The nutrition must be kept up, but an excessive amount of food is a frequent cause of the disease. As an assistance, exercise (Bouchardat), freedom from care and anxiety, baths, life in the open air, are mentioned.

THE ABUSE OF HYPNOTICS.

DR. JOHN B. CHAPIN, in the American Journal of Insanity, vol. xlviii. p. 202, reports seven cases admitted as insane, in which the excessive amount of hypnotics taken under medical advice was an important factor in accounting for their condition. The symptoms were hallucinations, restlessness, motor disturbances, fear of impending calamity, manifest constitutional disturbances, sensory disturbances, suicidal attempts, and delusions. The physical signs were dilated, sluggish pupil; diminished mental reflexes; feeble heartbeat; flabby, coated, pale tongue, and tumid abdomen. In hospital practice the use of hypnotics is becoming less with each year, and private practice should follow that example. However, the increasing number of the insane cared for at home leads to more extended use of hypnotics, with great temptation to enlarge the dose when violent symptoms arise.

PENTAL AS AN ANESTHETIC.

In the Therapeutische Monatshefte, 1891, p. 509, PROF. HOLLAENDER gives an interesting historical sketch of pental (trimethylethyl, also called 3-isoamyl, CH10). Soluble in alcohol, chloroform, or ether; insoluble in water; extremely volatile. Narcosis is readily obtained. Patients readily open their mouth on command, even during deep narcosis. No after-symptoms, except slight headache, possibly nausea or vomiting. It appears to be absolutely safe.

THE USE OF DRUGS IN THE TREATMENT OF EARLY PHTHISIS. DR. T. C. THOROWGOOD (British Medical Journal, 1891, p. 836), in a paper on this subject, stated that in bronchitis or persistent consolidation of lung after pneumonia, brilliant results have been obtained by five grains of hypophosphite of soda three times daily. In pleurisy with effusion, this treatment fails-although successful in a deposit producing friction-sounds of a rough character.

He believes that the potash salts have very great value as a liquefying agent-the lime to be used when secretion is profuse, which also checks sweating and diarrhoea. A respirator should be worn holding iodoform with alcohol, ether, and oil of eucalyptus; counter-irritation should not be forgotten.

HELENINE IN TUBERCULOSIS.

MR. T. J. BAKENHAM (British Medical Journal, 1891, p. 838) believes that in this drug we have a real protection against the disease. It is derived from the Inula helenium. He quotes Valenzuela (1883), Bacza and Korab (1885), Marpmann (1887). The following substances are prepared from the elecampane root: 1, helenine; 2, alant camphor; 3, alantic anhydride; 4

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alantol. The only substance that could be prepared in large quantities was alantic anhydride.

By culture experiments he found that helenine and associated bodies had a real action on the tubercle bacillus. He administered the drug to guineapigs during prolonged periods; subsequently inoculated them with tuberculous material; he fed them on helenine, inoculated them, and continued feeding on helenine.

The drug itself produced no ill effect, but the course of the disease, after inoculation, was retarded but not in any case arrested. In the animals protected by helenine, very few bacilli were found in the tissues.

The great drawback to the use of helenine in man is the expense. In a few cases six grains per diem have been used, which the author considers to be too small a dosage.

[These experiments have been carried out with great care, and the conclusions arrived at appear to be legitimate when the facts are carefully studied. It is to be hoped that a clinical report will soon be presented.—ED.]

CHLORALAMIDE.

DR. E. MANSEL SYMPSON (Practitioner, vol. xlvii. p. 274), presents the the results of his experience. While praising paraldehyde, he believes sulfonal and chloralamide to be more convenient and agreeable to the patient. He recommends it for the insomnia and delirium of acute fevers, delirium . tremens, nervous insomnia (dose 30 to 40 grains). Sulfonal is more powerful in mental disease, but chloralamide is better than paraldehyde in lung disease. It does not produce a necessity for larger doses, but a habit of going to sleep without it.

BENZO-NAPHTHOL.

La Semaine Médicale, 1891, No. 53, p. 210, contains a very practical note concerning the use of benzoate of B-naphthol (M. YVON and M. LE DR. BERLIOZ), which has a formula C1H,O(C,H,O), and belongs to the aromatic series. Insoluble in water; chloroform is the best excipient. This remedy, when introduced into the intestine, decomposes into ẞ-naphthol, which remains there, and benzoic acid, which is eliminated by the urine, partly as a benzoate and partly as a hippurate. This much can now be said:

1. That its coefficient of toxicity is small.

2. Its antiseptic power is comparable to other intestinal antiseptics. 3. It facilitates diuresis and diminishes the urinary toxicity.

