In the second case a relapse occurred eleven days after defervescence from a mild first attack; the patient had been taking naphthol during the whole twenty-three days occupied by the first attack and subsequent apyrexial period, and appeared to be convalescent, until a severe relapse occurred lasting four weeks and nearly proving fatal. On the sixth day of the relapse there was much pain in the lower part of the abdomen, considerable distention and vomiting; naphthol was therefore stopped, and the pain and distention became less, whilst the vomiting ceased on the following evening. The stools became very much more offensive after the drug was discontinued. In these two cases naphthol certainly seemed to excite gastric disturbance; if it had been discontinued for a day or two, it might perhaps again have been given without further trouble, as in the case of the boy mentioned above; but one did not like to run the risk of exciting a return of the sickness. Both these patients made a good recovery. It was disappointing to see in the first case a typical attack of enteric fever developing, and in the second a relapse occurring, in these patients who had been taking naphthol regularly for some time previously, for on the theory on which its use is based, relapse especially should be prevented. The aim of the plan of treatment being to put a stop to the growth and further multiplication of the virus in the alimentary canal, and in this way to prevent constant fresh supplies of toxic material-whether actual micro-organisms or the poisonous products of their life-actionpassing into the general circulation and maintaining the morbid process, one chief test of the practical value of the method would be the non-occurrence of a recrudescence of the disease. In these two instances, in spite of the administration of naphthol, the bacillus appears to have maintained its injurious activity unimpaired.

One point came out prominently, namely, that convalescence was more rapid than usual, and that the patients were less reduced in strength than is generally the case. I should like also to call attention to the absence of albuminuria, of any but the slightest degree of splenic enlargement, and of secondary complications. The disinfection of the stools, as shown by loss or reduction of offensive odor, might also reduce the risk of propagation of the disease to nurses or attendants. The author concludes:

(1) That the production of intestinal antisepsis is a rational mode of treatment of enteric fever, and that B-naphthol is a safe and tolerably efficient

arising from profound disturbance in the alimentary canal was lessened. (3) That the tendency to the occurrence of splenic enlargement, albuminuria, and of secondary complications such as boils, abscesses, etc., of purulent infective origin, is diminished. (4) That complete convalescence is more speedily and satisfactorily attained: and that there is less risk of a propagation of the disease to others. Finally we must bear in mind that in some patients naphthol may excite so much gastric disturbance as to prevent its use.-J. M. Clark, in Practitioner.

ANTIPYRINE DURING THE FIRST STAGE OF LABOR.

In an article published in this Journal for July 14, 1888, Dr. Egbert H. Grandin, visiting surgeon to the Maternity Hospital, called attention to the use of antipyrine in the first stage of labor. He stated that he had used it for the past year with gratifying results, and that the pains were rendered much less severe, while at the same time the progress of the labor was not interfered with.

In accordance with Dr. Grandin's suggestion, and during his term of service, Dr. T. H. Rockwell, house surgeon at the Maternity Hospital, used it in each case of labor where applicable. The first dose was given when the os was about one-third dilated, except in cases where the pains were very severe from the outset, when it was ordered earlier. Antipyrine, gr. xv, and spt. ammon. aromat., m xxx, were administered every two hours during the first stage for three doses. The temperature and the pulse were noted at the time the first dose was administered, and every hour thereafter until dilatation was complete.

In almost every instance the patient said she felt greatly relieved, and this was evident from her behaviour. In some cases the patient would fall asleep for an hour or so after the first or second dose These observations were all the more important since the class of patients delivered in the hospital includes many nationalities and social conditions, conspicuous among them being many Polish Jewesses and Bohemians, who, as a rule, are very restless and demonstrative during confinement, and the effect on these was quite noticeable.

Incidentally it was observed that generally the temperature fell from half a degree to a degree and a-half F. The pulse became somewhat more frequent and the respiration slightly increased. Occasionally, if the pulse was rather rapid before administering the drug, it decreased in frequency. Thus an ordinary case taken from the historybook shows:

At 4.45 a.m., patient's temperature was 98.6° F., pulse 100; 5 a.m., patient was given antipyrine, gr. xv, spt. ammon. aromat., m xx; 6 a.m., temperature 98.2°, pulse 68; 7 a.m., temperature 98.2°, pulse 68. Patient was given antipyrine, gr. xv, spt. ammon. aromat., m xxx. 9 a.m., temperature 99°, pulse 64; 10 a.m., temperature 98°, pulse 80.

