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MEDICINE.

(135) 1ti.1.gY of General Paralysis.HIIRSCHiL (Wien. klin. Rundschau, No-vember ioth, i895) analyses 200 cases ofgeneral paralysis occurring during tenemonths in Krafft-Ebing's clinic. Onlymen are treated of, as a syphilitic his-tory is difficult to obtain in women.lIereditary influences were traceablein only i per cent. The majority ofthe patients were in the lower walks oflife, and in no instance was the diseasedefinitely attributable to psychical-causes. Physical fatigue and insolationwere not regarded as causal antecedents,but Hirschl admits the possibility oftrauma as an exciting cause in patients-already infected with syphilis, andstates that this may occur in about I percent. of cases. He denies any connec-ltion between saturnine encephalopathyand general paralysis. He maintainsthat by far the most important etio-logical factor in the latter disease is'syphilis. The pre-existence of this he-considers proved in 56 per cent. andprobable in 25 per cent. of the 175 casesin which a history was obtainable; theincubation period varied from two to-twenty-nine years. He holds thatgeneral paralysis is due to syphilis and-syphilis alone, and that the i9 per cent.-of cases in which there was no indica-tion of this disease in the history hadprobably suffered from it unknowingly.He supports Obersteiner's view of theanalogy of general paralysis with syphi-litic perihepatitis; both begin as in-flammatory changes followed succes-sively by disappearance of the paren-chyma, interstitial changes, and event-ually atrophy of the cortex or liver re--spectively. Hirschl thinks that generalparalysis is really a late form of syphilis,beginning as syphilitic encephalitis,-and going on to syphilitic cerebralatrophy. He maintains that this theory-explains all the symptoms, is unaffectedby the resistanee of the disease to anti-syphilitic remedies, and is supportedby the fact that general paralysis and-syphilis spreadparipassu. His view asto the pathology of the cerebral processas based on Lang's dictum that any-organ in which a gumma develops musthave suffered from irritation in theearly stage of syphilis. The contagionresiduum in the brain of general para-lytiCs is propagated withl renewed-vigour, owing to the natural hyperaemiaof the oTgan during functional activity,-to funetional hyperaemia from variouspsychical and mental causes, or to theoceurrence of apparently slight trau-matie influences.

(136) BronchiectasisDURET (Arch. G6n. de M6Wd., January,1896), rplates a case in which recoveryoccurred after three operations. A girl

had a severe attack of whooping-coughwhen 8 years old, after which she suf-fered from cough and expectoration.When i8 years old she became worse,there being fever, cough, and abundantexpectoration. Three years later thecough and expectoration, which wasnow fcetid, further increased, and dys-pncea was present. The physical signsshowed that the lesion was in the lowerlobe of the right lung. The largesttrocar of Dieulafoy's apparatus waspassed into the chest in the seventhinterspace behind, and eventually thickpus with gangrenous d4bris was obtained.A flap of skin was then raised and por-tions of three ribs were resected. Thethickened tissue now exposed wasdivided by the thermo-cautery until acavity was laid open. Gangrenousmaterial escaped. Multiple cavitieswere then opened up by the cautery,and it was thought that the openings ofdilated bronchial tubes could be felt.After the detritus, etc., was cleared outa cavity remained of about the size ofa turkey's egg. The patient expector-ated about this time a most horriblyoffensive material. Two drainage tubeswere put in. The patient now steadilyimproved, and in a month's time wassent into the country. She continuedto do well for four months. Later the ex-pectoration increased, amounting to from30 to 50 c.cm. in the day, and the generalcondition became worse. A secondoperation was therefore undertakenabout nine months and a half after thefirst one. Some more cavities werecleared out, scraped with a Volkmann'sspoon, and packed with iodoform gauze.There was troublesome vomiting afterthis operation. A counter opening hadto be made fourteen days later belowthe right breast, and a large drainagetube was passed through. The patientnow began to improve again. The drain-age tubes remained in for four years.Twelve months later a cutaneo-bronchialfistula remained, and an operation wasperformed for its closure with success.Two years and a half afterwards thepatient was in excellent health. Itiwasthought that the air penetrated into theright lower lobe, and that this part ofthe lung had again become permeable.Three or four times a day she had amoderate attack of coughing, with theexpectoration of a clear and odourlessfluid. The author thinks that thiscame from dilated bronchi in the neigh-bourhood of the diseased focus. The ex-pectoration was diminishing.