4. The portion absorbed is rapidly eliminated by the urine.

5. It can be administered to seventy-five grains in an adult, and to thirty grains in a child-preferably in small doses frequently repeated.

TREATMENT OF BLENNORRHAGIC ORCHITIS BY THE CARBOLIC
ACID SPRAY.

DR. PAUL THIÉRY and M. HENRI FOSSE state at length the advantages of this method over permanent carbolic acid baths in carbuncles and boils, phlegmonous inflammations, urinary infiltrations, erysipelas, prolapsed

hæmorrhoids, lymphangitis, and preparatory antisepsis (Gazette Médicale de Paris, 1891, No. 44, p. 518, and No. 45, p. 532). This method is valuable because it is antiseptic, and, beside, presents two qualities of the poulticewarmth and moisture-for the pain and swelling. In support of their views they cite twenty-five cases in which this method has been employed. A synopsis of the first twenty cases is added, giving in each one the number of treatments necessary to cause the pain to disappear, as well as the number of days required. Pain was the leading symptom for the selection of this method, and as well when the inflammatory symptoms were marked. The patient is placed in position with the surfaces about the seat of disease protected by rubber cloth. The atomizer is about twelve inches distant, and the spray, as warm as possible, is directed against the parts, which are covered by a layer of light gauze, for twenty to thirty minutes. These sittings are repeated two or three times daily for so long a time as may be necessary. The solution used is one to twenty, or possibly as weak as one to fifty.

They conclude that this method is antiseptic, relieves pain, and favors resolution; it combats the two principal symptoms-pain and inflammation; it can replace with advantage the local remedies usually employed; there are never accidents; it diminishes the duration of the disease; it being an efficacious and harmless remedy, it should be used in epididymitis as well as in acute orchitis. It has not been possible to introduce into the body by this method such remedies as salicylate of soda or iodide of potash.

FATAL POISONING BY EPSOM SALT.

DR. WILLIAM LANG reports (The Lancet, 1891, vol. ii. p. 1037) that a woman, about thirty-five years old, accidentally took four ounces of sulphate of magnesia in a tumbler of hot water. She complained of burning pain in stomach and bowels, choking feeling, power going out of arms and legs. The tongue and mucous membrane of mouth were normal; no sickness, vomiting, or purging; pulse 96, and regular. He gave as emetic, thirty grains of sulphate of zinc, which did not act. Patient became collapsed, with dilated pupils, slight twitching of muscles of face, complete paralysis, and became comatose and died in one and a quarter hours after ingestion of the salt. There was no autopsy.

The following papers are worthy of note:

DR. S. S. WALLIAN ("Aërotherapeusis," New York Medical Journal, 1891, vol. liv. p. 398) gives a paper on "Imbibition as a Method of Exhibiting the Gases," which is a study of sulphuretted hydrogen, carbon dioxide, nitrogen monoxide and oxygen. He strongly advocates an oxygen water to which is added an equal or half its volume of chemically pure nitrogen monoxide.

PROF. A. BONOME (Fortschritte der Medicin, 1891, Bd. ix, p. 743), in “The Diplococcus of Pneumonia and the Bacteria of Hemorrhagic Dog Septicæmia," records his studies concerning immunity and the therapeutic importance of transfusion of blood and serum.

DR. T. LAUDER BRUNTON (Practitioner, vol. xlvii. p. 241), in “The Treatment of Cardiac Pain and Angina Pectoris," advocates the use of the nitrites, hydroxylamine (no clinical observation) for attacks; iodide of potash for

recurrence; iron and arsenic in fatty degeneration. Oertel's method with great caution. Tobacco generally forbidden.

DR. P. WATSON WILLIAMS (Ibid., p. 266), in "Cactus Grandiflorus," presents a clinical study of more than 200 cases, extending over some years. It acts upon the accelerator nerves of the heart and sympathetic ganglia, shortening the diastole and stimulating the spinal vasomotor nerve centres. More useful in functional diseases of heart; partial failure in angina pectoris ; not much use in dilated, thin walled hearts; fails in mitral obstruction, but useful in aortic regurgitation.

DR. THEODOR JOH. ZERNER (Wiener klinische Wochenschrift, 1891, No. 37, p. 679), in "The Influence of Digitalis upon the Respiration," shows as a result of experimental investigation that the amount of respiratory pressure and volume of air rose and fell with the increase and decrease of the bloodpressure; hence he concludes that digitalis increases the work of both ventricles.