CASE II.-1 p.m., antipyrine, gr. xv, spt. ammon. aromat., m xxx; 1.20 p.m., temperature 98°, pulse 64, respiration 20; 3 p.m., antipyrine, etc., repeated; temperature 97.4°, pulse 66, respiration 19; 4 p.m., temperature 97.4°, pulse 70, respiration 19; 5 p.m., temperature 97.2°, pulse 68, respiration 22.

In order to ascertain the effect of antipyrine in decreasing or lessening the duration of labor, comparative statistics were taken where the drug was not and where it was used. Comparing a number of consecutive cases (of primipara) where the drug was administered with a similar number of same cases where it was not, we obtain the following

data:

From the preceding data it is apparent that antipyrine does not increase the duration of labor, but, on the contrary, tends to lessen this stage on an average of about half an hour, while the second stage remains practically the same, and in no case was there any injury done the mother or child.

Thus we see that the results of carefully kept statistics go to substantiate the statement made by Dr. Grandin, namely, that antipyrine very materially lessens the severity of the pains during the first stage without increasing the duration of the labor and without in any way injuring either the mother or child. The drug has never given rise to alarming symptoms, and this immunity is doubtless due to the fact that we have always associated it with a stimulant, and further to the fact that during labor there exists a physiological stimulation of the heart's action.-Dr. Van Winkle, in N. Y. Med. Jour.

THE DISINFECTION OF PHYSICIANS' CLOTHING.— A simple, ready method is needed- and an inexpensive one as well. The man busy in practice will shirk cumbrous devices. If he has but to hang his suit on a hook, touch a light to a dash of alcohol, and close a door, he is altogether likely to carry out his good resolutions, and sterilize his clothing after each exposure. The galvanized iron closet devised by Dr. Chas. Jewett, which I have used for some months with mnch satisfaction, meets these indications. Certain modifications suggested by experience are added in this description. Few houses have spare closets which can be kept empty for this purpose, or so placed that fumes escaping would not greatly inconvenience the occupants of the remainder of the floor. But the metal box may be placed in any desired position, as in the yard or under the front steps. The disinfectant used is sulphur. The employment of dry heat at 230' Fahrenheit for one or two hours is impracticable by any simple method which does not require watching. Steam saturates, and might cause shrinking. Chlorine acts only in the presence of moisture, under which condition the colors and texture of fabrics will be affected. Sulphurous acid gas is efficient, inexpensive, and easily produced. It is endorsed by the writers on hygiene, by the national and local health boards, and by the Committee on Disinfectants of the American Public Health Association in their exhaustive report (Dr. Sternberg, Chairman, in Phil. Med. News.)

Half an ounce is all that is required by the cubic air space of this closet, but I usually throw half a pound into the bowl to ensure the most complete saturation, and to allow of some leakage. An ounce of alcohol ignites the sulphur readily. More than a small quantity of alcohol should not be used, for fear of the flames leaping up high--although danger of igniting the clothes is obviated by the

screen.

The closet should be six feet high, two feet wide, and eighteen inches deep. A shorter closet brings the clothing down on the screen. The screen is made of ordinary mosquito wire gauze. The openings are kept as small as they conveniently may be. Should the upper door not close tightly, a piece of cloth larger than the door can be placed on its inner side and lapped back over its edges, although this has not been found at all necessary in practice. Four hours' exposure of the clothing in this closet is probably sufficient, but the suit may well be hung up in the evening and left over night. It may be worn again in the morning without needing to be aired; in such cases the wearer scents sulphur faintly for some hours, but no one else is conscious of the odor. The cost of this closet is about $13.-Dr. Dickinson, in Brooklyn Med. Jour.

