results of all the infectious diseases. It is not only worse than a bad cold, contrary to the lay opinion on the subject, but it is far worse than its muchdreaded rival for venereal popularity-syphilis." Professor Lydston gives full consideration to the variations in the type of gonorrhoeas due to mixed infection and in considering the complications of gonorrhoea recognizes "the possibility of mixed infection in stricture." We commend the practical, common sense way in which the author speaks of the reflexes produced by stricture and other diseases of the urinary tract.

Part four deals conventionally with chancroid and its complications, while part five presents, through one hundred and thirty-seven pages, a most complete presentation of syphilis, its sequelæ and treatment. Almost every sentence contains a concise statement of some of the enormous collection of facts accumulated in connection with this protean disease. The chapter on the action of mercury in syphilis is most complete, scholarly and convincing.

Part six presents the "avoided" subject of sexual physiology, part seven, the diseases of the prostate and seminal vesicles, part eight, diseases of the urinary bladder, part nine, those of the kidney and ureter, while part ten completes the work with an admirably written chapter on the diseases of the testes and spermatic cord.

Taken all in all Dr. Lydston is to be congratulated on the results of his
labors and his book will be a valuable addition, as a work of reference, to
the library of the busy practical practitioner.

The plates are scarcely worthy of the book while the letter press is satis-
factory.
J. D. C.

Current Medical Literature

MEDICINE

Edited by Samuel B. Ward, M. D.

Weil's Disease, with a Short Experimental Study of Infective Icterus.— Dr. HARLOW BROOKS, in a paper before the New York Pathological Society, said that Weil's disease was characterized by a sudden onset, usually with chill and always with high fever. The violent onset differentiated Weil's disease from typhoid fever with jaundice. The temperature falls by lysis within eight or ten days and the other symptoms improve. Relapses are not uncommon. While it often occurs epidemically it is apparently non-contagious. The disease is almost certainly due to an infection, the source of which is undoubtedly putrid animal flesh. Butchers are commonly affected and those who frequently eat sausage. Healthy male adults, especially Germans, French and Russians, are usually the victims. The lesions are congestion and swelling of the spleen and lymphatics, parenchymatous nephritis, parenchymatous degeneration of the liver and marked icterus. There was a striking

resemblance of a fatal case of Weil's disease to acute yellow atrophy of the liver and the microscopic appearances were much the same. It might easily be confounded with mild yellow fever. The bacteriological findings have been negative, although Jaeger, who has had two autopsies, isolated a germ which, when inoculated into mice, produced lesions similar to those of Weil's disease. Dr. Brooks's case was a laborer, thirty-three years of age, who had been well up to six days prior to admission to the hospital. He gave no history of having eaten tainted meat. The disease began suddenly with fever and great pain in the muscles; then, three days later, there was marked jaundice with diarrhoea and nausea. Marked delirium appeared in a short time, then coma and, quickly, death. The most marked changes found post-mortem were in the liver cells: (1) The cells bordering on the larger capillaries of the portal system and medium-sized bile ducts were almost completely destroyed; (2) groups of cells were centres of degenerated liver lobules; (3) cells from the centres of the lobules more nearly normal, but granular and containing large fat spaces.

In the bacteriological examination of the liver and spleen two varieties of bacilli were found: (1) A rather short bacillus with rounded ends, staining best, but irregularly, with Loeffler's blue; (2) larger and thinner bacilli, but otherwise similar. Enormous cocci were present, but less numerous than the bacilli which resembled closely the diphtheria bacilli, were similar to those described by Jaeger and were pathogenic to guineapigs. The post-mortem examinations on inoculated animals showed the buccal mucous membrane to be yellowish, and that there was a clear yellowish fluid in the peritoneal cavity. The liver, spleen and kidneys were congested and degenerated. The bacillus was obtained in pure culture from the viscera. Experiments showed that the bacilli produced a toxin which causes the general lesions of the disease. Attempts made to inoculate animals by way of the gastro-intestinal tract were negative, except in the case of the monkey, which showed changes similar to those in the guinea-pig.

