is cold water. Should be used for simple reduction of temperature. Quinine in large doses is a valuable antipyretic, also antiperiodic.

J. P. Colvin considered water the antipyretic par excellence. Mode of use governed by condition of patient. Full bath rarely necessary for infant. Quinine next best antipyretic, especially in sepsis. Would cautionagainst continued use of coal-tar derivitives, especially if weak heart, lung complications or sepsis. Cold water can be used for unlimited time without impairing vitality of patient.

J. R. Rathmell used the cold sponge bath. The profession has gone. to extremes with some of these new remedies. Now about the happy medium, and the coal-tar derivitives are used scientifically. In connection. with these he uses the cold sponge bath.

H. Berlin said that the antipyretics were the greatest gain in antipyretics, which were not more harmful than many other remedies. A temperature of 105 would do little harm for a short time, but if long continued would be dangerous.

G. R. West said we should treat the cause. The indications for the coal-tar derivitives were analgesics rather than as antipyretics.

W. F. Westmoreland said the continued use of antipyretics would depress the vital forces. They should be given so as to have their effect at the height of the pyrexia. Sometimes the shock of cold water prohibits its use; here tepid water should be employed. Cold would do more harm than good.

R. R. Kime said the cause should be removed if possible, then consider if antipyretics would depress more than fever. Would condemn use of the coal-tar derivitives in septic infection.

P. L. Brouillette regarding cold water as best antipyretic, next to that quinine. Patient should be put in bath and cold water added.

Seale Harris, Union Springs, Ala., read a paper on "The Treatment of Puerperal Eclampsia," in which he claimed that veratrum viride was the remedy par excellence, as by lowering arterial tension it acts not only by its effect on the arteries, but by a direct effect on the heart and pneumogastric nerves, lessening the heart's action and the amount of irritating toxins flowing to the nerve centers. It has also a sedative effect. He uses 15 to 20 drops hypodermically with 1-6 to 1-4 gr. morphine, and continues 5 to 10 drops often enough to keep pulse at 60. When so used it will control the convulsions, giving time to restore the functions of kidneys and bowels, or to remove the offending foetus.

R. R. Kime said the veratrum was our safest and best remedy. Is said to act by bleeding patient in his own vessels, by sedation and by arousing glandular secretion. Bleeding indicated in the plethoric, but this favors infection.

W. F. Westmoreland thought the explanation that the veratrum acted by bleeding in her own vessels not sufficient. There is some action we do not understand.

J. P. Stewart related three peculiar types. No. I patient was two months in expectancy. Chloral, morphine, chloroform and blood-letting gave no relief, so abortion was produced; recovery. No 2. Convulsions occurred in normal labor; veratrum, morphine, chloroform failed. Immediate instrumental delivery gave instant relief. No. 3 occurred after parturition controlled by morphine and chloroform.

B. S. Wert used veratrum. Cases should be delivered at once.

G. R. West believed in veratrum, but had no experience. Treated his case successfully with morphine hypodermically, chloral by enemata and chloroform. Advised emptying the uterus. Where blood-letting seemed to be indicated considered it best to allow the blood lost from uterus to be sufficient.

The following were read by title: "The Woodbridge Treatment of Typhoid Fever," J. W. Duncan, Atlanta, Ga.; "Diseases and Treatment of the Accessory Sinuses of the Nose," B. F. Travis, Chattanooga, Tenn.

The following officers were elected for the ensuing year: President, Willis F. Westmoreland, Atlanta, Ga.; vice-presidents, M. B. Hutchins, Atlanta, Ga. Seale Harris, Union Springs, Ala.; C. R. Achison, Nashville, Tenn.; secretary, Frank Trester Smith, Chattanooga, Tenn.; treasurer, Geo. R. West, Chattanooga, Tenn.; chairman committee of arrangements, W. D. Haggard, Jr., Nashville, Tenn.

1897.