SHOCK. Dr. Cheever first describes this surgical condition, and then continues contrasting primary and secondary shock as follows:

Primary shock; reaction early and perfect, or slow and imperfect. Secondary shock: prostration, nausea, excitement, collapse. Loss of blood from accident or operation, adds to the shock, or complicates its symptoms.

Jar, crushing, mutilation, pain, cutting, bleeding, chilling, all act on the nervous system; react on the ganglia, the heart, the power of breathing, the temperature, the consciousness, the life.

Given then the problem and the phenomena of shock, what particular influences have the operative procedures of modern surgery upon them? They may be summed up in three points: 1. The effects of anesthetics. 2. The effects of the operations. 3. The effects of the dressings. These all belong together and affect each other. Anæsthetics annul pain, but end in nausea. Operations under anaesthetics are needlessly prolonged and exhausting.

Modern dressings are tedious and chilling Have we lessened or added to shock by modern surgery?

(6) As short a dressing as is practicable.

(7) As a cardinal point, avoid chilling the patient.

To promote reaction after the operation : (1) Persistent and carefully applied dry heat. (Be over-careful about accidental burns.) (2) Liquid nourishment, combined with a stimulant and a little laudanum, by enema.

(3) Subcutaneous injection of brandy. (4) Aromatic spirits of ammonia by the mouth. Champagne is sometimes retained when other things are rejected.

(5) Black coffee and brandy, the stimulant par excellence, when it can be retained on the stomach. (6) Quiet a horizontal, or more than horizontal position; sleep; assurance that all is over, and doing well.

Modern surgery has won three great triumphs: It substitutes sleep for pain.

It averts secondary hæmorrhage by the animal ligature.

It prevents fermentation by germicidal applications.

Can we add a fourth by stilling the nervous system, and averting, or diminishing secondary shock? Dr. Cheever, Boston Med. and Surg. Jour.

THE PATHOLOGY OF PERNICIOUS ANEMIA. The article is a resume of a recent contribution by Dr. Wm. Hunter to the Lancet. Space is wanting for more than a summary of the results of the investigations, and some short comment upon them. In the first place, he concludes, pernicious anæmia is to be regarded as a special disease, both clinically and pathologically. It constitutes a distinct variety of idiopathic anæmia. 2. Its essential pathological feature is an excessive destruction of blood. 3. The most important pathological change to be found is the presence of a large excess of iron in the liver. 4. This condition of the liver serves at once to distinguish pernicious anæmia, post-mortem, from all varieties of symptomatic anæmia, as also from the anæmia resulting from the loss of blood. 5. The blood-destruc

What can we do to prevent or diminish shock? (1) Wait for reaction.

(2) Never neglect to calm those suffering mental shock by a cheerful word and personal pres

both in its nature and its seats from that found in malaria, in paroxysmal hæmoglobinuria, and other forms of hæmoglobinuria. 6. The view can no longer be held that the occurrence of hæmoglobinuria simply depends on the quantity of hæmoglobin set free. 7. On the contrary, the seat of the destruction and the form assumed by the hæmoglobin on being set free, are important conditions regulating the presence or absence of hæmoglobinuria in any case in which an excessive disintegration of corpuscles has occurred.

8. In

paroxysmal hæmoglobinuria the disintegration of corpuscles occurs in the general circulation, and is due to the rapid dissolution of the red corpuscles. 9. In pernicious anæmia the seat of disintegration is chiefly the portal circulation, more especially that portion of it contained within the spleen and liver, and the destruction is affected by the action of certain poisonous agents, probably of a cadaveric nature, absorbed from the intestinal tract. Ed. Jour. Am. Med. Assoc.