(137) Megalocastrin and Gastroectasia.MARAGLIANO (Clinica Moderna, Decem-ber 30th, 1895), in a clinical lecture onthis subject, says the prognosis isgood if we have to deal simply with dis-turbance of the motor innervation ofthe stomach, and if there is no degene-ration of the muscular fibres. It is im-portant to note the effect of twenty-fourhours';complete rest, for if after this thestomach is able to empty itself after alimited meal the prognosis is good.The author does not believe in the valueof the amount of urine passed as a guideto prognosis, for the disease is not a

disturbance of chemical or absorptionprocesses so much as one of motility.As regards meals, the author prefers toadminister food in limited quantitiesand at long intervals. A mixed diet,with farinacea well cooked, is bettertolerated than a pure meat diet. Fatsshould be rigorously excluded. Milk andeggs may be allowed, and a little cog-nac. Wines, except those purified oforganic acids, are hurtful. The bestmineral waters are either those chemi-cally indifferent or slightly alkaline.Much benefit is to be derived from thedaily use of a powder made up of Na2SO4, 4 to 6 g.; Na2CO3, 2 g.; and NaCl., 50 cg., to be taken in a litre ofwarm water. In bad cases, even wherethere is no pyloric stenosis, the authoradvises surgical interference, and refersto io cases in which the dilated stomachwas reduced in size by surgical means,and with 8 successes.

(138) Pseudo-pertussls from a ForelnBody in the Larynx.

DE PRADEL (Arch. Internat. de Laryngol.November-December, I895) narrates acase in which he was called to see achildwho had swallowed a small pebblewhich was not found. Next night thechild had a typical attack of laryngismusstridulus, and for four months sufferedfrom apparently severe whooping-cough.The other children escaped entirely, andthe affection disappeared at once on theaccidental expulsion of the small pebbleduring a severe attack which came onwhile the child was playing roughly withits father. The author thinks the stonemust have been in the ventricle of thelarynx, and that much suffering mighthave been spared if the hospital phy-sician under whose care the child camehad made a laryngoscopic examination.

SURGERY.

(139) A New Radical Cure of Hydrocele.

BAUMIGARTEN (Aerztlich. cent. Anzeiqer,I895, No. 23) reviews and summarls sall the hitherto described radical opera-tions for hydrocele, and points outthat theoretically a radical cure canonly be effected by excision of thewhole tunica vaginalis, a procedurewhich is impossible without damage tothe testicle or epididymis. None of theordinary operations is, at the sametime, free from danger, productive ofrapid healing, and protective againstspeedy recurrence. His own operationis by means of a long incision frombelow the inguinal ring to the lowerborder of the scrotum. The wholehydrocele is then separated, withoutcutting from the subcutaneous tissue,and brought out from the wound, theskin of the scrotum being tucked awaybehind it, and packed with sublimategauze. A small incision is made in thehydrocele. and most of its fluid let out;the hole is then enlarged, and the wallof the cavity swabbed with gauze soakedin I in 4,000 perchloride. The wall isthen excised except the part in contactwith the testicle and epididymis, whichis vigorously scrubbed with more I in

