occurred in seven cases; it quickly disappeared without any rise of temperature.

Par

Treatment. The throat was sprayed either with a sublimate solution, sometimes 1-100, other times 1-1000, or with 10 per cent solution of chloral. The nose was sprayed with salt water, or 1 per cent solution of chloral. In 170 cases turpentine was given in doses of twelve to twenty drops, and only when there was no nephritis. Wine or brandy was always given. Tracheotomy was done 213 times; 178 for simply diphtheria, of which 124 died; 35 times for gangrenous diphtheria, all of which died.-Univ. Med. Magazine.

ALCOHOLISM AND INSANITY.-M. Vaillard, the distinguished Professor of Clinical Medicine at the Medical School of Marseilles, France, has recently published a series of lessons ("Lecons sur l Alcollisme”), in which he calls attention to the constantly increasing use of alcoholic drinks in France, and especially

in Marseilles. According to the statistics which he gives, the consumption of alcohol in Marseilles has increased from 9,700 hectoliters in 1878, to 19,675 hectoliters in 1891, an increase which is vastly out of proportion to the increase of population, it being well known that in France the population has been actually at a standstill until the last year, when there was a marked decrease, owing to the falling off of the birth-rate, for which alcohol, with the use of tobacco, was also shown to be largely responsible.

According to M. Vaillard, sixty-five per cent of the patients admitted to the Hospital for the Insane, at Marseilles, are chronic inebriates. These facts are certainly very instructive for Americans as well as Frenchmen. Bacter. World and Mod. Medicine.

THE CURE OF CONSUMPTION.-Dr. Burney Yeo, Professor of Clinical Therapeutics, King's College, London, has great faith in the curability of pulmonary tuberculosis, especially in the early stages of the disease. He calls particular attention to the importance of recognizing the disease in the pretuberculous, or the prephthisical stage. The symptoms are sufficiently characteristic to render a diagnosis probable, although not positively certain. With Prof. Grancher, he agrees that in the prephthisical stage, the symptoms may be nothing more than a little debility, a slight cough, pneumonia, and a slightly quickened respiration. As the disease advances, physical diagnosis may detect in certain private areas a harsh, low-pitched respiration, especially marked. during inspiration, jerky or interrupted respiration. These symptoms are especially important when distinctly localized and constant. Early hæmorrhage is useful in calling attention to the disease before it has reached an incurable stage. The principles upon which the rational treatment of the disease is based, as laid down by Prof. Yeo, may be summed up as follows:

1.

Whatever favors the sclerotic or fibrous evolution of the tubercle promotes the natural condition of cure. The most favorable cases for cure are those in which there is absence of excessive vascular irritability, as shown by flushing on slight provocation and marked vaso-motor disturbances.

2. The constitution in general should be sound, and there should be absence of marked hereditary predisposition.

3. In some cases, probably, the infecting agent is less virulent than in others, and doubtless also, the number of invading germs influence the extent of the infection and the probability of the cure.

4. The mode of infection must also be considered; that if the germs have reached the lymphatic channels or the blood, the wide diffusion of the infection makes an unfavorable prognosis imperative. Infection through the air is much more favorable for recovery.

5. The tuberculous patient must be made to digest as much food as possible. To gain flesh is of the greatest importance.

6.

A residence in a pure, dry atmosphere, is one of the most favorable conditions for a cure.

The most valuable remedy thus far discovered, and one most widely used at the present time, and in which the greatest confidence is placed, is creosote used by inhalation, and in large doses by the rectum. -Bacter. World and Mod. Medicine.

THE CURE OF RABIES BY THE BLOOD SERUM OF IMMUNE ANIMALS.-A recent number of the Annales de Micrographic contains an interesting article by Tizzoni and Schwarz, of Boulogne, detailing the results of experiments by the authors, for the purpose of determining the value of the blood serum of animals protected by vaccination against rabies. In the treatment of animals affected by the disease, and in rendering animals immune as regards this affection, they doubtless undertook, by their researches to solve the following problems:

Is the blood of animals vaccinated against rabies capable of destroying in vitro the virus of rabies, and if so, what is the substance to which it owes this property?

