the capillary pressure. In a normal dog, with normal vessels, the processes tending to cause oedema will be pulled up almost as soon as they have started, and moderate venuos congestion will produce no œedema. Dr. S. states that in the normal animal, the factor which retains the appearance of cedema is the impermeability of the vessel wall, since it is this impermeability which maintains the difference in osmotic pressure between blood and lymph. If the permeability can be increased in any way the balance of processes will be lost, exudation will predominate over absorption, and oedema results. A capillary wall is alive and is composed of cells which have a metabolism of their own and are dependent on a free supply of oxygen for their proper nutrition, along with nutrient material and a free exit for their waste products. If these cells are injured in any way the resistance of the membrane is diminished and its permeability is increased. Such an injury will follow if they be deprived for some time of a fresh supply of nutrient material and oxygen. It has been shown by Cohnheim that after long-continued anæmia of the rabbit's ear, the vessel became so permeable that the restoration of the normal circulation was followed by pronounced œdema of all the tissues. A long-continued venous obstruction, Dr. S. says, must affect the vessel-walls in the same way as anæmia, since here also the cells will be starved or asphyxiated, and hence it is that in the chronic conditions, which cause venous obstruction in man, we have the production of oedema. Malignant growths occurring in the neighborhood of a vein are usually associated with a condition of cachexia and consequently an impoverished blood supply to the endothelium. In summing up, we may say that oedema can never be brought about in the limbs by a moderate rise of venous pressure, so long as the capillaries retain their normal impermeability. So soon as the permeability of the vessels is increased oedema will follow. Any of the following ways may bring about the injury leading to this increase in impermeability: (1) Long-continued venous congestion (asphyxia of cells); (2) an excessive rise of intracapillary pressure breaking down the normal resistance of the cells; and (3) malnutrition due to an impoverished state of the blood. The oedema, as a consequence of uncompensated or imperfectly compensated heart disease, is much more frequent. This form of œdema is generally considered due to a rise in venous pressure and consequent venous obstruction. In the causation of dropsy in heart disease, alterations in the circulation must first be taken into account, as well as the alterations in the absorption and production of lymph. Taking the vascular system as a closed system of tubes having a definite capacity, the circulation coming to a standstill, the pressures at all parts of the system would become the same, making what is called the mean systemic pressure. The height of this mean pressure depends solely on the relation between the amount of contained fluid and the capacity of the system. If circulation be established by the heart's beat, the relation between the capacity and the volume of blood remaining unchanged, no alteration can occur in the mean pressure. The only alteration is in the distribution of the pressure. On the venous side of the heart the pressure will sink below the mean systemic pressure, while on the arterial side the pressure will be raised above the mean pressure. If after the circulation has been established the heart's action be interfered with, as by damage to the valves, or be checked altogether, the pressures on each side will tend to return to the zero of the system-the mean systemic pressure. As a result there will be a fall of arterial pressure and a rise of venous pressure to this point. The turning-point of the circulation, so to speak, lies in the region of the hepatic capillaries in the abdomen, and about the level of Poupart's ligament in the femoral vein. The heart failing, there would result a rise of pressure in the vena cava and in the large veins of the neck; but a fall of pressure in the portal vein, in the peripheral veins of the legs, as well as in the arteries. Dr. S. states that it seems, therefore, that failure of the heart's action, to whatever cause it may be due, can only bring about a fall of pressure in the capillaries of the intestines and peripheral parts of the body. There is another class of cases of dropsy in which the primary change affects the vessel-wall and not the intracapillary pressure. A change in the filtering membrane thus results, making it more permeable and allowing, under normal capillary pressures, an excessive exudation which is richer in proteids than is the normal lymph of the region in question. Cohnheim has classed all these cases, with alteration of the vessel-wall, as inflammatory œdemas. Alteration of the vessel-wall may be the result of either the application of the injurious agent to the vessels of any given part or of the introduction of poisonous substances into the blood stream. The author has shown that the chief action of poisonous bodies circulating in the blood was on the capillaries of the liver. The capillaries of the skin can also be affected by these bodies, as seen in the sudden onset of urticaria. Dr. S. believes that all cases of so-called nervous œdema can be explained by the circulation of some lymphagogue substance in the blood combined with local vaso-dilatation, which may often be hysterical or central in origin. Dropsy of renal disease is classed by Cohnheim among the inflammatory dropsies. We are unable, says the writer, to trace any adequate mechanical cause, such as raised capillary pressure, for the increased transudation. In all cases the primary cause of œdema is an increased transudation; and where we find dropsy we may say that in addition to the primary exudation there is also a derangement of some part of the absorbing mechanism.