the Jefferson Medical College Hospital. Visual acuity of right eye approximately normal, pupil responsive to variations of illumination, media clear and fundus healthy. The left eye was deeply injected, as in glaucoma; its cornea clear, anterior chamber almost annihilated, iris convex forward, pupil small and adherent in its circumference to the anteriorly dislocated and entirely opaque lens. The upper, inner section of the ciliary region was staphylomatous, the sclera at this point very thin and apparently ready to burst. Tension+2. Section was made through the equator of the globe; the vitreous chamber seemed to be entirely occupied by blood, to the exclusion of all clear vitreous humor. Macroscopic examination did not discover the source of the blood; its origin was probably rupture of a chorioidal vessel during the severe inflammatory attack of the previous week.

Euphthalmin: A New Mydriatic.—JAMES HINSHELWOOD of the Glasgow Bye Infirmary read a paper on this subject in the Ophthalmologic Section of the British Medical Association in August of this year, and his paper finds a place in the Ophthalmic Review for November, 1899. He has made numerous experiments with this new mydriatic, and in this article states results. His conclusions are:

(1) Two or three drops of the five per cent. solution of euphthalmin will dilate the pupil fully in from twenty to thirty minutes; (2) this dilatation may be considerably accelerated by the preliminary instillation of a drop of one per cent. solution of holocain; (3) there is produced a paresis of accommodation, variable in amount but always of a very transient character, passing off completely in from an hour and a half to two hours; (4) these is no discomfort or feeling of irritation produced by the instillation of the drug; (5) there is no injection of the conjunctival vessels, no tearing and no alteration of the cornea; (6) there is no elevation of ocular tension; (7) no toxic symptoms have ever been observed from its use; (8) the mydriasis disappears completely in from eight to twelve hours.

CLINICAL MICROSCOPY

Edited by Arthur W. Elting, M D.

The Origin of the Hæmoglobin and of the Red Blood Corpuscles.-By Dr. FERRANTE APORTI (Cent. f. innere Med., January 13, 1900). During the past four years primary anæmias have been treated at the Medical Clinic at Parma with intravenous injections of iron and arsenic. From clinical observations it was very apparent that iron increased only the hæmoglobin while arsenic increased only the red blood corpuscles.

The writer has performed a series of experiments upon dogs to confirm these observations. He endeavored to determine

1. How do the hæmoglobin and red blood corpuscles react when an animal is bled and fed on an iron free diet?

2.

What influence do iron and arsenic have upon the regeneration of the blood in animals treated in the above manner?

He demonstrated that after moderate blood letting, up to the number of three or four, at intervals of a few days, when the animal is kept on an iron free diet, there will after each blood letting be a regeneration of the red blood corpuscles and of the hæmoglobin. In such a case he assumes that the hæmoglobin is regenerated from the iron deposited in the organs prior to the introduction of the iron free diet. If, however, the blood lettings are continued there comes a time when the red blood corpuscles will be somewhat regenerated, but there will be no regeneration of the hæmoglobin, due to the fact that there is no longer any available iron in the organs.

By a series of experiments he showed that if the red blood corpuscles and hæmoglobin are much reduced by repeated blood letting and arsenic is administered, the red blood corpuscles will regenerate rapidly, while the hæmoglobin will remain the same or increase but slightly. If now the arsenic be discontinued and iron substituted, the hæmoglobin increases most rapidly, while the red blood corpuscles remain practically the

same.

He has also demonstrated that if inorganic preparations of iron are used the hæmoglobin rises rapidly, but there is no iron deposited in the tissues. If on the other hand organic iron compounds are used the hæmoglobin rises less rapidly, and a considerable amount of iron is deposited in the tissues.

He concludes:

I. There undoubtedly exists a certain independence between the formation of hæmoglobin and red blood corpuscles.

2. There are substances which influence only the formation of red blood corpuscles. Of these arsenic is one of the most important.

3. There are substances which influence chiefly, almost exclusively, the hæmoglobin formation, and of these iron is the most important.

The Pseudo-Chylous Forms of Ascites.-By DR. MICHELI and DR. MATTIROLO, (Wien. klin. Woch., January 18, 1900.) The difference in the pathogenicity of the different forms of milky exudates in the serous cavities naturally points to the fact that different etiological factors must be concerned. To the original chylous form of ascites there was added in 1892 by Verdelli and others a new variety, the so-called mixed ascites. The milky cloudiness in the latter form is explained by the presence of chyle with a fatty degeneration of the cells. To these two there is to be added still a third form of opalescency which cannot be due to fat because it is present in such small quantity. These cases are not at all common, but they are not so uncommon as one would naturally suppose. By a superficial examination they are not to be distinguished from the forms containing fat, for the fluids in both cases have a yellowish white color and resemble milk. Both contain more or less formed elements, and the opalescency of both is not modified by filtration.

Quincke in 1882 called attention to the fact that there were milky exudates, the opalescency of which was due to the presence of numerous albuminous granules.

Various authors have described cases in which the contents of fat in the fluid vary from .12 to .67 per cent. According to Letulle there must be at least 1.5 per cent. of fat in the form of an emulsion to produce a milky cloudiness of the fluid. Thus, in the class of cases just mentioned the fat cannot explain the milky character of the exudate. It is not possible that the albuminous particles play much of a role in the production of the opalescency.

The writers report four cases of milky exudates which contained but a very small quantity of fat. In all of the cases the quantity of fat was less than one per cent. They found, however, present in the exudates of all these four cases a small quantity of lecithin varying from .15 to .25 per cent. By further experiment the writers showed that the addition of .15 of a gram of lecithin to 1000 c. c. m. of a serous exudate would give it a very distinct opalescency. They therefore feel justified in concluding that the opalescency in the cases reported by them, at least, was due to the presence of lecithin, and they believe that the milky exudates, in which the opalescency cannot be explained by the presence of fat, are due to the presence of lecithin.

