and digestive organs, are discussed. The subjects presented are neurasthenia, insomnia, hysteria, epilepsy, chorea, neuralgia, articular neuroses, headaches, vertigo, writer's cramp, facial paralysis, hypochondriasis, palpitation of the heart, syncope, angina pectoris, asthma, hay fever, dyspepsia, nervous vomiting, constipation, diarrhoea, and obesity. The author has had a large experience in the treatment of such diseases, being a popular London practitioner. He presents his subject in an easy, flowing style, and gives a fair summary of our present knowledge regarding these diseases. Recent investigation has been devoted rather exclusively to organic diseases of the nervous system, and advances have been made largely along pathological lines; the study of symptoms has been perhaps somewhat neglected, and therefore a work of this kind, devoted largely to functional affections and their treatment, has met with success. The first edition of the work was exhausted within two years of its publication; the present edition contains several new chapters, and has been well received.

It cannot be said that any considerable addition to our knowledge is made in this book. Facts which are already familiar are presented in an attractive manner, descriptions of diseases are vivid, and symptoms are quite exhaustively analyzed. The author fortunately avoids speculation as to the mechanism of functional diseases, and does not even give a new theory of hysteria, a temptation to which writers frequently yield. The study of the etiology is satisfactory, and his presentation of the very numerous methods of treatment which may be employed in functional affections is quite complete. He has few, if any, original suggestions to make in the management of these disorders, but quotes freely from other writers, and indicates the methods which have, in his hands, met with success. In fact, the sections upon therapeutics are of considerable value to the general practitioner, for they contain a full account of almost every method of treatment in the functional disorders described. The book may, therefore, be recommended to those who need assistance in the management of functional nervous diseases.

M. A. S.

PROGRESS

OF

MEDICAL SCIENCE.

THERAPEUTICS.

UNDER THE CHARGE OF

REYNOLD W. WILCOX, M.A., M.D.,

PROFESSOR OF CLINICAL MEDICINE IN THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL ASSISTANT VISITING PHYSICIAN TO BELLEVUE HOSPITAL.

THE TREATMENT OF TUBERCULOSIS BY CANTHARIDINATE OF POTASH. In the Therapeutische Monatshefte, 1891, No. 11, S. 557, we find an excellent paper, in which is recorded the result of treatment of twenty cases of laryngeal and pulmonary tuberculosis, by DR. THEODOR HERYNG. He employed the preparation four times stronger than that recommended by Liebreich, in order to avoid the injection of a large amount of the solvent. Pain was prevented by preliminary injection of a few drops of a 10 per cent. cocaine solution. The various sites of injection were between the shoulderblades, epigastric, hypochondriac, and subclavian regions, all equally painful. The average dose was two-tenths of a milligramme (one three-hundred-andtwentieth of a grain), the maximum dose twice that quantity. With the latter dose occurred symptoms of irritation of bladder and kidneys, as follows: Pain and burning on micturition, daily amount of urine increased, and it contained albumin to 1 per cent., but never blood, excepting a few cells, nor casts. In patients previously free from fever, a moderate rise of temperature was sometimes observed four to six hours after injection, which disappeared without perspiration. The voice was almost immediately improved; the expectoration easier to raise, foamy and copious; number of bacilli unchanged. His conclusions are: 1. In the early period of laryngeal tuberculosis— i. e., superficial ulceration of vocal cords and infiltration of posterior wall of larynx-in some cases there followed a swelling of the infiltrated areas, and, through serous inhibition of the base of the ulceration, rapid cleaning up of the same followed. The healing of the ulcers was favorably influenced. In the use of the average dose (above cited) there was not noticed any irritation of the urinary apparatus. In severe cases, in badly nourished individuals, or in case of hectic, or when there exists irritation of intestines or kidneys, this treatment is contra-indicated. In doses one-half larger than above mentioned, symptoms of kidney and bladder irritation, backache, weakness, and

slight diarrhoea, but of several days' duration, appear. In cases of moderate severity, after prolonged medication with large doses, rapidly increasing oedema of the infiltrated areas and in the neighborhood of the ulcers, increases the dysphagia, which, however, of itself rapidly disappears.