Adjourned to meet in Nashville on the second Tuesday in October,

:0:

ABSTRACTS.

PATHOGNOMONIC SIGNS OF CONGENITAL SYPHILIS.

P. Silex (Berliner clinish Wochenschr., 1896, xxxiii, 139). The following is taken from an address delivered before the Berlin Med. Gesellschaft:

The author recognizes three characteristic signs of congenital syphilis. The first relates to the eyes, the second to the teeth, and the third to the skin. As the only real pathognomonic symptom relating to the eyes, he mentions chorioidea areolaris, in which are found, scattered over the fundus particularly in the neighborhood of the macula, black points and patches, which present here and there white spots of different size and larger areas with a black border. These represent atrophic colonies in the chorioidea, and pigment patches derived from the pigment of the stroma and pigment epithelium. The retina also being involved vision

in these cases is always very much impaired. Mercurial inunctions and exhibition of potassium iodide effected no change. In a few cases, the process, which is rare, remained unilateral. Of the numerous deformities of the teeth usually mentioned, S. only considers that one form pathognomonic, where the permanent upper incisors present a central excavation, denuded of enamel, beginning on the surface for mastication, and continuing upward in the shape of a crescent. As a sign which is only found in congenital syphilis, he considers the well-known scars radiating outward in straight lines, which do not confine themselves to the corners of the mouth or to the lips, but radiate further to cheek and chin. The histological examination of a case which was particularly marked, proved that these lines are not scars in the anatomical sense, as papillæ, glands, and vessels were well preserved in the tissue under consideration. Very likely the peculiar furrow-like appearances, which are called pseudo-scars by S., are due to a muscular tension of the skin. These three kinds of conditions which were demonstrated by the author both on the subject and through illustrations, are considered by him absolutely pathognomonic. So that the presence of even one of them will lead to a positive diagnosis of congenital syphilis.-Pediatrics.

OXYGEN AS AN ANAESTHETIC.

In The Medical Record, September 12, Dr. J. L. Corish states that an extended series of experiments in the employment of ether, chloroform, nitrous oxide and oxygen, lead him to the following conclusions:

"(a) The excitement stage due to the cutting off of the oxygen from the circulation, thereby causing nervous reflex muscular movements and irritation of the air passages, is abolished when the oxygen is added, on account of the blood receiving sufficient oxygen.

"(b) The cyanosis which is caused by the reflex paralysis of the vaso-motors, thereby allowing dilatation of the venous and contraction of the arterial blood vessels, due to a lack of oxygen at the nerve centers, is little marked or entirely absent.

"(c) That there is no increase of the mucous secretions is due to the removal of the cause of irritation and congestion of the mucous membranes. This nuisance, which in many instances is intolerable, particularly in the surgery of the nose and mouth, has in some cases in which the secretion entered the larynx caused dangerous symptoms of asphyxiation or subsequent pneumonia.

"(d) The vomiting and nausea, owing to the congestion of the stomach. and irritation of the palate, are alleviated and this of necessity does away with the danger of food becoming lodged in the air passages.

"(e) The anesthesia may be continued without stertor. The symp

tom, due to muscular paralysis of the palate, is not a necessary accompaniment of anesthesia. It shows that excess of the anesthetic is being used. The palate is controlled by both voluntary and involuntary forces. This symptom is a very good guide for the operator to go by.

"(f) The recovery from anesthesia is quicker and more complete, owing to a minimum of ether being used. The recovery cannot be hastened by the employment of oxygen separately after the operation.

"(g) The amount of ether used is just sufficient to keep the patient under its effects, and when thoroughly mixed with the oxygen (compound) no serious symptoms can result. The patient will not breathe at all if oxygen is given to the point of saturation, and therefore no more ether will be taken in than is required until the respiratory center calls for more oxygen.