THE USE OF TEREBENE. In the N. Y. Med. Jour., Dr. D. M. Cammann reports a number of cases of bronchitis and other lung affections treated by the use of terebene, from 15 grains to drachm boing given three times daily. Of these cases thirteen were of bronchitis, most with more or less pleuritic adhesions. Three were acute bronchitis, ten emphysema, two asthma and bronchitis, ten phthisis, one pleurisy, and one of the third stage of pleuro-pneumonia. Two of these-both cases of acute bronchitis were cured, one in four and the other in eleven days. Thirty-three cases were improved, most of them markedly, but a few only to a slight degree. Five were unimproved, two of the patients being obliged to discontinue the drug after two or three days, as it produced vomiting. The shortest time the treatment was continued in any case was four days, the longest time six months. The average length of treatment was a little over twenty-six days. Most of the patients took 15 minims, and some as much as drachm, in a mucilaginous mixture, four times daily. In all except three the cough was improved, becoming softer and less frequent. In twenty-six the quantity of the expectoration was lessened, in four it was unchanged, and in two it was increased. The latter were under treatment only one week, and it was found in some of the other cases that the expectoration was increased for the first few days and afterwards diminished. In seventeen cases the expectoration became thinner and more watery; in six it was no thinner In the other cases no note was kept in regard to this point. In those troubled with dyspnoea it was diminished in eight. The patients noticed an increase in the urine in nine cases; no increase was noticed in fifteen. In many of the cases the appetite improved. In two cases the terebene caused vomiting, in two nausea, in one dizziness and nausea, and in two dizziness. These symptoms usually disappeared when the dose was reduced. It is beneficial in affections of the bronchial mucous membrane, both acute and chronic. It relieves the dyspnoea of emphysema, it is readily borne by the stomach, and it seems to have a resolvent action on pleuritic adhesions.-Therap. Gaz.

TREATMENT OF POST-PARTUM HÆMORRHAGE-In the presence of sudden and abundant hæmorrhage

post-partum, Dr. Ségournet administers powdered ergot, freshly prepared, introduces the carefully disinfected hand quickly into the uterus and compresses the aorta (which is easily recognized by its pulsations) between the fingers and the vertebral column. The hæmorrhage is arrested at once Pressure is maintained as long as possible, and is not relaxed until an aid compresses the aorta through the abdominal walls and shuts off the circulation below. If hæmorrhage does not recur the hand is not introduced into the uterus again, but the compression of the aorta through the abdominal walls is maintained for some time, occasionally The advantages of this method are that it requires no instruments, which are so likely either not to be at hand or to be out of order, and that it is easily and quickly applied, and perfectly trustworthy.-An. de Gynécol.

even an hour or more.

COCOANUT AS A Vermifuge.-Referring to the recent statement of Professor Pariso as to the vermifuge properties of the cocoanut (Pharm. Journ.), a correspondent of the Times of India writes that the cocoanut has been used as a vermifuge in India for probably forty generations by the beef-eaters of the country, and is so well known there as a means of expelling the fat worm that he cannot conceive how information of this fact has not reached England before. When properly prepared and intelligently administered, so says this writer, the cocoanut is equally efficacious with male fern oil, kousso, pomegranate-root, or turpentine, while it is as pleasant to the palate as they are offensive. He is of the opinion that this is only one of the many valuable Indian remedies that would become better known to the European practitioner if an edition of the Pharmacopoeia of India were published, properly brought up to date. Pharm. Journ., 1888.

ALBUMINURIA IN RELATION TO LIFE INSURANCE. -At the recent annual meeting of the Association of American Physicians, held at Washington, the subject of renal disease was dealt with by several members from various points of view. One of the most practically interesting papers was read by Dr. James Tyson, of Philadelphia, and referred to the significance of albuminuria in respect to life insurance. The writer pointed out that in certain cases candidates presenting this symptom might be accepted, although he would draw the line rigidly at those who, in their general health, in the fact that no casts accompany the albumen, in the small quantity of the latter, and the high specific gravity of the urine, present no evidence of structural kidney disease. When the specific gravity is above 1020, the assumption is that the albuminuria is functional; if it be 1010, it would be hazardous to accept such a case, however good his health may be, even in the absence of casts.

Of course, evidence of cardiac hypertrophy with albuminuria would suffice to exclude the candidate; nor if a patient suffering from albuminuria were over forty years of age should he be accepted unless he has long been under observation. The subjects of true gout were also recommended as unfit, seeing their liability to renal disease.-Lancet.

THE DIETARY OF ASTHMATICS.-Asthmatics, from necessity, become spare feeders, and are often very thin. In so many cases a heavy meat meal is followed by an attack that a restricted dietary is inevitable. To certain asthmatics certain articles are specially injurious, while to others they are

not so.