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4,000; the same procedure is directedtowards the subcutaneous tissue. Thewound is sewn, up with seven or eightstitches; no drainage is made, but thelower few stitches are left further apartthan the upper. Any vessels whichbleed are twisted, but not ligatured.The wound is put up in a dry dressingsupported by a firm bandage, arrangedlike a pair of bathing drawers; it is nottouched for a week, when the stitchesare removed. The whole surface of thetesticle is at first adherent to thescrotal connective tissue; after a fewmonths, however, the bands relax, andthe cremaster becomes as effectual asbefore. The special advantages whichBaumgarten claims for his operationare that no hydrocele fluid is allowed toescape into the cellular tissue of thesbrotum, that the substitution of torsionfor ligation of the vessels removes asource of irritation, that as much of thetunica vaginalis as possible is removed,and the remainder well scrubbed withsublimate, and that drainage is dis-pensed with. He also states that thewound healed more rapidly, and withless scarring than with other methods.He quotes an illustrative case, whichhad remained ten months after theoperation without recurrence.

(140) Latent Cerebellar Abscess due toChronle Suppurative Otitis.

MONNIER (Arch. Internat. de Laryngol.,etc: November-December, I895) de-scribes a case in which, after an attackof influenza in a child aged 12, a chronicotorrheea suddenly ceased, and pain,fever, and delirium supervened. Theantrum and subdural space were opened,and pus evacuated from both, givinggreat immediate relief with descent oftemperature to 370 C. Two nights latercoma supervened, without paralysis, butwith trismus suCh as to render swallow-ing very difficult. In spite of changeof dressing and irrigation, death tookplace. A large abscess was found in thecorresponding lobe of the cerebellum.The author draws the deduction that if,after trephining the antrum withamelioration of symptoms, cerebral dis-turbance comes on, in the absence oflocalising signs the cerebellum shouldbe explored.

(141) A Case or Pyloroplasty.PACI (I Policlin., October ist, I895)reports the case of a woman, aged 3I,who for ten years off and on had suf-fered from symptoms of gastric ulcerand dilated stomach. Admitted intohospital on December igth, 1894, itwas seen that she vomited after food,bringing up the food mixed with a

copious very acid liquid and occasion-ally blood. The stomach was dilated,descending to two fingers' breadthbelow the umbilicus. The least pres-sure gave acute pain, radiating intothe back. The most painful spot wasin the pyloric region, where there wasa tumour the size of a small apple.Splashing and rumbling sounds wereoccasionallyheard. The stomach wasdaily washed out with i per cent. boricsolution and other medical means em-

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ployed; but the patient got no better,so that on January 12th the operationof pyloroplasty was performed. Manyadhesions between the pylorus andadjoining stluctures were found, andthere was considerable inflammation ofand about the pylorus. A perforatingulcer in the process of repair was foundin the pylorus. The pyloric orifice wasfound contracted and there was muchthickening. The operation lasted anhour altogether. Rather troublesomevomiting set in afterwards, but withthis exception the patient did well.In the post-operation vomiting bilewas found, whereas previously therehad never been any bile in the vomit.The patient had one or two attacks ofgastralgia, but otherwise is better inevery respect; he is no longer troubledwith vomiting, has gained weight, andwhen last seen, on August ioth, seemedwell in all respects. The stomach thenwas hardly dilated at all. The authorbelieves that the ulcer was of neuro-pathic origin, and allied to the per-forating ulcer of the foot.