CHROMIC ACID IN ORAL SYPHILIS.

DR. ERNEST FEIBES gives a very careful review of the literature of the local use of chromic acid in the treatment of syphilitic diseases of the cavity of the mouth (Ibid., S. 578). Concentrated solutions in water, from 10 to 50 per cent., are applied with a camel's-hair brush, and the mouth, after two or three minutes, rinsed out with chloroform water to remove the taste as well as the excess of acid. He regards it as the best local treatment in syphilis of the mucous membranes, even after an extensive experience with applications of silver.

HYDRASTININ.

DR. PAUL STRASSMANN, in the Deutsche med. Wochenschrift, 1891, No. 47, S. 1283, presents a very thoughtful paper upon this drug, which is to be distinguished from hydrastin. The dose is: in form of pill, one-half grain each; in subcutaneous injection, one to two grains. The results of administration in twenty-seven cases lead him to believe it to be a very valuable remedy in the menorrhagias and metrorrhagias due to various pathological conditions so often met with in gynecological practice. At present, however, the remedy is quite expensive.

[This preparation bids fair to displace the use of the fluid extract of hydrastis Canadensis, now so widespread in this country.-ED.]

ANTIFEBRIN AND PHENACETIN DERIVATIVES.

DR. HANS ARONSON (Ibid., S. 1285) adds much to our knowledge of the method of action of the acid derivatives of antifebrin and phenacetin. Reviewing the work of Ehrlich, Liebreich, and Penzoldt, in regard to the modification of the properties of these drugs by the insertion in the molecule of various groups (sulphur, carboxyl, benzol), he concludes that the solution of the problem of obtaining soluble antipyretics among the derivatives of acetanilide and phenacetin lies not in the introduction into the molecule of acid, but of basic groups. As an example, he cites phenocoll, which is an amidated phenacetin and bears the same relation to it as glycocoll does to acetic acid, and promises to be a valuable antipyretic, as well as a prompt and safe remedy for the relief of neuralgia, in doses of from eight to fifteen grains, repeated at hourly intervals.

CHLORALAMID IN CARDIAC AFFECTIONS.

DR. T. HOBART EGBERT, in New Remedies, 1891, No. 6, p. 61, reports the results of the administration of this drug in four cases. The indications for its use were: 1, nervousness and insomnia; 2, alcoholic subject, highly delirious, making much disturbance; 3, irritable heart; 4, almost intolerable

and constant cephalalgia. The amount of chloralamid should not ordinarily exceed 120 grains in the twenty-four hours. It may be combined with brandy, compound tincture of gentian, tincture of belladonna, or compound spirits of lavender, as the necessities of the case may demand.

THE SYRUP OF HYDRIODIC ACID.

A practical paper, by DR. ATKINSON (Ibid., p. 62), in which the preparation recommended contains 6.67 grains of pure hydriodic acid in each ounce. He advocates its use in the spasmodic seizures of asthma and whoopingcough, in resulting consolidation of pneumonia, fibrous hardening around tubercular deposits in phthisis, in bronchorrhoea of old people, scrofula and scrofulous ophthalmia, lymphatic enlargements of the glands of the neck and groin, later forms of syphilis, in goitre, rheumatism, both acute and chronic, and in many chronic skin affections, in the treatment of obesity. The various adjuvants which will result in useful and not inelegant formulæ are: compound tincture of cinchona and syrup of senega, sulphate of codeia and compound tincture of cardamom, syrup of tolu, elixir of calisaya, sulphate of morphine, hypophosphite of soda, the same combined with the same salt of lime, tincture of the citrate of iron, wine of tar, fluid extracts of grindelia or gelsemium, tincture of valerian or belladonna, fluid extract of grindelia with infusion of the leaves of the common chestnut. The wide range of usefulness, the many advantages over other iodine preparations, the small number of substances which are incompatible, are strong arguments for the more general use of this drug, of which there are several reliable manufacturers.

THE MECHANICAL TREATMENT OF ERYSIPELAS.