Does the blood act in the living organism in the same manner as in vitro, and may it be employed as a means of transmitting immunity from vaccinated animals, to animals not thus protected?

Is the blood of vaccinated animals capable of curing the disease during the incubation period of rabies, as well as of conferring immunity?

4. Finally: Is the diffusion in the bodies of animals vaccinated against rabies, of the substance which confers immunity limited to the blood only, or does it extend to the tissues and viscera ?

The following are some of the most interesting results and conclusions reached by the experimenters:

1. The serum of the blood of a rabbit vaccinated against rabies has the power of destroying in vitro the virulence of rabic spinal cords.

2.

The serum of the blood of dogs possesses this property to a much less extent than does the serum of rabbits.

3. The active principle of the rabic virus is a nondializable substance which is precipitated by alcohol; the precipitate retaining the activity of the virus, being little affected by the precipitation. The active principle is a proteid substance belonging to the class of globulins.

4. That the blood of animals vaccinated against rabies acts in the organism as in vitro, in destroying the rabic virus, and this confers immunity upon animals into which it has been injected.

5. That the serum of the blood of dogs vaccinated against rabies is much less active in conferring inmunity than that of rabbits similarly protected by vaccination.

6. That by the injection of the serum of vaccinated animals, a curative as well as a prophylactic action is obtainable.

THE DECLINE OF ANTIPYRIN.-When first introduced to the medical profession, antipyrin was specially commended as a means of reducing temperature in febrile conditions. That the thermometer indicated a distinct decline in temperature after the use of this agent, was received as an evidence of its . value as an antipyretic remedy.

The general conclusion reached by the experimenters is the following: In rabies, as has been demonstrated for other infections, the beneficial effects of vaccination are due to the presence in the blood of a substance capable of conferring immunity, which comports itself as a globulin, and probably belongs to the class of enzymes. In immunization, whether prophylactic or curative, it is possible to substitute in animals, and probably also in men, for the antirabic vaccinations which are practiced at the present day, injections of the serum of the blood of animals vaccinated against rabies, with all the advantages which result from the substitution of an inoffensive substance devoid of virulence, for a virulent substance, the vir ulence of which has been attenuated by dry heat.Bacter. World and Mod. Medicine.

Further experience, however, has not fulfilled the expectations which were raised concerning the value of this drug.

It has been found that while it reduces temperature, it at the same time often brings the patient into a state of almost complete collapse. Careful physiological experiments have shown that the drug does not diminish temperature by decreasing heat production, but by increasing heat elimination, and that in small doses it actually stimulates heat production. It is certainly not an over-statement of the fact to say that the majority of the leaders in therapeutics have abandoned the use of this drug, in favor of other less dangerous means.

In the treatment of cases of poison by antipyrin which have been reported, it is clearly shown that the drug is a toxic agent of great power. The majority of judicious practitioners who have had experience with the drug, will quite agree with Prof. Thompson, of New York, who, in an excellent clinical article on the "Reduction of Temperature in Typhoid Fever," which appears in the fourth volume of "International Clinics," warns against the use of antipyrin, and favors the employment of hydropathic means.

Dr. Sidney Coupland, in an article on "Cerebral Rheumatism," in the same work, points out the uselessness of all antipyretics. He recommends the employment of cold, externally applied, as the best means of reducing hyperpyrexia.-Bacter. World and Med. Mod.

TREATMENT OF THE UPPER AIR-PASSAGES IN ASTHMA. Dr. F. H. Bosworth (N. Y. Med. Journal) reports eighty-eight cases of asthma, in addition to the eighty reported in 1888, treated by correcting a coexistent nasal lesion. Their treatment is based on the theory that the asthmatic paroxysm is dependent on three conditions: First, a general neurotic habit; second, a diseased condition of the intra-nasal mucous membrane; and third, some obscure atmospheric condition (the exciting cause). Forty-two of these cases were cured, thirty-three improved, two unimproved, and in eleven the results are not known. In the large majority of cases the lesion was either nasal polypus, deflected septum, or hypertrophic rhinitis. Only those cases that have had at least a year of immunity are considered cured. Some of those noted as improved went for months without an attack, and in all the paroxysms were notably mitigated. The neurotic habit should not be neglected in treatment.-Med. Summary.