(142) Technlque or Suprapublc Puncture.VON DITTEL (Wien. klin. Woch., No-vember 28th, I895) has tapped thebladder above the pubes considerablymore than Ioo times. He washes itout by means of a two-way cannula,and then introduces a Jaques catheter(No. 8), the caoutchouc of which hasthe property of swelling up and soeffectually preventing any escape ofurine. This catheter must be changedat least once in eight days; its stopperis to be removed whenever the neces-sity for micturition is felt-once atleast every four or five hours. Whenintroduced in this way the foreign bodyseems much less likely to inducevesical catarrh than if inserted pervias naturales; this is probably due tothe absence of the bacteria of theurethra. The puncture has a greattendency to spontaneous closure, wllichis a manifest advantage when the indi-cations for its employment have beenobviated. Von -Dittel has alwaysoperated in the mid line, but of lateSchopf has conceived the ingeniousnotion of a lateral puncture, wherebythe rectus or pyramidalis is used as asphincter and the permanent catheterdone away with. One disadvantage ofthis method is that the puncturerequires keeping open by the nightlypassage of a sound or drain. Further-more, von Dittel has shown that thedepth of the peritoneal pouches en-closed by the urachus, obliteratedhypogastric arteries. and epigastricarteries is very variable, so that insome cases but a very small portion ofthe anterior wall of the bladder is freefrom peritoneum. In such instanceslateral puncture may lead to perforativeperitonitis, and of this the authorrecords -one fatal case. He has there-fore abandoned Schopf's procedure andreverted to his own former method.He has found, however, that the poor-ness in vessels of the linea alba some-times leads to necrotic changes roundthe puncture, and therefore now adopts

the plan, particularly in old people,of operating just at the edge of thistendon.

MIDWIFERY AND DISEASES OFWOMEN.

(143) Abdominal Seetio fOP Disease OfFemale Organs.

BAZTERRICA AND MOLINARI (Annales deGyn4c et d'Obst4t., January, 1896) reportiI6 abdominal sections performed inone year at Buenos Ayres. There wereonly 4 deaths (I from total abdominalhysterectomy. 2 from pyosalpinx opera-tion, and i from subperitoneal openingof a parametric abscess). The I6ovariotomies all recovered. Of the 58cases of removal of inflamed appendagesall except 2 pyosalpinx cases recovered.Fourteen other cases of pyosalpinx in thesame class got well. Six out of 7 totalabdominal hysterectomies were saved;8 intraperitoneal myomectomies and2 Battey's operations for fibroid re-covered. The remaining operationswere less severe (exploratory, repairof hernia of cicatrix, etc.). Bazterricastrongly advocates total abdominalhysterectomy. He has performed it23 times with I death only. It is greatlypreferable to the older method of leav-ing an extraperitoneal or intraperitonealpedicle. He also speaks well of Battey'soperation when thoroughly performed.Out of 4 cases the haemorrhages ceased; inall, in I the tumour remained stationaryup to the, end of the first year afteroperation in 2 it diminished consider-ably, and in i, an enormous pelvicfibroid, it disappeared in six months.Operation for pyosalpinx is alwaysattended with danger. If any_usp bspilt in the peritoneal cavity flushingof the peritoneum diminishes anddilutes the germs. In such a caseMikulicz's drainage (packing the pelviswith iodoform gauze or sterilised gauze)is specially applicable.

(144) Results of Hysterectomy for Car-cinoma of the Uterus.

RUSSELL (Johns Hopkins Hosp. Bulletin,November and December, I895) has ana-lysed the subsequent course of 47 casesof hysterectomy for malignant uterinedisease performed in Kelly's clinicand private practice. Of these opera-tions 4o were by the vaginal, 4 by thecombined, and 3 by the abdominalmethod. Of the patients 5, or io percent., died from the operation, and X6,or 34 per cent., died with recurrence;21, or44 per cent., were still living, axadone died from heart lesion eighteenmonths after the operation. the other4 cases were not heard from. Of the 2Istill living, I6 had passed the limit oftwo years ordinarily assigned for the-duration of the untreated disease, andwere in good health. In the i6 fatalcases recurrence and death took placewithin eighteen months. Of thosewhich recovered, I had a local recur-rence in the scar three months after theoperation; this was excised, and up, tothe time of writing she had been in per-fect health for two years and a-half.Two others developed carcinoma of the