Weil's disease, acute yellow atrophy of the liver, yellow fever and phosphorus poisoning had similar lesions and almost identical symptoms. They were all dependent upon toxæmia, bacterial or otherwise. The pathogenesis in all was the same, although the specific exciting cause differed. The symptoms were probably due, at least in part, to the extensive destruction of liver tissue.

Affections of the Lungs in Typhoid.-A. FRANKEL, in the Centralblatt für innere Medicin, 1899, No. 4, shows that complications on the part of the respiratory tract are well known and that these affect not only the bronchi, but the lung itself, giving rise to the term "typho-pneumonia." The definition of typho-pneumonia is very variable. Rokitansky and Griesinger declare it to be a primary localization of the typhoid poison in the lungs, while other writers argue against this acceptation. In order to remove the confusion these cases can be divided in three groups:

(1) Fibrinous pneumonia, which runs with typhoid symptoms without typhoid being actually present.

(2) Complications of typhoid with pneumonia.

(3) Pneumonia which is the product of typhoid.

The first group is the so-called asthenic pneumonia of the older clinicians. There is a marked tendency to prostration and collapse, but they have nothing to do with typhoid. They are always true fibrinous pneumonias, but at times are centrally located. They often have no typical symptoms and may be accompanied by roseola. Complications of typhoid with pneumonia are rare Occurrences. The writer has observed it only six times in 500 cases. The pneumonia may complicate any stage of the typhoid. Its recognition is very difficult, especially at the height of typhoid, since all the symptoms are masked, the temperature curve atypical and the expectoration usually absent. The diagnosis is easier in the stage of lysis. The author, by many bacteriological examinations, has determined that in these cases it is always a true pneumococcus infection. In regard to the third group, Fränkel believes it is not yet certain that there is a pneumo-typhoid, i. e., a primary localization of the typhoid poison in the lungs. Curschmann, in his latest monograph, holds this opinion, but the writer believes that Curschmann has lobular and hypostatic pneumonias in mind and not the lobar. The presence of typhoid bacilli in lobular nodules, which he himself had first discovered, is explained by secondary migration into the lungs of typhoid bacilli circulating in the blood, and not by a primary development. Without doubt the typhoid bacilli can induce pneumonic symptoms, but a primary pulmonic typhoid is not to be diagnosticated. The outcome of these typhoid pneumonias is the same as primary pneumonias, but the conditions of contracture and bronchiectasis, which are less known, may result. The empyema accompanying typhoid contains at times typhoid bacilli and at other times is free from them, and owes its origin to a secondary infection. The true typhoid empyema has a relatively good prognosis.

Therapeutic Modification of the Gastric Secretion — By Franz Riegel. (Zeit. für. klin. Med., Bd. 37, Hft. 5 й 6.) The writer briefly reviews the results of previous experiments made to determine the effect of various chemical and medicinal substances upon the gastric secretion. The results of different observers are very contradictory, and the writer concludes that there is not a single substance to which all observers ascribe an influence upon the gastric secretion, either in the sense of an increase or decrease. The previous experiments have been made on men and on dogs. The fact that the vagus is the chief secretory nerve of the stomach having been demonstrated by Schneyer and Uschakoff, and, it being known that atropin paralyzes the vagus, the writer was led to try the action of atropin upon the gastric secretion. The experiment was made on dogs. The method practiced was to divide the dog's stomach into two separate compartments after Pawlow's method. Into one compart

ment he would introduce food, or food with the drug experimented with, and in the other compartment observe the process of secretion.

The drug was sometimes administered with the food and sometimes subcutaneously. He found that atropin markedly diminished the gastric secretion, both as to quantity and strength.

Pilocarpin, on the other hand, markedly increased the gastric secretion in quantity, while the strength of the secretion remained about normal. As a result of these experiments, he has used atropin in over eighty cases of stomach disease, in which he wished to diminish the quantity of the secretion, as well as the acidity, and has had excellent results.

He has also used pilocarpin in cases of diminished gastric secretion, but the action upon the salivary glands and sweat glands renders it less valuable as a medical agent in diseases of the stomach.

Visceral Syphilis.-C. THOREL, in Virchow's Archiv for November, 1899, discusses this subject. He remarks on the lack of statistics on syphilitic affections on the internal organs.