-Dr. Ernest H. Starling, in Lancet. -: 0: THERAPEUTICS. THE TREATMENT OF ACUTE DYSENTERY. During the past year Testevin has treated thirty-six cases of acute dysentery among the soldiers at Grenoble. His treatment had for its objects: first, to decrease the number of movements; second, to render the intestinal tract antiseptic; third, to remedy the local anatomical lesion; fourth, to combat the tendency to collapse. To diminish peristalsis he used hypodermic injections of morphin, 1-12 grain every hour, a large mustard plaster being applied over the abdomen at the same time to aid in relieving pain. In other instances he found it of advantage, if there was a tendency to febrile involvement, to apply an ice-bag over the lower portion of the bowel. Intestinal antisepsis. was attained by the administration of calomel in the dose of eight grains a day, for two or three days, in association with camphor and opium. As soon as the bilious action of the calomel was established so that the stools showed its effects, it was replaced by doses of bismuth varying from 60 to 120 grains in the twenty-four hours, and this was fortified in its effects by the use of five to ten drop doses of laudanum. These doses of laudanum also facilitated the tolerance of full doses of salol, varying from fifteen to twenty grains in each twenty-four hours. For the local lesion. he used injections of creosote made up as follows: B Pure creosote, 15 minims; Milk or bouillon, 5 drachms. To be added to six ounces of boiled water and given as one injection. Preliminary to this, an injection containing fifteen grains of boric or salicylic acid is administered in order to wash out any fecal matter that may be in the rectum. The warm creosote injection is retained as long as possible. Three injections a day are usually sufficient, and after each one, if much irritability of the bowel exists, a very small suppository of belladonna and cocain may be placed in the rectum. If the case is very severe, rectal injections of nitrate-of-silver solution may be used. For the collapse, hot-air baths or immersion baths of hot water, sinapisms to the limbs, and hot bottles about the patient, are ordered. To sustain the heart, hypodermic injections of spartein, caffein, and if necessary of ether, are given. Finally, if the condition is extremely grave, he gives injections of normal saline solution into the subcutaneous tissues; these injections are absolutely aseptic and given in the quantity of half a pint to a pint or more, two or three times in twenty-four hours. By means of this treatment he has been able to cure patients who seemed to be in a desperate condition.-La Médecine Moderne, May 13. ALCOHOL IN CHILDREN'S DISEASES. The following is abstracted from a paper upon the subject by Dr. A. Seibert, of New York city, in the New York Medicinische Monatsschrift: Nursing mothers should refrain from drinking beer if their infants have gastro-enteric disease. Tea or coffee, without milk, is a better stimulant in the gastro-enteric diseases of children than is alcohol, which acts as an irritant poison in such cases. Alcohol is contraindicated in the typhoid fever of children, he using it only in about 5 per cent. of his cases, and then only in collapse. It has no germicidal effect upon the contents of the digestive tube, but rather increases germ life, whilst it retards digestion. Cases fed upon soup water, coffee and tea recover the soonest; those fed upon milk without alcohol do not do so well, and those fed upon milk with alcohol improve the slowest. In pneumonia alcohol is contraindicated except to combat collapse, its continuous administration in this affection does not prevent collapse, but rather helps induce it. He believes in plenty of fresh air in the sick chamber, despite the "time-honored seventy-two degrees F. rule." He feeds these cases on soups, and gives water and stimulates with tea and coffee. Milk is given if it can be borne. In scarlatina he uses alcohol only in septic infection from throat slough, and then only at night, to induce sleep and diminish the sensibility to local cleansing manoeuvers, sometimes also giving an enema of antipyrine. This usually results in refreshing sleep, but when gastric disturbance has caused the withdrawal of alcohol, he has noticed no evil after effects. Alcohol is useless in diphtheria, as it is no antidote to the Loeffler bacillus, and only adds to the myocarditis that so often causes heart failure in this disease. He has used alcohol in large doses in impending col lapse for a day or two, but is not satisfied that it was the cause of recovery, and is inclined to attribute a favorable termination to energetic local measures that were begun at the same time. He had treated twenty-seven cases of diphtheria with serum, and all recovered but a child of eleven months, the only one in which alcohol had been used. For nephritis he only uses alcohol as a diuretic, giving it in small doses, and only for one or two days. It is apt to set up acute nephritis in larger doses, or even in small doses, if continued more than a day or two. It is absolutely contraindicated in gastro-enteric disturbance. M. Sig. Three such capsules or tablets to be given daily. After evacuation and expulsion of the core, the opening is filled with a paste composed of: THE STRYCHNIA CURE OF ALCOHOLISM AND OPIUM HABIT. A certain proportion of the submerged 4,000 who pass yearly through the alcohol wards of Bellevue Hospital distinctly and seriously wish to have a treatment given them which will take away their tendency to periodical sprees, writes Dr. C. L. Dana, of New York, to the Medical News. Consequently the use of strychnia and the solanaceæ, with cer |