"(h) Owing to the amount of oxygen stored up in the system by this method, the etherization may be discontinued at times for from fifteen to thirty minutes and complete anæsthesia may be readily and quickly reinduced in thirty seconds, if occasion requires, by application of the previous method. This advantage to the specialist in pharyngeal operations must be apparent.

"(i) Owing to the character of the heart beat not being much altered, the combined anæsthetic can be given with comparatively less danger in cases of stenosis and insufficiency of the cardiac valves.

"Finally, I wish to state that I believe and think it will be borne out by subsequent experiments that when the oxygen is given in superabundance in connection with ether, a double effect will be produced, i. e., an anæsthesia from ether primarily and from oxygen secondarily. Ether is eliminated from the system by means of the lungs through respiratory efforts. If we can supply sufficient oxygen to the system, so that the respiratory center is not irritated or rendered dormant, we prolong our anæsthesia until such time as the ether is split up chemically and passed off through the skin. Another point to be observed in the use of oxygen with ether is this: In extensive operations in which great loss of blood is to be expected and it is usual to constrict the limbs, it would be advisable to administer oxygen before the tourniquet is applied, so that when the blood is allowed to re-enter the circulation it will be in a condition more in conformity with that of the rest of the body.

"With regard to the anaesthetic power of oxygen when properly induced, in its application to surgery, I am positive that it will be of very great value in operations on young children who may require surgical interference of short duration. Operations about the mouth and nose. could be performed to the entire satisfaction of the operator, as the apparatus could be dispensed with immediately on the cessation of respiration.

Under the condition of oxygen anæsthesia, so to speak, the system is saturated with oxygen, the blood in the veins assumes an arterial hue, and the surgeon would have difficulty in recognizing venous from arterial hæmorrhage, but this would be insignificant in comparison to the benefits. obtained."-Am. Medical Review.

SURGERY-DEATH AFTER EXPLORATORY PUNCTURE OF HYDATID CYSTS.

Chauffard (Sem. Méd., August 8, 1896), records a case in which an exploratory puncture was made to confirm the diagnosis of hydatid cyst of the liver. Every antiseptic precaution was observed, and the fluid withdrawn was characteristic and clear. No pain was complained of. A few moments later the patient felt suddenly ill, intense irritation of the skin was experienced; this was followed by two severe epiletoid seizures. The mouth became filled with foam, and death ensued from cardiac collapse about twenty-five minutes after the operation. Post-mortem examination proved, apart from the liver, entirely negative. The heart was contracted in systole and empty. There was no effusion of liquid into the peritoneum, and no sign of inflammation of serous membranes. The liver was very large, and after removal of the cystic cavities weighed 2,450 g. Compensatory hyperplasia has frequently been noticed in these. cases. During life the liver had performed its functions well, and there was no glycosuria or urobilinuria. Post-mortem no cirrhotic or sclerotic lesions were present; the hepatic cells were well preserved. The trabecular arrangement was disturbed, the glandular element having obliterated the capillary network, and an almost exclusively cellular parenchyma remaining. This is probably a condition identical with that of the foci of nodular hyperplasia observed in the subjects of tuberculous, syphilitic, or malarial disease. Death after puncture, which is rare, usually results in cases of intra-peritoneal rupture. Two theories only can account for this case: I. That the symptoms were reflex, and of traumatic origin. 2. That they were due to intoxication by a special hydatid poison. The latter is the generally accepted, and, in this case, the only possible view. The three groups of symptoms-cutaneous, cerebro-spinal, and myocardiac-which are frequently met with after puncture of hydatid cysts can hardly be due to an ordinary traumatic reflex; there is obviously some reflex connected with the puncture of the cyst itself. Death through hepato-cardiac reflex was negatived in this case by the fact that the heart was arrested in systole. In the most attenuated form of hydatid intoxication-urticaria-patients are found to be very differently affected, and individual idiosyncrasy, with regard to the poison resulting from effusion into the peritoneum of a few drops of the fluid is the only way of accounting for the terrible effects produced in this case.-British Medical Journal.