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breast, and i metastases in the cervicaland axillary glands. Nine of the casessuffered from adeno-carcinoma of thebody of the uterus; of these 7 were stillliving (one to five years after the opera-tion), i died from the operation, andthe other from recurrence, the operationnot having been complete. No recur-rence took place in any other case. Ofthe 38 hysterectomies for carcinoma ofthe cervix, 14 patients were still living;in 3 of these the operation was donemore than four, and in 4 more thanthree, years ago. Russell finds that byfar the greatest tendency to recurrenceis during the first eighteen months afteroperation, but that the patient is notfree from this danger even after fouryears; he also emphasises the fact thatthe probability of recurrence is muchhigher with carcinoma of the cervixthan of the body. The results, on thewhole, convince him that the operationof hysterectomy is not only valuable asa palliative measure in malignant dis-ease of the uterus, but is in a distinctproportion of cases an actual means ofradical cure.

(145) Cyanosed Fietus: TricuspidInsumciency.

BRINDEAU (Annales de Gync. et d'Obstgt.,January, I896) delivered a child weigh-ing 51 lbs.; it was deeply cyanosed,and lived only a few hours. Behind theright angle of the jaw was a smoothlivid tumour as big as a hen's egg; onthe left side lay a similar swelling of thesize of a walnut. Enormous veins radi-ated from these swellings, which ex-tended towards the temples. They pul-sated, and on auscultation a continuoussouffle, loudest during systole, washeard. They could be reduced on pres-sure, reappearing directly it was re-moved. After death the right chambersof the heart were seen to be greatlydilated. The tricuspid orifice admittedthe thumb; the ductus arteriosus wasdilated; the tumours were formed bythe distended jugular veins.

(146) An Explanation or " Supernume'rary " Ovaries.

ENGSTROM (Monatschrift f. Geburtshiilfeu. Gynak., January, I896) shows that anovary may be pulled in two by thetraction of inflammatory adhesions.This fully accounts for many "super-numerary" or "accessory " ovaries,though the author admits of a moregenuine form. Of the first type was aspecimen which he removed togetherwith a myomatous uterus. The patientwas 53, and had suffered repeatedlyfrom pelvic inflammation. The omen-tum and several coils of small intestineadhered strongly to the back of the myo-ma and to the appendages. Both tubeswere obstructed. There appeared to betwo ovaries on the left side. On closerinspection they were seen to representone left ovary drawn out into two pieces,though still connected by a band like apiece of string over half an inch long.This band contained Graafian follicles.The inner part of the ovary lay in nor-mal relation to the uterus; the ovarianligament was well developed. The

tissue was healthy. The other part ofthe original ovary was destitute of anyovarian ligament in an anatomicalsense; much of its interior was occupiedby a blood cyst, so that little normalovarian stroma existed. Engstrom, how-ever, declares that in the course ofanother operation for fibroid he metwith a true congenital supernumeraryovary. A myoma was enucleated fromthe right broad ligament. The rightovary was i inch long and > inch broad,and was connected by an ovarianligament with the uterus. Within aninch inferior and internal to it lay asecond ovary, I inch long and I inchbroad; there was a true and distinctovarian ligament, and no trace of anyinflammatory change in its neighbour-hood.

(147) Operation ont a Tubal Cyst:Sterility Cured.

GERSUNY (Centralbl. f. Gyniik., No. 2,1896) removed a tumour of the leftovary from a woman, aged 25, on Aprilioth, 1895. It proved to be a tubo-ovarian cyst. The patient had men-struated since 17, and had been married5 years without conceiving. Gersunyfound that the right tube ended in ablind dilated pouch " as big as awalnut." The ovary was normal. Therewas no trace of peritonitis. The tubalsac was incised at the point where ittouched the ovary; dark fluid escaped,and the mucous membrane was foundperfectly healthy. The ovary was in-vaginated (excepting a small part of itssubstance attached to the broad liga-ment) into the hole made in the tube,and the edges of the hole were sewn tothe ovary by interrupted sutures. Thenthe abdominal wound was closed. Thepatient menstruated at the beginning ofJune, July, and August, but no moreafter August. Gersuny saw her onNovember 25th. She was in goodhealth; the breasts were rather tense,the cicatrix of the abdominal wounddark purple in colour, and the uterusspherical and as big as an orange. Thefundus rose above the symphysis, andthe cervix was very short. This experi-mental operation seems to prove that atube after it has become sacculated canresume its functions if its tissues havenot been destroyed by dlsease.