DR. CHEVAL (Journal de Médecine de Bruxelles, 1891, No. 19, p. 585), in "The Electro-thermo-cautery," presents an elaborate paper on the physics of electricity, with practical remarks as to the source of electricity and the arrangement of apparatus.

DR. A. MANQUAT (Lyon Médical, 1891, No. 43, p. 252), in a very complete article entitled "The Indications of Quinine," gives concise directions for the use of this drug, especially in malarial fevers, typhoid, and also when locally applied.

THE TOXIC PROPERTIES OF ACONITE PREPARATIONS.

In the Gazette Hebdomadaire de Médecine et de Chirurgie, 1891, No. 44, p. 521, DR. L. LEREBOULLET, after citing the various opinions regarding the poisonous dose of aconite, calls attention to the variable proportion of the aconitine which is contained in the plant. Even the granules of aconitine, which seem to be harmless, can readily give rise to fatal symptoms if carelessly used. Caution must be exercised, lest, after using weak preparations the practitioner may choose a dose which in a good preparation may be absolutely dangerous. The increasing number of accidents shows that this warning is timely.

THE EFFECT OF CHLOROFORM ON THE RESPIRATORY CENTRE, THE VASOMOTOR CENTRE, AND THE HEART.

DR. LEWIS A. SHORE, at the same meeting, gave an account of certain experiments made by Dr. Gaskell and himself to determine what this effect is (Ibid., p. 1089). Application of one or two drops of chloroform directly to the exposed fourth ventricle of the medulla of rabbits was fatal. Respiration ceased by quickly diminishing the extent and depth of the breathing without influencing the rate. With this failure the blood-pressure gradually fell, but was still considerable when the respiration stopped. Intra-arterial injections slightly stimulated the respiratory centre, and then paralyzed it; also the vasomotor centre, which was paralyzed with large doses. The respiratory centre failed before there was any depression of the vasomotor centre. Intra-venous injection produced failure of the heart's action, rather than

paralysis of the vasomotor centre. From an experiment in which the brain of one animal was supplied with blood from another, it was shown, in confirmation of the preceding experiments, that the fall of blood-pressure was due primarily to direct action on the heart, and not to a depression of the vasomotor centre. The respiration begins to fail before the fall of pressure is dangerous. These experiments show that chloroform can be administered without interfering with perfectly regular respiration, and complete insensibility can be produced without obvious weakening of the heart. The practical deduction is, that this anesthetic must be administered gradually and with plenty of air, and that great care should be taken not to push the chloroform when struggling or gasping respiration occurs.

A CASE OF TRAUMATIC TETANUS SUCCESSFULLY TREATED WITH CHLORAL AND CALABAR BEAN.

DR. A. RADCLIFFE reports that a ten-year-old boy, ten days after injury to top of foot, complained of stiffness in back, jaws stiff, and he could not eat. On the following day the foot had healed; there was no soreness, but risus sardonicus was present. He could open his mouth a little, and walked about the room. He was placed in a dark room and given chloral, seven grains every hour, and four drops of the fresh fluid extract of Calabar bean every two hours. The symptoms increased until a complete picture of the disease was presented, the contractions being at times so severe that chloroform was necessary. Recovery took place after he had been under treatment for five weeks (Therapeutic Gazette, 1891, No. 11, p. 742).

A NEW METHOD OF TREATING DIPHTHERIA.

In the Practitioner for 1891, No. 282, p. 430, we find a very instructive paper by DR. C. SMITH, based upon the observation of seventeen cases. His treatment consists in the continuous inhalation of a vapor composed of a mixture of carbolic acid, eucalyptus oil, and turpentine until the patient is well, and at the same time support to the heart by stimulants, as well as tincture of digitalis, tincture of belladonna, and aromatic spirits of ammonia. The method of application is claimed to be new. Place the patient in bedfirst, to facilitate the inhalation; secondly, by retention of the horizontal position to spare the heart. Fix a tent over the patient by arranging a sheet, which should not be too large, but should be closed in on every side, except in front of his face, so that he can look about, be readily watched, and receive a supply of fresh air. The ingredients are carbolic acid, one part; eucalyptus oil, one part; turpentine, from eight parts to four, if stronger preparation is desired. Use steam continuously in the cot; soak two cloths about a foot square in the mixture, place one close to the face, the other on the pillow near the head. For adults, one or two other cloths may be hung about the cot. These cloths must not touch the face, and should be kept continually moistened. Breathing must be done through the mouth. The acid preferred is Calvert No. 2, which is pleasant and causes less discomfort. If the stronger preparation is used, to combat the depression of the heart use brandy in full doses or the drugs mentioned above. Steam must be always