PROF. WÖLFLER reports thirteen cases treated by application of adhesive plaster around the area involved (The Medical Press and Circular, 1891, No. 20, p. 461). The hair is removed from the surface before the application is made. The plaster must be allowed to remain at least two or three days after the redness and fever have gone. This treatment is more valuable when the disease is situated on the face than on the extremities.

LYSOL.

In an unsigned paper (Ibid., No. 5, p. 49) the subject of the cresols is clearly presented. Starting with Fränkel's view, that the antiseptic virtues of creolin depend upon some higher homologues of phenol, it was believed that the cresols in soluble form would be more active as disinfectants than in emulsion. The result of this study was the production of lysol, which contains 50 per cent. of cresols, is miscible with water, and forms clear solutions with alcohol, petroleum or benzene, chloroform, carbon bisulphide, and glycerin. Gerlach, Schottelius, and Simmonds have found it active and prompt in arresting the development of microorganisms. Cramer, Wehmer, Michelsen, and Haenel have recommended it for surgery and gynecology; Lemke and Straube for veterinary purposes. Fürbringer believes that after cleansing the nails with a one-half to one per cent. solution, the hands being

immersed two or three minutes, using a brush, other disinfection is unnecessary. This process does not attack the hands, but, on the contrary, makes them soft and supple. For sterilization of instruments, one-fourth of one per cent. solution is sufficient. Cramer and Wehmer believe that it is five times stronger than carbolic acid, and one eighth as poisonous. In addition, when one considers the weak solutions necessary, it is relatively cheap.

ANTIPYRINE.

SURGEON PATRICK HEHIR, in the Indian Medical Gazette, 1891, No. 10, p. 292, argues that smaller doses than advised by Lauder Brunton, Ringer, Bartholow, and Waring, are efficient, if the intervals be short. In India, he believes that the maximum dose of from ten to fifteen grains should not be exceeded, and that even this quantity should not be frequently repeated, except under extreme circumstances.

In malarial fevers, especially of the remittent type, the small-dose method systematically adopted, and combined with ordinary diaphoretics during each day's exacerbation, will keep the pyrexia within bounds, reduce the headache and pains in the bones, as well as relieve, to some extent, the feeling of general discomfort, but it is not antiperiodic in its properties.

In the so-called " ardent fever"-a condition coming on usually after exposure to the sun, and manifesting itself in a dry, pungent, or hot skin, with a temperature of 104°-106° F., full bounding pulse, intense headache, and, it may be, delirium, the fever lasting for from two to six days-it is an extremely valuable remedy.

THE TREATMENT OF GASTRIC HYPERSECRETION.

The gastric dyspepsia which is the result of hypersecretion-the gastrosuccorrhoea of Reichmann-is believed by MM. BOUVERET and DEVIC to be far from infrequent (La Semaine Médicale, 1891, No. 55, p. 218). Two forms are so distinguished: the intermittent and the chronic. The first is frequently found in the course of certain organic diseases of the nervous centres, such as general paralysis, sclerosis en plaques, and particularly locomotor ataxia. The more frequent form-the chronic-calls for the fulfilment of four indications: 1. To remove all causes of irritation of the mucous membrane of the stomach. 2. To prescribe a regimen in accordance with gastric chemistry, and, at the same time, sufficient for nutrition. 3. To remedy the unfortunate results of hypersecretion. 4. To check the flow of gastric fluids.

The details of treatment are: 1. Forbid tobacco, alcohol, spices, tea, coffee; limit the amount of salt in the food, enforce mental quietude, and advise a calm life and rest in the country. 2. A meat diet, limited amount of fat, reduced quantity of starches, small amount of bread; for liquids, ordinary water, neither too cold nor too hot, with a few drops of rum or brandy only, amount limited to two glasses with the two principal meals. 3. Alkalies, such as two to five drachms of bicarbonate of soda in divided doses throughout the day, commencing one or two hours after the meals; washing of the stomach three or four times weekly. 4. Hydrotherapy under the form of a rain douche of short duration, or the cold wet pack, or the abdominal compress of Priessnitz.