THERAPEUTICS.

(148) Treatment of Splenic Anenmia.K6STER (Centrafil. f. inn. Med., Janu-ary 25th, I 896) relates a case successfullytreated by oxygen inhalations. Apatient, aged 44, had an attack of influ-enza two years previously, after whichhe began to suffer from general weak-ness, dyspncea, palpitation. On admis-sion the complexion had a slightly yel-lowish tinge. The spleen was enlarged,and extended forwards as far as the leftmammary line. The red blood cellsnumbered 8oo,ooo in a c.mm., and therewere numerous poikilocytes and micro-cytes, as well as a few esinophile cells;the white cells were not increased. Theheemoglobin stood at 25 per cent. De-

lirium was present at night. Thepatient was treated with arsenic anidquinine, but he steadily became worse.The dyspncea became more more marked.and the red cells further decreased.Some cedema sf the legs appeared. Thepatient was made to inhale 4 litres ofoxygen, and this was repeated everyday. Considerable improvement atonce set in. In two days the splenic enn-largement began to decrease. The redcells also increased, but poikilocytesand microcytes were still abundantlypresent. There were no macrocytes ornucleated red cells. The hiemoglobinnow stood at 45 per cent. In a month'stime, when the patient left the hospital,the red cells numbered 3,800,ooo, andthe hliemoglobin had increased to 75 percent. Two months later the spleen was%of normal size, and the patient was well.The diagnosis of splenic aniemia orpseudo-leukemia was undoubted. Underarsenic and quinine the disease became,worse. The great dyspncea and diminu-tion of red cells in this case were strik-ing. Oxygen inhalations were had re-course to with little hope of success, asrecovery appeared almost impossible.The author describes a very simplemethod of fitting up the apparatus foroxygen inhalation, consisting chiefly oflitre flasks, a small funnel for a mouth-piece, etc. Whether the result wasdirectly due to the oxygen or whethertime was thus allowed for the arsenicto act cannot be definitely stated, butthe immediate improvement must showthat the oxygen inhalations had some-thing to do with the results obtained.Good effects have been seen with th&same treatment in cases of leukgemia,but then much larger quantities ofoxygen were used.

(149) The Serum Treatment ofDiphtheria.

ADOLPH, of v. Noorden's clinic (Deut.med. Woch., January i6th, 1896) reportsthe results of IOO cases thus treated.They were not as favourable as thoseof other hospitals-perhaps becauseformerly only the most severe caseswere admitted. Recently better resultshave been obtained. ()f the ioo cases,20 died; 27 were tracheotomised, withI 2 deaths; of the 73 non-tracheotomised,8 died (ii per cent.); 8 of the trache-otomised cases were moribund on ad-mission. In all the cases there wasmarked clinical evidence of diph-theria, and in 93 the presence ofLoeffler's bacillus was demonstrated.In the remaining cases there wasevidence enough to show that thedisease was genuine diphtheria. Therewas paralysis in 22 cases. Paralysis ofdeglutition occurred in I7, with 9deaths; partial paralysis of the palatein 3; ocular paralysis in i, laryngealparalysis in I; and ataxia in 6 cases.Albumen was present in 58 and markednephritis in 6 cases, 4 of which died.In i case there was a haemorrhagicnephritis at the beginning of thediphtheria. In 3 cases there wassevere cardiac weakness, and theseall died. The diphtheria was com-plicated by measles in 12 cases. There

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was incontinence of urine in 3 cases,probably due to paralysis of thebladder. In one case a relapse wasnoted after fourteen days. A con-siderable degree of laryngeal stenosisdisappeared in 8 cases without trache-otomy. An eruptionl resembling urti-paria was seen in 27 cases. The authorgives details of 3 cases in which therewere pains in the joints, apparentlyin connection with the serum treat-ment. In one case there was subse-quent fever lasting one to two days,also to be attributed to the serum.Considerable quantities of serum wereused, rarely less than I,ooo units. Morerecently the author has mostly usedonly about 6oo units.