Pepsin Secretion in Diseases of the Stomach.—By Dr. ROTH (Zeit. für klin. Med., Bd. 39, Hft. 1-2). The secretion of pepsin in different diseases of the stomach has hitherto received but little attention. The reasons for this are in the first place the fact that the HCl, secretion is a far better indicator of the pathological condition, and furthermore because there has till recently, been no good method for the quantitative estimation of pepsin. The writer discusses in some detail the various methods hitherto used for the estimation of pepsin, especially the method advised by Hammerschlag. For his experiments the writer used the method introduced by Mett in 1889. The method consists in filling small glass tubes from one to two millemetres in diameter with egg albumen and coagulating it in thin tubes. They are then broken up into bits of two to three centimetres in length, and these are subjected to the action of the gastric juice to be tested, and the extent of the digestive action determined by the amount of the coagulated albumen which is digested out of the tube. Only rarely is there a parallelism between the HCl. and the pepsin. The writer found that most pepsin was secreted in irritative conditions of the stomach, as in ulcer and hypersecretion. In uncomplicated hyperacidity there is no special increase in the amount of pepsin secreted. In dilatation of the stomach there appeared to be a slight increase but this may be due to the retained gastric contents. The smallest amount of pepsin was secreted in processes associated with a destruction of the secreting elements, that is, in chronic gastritis, atrophy of the mucous membrane, and carcinoma. In the latter it is especially due to the accompanying catarrh of the stomach. There are, however, many cases of carcinoma of the stomach in which the pepsin secretion is normal. In certain nervous diseases there is a diminution of the pepsin secretion. The writer concludes:

I. That Mett's method is well suited for the quantitative estimation of pepsin in general practice.

2. To obtain reliable results one must always experiment under the same conditions, and with the same amount of free hydrochloric acid in the gastric juice.

3. The variations in the secretion of pepsin are normally as great as are those of HCI.

4. There are cases in which there is a greater secretion of pepsin than normal (hyper-pepsia).

5. The most pepsin is secreted in irritative conditions. The least pepsin is secreted in a trophy of the mucous membrane of the stomach in certain cases of carcinoma and in some nervous disturbances.

6. The pepsin estimations have but little diagnostic importance. They are, however, of value in indicating the treatment to be used.

The Origin of Urinary Casts.-By Dr. E. VON ZCYHLARD (Wien. klin. Woch., January 4, 1900).

To Henle is given the credit for having first discovered urinary casts, although they were undoubtedly seen by earlier observers. Henle's observations were made in 1842. He observed only the so-called hyaline casts, and subsequent writers have devoted much attention to them. Henle believed because of certain reactions they manifested that the hyaline casts were composed of fibrin, and he called them fibrin casts. All the older writers accepted this view, and only rarely does one find in the older books any mention of the possibility of a different origin. The view that they were of a fibrinous character was first opposed by Oedmansen and Axel Key, who believed that the hyaline casts were partly a product of a secretory activity of the kidney epithelium, and were partly the result of homogeneously metamorphosed kidney epithelium.

Rovida energetically opposed the view that the hyaline casts were of a fibrinous character. Hyaline casts present many of the chemical reactions of fibrin but others are lacking. Bizzozero accepted Rovida's ideas that hyaline casts resulted from a secretory activity of the epithelium. After the discovery of Weigert's fibrin stain, a means seemed to be furnished of settling this question definitely. Weigert himself found that hyaline casts, except for minute portions of them, did not stain with his fibrin stain. O. Israel and Ernst came to the opposite conclusion: namely, that the great majority of hyaline casts were of the fibrinous character. Lubarsch ardently supported the view that hyaline casts originated from the cell protoplasm, either through a secretory activity or a transformation of the protoplasm.

With regard to the granular casts the writer believes these to be composed mainly of detritus, due mainly to degeneration of epithelial cells and leucocytes and red blood corpuscles. As for the origin of epithelial casts the writer believes that they are formed mainly from the desquamated epithelium of the collecting tubules, and opposes the view that the cells come from the convoluted tubules, and urges in support of this view the fact that the lumen of the Hemle's loop has a smaller calibre than the diameter of an epithelial cell of the convoluted tubule.

ALBANY

MEDICAL ANNALS

Original Communications

STATE CARE OF TUBERCULOUS PATIENTS.*

I

REPORT OF THE COMMITTEE ON HYGIENE.

To the Medical Society of the State of New York:

Your Committee on Hygiene would respectfully report: Directed by our sense of responsibility, by the logic of the situation, as well as by the resolution of the Society of last year, your Committee has given particular consideration to the subject of state sanatoria for the cure and prevention of consumption.

We think it expedient to trace the growing interest which this Society has taken in the subject of consumption, since the discovery of its infectious nature. The quickening influence of Koch's immortal discovery appears in this Society's transactions for 1891, the scientific event of the meeting of that year being a "Discussion on Tuberculosis," including the following communications:

"Its History," by H. R. Hopkins; "Its Pathology and Etiology," by Heneage Gibbs; "Tubercular Manifestations in the Upper Air Tract and Special Treatment," by Jno. O. Roe; "Treatment including Prophylaxis as Related to Climate," by Samuel B. Ward; "Treatment as Related to Therapeutics," by E. L. Shurly; "Inoculations with Professor Koch's Tuberculin,"

*The Report of the Committee on Hygiene, presented to the Medical Society of the State of New York, January 30, 1900; and the Discussion held in the Assembly Chamber of the State Capitol, Tuesday evening, January 30, 1900.