The dietary which suits most asthmatics best is that which limits them to two meat meals, viz., breakfast and lunch or early dinner, and restricts their food for the rest of the day to liquids, with only bread, toast, or buscuits as solids; the great principle being that the asthmatic should retire to bed with gastric digestion quite complete, and thus preclude any presure upward against the diaphragm from flatulent accumulations in the stomach. Where there is much dyspepsia, and especially where flatulency occurs immediately after meals, it is advisable to omit sugar and starch from the dietary and to avoid potatoes, and in these cases a little alcohol in the form of whiskey, or brandy and water, should be taken with lunch or dinner. Coffee is generally a suitable beverage, and should be taken at least once a day, black, as it distinctly lessens the spasm without rendering the patient sleepless, whereas tea, though it is a product of the same natural order of plants, acts in a different way and often increases the neurosis. Various extracts, such as Brand's and Valentine's, and strong beef-tea, especially when taken warm, are. excellent, as they are easily assimilated, and enable the patient to get over the asthmatic attack without great prostration.

It need hardly be added that all articles of food which are in themselves more or less indigestible, such as pastry, pickles, uncooked vegetables, salads, garlic, and fruit, except when perfectly ripe, and we may add cheese in its various forms, and richly dressed or highly flavored dishes, are to be strictly avoided.-Dietetic Gaz.

TREATMENT OF PNEUMONIA BY DIGITALIS.-M. Petresco has treated a large number of cases of acute pneumonia with great success by the administration of four grams of digitalis leaves in infusion every half hour, by mouth. The infusion is prepared with 4 grams of digitalis leaves to 200 grams of water and 40 grams of syrup. disease is generally checked in three days. fever and all the physical phenomena, local as well as general, disappear rapidly. In spite of the large doses he has never seen poisonous effects,

The

The

tolerance having been incontestably proved by 577 observations. By this treatment it is claimed that the mortality of pneumonia has been reduced to 1.22 per cent.-Lyon Med.

CAPILLARY ASPIRATION OF THE Bladder. This was one of the subjects brought before the Society of Naturalists, at Cologne, by Drs. Rosenberger, of Wurzberg, and English, of Vienna. The first speaker remarked it was a procedure warmly recommended by Lücke, and he wondered that it was so little practised. The operation was easily performed. Any kind of aspirator could be used, and a fine needle no thicker than an ordinary knitting needle passed into the bladder above the symphysis in the linea alba. When all the fluid was evacuated the canula should be removed, with a sudden jerk. By this means no bleeding took place, especially if care was taken to keep the sides of the canal together until they adhered. Of course all antiseptic precautions should be made use of. In old people it was sometimes necessary and frequently useful. It often happened that when aspiration had been performed two or three times the patient could micturate naturally, or a catheter could be introduced, when before such a thing was impossible. It was a procedure generally indicated in retention of a passing character, and when catheterization set up violent hæmorrhage from the urethra. The pain from the operation was slight, frequently less than was caused by introduction of a catheter. Dr. English, of Vienna, said he had never practised capillary aspiration of the bladder, and criticised the procedure adversely as both unnecessary and dangerous.-Med. Press and Circular.

TANNIN IN PHTHISIS.--Dr. de Viti Demarco, of Otranto, has found that large doses of tannin will reduce the temperature of phthisis, and will sometimes produce a most beneficial effect on the course of the disease. He prescribes it in the form of a pill, to be taken every two hours. Each pill contains seven grains and a half of tannin, with a quarter of a drop of creasote. In one case, where there were cavities in the left apex, the whole of the lung being affected, the temperature rising as high as 40° C. at night, apyrexia was obtained in twelve days, and at the end of three months the general condition was much improved, the cough and expectoration being greatly lessened, the weight having increased, and there being an entire absence of fever. Notwithstanding the prolonged use of the tannin, no unpleasant symptoms were produced by it.--Lancet.

ERGOT IN INCONTINENCE OF URINE IN CHILDREN.-A writer in the Medical Analectic says that he has been using for many years the fluid extract of ergot in the treatment of incontinence