(150) Behring's Antitoxin in Angina.BLUMER (Johns Hlopkins Hosp. Bull.,November-December, 1896) records i8cases of angina, of which i6 underwentthe serum treatment. Of these latter 3were non-diphtheritic; of the remain-ing 13, 2, which were practicallymoribund on' admissioni, died. Theonly case of diphtheria untreated byantitoxin was one in which no mem-brane appeared; the patient was curedby a bichloride spray. Among theother cases of diphtheria one was anexample of the acute lacunar diphtheriaof the tonsils (simulating follicular ton-sillitis) described by Koplik andanother of multiple wound infection bythe bacillus diphtheriae. Of the caseswhich simulated diphtheria 2 were dueto streptococcus pyogenes, I to bacilluspyocyaneus, and I to the pseudo-dLiphtheria bacillus. One of the casesof true diphtheria contracted a secondattack three weeks after the first; inthis no antitoxin was uised, and a thirdattack supervened after another 37days. This Blumer considers to confirmthe view as to the shorter duration ofacquired (2I days) as compared withnatural (37 days) immunity. This caseis also interesting as showing the possi-bility of auto-inoculation, and as illus-trating the length of time (3 monthsand 3 days) during wlhich Loeffler'sbacillus may persist in the throat inspite of chemical agents, Loeffler'ssoluol solution having been repeatedlyemployed. Blumer finds that the serumhas a markedly favourable effect uponthe general condition and the tempera.ture in true diphtheria, whereas inother forms of angina the temperatureis not influenced by it. In severalcases skin eruptions (usually urticarial)appeared, but gave no serious trouble-he regards them as due to other consti-tuents of the serum than those on whichits antitoxic properties depend.

(151) rhioforin.DE BuCk (Reprint from Belg. M4d., No.50, I895), after drawing attention to theexcellent results obtained by Rogmanin ophthalmic surgery (Belg. M&d.,November 28th, 1895, and Flandre Med.,August'23rd I894) and corneal and con-junctival afections treated with thio-form (basic dithio-salicylate of bis-muth), praises its qualities in dermat-ology and medicine. Its value lies, the

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author believes, in its topical antiseptic,desiccative action, and in its forming aprotective insulating layer for the partsbeneath. All raw, weeping or ulceratedsurfaces heal rapidly under thioformwhether in the form of the pure pow-der or mixed with equal parts of levi-gated boric acid. It is indicated in allulcerative skin affections, and whereepidermic softening exists. InternallyDe Buck found its constipating and dis-infectant qualities manifest in 3 casesof acute enteritis; in a fourth chroniccase it caused gastric irritation and didnot influence the muco-sanguinolentstools. The dose of 2 gr. for an adult,1 to i gr. for a child, in powder or muci-fage, was perfectly well borne by thestomach. The author considers thedrug suited for internal use, since thedithio-salicylates are less toxic than thecorresponding salicylic salts.

PATHOLOGY.

(152) The Influence of the Nervous Systemon Infective Processes.

TRAMBUSTI AND COMBA (Lo Sperim.,An. 49, fasc. 3) have carried out a seriesof experiments on rabbits with theobject of finding out what influencechanges in the nervous system havewith regard to the localisation andcourse of infection. The organ chosenby them was the kidney, whose nervoussupply they seriously affected by ex-tirpating the inferior ganglion of thecoeliac plexus. After this operationtheyinjected cultures of streptococcuserysipelatis into 5 rabbits and cultures ofstaphylococcus pyogenes aureus into 7other rabbits. Eleven of these animalsdied in from 2 to 28 days, and onexamination it was found that in everycase the micro-organism had selectedthe kidney by preference, whereas incontrol animals the kidney was un-affected. From their experiments theauthors conclude that injury to thenerves of an organ predisposes it toinfection, and that vasomotor paralysis,instead of being a protection as someauthors have said, against infection,rather predisposes thereto. Since therewas no microbic localisation in theliver the authors hold that this organreceives its nervous supply from thesuperior coeliac ganglion and not fromthe inferior.