He cites Petersen's figures, who, in 21,757 autopsies, found signs of congenital syphilis in 2.3 per cent of all cases and acquired syphilis in only 1.8 per cent. He states that the statistics of Petersen are old and, perhaps, not founded upon sufficiently close pathological study. He also cites Stolper's statistics. In 61 cases of syphilis of the viscera the lungs were involved 5 times, the stomach once, the intestines 12 times, the liver 28 times, the pancreas 3 times, the kidneys 16 times and the heart 14 times. These statistics include both fibrous and gummatous changes. Thorel throws doubt on the chronic interstitial changes in this table. He thinks that the history and microscopical appearances of organs with chronic interstitial change should very strongly point to syphilis before they are classed as such, and that changes which might be due to some other cause should be left out of such tables. The author protests against a great many cases of so-called aortic syphilis being classed with this disease, and also many cases of tabes and general paresis. He holds that there is nothing definitely syphilitic about many of these cases from a histological standpoint, and that all such matters should be based upon anatomical and not on clinical findings. The author then reports two cases of his own: one of gummata of the pancreas, with chronic interstitial pancreatitis, and the other, gumma of the heart muscle, with chronic interstitial myocarditis. In discussing both of these cases, he states that there is nothing specific about the interstitial changes, and that without the gummata no definite diagnosis of syphilis could have been made. He further states that many such interstitial changes, not associated with gummata, are probably secondary to syphilis, that there is usually nothing specific about them histologically, though there may be peculiarities which lead us to suspect a syphilitic origin. He states that in such cases we should not make a flat-footed diagnosis of syphilitic lesion, but only state its probability. He thinks that we are only on the borderland of knowledge in these cases, and that

definite gummatous changes must be present before an absolute diagnosis of visceral syphilis can be made.

Carbolic Acid Injections in Tonsilitis.- H. JUDSON LIPES (New York Medical Journal, October 21, 1899) has used a three per cent solution of carbolic acid in the treatment of follicular amygdalitis and the angina of scarlet fever with success. The cases included five of scarlet fever, six of diphtheria, three of suppurative, four of simple and three of follicular amygdalitis. In diphtheria no beneficial effects were observed. In scarlet fever immediate relief was obtained, with prompt reduction of the fever and improvement of the general condition. The method of procedure is simple. A few drops of the solution are injected into each tonsil at several points. A small syringe is used with a long needle, having a shoulder about four millimetres from the point. The shank and middle are together about six centimetres with the extremity turned at an angle of forty-five degrees, the elbow being about three millimetres from the point.

The Therapy of Bronchial Asthma.-(J. A. GOLDMAN, in Wiener med. Wochenschr., October 21, 1899.) The author reviews the different methods of treatment that have given good results up to the present time. But the most rational method, he thinks, is the inhalation treatment, and recommends particularly “Neumeier's Asthma Powder," which is made up of stramonium, lobelia, nitrate of soda, nitrate of potash, iodide of potash and white sugar.

The iodide of potash, he considers, a particularly valuable ingredient of the powder, as used in this way it causes no disagreeable after-effects. Goldmann treated 45 cases of asthma in a year with this powder, and found that its inhalation, when burned in the room, caused an immediate relief of the acute paroxysms in every case. In 14 cases of true bronchial asthma he was able to cut short the attack each time, and a continuance of the treatment resulted in longer intervals between the attacks.

The Treatment of Gout. In the British Medical Journal for October 28, 1899, BAIN writes that foods rich in nuclein and nucleoproteids should be forbidden in cases of gout, unless investigation shows them to be harmless. The gouty patient's diet should be determined by the condition of his alimentary canal and its annexes and how much exercise the patient takes, systematically, without fatigue. He declares it absurd to make the same rules for all gouty patients; that it cannot be necessary to abstain from all kinds of meat, since muscle is relatively poor in nucleoproteid and that vegetarians sometimes have gout. The efficacy of carefully regulated physical exercise in the prevention of gouty manifestations cannot be overestimated. This agent, considered by Sydenham of greater importance than diet or drugs, the author contends, is underestimated, and too much attention is paid to the so-called uric acid solvents. As regards the use of sodium salicylate, Bain agrees with Luff in believing it inadvisable, since the drug increases the excretion of uric acid at the expense of the leucocytes.