(153) Immunity against Typhoid and CoilBacilli.

LOEFFLER AND ABEL (Centralbl.f. Bakt.,Paras. u. Infekt., Bd. xix, I896, P. 51)give the details of an investigation uponthe specific properties of the protectivesubstances in the blood of animalsimmunised to B. typhosus and colicommunis. For those details we mustrefer the reader to the original paper;here we can only give their conclusions.They are as follows: (i) By treatingdogs with increasing doses of virulentcultures of B. typhosus or B. coli sub-stances appear in the blood of theseanimals which possess a specific pro-tective property only against that kindof bacillus which has led to -their for-

mation. (2) The serum of normalanimals protects against the fatal orlower multiples of the fatal dose oftyphoid or coli communis. The strengthof the dose supportable bears a certainratio to the amount of previously in-jected serum. (3) The specific efficacyof the protecting substances in theblood of previously treated animals firstbecomes manifest if doses of the par-ticular bacterium are given to theanimal to be protected which are mul-tiples of those doses against whichnormal serum confers immunity. (4) Thespecific protective action of the sub-stances also shows itself on injectionof a mixture of the bacteria and theserum. (5) Typhoid serum protectsagainst a somewhat larger dose of B.coli than normal serum, and coli serumprotects against a somewhat larger doseof typhoid bacilli than normal serum.By this somewhat increased protectionthe family resemblance of the two kindsof bacilli is manifested. (6) The specificsera do not protect against the sub-stances contained within the bodies ofdead bacilli to a greater extent thandoes normal serum. (7) By injection ofnormal serum into the abdominal cavityof guinea-pigs, and twenty-four hourslater twice the fatal dose of dead bacilli,guinea-pigs maay be immunised withintwo weeks against ioo times the fataldose of living typhoid bacilli. (8) Ifless than the fatal dose of typhoidbacillibe given at the first injection, and after-wards increasing multiples of the fataldose be given, guinea-pigs may be madewithin forty-eight hours to withstandioo times the fatal dose (forced im-munisation). (9) By injection of 0.5 toI c.cm. of a powerful typhoid serumanimals which have been inoculatedintraperitoneally with thrice the fataldose of typhoid bacilli may be renderedimmune to an infection that kills thecontrol animal in twenty hours, even ifthe injection of the protecting serumhave been delayed eight hours.

(154) Pathogenesis or iuraema.'AJELLO AND PARAVEANDALO (Lo Sperim,an. 49, fasc 4), as the result of numerousexperiments on animals, believe thaturaemia is closely related to the pre-sence or absence of an internal renalsecretion. Just as other glands haveinternal secretions, so has the kidney.The authors found that animals, afterunilateral nephrectomy and withoutany treatment, died in from eight daysto eleven months with albuminuria andcachexia. On the other hand, animals,after unilateral nephrectomy, when in-oculated with renal juice prepared afterthe method of Brown-Sequard andD'Arsonval (20 c.cm. injected daily indogs, I0 c.cm. in rabbits), did not pre-sent any albuminuria or cachexia andlived in good health until killed forother experiments. After double ne-phrectomy without treatment the aiii-mals died in four to forty-eight hours;if treated with renal juice they livedfrom forty-eight hours to four days andmore. The implantation of kidneys,whether subcutaneously or in the peri-toneal cavity, gave negative results.

Tm BameN 132 M.x6t-rAL TOURNALJ LF.HB. 22? IW.

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